Current through Supplement No. 394, October, 2024
1. Inpatient
psychiatric services for individuals under age twenty-one must be provided:
a. Under the direction of a
physician;
b. By a psychiatric
hospital or an inpatient psychiatric program in a hospital, accredited by the
joint commission on accreditation of health care organizations, or by a
psychiatric facility that is not a hospital and which is accredited by the
joint commission on accreditation of health care organizations, the commission
on accreditation of rehabilitation facilities, the council on accreditation of
services for families and children, or by any other accrediting organization
with comparable standards; and
c.
Before the recipient reaches age twenty-one, or, if the individual was under
age twenty-one at the time of admission, before the earlier of:
(1) The date the recipient no longer requires
inpatient psychiatric services; or
(2) The date the recipient reaches age
twenty-two.
2.
A psychiatric facility or program providing inpatient psychiatric services to
individuals under age twenty-one shall:
a.
Except as provided in subdivision c, obtain a certification of need from an
independent review team qualified under subsection 3 prior to admitting a
recipient;
b. Obtain a
certification of need from an independent review team qualified under
subsection 3 for an individual who applies for Medicaid while in the facility
or program covering any period for which claims are made; or
c. Obtain a certification of need from an
independent review team qualified under subsection 3 for an emergency admission
of an individual, within fourteen days after the admission, covering any period
prior to the certification for which claims are made.
3.
a. An
independent review team must:
(1) Be composed
of individuals who have no business or personal relationship with the inpatient
psychiatric facility or program requesting a certification of need;
(2) Include a physician;
(3) Have competence in diagnosis and
treatment of mental illness; and
(4) Have knowledge of the recipient's
situation for which the certification of need is requested.
b. Before issuing a certification
of need, an independent review team must use professional judgment and
standards approved by the department and consistent with the requirements of 42
CFR part 441, subpart D, to demonstrate:
(1)
Ambulatory care resources available in the community do not meet the treatment
needs of the recipient;
(2) Proper
treatment of the recipient's psychiatric condition requires services on an
inpatient basis under the direction of a physician; and
(3) The requested services can reasonably be
expected to improve the recipient's condition or prevent further regression so
services may no longer be needed.
4. Payment may not be made for services
provided to a recipient under age twenty-one in a psychiatric residential
treatment facility without a certification of need.
5. Prior to the dates of services of January
1, 2019, payment may not be made for any other medical services not provided by
a psychiatric residential treatment facility if the facility is an institution
for mental diseases.
General Authority: NDCC 50-24.1-04
Law Implemented: NDCC 50-24.1-04; 42 CFR Part
441, subpart D
