§ 1151.65. Plan of care.
(a) Before authorization for payment for care provided to a recipient 21 years of age or older, the attending or staff physician shall establish, and include in the recipient’s medical record, an individual written plan of care. The plan of care shall be designed to maintain the recipient at or restore the recipient to the greatest possible degree of health and independent functioning. The plan shall include:
(1) Diagnoses, symptoms, complaints and complications indicating the need for admission.
(2) Treatment objectives.
(3) A description of the functional level of the individual.
(4) Orders for medications, treatments, restorative and rehabilitative services, activities, therapies, social services and diet.
(5) Special procedures recommended for the health and safety of the patient.
(6) Plans for continuing care, including review and modification to the plan of care.
(7) Plans for discharge.
(b) If a recipient is under age 21, an individual written plan of care designed to achieve the recipient’s discharge from inpatient status at the earliest possible time shall be included in the recipient’s medical record. The plan shall:
(1) Be developed and implemented within 14 days after admission.
(2) Be based on the diagnostic evaluation of the recipient that includes examination of the medical, psychological, social, behavioral and developmental aspects of the individual’s condition and medical need for inpatient psychiatric care.
(3) Be developed by the interdisciplinary team of professionals under § 1151.66 (relating to team developing plan of care) in consultation with the recipient and those in whose care the recipient will be placed upon discharge.
(4) State treatment objectives.
(5) Prescribe an integrated program of therapies, activities and experiences designed to meet the objectives in paragraph (4).
(6) Include, at an appropriate time, postdischarge plans and coordination of inpatient services with partial discharge plans and related community services to ensure continuity of care with the recipient’s family, school and community upon discharge.
(c) Subsections (a) and (b) apply only to private psychiatric hospitals. Distinct part psychiatric units of acute care general hospitals shall comply with 42 CFR 456.80 (relating to individual written plan of care).
Authority The provisions of this § 1151.65 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 § 1151.65 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 pages (181801) to (181802).
Cross References This section cited in 55 Pa. Code § 1151.61 (relating to payment conditions: general); 55 Pa. Code § 1151.67 (relating to payment conditions related to the recipient’s continued need for care); and 55 Pa. Code § 1151.74 (relating to responsibilities of the inpatient psychiatric facility utilization review committee).
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