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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 29. PUBLIC WELFARE |
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Chapter 29-9. MEDICAID PROGRAM |
Section 29-948. INPATIENT PSYCHIATRIC SERVICES FOR INDIVIDUALS UNDER 22 YEARS OF AGE
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948.1Inpatient psychiatric services for individuals under the age of twenty-two (22) may be provided by:
(a) A psychiatric hospital or an inpatient psychiatric program in a hospital accredited by the Joint Commission on Accreditation of Healthcare Organizations; or
(b) A psychiatric residential treatment facility (PRTF).
948.2 Inpatient psychiatric services for individuals under the age of twenty-two (22) shall be:
(a) Provided under the direction of a physician;
(b) Provided in a facility or program described in §948.1;
(c) Provided before the individual reaches the age of twenty-two (22), or, if
the individual was receiving the services immediately before reaching the
age of twenty-two (22), before the earlier of the following:
(i)The date the individual no longer requires the services; or
(ii)The date the individual reaches the age of twenty-two (22).
(d) Certified in writing to be necessary in the setting in which the services shall be provided or are being provided in emergency circumstances in accordance with 42 CFR 441.152; and
(e) Meet the conditions of participation governing the use of restraint or
seclusion set forth in 42 CFR 483.350 et seq., if services are provided by a PRTF.
948.3For each Medicaid beneficiary or applicant who is admitted to a facility or program, the certification required pursuant to §948.2(d) shall be made by an independent team that includes a physician who has competence in diagnosis and treatment of mental illness and has knowledge of the beneficiary’s health status. For an individual who applies for Medicaid while in the facility or program, the certification shall be made by the team responsible for the plan of care as described in §948.6 and shall cover any period before application for which claims are made. For emergency admissions, the certification shall be made by the team responsible for the plan of care within fourteen (14) days after admission.
948.4A PRTF shall:
(a) Be licensed in the state where the facility is located, if required by the state;
(b) Have a current written provider agreement with the District of Columbia Medicaid Program;
(c) Have a written individual plan of care for each patient as described in §948.5, developed by an interdisciplinary team of physicians and other professionals as described in §948.6 in consultation with the patient and his or her parents, legal guardians, or others in whose care the patient will be released after discharge; and
(d) Maintain appropriate administrative and medical records for a minimum of six (6) years beyond the age of twenty-two (22) years and make such records available to officials of the Department of Health Care Finance, the Department of Mental Health, Department of Health, or other governmental officials of District, state, or federal agencies, or their designees.
948.5Each facility or program shall have a written plan of care for each beneficiary that complies with the requirements set forth in 42 CFR 441.155 and include the following:
(a) A certification of need for services that meets the requirements of 42 CFR 441.152;
(b) An assessment of the beneficiary’s immediate and long-range therapeutic needs, developmental priorities, and personal strengths and liabilities;
(c) An assessment of the resources of the beneficiary’s family, including parents, legal guardians, or others into whose care the beneficiary will be released after the discharge;
(d) The establishment of treatment objectives; and
(e) The prescribing of therapeutic modalities to achieve the plan’s objectives.
948.6The interdisciplinary team consisting of physicians and other personnel that develops an individual plan of care shall:
(a) Be employed by the facility directly or under contract;
(b) Have demonstrated competency in child psychiatry (for example, residency in child and adolescent psychiatry and experience in inpatient child and adolescent inpatient/residential treatment settings);
(c) Include at a minimum:
(1)A board-certified or board-eligible psychiatrist;
(2)A clinical psychologist who has a doctoral degree and a physician licensed to practice medicine or osteopathy; or
(3) A physician licensed to practice medicine or osteopathy with specialized training and experience in the diagnosis and treatment of mental diseases and a psychologist who has a master’s degree in clinical psychology or who has been certified by the state or by the state psychological association; and
(d) Include one (1) of the following:
(1) A psychiatric social worker;
(2)A registered nurse who has specialized training or one (1) year of experience in treating mentally ill individuals;
(3)An occupational therapist who is licensed, if required by the state, and has specialized training or one (1) year of experience in treating mentally ill individuals; or
(4)A psychologist who has a master’s degree in clinical psychology or who has been certified by the state or by the state psychological association.
948.7Each facility or program shall not admit a District Medicaid beneficiary or applicant unless the admission has been certified as medically necessary by the District of Columbia Department of Mental Health (DMH).
948.8Each facility or program shall provide active treatment consistent with the requirements set forth in 42 CFR 441.155.
948.9The written plan of care shall be developed within fourteen (14) days of admission and reviewed at least every thirty (30) days thereafter.
948.10Each PRTF shall provide to the requesting District child-serving agency the initial plan of care and any subsequent treatment plan adjustments, including all thirty (30) day reviews of the plan of care.