Section 1830.250 - MHP Payment Authorization for Psychiatric Nursing Facility Services(a) The following conditions apply to the provisions of psychiatric nursing facility services by the MHP: (1) The MHP of the beneficiary shall not exclude any nursing facility that is licensed and certified to provide psychiatric nursing facility services and is in good standing with the Medi-Cal program from providing services to the beneficiary on the grounds that the facility would be providing out-of-plan services pursuant to Section 1830.220.(2) Psychiatric nursing facility services shall be billed by the psychiatric nursing facility to the fiscal intermediary, rather than the MHP.(b) A psychiatric nursing facility shall submit a separate written request for MHP payment authorization of psychiatric nursing facility services to the Point of Authorization of the MHP of the beneficiary for each of the following: (1) The planned admission of a beneficiary.(2) Services the psychiatric nursing facility believes are medically necessary that exceed the days previously authorized by the MHP.(3) Services that qualify for Medical Assistance Pending Fair Hearing pursuant to Section 1850.215.(c) Unless there is a contract between the psychiatric nursing facility and the MHP that provides for different time frames, a psychiatric nursing facility shall submit the request for MHP payment authorization for psychiatric nursing facility services to the Point of Authorization of the beneficiary's MHP not later than: (1) Prior to a planned admission;(2) Ten working days prior to the expiration date of a previous MHP payment authorization; or(3) The date that a beneficiary qualifies for Medical Assistance Pending Fair Hearing pursuant to Section 1850.215.(d) A written request for MHP payment authorization to the Point of Authorization shall be in the form of a Treatment Authorization Request (TAR).(e) Approval or disapproval for each MHP payment authorization shall be documented by the Point of Authorization in writing on the same TAR on which the psychiatric nursing facility requested MHP payment authorization.(f) A Point of Authorization shall approve, deny or defer the request for MHP payment authorization within three working days of the receipt of the request. If the request is deferred, the MHP shall advise the psychiatric nursing facility of the additional documentation required by the MHP. The Point of Authorization shall send an approved or denied TAR to the fiscal intermediary within 14 calendar days of the approval or denial.(g) MHP payment authorizations shall be approved by the MHP's Point of Authorization as follows: (1) Requests for MHP payment authorization for planned admissions and continued stays shall be approved when written documentation provided indicates that the beneficiary meets medical necessity criteria for reimbursement of psychiatric nursing facility services, as specified in Section 1830.205, in addition to any other requirements of this Chapter that apply to the admission.(2) An MHP payment authorization approved by the MHP for a specific time period shall not be terminated or reduced because the beneficiary receiving the psychiatric nursing facility services: (A) Is on leave of absence from the facility, subject to the limitations described in Title 22, Section 51535, or(B) Has exercised the bed hold option provided by Title 22, Sections 72520, 73504, 76506, and 76709.1, subject to the limitations of Title 22, Section 51535.1.(3) Medical Assistance Pending Fair Hearing Decision requests for MHP payment authorization by a psychiatric nursing facility shall be approved by the MHP when necessary documentation, as specified in Section 1850.215, is submitted.(h) The MHP that approves the MHP payment authorization shall have financial responsibility as described in this Chapter for the services authorized, unless financial responsibility is assigned to another entity pursuant to Sections 1850.405 and 1850.505.Cal. Code Regs. Tit. 9, § 1830.250
1. New section filed 10-31-97 as an emergency; operative 11-1-97 (Register 97, No. 44). A Certificate of Compliance must be transmitted to OAL by 3-2-98 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 3-2-98 as an emergency; operative 3-2-98 (Register 98, No. 10). A Certificate of Compliance must be transmitted to OAL by 6-30-98 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 6-17-98 as an emergency; operative 6-30-98 (Register 98, No. 25). Pursuant to Chapter 324 (Statutes of 1998) Item 4440-103-0001(4), a Certificate of Compliance must be transmitted to OAL by 7-1-99 or emergency language will be repealed by operation of law on the following day.
4. Editorial correction of HISTORY 3 (Register 98, No. 39).
5. Editorial correction extending Certificate of Compliance date to 7-1-2001 pursuant to Chapter 50 (Statutes of 1999) Item 4440-103-0001(4) (Register 99, No. 33). Notwithstanding any other provision of law, emergency regulations adopted pursuant to Welfare and Institutions Code section 14680 to implement the second phase of mental health managed care as provided in this part shall remain in effect until permanent regulations are adopted, or June 30, 2006, whichever occurs first.
6. Editorial correction of HISTORY 5 (Register 2000, No. 42).
7. Editorial correction of HISTORY 5 and repealer and new section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20). Note: Authority cited: Section 14680, Welfare and Institutions Code. Reference: Sections 5777, 5778 and 14684, Welfare and Institutions Code; and Title 42, Code of Federal Regulations, Section 438.210.
1. New section filed 10-31-97 as an emergency; operative 11-1-97 (Register 97, No. 44). A Certificate of Compliance must be transmitted to OAL by 3-2-98 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 3-2-98 as an emergency; operative 3-2-98 (Register 98, No. 10). A Certificate of Compliance must be transmitted to OAL by 6-30-98 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 6-17-98 as an emergency; operative 6-30-98 (Register 98, No. 25). Pursuant to Chapter 324 (Statutes of 1998) Item 4440-103-0001(4), a Certificate of Compliance must be transmitted to OAL by 7-1-99 or emergency language will be repealed by operation of law on the following day.
4. Editorial correction ofHistory3 (Register 98, No. 39).
5. Editorial correction extending Certificate of Compliance date to 7-1-2001 pursuant to Chapter 50 (Statutes of 1999) Item 4440-103-0001(4) (Register 99, No. 33). Notwithstanding any other provision of law, emergency regulations adopted pursuant to Welfare and Institutions Code section 14680 to implement the second phase of mental health managed care as provided in this part shall remain in effect until permanent regulations are adopted, or June 30, 2006, whichever occurs first.
6. Editorial correction ofHistory5 (Register 2000, No. 42).
7. Editorial correction ofHistory5 and repealer and new section filed 5-19-2006; operative 6-18-2006 (Register 2006, No. 20).