Current through 2024-38, September 18, 2024
A team, whose composition is specified at 46.13-1, will
inspect at least annually the care and services provided to each member
receiving inpatient services in the hospital. No hospital shall be notified of
the time of inspection more than forty-eight (48) hours before the scheduled
arrival of the team.
46.13-1
Team Composition
The Inspection Team shall consist of one or more
psychiatric nurse consultants, a medical social work consultant, MSW level
social worker and a psychiatrist or physician knowledgeable about inpatient
services in psychiatric hospitals.
46.13-2
Personal Contact With And
Observation Of Members And Review Of Records
The Team's inspections must include review of each
member's record.
A. For members under
age twenty one (21) receiving inpatient services, the inspections must also
include personal contact with and observation of each member.
B. For members age sixty five (65) or older
receiving inpatient services, if the record does not contain complete periodic
assessments described at 46.10, or if the Team deems such reports inadequate,
the inspection will also include personal contact with and observation of the
member.
46.13-3
Determination By Team
The team must determine in its inspection that:
A. The services available in the hospital are
adequate to:
1. Meet the health needs of each
member and
2. Promote each member's
maximum physical, mental, and psychosocial functioning.
B. It is necessary and desirable for the
member to continue to receive inpatient services within the hospital;
C. It is not feasible to meet the member's
health needs through alternative institutional services; and
D. Each member under age twenty one (21) is
receiving active treatment as defined at 46.01-3.
46.13-4
Basis for Determinations
In making the determinations on adequacy of services and
related matters for each member under 46.13-3, above, the team may consider
such items as whether or not:
A. The
medical evaluation, social and psychological evaluation, and the plan of care
are complete and current;
B. The
plans of care are followed and all ordered services, including dietary orders,
are provided and properly recorded;
C. The attending physician reviews prescribed
medications at least every thirty (30) days;
D. Tests or observations of each member
indicated by his medication regimen are made at appropriate times and properly
recorded;
E. Physician, nurse, and
other professional progress notes are made as required and appear to be
consistent with the observed condition of the member;
F. The member receives adequate services,
based on observations such as
1.
Cleanliness;
2. Absence of bed
sores;
3. Absence of signs of
malnutrition or dehydration; and
4.
Apparent maintenance of maximum physical, mental, and psychosocial
functions;
G. The member
needs any service that is not furnished by the hospital or through arrangements
with others;
H. The member needs
continued placement in the hospital or there is an appropriate plan to transfer
the member to an alternate method of care.
I. Whether certification or recertification
has been timely and properly documented.
