Haw. Code R. § 17-1737-18.1

Current through September, 2024

Section 17-1737-18.1 - Inpatient psychiatric Services for individuals under age twenty-one in psychiatric facilities or programs

(a) Inpatient psychiatric services for recipients under age twenty-one shall be provided:

(1) Under the direction of a physician;

(2) By:

(A) A psychiatric hospital or an inpatient psychiatric program that is accredited by the joint commission on accreditation of healthcare organizations; or

(B) A psychiatric facility which is accredited by the joint commission on accreditation of healthcare organizations, the commission on accreditation of rehabilitation facilities, the council on accreditation

(C) of services for families and children, or by any other accrediting organization, with comparable standards that is recognized by the State; and

(D) Is authorized to practice under the Medicaid program and meets the provisions of chapter 17-1736.

(3) Before the individual reaches the age twenty-one or, if the individual was receiving the services immediately before he or she reached age twenty-one, services will continue until the earlier of the following:

(A) The date the individual no longer requires the services; or

(B) The date the individual reaches age twenty-two.

(4) To an individual certified to be in need of the services.

(A) Ambulatory care resources available in the community do not meet the treatment needs of the recipient; and

(B) The services can reasonably be expected to improve the recipient's condition or prevent further regression so that the services will no longer be needed.

(b) The individual shall receive active treatment which involves a developed and supervised individual plan of care to improve the individual's condition to the extent that inpatient care is no longer necessary. The plan of care shall:

(1) Be based on a diagnostic evaluation that includes examination of the medical, psychological, social, behavioral and developmental aspect of the recipient's situation and reflects the need for inpatient psychiatric care;

(2) Be developed by a team of professionals in consultation with the recipient, and his parents, legal guardians, or others in whose care he will be released after discharge;

(3) State treatment objectives;

(4) Prescribe an integrated program of therapies, activities, and experiences designed to meet the objectives;

(5) Include, at an appropriate time, post-discharge plans and coordination of inpatient services with partial discharge plans and related community services to ensure continuity of care with the recipient's family, school, and community upon discharge;

(6) The plan shall be reviewed every thirty days to:

(A) Determine that services being provided are or were required on an inpatient basis; and

(B) Recommend changes in the plan as indicated by the recipient's overall adjustment as an inpatient.

(c) The individual plan of care must be developed by an interdisciplinary team of physicians and other personnel who are employed by, or provide services to patients in, the facility.

(1) The interdisciplinary team shall be capable of:

(A) Assessing the recipient's immediate and long-range therapeutic needs, developmental priorities, and personal strengths and liabilities;

(B) Assessing the potential resources of the recipient's family;

(C) Setting treatment objectives; and

(D) Prescribing therapeutic modalities to achieve the plan's objectives.

(2) The team shall include, as a minimum, either:

(A) A board-eligible or board-certified psychiatrist; or

(B) A clinical psychologist who has a doctoral degree and a physician licensed to practice medicine or osteopathy;

(3) The team shall also include one of the following:

(A) A psychiatric social worker;

(B) A registered nurse with specialized training or one year's experience in treating mentally ill individuals; or

(C) An occupational therapist who is licensed, if required by the State, and who has specialized training or one year of experience in treating mentally ill individuals;

(d) Prior authorization is required before inpatient psychiatric services for recipients under age twenty-one are provided.

Haw. Code R. § 17-1737-18.1

[Eff 02/16/02] (Auth: HRS § 346-14; 42 C.F.R. §431.10 ) (Imp: 42 C.F.R. §§441.150 through 441.156 )