Ala. Admin. Code r. 560-X-5-.04

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-5-.04 - Certification Of Need For Service

(1) Certification of need for services is a determination which is made by a physician regarding the Medicaid recipient's treatment needs for admission to the facility.

(2) The physician must certify for each applicant or recipient that inpatient services in a mental hospital are or were needed.

(3) The certification must be made at the time of admission. No retroactive will be accepted.

(4) For individuals applying for Medicaid while in the hospital, the certification must be made before Medicaid can authorize payment.

(5) The physician must complete the PSY-5 form which is the certification of need for care. This form must be kept in the patient's record.

(6) The PSY-6 form, or acceptable equivalent approved by Medicaid, which is the recertification of need for continued inpatient services for each applicant or recipient, must be completed by a physician, a physician assistant, or a nurse practitioner acting under the supervision of a physician.

(7) The PSY-6 form, or acceptable equivalent must be completed at least every 60 days after initial certification. This form must be kept in the patient's record.

(8) The physician must complete an assessment note in the patient's record within 24 hours of a patient's return from any leave status.

Author:

Ala. Admin. Code r. 560-X-5-.04

Rule effective October 1, 1982. Repealed: Filed February 7, 1994; effective March 14, 1994. New Rule: Filed September 6, 1995; effective October 12, 1995. Amended: Filed October 6, 1997; effective November 10, 1997.

Statutory Authority:42 C.F.R. Section 441, Subpart D.