Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1151 - INPATIENT PSYCHIATRIC SERVICES
PAYMENT CONDITIONS FOR INPATIENT PSYCHIATRIC SERVICES
Section 1151.65 - Plan of care

Universal Citation: 55 PA Code ยง 1151.65

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

(a) Before authorization for payment for care provided to a recipient 21 years of age or older, the attending or staff physician shall establish, and include in the recipient's medical record, an individual written plan of care. The plan of care shall be designed to maintain the recipient at or restore the recipient to the greatest possible degree of health and independent functioning. The plan shall include:

(1) Diagnoses, symptoms, complaints and complications indicating the need for admission.

(2) Treatment objectives.

(3) A description of the functional level of the individual.

(4) Orders for medications, treatments, restorative and rehabilitative services, activities, therapies, social services and diet.

(5) Special procedures recommended for the health and safety of the patient.

(6) Plans for continuing care, including review and modification to the plan of care.

(7) Plans for discharge.

(b) If a recipient is under age 21, an individual written plan of care designed to achieve the recipient's discharge from inpatient status at the earliest possible time shall be included in the recipient's medical record. The plan shall:

(1) Be developed and implemented within 14 days after admission.

(2) Be based on the diagnostic evaluation of the recipient that includes examination of the medical, psychological, social, behavioral and developmental aspects of the individual's condition and medical need for inpatient psychiatric care.

(3) Be developed by the interdisciplinary team of professionals under § 1151.66 (relating to team developing plan of care) in consultation with the recipient and those in whose care the recipient will be placed upon discharge.

(4) State treatment objectives.

(5) Prescribe an integrated program of therapies, activities and experiences designed to meet the objectives in paragraph (4).

(6) Include, at an appropriate time, postdischarge plans and coordination of inpatient services with partial discharge plans and related community services to ensure continuity of care with the recipient's family, school and community upon discharge.

(c) Subsections (a) and (b) apply only to private psychiatric hospitals. Distinct part psychiatric units of acute care general hospitals shall comply with 42 CFR 456.80 (relating to individual written plan of care).

The provisions of this §1151.65 amended under sections 201 and 443.1(1) of the Public Welfare Code (62 P. S. §§ 201 and 443.1(1)).

This section cited in 55 Pa. Code § 1151.61 (relating to payment conditions: general); 55 Pa. Code § 1151.67 (relating to payment conditions related to the recipient's continued need for care); and 55 Pa. Code § 1151.74 (relating to responsibilities of the inpatient psychiatric facility utilization review committee).

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