317:30-5-95.26. Medical necessity criteria for continued stay - acute psychiatric admission for children
For continued stay acute psychiatric admissions for children must meet all of the conditions set forth in (1) to (5) of this subsection.
(1) A primary diagnosis from the most recent edition of "The Diagnostic and Statistical Manual of Mental Disorders" (DSM) with the exception of V-Codes, adjustment disorders, and substance abuse related disorders, accompanied by a detailed description of the symptoms supporting the diagnosis. In lieu of a qualifying diagnosis, children 18-20 years of age may have a diagnosis of any personality disorder. Adjustment or substance related disorders may be a secondary diagnosis.
(2) Patient continues to manifest a severity of illness that requires an acute level of care as defined in the admission criteria and which could not be provided in a less restrictive setting.
(A) Documentation of regression is measured in behavioral terms.
(B) If condition is unchanged, evidence of re-evaluation of treatment objectives and therapeutic interventions.
(3) Conditions are directly attributable to a mental disorder as the primary need for professional attention (this does not include placement issues, criminal behavior, status offenses).
(4) Documented efforts of working with the child's family, legal guardians and/or custodians and other human service agencies toward a tentative discharge date.
(5) Requires secure 24-hour nursing/medical supervision as evidenced by:
(A) Stabilization of acute psychiatric symptoms;
(B) Need for extensive treatment under the direction of a physician; and
(C) Physiological evidence or expectation of withdrawal symptoms which require 24-hour medical supervision.