§ 1151.71. Concurrent hospital review.
(a) Each inpatient psychiatric facility shall conduct reviews of each MA recipients need for admission and continued need for psychiatric inpatient services in accordance with the Departments Manual for Concurrent Hospital Review (CHR) unless granted an exemption by the Department.
(b) The Department will regularly monitor each inpatient psychiatric facilitys utilization review program to determine whether it is operating in accordance with the CHR process and this section. Monitoring is carried out through review of admissions, continued stays, patient records and claims paid by the Department.
(c) The Department will approve or disapprove the recipients need for admission and need for continued hospitalization through its CHR process unless an exemption is granted by the Department.
(d) If a discrepancy exists between a hospitals utilization review plan and the instructions in the Departments Manual for Concurrent Review of Inpatient Hospital Services, the Departments manual shall take precedence.
The provisions of this § 1151.71 amended under sections 201 and 443.1(1) of the Public Welfare Code (62 P. S. § § 201 and 443.1(1)).
The provisions of this § 1151.71 adopted September 30, 1983, effective July 1, 1983, 13 Pa.B. 2796; 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 (181804) to (181805).
This section cited in 55 Pa. Code § 1151.61 (relating to payment conditions: general); and 55 Pa. Code § 1151.67 (relating to payment conditions related to the recipients continued need for care).
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