Services for the Indiana Health Coverage Programs (IHCP) Medicaid Rehabilitation Option (MRO) include community-based mental healthcare for individuals with serious mental illness, youth with serious emotional disturbance, and/or individuals with substance use disorders. MRO services are clinical behavioral health services provided to members and families of members living in the community who need aid intermittently for emotional disturbances, mental illness, and addiction. A qualified behavioral health professional, as outlined in 405 IAC 5-21.5-1(c), must provide these services.
IHCP reimbursement for MRO services is available for members who meet specific diagnosis and level of need (LON) criteria under the approved Division of Mental Health and Addiction assessment tool or who submit prior authorization (PA) for MRO services. Members who have a qualifying MRO diagnosis are assigned a service package based on their individual LON. For the majority of members receiving MRO services, the assigned MRO service packages provide a sufficient number of services and units of services to meet their needs. However, for members who require additional medically necessary services not included in the service package, or additional units of services assigned in the service package, a PA request is required.
MRO services are designed to assist in the rehabilitation of the member's optimum functional ability in daily living activities by:
- Assessing the member's needs and strengths
- Developing an Individualized Integrated Care Plan (IICP) that outlines objectives of care, including how MRO services help the member reach his or her rehabilitative and recovery goals
- Delivering appropriate services to the member
For step-by-step information about verifying eligibility, and checking and updating PA requests for MRO services, see the Quick Reference Guide: Provider Healthcare Portal: Medicaid Rehabilitation Option (MRO). Additional information is also available in the Medicaid Rehabilitation Option Services provider reference module.