R414-31-3. Program Access Requirements

(1) Before admission for inpatient psychiatric services or before authorization for Medicaid payment, a facility physician must make a medical evaluation of the member's need for care in the hospital and certify that inpatient services are needed. (2) The certification must document that: (a) ambulatory care resources available in the community do not meet the treatment needs of the member; (b) proper treatment of the member's psychiatric condition requires services on an inpatient basis under the direction of a physician; and (c) the services can reasonably be expected to improve the member's condition or prevent further regression so that services are no longer necessary. (3) The Office of Licensing within the Division of Licensing and Background Checks, reviews the medical evaluation and certification and determines that the member meets certification of need requirements.