Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1151 - INPATIENT PSYCHIATRIC SERVICES
PAYMENT CONDITIONS FOR INPATIENT PSYCHIATRIC SERVICES
Section 1151.62 - Certification of Need for admission

(a) If a recipient is 21 years of age or older, the attending or staff physician shall certify in the medical record either at the time of admission or on the first day of a benefit period, when applicable, or upon application for MA, that acute psychiatric services in a private psychiatric hospital are needed.

(b) If a recipient under 21 years of age is being admitted, an independent team shall certify at the time of admission the need for acute psychiatric services in a private psychiatric hospital and document this in the medical record. The team shall:

(c) For an individual under 21 years of age who applies for MA while in the private psychiatric hospital, the team responsible for the individual's plan of care under § 1151.66 (relating to team developing plan of care) shall:

(d) In the event of an emergency admission of a recipient under 21 years of age, the recipient's need for inpatient psychiatric services shall be certified under subsection (c).

(e) Subsections (a)-(d) apply only to private psychiatric hospitals. Distinct part psychiatric units of acute care general hospitals shall comply with 42 CFR 456.60 (relating to certification and recertification of need for inpatient care).