471 NAC 20-028. ADULT INPATIENT HOSPITAL PSYCHIATRIC SERVICES

028. ADULT INPATIENT HOSPITAL PSYCHIATRIC SERVICES. The care and treatment of an inpatient with a primary psychiatric diagnosis who is receiving inpatient care must be under the direction of a psychiatrist or physician who meets the State's licensing criteria and is enrolled as a provider with Nebraska Medicaid with a primary specialty of psychiatry. Inpatient hospital psychiatric services must be prior-authorized by the Department-contracted peer review organization or management designee. In addition, out-of-state hospitalizations must be approved by Nebraska Medicaid. 028.01 PROVIDER AGREEMENT. A hospital which provides inpatient psychiatric services must complete the appropriate Nebraska Medicaid approved provider agreement form and submit the completed form to Nebraska Medicaid for approval and enrollment as a provider. The hospital must submit with the provider agreement: (A)A complete description of the psychiatric program and the elements of the program ; (B)A statement of the total number of licensed psychiatric beds, as approved by the Nebraska Department of Health and Human Services, Division of Public Health or agency in the state in which the facility is located; a listing of the bed numbers for those licensed psychiatric beds; and the size of the proposed psychiatric unit; (C)Documentation that the inpatient program meets the family-centered, community-based requirements in this chapter; (D)A description of how family psychotherapy services will be provided; (E)A description of how the hospital services will interface with community services for discharge planning and service provision after discharge; (F)A copy of the most recent Joint Commission or American Osteopathic Association (AOA) accreditation survey; and (G)Any other information requested. 028.01(i) ON-SITE REVIEW. Any facility requesting a provider agreement must make the facility available for an on-site review before issuance of a provider agreement. 028.01(ii) STANDARDS FOR PARTICIPATION FOR INPATIENT HOSPITAL PSYCHIATRIC SERVICE PROVIDERS. A hospital that provides inpatient hospital psychiatric services must meet the following standards for participation to ensure that payment is made only for active treatment. The hospital: (1) Is maintained for the care and treatment of patients with primary psychiatric disorders; (2) Is licensed or formally approved as a hospital by the Nebraska Department of Health and Human Services, Division of Public Health, or if the hospital is located in another state, the officially designated authority for standard - setting in that state; (3) Is accredited by the Joint Commission or by the American Osteopathic Association (AOA); (4) Meets the requirements for participation in Medicare for psychiatric hospitals; (5) Has in effect a utilization review plan applicable to all Nebraska Medicaid beneficiaries; (6) Must have medical records that are sufficient to permit Nebraska Medicaid to determine the degree and intensity of treatment furnished to the client; and (7) Must meet staffing requirements Nebraska Medicaid finds necessary to carry out an active treatment program in compliance with this chapter. 028.01(iii) DISTINCT PART OF A HOSPITAL AS A PSYCHIATRIC UNIT. A distinct part of a hospital may be considered a psychiatric unit if it meets the standards for participation, even though the hospital of which it is a part does not. 028.01(iv) STAFFING STANDARDS FOR PARTICIPATION. The hospital must have staff adequate in number and qualified to carry out an active program of treatment for beneficiaries who are provided services in the hospital. The hospital must meet the following standards. 028.01(iv)(1) HOSPITAL PERSONNEL. Hospitals which provide inpatient psychiatric services must be staffed with the number of qualified professional, technical, and supporting personnel, and consultants required to carry out an intensive and comprehensive active treatment program that includes evaluation of individual and family needs; establishment of individual and family treatment goals; and implementation, directly or by arrangement, of a broad-range therapeutic program including, at least, professional psychiatric, medical, surgical, nursing, social work, psychological, and activity therapies required to carry out an individual treatment plan for each beneficiary and their family. The following standards must be met: (a)Qualified professional and technical personnel must be available to evaluate each beneficiary at the time of admission, including diagnosis of any intercurrent disease. Services necessary for the evaluation include: (i)Laboratory, radiological, and other diagnostic tests; (ii)Obtaining psychosocial data; (iii)A complete family assessment in compliance with the requirements in this chapter; (iv)Carrying out psychiatric and psychological evaluations; and (v)Completing a physical examination, including a complete neurological examination when indicated, shortly after admission; (b)The number of qualified professional personnel, including consultants and technical and supporting personnel, must be adequate to ensure representation of the disciplines necessary to establish short-range and long-term goals; and to plan, carry out, and periodically revise a treatment plan for each beneficiary based on scientific interpretation of: (i)The degree of physical disability and indicated remedial or restorative measures, including nutrition, nursing, physical medicine, and pharmacological therapeutic interventions; (ii)The degree of psychological impairment and appropriate measures to be taken to relieve treatable distress and to compensate for nonreversible impairments where found; (iii)The capacity for social interaction, and appropriate nursing measures and milieu therapy to be undertaken, including group living experiences, occupational and recreational therapy, and other prescribed activities to maintain or increase the beneficiary's capacity to manage activities of daily living; and (iv)The environmental and physical limitations required to protect the beneficiary's health and safety with a plan to compensate for these deficiencies and to develop the beneficiary's potential for return to their own home, a foster home, a skilled nursing facility (NF), a community mental health center, or other alternatives to full-time hospitalization. 028.01(iv)(2) DIRECTOR OF INPATIENT PSYCHIATRIC SERVICES AND MEDICAL STAFF. Inpatient psychiatric services must be under the supervision of a clinical director, service chief, or the equivalent who is qualified to provide the leadership required for an intensive treatment program. The number and qualifications of physicians must be adequate to provide essential psychiatric services. The following standards must be met: (a)The clinical director, service chief, or equivalent must meet the training and experience requirements for a psychiatrist or a physician for Nebraska Medicaid ; (b)The medical staff must be qualified legally, professionally, and ethically for the positions to which they are appointed; (c)The number of physicians must be commensurate with the size and scope of the treatment program; (d)The physician's personal involvement in all aspects of the beneficiary's psychiatric care must be documented in the beneficiary's medical record ; and (e)The physician must be available, in person or by telephone, to provide assistance and direction as needed. 028.01(iv)(3) AVAILABILITY OF PHYSICIANS AND OTHER PERSONNEL. Physicians, advanced practice registered nurses (APRN), and other appropriate professional personnel must be available at all times to provide necessary medical, surgical, diagnostic, and treatment services, including specialized services. If medical, surgical, diagnostic, and treatment services are not available within the hospital, qualified consultants or attending physicians must be immediately available, or a satisfactory arrangement must be established for transferring beneficiaries to a general hospital certified for Medicare. 028.01(iv)(4) NURSING SERVICES. Nursing services must be under the direct supervision of a registered professional nurse who is qualified by education and experience for the position. The number of registered professional nurses, licensed practical nurses (LPN), and other nursing personnel must be adequate to formulate and carry out the nursing components of a treatment plan for each beneficiary. The following standards must be met: (a)The registered professional nurse supervising the nursing program must have a master's degree in psychiatric or mental health nursing or its equivalent from a school of nursing accredited by the National League for Nursing, or must be qualified by education or experience in the care of the mentally ill, and have demonstrated competence to: (i)Participate in interdisciplinary formulation of treatment plans; (ii)Give skilled nursing care and therapy; and (iii)Direct, supervise, and train others who assist in implementing and carrying out the nursing components of each beneficiary's treatment plan; (b)The staffing pattern must ensure the availability of a registered professional nurse 24 hours each day for: (i)Direct care; (ii)Supervising care performed by other nursing personnel; and (iii)Assigning nursing care activities not requiring the services of a professional nurse to other nursing service personnel according to the beneficiary's needs and the preparation and competence of the nursing staff available; (c)The number of registered professional nurses, including nurse consultants, must be adequate to formulate a nursing care plan in writing for each beneficiary and to ensure that the plan is carried out; and (d)Registered professional nurses and other nursing personnel must be prepared by continuing in-service and staff development programs for active participation in interdisciplinary meetings affecting the planning or implementation of nursing care plans for beneficiaries. The meetings include diagnostic conferences, treatment planning sessions, and meetings held to consider alternative facilities and community resources. 028.01(iv)(5) PSYCHOLOGICAL SERVICES. The psychological services must be under the supervision of a licensed psychologist. The psychology staff, including consultants, must be adequate in numbers and be qualified to plan and carry out assigned responsibilities. The following standards must be met: (a)The psychology department or service must be under the supervision of a licensed psychologist; (b)Psychologists, consultants, and supporting personnel must be adequate in number and be qualified to assist in essential diagnostic formulations, and to participate in: (i)Program development and evaluation of program effectiveness; (ii)Training and research activities; (iii)Therapeutic interventions ; and (iv)Interdisciplinary conferences and meetings held to establish diagnoses, goals, and treatment programs; or (c)Psychotherapy must be ordered and directed by a physician or advanced practice registered nurse (APRN) . 028.01(iv)(6) SOCIAL WORK SERVICES AND STAFF. Social work services must be under the supervision of a qualified social worker. The social work staff must be adequate in numbers and be qualified to fulfill responsibilities related to the specific needs of individual beneficiaries and their families, the development of community resources, and consultation with other staff and community agencies. The following standards must be met: (a)The director of the social work department or service must have a master's degree from an accredited school of social work and must meet the experience requirements for certification by the Academy of Certified Social Workers and must be licensed by the Nebraska Department of Health and Human Services, Division of Public Health as a mental health practitioner; and (b)Social work staff, including other social workers, consultants, and other assistants or case aides, must be qualified and numerically adequate to: (i)Provide psychosocial data for diagnosis and treatment planning, and for direct therapeutic services to beneficiaries, patient groups, or families; to develop community resources, including family or foster care programs; to conduct appropriate social work research and training activities; and to participate in interdisciplinary conferences and meetings concerning diagnostic formulation and treatment planning, including identification and utilization of other facilities and alternative forms of care and treatment; (c) Qualified therapists, consultants, volunteers, assistants, or aides must be sufficient in number to provide comprehensive therapeutic activities, including occupational, recreational, and physical therapy (PT), as needed, to ensure that appropriate treatment is provided to each beneficiary, and to establish and maintain a therapeutic milieu. The following standards must be met: (i)Occupational therapy (OT) services must be provided preferably under the supervision of a graduate of an occupational therapy (OT) program approved by the Council on Education of the American Medical Association who is licensed by the Nebraska Department of Health and Human Services, Division of Public Health or is eligible for the National Registration Examination of the American Occupational Therapy Association. In the absence of a full-time, fully-qualified occupational therapist (OT), an occupational therapy assistant (OTA) may function as the director of the activities program with consultation from a fully-qualified occupational therapist (OT); (ii)When physical therapy (PT) services are offered, the services must be given by or under the supervision of a qualified physical therapist (PT) who is a graduate of a physical therapy (PT) program approved by the Council on Medical Education of the American Medical Association in collaboration with the American Physical Therapy Association or its equivalent and is licensed by the Nebraska Department of Health and Human Services, Division of Public Health. In the absence of a full-time, fully-qualified physical therapist (PT), physical therapy (PT) services must be available by arrangement with a certified local hospital, or by consultation or part-time services furnished by a fully-qualified physical therapist (PT); (iii) Educational program services, when required by law, must be available. Educational program services must only be one aspect of the treatment plan, not the primary reason for admission or treatment. Educational program services are not covered for payment by Nebraska Medicaid ; (iv)Recreational or activity therapy services must be available under the direct supervision of a member of the staff who has demonstrated competence in therapeutic recreation programs; (v)Other occupational therapy (OT), recreational therapy, activity therapy, physical therapy assistants (PTA), or aides must be directly responsible to qualified supervisors and must be provided special on-the-job training to fulfill assigned functions; (vi)The total number of rehabilitation personnel, including consultants, must be sufficient to: (1) Permit adequate representation and participation in interdisciplinary conferences and meetings affecting the planning and implementation of activity and rehabilitation programs, including diagnostic conferences; and (2) Maintain all daily scheduled and prescribed activities, including maintenance of appropriate progress records for individual beneficiaries; and (vii)Volunteer service workers must be: (1) Under the direction of a paid professional supervisor of volunteers; (2) Provided appropriate orientation and training; and (3) Available daily in sufficient numbers to assist beneficiaries and their families in support of therapeutic activities. 028.02 COVERAGE CRITERIA FOR INPATIENT HOSPITAL SERVICES. Nebraska Medicaid covers inpatient hospital psychiatric services for beneficiaries age 21 and over when the services meet the criteria in this chapter and when the following requirements are met: (A)The attending physician must personally and face-to-face evaluate the beneficiary and write the psychiatric evaluation and diagnosis formulation; (B)The beneficiary must be treated by a physician or advanced practice registered nurse (APRN) personally and face-to-face at least six out of seven days and the interaction must be documented in the beneficiary's clinical record; (C)A psychiatrist or physician for Nebraska Medicaid serves as the attending physician and defines the medical necessity and active treatment requirements noted in this chapter’s General Requirements; and (D)The treatment plan must be developed and supervised by a multi-disciplinary team under the direction and supervision of the physician. It must be implemented upon admission and must be reviewed every 30 days or more often if medically necessary by the multi-disciplinary team. Treatment plans must meet the medical necessity and active treatment requirements in this chapter. 028.03 ADMISSION CRITERIA FOR INPATIENT HOSPITAL PSYCHIATRIC SERVICES. One or more of the following problems must be present: (A)The beneficiary needs a specific form of psychiatric treatment that can only be provided in the hospital, and the structured environment of the hospital is necessary for the beneficiary's treatment; (B)Specific observations are needed for evaluation and disposition; (C)Specific observations are needed for following treatment, or control of behavior is necessary for effective somatic therapy or psychotherapy; (D)The beneficiary's disorder is a serious threat to their adaptation to life and continuing developmental process, and hospitalization at this time is necessary to control this factor; (E)The beneficiary is experiencing psychiatric symptoms, the magnitude of which is not tolerable to self or society and that cannot be alleviated through treatment; (F)The beneficiary is unable to be cared for by self or others, due to psychiatric disorder; (G)All beneficiaries must require and receive active treatment as defined in federal regulations , which is available only in an inpatient setting, except that beneficiaries that are age 65 and older in an institution for mental disease (IMD) pursuant to this chapter ); or (H)Ambulatory care services in the community do not meet the treatment needs of the beneficiary. In those communities where outpatient resources are not available, the community pattern of referral must be used when appropriate. 028.03(i) GUIDELINES FOR INTERPRETATION. Admission of a beneficiary age 21 and older to an acute care facility or an acute level of care may be made only after all resources at a less restrictive level have been explored and deemed inappropriate. The following will not be accepted as adequate medical indicators for hospital inpatient admission: (1)Non-availability of group home, halfway house, residential treatment or other placement alternatives; (2)Admission to support or arrange placement in group home, halfway house, or residential treatment; (3)Admission solely for emergency placement or protective custody; (4)Admission due to failure of current placement; (5)Reason for acute level of care is to obtain Nebraska Medicaid benefits that would otherwise not be reimbursed; (6)Admission to avoid placement in the criminal justice system; (7)Admission for conduct disorders or behavioral issues that do not demonstrate an imminent danger to self or others; (8)Social and family problems; and (9)Psychometric evaluation including learning disabilities. 028.03(ii) BENEFICIARY ASSESSMENT. Admission to an acute care facility must meet the first two elements listed below plus at least one other element from this beneficiary assessment section. The additional element must be as a result of the major psychiatric disorder referred to in the first element below . In addition, one element from the acute services section must be met. Elements 1 and 2 must be met on all admissions, plus one of the elements from 3 to 7: (1)Documented evidence of a major psychiatric disorder that necessitates 24-hour medical supervision and daily physician or advanced practice registered nurse (APRN) contact; and (2)Documented initial treatment plan with provisions for: (a)Resolution of acute medical problems; (b)Evaluation of, and needs assessment for, medications; (c)Protocol to ensure beneficiary's safety; and (d)Discharge plan initiated at the time of admission. (3)Demonstrates imminent danger to self or others at the time of admission evidenced by at least one of the following: (a)Suicide attempt or specific suicide plan with access to means; (b)Danger to others through a specific action or activity; (c)Command hallucination with suicidal or homicidal content; (d)Hallucinations, delusional behavior, or other bizarre psychotic behavior; (4)Presence of other behavior or symptoms to such a degree or in such a combination that acute care is the least restrictive treatment available as demonstrated by at least one of the following: (a)Physical aggression toward family, peers, or coworkers which could not be considered self-protective; (b)Explosive behavior without provocation or serious loss of impulse control; (c)Dangerous, assaultive, uncontrolled or extreme impulsive behavior which puts the beneficiary at significant risk ; (d)Severe impairment in concentration or hyperactivity; or (e)Behaviors consistent with an acute psychiatric disorder which may include significant mental status changes; and there is documented evidence that no medical condition would account for the symptoms; (5)Severe impairment in psychosocial functioning as demonstrated by at least one of the following: (a)Psychotic behavior, delusions, paranoia, or hallucinations; or (b)Severe decompensation and interference with baseline functioning; (6)Documented failure of current intensive outpatient treatment including two or more of the following indications: (a)Intensification or perseverance of severe psychiatric symptoms; (b)Noncompliance with medication regime; (c)Lack of therapeutic response to medication; or (d)Lack of beneficiary participation in or response to outpatient treatment modalities; or (7)Admissions ordered by the court will be covered when accompanied by substantiation of medical necessity. 028.03(iii) DOCUMENTATION SUPPORT. Documentation supports the need for controlled, clinical observation and psychiatric evaluation, where acute care is the least restrictive treatment alternative. 028.03(iv) JUSTIFICATION FOR CONTINUED STAY. The beneficiary must meet the first two elements listed below plus two additional elements for the approval of continued stay. Elements 1 and 2 must be met on all admissions, plus one of the elements from 3 to 7. (1)Evidence of a major psychiatric disorder that necessitates 24-hour medical supervision and physician or advanced practice registered nurse (APRN) contact; and (2)A comprehensive treatment plan and clinical pathway of inpatient care must be completed within 72 hours of admission and implemented to facilitate the beneficiary's progression toward living in a less supervised setting. Documentation must support the beneficiary's and family's active involvement with the treatment goals and with revisions in the treatment plan as appropriate based on the beneficiary's progress or lack of progress. (3)Isolation, seclusion, or restraint procedures within the last 72 hours requiring 24-hour medical supervision and supported by medical record documentation; (4)Continuing evidence of symptoms and behaviors reflecting significant risk, imminent danger, or actual demonstrated danger to self or others; requiring one-to-one suicideor homicide precautions , close observation, step down precautions including checks every 15–60-minute ; (5)Monitoring or adjustment of psychotropic medication(s) related to lack of therapeutic effect or complication(s) in the presence of complicating medical and psychiatric conditions necessitating 24-hour medical supervision and supported by medical record documentation; (6)Persistence of psychotic symptoms and continued temporary inability of the beneficiary to perform the activities of daily living or meet their basis needs for nutrition and safety due to a psychiatric disorder or the temporary mental state of the beneficiary; or (7)Continued need for 24-hour medical supervision, reevaluation or diagnosis of a beneficiary exhibiting behaviors consistent with acute psychiatric disorder. Referral for physician or advanced practice registered nurse (APRN) review is necessary if symptoms are unimproved or worse within any sevenday interval. 028.03(v) SIGNS AND SYMPTOMS. In addition to the admission criteria, one or more of the following signs or symptoms of the problem must be present: (1)A suicide attempt that requires acute medical intervention or suicidal ideation with a lethal plan and the means to carry out this plan; (2)Psychiatric decompensation to a level in which the beneficiary is not able to communicate or perform life-sustaining activities of daily living; (3)Delusions or hallucinations that significantly impair the beneficiary's ability to communicate or perform life-sustaining activities of daily living; (4)Catatonia; (5)The presence of combined illnesses where neurological or other disease process coexists with a psychiatric disturbance, demanding special diagnostic or treatment interventions, which exceed non-hospital capacity; (6)Aggression to others causing physical injury or homicidal ideation with a lethal plan and the means to carry out the plan, that is the result of a severe emotional psychiatric decompensation; and (7)Medication initiation or change when the beneficiary has a documented history of reactions to psychotropic medications that have resulted in the need for acute medical care in a hospital or an emergency room. 028.04 PRIOR AUTHORIZATION PROCEDURES. All inpatient admissions must be prior-authorized by the Nebraska Medicaid’s contracted peer review organization or management designee. Each beneficiary will have a specific prior-authorization number assigned by the Nebraska Medicaid’s contracted peer review organization or management designee if the admission is approved. Providers should follow the Nebraska Medicaid’s contracted peer review organization or management designee requirements on facilitating prior authorization. 028.05 DOCUMENTATION IN THE BENEFICIARY’S CLINICAL RECORD. The medical records maintained by a hospital permit determination of the degree and intensity of the treatment provided to beneficiaries who receive services in the hospital. For inpatient hospital psychiatric services, clinical records must stress the psychiatric components of the record, including history of findings and treatment provided for the psychiatric condition for which the beneficiary is hospitalized. All documents from the beneficiary's medical record submitted to Nebraska Medicaid must contain sufficient information for identification. The medical record must include: (A)The identification data, including the beneficiary's legal status and whether the admission is voluntary a Mental Health Board commitment, or court mandated; (B)A provisional or admitting diagnosis which is made on every beneficiary at the time of admission and includes the diagnoses of intercurrent diseases as well as the psychiatric diagnoses; (C)The complaint of others regarding the beneficiary, as well as the beneficiary's comments; (D)The psychiatric evaluation, including a medical history, which contains a record of mental status and notes the onset of illness, the circumstances leading to admission, attitudes, behavior, estimate of intellectual functioning, memory functioning, orientation, and an inventory of the beneficiary's strengths in a descriptive, not interpretative, fashion; (E)A complete neurological examination, when indicated, recorded at the time of the admitting physical examination; (F)A social history sufficient to provide data on the beneficiary's relevant past history, present situation, social support system, community resource contacts, and other information relevant to good treatment and discharge planning; (G)A family assessment as described in this chapter; (H)Reports of consultations, psychological evaluations, electroencephalograms, dental records, and special studies; (I)The beneficiary's treatment plan and treatment plan reviews; (J)The treatment received by the beneficiary, which is documented in a manner and with a frequency to ensure that all active therapeutic efforts are included; (K)Progress notes which are recorded by the psychiatrist or physician, nurse, social worker, and, when appropriate, others significantly involved in active treatment modalities. The frequency is determined by the condition of the beneficiary, but progress notes must be recorded daily by nursing staff, and at each contact by psychiatrist or physician and by all other therapeutic staff . Progress notes must contain a concise assessment of the beneficiary's progress and recommendations for revising the treatment plan as indicated by the beneficiary's condition; (L)The psychiatric diagnosis contained in the final diagnosis ; (M)Transition and discharge planning documentation; (N)Proof of family and community involvement; (O)A copy of the appropriate Nebraska Medicaid approved confidential report certification; and (P)The discharge summary, including a recapitulation of the beneficiary's hospitalization, recommendations for appropriate services concerning follow-up, and a brief summary of the beneficiary's condition on discharge. 028.06 CERTIFICATION AND RECERTIFICATION BY PSYCHIATRISTS. Nebraska Medicaid pays for covered inpatient hospital psychiatric services only if a psychiatrist or physician certifies, and recertifies at designated intervals, the medical necessity for the services of the hospital inpatient stay. Appropriate supporting material may be required. The psychiatrist's or physician's certification or recertification statement must document the medical necessity for the admission to and continued hospitalization for inpatient psychiatric treatment, based on a current evaluation of the beneficiary's condition. For beneficiaries admitted to a hospital, a psychiatrist's or physician's certification by written order for admission is required at the time of admission for inpatient services. 028.06(A) FAILURE TO CERTIFY OR RECERTIFY. If a hospital fails to obtain the required certification and recertification statements in an individual case, Nebraska Medicaid must not make payment for the case. 028.07 HOSPITAL UTILIZATION REVIEW (UR). . A site visit by Nebraska Medicaid for purposes of utilization review (UR) may be required for further clarification. 028.08 BILLING. Providers must submit claims for inpatient hospital psychiatric services on the appropriate Nebraska Medicaid approved health care claim form or electronic claim. 028.09 OTHER REGULATIONS. For inpatient services provided by an institution for mental disease (IMD), public or private, see the requirements in this chapter, inpatient hospital services for beneficiaries age 65 and over in institutions for mental disease (IMD's). 028.10 LIMITATIONS. For inpatient hospital psychiatric services, the following limitations apply: (A)Care must be supervised by a psychiatrist or physician. All inpatient hospital services must be prior-authorized; and (B)Payment for inpatient hospital services is made according to this title . 028.11 FORM COMPLETION. Inpatient hospital psychiatric service providers must enter the review number from Nebraska Medicaid contracted peer review organization or management designee as required. Payment for approved services is made to the hospital. 028.12 EXCEPTIONS. Additional documentation from the beneficiary's medical record may be requested by Nebraska Medicaid's psychiatric consultants prior to considering authorization of payment. 028.13 EMERGENCY PROTECTIVE CUSTODY (EPC) SERVICES IN AN ACUTE CARE HOSPITAL. Emergency protective custody (EPC) services may be reimbursed in an acute care hospital without licensed psychiatric beds for an average of three to five days, up to seven days under the following conditions: (A)The hospital is licensed by the Nebraska Department of Health and Human Services, Division of Public Health; (B)The hospital is accredited by the Joint Commission or the American Osteopathic Association (AOA); (C)The admitting and attending physician is a psychiatrist; (D)The hospital provides a setting that is separate from the rest of the hospital activities and is a safe, therapeutic environment; (E)The hospital provides an active treatment program in the form of assessment and diagnostic interventions; (F)The hospital emergency protective custody (EPC) services is approved by Nebraska Medicaid ; and (G)The hospital emergency protective custody (EPC) services meets all other standards for inpatient hospital psychiatric care. 028.13(i) EMERGENCY PROTECTIVE CUSTODY (EPC) SERVICES LIMITATION. The exception for emergency protective custody (EPC) services is available only to hospitals that do not have licensed psychiatric beds.