§ 1151.82. Inspections of care reports.
(a) The inspection of care team will submit reports on each inspection of care within 45 days following the inspection to:
(1) The hospital administrator along with a copy for the chairperson of the utilization review committee.
(2) The Office of Mental Health of the Department.
(3) The CAO, if recommendations are made for alternate placement.
(b) If the report of the inspection of care team recommends alternate care for a recipient:
(1) The CAO shall notify the recipient or the recipient’s representative and the hospital administrator of the intended denial of payment authorization.
(2) The recipient or the recipient’s representative has 30 days from the date the notice is mailed to appeal the decision. The facility does not have the right to appeal unless it is acting as the recipient’s representative.
(c) If the recipient or the recipient’s representative appeals the decision within 10 days from the date the notice is mailed, payment for inpatient psychiatric care will continue pending the outcome of the hearing.
(d) If an appeal is entered after the tenth day, payment will be discontinued effective with the first day the inspection of care team recommended alternative care pending the outcome of the hearing.
(e) If the recipient or the recipient’s representative appeals the Department’s recommendation for an alternative level of care within the specified time period, the Department will continue to make payment for private psychiatric hospital inpatient care. If the Department is sustained in its action, the Department will recover from the facility a payment that would not have been made if the action of the Department had not been appealed. The period for which the Department will recover excess payment begins on the effective date specified on the notice and ends with the date that the appropriate change in the level of care is made.
(f) If the report of the inspection of care team cites deficiencies, the hospital shall submit a written response to the Department within 30 days of the control date on the summary report. The response shall outline the hospital’s planned course of action including acceptable time frames for correcting deficiencies. The inspection of care team will conduct follow-up visits to determine if the deficiencies have been corrected.
(g) This section applies only to private psychiatric hospitals.
Authority The provisions of this § 1151.82 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 § 1151.82 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 (181814) to (181815).
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