1. (a) The department will not pay for inpatient psychiatric hospital services unless the department has authorized the recipient's admission. Before the department will authorize admission, the department will verify that the requirements of (b) and (c) of this section are met.

2. (b) Upon admission, an inpatient interdisciplinary team that meets the requirements of (d) of this section must

   1. (1) complete a diagnostic evaluation that

      1. (A) includes a psychiatric assessment;
      2. (B) is performed no more than 60 days before admission or no more than 72 hours after admission; and
      3. (C) indicates the need for inpatient psychiatric services;

   2. (2) certify in the recipient's medical record that

      1. (A) available alternate community resources for ambulatory care do not meet the treatment needs of the recipient, if the recipient is under 21 years of age;
      2. (B) proper treatment of the recipient's psychiatric condition requires services on an inpatient basis, as appropriate; and
      3. (C) inpatient psychiatric services can reasonably be expected to improve the recipient's condition or prevent further regression;

   3. (3) provide to the department

      1. (A) the results of the diagnostic evaluation required in (1) of this subsection;
      2. (B) the results of a functional assessment;
      3. (C) the results of any direct patient observations and assessments obtained following the recipient's referral; and
      4. (D) other information from referral sources, other community agencies, and the family, that is relevant to the recipient's condition; and
   4. (4) develop a plan of care based upon the information provided under this subsection that meets the requirements of 7 AAC 140.365.
3. (c) Based on the information received under (b)(3) of this section, the department will determine if the proposed treatment and other services are consistent with the recipient's clinical diagnosis and if they appropriately address the recipient's needs.

4. (d) An inpatient interdisciplinary team that provides the services required in (b) of this section must, by virtue of education and experience, have the capability of assessing the recipient's immediate and long-range therapeutic requirements, developmental priorities, personal strengths, liabilities, and the potential resources of the recipient's family. Except as provided in (f) of this section, an inpatient interdisciplinary team must include

   1. (1) either a

      1. (A) psychiatrist licensed under AS 08.64;
      2. (B) psychologist licensed under AS 08.86 who has a doctorate degree in clinical psychology and a physician licensed under AS 08.64 to practice medicine or osteopathy; or
      3. (C) physician licensed under AS 08.64 to practice medicine who has specialized training and experience in the diagnosis and treatment of mental diseases and a psychological associate licensed under AS 08.86;
   2. (2) a representative of the office of the Department of Family and Community Services responsible for children's services if the child is in that subunit's custody, or a representative of the division of the Department of Family and Community Services responsible for juvenile justice if the child is in that division's custody;
   3. (3) a clinical social worker licensed under AS 08.95;
   4. (4) a registered nurse licensed under AS 08.68 who has specialized training or one year's experience in treating mentally ill patients; and

   5. (5) depending upon the needs of the recipient, either

      1. (A) an occupational therapist licensed under AS 08.84 who has specialized training or one year's experience in treating mentally ill patients; or
      2. (B) a psychological associate licensed under AS 08.86 who has a master's degree in clinical psychology.

5. (e) Upon the admission of a recipient under 21 years of age to an inpatient psychiatric hospital, the provider shall arrange for appropriate EPSDT screening services, in accordance with 7 AAC 110.200 - 7 AAC 110.210. The provider shall ensure that a child has received EPSDT screening

   1. (1) no more than the 60 days immediately preceding the date of admission; or
   2. (2) no more than five days after the date of admission.
6. (f) Members of the interdisciplinary team of an out-of-state inpatient psychiatric hospital must be licensed by the jurisdiction in which the inpatient psychiatric hospital is located.
7. (g) The department will issue a prior authorization required under this section in accordance with the State of Alaska, Department of Health, Behavioral Health Inpatient Psychiatric Review Provider Manual, adopted by reference in 7 AAC 160.900.

(Eff. 2/1/2010, Register 193)