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
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:
(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.