Ala. Admin. Code r. 560-X-5-.11

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-5-.11 - Continued Stay Reviews

(1) The hospital's utilization review personnel will be responsible for performing continued stay reviews on recipients who require continued inpatient hospitalization.

(2) The initial continued stay review should be performed on the date assigned by Medicaid. Subsequent reviews should be performed at least every 90 days from the initial CSR date assigned, provided the patient is approved for continued stay. Each continued stay review date assigned should be recorded in the patient's record.

(3) If the facility's utilization review personnel determines the patient does not meet the criteria for continued stay, the case should be referred to the facility's psychiatric advisor. If the advisor finds that the continued stay is not needed, the hospital's utilization review procedure for denial of a continued stay should be followed.

(4) If a final decision of denial is made, the hospital must notify the recipient and the attending physician within two days of the adverse determination. Medicaid should be notified in writing within ten (10) days after the denial is made.

(5) The facility's utilization review personnel shall be responsible for phoning Medicaid with a report whenever patients are placed on leave status or return from leave. A brief summary describing the outcome of the therapeutic leave should be addressed at this time for patients returning from any leave status.

Author:

Ala. Admin. Code r. 560-X-5-.11

New Rule: Filed September 6, 1995; effective October 12, 1995. Amended: Filed October 6, 1997; effective November 10, 1997.

Statutory Authority:42 C.F.R. Section 441.102; Section 456.231 through 456.238.