25D .0201 - INTERMEDIATE CARE FACILITIES

25D .0201. INTERMEDIATE CARE FACILITIES

(a) Prior approval for services in intermediate care facilities shall be required for all new admissions.

(b) Utilization review in each facility shall be provided through personnel under contract.

(c) With respect to intermediate care facilities, prior approval shall be required for all Utilization Review Committee recommendations that require a change in the level of care; however, these recommendations will be taken into consideration at the time of review.

(d) Prior approval shall be required for intermediate care facility patients seeking Title XIX assistance who were previously private pay or insured by a third party carrier.

(e) Prior approval shall be required when a patient is discharged from an intermediate care facility to a lower level of care or to his own home, and later returns to a level of care that requires prior approval.

(f) Prior approval shall be required when an intermediate care facility Medicaid patient's benefits are terminated for 90 days or more before reinstatement, even though the patient remains in the same facility.

(g) Prior approval shall not be required for an intermediate care facility patient who is hospitalized and returns to the previously approved level of care.

(h) Prior approval shall not be required for an approved intermediate care facility patient who leaves the facility for an overnight stay, provided the absence is authorized by the attending physician.

(i) Prior approval shall not be required when the professional standards review team recommends a change in the level of care. These recommendations shall be accepted.

(j) The form approved for intermediate care facility placement shall be valid for 60 days. This form shall be filed by the team, and shall certify that the person is entitled to care for a specified period. The form shall state the medical problem involved.

(Authority G.S. 108A-25(b); 108A-54; 42 C.F.R. 440.50; 42 C.F.R. 440.150; 42 C.F.R. 440.230(d); Eff. February 1, 1976; Readopted Eff. October 31, 1977; Transferred from 10A NCAC 22O .0108 and 10A NCAC 22O .0408 Eff. May 1, 2012.)

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