Addiction Services Outpatient Certification

A provider with 10 or less direct services providers providing outpatient, intensive outpatient, partial hospitalization, and detoxification/withdrawal management services. A provider must be compliant with 440 IAC 4.4.

Completing the application in the DMHA Provider Portal, you will be asked to provide the following information via rich text:

Policies and procedures for applications in DMHA Provider Portal (Note: these are required to be entered as rich text)
- Admission Criteria [440 IAC 4.4-2-4.5 (c)]
- Confidentiality [42 CFR 2 – 2.16, 2.19, 2.22, 2.23, and 2.31]
  - Policy regarding access
  - Policy regarding consent
  - Policy regarding notice
- Consumer Intake Assessments [440 IAC 4.4-2-4.5 (d) and (e)]
- Consumer Progress [440 IAC 4.4-2-4.5 (h)]
- Consumer Rights [IC 12-27 – IC 12-27-2-1 and IC 12-27-9-5]
- Discharge Planning [440 IAC 4.4-2-4.5 (i)]
- Treatment Planning [440 IAC 4.4-2-4.5 (f) and (g)]
Documents that should be uploaded in the application in the DMHA Provider Portal:
- Detoxification letter, if appropriate, should be a statement on company letterhead, signed by the CEO declaring detoxification/withdrawal management services will be provided under the supervision of a physician or a clinical nurse specialist licensed to practice in Indiana. Provide current license number(s).
- Current Fire/Safety Inspection report. If violation was cited, a follow up report is required.