Section 17b-262-505 - Certification of need review requirements for inpatient psychiatric services for a client under age twenty-one in a psychiatric hospital(a) In order to receive payment for inpatient psychiatric hospital services for individuals under age twenty-one, each individual admission, including elective and emergency admissions, shall have a certification of need review.(b) The certification of need review shall be a part of the client's medical record, with written documentation certifying that: (1) ambulatory care resources available in the community do not meet the treatment needs of the client;(2) proper treatment of the client's psychiatric condition requires inpatient care under the direction of a physician; and(3) the services shall reasonably be expected to improve the client's condition or prevent further regression so that inpatient services shall no longer be needed.(c) When the admission of a Medical Assistance Program client is elective, an independent team is responsible to perform the certification of need review. The department shall act as the independent team.(d) When the admission is an individual who is not Medical Assistance Program eligible and who applies for the Medical Assistance Program while in the hospital, the certification of need review shall be conducted at the time of application for Medical Assistance Program coverage or by the first day of Medical Assistance Program coverage. An interdisciplinary team conducts the certification of need review which shall cover any period prior to application for which Medical Assistance Program claims are made. In addition, this certification of need review shall be validated by the independent team.(e) For emergency admissions, the certification of need review shall be completed by an interdisciplinary team within fourteen days after the emergency admission and validated by the independent team.(f) When the client is transferred from a psychiatric hospital to an acute care hospital and upon discharge readmitted to the psychiatric hospital, a new certification of need review by the independent team is required.Conn. Agencies Regs. § 17b-262-505
Adopted effective March 6, 1998