Alabama Administrative Code
Title 560 - ALABAMA MEDICAID AGENCY
Chapter 560-X-5 - PSYCHIATRIC FACILITIES FOR INDIVIDUALS 65 OR OVER
Section 560-X-5-.10 - Inpatient Utilization Review

Universal Citation: AL Admin Code R 560-X-5-.10

Current through Register Vol. 43, No. 02, November 27, 2024

(1) The determination of the level of care will be made by a licensed nurse of the hospital staff.

(2) Five percent of all admissions and concurrent stay charts will be retrospectively reviewed by the Medicaid Agency or designee on a monthly basis.

(3) For an individual who applies for Medicaid while in the facility, a Psychiatric Admission form must be signed by the attending physician at the time application for Medicaid is made.

(4) The following information shall be included on the Physician Admission Form:

(a) Recipient information:
1. admitting diagnosis;

2. events leading to hospitalization;

3. history of psychiatric treatment;

4. current medications;

5. physician orders;

6. presenting signs and symptoms.

(b) Events leading to present hospitalization.

(c) History and physical.

(d) Mental and physical capacity.

(e) Summary of present medical findings including prognosis.

(f) Plan of care.

(5) Medicaid's Psychiatric Criteria for Age 65 or Over will be utilized in reviewing whether the admission and continued stay were appropriately billed.

Author: Jan Sticka, Program Manager, Inpatient QI Program Associate Director, Institutional Services

Statutory Authority: 42 C.F.R. Section 456.171.

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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