(a) Before
authorization for payment for care provided to a recipient 21 years of age or
older, the attending or staff physician shall establish, and include in the
recipient's medical record, an individual written plan of care. The plan of
care shall be designed to maintain the recipient at or restore the recipient to
the greatest possible degree of health and independent functioning. The plan
shall include:
(1) Diagnoses, symptoms,
complaints and complications indicating the need for admission.
(2) Treatment objectives.
(3) A description of the functional level of
the individual.
(4) Orders for
medications, treatments, restorative and rehabilitative services, activities,
therapies, social services and diet.
(5) Special procedures recommended for the
health and safety of the patient.
(6) Plans for continuing care, including
review and modification to the plan of care.
(7) Plans for discharge.
(b) If a recipient is under age 21, an
individual written plan of care designed to achieve the recipient's discharge
from inpatient status at the earliest possible time shall be included in the
recipient's medical record. The plan shall:
(1) Be developed and implemented within 14
days after admission.
(2) Be based
on the diagnostic evaluation of the recipient that includes examination of the
medical, psychological, social, behavioral and developmental aspects of the
individual's condition and medical need for inpatient psychiatric
care.
(3) Be developed by the
interdisciplinary team of professionals under §
1151.66 (relating to team
developing plan of care) in consultation with the recipient and those in whose
care the recipient will be placed upon discharge.
(4) State treatment objectives.
(5) Prescribe an integrated program of
therapies, activities and experiences designed to meet the objectives in
paragraph (4).
(6) Include, at an
appropriate time, postdischarge plans and coordination of inpatient services
with partial discharge plans and related community services to ensure
continuity of care with the recipient's family, school and community upon
discharge.
(c) Subsections
(a) and (b) apply only to private psychiatric hospitals. Distinct part
psychiatric units of acute care general hospitals shall comply with
42 CFR
456.80 (relating to individual written plan
of care).
Notes
The
provisions of this § 1151.65 adopted September 30, 1983, effective
7/1/1983, 13 Pa.B. 2796; amended
October 29, 1993, effective 7/1/1993, 23 Pa.B.
5241.
The provisions of this § 1151.65 amended under sections
201 and 443.1(1) of the Public Welfare Code (62 P. S. §§
201 and
443.1(1)).
This section cited in 55 Pa. Code §
1151.61 (relating to payment
conditions: general); 55 Pa. Code §
1151.67 (relating to payment
conditions related to the recipient's continued need for care); and 55 Pa. Code
§
1151.74 (relating to
responsibilities of the inpatient psychiatric facility utilization review
committee).
