42 CFR §431.620

1. (a)Basis and purpose. This section implements section 1902(a)(20)(A) of the Act, for States offering Medicaid services in institutions for mental diseases for beneficiaries aged 65 or older, by specifying the terms of the agreement those States must have with other State authorities and institutions. (See part 441, subpart C of this chapter for regulations implementing section 1902(a)(20) (B) and (C).)
2. (b)Definition. For purposes of this section, an “institution for mental diseases” means an institution primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases. This includes medical attention, nursing care, and related services.
3. (c)State plan requirement. A State plan that includes Medicaid for persons aged 65 or older in institutions for mental diseases must provide that the Medicaid agency has in effect a written agreement with—
   1. (1)The State authority or authorities concerned with mental diseases; and
   2. (2)Any institution for mental diseases that is not under the jurisdiction of those State authorities, and that provides services under Medicaid to beneficiaries aged 65 or older.
4. (d)Provisions required in an agreement. The agreement must specify the respective responsibilities of the agency and the authority or institution, including arrangements for—
   1. (1)Joint planning between the parties to the agreement;
   2. (2)Development of alternative methods of care;
   3. (3)Immediate readmission to an institution when needed by a beneficiary who is in alternative care;
   4. (4)Access by the agency to the institution, the beneficiary, and the beneficiary's records when necessary to carry out the agency's responsibilities;
   5. (5)Recording, reporting, and exchanging medical and social information about beneficiaries; and
   6. (6)Other procedures needed to carry out the agreement.