Title 7 . Health and Social Services

Chapter 43 . Hearings

Section 552. Admission

7 AAC 43.552. Admission

(a) Admission of a Medicaid recipient to an inpatient psychiatric hospital facility or residential psychiatric treatment center requires prior authorization from the division. Before the division will authorize admission, the requirements of (b) and (c) of this section must be met.

(b) Before admission, an inpatient interdisciplinary team that meets the requirements of (f) of this section must

(1) complete a diagnostic evaluation that

(A) includes a psychiatric assessment;

(B) is performed within 60 days before admission or within 14 days after emergency admission; and

(C) indicates the need for inpatient psychiatric services;

(2) certify in the recipient's medical record that

(A) available alternate local community resources for ambulatory care do not meet the treatment needs of the recipient;

(B) proper treatment of the recipient's psychiatric condition requires services on an inpatient or residential basis, as appropriate; and

(C) inpatient psychiatric services can reasonably be expected to improve the recipient's condition or prevent further regression;

(3) provide to the division the following information about the recipient:

(A) a written statement describing the results of the diagnostic evaluation required in (1) of this subsection;

(B) a written statement describing the results of a functional assessment;

(C) the results of any direct patient observations and assessments obtained following the recipient's referral; and

(D) other information from referral sources, other involved community agencies, and the family, that is relevant to the recipient's condition; and

(4) develop a plan of care based upon the information provided under this subsection that meets the requirements of 7 AAC 43.555.

(c) Based on the information received under (b)(3) of this section, the division will submit to the department a determination that the proposed treatment and other services are consistent with the recipient's clinical diagnosis and that they appropriately address the recipient's needs.

(d) The division will, in its discretion, authorize Medicaid payment for an individual who applies for Medicaid after entering an inpatient psychiatric hospital facility or a residential psychiatric treatment center.

(e) For an emergency admission, the requirements of this section must be met no later than 14 days after the date of admission.

(f) An inpatient interdisciplinary team that provides the services required in (b) of this section must, by virtue of education and experience, have the capability of assessing the recipient's immediate and long-range therapeutic requirements, developmental priorities, personal strengths, liabilities, and the potential resources of the recipient's family. An inpatient interdisciplinary team

(1) must include a

(A) psychiatrist licensed under AS 08.64;

(B) psychologist licensed under AS 08.86 who has a doctorate degree in clinical psychology and a physician licensed under AS 08.64 to practice medicine or osteopathy; or

(C) physician licensed under AS 08.64 to practice medicine who has specialized training and experience in the diagnosis and treatment of mental diseases and a psychological associate licensed under AS 08.86;

(2) beginning January 1, 1995, must include a representative of the department's division of family and youth services, designated by that division's director, or beginning July 1, 1999, division of juvenile justice, designated by that division's director, as appropriate, who has training and experience that would otherwise qualify that representative as a mental health professional clinician; and

(3) in addition to the inpatient interdisciplinary team members required by (1) and (2) of this subsection, must include

(A) a clinical social worker licensed under AS 08.95;

(B) a registered nurse licensed under AS 08.68 who has specialized training or one year's experience in treating mentally ill patients;

(C) an occupational therapist licensed under AS 08.84 who has specialized training or one year's experience in treating mentally ill patients; or

(D) a psychological associate licensed under AS 08.86 who has a master's degree in clinical psychology.

(g) The division will issue a prior authorization required under this section in accordance with this section, 7 AAC 43.555, 7 AAC 43.560, and the Alaska Medicaid Protocols and Medical Necessity Criteria for Inpatient and Residential Psychiatric Treatment: Medicaid Payment Prior Authorization Manual, as revised as of August 18, 2000. The Alaska Medicaid Protocols and Medical Necessity Criteria for Inpatient and Residential Psychiatric Treatment: Medicaid Payment Prior Authorization Manual, as revised as of August 18, 2000, is adopted by reference.

History: Eff. 1/8/93, Register 125; am 3/26/93, Register 126; am 6/5/93, Register 126; am 12/31/94, Register 132; readopt 8/7/96, Register 139; am 1/14/2000, Register 153; am 11/1/2000, Register 156; am 4/19/2001, Register 158

Authority: AS 47.05.010

AS 47.07.030

AS 47.07.040

Editor's note: The Alaska Medicaid Protocols and Medical Necessity Criteria for Inpatient and Residential Psychiatric Treatment: Medicaid Payment Prior Authorization Manual, adopted by reference in 7 AAC 43.552(g) , may be obtained by writing to First Mental Health, Inc., 4411 Business Park Boulevard, Building M, Suite 32, Anchorage, Alaska 99503-7117. This manual is also available for inspection at the Department of Health and Social Services, Division of Medical Assistance, 4501 Business Park Boulevard, Suite 24, Anchorage, Alaska.

The substantive provisions of 7 AAC 43.552 were formerly found in 7 AAC 43.550. As of Register 126, July 1993, 7 AAC 43.552 was created as a separate section; however, the history line to this section also reflects the history of this material as it was amended while a part of 7 AAC 43.550. The content of 7 AAC 43.552(f) was originally adopted on January 8, 1993 as part of an emergency amendment to 7 AAC 43.580 that defined the term "interdisciplinary team," and was later amended on 3/26/93. As of Register 126, July 1993, this term was amended to read "inpatient interdisciplinary team" and a portion of that definition was moved to its present location in 7 AAC 43.552(f) .

Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.552 in its entirety, without change, under AS 47.05 and AS 47.07. Executive Order No. 72 transferred certain rate-setting authority to the department.