Private Mental Health Institution License

An inpatient hospital setting, including inpatient and outpatient services provided in that setting, for the treatment and care of individuals with psychiatric disorders or chronic addictive disorders, or both, that is physically, organizationally, and programmatically independent of any hospital or health facility licensed by the Indiana state Department of Health under IC 16. A private mental health institution must be accredited through an approved accrediting body by the Division.

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

Policies and Procedures for application in DMHA Provider Portal (Note: these are required to be entered as rich text.)
- 440 IAC 1.5-3-9(f)(g)(h)
  - This should also include the process for admitting a child (age fourteen and under) to a non-segregated unit (adult unit) in an emergency. Include the criteria for such an emergency admission OR the policy stating that such an admission will not occur.
- IC 12-27
  - This should include compliance with 440 IAC 1.5-2-4(4).
- IC 16-39
Documents that should be uploaded in the application in the DMHA Provider Portal:
- Organizational structure of applicant agency
- List of governing board and executive staff
- Copy of the report from the most recent inspection by
  - Division of Fire Prevention and Building Safety, State Fire Marshal
  - State Department of Health, Food Protection if a Medicare facility, or the county health department if not a Medicare facility
- A floor plan of the inpatient setting. If the private mental health institution occupies only part of the building, include a floor plan of the entire building. Indicate location of inpatient beds and types of certifications or licenses of other areas in the building.
- Complete copy of all accreditation decision reports and letter of accreditation.
- New construction plans, if appropriate.
- Any and all existing waivers from DMHA
- Medicare Administration Contract letter, if applicable