reimbursement is available for mental health services provided by licensed
physicians, psychiatric hospitals, general hospitals, psychiatric residential
treatment facilities for children under twenty-one (21) years of age,
outpatient mental health facilities, and psychologists endorsed as health
service providers in psychology subject to the limitations set out in this
rule. For purposes of this rule, "psychiatric residential treatment facility"
or "PRTF" means a facility that meets the requirements set forth in section 3.1
of this rule.
(b) Reimbursement for
inpatient psychiatric services is not available in institutions for mental
diseases for a member under sixty-five (65) years of age unless the member is
under twenty-one (21) years of age, or under twenty-two (22) years of age and
had begun receiving inpatient psychiatric services immediately before his or
her twenty-first birthday.
Medicaid reimbursement is available for inpatient psychiatric services provided
to an individual between twenty-two (22) and sixty-five (65) years of age in a
certified psychiatric hospital of sixteen (16) beds or less.
(d) Prior authorization is required for all
inpatient psychiatric admissions including admissions for substance abuse.