C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 441—SERVICES: REQUIREMENTS AND LIMITS APPLICABLE TO SPECIFIC SERVICES › Subpart D—Inpatient Psychiatric Services for Individuals Under Age 21 in Psychiatric Facilities or Programs

42 C.F.R. § 441.152

Certification of need for services

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(a) A team specified in § 441.154 must certify that—

(1) Ambulatory care resources available in the community do not meet the treatment needs of the beneficiary;

(2) Proper treatment of the beneficiary's psychiatric condition requires services on an inpatient basis under the direction of a physician; and

(3) The services can reasonably be expected to improve the beneficiary's condition or prevent further regression so that the services will no longer be needed.

(b) The certification specified in this section and in § 441.153 satisfies the utilization control requirement for physician certification in §§ 456.60, 456.160, and 456.360 of this subchapter.

[43 FR 45229, Sept. 29, 1978, as amended at 61 FR 38398, July 24, 1996]
Notes of Decisions
Cited in 5 cases, 2003–2009 · leading case: Psychiatric Healthcare Corp. v. Dep't of Soc. Servs., 100 S.W.3d 891 (Mo. Ct. App. 2003).
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Psychiatric Healthcare Corp. v. Dep't of Soc. Servs., 100 S.W.3d 891 (Mo. Ct. App. 2003). · cites it 3× “(1) Ambulatory care resources available in the community do not meet the treatment needs of the recipient; (2) Proper treatment ... requires services on an inpatient basis .”
Kootenai Med. Ctr. v. Idaho Dep't of Health & Welfare, 216 P.3d 630 (Idaho 2009). · cites it 8× “05 conflicts with the certification requirement found in 42 C.F.R. 441.152; (3) whether the hearing officer’s preliminary orders were supported by substantial evidence in the record; and (4) whether the Department is entitled to an award of attorney fees and costs on appeal.”
Psychiatric Solutions of Virginia, Inc. v. Finnerty, 676 S.E.2d 358 (Va. Ct. App. 2009). “Absent such information, appellant’s treatment team was deprived of information important to the stated goals of “improving] the recipient’s condition or preventing] further regression so that the [inpatient] services will no longer be needed,” 42 C.F.R. § 441.152 (emphasis…”
Kootenai Med. Ctr. v. Idaho Dept. of Health & Welfare (Idaho 2009). · cites it 8× “05 conflicts with the certification requirement found in 42 C.F.R. 441.152; (3) whether the hearing officer‟s preliminary orders were supported by substantial evidence in the record; and (4) whether the Department is entitled to an award of attorney fees and costs on appeal.”
Kootenai Med. Ctr. v. Idaho Dept. of Health & Welfare (Idaho 2009). · cites it 8× “05 conflicts with the certification requirement found in 42 C.F.R. 441.152; (3) whether the hearing officer‟s preliminary orders were supported by substantial evidence in the record; and (4) whether the Department is entitled to an award of attorney fees and costs on appeal.”
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