§ 5100.90a. State mental hospital admission of involuntarily committed individuals—statement of policy.
(a) To manage treatment resources more effectively and assure adequate Medical Assistance reimbursement to community general and private psychiatric hospitals for days of active treatment provided to Medical Assistance eligible persons with mental illness, appropriate action shall be taken by the affected parties. The following policy and procedures should be followed:
(1) Community general and private psychiatric hospital staff should notify via telephone appropriate county MH/MR staff—county administrator or designated agency—upon Medical Assistance patients admission to the community general or private psychiatric hospital. This information may be released to county administrators under § 5100.32(a)(5) (relating to nonconsensual release of information).
(2) Immediately upon determination of the need for long-term psychiatric care, a referral package should be sent to the admissions unit of the State mental hospital (SMH) so it is received at least 2 days prior to the date of the scheduled commitment hearing. The County MH/MR Administrator or their designated agency should be notified by the community general or private psychiatric hospital of the patient’s need for long-term psychiatric care. The items to be included in the referral package accompanying a patient on admission to a State hospital under sections 304—306 of the Mental Health Procedures Act (50 P. S. § § 7304—7306) include:
(i) Signed and completed 304/305/306 commitment papers.
(ii) Psychiatric assessment.
(iii) Medical assessment.
(iv) Current medications.
(v) Laboratory and X-ray results.
(vi) Consultant’s reports.
(vii) Social history with special emphasis on family assessment and discharge resources.
(viii) Psychological assessments—if available.
(ix) BSU activity.
(x) Assessments from other clinical disciplines involved in the patient’s treatment.
(3) The SMH admissions staff and the staff of the community general or private psychiatric hospital will agree upon the date that the patient will be admitted to the State hospital. The SMH admissions staff shall notify the community general or private psychiatric hospital of the agreed upon date of admission prior to the patient’s scheduled hearing date.
(4) The community general or private psychiatric hospital staff shall notify the hearing officer of the date of availability of a SMH bed.
(5) The hearing officer shall conduct the hearing in a timely fashion in accordance with the timeframes required by the Mental Health Procedures Act of 1976. A commitment order should contain the agreed upon admission date to the SMH.
(6) The community general or private psychiatric hospital staff shall maintain appropriate documentation of the continuance of active treatment in the medical record until the patient is transferred to the SMH. Refer to § 1101.51 (d) and (e) (relating to ongoing responsibilities of providers) for the description of appropriate documentation of the continuance of active treatment.
(7) If the SMH bed is unavailable on the scheduled date of transfer, the SMH is responsible for contacting other State hospital facilities—within a 75-mile radius—to obtain a bed for the patient. If no bed is available in the surrounding SMHs, the initial SMH shall contact the next nearest SMH facility until a bed is found. SMH admissions staff may not deny access to a patient when a bed is available, except if, for clinical reasons, the clinical director deems the admission inappropriate. The area director is responsible for reviewing and monitoring denial of access to other State mental health facilities when a bed is available.
(8) The SMH will include in their Letter of Agreement with the county MH/MR program, the methodology used for referring patients to another SMH when a bed is not available. It is the intent of the Office of Mental Health to assure, whenever feasible, that the patient’s treatment be in or near the patient’s home community.
(b) Medical Assistance should be able to reimburse the community general or private psychiatric facility for the eligible days that the Medical Assistance eligible patient is in the facility when the policy and procedures in subsection (a) are followed to include the following:
(1) The specific date of admission to the SMH appropriately documented on the court commitment.
(2) The continuance of active treatment adequately documented in the patient’s medical record.
(3) The actual transfer of the patient to the SMH occurs on the date documented on the court commitment.
Source The provisions of this § 5100.90a adopted November 18, 1988, effective retroactively to November 9, 1988, 18 Pa.B. 5168.
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