Behavioral and Primary Healthcare Coordination Program
Behavioral and Primary Healthcare Coordination Program
Indiana Medicaid offers coverage for Behavioral and Primary Healthcare Coordination (BPHC) of Home- and Community-Based Services (HCBS). This service helps members manage their physical and behavioral health care needs through education, support and advocacy.
Individuals must meet both HCBS eligibility and Medicaid eligibility guidelines to be eligible for the BPHC service. To be eligible, individuals must:
Be 19 years of age or older
Be diagnosed with a BPHC-eligible primary behavioral health diagnosis
Be eligible for Traditional Medicaid, Healthy Indiana Plan (HIP) State Plan Plus, HIP State Plan Basic, Hoosier Care Connect, Hoosier Healthwise or Indiana PathWays for Aging (PathWays)
Demonstrate a level of need by meeting the following criteria:
Demonstrated needs related to management of the member’s behavioral and physical health
Demonstrated impairment in self-management of physical and behavioral health services
A health need that requires assistance and support in coordinating behavioral and physical health treatment
A recommendation for intensive community-based care, based on the uniform DMHA-approved behavioral health assessment tool, as indicated by a rating of 3 or higher
Covered Services
In addition to Medicaid-covered services, BPHC offers one service that consists of the coordination of healthcare services to manage the mental health/addiction and physical healthcare needs of eligible individuals.
Member Information
- Referrals to the BPHC service may come from any source within the community:
Community mental health centers (CMHCs) or other treatment providers may identify individuals who appear to meet the eligibility criteria.
Individuals may notify their provider of interest in the BPHC service.
An individual’s family members or caregivers may inquire about the service and assist the individual in contacting a DMHA-approved BPHC provider agency.
To apply for the BPHC service, go to your local CMHC.
You must also apply for Medicaid. You can learn more about applying for Medicaid by going to the Apply for Coverage webpage.
For more information on BPHC, please visit the Behavioral and Primary Healthcare Coordination webpage or email BPHCservices@fssa.in.gov.
Provider Information
The BPHC service may be delivered by providers meeting specific state-defined criteria. The DMHA certifies agencies to provide the BPHC service. DMHA-certified CMHCs are the exclusive providers of the BPHC service.
DMHA-approved providers must also be enrolled with the IHCP as a behavioral health provider (provider type 11) with the BPHC specialty (provider specialty 612). Refer to the Become an IHCP Provider webpage for more information.
Additional provider resources regarding BPHC services are available at the following links:
DMHA Behavioral and Primary Healthcare Coordination Service provider reference module
Home- and Community-Based Services Billing Guidelines provider reference module