Pa. Code 5100.90a

State mental hospital admission of involuntarily committed individuals-statement of policy

This statement of policy establishes procedures for transferring involuntarily committed Medical Assistance-eligible patients from community general or private psychiatric hospitals to State mental hospitals (SMH). It outlines notification requirements, referral package contents, bed availability coordination, documentation of active treatment, and Medicaid reimbursement conditions. Facility operators must follow specific steps—including timely referral packages, agreed-upon admission dates, and documented continuance of treatment—to ensure proper MA reimbursement during the transfer period.

55 Pa. Code § 5100.90a - State mental hospital admission of involuntarily committed individuals-statement of policy 

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(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.

Notes

55

 Pa. Code §
 
5100.90a

The
 provisions of this § 5100.90a adopted November 18, 1988, effective
 retroactively to November 9, 1988, 18 Pa.B.
 5168.

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