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42 C.F.R. § 456.233   Initial continued stay review date.

Title 42 - Public Health

Title 42: Public Health
PART 456—UTILIZATION CONTROL
Subpart D—Utilization Control: Mental Hospitals
UR Plan: Review of Need for Continued Stay

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§ 456.233   Initial continued stay review date.

The UR plan must provide that—

(a) When a recipient is admitted to the mental hospital under admission review requirements of this subpart, the committee assigns a specified date by which the need for his continued stay will be reviewed;

(b) If an individual applies for Medicaid while in the mental hospital, the committee assigns the initial continued stay review date within 1 working day after the mental hospital is notified of the application for Medicaid;

(c) The committee bases its assignment of the initial continued stay review date on—

(1) The methods and criteria required to be described under §456.235(a);

(2) The individual's condition; and

(3) The individual's projected discharge date;

(d)(1) The committee uses any available appropriate regional medical care appraisal norms, such as those developed by abstracting services or third party payors, to assign the initial continued stay review date;

(2) These norms are based on current and statistically valid data on duration of stay in mental hospitals for patients whose characteristics, such as age and diagnosis, are similar to those of the individual whose need for continued stay is being reviewed;

(3) If the committee uses norms to assign the initial continued stay review date, the number of days between the individual's admission and the initial continued stay review date is no greater than the number of days reflected in the 50th percentile of the norms. However, the committee may assign a later review date if it documents that the later date is more appropriate;

(e) The initial continued stay review date is not in any case later than 30 days after admission of the individual or notice to the mental hospital of his application for Medicaid; and

(f) The committee insures that the initial continued stay review date is recorded in the individual's record.

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