Behavioral and Primary Healthcare Coordination
BPHC Service Program
The Behavioral and Primary Healthcare Coordination program offers a service that consists of the coordination of healthcare services to manage the mental health/addiction and physical healthcare needs of eligible recipients. This includes logistical support, advocacy and education to assist individuals in navigating the healthcare system and activities that help recipients gain access necessary to manage their physical and behavioral health conditions.
The BPHC program is not designed to meet all of an individual’s needs, but merely to assist in the coordination of services for the eligible recipient. Individuals who are deemed clinically eligible for BPHC may become eligible for Medicaid due to BPHC financial eligibility standards and therefore eligible to receive all Medicaid covered services for which they qualify to meet their complex needs.
The BPHC program will provide eligible individuals with help in managing their physical and behavioral health. Community mental health centers will provide services such as help in scheduling appointments with doctors, coaching on communicating more effectively with doctors and following instructions on medications or other doctor recommendations.
BPHC service activities may include support in adhering to health regimens, scheduling and keeping medical appointments, obtaining and maintaining a primary medical provider and facilitating communication across providers. In addition, BPHC includes: direct assistance in gaining access to services, coordination of care within and across systems, oversight of the entire case, and linkage to appropriate services: needs based assessment of the eligible recipient to identify service needs; development of an individualized integrated care plan; referral and related activities to help the recipient obtain needed services; monitoring and follow-up; and evaluation.
To be clinically eligible for BPHC, an individual must meet the following target group criteria:
- 19 years old or older.
- Has been diagnosed with a BPHC eligible primary mental health diagnosis.
Based on the behavioral health clinical evaluation, referral form, supporting documentation and FSSA/DMHA approved behavioral health assessment tool results, the applicant must meet all of the following needs-based criteria:
- Demonstrated needs related to management of his/her behavioral and physical health,
- Demonstrated impairment in self-management of physical and behavioral health services,
- A health need which requires assistance and support in coordinating behavioral and physical health treatment, and
- A recommendation for intensive community-based care based on the uniform FSSA/DMHA approved behavioral health assessment tool as indicated by a rating of three or higher.
To be eligible for BPHC, an individual must reside in a setting which meets federal setting requirements for home and community-based services. Each setting must be assessed independently to determine if an applicant resides in a community-based setting.
Financial Eligibility Criteria
An individual can have countable income up to 300% above FPL. These income limits are updated annually when the federal government releases the new FPL standards. Annual updates can be accessed in the Federal Register located at www.federalregister.gov/ upon publication. They are typically published in late January and become effective for Indiana Medicaid eligibility determinations in March or April. There are certain income disregards that may be applied that may lower countable income. For example, if there are children or other qualifying dependents in the individual’s household, an individual’s income may be higher; specifically, a $361 per qualifying individual deduction may be applied. There is no asset limit for the program. Determination of financial eligibility is conducted by the Division of Family Resources.
- BPHC IICP development 4/28/21
- BPHC and HCBS comprehensive training 3/8/21
- BPHC training slides 7/29/20
- Critical incident reports quality assurance 6/2019
Rules and regulations
- BPHC provider module 7/28/2022
- BPHC Rule (AC Article 5-21.8) 9/2014
- State Plan Amendment 10/1/20
- 1915(b)(4) Waiver Fee-for-Service Selective Contracting Program 10/1/18