Effective Date: 11-15-2021
Occasionally, it may be necessary to place a child who is in the custody of the Children’s Division into an acute mental health hospital setting. Such a placement should be limited to situations where a child is in crisis and needs the safety monitoring, assessment, and treatment services that only an inpatient psychiatric hospital setting can provide. MO HealthNet provides payment based on the number of days certified as medically necessary, while Children’s Division is financially responsible for any additional days through discharge.
Criteria for Placement
The American Academy of Child and Adolescent Psychiatry provides the following basic guidelines for psychiatric hospital admission:
- The child has a psychiatric disorder which is of such severity as to cause significant impairment of daily functioning in at least two (2) important areas of his/her life, i.e., school performance, social interactions, or family relationships;
- The treatment proposed is relevant to the problems diagnosed and adjudged likely to benefit the child; and
- Other available less restrictive treatment resources must have been considered and determined to be not available or not appropriate to the child’s needs or have been attempted and proven unsuccessful.
If a child is in psychiatric crisis, or in cases where the child has already been hospitalized, the Children’s Service Worker should consult with appropriate supervisory staff immediately to determine if the child is a potential candidate for psychiatric hospitalization.
Placement and Service Delivery
MO HealthNet provides payment for inpatient days certified as medically necessary by its review authority, Conduent. Children’s Division is financially responsible for any days the child remains in the hospital beyond the certified medically necessary length of stay days.
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:
- Begin working on the child’s discharge plan at the onset of placement, ensuring the child moves within the number of days certified by the MHD review authority, Conduent, unless the Regional Director or RCST approves an extension (see next section);
- Request the hospital provide, in writing, a treatment plan, diagnosis, and the expected length of stay within three (3) calendar days of admittance;
- Notify the Regional Director, in writing, of the placement, including the reasons for this type of placement, expected length of stay, and discharge plan, if known;
- If long-term residential treatment services (RTS) are anticipated, make a residential referral through FACES for the RCST within three (3) days of placement. The referral should include the following:
- Form CS-9;
- A list of specifically identified and described problems;
- A list of specifically identified strengths;
- Placement history including date child entered CD custody and number and type of previous placements;
- Current social/family history;
- Current IEP and/or other appropriate educational records;
- Current medical evaluation and other appropriate medical records;
- Current psychological evaluation and counseling reports; and
- Any other appropriate information (including hospital admission summary and diagnoses).
- If the child is in need of an inpatient extension beyond the days originally certified as medically necessary, inquire if the hospital has contacted Conduent to request additional days be certified. Any additional days certified as medically necessary will be reimbursed by MO HealthNet.
Length of Stay Exceeds Number of Days Certified as Medically Necessary
MO HealthNet provides payment to enrolled providers for inpatient days certified as medically necessary by its review authority, Conduent. Children’s Division is financially responsible for any days the child remains in the hospital beyond the certified medically necessary length of stay days.
Approval for extension beyond the number of days certified as medically necessary shall only be authorized by the Regional Director or RCST, depending on the anticipated discharge plan. As soon as it appears a stay beyond the number of days certified as medically necessary is needed, the Children’s Service Worker shall request approval for an extension:
- From the Regional Director for a child moving into a resource home placement within the community upon discharge, or
- From the RCST for a child being referred for residential treatment upon discharge.
The following information should be included in the request for extension:
- Child’s name and DCN;
- Current placement/facility;
- Explanation of the continued need for stay at the psychiatric facility;
- Description of the efforts made to secure an alternate placement; and
- Copy of the hospital’s diagnosis and recommended treatment upon discharge.
The Regional Director or RCST shall notify the Children’s Service Worker of the decision regarding approval for the child to remain in the facility prior to expiration of the maximum number of days certified by Conduent.
It is the responsibility of the Regional Director or RCST to provide the hospital with written authorization to allow the child to remain in the hospital beyond the number of days certified by Conduent as medically necessary. The written authorization must clearly state that CD is responsible for payment beyond the medically necessary length of stay days.
The hospital should invoice the county office for any inpatient days beyond those certified as medically necessary:
- For a child discharged from the hospital to a resource home placement within the community, a Payment Request should be submitted through approval levels to DFAS for reimbursement.
- For a child with a plan to enter residential treatment upon discharge, the invoice should be submitted to the RCST who will facilitate a Child-Specific Contract for payment.