Emergency Assistance - Psychiatric Indigent Inpatient (PII)
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Emergency Assistance - Psychiatric Indigent Inpatient (PII)


Revised May 2, 2014



Purpose: The Psychiatric Indigent Inpatient (PII) program uses state dollars to fund voluntary psychiatric inpatient hospital services for those who cannot qualify for other state medical assistance or Medicaid programs.

WAC 388-865-0217Psychiatric indigent inpatient program.

This program only covers voluntary psychiatric inpatient hospital services that are approved through the Regional Support Networks (RSN). It does not cover people who are admitted through the Involuntary Treatment Act (ITA). ITA payments do not go through ACES. Hospitals continue to bill ITA claims as they have in the past.

For more information on mental health benefits that are available to DSHS clients, see the PUBLIC MENTAL HEALTH SYSTEM BENEFITS BOOKLET FOR PEOPLE ENROLLED IN MEDICAID.


WAC 388-865-0217

WAC 388-865-0217

Effective July 16, 2006

WAC 388-865-0217 Psychiatric indigent inpatient program.

  1. The psychiatric indigent inpatient (PII) program is a state-funded, limited casualty (LCP) program specifically for mental health clients identified in need of inpatient psychiatric care by the regional support network (RSN).

  2. The psychiatric indigent inpatient (PII) program pays only for emergent voluntary inpatient psychiatric care in community hospitals within the state of Washington. Psychiatric indigent inpatient (PII) does not cover ancillary charges for physician, transportation, pharmacy, or other costs associated with a voluntary inpatient psychiatric hospitalization. 

  3. To be eligible for the psychiatric indigent inpatient (PII) program, a client is subject to the following conditions and limitations:

  1. The client must have a voluntary inpatient psychiatric admission authorized by a regional support network (RSN) in the month of application or within the three months immediately preceding the month of application.

  2. Consumers applying for the psychiatric indigent inpatient (PII) program are subject to the income and resource rules for TANF and TANF-related clients in chapters 388-450 and 388-470  WAC.

  3. If a client's income and/or resources exceed the standard for medically needy (MN), as described in WAC 388-478-0070, the client must spend down the excess amount as described in WAC 388-519-0100 for the client to be eligible for the psychiatric indigent inpatient (PII) program.  Spenddown is a client financial obligation for medical expenses.  The department deducts the spenddown from payments to providers (see WAC 388-502-0100 ).

  4. A client who is voluntarily admitted must have incurred an emergency medical expense requirement (EMER) of two thousand dollars over a twelve-month period.  EMER is a client financial obligation.  The department deducts the EMER from payments to providers (see WAC 388-502-0100 ).

  1. Qualifying emergency medical expense requirement (EMER) expenses are psychiatric inpatient services in a community hospital.

  2. The emergency medical expense requirement (EMER) period lasts for twelve calendar months, beginning on the first day of the month of certification for psychiatric indigent inpatient (PII) and continuing through the last day of the twelfth month.

  1. A client is limited to a single three-month period of psychiatric indigent inpatient (PII) eligibility per twelve-month emergency medical expense requirement (EMER) period.

  1. Clients are not eligible for the psychiatric indigent inpatient (PII) program if they:

  1. Are eligible for, or receiving, any other cash or medical program; or

  2. Entered the Washington state specifically to obtain medical care; or

  3. Are an inmate of a federal or state prison.

  4. Are committed under the Involuntary Treatment Act (ITA).

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

  1. PII requires a $2,000 EMER for voluntary inpatient psychiatric hospital services per client during a 12 calendar-month period. The 12 month period begins on the first day of the month of certification and goes through the last day of the 12th calendar month.

  2. A client incurs the $2,000 EMER expense one time during a 12 month period. If a client is voluntarily admitted again after the 3 month certification but still during the 12 month EMER period and applies for PII, a new Provider One authorization number is issued and an exception to rule will be required. If approved, the exception can waive the EMER for that client for that time period.

  3. The client is responsible for the $2,000 EMER and any spenddown. DSHS does not cover these expenses. Individuals with countable income equal to or below the federal poverty level based on their household size may be eligible to have the $2000 EMER expense written off by the hospitals under charity care laws per WAC 246-453-020.

  4. Financial eligibility for PII follows the TANF rules, including the 50% earned income disregard.


EXAMPLE

Mark admitted as a voluntary psychiatric inpatient at Harborview Hospital in Seattle on July 10. He is married with 2 children; he earns $2500 per month and his wife earns $2000 per month. They have no health insurance. The CSO receives a hospital application from Harborview for PII on July 30. Mark has incurred $10,000 in inpatient psychiatric hospital services as of July 25 and expects to remain inpatient for another two to four weeks.


Monthly Income: $2500 + $2000  = $4500
  $4500 X 50% (disregard)  = $2250
  $2250
Less the MNIL standard for 4 person household (as of 7/1/06) $742
Spenddown per month for PII $1508

Mark's PII Liability: $2,000 EMER
  + $4,524 Spenddown (3 month certification)
  $6,524  

Mark is determined eligible for PII with a certification period of July, August and September.


  1. PII must be authorized by a Regional Support Network (RSN) in the month of application or within the preceding three months. The authorization code must be input to ACES for approval of the PII program.  The authorization code is the 9 digit authorization number generated by Provider One on cases where the authorization status is approved.

  2. Referrals to the Medicaid Purchasing Administration (MPA) Medical Consultant are not required for PII.


WORKER RESPONSIBILITIES

  1. To open a PII assistance unit, enter the Provider One authorization number written on the DSHS 14-001, Application for Benefits, into the RSN Number field on the ALAS screen in ACES. 

    If you receive an application without an authorization number, take the following steps:

    • Contact the hospital and obtain the authorization number, and

    • Confirm that the authorization status is approved.

    • If the authorization status is denied, deny PII.

    • If there is no authorization number, deny PII.


NOTE: Regional Support Networks (RSNs) Contact Information is available at http://www.dshs.wa.gov/dbhr/rsn.shtml.

  1. Please ensure the hospital providing the services receives a copy of all PII letters (award letters are 02-31, or 20-05 if spenddown is involved), by entering the hospital in ACES as an AREP (code HO).  Add freeform text to the letter indicating whether the client has income equal to or below the federal poverty level based on their household size.

  2. In determining financial eligibility for PII, the hospital expense for the inpatient psychiatric treatment is applied first towards the EMER requirement.  If the client is also required to meet a spenddown, any unused balance may be applied towards meeting the client's spenddown.  Spenddown is calculated according to WAC 182-519-0110 and expenses used towards meeting the spenddown are prioritized according to the rules outlined in the WAC.  In addition, unused voluntary psychiatric inpatient hospital expenses (left after the EMER determination) may be used to meet spenddown liability.

  3. PII is a program administered by the Division of Behavioral Health and Recovery (DBHR). Contact DBHR for policy questions. Your contact is John Taylor, Phone: (360) 725-3774, E-mail: john.taylor@dshs.wa.gov.


ACES PROCEDURES

See Medical - Psychiatric Indigent Inpatient  This site is under construction.  
Modification Date: May 2, 2014