§ 1151.67. Payment conditions related to the recipient’s continued need for care.
(a) For MA payments to be made on behalf of a recipient for continuing care in a private psychiatric hospital:
(1) The plan of care at § 1151.65 (relating to plan of care) shall be reviewed within 14 days after admission to determine whether inpatient psychiatric services are or were needed and to make necessary changes in the plan. Review of the plan of care shall be carried out by:
(i) The team specified in § 1151.66 (relating to team developing plan of care), if the recipient is 20 years of age or younger.
(ii) The attending or staff physician and other personnel involved in the recipient’s care, if the recipient is 21 years of age or older.
(2) The recipient’s need for inpatient psychiatric care shall be recertified at least every 90 days by:
(i) The team specified in § 1151.66, if the recipient is 20 years of age or younger.
(ii) The attending or staff physician and the personnel involved in the recipient’s care if the recipient is 21 years of age or older.
(3) The recertification of the recipient’s need for inpatient psychiatric care as specified in paragraph (2) shall be substantiated by the medical, psychiatric and social information in the recipient’s chart.
(4) The medical necessity for the recipient’s care on an inpatient basis shall be established under § § 1151.70—1151.78 (relating to utilization control).
(b) Subsection (a) applies only to private psychiatric hospitals. Distinct part psychiatric units of acute care general hospitals shall comply with 42 CFR 456.60 (relating to certification and recertification of need for inpatient care).
Authority The provisions of this § 1151.67 amended under sections 201 and 443.1(1) of the Public Welfare Code (62 P. S. § § 201 and 443.1(1)).
Source The provisions of this § 1151.67 adopted September 30, 1983, effective July 1, 1983, 13 Pa.B. 2796; amended October 29, 1993, effective July 1, 1993, 23 Pa.B. 5241. Immediately preceding text appears at serial page (181803).
Cross References This section cited in 55 Pa. Code § 1151.61 (relating to payment conditions: general).
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