Ala. Admin. Code r. 560-X-5-.03
Current through Register Vol. 43, No. 1, October 31, 2024
Section 560-X-5-.03 - Geriatric Inpatient Psychiatric Benefits(1) For purposes of this chapter, an inpatient is a person, age 65 or over, who has been admitted to a freestanding psychiatric facility specializing in the diagnosis, treatment and care of geriatric patients occupying beds, for the purpose of maintaining or restoring to the greatest possible degree of health and independent functioning.(2) The number of days of care charged to a recipient or inpatient psychiatric service is always units of full days. A day begins at midnight and ends 24 hours later. The midnight to midnight method is used in reporting days of care for the recipient, even if the facility uses a different definition of day for statistical or other purposes.(3) Medicaid reimbursement is available for the day of admission, but not the day of discharge.(4) Therapeutic visits away from the psychiatric facility to home, relatives or friends are authorized if certified by the attending physician as medically necessary in the treatment of the recipient.(a) Therapeutic visits may be authorized up to 14 days per admission if certified by the attending physician as medically necessary in the treatment of the recipient. No part of the time spent on any therapeutic leave may be billed to Medicaid.(b) Return to inpatient status from therapeutic visits exceeding 14 days per admission will be considered a readmission with the required certification of need for treatment documented in the patient's record.(c) Therapeutic visit records will be reviewed retrospectively by the Quality Assurance Program at Medicaid. Providers that have received payments for therapeutic visits will have funds recouped. Author:
Ala. Admin. Code r. 560-X-5-.03
Rule effective October 1, 1982. Repealed: Filed February 7, 1994; effective March 14, 1994. New Rule: Filed September 6, 1995; effective October 12, 1995. Amended: Filed October 6, 1997; effective November 10, 1997.Statutory Authority: State Plan, Attachment 3.1-A, 4.19A. 42 C.F.R. Section 436.1004.