HAR §17-1737-18. Inpatient psychiatric care

(a) Inpatient psychiatric care shall be provided only in an authorized psychiatric facility and by authorized psychiatric providers. (b) Admission to a psychiatric facility shall be by: (1) A psychiatrist; or (2) A non-psychiatrist physician with a psychiatrist concurring that admission is needed. (c) Authorization for inpatient psychiatric care is required for: (1) All application or pending cases; and (2) Medicaid patients with third party coverage or any other available resources except for medicare. (d) The department of human services form for medical authorization shall be used to request authorization for inpatient psychiatric care. The following procedures shall be taken: (1) The form shall be completed by the inpatient psychiatric facility and shall be signed and dated by a psychiatrist or countersigned and dated by a psychiatrist when the patient is admitted by non-psychiatrist physician; (2) The psychiatric facility and the physician shall both be responsible for submitting the UNOFFICIAL 1737-17 form to the medical assistance program (medicaid) office; (3) The form shall be received in the medical assistance program (medicaid) office of the department within five working days from the time of the patient's admission. The postmarked date shall be accepted provided it is within the five working days requirement from the time of patient's admission; (4) Reimbursements to the physician and psychiatric facility is subject to denial when forms are not received within the specified time; (5) A form shall be submitted for each admission; and (6) An extension form will not be required regardless of length of stay. (e) The length of hospital stay is applicable to all categories and the following shall be followed: (1) No more than thirty days per calendar year shall be authorized. Inpatient days not used in the authorized calendar year shall not be added to the inpatient days allowed for the following calendar year; (2) The number of inpatient days available through a third party coverage shall be counted as part of the authorized number of days under Medicaid. The psychiatric facility shall apply the number of inpatient days that are available from the third party resource to the authorized number of days under Medicaid; and (3) One inpatient day can be exchanged for two outpatient hours. (f) Emergency inpatient psychiatric care shall be provided as follows: (1) In communities where a psychiatric facility is not readily available, emergency inpatient psychiatric service may be provided for up to forty-eight hours at the closest licensed general hospital; and (2) A patient shall be transferred to an authorized psychiatric facility or to a long-term psychiatric facility if the attending physician determines that the patient requires inpatient psychiatric service beyond the forty-eight hour period. (g) Voluntary patients may obtain psychiatric inpatient hospital passes only as needed for discharge UNOFFICIAL 1737-18 planning purposes. Involuntary patients will be regulated according to legal requirements. (1) A patient is authorized eight hours to assist in his discharge preparation. The hours may be used in a flexible and judicious manner throughout the duration of admission. (2) Exceptions may be made for patients who will benefit from program under the auspices of the treating hospital. (3) All other types of hospital passes are not reimbursable. [Eff 08/01/94; am 06/19/00 ] (Auth: HRS §346-14; 42 C.F.R. §431.10) (Imp: HRS §431M-4; 42 C.F.R. §§440.10, 440.160) §17-1737-18.1 Inpatient psychiatric Services for individuals under age twenty-one in psychiatric facilities or programs. (a) Inpatient psychiatric services for recipients under age twenty-one shall be provided: (1) Under the direction of a physician; (2) By: (A) A psychiatric hospital or an inpatient psychiatric program that is accredited by the joint commission on accreditation of healthcare organizations; or (B) A psychiatric facility which is accredited by the joint commission on accreditation of healthcare organizations, the commission on accreditation of rehabilitation facilities, the council on accreditation of services for families and children, or by any other accrediting organization, with comparable standards that is recognized by the State; and (C) Is authorized to practice under the Medicaid program and meets the provisions of chapter 17-1736. (3) Before the individual reaches the age twenty-one or, if the individual was receiving the services immediately before he or she reached age twenty-one, services will continue until the earlier of the following: (A) The date the individual no longer requires the services; or (B) The date the individual reaches age twenty-two. UNOFFICIAL 1737-19 (4) To an individual certified to be in need of the services. (A) Ambulatory care resources available in the community do not meet the treatment needs of the recipient; and (B) The services can reasonably be expected to improve the recipient’s condition or prevent further regression so that the services will no longer be needed. (b) The individual shall receive active treatment which involves a developed and supervised individual plan of care to improve the individual’s condition to the extent that inpatient care is no longer necessary. The plan of care shall: (1) Be based on a diagnostic evaluation that includes examination of the medical, psychological, social, behavioral and developmental aspect of the recipient’s situation and reflects the need for inpatient psychiatric care; (2) Be developed by a team of professionals in consultation with the recipient, and his parents, legal guardians, or others in whose care he will be released after discharge; (3) State treatment objectives; (4) Prescribe an integrated program of therapies, activities, and experiences designed to meet the objectives; (5) Include, at an appropriate time, post-discharge 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; (6) The plan shall be reviewed every thirty days to: (A) Determine that services being provided are or were required on an inpatient basis; and (B) Recommend changes in the plan as indicated by the recipient’s overall adjustment as an inpatient. (c) The individual plan of care must be developed by an interdisciplinary team of physicians and other personnel who are employed by, or provide services to patients in, the facility. (1) The interdisciplinary team shall be capable of: UNOFFICIAL 1737-20 (A) Assessing the recipient’s immediate and long-range therapeutic needs, developmental priorities, and personal strengths and liabilities; (B) Assessing the potential resources of the recipient’s family; (C) Setting treatment objectives; and (D) Prescribing therapeutic modalities to achieve the plan’s objectives. (2) The team shall include, as a minimum, either: (A) A board-eligible or board-certified psychiatrist; or (B) A clinical psychologist who has a doctoral degree and a physician licensed to practice medicine or osteopathy; (3) The team shall also include one of the following: (A) A psychiatric social worker; (B) A registered nurse with specialized training or one year’s experience in treating mentally ill individuals; or (C) An occupational therapist who is licensed, if required by the State, and who has specialized training or one year of experience in treating mentally ill individuals; (d) Prior authorization is required before inpatient psychiatric services for recipients under age twenty-one are provided. [Eff 02/16/02 ] (Auth: HRS §346-14; 42 C.F.R. §431.10) (Imp: 42 C.F.R. §§441.150 through 441.156)