Idaho Admin. Code r. 16.03.09.703

Current through September 2, 2024

Section 16.03.09.703 - INPATIENT BEHAVIORAL HEALTH SERVICES: PROCEDURAL REQUIREMENTS

01.Prior Authorization. Some services may require a prior authorization from the Department, or its designee. The Department will set documentation requirements in the Idaho Medicaid Provider Handbook to ensure quality of care and integrity of services. Requests for prior authorization must include:

a. Diagnosis; and

b. Summary of present medical findings including symptoms, complaints and complications indicating the need for admission; and

c. Medical history; and

d. Mental and physical functional capacity; and

e. Prognosis.

02.Individual Plan of Care - Content. The individual plan of care is a written plan developed for the participant upon admission. The objective of the plan is to improve their condition to the extent that acute psychiatric care is no longer necessary. It must be developed by an interdisciplinary team as defined in Subsection 703.03 of this rule. The plan of care must be implemented within seventy-two (72) hours of admission, and reviewed at least every three (3) days. The individual plan of care must contain:

a. A diagnostic evaluation that includes examination of the medical, behavioral, and developmental aspects of the participant's situation and reflects the medical necessity for in-patient care; and

b. Treatment objectives related to conditions that necessitated the admission; and

c. An integrated program of therapies, treatments (including medications), activities (including special procedures to assure the health and safety of the participant), and experiences designed to meet the objectives; and

d. A discharge plan designed to achieve the participant's discharge at the earliest possible time that includes plans for coordination of community services to ensure continuity of care with the participant's family, school, and community upon discharge.

03.Individual Plan of Care - Interdisciplinary Team. The individual plan of care must be developed by an interdisciplinary team capable of assessing the participant's immediate and long range therapeutic needs, developmental priorities and personal strengths and liabilities, assessing the potential resources of the participant's family, setting the treatment objectives, and prescribing therapeutic modalities to achieve the plan's objectives. The team must include at a minimum:

a. One (1) of the following:

i. A board-certified psychiatrist; or

ii. A licensed psychologist and a physician licensed to practice medicine or osteopathy; or

iii. A physician licensed to practice medicine or osteopathy with specialized training and experience in the diagnosis and treatment of mental disease and a licensed clinical professional counselor; and

b. One (1) of the following:

i. A licensed, clinical or master's social worker; or

ii. A registered nurse with specialized training or one (1) year's experience in treating individuals with behavioral health needs; or

iii. A licensed occupational therapist who has had specialized training or one (1) year of experience in treating individuals with behavioral health needs,

c. The participant and their parents, legal guardians, or others into whose care they will be released after discharge.

Idaho Admin. Code r. 16.03.09.703

Effective March 17, 2022