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COMMONWEALTH OF PENNSYLVANIA

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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 54 Pa.B. 5598 (August 31, 2024).

55 Pa. Code § 1151.61. Payment conditions: general.

PAYMENT CONDITIONS FOR INPATIENT
PSYCHIATRIC SERVICES


§ 1151.61. Payment conditions: general.

 For payment to be authorized for inpatient psychiatric services:

   (1)  The recipient’s need for admission shall be certified under §  1151.62 (relating to Certification of Need for admission).

   (2)  A medical and psychiatric evaluation shall be made by the attending physician or staff physician under §  1151.63 (relating to medical and psychiatric evaluation).

   (3)  A social evaluation must be made under §  1151.64 (relating to social evaluation) by one of the following:

     (i)   The social service staff of the CAO or its agent for recipients applying for admission to an inpatient psychiatric facility.

     (ii)   An appropriate member of the inpatient psychiatric facility’s staff, if the individual applies for MA while in an inpatient psychiatric facility.

   (4)  A plan of care shall be established and implemented under §  1151.65 (relating to plan of care).

   (5)  The recipient’s admission to the inpatient psychiatric facility shall be under State statutes and regulations governing admission to inpatient psychiatric facilities.

   (6)  The medical justification for the recipient’s need for care on an inpatient basis shall be established under § §  1151.70—1151.78 (relating to utilization control).

   (7)  The recipient’s continued need for care, if applicable, shall meet §  1151.67 (relating to payment conditions related to the recipient’s continued need for care).

Authority

   The provisions of this §  1151.61 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 §  1151.61 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 (181798).


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