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To ensure quality care, facilities that provide acute medical and behavioral health inpatient services should meet the following expectations.
Prior to admission:
During admission, services must include:
In addition, ongoing care must meet specific medical necessity criteria for the service requested.
If these criteria are not met, a penalty will be imposed on the Diagnosis-Related Group (DRG) payment and any associated professional charges for the member’s stay may be denied. This level of quality care is expected and necessary in this setting to ensure the acuity of the patient is being addressed in the appropriate setting.