Alabama Administrative Code
Title 560 - ALABAMA MEDICAID AGENCY
Chapter 560-X-5 - PSYCHIATRIC FACILITIES FOR INDIVIDUALS 65 OR OVER
Section 560-X-5-.09 - Inspection Of Care
Current through Register Vol. 43, No. 02, November 27, 2024
(1) The Medicaid Quality Assurance Program will periodically perform an inspection of care and services provided to recipients in accordance with 42 C.F.R. Part 456, Subpart I. The review team must consist of psychiatrist or physician with knowledge and experience in the provision of care in mental institutions and other appropriate mental health and social service personnel. This physician may not inspect the care of a recipient for whom he is the attending physician or for whom he has served as the consulting physician. The Medicaid Agency will determine, based on the quality of care and services provided in the facility and the condition of recipients in the facility, at what intervals inspections will be made. However, the review team must inspect the care and services provided to each recipient in the facility at least annually. The inspection must include:
In making determination of adequacy of services, the team may consider items such as, but not limited to:
(2) Each recipient's chart will be reviewed by the Medicaid review team to assure that the following items are included on the chart:
(3) The review team will also review the chart for:
(4) The review team must submit a report on each inspection that contains observations, conclusions, and recommendations as specified in 42 C.F.R. 456.611.
(5) At the time of the inspection, the team will also review each recipient's record for compliance with all state and federal regulations. Payments for admissions that are found to be out of compliance may be recouped by Medicaid.
Author:
Statutory Authority: 42 C.F.R. Part 456, Subpart I; Section 456-600-456.614