OAR 410-172-0690: Admission Procedure for Psychiatric Residential Treatment Services for Children

(1) Admission procedures for children eligible for Medicaid shall be reviewed through an independent psychiatric review process established by the Division to certify the need for services. (2) Referral to psychiatric residential treatment services shall be because: (a) Medically appropriate treatment of the child’s psychiatric condition requires services on a 24-hour residential basis under the direction of a Licensed Medical Practitioner (LMP) as defined in OAR 309-019-0105; and (b) The services can reasonably be expected to improve the child’s condition or prevent further regression so that the services will no longer be needed. (3) The referring source shall make available to the third-party reviewer for the Certificate of Need (CON) process the following information about the referred child: (a) A written psychological or psychiatric evaluation or progress note from a face-to-face service completed by a treating, LMP within the previous 60 days that recommends treatment in a 24-hour facility under the direction of an LMP; (b) A written psychosocial history; (c) Other information from the referral source, other involved community agencies, and the family that are pertinent and appropriate; (d) Identified care coordinator; (e) Identified child and family team members; (f) Service Coordination Plan: (A) Intensive Care Coordination Plan as defined in OAR 410-141-3870; or (B) Wraparound Plan of Care as defined in OAR 309-019-0326; (g) Documentation regarding lower level of care outcomes or justification regarding how 24-hour psychiatric residential based treatment under the care of an LMP will meet the needs of the child; and (h) For fee-for-service members, a letter from Community Mental Health Program (CMHP) approving the referral to this level of care. (4) For emergency admissions, the CON shall be made by the team responsible for a plan of care as described in CFR 441.156 within 14 days from the date of admission.