Child Mental Health Wraparound (CMHW) Services
Indiana has made certain assurances to the Centers for Medicare and Medicaid Services (CMS) that all providers are qualified (initially at provider approval and continually through service delivery) to deliver 1915(i) Home and Community-Based (HCBS) services to CMHW participants. Only a DMHA approved Agency or Individual provider enrolled by Medicaid may be reimbursed for delivering a CMHW Services to an eligible participant.
A CMHW service provider must be approved by the DMHA according to the specific qualifications for and standards of the service that the individual provider or agency is applying to provide. To ensure that CMHW services providers meet licensure and/or approval requirements prior to furnishing CMHW services, DMHA requires all providers to undergo an application process to verify qualifications of the Agency or Individual requesting to provide CMHW services. All Agencies and Individuals wishing to enroll as a CMHW service provider must complete the provider application process described in the CMHW Services Provider Manual.
Provider Approval Forms
The following forms (and associated instruction sheets) are used in the Provider approval process. Questions about the process may be directed to the DMHA Youth Services Provider Specialist at DMHAYouthServices@fssa.IN.gov.
- Tobi user agreement
- Provider Demographic Instruction Sheet
- Provider Demographic Application
- Wraparound Facilitator Service Provider Instruction Sheet
- Wraparound Facilitator Service Provider Application
- Habilitation Services Provider Instruction Sheet
- Habilitation Services Provider Application
- Training & Support for the Unpaid Caregiver Services Provider Instruction Sheet
- Training & Support for the Unpaid Caregiver Services Provider Application
- Respite Services Provider Instruction Sheet
- Respite Services Provider Application
- Rendering Services Provider Application
- Provider Agreement
- CPS Background History Check Form
- Background History Check Info
- CPS Background Screen Instructions
- Inkless Registration Instructions
Provider Renewal of Approval Forms
All providers must reapply for a renewal of approval as a CMHW services provider. The following form is a resource for providers:
Provider Training & Certifications
All providers are required to complete training based upon the type of service DMHA has authorized the provider to deliver. Refer to the Provider Manual for additional information about new provider and recertification training requirements.
- Child Mental Health Wraparound Orientation for Wraparound Facilitators: Participants in this webinar will have access to a certificate at its completion which can be submitted with an application. Click here to view the webinar.
- Child and Adolescent Needs and Strengths (CANS) Training and Certification: For information about the CANS training and registration, click here. You can also receive additional information by contacting our CANS trainer (click here). The CANS certification is required for Wraparound Facilitator applicants.
- Wraparound Practitioner Certification (WPC) Program: Required for all Wraparound Facilitation Service providers. Additional information regarding enrollment in the certification program will be provided to eligible applicants at time of provider approval. Completion of the certification program will be required for continued approval of the provider as a Wraparound Facilitator.
- Résumé requirements for DMHA Wraparound HCBS
- CMHW Services HCPCS Billing Codes
- HP Billing and Claims Support
- IHCP Information (Medicaid Provider Information)
- JIRA helpdesk instructions
Other CMHW Service Forms