55 Pa. Code § 1151.74 - Responsibilities of the inpatient psychiatric facility utilization review committee
The utilization review committee, or its representative, shall:
(1) Conduct admission reviews in
accordance with §
1151.75 (relating to admission
review requirements).
(2) Conduct
continued stay reviews in accordance with §
1151.76 (relating to continued
stay review requirements).
(3)
Conduct medical care evaluation studies in accordance with §
1151.77 (relating to medical care
evaluation studies).
(4) Notify the
Department's Concurrent Hospital Review Section of a recipient's assigned
initial or continued length of stay. This notification shall be done on the
form specified and in accordance with the instructions in the Manual for
Concurrent Review of Inpatient Hospital Services.
(5) Provide that each recipient's record
include:
(i) Identification of the
recipient.
(ii) Copies of the
certification of days records.
(iii) The names of the recipient's
physician.
(iv) The date of
admission and date of application for and authorization of MA benefits if
application is made after admission.
(v) The plan of care required under §
1151.65 (relating to plan of
care).
(vi) Initial and subsequent
review dates specified in accordance with this chapter.
(vii) Justification of the recipient's need
for admission and need for continued inpatient hospital services as documented
by the attending physician.
(viii)
The reasons and plan for continued stay, if the physician believes continued
stay is necessary.
(ix) Other
supporting material the utilization review committee believes
appropriate.
(6) Notify
the Department's Concurrent Hospital Review Section of a change in a
recipient's diagnosis.
(7) Maintain
utilization review records for a minimum of 4 years from the date of submission
of that year end cost report.
(8)
Submit copies of utilization review records and documents, medical records,
psychiatric and social evaluation records, certification of days records and
discharge planning information to the Department upon request.
(9) Maintain copies of certification of days
records with the patient's medical record and with the hospital copy of the
invoice submitted for payment.
(10)
Review cases that the Department identifies as being a questionable utilization
of inpatient psychiatric facilities or services or that contain noncompensable
services or items as listed in §
1151.48 (relating to
noncompensable services and items).
(11) Initiate discharge planning during the
admission review process to provide timely placement in an appropriate level of
care for patients that may require posthospital care.
Notes
The provisions of this § 1151.74 amended under sections 201 and 443.1(1) of the Public Welfare Code (62 P. S. §§ 201 and 443.1(1)).
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