1. (1) Before admission to a psychiatric facility or before authorization for payment, the attending physician or staff physician must make a medical evaluation of each recipient's need for care in the facility and appropriate professional personnel must make a psychiatric and social evaluation. The psychiatric evaluation must be completed within 60 days of admission. The specific requirements for psychiatric medical records may be found at 42 CFR, 482.61.

2. (2) Each medical evaluation must include:

   1. (a) Diagnosis within the ICD-9 range of 290-316 (dates services prior and up to September 30, 2015} or ICD-10 range of F01.50 – F69, F80.0 - F99, G44.209, H93.25, R37, R45.1 - R45.2, R45.5 – R45.82, R480, Z87.890 (dates of services October 1, 2015 and forward.
   2. (b) Summary of present medical findings,
   3. (c) Medical history,
   4. (d) Mental and physical functional capacity,
   5. (e) Prognosis, and

   6. (f) A recommendation by a physician concerning:

      1. 1. Admission to the psychiatric facility, or
      2. 2. Continued care in the psychiatric facility for individuals who apply for Medicaid while in the facility.

Author: Solomon Williams, Associate Director, Institutional Services

Statutory Authority: State Plan, Attachment 3.1-A, pp. 7, 7.16; 42 C.F.R. §456.170.

History: Rule effective October 1, 1988. Amended effective September 13, 1989. Emergency rule effective August 21, 1991. Amended effective November 13, 1991. Amended: Filed November 8, 2001; effective December 13, 2001. Amended: Filed May 12, 2005; effective June 16, 2005. Amended: Filed August 27, 2015; effective October 1, 2015.