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BT2026134: IHCP and DMHA to enforce service caps for Child Mental Health Wraparound program
Act
by Sep 16, 2026
Effective date
Aug 1, 2025
Identified
Aug 14, 2026
Summary
Indiana IHCP is enforcing existing service caps for Child Mental Health Wraparound (CMHW) program services effective August 1, 2025. Three HCPCS codes (H2014 HA, H2015 HA, T1005 HA) now have daily and/or monthly unit limits; claims exceeding these limits will be denied, and retroactive claims from Aug 1, 2025 through Aug 1, 2026 will be mass adjusted with adjustments appearing on remittance advices beginning September 16, 2026.
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What to do
by Sep 16, 2026 · 7 steps
01Billing team must implement service cap enforcement in billing software for IHCP CMHW claims.
02For H2014 HA: limit to 12 units (3 hours) per member per day and 120 units (30 hours) per member per month.
03For H2015 HA: limit to 8 units (2 hours) per member per day.
04For T1005 HA: limit to 27 units (6 hours 45 minutes) per member per day.
05Configure system to deny claims exceeding daily/monthly thresholds.
06Claims will be automatically mass adjusted by IHCP for DOS Aug 1, 2025 - Aug 1, 2026; review RAs beginning Sept 16, 2026 for claim adjustments (ICNs beginning with 52).
07Contact FSSA IHCP Reimbursement mailbox (FSSA.IHCPReimbursement@fssa.in.gov) for billing/reimbursement questions.
If missed: Failure to enforce caps will result in automatic claim denials for prospective claims and retroactive adjustments for historical claims.
Codes mentioned
H2014H2015T1005
Original notice
BT2026134: IHCP and DMHA to enforce service caps for Child Mental Health Wraparound program
in.gov · Always check the source before changing claims.
Related changes
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