405 IAC 5-20-4 - Individually developed plan of care
Current through March 30, 2022
Authority: IC 12-15-1-10; IC 12-15-21-2; IC 12-15-21-3
Affected: IC 12-13-7-3; IC 12-15
Sec. 4.
(a) Each
Medicaid eligible member admitted to a psychiatric hospital or PRTF must have
an individually developed plan of care. In the case of a person between
twenty-two (22) and sixty-five (65) years of age in a psychiatric hospital of
sixteen (16) beds or less or a person sixty-five (65) years of age and over,
the plan of care must be developed by the attending or staff physician. For a
person under twenty-one (21) years of age, the plan of care must be developed
by the physician and interdisciplinary team. In all cases, the plans of care
must be developed not later than fourteen (14) days after admission. For a
member who becomes eligible for Medicaid after admission to a facility, the
plan of care must be prepared to cover all periods for which Medicaid coverage
is claimed and as follows:
(1) The individual
plan of care for a member between twenty-two (22) and sixty-five (65) years of
age in a psychiatric hospital of sixteen (16) beds or less and for a member
sixty-five (65) years of age and over shall set forth treatment objectives and
prescribe an integrated program of appropriate therapies, activities, and
experiences designed to meet these objectives. The plan shall be based upon a
diagnostic evaluation that includes examination of the medical, psychological,
social, and behavioral aspects of the member's situation. It shall include, at
an appropriate time, a postdischarge plan and plan for coordination of
inpatient services with partial discharge plans and appropriate related
services in the member's community to ensure continuity of care when returned
to the member's family and community upon discharge. The plan of care shall be
reviewed and updated at least every ninety (90) days by the member's attending
or staff physician for determinations that the services provided were and are
required on an inpatient basis and for recommendations as to necessary
adjustments in the plan as indicated by the member's overall adjustment as an
inpatient. The quarterly plan of care must be in writing and made a part of the
member's record.
(2) The individual
plan of care for a member under twenty-one (21) years of age shall comply with
the requirements as set forth in
42 CFR
441.155. Additionally The periodic update of
the plan of care must be in writing and made a part of the member's record.
Recertification is required at least every sixty (60) days. Initial evaluative
examinations are exempt from prior authorization.
(b) The interdisciplinary team required to
develop the plan of care for an individual under twenty-one (21) years of age
shall include at least one (1) of the persons identified in subdivisions (1)
through (3) and one (1) of the persons identified in subdivision (4) as
follows:
(1) A board certified or eligible
psychiatrist.
(2) A psychologist
endorsed as a health service provider in psychology (HSPP) and a physician
licensed to practice medicine or osteopathy.
(3) A physician licensed to practice medicine
or osteopathy with specialized training and experience in the diagnosis and
treatment of mental diseases and a psychologist endorsed as an HSPP or a
licensed psychologist.
(4) One (1)
of the following (deemed to be other professionals qualified to make
determinations as to mental health conditions and treatments thereof):
(A) A licensed, clinical social worker, a
licensed marital and family therapist, a licensed mental health counselor, or a
person holding a master's degree in social work, marital and family therapy, or
mental health counseling.
(B) An
advanced practice nurse or a registered nurse who has specialized training or
one (1) year experience in treating the mentally ill.
(C) An occupational therapist registered with
the National Association of Occupational Therapists and who has specialized
training or one (1) year of experience in treating the mentally ill.
(D) A psychologist endorsed as an HSPP or a
licensed psychologist.
Notes
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