Medicaid (Title XIX of the Social Security Act)
Requirements for Mental Hospitals, Institutions for Mental Diseases and Intermediate Care Facilities for the Mentally Retarded (ICF-MRs)

b.) Requirements for Mental Hospitals, Institutions for Mental Diseases and Intermediate Care Facilities for the Mentally Retarded (ICF-MRs)

At the time of an enrollee’s admission to an inpatient hospital, an inpatient mental hospital or an ICF-MR (or at the time of a patient’s application for medical assistance), a qualified medical professional must certify that the enrollee needs (or needed) services provided at the facility.15  Inpatient mental hospitals and ICF-MRs must maintain a program of regular medical review16 and periodic recertification17 of each patient’s continued need for services in the facility.18  The state must establish a medical review program where an independent team evaluates the professional management of the care and services provided to patients in mental hospitals and ICF-MRs.19  The state must develop individual plans for enrollee patients in institutions for mental diseases who are age 65 and older.20  These plans must include assurances that there will be initial and regular review of the patient’s needs and a periodic determination of his continued need for treatment in the institution.21  The plans must also provide for agreements with mental disease authorities arranging for access to patients and facilities, joint planning and development of alternative methods of care, furnishing information and making reports.22