Ala. Admin. Code r. 560-X-41-.01

Current through Register Vol. 43, No. 02, November 27, 2024

Section 560-X-41-.01 - General

(1) Inpatient psychiatric services for recipients under age 21 are covered services when provided:

(a) Under the direction of a physician,

(b) By a psychiatric hospital enrolled as a Medicaid provider in accordance with Rule No. 560-X-41-.02; OR

(c) By a psychiatric residential treatment facility (PRTF) which is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Commission on Accreditation of Rehabilitation Facilities (CARF), the Council on Accreditation of Services for Families and Children (COA), or by other accrediting organization with comparable standards that is recognized by the State;

(d) Before the recipient reaches age 21 or, if the recipient was receiving services immediately before he/she reached age 21, before the earlier of:

(1) the date he/she no longer requires the services,

(2) the date he/she reaches age 22, or

(3) the expiration of covered days as limited in (2) below, and

(e) To a recipient who is admitted to and remains in the facility for the course of the hospitalization; and

(f) As certified in writing to be necessary in the setting in which it will be provided in accordance with 42 CFR 441.152.

(2) Inpatient psychiatric services for recipients under age 21 are unlimited if medically necessary and the admission and/or the continued stay reviews meet the approved psychiatric criteria. These days do not count against the recipient's inpatient day limitation for care provided in an acute care hospital.

(3) Residential psychiatric treatment services for recipients under age 21 are unlimited if medically necessary and the admission and continued stay reviews meet the approved psychiatric criteria. All treatment plan updates and certifications of need for services shall be performed as specified in Rule 560-X-41-.06.

(4) Psychiatric hospitals and PRTFs shall comply with all applicable regulations regarding the use of restraint and seclusion as cited in 42 CFR, Part 441, Subpart D, and 42 CFR, Part 483, Subpart G.

(5) The specific requirements for psychiatric medical records may be found at 42 CFR 482.61.

(6) The specific requirements for psychiatric facility staff may be found at 42 CFR 482.62.

Ala. Admin. Code r. 560-X-41-.01

Rule effective October 1, 1988. Emergency rule effective November 1, 1988. Amended effective February 9, 1989; September 13, 1989. Emergency rule effective August 21, 1991. Amended: Effective November 13, 1991. Amended: Filed November 8, 2001; effective December 13, 2001. Amended: Filed May 12, 2005; effective June 16, 2005.

Amended by Alabama Administrative Monthly Volume XXXIII, Issue No. 09, June 30, 2015, eff. 7/16/2015.

Amended by Alabama Administrative Monthly Volume XXXVIII, Issue No. 03, December 31, 2019, eff. 2/14/2020.

Amended by Alabama Administrative Monthly Volume XXXIX, Issue No. 04, January 29, 2021, eff. 3/15/2021.

Author: Solomon Williams, Associate Director, Institutional Services

Statutory Authority: State Plan, Attachment 3.1-A, pp. 7, 7.16; 42 C.F.R. §§ 441, Subpart D, Part 483, Subpart G, §440.240.