1. (a) The psychiatric residential treatment facility shall not admit any child for whom the psychiatric residential treatment facility cannot provide adequate care.
2. (b) The psychiatric residential treatment facility shall not admit any out-of-state child without a written agreement from the payor, and responsible party if different, regarding return to the child’s sending state upon scheduled or unscheduled discharge.

3. (c) A psychiatric residential treatment facility licensed under the Child Welfare Agency Licensing Act, Arkansas Code § 9-28-401 et seq., and holding a permit from the Health Services Permit Agency shall not admit a child for psychiatric residential treatment unless the child is:

   1. (1) An Arkansas resident;
   2. (2) A child of a parent who is an Arkansas resident;
   3. (3) A child placed by or on behalf of another state’s child welfare agency;
   4. (4) A child for whom the psychiatric residential treatment facility is being paid by another state's Medicaid program;
   5. (5) A child of an active-duty member or veteran of the uniformed services as defined in Arkansas Code § 6-4-302; or
   6. (6) A nonresident child victim of human trafficking when the regulated psychiatric residential treatment facility maintains responsibility for the return of the child to the out-of-state custodian.

4. (d) Each child shall have a:

   1. (1) Medical exam no more than one (1) year before admission; or
   2. (2) Documented appointment date for an exam within one (1) week after admission.

5. (e) Each child shall have:

   1. (1) Proof of current immunizations;
   2. (2) A letter of exemption in accordance with the Department of Health; or
   3. (3) A scheduled appointment within one (1) week after admission.
6. (f) The psychiatric residential treatment facility shall obtain written verification of the placing agent’s authority to place the child at the time of admission.
7. (g) The psychiatric residential treatment facility shall obtain written authority for medical care for the child from the placing agent at the time of admission.
8. (h) The psychiatric residential treatment facility shall comply with the Interstate Compact on the Placement of Children, Arkansas Code § 9-29-201 et seq., when admitting children from outside Arkansas, if applicable.
9. (i) The resident shall be discharged no later than their twenty-first birthday.

10. (j) Per 42 C.F.R. §§ 441.152 and 441.153 (1996), admission into a psychiatric residential treatment facility requires the following:

    1. (1) An independent team that:

       1. (A)

11. (i) Includes a physician.

    1. (ii) If the child is on Arkansas Medicaid, the physician is the PASSE medical director.

       1. (iii) If the child is from out-of-state, the physician is employed by the payor;
       2. (B) Has competence in diagnosis and treatment of mental illness, preferably in child psychiatry; and
       3. (C) Has knowledge of the resident’s situation;

    2. (2) The independent team will certify that:

       1. (A) Ambulatory care services available in the community do not meet the treatment needs of the resident;
       2. (B) Proper treatment of the resident’s psychiatric condition requires services on an inpatient basis under the direction of a physician; and
       3. (C) The services can reasonably be expected to improve the resident’s condition or prevent further regression so that the services will no longer be needed.

12. (k) Pursuant to 42 C.F.R. § 483.440 (1991):

    1. (1) Residents who are admitted by the psychiatric residential treatment facility must be in need of and receiving active treatment services;
    2. (2) Admission decisions must be based on a preliminary evaluation of the resident that is conducted or updated by the psychiatric residential treatment facility or by outside sources;

    3. (3) A preliminary evaluation must contain background information as well as currently valid assessments of functional developmental, behavioral, psychiatric, social, health, and nutritional status to determine if the psychiatric residential treatment facility can provide for the individual's needs and if the individual is likely to benefit from placement in the psychiatric residential treatment facility.

       1. (l) The psychiatric residential treatment facility shall not admit, after July 1, 2025, a child who is under ten (10) years of age.

          1. (m) At the time of admission, the following information shall be documented in the child’s record:
    4. (1) Name, signature, and role or relationship of the person who relinquished the child into care;
    5. (2) A brief description of the symptoms of a psychiatric diagnosis that require admission;
    6. (3) The date and time of the admission;
    7. (4) A brief description of the child’s history, if known, including behavioral history, mental health treatment, and response;
    8. (5) Any known medical history and known current health conditions;
    9. (6) All medications currently prescribed for the child, if known and available; and
    10. (7) The child’s current mental health diagnosis and symptoms, other behaviors related to the mental health diagnosis or known other co-occurring conditions.
13. (n) Intake information shall be completed on each child in the facility’s care within ten (10) working days after admission.

14. (o) The intake shall include:

    1. (1) Demographic information on the child and parent or legal guardian, including:

       1. (A) Name;
       2. (B) Address;
       3. (C) Birth date;
       4. (D) Gender;
       5. (E) Race; and
       6. (F) Religious preference;
    2. (2) A factual description of the symptoms and behaviors related to the mental health condition;
    3. (3) A brief social history of the family;
    4. (4) The child’s current legal status or custody;
    5. (5) Any history of previous placements outside the family;
    6. (6) All previous mental health treatment and provider of treatment services; and
    7. (7) An assessment to establish the child’s baseline that will be used to determine treatment outcomes throughout the stay; the assessment must be a standardized tool used to determine outcome measures.

15. (p)

    1. (1) When refusing admission to a resident, the psychiatric residential treatment facility shall provide a written statement to the referral source with the reason for the refusal.
    2. (2) Written statements refusing admission shall be provided to the designated representative or representatives of the Office of Long-Term Care upon request.

Codification Notes: "PASSE" means a Provider-Led Arkansas Shared Savings Entity.