L31531 HOME HEALTH - PSYCHIATRIC CARE

 

Region IV J11HH-11-002-L

 

10/18/2012

 

 

• The evaluation, psychotherapy and teaching activities needed by patients suffering from a diagnosed psychiatric disorder that requires active treatment by a psychiatrically trained nurse may be covered as skilled nursing care.

o Patients may also require medical social services, occupational therapy, home health aide visits or other home health services related to the treatment of their psychiatric diagnosis.

 

• The patient must be confined to the home.

o "The condition of these patients should be such that there exists a normal inability to leave home and, consequently, leaving the home would require a considerable and taxing effort."

o A patient with a psychiatric disorder is considered to be homebound:

 "...if his/her illness is manifested in part by a refusal to leave the home

 is of such a nature that it would not be considered safe for him/her to leave home unattended even if he/she has no physical limitations."

 The following conditions support the homebound determination:

• Agoraphobia, paranoia or panic disorder

• Disorders of thought processes wherein the severity of delusions, hallucinations, agitation and/or impairment of thoughts/cognition grossly affect the patient’s judgment and decision making, and therefore the patient’s safety

• Acute depression with severe vegetative symptoms

• Psychiatric problems associated with medical problems that render the patient homebound

o "If a patient does in fact leave the home, the patient may nevertheless be considered homebound if the absences from the home are infrequent or for relatively short duration, or are attributable to the need to receive medical treatment."

• Services must be provided under a Home Health Plan of Care approved and signed by the treating physician.

• Nursing services provided must meet the part-time or intermittent requirements for home health services. "In most instances, this definition will be met if a patient requires a skilled nursing service at least every 60 days."

• Services must be reasonable and necessary for treating the patient's psychiatric diagnosis and/or symptoms.

• The services of a skilled psychiatric nurse must be required to provide the necessary care:

o Observation/assessment.

o Teaching/training activities.

o Management and evaluation of a patient care plan.

o Direct patient care of a diagnosed psychiatric condition which may include behavioral/cognitive interventions.

• Note: Psychiatric nursing must be furnished by an agency that does not primarily provide care and treatment of mental disorders. These agencies are precluded from participating as Medicare home health agencies.

 

QUALIFICATIONS FOR PSYCHIATRICALLY TRAINED NURSES PROVIDING PSYCHIATRIC EVALUATION AND THERAPY IN THE HOME

 

• Nurses who provide psychiatric evaluation and therapy as skilled nursing care to patients of a home health agency are required to have special training and/or experience beyond the standard curriculum required for an RN.

• Palmetto GBA would consider the special training and/or experience requirements to be met, if the registered nurse (RN) meets one of the following criteria:

o An RN with a Master’s degree with a specialty in psychiatric or mental health nursing and licensed in the state where practicing would qualify.

 The RN must have nursing experience (recommended within the last three years) in an acute treatment unit in a psychiatric hospital, psychiatric home care, psychiatric partial hospitalization program or other outpatient psychiatric services.

o An RN with a Bachelor’s degree in nursing and licensed in the state where practicing would qualify.

 The RN must have one year of recent nursing experience (recommended within the last three years) in an acute treatment unit in a psychiatric hospital, psychiatric home care, psychiatric partial hospitalization program or other outpatient psychiatric services.

o An RN with a Diploma or Associate degree in nursing and licensed in the state where practicing would qualify.

 The RN must have two years of recent nursing experience (recommended within the last three years) in an acute treatment unit in a psychiatric hospital, psychiatric home care, psychiatric partial hospitalization program or other outpatient psychiatric services.

o An RN who has worked as a psychiatric Home Health (HH) Nurse within the last calendar year prior to the effective date of this policy will be grandfathered in.

• On an individual basis, other combinations of education and experience may be considered.

• It is highly recommended that psychiatric RNs also have medical/surgical nursing experience because many psychiatric patients meet homebound criteria due to a physical illness.

• Home Health agencies should 1) submit the resume of any nurse currently providing psychiatric services under the Home Health Medicare benefit, 2) submit the resume of any RN that will be providing psychiatric services under the Home Health Medicare benefit. Send the resume to the following address:

o Palmetto Government Benefits Administrators

J11 Part A, Medical Affairs

Mail Code AG-300

P. O. Box 100238

Columbia, SC 29202-3238

OR

Fax 1-803-935-0199

OR

Email J11A.Policy@PalmettoGBA.com

• *Home Health Agencies should include a cover letter with each resume. The cover letter must include the agencies complete mailing address and the name and phone number of a contact person at the agency.

• The resume will be reviewed and you will be notified if the RN meets the requirements or not within 30 days.

o *Note: This notification should be in your files prior to the RN rendering psychiatric services.

• Nurses with these qualifications would meet the requirements necessary to provide psychiatric evaluation and therapy to Medicare home health patients.

o The services of a psychiatric nurse are to be provided under a plan of care established and reviewed by the treating physician.

• For additional information, see the BILLING WHEN SEPARATE VISITS WERE MADE FOR MEDICAL AND PSYCHIATRIC NURSING CARE section of this policy.

 

 

• Diagnostic Criteria

o A Patient must have an Axis I Diagnosis as defined in the Diagnostic and Statistical Manual of Mental Health Disorders, 4th Edition, DSM-IV-TR.

 This diagnosis must match the diagnosis that the ordering physician is treating and/or for which the patient was hospitalized.

 This diagnosis must be fully documented and available in the medical record.

 The DSM-IV-TR utilizes a multiaxial assessment methodology and "Axis I" is defined as "Clinical disorders, other conditions that may be a focus of clinical assessment" as opposed to personality disorders, mental retardation, general medical conditions, psychosocial and environmental problems and global assessment of functioning.

o The patient must be under the care of a physician who is qualified to sign the physician’s certification and recertify the plan of care at least every 60 days (two months).

 The physician's evaluation and subsequent recertifications must become part of the patient's medical record.

o If the skills of a psychiatric RN are required, the service must be reasonable and necessary and intermittent.

o Reasonable goals must be established and there must be a reasonable expectation that the goals will be achieved.

 Decreasing and/or shortening in-patient and emergency room care may be a goal for the psychiatric patient's plan of care.

 

 

• Home Health Plan of Care

o The Plan of Care for a psychiatric patient must be completed. Emphasis must be placed on documentation of mental status and those skills necessary to treat the psychiatric diagnosis.

 

 

Psychiatric Interdisciplinary Team's Role

 

• Physician:

o Certifies/Recertifies the patient’s homebound status

o Approves Home Health Plan of Care which must be signed and dated prior to the home health agency billing for services.

o Prescribes medications as necessary

o Provides supplemental orders when medically necessary

 

• Skilled Nursing Care:

o Registered Psychiatric Nurse:

 Makes initial assessment visit utilizing observation/assessment skills

 Manages medical illness; performs psycho-biological interventions

 Evaluates, teaches and reviews medications and compliance; administers IM or IV medication

 Manages situational or other crises; performs assessments of potential self-harm or harm to others, and refers to the treating physicians as necessary

 Teaches self-care, mental and physical well-being, promotes independence and patient’s rights

 Promotes and encourages patient/caregiver to maintain a therapeutic environment

 Provides supportive counseling psychotherapy and psycho-therapeutic interventions according to education and licensure.

• Provides psycho-education such as teaching/training with disease process, symptom and safety management, coping skills and problem solving

 Provides evaluation and management of the patient's care plan

 Counseling services may be rendered by either a trained psychiatric nurse or a social worker.

• These services should not be duplicative.

• Concurrent counseling or psychotherapy services by multiple providers are not medically necessary

 Although intervention with family members may be appropriate on occasion, services by a trained psychiatric nurse to family members are not a covered home health benefit, even if the patient will benefit.

 

• Medical Social Services

o Medical social services provided by a qualified medical social worker (MSW) or a social work assistant under the supervision of a qualified MSW, may be covered as home health services when all of following apply:

 The patient meets the qualifying criteria for coverage of Home Health services.

 The services of these professionals are necessary to resolve social or emotional problems which are, or are expected to be, an impediment to the effective treatment of the patient's psychiatric condition or his/her rate of recovery.

 The plan of care clearly indicates that the skills of a qualified MSW (or a social worker assistant under the supervision of a qualified MSW) are required to safely and effectively provide the needed care.

o When the above requirements are met, coverage for social worker visits may include, but are not limited to the following:

 Assessment of the social and emotional factors related to the patient’s illness, the need for care, response to treatment and adjustment to care

 Assessment of the relationship of the patient’s medical and nursing requirements to the individual’s home situation, financial resources and availability of community resources

 Counseling services that are required by the patient for the treatment of their psychiatric condition (Psychotherapy services, constituting active treatment of the psychiatric condition, may be provided by licensed clinical social workers.)

 Brief counseling (two or three visits) of the patient's family or care-giver(s) when they are reasonable and necessary to resolve problems that are a clear and direct impediment to the treatment of patient's illness or injury or rate of recovery

 Appropriate action to obtain available community resources to assist in resolving the patient's problem

o Note: Medicare does not cover the services of an MSW to assist in filing the application for Medicaid or follow up on the application.

 Federal regulation requires the state to provide assistance in completing the application to anyone who chooses to apply for Medicaid.

o Note: A patient may require separate and distinct services provided by a skilled psychiatric nurse and a medical social worker.

 However, care must be used to avoid duplication of services that could be provided by both of these disciplines, e.g., counseling of the patient.

 

• Home Health Aide (HHA)

o Home health aides may perform personal care or other covered home health aide services.

 

• Occupational Therapist (OT)

o The skills of an occupational therapist may be required to decrease or eliminate limitations in functional activity imposed by psychiatric illness or disability.

 Occupational therapists may address factors which interfere with the performance of specific functional activities due to cognitive, sensory, psychosocial or perceptual deficits.

o The skills of an occupational therapist to assess and reassess a patient’s rehabilitation needs and potential or to develop and/or implement an occupational therapy plan are covered when they are reasonable and necessary because of the patient’s condition.

o The planning, implementing and supervision of therapeutic programs (including, but not limited to those listed below) are skilled occupational therapy services.

 As such these services are covered if they are reasonable and necessary for the treatment of the patient's illness or injury.

• Selecting and teaching task oriented therapeutic activities designed to restore and increase cognitive abilities and functional participation in ADLs and advanced ADLs

• Planning, implementing and supervising therapeutic tasks and activities designed to restore sensory-integrative function

• Planning, implementing and supervising of individualized therapeutic activity programs (as well as adapting the environment) as part of an overall “active treatment” program for a patient with a diagnosed psychiatric illness

• Assessing and planning for improved home safety

 

 

• Billing When Separate Visits Were Made for Medical and Psychiatric Nursing Care

o Psychiatric nursing care is not separately billable from non-psychiatric nursing care.

o Both of these services constitute skilled nursing care and may be furnished by the psychiatric nurse, in the course of a single visit.

o Therefore, visits will not be covered for one nurse to provide psychiatric nursing care and another to provide non-psychiatric nursing care, unless the non-psychiatric nursing care is of such a highly specialized and technical nature, that the service could not be safely rendered by the psychiatric nurse (e.g. infusion therapy).

 

 

• Concurrent Admission to Home Health and Partial Hospitalization Program

o Because Partial Hospitalization services are intended to meet all of the patient's psychiatric care needs, patients admitted to a Partial Hospitalization Program (PHP) are not generally considered appropriate for psychiatric home health services.

o Medical necessity must be substantiated on a case by case basis.

o If there are concurrent admissions, the home health claims will be reviewed to verify the medical necessity of the service(s) provided and that the homebound criterion is met.

 

 

• Discharge Criteria

o Patients should cease receiving psychiatric home health services when:

 Physician orders discharge

 Patient discontinues/refuses service with physician or nurse

 Patient is not compliant with the treatment plan, despite appropriate provider interventions

 Patient/family requests discharge

 The treatment objectives and stated functional outcome goals have been attained or are no longer attainable

 The patient is no longer homebound

 Other appropriate discharge protocols, e.g., the patient moves or is transferring to another agency, etc.

 

 

• Psychiatric Nursing in Group Setting

o Group interventions for psychiatric home health patients are not covered under the home health benefit. The plan of care and treatment must be individualized.

 

 

Bill Type Codes:

• Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service.

• Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type.

• Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

 

032x Home Health - Inpatient (plan of treatment under Part B only)

033x Home Health - Outpatient (plan of treatment under Part A, including DME under Part A)

 

Revenue Codes:

• Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service.

• In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination.

• Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

 

0430  Occupational Therapy - General Classification

0550  Skilled Nursing - General Classification

0560  Home Health (HH) - Medical Social Services - General Classification

0570  Home Health (HH) Aide - General Classification

 

 

CPT/HCPCS Codes

• As of July 1999, Home Health agencies must use the following HCPCS codes when billing for Home Health services provider under a plan of treatment. These services must report time spent with the patient in 15-minute increments.

 

G0152 SERVICES PERFORMED BY A QUALIFIED OCCUPATIONAL THERAPIST IN THE HOME HEALTH OR HOSPICE SETTING, EACH 15 MINUTES

G0154 DIRECT SKILLED NURSING SERVICES OF A LICENSED NURSE (LPN OR RN) IN THE HOME HEALTH OR HOSPICE SETTING, EACH 15 MINUTES

G0155 SERVICES OF CLINICAL SOCIAL WORKER IN HOME HEALTH OR HOSPICE SETTINGS, EACH 15 MINUTES

G0156 SERVICES OF HOME HEALTH/HOSPICE AIDE IN HOME HEALTH OR HOSPICE SETTINGS, EACH 15 MINUTES

 

 

ICD-9 Codes that Support Medical Necessity

 

Patients must have Axis I Diagnosis as defined in the DSM-IV-TR.

290.11 PRESENILE DEMENTIA WITH DELIRIUM

290.12 PRESENILE DEMENTIA WITH DELUSIONAL FEATURES

290.13 PRESENILE DEMENTIA WITH DEPRESSIVE FEATURES

290.20 SENILE DEMENTIA WITH DELUSIONAL FEATURES

290.21 SENILE DEMENTIA WITH DEPRESSIVE FEATURES

290.3 SENILE DEMENTIA WITH DELIRIUM

290.41 VASCULAR DEMENTIA, WITH DELIRIUM

290.42 VASCULAR DEMENTIA, WITH DELUSIONS

290.43 VASCULAR DEMENTIA, WITH DEPRESSED MOOD

291.0 ALCOHOL WITHDRAWAL DELIRIUM

291.1 ALCOHOL-INDUCED PERSISTING AMNESTIC DISORDER

291.2 ALCOHOL-INDUCED PERSISTING DEMENTIA

291.81 ALCOHOL WITHDRAWAL

291.89 OTHER SPECIFIED ALCOHOL-INDUCED MENTAL DISORDERS

292.0 DRUG WITHDRAWAL

292.11 DRUG-INDUCED PSYCHOTIC DISORDER WITH DELUSIONS

292.12 DRUG-INDUCED PSYCHOTIC DISORDER WITH HALLUCINATIONS

292.2 PATHOLOGICAL DRUG INTOXICATION

292.81 - 292.84 DRUG-INDUCED DELIRIUM - DRUG-INDUCED MOOD DISORDER

292.85 DRUG INDUCED SLEEP DISORDERS

292.89 OTHER SPECIFIED DRUG-INDUCED MENTAL DISORDERS

292.9 UNSPECIFIED DRUG-INDUCED MENTAL DISORDER

293.81 - 293.84PSYCHOTIC DISORDER WITH DELUSIONS IN CONDITIONS CLASSIFIED ELSEWHERE - ANXIETY DISORDER IN CONDITIONS CLASSIFIED ELSEWHERE

293.89 OTHER SPECIFIED TRANSIENT MENTAL DISORDERS DUE TO CONDITIONS CLASSIFIED ELSEWHERE, OTHER

293.9 UNSPECIFIED TRANSIENT MENTAL DISORDER IN CONDITIONS CLASSIFIED ELSEWHERE

294.0 AMNESTIC DISORDER IN CONDITIONS CLASSIFIED ELSEWHERE

294.11 DEMENTIA IN CONDITIONS CLASSIFIED ELSEWHERE WITH BEHAVIORAL DISTURBANCE

294.20 DEMENTIA, UNSPECIFIED, WITHOUT BEHAVIORAL DISTURBANCE

294.21 DEMENTIA, UNSPECIFIED, WITH BEHAVIORAL DISTURBANCE

294.8 OTHER PERSISTENT MENTAL DISORDERS DUE TO CONDITIONS CLASSIFIED ELSEWHERE

295.00 SIMPLE TYPE SCHIZOPHRENIA UNSPECIFIED STATE

295.01 - 295.04 SIMPLE TYPE SCHIZOPHRENIA SUBCHRONIC STATE - SIMPLE TYPE SCHIZOPHRENIA CHRONIC STATE WITH ACUTE EXACERBATION

295.10 DISORGANIZED TYPE SCHIZOPHRENIA UNSPECIFIED STATE

295.11 - 295.14 DISORGANIZED TYPE SCHIZOPHRENIA SUBCHRONIC STATE - DISORGANIZED TYPE SCHIZOPHRENIA CHRONIC STATE WITH ACUTE EXACERBATION

295.30 PARANOID TYPE SCHIZOPHRENIA UNSPECIFIED STATE

295.31 - 295.34 PARANOID TYPE SCHIZOPHRENIA SUBCHRONIC STATE - PARANOID TYPE SCHIZOPHRENIA CHRONIC STATE WITH ACUTE EXACERBATION

295.40 - 295.45 SCHIZOPHRENIFORM DISORDER, UNSPECIFIED - SCHIZOPHRENIFORM DISORDER, IN REMISSION

295.50 - 295.55 LATENT SCHIZOPHRENIA UNSPECIFIED STATE - LATENT SCHIZOPHRENIA IN REMISSION

295.70 SCHIZOAFFECTIVE DISORDER, UNSPECIFIED

295.71 - 295.74 SCHIZOAFFECTIVE DISORDER, SUBCHRONIC - SCHIZOAFFECTIVE DISORDER, CHRONIC WITH ACUTE EXACERBATION

295.75 SCHIZOAFFECTIVE DISORDER, IN REMISSION

296.01 - 296.05 BIPOLAR I DISORDER, SINGLE MANIC EPISODE, MILD - BIPOLAR I DISORDER, SINGLE MANIC EPISODE, IN PARTIAL OR UNSPECIFIED REMISSION

296.11 - 296.15 MANIC AFFECTIVE DISORDER RECURRENT EPISODE MILD DEGREE - MANIC AFFECTIVE DISORDER RECURRENT EPISODE IN PARTIAL OR UNSPECIFIED REMISSION

296.21 - 296.25 MAJOR DEPRESSIVE AFFECTIVE DISORDER SINGLE EPISODE MILD DEGREE - MAJOR DEPRESSIVE AFFECTIVE DISORDER SINGLE EPISODE IN PARTIAL OR UNSPECIFIED REMISSION

296.31 - 296.35 MAJOR DEPRESSIVE AFFECTIVE DISORDER RECURRENT EPISODE MILD DEGREE - MAJOR DEPRESSIVE AFFECTIVE DISORDER RECURRENT EPISODE IN PARTIAL OR UNSPECIFIED REMISSION

296.41 - 296.45 BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MANIC, MILD - BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MANIC, IN PARTIAL OR UNSPECIFIED REMISSION

296.51 - 296.55 BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) DEPRESSED, MILD - BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) DEPRESSED, IN PARTIAL OR UNSPECIFIED REMISSION

296.61 - 296.65 BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MIXED, MILD - BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) MIXED, IN PARTIAL OR UNSPECIFIED REMISSION

296.7 BIPOLAR I DISORDER, MOST RECENT EPISODE (OR CURRENT) UNSPECIFIED

296.80 BIPOLAR DISORDER, UNSPECIFIED

296.81 ATYPICAL MANIC DISORDER

296.82 ATYPICAL DEPRESSIVE DISORDER

296.89 OTHER AND UNSPECIFIED BIPOLAR DISORDERS, OTHER

296.90 UNSPECIFIED EPISODIC MOOD DISORDER

296.99 OTHER SPECIFIED EPISODIC MOOD DISORDER

297.0 - 297.9 PARANOID STATE SIMPLE - UNSPECIFIED PARANOID STATE

298.0 - 298.9 DEPRESSIVE TYPE PSYCHOSIS - UNSPECIFIED PSYCHOSIS

299.00 - 299.01 AUTISTIC DISORDER, CURRENT OR ACTIVE STATE - AUTISTIC DISORDER, RESIDUAL STATE

299.10 CHILDHOOD DISINTEGRATIVE DISORDER, CURRENT OR ACTIVE STATE

299.11 CHILDHOOD DISINTEGRATIVE DISORDER, RESIDUAL STATE

299.80 OTHER SPECIFIED PERVASIVE DEVELOPMENTAL DISORDERS, CURRENT OR ACTIVE STATE

299.81 OTHER SPECIFIED PERVASIVE DEVELOPMENTAL DISORDERS, RESIDUAL STATE

300.00 - 300.9 ANXIETY STATE UNSPECIFIED - UNSPECIFIED NONPSYCHOTIC MENTAL DISORDER

310.81 PSEUDOBULBAR AFFECT

310.89 OTHER SPECIFIED NONPSYCHOTIC MENTAL DISORDERS FOLLOWING ORGANIC BRAIN DAMAGE

311 DEPRESSIVE DISORDER NOT ELSEWHERE CLASSIFIED

331.11 PICK'S DISEASE

331.19 OTHER FRONTOTEMPORAL DEMENTIA

331.2 SENILE DEGENERATION OF BRAIN

331.6 CORTICOBASAL DEGENERATION

331.82 DEMENTIA WITH LEWY BODIES

332.1 SECONDARY PARKINSONISM

333.71 ATHETOID CEREBRAL PALSY

333.72 ACUTE DYSTONIA DUE TO DRUGS

333.85 SUBACUTE DYSKINESIA DUE TO DRUGS

333.90 UNSPECIFIED EXTRAPYRAMIDAL DISEASE AND ABNORMAL MOVEMENT DISORDER

333.92 NEUROLEPTIC MALIGNANT SYNDROME

333.94 RESTLESS LEGS SYNDROME

333.99 OTHER EXTRAPYRAMIDAL DISEASES AND ABNORMAL MOVEMENT DISORDERS

780.1 HALLUCINATIONS

780.33 POST TRAUMATIC SEIZURES

 

 

Documentations Requirements

• Documentation supporting the medical necessity should be legible, maintained in the patient’s medical record, and must be made available to the A/B MAC upon request.

• Documentation should address the diagnoses and interventions identified on the Plan of Care.

• Documentation should be brief and factual. Use descriptive charting: be problem-specific.

• Documentation should clearly support the medical necessity for services.

• Each visit note should include documentation of any psychiatric or medical assessment, an evaluation of the patient’s mental status, level of function and progress toward goals.

o Document objectively when describing behaviors and/or findings.

• Document changes in the patient’s condition and the actions taken, e.g., notification of the physician.

• Document the assessment of home milieu and supportive environment.

• Teaching has to be directed to improving function.

o Document identified teaching needs in response to psychiatric symptoms.

o Document all patient/family education, the reason for education, what was taught, and the patient’s response.

o If repetitive teaching is required, documentation must clearly show the medical necessity of that teaching.

• Document the patient’s understanding and compliance of the medication regimen and treatment plan, and how verified.

• Document the administration of IM and/or IV medications, their effectiveness, and any side effects of the patient's medication regime.

• Document patient safety issues.

• Documentation should show that periodic venipuncture for blood levels for psychiatric medications, such as Lithium, Tegretol, Clozaril and others, and other related laboratory work, are performed when necessary and pertinent reports of results are in the medical record.

o This ensures patient compliance and appropriate therapeutic levels.

• Clinical documentation requirements must be kept on file in the patient’s medical record and be available to the Intermediary upon request.

• The person rendering the service must sign each visit note.

o If psychiatric services were rendered it must have been performed by a psychiatric RN, and their resume must have been reviewed and approved by Palmetto GBA.

 

Utilization Guidelines

• Psychiatric skilled nursing care must be provided by a credential nurse (Services will be denied if their psychiatric credentials are not on file with Palmetto GBA.)

• For patients with Alzheimer’s disease please refer to the Local Coverage Determination (LCD) Home Health Skilled Nursing Care-Teaching and Training Alzheimer’s Disease and Behavioral Disturbances L31532/J11HH-11-003-L.

Sources of Information and Basis for Decision

 

Diagnostic and Statistical Manual of Mental Health Disorders, 4th Edition, DSM-IV, American Psychiatric Association, 2000

 

IASD Health Services Corporation policy on Home Health Psychiatric Care, 9/1/96

 

Diagnostic and Statistical Manual of Mental Health Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

 

 Local Coverage Determination - L31531 HOME HEALTH - PSYCHIATRIC CARE