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37.88.1105    INPATIENT PSYCHIATRIC SERVICES, PARTICIPATION REQUIREMENTS

(1) These requirements are in addition to those contained in rule provisions generally applicable to Medicaid providers.

(2) Inpatient psychiatric service providers, as a condition of participation in the Montana Medicaid program, must comply with the following requirements:

(a) maintain a current license as a hospital or a residential treatment facility under the rules of the department's Quality Assurance Division to provide inpatient hospital psychiatric care or residential psychiatric care, or, if the provider's facility is not located within the state of Montana, maintain a current license in the equivalent category under the laws of the state in which the facility is located;

(b) maintain a current certification for Montana Medicaid under the rules of the department's Quality Assurance Division to provide inpatient hospital psychiatric care or residential psychiatric care or, if the provider's facility is not located within the state of Montana, meet the requirements of (2) (g) and (2) (h) ;

(c) for all providers, enter into and maintain a current provider enrollment form with the department's fiscal agent to provide inpatient psychiatric treatment services;

(d) license and/or register facility personnel in accordance with applicable state and federal laws;

(e) accept, as payment in full for all operating and property costs, the amounts paid in accordance with the reimbursement method set forth in these rules;

(f) for providers maintaining patient trust accounts, insure that any funds maintained in those accounts are used only for those purposes for which the patient, legal guardian or personal representative of the patient has given written authorization. A provider may not borrow funds from these accounts for any purpose;

(g) for hospital providers:

(i) comply with 42 CFR sections 482.1 through 482.62 and meet the requirements of section 1861(f) of the Social Security Act, which are federal regulations and statutes setting forth requirements for psychiatric hospitals. The department hereby adopts and incorporates herein by reference the above-cited regulations and statutes. Copies of these regulations and statutes may be obtained from the Department of Public Health and Human Services, Addictive and Mental Disorders Division, 1400 Broadway. P.O. Box 202951, Helena, MT 59620-2951; or

(ii) be accredited by the joint commission on accreditation of health care organizations (JCAHCO) or any other organization designated by the Secretary of the United States Department of Health and Human Services as authorized to accredit psychiatric hospitals for Medicaid participation.

(h) maintain accreditation as a residential treatment facility by the joint commission on accreditation of health care organizations (JCAHCO) or any other organization designated by the Secretary of the United States Department of Health and Human Services as authorized to accredit residential treatment facilities for Medicaid participation;

(i) submit to the department prior to receiving initial reimbursement payments and thereafter within 30 days after receipt, all accreditation determinations, findings, reports and related documents issued by the accrediting organization to the provider;

(j) provide inpatient psychiatric services according to the service requirements for individuals under age 21 specified in Title 42 CFR, Part 441, subpart D (1997) , which is a federal regulation which is herein incorporated by reference. A copy of these regulations may be obtained through the Department of Public Health and Human Services, Addictive and Mental Disorders Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951;

(k) agree to indemnify the department in the full amount of the state and federal shares of all Medicaid inpatient psychiatric services reimbursement paid to the facility during any period when federal financial participation is unavailable due to facility failure to meet the conditions of participation specified in these rules or due to other facility deficiencies or errors.

History: 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195.

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