Haw. Code R. § 17-1737-18

Current through September, 2024

Section 17-1737-18 - Inpatient psychiatric care

(a) Inpatient psychiatric care shall be provided only in an authorized psychiatric facility and by authorized psychiatric providers.

(b) Admission to a psychiatric facility shall be by:

(1) A psychiatrist; or

(2) A non-psychiatrist physician with a psychiatrist concurring that admission is needed.

(c) Authorization for inpatient psychiatric care is required for:

(1) All application or pending cases; and

(2) Medicaid patients with third party coverage or any other available resources except for medicare.

(d) The department of human services form for medical authorization shall be used to request authorization for inpatient psychiatric care. The following procedures shall be taken:

(1) The form shall be completed by the inpatient psychiatric facility and shall be signed and dated by a psychiatrist or countersigned and dated by a psychiatrist when the patient is admitted by non-psychiatrist physician;

(2) The psychiatric facility and the physician shall both be responsible for submitting the form to the medical assistance program (medicaid) office;

(3) The form shall be received in the medical assistance program (medicaid) office of the department within five working days from the time of the patient's admission. The postmarked date shall be accepted provided it is within the five working days requirement from the time of patient's admission;

(4) Reimbursements to the physician and psychiatric facility is subject to denial when forms are not received within the specified time;

(5) A form shall be submitted for each admission; and

(6) An extension form will not be required regardless of length of stay.

(e) The length of hospital stay is applicable to all categories and the following shall be followed:

(1) No more than thirty days per calendar year shall be authorized. Inpatient days not used in the authorized calendar year shall not be added to the inpatient days allowed for the following calendar year;

(2) The number of inpatient days available through a third party coverage shall be counted as part of the authorized number of days under Medicaid. The psychiatric facility shall apply the number of inpatient days that are available from the third party resource to the authorized number of days under Medicaid; and

(3) One inpatient day can be exchanged for two outpatient hours.

(f) Emergency inpatient psychiatric care shall be provided as follows:

(1) In communities where a psychiatric facility is not readily available, emergency inpatient psychiatric service may be provided for up to forty-eight hours at the closest licensed general hospital; and

(2) A patient shall be transferred to an authorized psychiatric facility or to a long-term psychiatric facility if the attending physician determines that the patient requires inpatient psychiatric service beyond the forty-eight hour period.

(g) Voluntary patients may obtain psychiatric inpatient hospital passes only as needed for discharge planning purposes. Involuntary patients will be regulated according to legal requirements.

(1) A patient is authorized eight hours to assist in his discharge preparation. The hours may be used in a flexible and judicious manner throughout the duration of admission.

(2) Exceptions may be made for patients who will benefit from program under the auspices of the treating hospital.

(3) All other types of hospital passes are not reimbursable.

Haw. Code R. § 17-1737-18

[Eff 08/01/94; am 06/19/00] (Auth: HRS § 346-14; 42 C.F.R. §431.10 ) (Imp: HRS § 431M-4; 42 C.F.R. §§440.10, 440.160 )