Section 17b-262-810 - Certification of need requirements(a) In order to receive payment for PRTF services for an individual, admissions shall have a certification of need as required in 42 CFR 441 Subpart D, as amended from time to time.(b) The certification of need shall be based on a determination 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 services on an inpatient basis 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 client is elective, an independent team shall perform the certification of need. The facility shall maintain written documentation of the independent team's certification of need as evidenced by the signature of a member of the independent team on a certification of need form or letter(s) of authorization by the independent team.(d) When the admission is of a person who is not Medicaid eligible and who applies for Medicaid while in the PRTF, the certification of need shall be conducted at the time of application for or by the first day of Medicaid eligibility. The interdisciplinary team responsible for the individual plan of care shall perform the certification of need, which shall cover any period prior to application for which Medicaid claims are made. The facility shall maintain written documentation of the certification of need.(e) For psychiatric emergency admissions, the certification of need shall be performed by the interdisciplinary team responsible for the plan of care not later than fourteen days after the day of admission. The facility shall maintain written documentation of the certification of need as evidenced by the signature of a member of the independent team on a certification of need form.(f) When the client is admitted from a PRTF to a hospital and, upon discharge, is readmitted to the PRTF, a new certification of need shall be performed.Conn. Agencies Regs. § 17b-262-810
Adopted effective September 4, 2009