405 IAC 5-20-5 - Certification of need for admission
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; IC 26-2-8-106
Sec. 5.
Medicaid reimbursement is available for services in an inpatient psychiatric facility only when the member's need for admission has been certified. The certification of need must be completed as follows:
(1) By the attending physician or staff
physician 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.
(2) In accordance with
42 CFR
441.152(a), effective
October 1, 1995 (not including secondary Code of Federal Regulations citations
therein), and 42 CFR
441.153, effective October 1, 1995 (not
including tertiary Code of Federal Regulations citations resulting therefrom),
for an individual twenty-one (21) years of age and under.
(3) By telephone precertification review
prior to admission for an individual who is a member of Medicaid when admitted
to the facility as a nonemergency admission, to be followed by a written
certification of need within ten (10) working days of admission.
(4) By telephone precertification review
within forty-eight (48) hours of an emergency admission, not including
Saturdays, Sundays, and legal holidays, to be followed by a written
certification of need within fourteen (14) working days of admission. If the
provider fails to call within forty-eight (48) hours of an emergency admission,
not including Saturdays, Sundays, and legal holidays, Medicaid reimbursement
shall be denied for the period from admission to the actual date of
notification.
(5) In handwriting or
electronically, consistent with IC
26-2-8-106, within ten (10)
working days after receiving notification of an eligibility determination for
an individual applying for Medicaid while in the facility and covering the
entire period for which Medicaid reimbursement is being sought.
(6) In handwriting or electronically,
consistent with IC
26-2-8-106, at least every sixty
(60) days after admission, or as requested by the office to recertify that the
member continues to require inpatient psychiatric hospital services.
Notes
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