Ala. Admin. Code r. 560-X-5-.10

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

Section 560-X-5-.10 - Inpatient Utilization Review

(1) The determination of the level of care will be made by a licensed nurse of the hospital staff.

(2) Five percent of all admissions and concurrent stay charts will be retrospectively reviewed by the Medicaid Agency or designee on a monthly basis.

(3) For an individual who applies for Medicaid while in the facility, a Psychiatric Admission form must be signed by the attending physician at the time application for Medicaid is made.

(4) The following information shall be included on the Physician Admission Form:

(a) Recipient information:

1. admitting diagnosis;

2. events leading to hospitalization;

3. history of psychiatric treatment;

4. current medications;

5. physician orders;

6. presenting signs and symptoms.

(b) Events leading to present hospitalization.

(c) History and physical.

(d) Mental and physical capacity.

(e) Summary of present medical findings including prognosis.

(f) Plan of care.

(5) Medicaid's Psychiatric Criteria for Age 65 or Over will be utilized in reviewing whether the admission and continued stay were appropriately billed.

Ala. Admin. Code r. 560-X-5-.10

New Rule: Filed September 6, 1995; effective October 12, 1995. Amended: Filed October 6, 1997; effective November 10, 1997. Amended: Filed September 11, 2012; effective October 16, 2012. Amended: Filed November 12, 2013; effective December 17, 2013

Author: Jan Sticka, Program Manager, Inpatient QI Program Associate Director, Institutional Services

Statutory Authority:42 C.F.R. Section 456.171.