§ 1151.62. Certification of Need for admission.
(a) If a recipient is 21 years of age or older, the attending or staff physician shall certify in the medical record either at the time of admission or on the first day of a benefit period, when applicable, or upon application for MA, that acute psychiatric services in a private psychiatric hospital are needed.
(b) If a recipient under 21 years of age is being admitted, an independent team shall certify at the time of admission the need for acute psychiatric services in a private psychiatric hospital and document this in the medical record. The team shall:
(1) Include a physician.
(2) Have competence in diagnosis and treatment of mental illness, preferably in child psychiatry.
(3) Have knowledge of an individual’s situation.
(c) For an individual under 21 years of age who applies for MA while in the private psychiatric hospital, the team responsible for the individual’s plan of care under § 1151.66 (relating to team developing plan of care) shall:
(1) Certify the need for acute psychiatric services in a private psychiatric hospital.
(2) If claims are made, certify the need for acute psychiatric services in a private psychiatric hospital for a period before application.
(d) In the event of an emergency admission of a recipient under 21 years of age, the recipient’s need for inpatient psychiatric services shall be certified under subsection (c).
(e) Subsections (a)—(d) apply 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 § 1151.62 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 § 1151.62 adopted September 30, 1983, effective July 1, 1983, 13 Pa.B. 2796; amended June 18, 1993, effective July 1, 1993, 23 Pa.B. 2917; amended October 29, 1993, effective July 1, 1993, 23 Pa.B. 5241. Immediately preceding text appears at serial page (181799).
Notes of Decisions Psychiatric hospitals are entitled to Medicaid reimbursement when the services rendered are psychiatric and drug/alcohol detoxification treatments in nature. University of Pittsburgh v. Department of Public Welfare, 616 A.2d 149 (Pa. Cmwlth. 1992).
Cross References This section cited in 55 Pa. Code § 1151.61 (relating to payment conditions: general).
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