Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1151 - INPATIENT PSYCHIATRIC SERVICES
PROVIDER PARTICIPATION
Section 1151.31 - Participation requirements
Universal Citation: 55 PA Code ยง 1151.31
Current through Register Vol. 54, No. 12, March 23, 2024
(a) In addition to the participation requirements established in Chapter 1101 (relating to general provisions), to participate in the MA Program, a private psychiatric hospital shall:
(1) Be licensed by
the Department's Office of Mental Health.
(2) Be approved by the Department's Office of
Mental Health under Chapter 5100 (relating to mental health
procedures).
(3) Have in effect a
utilization review plan that meets the requirements at 42 CFR Part 456 ,
Subpart D (relating to utilization control: mental hospitals) and
42 CFR
482.30 (relating to conditions of
participation: utilization review) as certified by the Department's Office of
MA Programs.
(4) Be accredited by
the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO).
(5) Be certified by the
Department of Health as being in substantial compliance with the Medicare
requirements for participation for specialty hospitals at 42 CFR Part 482 ,
Subpart E (relating to requirements for specialty hospitals).
(6) Be enrolled in the MA Program as a
private psychiatric hospital.
(b) In addition to the participation requirements established in Chapter 1101, to participate in the MA Program, a psychiatric unit of a general hospital shall:
(1) Be a part of a general hospital enrolled
in the MA Program.
(2) Meet the
criteria of a distinct part unit as set forth under subsection (c).
(3) Be approved as a psychiatric unit by the
Department's Office of Mental Health.
(4) Be enrolled in the MA Program as a
distinct part psychiatric unit.
(c) To qualify as a distinct part psychiatric unit for MA purposes, the unit shall:
(1) Have
written admission criteria that are applied uniformly to both MA patients and
non-MA patients.
(2) Have readily
available admission and discharge records that are separately identified from
those of the hospital in which the unit is located.
(3) Have policies requiring that necessary
clinical information is transferred to the unit when a patient of the hospital
is transferred to the unit.
(4)
Have utilization review standards applicable for the type of care offered in
the unit.
(5) Have beds physically
separate from (that is, not commingled with) the hospital's other
beds.
(6) Be treated as a separate
cost center for cost finding and apportionment purposes.
(7) Use an accounting system which properly
allocates costs.
(8) Maintain
adequate statistical data to support the basis of the cost
allocation.
(9) Report its costs in
the hospital's cost report covering the same fiscal period and using the same
method of apportionment as the hospital.
The provisions of this § 1151.31 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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