Current through Register Vol. 54, No. 44, November 2, 2024
(a) To
manage treatment resources more effectively and assure adequate Medical
Assistance reimbursement to community general and private psychiatric hospitals
for days of active treatment provided to Medical Assistance eligible persons
with mental illness, appropriate action shall be taken by the affected parties.
The following policy and procedures should be followed:
(1) Community general and private psychiatric
hospital staff should notify via telephone appropriate county MH/MR
staff-county administrator or designated agency-upon Medical Assistance
patients admission to the community general or private psychiatric hospital.
This information may be released to county administrators under §
5100.32(a)(5)
(relating to nonconsensual release of information).
(2) Immediately upon determination of the
need for long-term psychiatric care, a referral package should be sent to the
admissions unit of the State mental hospital (SMH) so it is received at least 2
days prior to the date of the scheduled commitment hearing. The County MH/MR
Administrator or their designated agency should be notified by the community
general or private psychiatric hospital of the patient's need for long-term
psychiatric care. The items to be included in the referral package accompanying
a patient on admission to a State hospital under sections 304-306 of the Mental
Health Procedures Act (50 P. S. §§ 7304-7306) include:
(i) Signed and completed 304/305/306
commitment papers.
(ii) Psychiatric
assessment.
(iii) Medical
assessment.
(iv) Current
medications.
(v) Laboratory and
X-ray results.
(vi) Consultant's
reports.
(vii) Social history with
special emphasis on family assessment and discharge resources.
(viii) Psychological assessments-if
available.
(ix) BSU
activity.
(x) Assessments from
other clinical disciplines involved in the patient's treatment.
(3) The SMH admissions staff and
the staff of the community general or private psychiatric hospital will agree
upon the date that the patient will be admitted to the State hospital. The SMH
admissions staff shall notify the community general or private psychiatric
hospital of the agreed upon date of admission prior to the patient's scheduled
hearing date.
(4) The community
general or private psychiatric hospital staff shall notify the hearing officer
of the date of availability of a SMH bed.
(5) The hearing officer shall conduct the
hearing in a timely fashion in accordance with the timeframes required by the
Mental Health Procedures Act of 1976. A commitment order should contain the
agreed upon admission date to the SMH.
(6) The community general or private
psychiatric hospital staff shall maintain appropriate documentation of the
continuance of active treatment in the medical record until the patient is
transferred to the SMH. Refer to §
1101.51(d) and
(e) (relating to ongoing responsibilities of
providers) for the description of appropriate documentation of the continuance
of active treatment.
(7) If the SMH
bed is unavailable on the scheduled date of transfer, the SMH is responsible
for contacting other State hospital facilities-within a 75-mile radius-to
obtain a bed for the patient. If no bed is available in the surrounding SMHs,
the initial SMH shall contact the next nearest SMH facility until a bed is
found. SMH admissions staff may not deny access to a patient when a bed is
available, except if, for clinical reasons, the clinical director deems the
admission inappropriate. The area director is responsible for reviewing and
monitoring denial of access to other State mental health facilities when a bed
is available.
(8) The SMH will
include in their Letter of Agreement with the county MH/MR program, the
methodology used for referring patients to another SMH when a bed is not
available. It is the intent of the Office of Mental Health to assure, whenever
feasible, that the patient's treatment be in or near the patient's home
community.
(b) Medical
Assistance should be able to reimburse the community general or private
psychiatric facility for the eligible days that the Medical Assistance eligible
patient is in the facility when the policy and procedures in subsection (a) are
followed to include the following:
(1) The
specific date of admission to the SMH appropriately documented on the court
commitment.
(2) The continuance of
active treatment adequately documented in the patient's medical
record.
(3) The actual transfer of
the patient to the SMH occurs on the date documented on the court
commitment.