Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1151 - INPATIENT PSYCHIATRIC SERVICES
INSPECTIONS OF CARE
Section 1151.82 - Inspections of care reports

(a) The inspection of care team will submit reports on each inspection of care within 45 days following the inspection to:

(b) If the report of the inspection of care team recommends alternate care for a recipient:

(c) If the recipient or the recipient's representative appeals the decision within 10 days from the date the notice is mailed, payment for inpatient psychiatric care will continue pending the outcome of the hearing.

(d) If an appeal is entered after the tenth day, payment will be discontinued effective with the first day the inspection of care team recommended alternative care pending the outcome of the hearing.

(e) If the recipient or the recipient's representative appeals the Department's recommendation for an alternative level of care within the specified time period, the Department will continue to make payment for private psychiatric hospital inpatient care. If the Department is sustained in its action, the Department will recover from the facility a payment that would not have been made if the action of the Department had not been appealed. The period for which the Department will recover excess payment begins on the effective date specified on the notice and ends with the date that the appropriate change in the level of care is made.

(f) If the report of the inspection of care team cites deficiencies, the hospital shall submit a written response to the Department within 30 days of the control date on the summary report. The response shall outline the hospital's planned course of action including acceptable time frames for correcting deficiencies. The inspection of care team will conduct follow-up visits to determine if the deficiencies have been corrected.

(g) This section applies only to private psychiatric hospitals.