(Medicare Benefit Policy Manual)

(2)  The staffing pattern must e nsure  the availability of a registered nurse 24 hours each day.  There must be adequate numbers of registered nurses, licensed practical nurses, and mental health workers to provide the nursing care necessary  under each patients active treatment program.   50 - Psychological Services  (Rev. 59, Issued: 11- 09-06, Effective: 01- 01-05, Implementation: 12 -04-06)  The IPF must provide or have available psychological services to meet the needs of the patients.  The services must be furnished in accordance with acceptabl e standards of practice, service objectives, and established policies and procedures, according to 42 CFR 412.27  and 42 CFR 482.62 .  60 - Social Services  (Rev. 253, Issued: 12-  14-18, Effective: 01- 16-19, Implementation: 01 - 16-19)  In accordance with 42 CFR 412.27 and 42 CFR 482.62 , there must be a director of social services who monitors and evaluates the quality and appropriateness of social services furnished.  The services must be furnished in accordance with accept ed standards of practice and established policies and procedures..   1.  The director of the social work department or service must have a Masters degree from an accredited school of social work or must be qualified by education and experience in the social services needs of the mentally ill.  If the director does not hold a Masters degree in social work, at least one staff member must have this qualification.   2.  Social service staff responsibilities must include, but are not limited to, participating in  discharge planning, arranging for follow -up care, and developing mechanisms for exchange of appropriate information with sources outside the hospital.  70 - Therapeutic Activities  (Rev. 59, Issued: 11- 09-06, Effective: 01- 01-05, Implementation: 12 -04-06)  According to 42 CFR 412.27 and 42 CFR 482.62  IPFs  must provide a therapeutic activities program.    (1)  The program must be appropriate to the needs and interests of patients and be directed toward restoring and maintaining optimal levels o f physical and psychosocial functioning.    (2)  The number of qualified therapists, support personnel, and consultants must be adequate to provide comprehensive therapeutic activities consistent with each patients active treatment program.   80 - Benefit Limits in Psychiatric Hospitals  (Rev. 253, Issued: 12-  14-18, Effective: 01- 16-19, Implementation: 01 - 16-19)  The psychiatric benefit application (190 days) applies to freestanding psychiatric hospitals per 42 CFR 409.62 .  The 190- lifetime limitation does not apply to certified psychiatric distinct part units.  Section 409.62 states, There is a lifetime maximum of 190 days on inpatient psychiatric hospital services available to any beneficiary.  Therefore, once an individual receives benefits for 190 days of care in a psychiatric hospital, no further benefits of that type are availabl e to that individual.   90 - Benefits Exhaust  (Rev. 253, Issued: 12-  14-18, Effective: 01- 16-19, Implementation: 01 - 16-19)  Effective December 3, 2007, for payment purposes, an IPF discharge occurs when benefits exhaust , and the benefits exhaust date will  substitute for the discharge date.  The claim will be paid either on the discharge date if the benefits are available or on benefit exhaust date if the discharge is after the benefits exhaust date.  When the services actually are provided, the PRICER vers ion used to price claims for the time will be used.  No pay/110 TOBs are allowed instead of continually adjusting the claims (117 TOB) until actual discharge occurs once benefits exhaust.   Under the Tax Equity and Fiscal Responsibility Act (TEFRA), the Provider Statistical and Reimbursement (PS&R) report used the benefits exhaust date as the discharge date.  This changed when the IPF PPS was implemented, and the 'actual' discharge date was used.  The days stay with the year they occurred, making it easier f or the PS&R report (especially during the blend period) to settle the cost report.  This means that:   1. Claims will be settled on the appropriate cost report;   2. The appropriate PPS -TEFRA blend percentage will be paid;   3. Patients with long lengths of s tay will be counted on the correct PS&R report; and  4. The PRICER version used will be the one in effect at the time the services were provided.                       Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R253BP  12/14/2018  Updates to the Inpatient Psychiatric Facility Benefit Policy Manual  01/16/2019  11062 R223BP  05/13/2016  Clarification of Inpatient Psychiatric Facilities (IPF) Requirements for Certification, Recertification and Delayed/Lapsed Certification and Recertification  08/15/2016  9522 R194BP  09/03/2014  Pub. 100- 02 Language -Only Update for ICD- 10 Upon Implementation of ICD -10 8605 R181BP  03/14/2014  Pub. 100- 02 Language -Only Update for ICD- 10  Rescinded and replaced by Transmittal 194  10/01/2014  8605 R69BP  04/27/2007  Change to the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) Discharge Bill  12/03/2007  5474 R59BP  11/09/2006  Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)  12/04/2006  5287 R56BP  11/03/2006  Inpatient Psychiatric Facility Prospective Payment System (IPF PPS)  12/04/2006  5287 R1BP  10/01/2003  Initial Publication of Manual  NA NA Back to top of Chapter