Alabama Administrative Code
Title 560 - ALABAMA MEDICAID AGENCY
Chapter 560-X-41 - PSYCHIATRIC FACILITIES FOR INDIVIDUALS UNDER AGE 21
Section 560-X-41-.06 - Active Treatment
Universal Citation: AL Admin Code R 560-X-41-.06
Current through Register Vol. 42, No. 11, August 30, 2024
(1) Inpatient psychiatric services are covered by Medicaid only if they involve active treatment which means implementation of a professionally developed and supervised individual plan of care that is:
(a) Developed and implemented no later than
14 working days after admission, and
(b) Designed to achieve the recipient's
discharge from inpatient status at the earliest possible time.
(2) An individual plan of care is a written plan developed for each recipient in accordance with (2)(a-f) below to improve the recipient's condition to the extent that inpatient care is no longer necessary. The plan of care must:
(a)
Be based on a diagnostic evaluation that includes examination of the medical,
psychosocial, social, behavioral, and developmental aspects of the recipient's
situation and reflects the need for inpatient psychiatric care;
(b) Be developed by a team of professionals
specified in (3) below in consultation with the recipient and their parents,
legal guardians, or others in whose care he/she will be released after
discharge;
(c) State treatment
objectives;
(d) Prescribe an
integrated program of therapies, activities, and experiences designed to meet
the objectives;
(e) Include, at an
appropriate time, post-discharge plans and coordination of inpatient services
with partial discharge plans and related community services to ensure
continuity of care with the recipient's family, school, and community upon
discharge; and
(f) Be reviewed at
least every 30 days by the team specified in (3) below to determine that
services provided are/were required on an inpatient basis, and recommend
changes in the plan as indicated by the recipient's overall adjustment to the
treatment.
(3) Team developing individual plan of care.
(a) The
individual plan of care must be developed by an interdisciplinary team of
physicians and other personnel who are employed by, or who provide services to
patients in, the facility. Based on education and experience, including
competence in child psychiatry, the team must be capable of:
1. Assessing the recipient's immediate and
long-range therapeutic needs, developmental priorities, and personal strengths
and liabilities;
2. Assessing the
potential resources of the recipient's family;
3. Setting treatment objectives;
and
4. Prescribing therapeutic
modalities to achieve the plan's objectives.
(b) The team must include, as a minimum,
either:
1. A Board-eligible or Board-certified
psychiatrist licensed in the State of Alabama;
2. A licensed clinical psychologist who has a
doctoral degree and a physician licensed to practice medicine or osteopathy;
or
3. A physician licensed to
practice medicine or osteopathy with specialized training and experience in the
diagnosis and treatment of mental diseases, and a psychologist who has a
master's degree in clinical psychology or who has been certified by the State
of Alabama.
(c) The team
must also include one of the following:
1. A
licensed social worker with specialized training or one year of experience in
treating mentally ill individuals;
2. A registered nurse with specialized
training or one year of experience in treating mentally ill
individuals;
3. An licensed
occupational therapist with specialized training, or one year of experience in
treating mentally ill individuals; or
4. A psychologist who has a master's degree
in clinical psychology or who has been certified by the State of
Alabama.
(d) The
specific staff requirements for psychiatric facilities may be found at
42
CFR 482.62.
Author: Lynn Sharp, Associate Director, Institutional Services
Statutory Authority: 42 C.F.R. §§441.154, 441.155, 441.156.
Disclaimer: These regulations may not be the most recent version. Alabama may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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