Ala. Admin. Code r. 560-X-41-.06
Current through Register Vol. 43, No. 02, November 27, 2024
Section 560-X-41-.06 - Active Treatment(1) Inpatient psychiatric services are covered by Medicaid only if they involve active treatment which means implementation of a professionally developed and supervised individual plan of care that is: (a) Developed and implemented no later than 14 working days after admission, and(b) Designed to achieve the recipient's discharge from inpatient status at the earliest possible time.(2) An individual plan of care is a written plan developed for each recipient in accordance with (2)(a-f) below to improve the recipient's condition to the extent that inpatient care is no longer necessary. The plan of care must:(a) Be based on a diagnostic evaluation that includes examination of the medical, psychosocial, social, behavioral, and developmental aspects of the recipient's situation and reflects the need for inpatient psychiatric care;(b) Be developed by a team of professionals specified in (3) below in consultation with the recipient and their parents, legal guardians, or others in whose care he/she will be released after discharge;(c) State treatment objectives;(d) Prescribe an integrated program of therapies, activities, and experiences designed to meet the objectives;(e) Include, at an appropriate time, post-discharge plans and coordination of inpatient services with partial discharge plans and related community services to ensure continuity of care with the recipient's family, school, and community upon discharge; and(f) Be reviewed at least every 30 days by the team specified in (3) below to determine that services provided are/were required on an inpatient basis, and recommend changes in the plan as indicated by the recipient's overall adjustment to the treatment.(3) Team developing individual plan of care.(a) The individual plan of care must be developed by an interdisciplinary team of physicians and other personnel who are employed by, or who provide services to patients in, the facility. Based on education and experience, including competence in child psychiatry, the team must be capable of: 1. Assessing the recipient's immediate and long-range therapeutic needs, developmental priorities, and personal strengths and liabilities;2. Assessing the potential resources of the recipient's family;3. Setting treatment objectives; and4. Prescribing therapeutic modalities to achieve the plan's objectives.(b) The team must include, as a minimum, either:1. A Board-eligible or Board-certified psychiatrist licensed in the State of Alabama;2. A licensed clinical psychologist who has a doctoral degree and a physician licensed to practice medicine or osteopathy; or3. A physician licensed to practice medicine or osteopathy with specialized training and experience in the diagnosis and treatment of mental diseases, and a psychologist who has a master's degree in clinical psychology or who has been certified by the State of Alabama.(c) The team must also include one of the following:1. A licensed social worker with specialized training or one year of experience in treating mentally ill individuals;2. A registered nurse with specialized training or one year of experience in treating mentally ill individuals;3. An licensed occupational therapist with specialized training, or one year of experience in treating mentally ill individuals; or4. A psychologist who has a master's degree in clinical psychology or who has been certified by the State of Alabama.(d) The specific staff requirements for psychiatric facilities may be found at 42 CFR 482.62. Author: Lynn Sharp, Associate Director, Institutional Services
Ala. Admin. Code r. 560-X-41-.06
Rule effective October 1, 1988. Amended effective 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.Statutory Authority:42 C.F.R. §§441.154, 441.155, 441.156.