PROVIDER PARTICIPATION

1. (a) In addition to the participation requirements established in Chapter 1101 (relating to general provisions), to participate in the MA Program, a private psychiatric hospital shall:

   1. (1) Be licensed by the Department’s Office of Mental Health.
   2. (2) Be approved by the Department’s Office of Mental Health under Chapter 5100 (relating to mental health procedures).
   3. (3) Have in effect a utilization review plan that meets the requirements at 42 CFR Part 456, Subpart D (relating to utilization control: mental hospitals) and 42 CFR 482.30 (relating to conditions of participation: utilization review) as certified by the Department’s Office of MA Programs.
   4. (4) Be accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
   5. (5) Be certified by the Department of Health as being in substantial compliance with the Medicare requirements for participation for specialty hospitals at 42 CFR Part 482, Subpart E (relating to requirements for specialty hospitals).
   6. (6) Be enrolled in the MA Program as a private psychiatric hospital.

2. (b) In addition to the participation requirements established in Chapter 1101, to participate in the MA Program, a psychiatric unit of a general hospital shall:

   1. (1) Be a part of a general hospital enrolled in the MA Program.
   2. (2) Meet the criteria of a distinct part unit as set forth under subsection (c).
   3. (3) Be approved as a psychiatric unit by the Department’s Office of Mental Health.
   4. (4) Be enrolled in the MA Program as a distinct part psychiatric unit.

3. (c) To qualify as a distinct part psychiatric unit for MA purposes, the unit shall:

   1. (1) Have written admission criteria that are applied uniformly to both MA patients and non-MA patients.
   2. (2) Have readily available admission and discharge records that are separately identified from those of the hospital in which the unit is located.
   3. (3) Have policies requiring that necessary clinical information is transferred to the unit when a patient of the hospital is transferred to the unit.
   4. (4) Have utilization review standards applicable for the type of care offered in the unit.
   5. (5) Have beds physically separate from (that is, not commingled with) the hospital’s other beds.
   6. (6) Be treated as a separate cost center for cost finding and apportionment purposes.
   7. (7) Use an accounting system which properly allocates costs.
   8. (8) Maintain adequate statistical data to support the basis of the cost allocation.
   9. (9) Report its costs in the hospital’s cost report covering the same fiscal period and using the same method of apportionment as the hospital.

Authority

The provisions of this § 1151.31 amended under sections 201 and 443.1(1) of the Public Welfare Code (62 P. S. § § 201 and 443.1(1)).

Source

The provisions of this § 1151.31 adopted September 30, 1983, effective July 1, 1983, 13 Pa.B. 2976; amended November 18, 1983, effective November 19, 1983, 13 Pa.B. 3665; amended June 18, 1993, effective July 1, 1993, 23 Pa.B. 2917; amended October 29, 1993, effective July 1, 1993, 23 Pa.B. 5241. Immediately preceding text appears at serial pages (181769) to (181771).