Limitations on inpatient psychiatric services for individuals under age twenty-one

1. Inpatient psychiatric services for individuals under age twenty-one must be provided: a. Under the direction of a physician; b. By a psychiatric hospital or an inpatient psychiatric program in a hospital, accredited by the joint commission on accreditation of health care organizations, or by a psychiatric facility that is not a hospital and which is accredited by the joint commission on accreditation of health care 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; and c. Before the recipient reaches age twenty-one, or, if the individual was under age twenty-one at the time of admission, before the earlier of: (1) The date the recipient no longer requires inpatient psychiatric services; or (2) The date the recipient reaches age twenty-two. 2. A psychiatric facility or program providing inpatient psychiatric services to individuals under age twenty-one shall: a. Except as provided in subdivision c, obtain a certification of need from an independent review team qualified under subsection 3 prior to admitting a recipient; b. Obtain a certification of need from an independent review team qualified under subsection 3 for an individual who applies for Medicaid while in the facility or program covering any period for which claims are made; or c. Obtain a certification of need from an independent review team qualified under subsection 3 for an emergency admission of an individual, within fourteen days after the admission, covering any period prior to the certification for which claims are made. 3. a. An independent review team must: (1) Be composed of individuals who have no business or personal relationship with the inpatient psychiatric facility or program requesting a certification of need; (2) Include a physician; (3) Have competence in diagnosis and treatment of mental illness; and (4) Have knowledge of the recipient's situation for which the certification of need is requested. b. Before issuing a certification of need, an independent review team must use professional judgment and standards approved by the department and consistent with the requirements of 42 CFR part 441, subpart D, to demonstrate: (1) Ambulatory care resources available in the community do not meet the treatment needs of the recipient; (2) Proper treatment of the recipient's psychiatric condition requires services on an inpatient basis under the direction of a physician; and (3) The requested services can reasonably be expected to improve the recipient's condition or prevent further regression so services may no longer be needed. 4. Payment may not be made for services provided to a recipient under age twenty-one in a psychiatric residential treatment facility without a certification of need. 5. Prior to the dates of services of January 1, 2019, payment may not be made for any other medical services not provided by a psychiatric residential treatment facility if the facility is an institution for mental diseases.