471 NAC 20-029. INPATIENT HOSPITAL SERVICES FOR BENEFICIARIES AGE 65 AND OVER IN INSTITUTIONS FOR MENTAL DISEASE (IMD)

029. INPATIENT HOSPITAL SERVICES FOR BENEFICIARIES AGE 65 AND OVER IN INSTITUTIONS FOR MENTAL DISEASE (IMD). 029.01 LEGAL BASIS. Nebraska Medicaid covers institution for mental disease (IMD) services, for beneficiaries age 65 and over according to federal regulations Nebraska Medicaid provides institution for mental disease (IMD) services according to Nebraska statutes. 029.02 STANDARDS FOR PARTICIPATION. To participate in Nebraska Medicaid , the institution for mental disease (IMD) must: (A)Be in conformity with all applicable federal, state, and local laws; (B)Be licensed as a hospital by the Nebraska Department of Health and Human Services, Division of Public Health or the licensing agency in the state where the institution for mental disease (IMD) is located; (C)Be certified as meeting the conditions of participation for hospitals in federal regulations ; (D)Be accredited by the Joint Commission or the American Osteopathic Association (AOA), and submit a copy of the most recent accreditation survey with the appropriate Nebraska Medicaid approved provider agreement form ; (E)Meet the definition of an institution for mental disease (IMD) as stated in this chapter; (F)Meet the current Joint Commission or American Osteopathic Association (AOA) standards of care; and (G)Meet all requirements in this chapter except active treatment. 029.02(i) PROVIDER AGREEMENT. The provider must complete the appropriate Nebraska Medicaid approved provider agreement form , and submit the form, along with a copy of its current Joint Commission or American Osteopathic Association (AOA) accreditation survey, program, policies, and procedures to Nebraska Medicaid to enroll in Nebraska Medicaid as a provider. If approved, Nebraska Medicaid notifies the institution for mental diseases (IMD) of its provider number. 029.02(ii) ANNUAL UPDATE. With the annual cost report, the provider must submit a copy of all program information, their most recent license and accreditation certificates, and any other information specifically requested by Nebraska Medicaid. Claims will not be paid if this has not been received and approved. This information must be submitted with a new copy of the appropriate Nebraska Medicaid approved provider agreement f. 029.02(iii) MONTHLY REPORTS. The institution for mental diseases (IMD) must submit a monthly report to Nebraska Medicaid . The report must be submitted by the 15th of the following month. The report must contain: (1)The names of all Nebraska Medicaid beneficiaries admitted or discharged during the month; and (2)The date of each Nebraska Medicaid beneficiary's admission or discharge. 029.02(iv) RECORD REQUIREMENTS. The institution for mental diseases (IMD) must enter the appropriate Nebraska Medicaid approved inpatient mental health services form or electronic claim that is submitted to Nebraska Medicaid. 029.02(iv)(1) TRANSFER. Transfer to another institution for mental diseases (IMD) or readmission constitutes a new admission for the receiving facility. 029.02(iv)(2) AN INDIVIDUAL WHO APPLIES FOR NEBRASKA MEDICAID. For an individual who applies for Nebraska Medicaid while in the institution for mental diseases (IMD), the certification must be: (a)Made by the team that develops the individual plan of care as outlined in this chapter; and (b)Cover any period before application for which claims are made. 029.02(iv)(3) NEBRASKA MEDICAID. When Nebraska Medicaid eligibility is determined, authorization for previous and continued care must be obtained from the Department contracted peer review organization or management designee. 029.03 ADMISSION CRITERIA. As outlined in this chapter. 029.04 SIGNS AND SYMPTOMS. As outlined in this chapter. 029.05 PRIOR AUTHORIZATION AND INITIAL CERTIFICATION PROCEDURES. Institution for mental diseases (IMD) services for beneficiaries age 65 or older must be prior-authorized as follows: (A)Admissions must be prior-authorized by the Nebraska Medicaid's contracted peer review organization or management designee. Providers should follow the Nebraska Medicaid’s contracted peer review organization or management designee requirements on facilitating prior authorization. The appropriate Nebraska Medicaid approved confidential report form received from the peer review organization or management designee must be maintained in the beneficiary's medical record; (B)A psychiatrist must pre-certify, at the time of admission, that the beneficiary requires inpatient services in a psychiatric hospital. The psychiatrist must complete, sign, and date the appropriate Nebraska Medicaid approved confidential report f within 48 hours after admission or at the time of application for medical assistance if this date is later than the date of admission. The 48-hour period does not include weekends or holidays. Copies of the admission notes, and plan of care may be attached to the signed and dated appropriate Nebraska Medicaid approved confidential report form to certify that inpatient services are or were needed; (C) The facility must contact Nebraska Medicaid for determination of medical eligibility; (D)The facility must complete the appropriate Nebraska Medicaid approved inpatient mental health services form , attach a copy of the completed appropriate Nebraska Medicaid approved confidential report form , and forward to Nebraska Medicaid . The facility must retain the original copy of the appropriate Nebraska Medicaid approved confidential report form in the beneficiary's medical record; (E)The document number on the appropriate Nebraska Medicaid approved inpatient mental health services form must be entered on each Nebraska Medicaid approved health care claim form or standard electronic health care claim transaction and submitted to Nebraska Medicaid; and (F)When the individual is discharged or expires, the facility must complete the appropriate form and forward to Nebraska to close the authorization. 029.06 TRANSFERS. Initial certification procedures must be followed for each transfer or readmission. 029.07 SIXTY-DAY RECERTIFICATION. A psychiatrist must recertify, in the beneficiary's record, the beneficiary's need for continued care in a mental hospital or need for alternative arrangements at least every 60 days after the initial certification. 029.08 INTERDISCIPLINARY PLAN OF CARE. The psychiatrist and the facility interdisciplinary team must develop and implement an individual written plan of care for each beneficiary within 48 hours after the beneficiary's admission. This plan of care must be placed in the beneficiary's chart when completed. This requirement is met by completion of the appropriate form, which is retained in the beneficiary's record. The written plan of care must include: (A)Diagnoses, symptoms, complaints, and complications indicating the need for admission; (B)A description of the beneficiary's functional level; (C)Objectives; (D)Any orders for: (i)Medications; (ii)Treatments; (iii)Restorative and rehabilitative services; (iv)Activities; (v)Therapies; (vi)Social services; (vii)Diet; and (viii)Special procedures recommended for the beneficiary's health and safety; (E)Plans for continuing care, including review and modification of the plan of care; (F)Appropriate medical treatment in the institution for mental diseases (IMD) every 60 days; (G)Appropriate social services every 60 days; (H)Family involvement; and (I)Plans for discharge, including referrals for outpatient follow-up care. 029.09 FACILITY INTERDISCIPLINARY PLAN OF CARE TEAM REVIEW. The attending or staff psychiatrist and other personnel involved in the beneficiary's care must review each plan of care at least every 90 days. The beneficiary's record must contain documentation of the 90-day interdisciplinary team review. 029.10 ADMISSION EVALUATION. Institution for mental diseases (IMD) staff must develop an admission evaluation for each beneficiary within 30 days after the beneficiary's admission. This evaluation must be placed in the beneficiary's record when completed. The admission evaluation must include: (A)The appropriate form ; (B)A medical evaluation, including: (i)Diagnosis; (ii)Summary of current medical findings; (iii)Medical history; (iv)Mental and physical functional capacity; (v)Prognosis; (vi)The psychiatrist's recommendation concerning the beneficiary's admission to the mental hospital or the beneficiary's need for continued care in the mental hospital, if the beneficiary applies for Nebraska Medicaid while in the mental hospital; (C)A psychiatric evaluation; (D)A social evaluation; and (E)An initial plan of care sufficient to meet the beneficiary's needs until the facility interdisciplinary team has developed the individual written plan of care. 029.11 ADMISSION EVALUATION. The institution for mental diseases (IMD) must make available to the psychiatrist current information on resources available for continued out-of-hospital care of beneficiaries and must arrange for prompt transfer of appropriate medical and nursing information to ensure continuity of care upon the beneficiary's discharge. Federal regulations require that, when the beneficiary is approved for an alternate plan of care, the institution for mental diseases (IMD) is responsible for discharge planning. In cooperation with community regional mental health programs, the institution for mental diseases (IMD) must: (A)Initiate alternate care arrangements; (B)Assist in beneficiary transfer; and (C)Follow-up on the beneficiary's alternate care arrangements. 029.11(i) TRANSFER. When the beneficiary is being transferred to a long-term care (LTC) facility , the facility's staff must be included in the discharge process and must receive appropriate and adequate medical and nursing information to ensure continuity of care. The institution for mental diseases (IMD) must also contact Nebraska Medicaid .