Conditions for Continuing Care

(A) To continue to qualify for psychiatric inpatient hospital services, members must continue to meet the admission criteria described in 130 CMR 425.406 or 425.407, whichever is applicable, or meet one of the conditions in 130 CMR 425.417(B). Members who are younger than 21 years of age must also be reviewed by a screening team prior to the 30th day after admission and every 30 days thereafter. (B) Additional Conditions. The following additional conditions qualify a member 21 years of age or older to continue to receive psychiatric inpatient hospital services, even if the member does not qualify under 130 CMR 425.417(A): (1) the persistence of conditions that necessitated admission, despite therapeutic efforts, or the emergence of additional problems consistent with the admissions criteria in 130 CMR 425.406 or 425.407; (2) a severe reaction to medication; or (3) a need for stabilization of psychiatric conditions, integration of gains, or preparation for transition to outpatient care or a residential setting.