5.3 Private Psychiatric Hospital Placements
Occasionally, it may be necessary to place a child who is in the custody of the Children’s Division (CD) into a private psychiatric hospital or a general hospital which offers inpatient psychiatric services. Such a placement should be limited to situations where a child needs the diagnostic and treatment services that only a psychiatric hospital can provide. Staff is encouraged to use facilities which are contracted with CD. This is especially important if it is anticipated that the child's stay will exceed the MO HealthNet Professional Activity Study (PAS).
MO HealthNet provides payment for these placements based on a PAS determination. The number of days for which MO HealthNet will pay depends on the specific diagnosis. Each hospital should have a listing of the PAS for each distinct diagnosis or combination of diagnoses. The actual number of days paid by MO HealthNet will be determined by the discharge diagnosis. The hospital should be able to complete a preliminary diagnosis and estimate the number of days of stay within the first week.
The Regional Director must be notified as soon as it appears a stay beyond the approved PAS will be necessary. It is the responsibility of the Regional Director or RCST Coordinator to approve extra days.
The Children’s Service Worker monitors the number of days a child is in a psychiatric facility. Near the end of the allowed length of stay, the worker contacts the facility to discuss the child's discharge plan. When a MO HealthNet eligible child is in need of a psychiatric inpatient extension that is medically necessary (versus no other placement available), the worker should request, with Regional Office approval, that the facility seek prior approval of the extension through the MO HealthNet Division (MHD) for MHD payment of the service. If MHD denies the extension, the facility should submit the invoice for payment to the CD county office. Such an invoice is forwarded through normal supervisory channels to the Program Development Systems Unit (PDSU). PDSU completes and enters form CS-65 in the Children's Services Integrated Payment System (CSIPS) to generate payment. A copy of the CS-65 form will be returned to the case manager county and the Regional Director who approved the extension. Psychiatric hospital placement beyond what is covered through MO HealthNet will be charged to the residential treatment appropriation.
NOTE: Some psychiatric hospital facilities also have residential treatment units which permit transition from the one unit to the other. RCST staff shall approve and authorize any such placement into the residential treatment unit.
It is necessary to monitor and evaluate the placement of children in a private psychiatric hospital. To do so effectively, the following procedures have been developed:
- Prior to or upon placement of a child in a private psychiatric hospital, county staff shall:
- Attempt to utilize a hospital which has a contract with the Children’s Division;
- Request that the hospital provide, in writing, a treatment plan, diagnosis, and the expected length of stay within seven (7) calendar days of admittance;
- Notify the Regional Director, in writing, of the placement, including the reasons for this type of placement and expected length of stay;
- Notify the hospital that the maximum length of stay shall be that of the PAS for this diagnosis unless approval is received from the Regional Director; and
- Refer to the Regional Office, any child(ren) placed in a private psychiatric hospital, where placement beyond the PAS limits is anticipated.
- During the child's stay in the hospital, county staff shall:
- Develop a control system to indicate the maximum stay approved by the PAS;
- Make plans to move the child no later than the PAS deadline, unless the Regional Director approves an extension; and
- Notify the Regional Director, via a report requesting an extension, as soon as the length of stay is expected to exceed the PAS. Approval for extension shall only be authorized by the Regional Director. The following information should be included in the report:
- A description of the efforts made to secure an alternate placement;
- A copy of the hospital's diagnosis and recommended treatment;
- An explanation of the continued need for care at the psychiatric facility; and
- An indication, if appropriate, that a referral has been made to the area office for residential treatment services (RTS) or Department of Mental Health, or if transfer of custody is planned;
- Request the hospital seek prior approval of the extension through MHD for extended MO HealthNet payment of the service. The hospital should request MHD to notify the CD county office of the decision.
- If MHD approved the extension, request the hospital invoice MHD to determine the amount to be paid through MO HealthNet.
- If MHD denied the extension, request the hospital to invoice the county office. Send the invoice, through normal supervisory channels, to PDSU.
- As soon as possible, forward to the area office the hospital diagnosis indicating continued need for psychiatric care. The area office will utilize this material in attempting to obtain an appropriate alternate placement.
- For children whose diagnosis indicates a need for long-term treatment in a psychiatric or other facility, assess whether continued CD custody is appropriate.
- If a child is approved for continued treatment in a psychiatric facility, the Regional Director shall:
- Notify the county of the decision regarding approval for child to remain in the facility prior to expiration of the PAS days; and
- Notify Children’s Division Director of children approved for inpatient psychiatric hospitalization past the PAS end date. This notification will include:
- Child's DCN number;
- Current location of child; and
- An explanation of the continued need for treatment at the psychiatric facility.