Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1151 - INPATIENT PSYCHIATRIC SERVICES
PAYMENT CONDITIONS FOR INPATIENT PSYCHIATRIC SERVICES
Section 1151.61 - Payment conditions: general

Universal Citation: 55 PA Code ยง 1151.61

Current through Register Vol. 54, No. 44, November 2, 2024

For payment to be authorized for inpatient psychiatric services:

(1) The recipient's need for admission shall be certified under § 1151.62 (relating to Certification of Need for admission).

(2) A medical and psychiatric evaluation shall be made by the attending physician or staff physician under § 1151.63 (relating to medical and psychiatric evaluation).

(3) A social evaluation must be made under § 1151.64 (relating to social evaluation) by one of the following:

(i) The social service staff of the CAO or its agent for recipients applying for admission to an inpatient psychiatric facility.

(ii) An appropriate member of the inpatient psychiatric facility's staff, if the individual applies for MA while in an inpatient psychiatric facility.

(4) A plan of care shall be established and implemented under § 1151.65 (relating to plan of care).

(5) The recipient's admission to the inpatient psychiatric facility shall be under State statutes and regulations governing admission to inpatient psychiatric facilities.

(6) The medical justification for the recipient's need for care on an inpatient basis shall be established under §§ 1151.70-1151.78 (relating to utilization control).

(7) The recipient's continued need for care, if applicable, shall meet § 1151.67 (relating to payment conditions related to the recipient's continued need for care).

The provisions of this §1151.61 amended under sections 201 and 443.1(1) of the Public Welfare Code (62 P. S. §§ 201 and 443.1(1)).

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