California Code of Regulations › Title 22 - Social Security › Division 5 - Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies › Chapter 4 - Intermediate Care Facilities › Article 3 - Services › Section 73425 - Special Subacute Psychiatric Program Services-Mentally Disordered

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Mentally
				  disordered subacute psychiatric programs are designed to serve patients who
				  have a chronic psychiatric impairment and whose adaptive functioning is
				  severely impaired. These patients require continuous and intensive supervision
				  and can be expected to benefit from an active subacute psychiatric program
				  effort designed to improve their adaptive functioning to the point of entry
				  into a rehabilitation program. A facility may, but is not required to, provide
				  special subacute psychiatric program services. If the facility meets all of the
				  requirements of this section, it shall be entitled to a supplemental special
				  program rate under the Medi-Cal program (Title 22, California Administrative
				  Code, Section
				  51335(k)). Such
				  special program services are those therapeutic services provided to mentally
				  disordered persons having special needs or deficits in one or more of the
				  following general areas: Self-Help Skills, Behavior Adjustment, Interpersonal
				  Relationships, Prevocational Preparation and Prerelease Planning.
(b) To be approved by the Department to
				  furnish such special subacute psychiatric programs to the mentally disordered,
				  a facility shall have:
(1) A minimum
				  initially of 30 patients in the facility who have been certified by the local
				  mental health director as eligible for special subacute psychiatric program
				  services. Eligibility for special subacute psychiatric services shall be
				  redetermined every 30 days by the local mental health director. Patient
				  eligibility for the special subacute psychiatric program shall be limited to a
				  maximum of 90 days. The Department may authorize exceptions to this provision
				  in writing to the local mental health director on an individual patient basis.
				  At any time that the number of eligible patients receiving special program
				  services drops below 27, total program reimbursement shall be terminated unless
				  otherwise agreed to by the Department.
(2) An approved facility plan.
(A) To participate in this program, a
				  facility shall submit to the Department's headquarters review and approval team
				  for approval, an application and a facility plan which meets all the
				  requirements of Section
				  73425(c).
(B) When the Department through the
				  headquarters review and approval team determines that the facility plan meets
				  the specified needs of the patient population, it shall provide its written
				  approval of the plan to the facility.
(C) Where the headquarters review and
				  approval team disapproves a facility plan, it shall submit a written report to
				  the facility which specifies components of the plan which need to be improved
				  or corrected. The facility may submit a revised facility plan and a new
				  application to the headquarters review and approval team at any
				  time.
(3) Within 45 days
				  after written approval of the facility plan, by the headquarters review and
				  approval team an on-site visit by the Department to evaluate the
				  appropriateness of the implementation of the facility plan. Upon the
				  recommendation of the on-site visit team, the Department shall certify the
				  facility's Special Subacute Psychiatric Program Services-- Mentally Disordered.
				  Eligibility for Medi-Cal reimbursement shall commence on the first day that the
				  on-site visit team determined that full implementation of the approved plan
				  actually occurred; provided, however, that the first day of payment shall not
				  be prior to the actual date of written approval of the plan.
(4) Executed an approved Medi-Cal provider
				  participation agreement.
(5)
				  Maintained compliance with the approved facility plan. Failure to comply with
				  special program requirements of the plan shall cause the termination of
				  eligibility for reimbursement for special program services, unless otherwise
				  excused in writing by the Department.