Ala. Admin. Code r. 560-X-41-.02

Current through Register Vol. 42, No. 12, September 30, 2024

Section 560-X-41-.02 - Conditions Of Participation

(1)Hospitals:

(a) In order to participate in the Title XIX Medicaid program and to receive Medicaid payment for inpatient psychiatric services for individuals under age 21, a provider must meet the following conditions:

1. Be certified for participation in the Medicare/Medicaid program;

2. Be licensed as an Alabama psychiatric hospital in accordance with current rules contained in the Alabama Administrative Code Chapter 420-5-7. State hospitals which do not require licensing as per state law are exempt from this provision (Code of Ala. 1975, Section 22-50-1, et seq.);

3. Be accredited by the Joint Commission on Accreditation of Healthcare Organizations;

4. Have a distinct unit for children and adolescents;

5. Have a separate treatment program for children and adolescents;

6. Be in compliance with Title VI and VII of the Civil Rights Act of 1964 Section 504 of the Rehabilitation Act of 1973, and with the Age Discrimination Act of 1975.

7. Execute an Alabama Medicaid Provider Agreement for participation in the Medicaid program;

8. Submit a written description of an acceptable utilization review (UR) plan currently in effect; and

9. Submit a budget of costs for medical inpatient services for its initial cost reporting period, if a new provider.

Application by Alabama psychiatric hospitals for participation in the Medicaid program shall be made to the appropriate address indicated in the Provider Manual.

(2)Psychiatric Residential Treatment Facilities (PRTFs):

(a) In order to participate in the Title XIX Medicaid program and to receive payment for residential psychiatric treatment services for individuals under age 21, PRTFs must meet the following conditions:

1. Be accredited by JCAHO, CARF, COA, or be certified as an Alabama PRTF in accordance with standards promulgated by the Alabama Department of Human Resources (DHR), the Department of Mental Health (DMH), or the Department of Youth Services (DYS), or the Department of Children's Affairs (DCA) Upon enrollment and each time the PRTF is recertified a copy of the certification letter must be sent to Medicaid within forty-five business days.

2. Be in compliance with Title VI and VII of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975;

3. Execute a contract or placement agreement with DHR, DMH, DYS, DCA, or Federally Recognized Indian tribes to provide residential psychiatric treatment services in the State of Alabama;

4. Execute a provider agreement with Alabama Medicaid to participate in the Medicaid program;

5. Submit a written description of an acceptable UR plan currently in effect;

6. Submit a written attestation of compliance with the requirements of 42 CFR, Part 483, Subpart G, regarding the reporting of serious occurrences and the use of restraint and seclusion upon enrollment and yearly on or before July 21;

7. Be in compliance with staffing and medical record requirements necessary to carry out a program of active treatment for individuals under age 21;

(b) All correspondence regarding application and certification by Alabama PRTFs for participation in the Medicaid program should be mailed to the appropriate address indicated in the Provider Manual.

Ala. Admin. Code r. 560-X-41-.02

Rule effective October 1, 1988. Amended effective September 13, 1989. Emergency rule effective August 21, 1991. Amended effective November 13, 1991. Amended: Filed August 7, 2000; effective September 11, 2000. Amended: Filed November 8, 2001; effective December 13, 2001. Amended: Filed May 12, 2005; effective June 16, 2005. Amended: Filed December 12, 2007; effective January 16, 2008.

Amended by Alabama Administrative Monthly Volume XXXVIII, Issue No. 07, April 30, 2020, eff. 6/14/2020.

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 CFR, Part 441, Subpart D; §431.107.