Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1151 - INPATIENT PSYCHIATRIC SERVICES
UTILIZATION CONTROL
Section 1151.71 - Concurrent hospital review
Current through Register Vol. 54, No. 44, November 2, 2024
(a) Each inpatient psychiatric facility shall conduct reviews of each MA recipient's need for admission and continued need for psychiatric inpatient services in accordance with the Department's Manual for Concurrent Hospital Review (CHR) unless granted an exemption by the Department.
(b) The Department will regularly monitor each inpatient psychiatric facility's utilization review program to determine whether it is operating in accordance with the CHR process and this section. Monitoring is carried out through review of admissions, continued stays, patient records and claims paid by the Department.
(c) The Department will approve or disapprove the recipient's need for admission and need for continued hospitalization through its CHR process unless an exemption is granted by the Department.
(d) If a discrepancy exists between a hospital's utilization review plan and the instructions in the Department's Manual for Concurrent Review of Inpatient Hospital Services, the Department's manual shall take precedence.
The provisions of this §1151.71 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); and 55 Pa. Code § 1151.67 (relating to payment conditions related to the recipient's continued need for care).
