Section 97, Private Non-Medical Institutions, (PNMI) Appendix E - Clinical Documentation for Continued Stay Reviews

As of May 1, 2025, providers of Section 97 appendix E (PNMI E) must submit clinical documentation supporting medical necessity.  

Providers must submit this clinical documentation into the Atrezzo system every 90 days as part of each member’s continued stay review. The documentation must include all of the following:   

• The member’s diagnosis 

• Level of care utilization system (LOCUS) score 

• Treatment plan 

• Discharge plan 

• A medical necessity form (if required by the Department) 

The submitted clinical documentation may also include the following to support medical necessity: 

• Progress notes 

• Incident reports 

For questions, please contact Bruce Cosgrove, Provider Relations Specialist.