104 CMR 30. PHPs have their own set of rules and guidelines that are not discussed here ( click here to read more about PHPs). The inclusion of two patient identifiers is helpful and often required on each document, such as a patient name and medical record number. A wide range of referral options is essential to ensure that those persons in treatment are able to access a wide range of additional services. These services are provided primarily by medical practitioners within the context of treatment of general medical conditions. The physician provides supervision of the clinical needs of the individuals enrolled in the program. A description of the essential treatment services such as group, occupational, and psycho-educational therapies will be provided. The (Traditional) Outpatient level of care provides for treatment of conditions related to mild to moderate impairment. SECOND, external behavioral health linkages between programs or practitioners that are separate organizational entities, such as a county case manager who refers apersonto program to avert an inpatient stay. These types of conflicts often require multiple discussions with payers and accreditation organizations and may result in the programsevering relations with one or moreof theorganizations. Priorities are to monitor progress, review treatment planning, coordinate therapeutic team efforts, and facilitate discharge planning. The inclusion of report writing functions is important since it can be used to send letters to primary care providers, and to extract relevant clinical data from the record and organize it into referral forms or reports. Client rights guidelines includes: Rights and Responsibilities, Compliant/Grievance process, confidentiality, access to emergency services if in crisis and must be signed . The inclusion of motivational interviewing techniques has been an important addition to clinical programming and has led to increased engagement of individuals who display avoidance or ambivalence toward treatment.8. Symptoms continue to impair multiple areas of daily functioning and medications are being adjusted, Impaired insight and skill deficits place one at a significant risk for further functional deterioration, Individual displays willingness yet difficulty understanding or coping with significant crises or stressors, There is a continued significant risk for harm to self or others. Women with postpartum psychosis will need referral into acute inpatient psychiatric treatment. On the other hand, integrated occupational therapy programs complement other services and teach valuable skills within an evidence -based model that contributes significantly to positive clinical outcomes. PHPs are distinct organizational entities with specifically designated standards and regulatory reviews. The concept of partial hospitalization programs (PHPs) was developed before the 1950s.1 However, in the United States, PHPs did not take hold until Congress passed the Community Mental Health Act of 1963, which required that PHPs must be a core component of Community Mental Health Centers (CMHCs). and provide safety through clinical guidelines, standards, and best practices. Medicare Advantage Plans are not obligated to cover these levels of care. Theory/evidence-based groups are derived from cognitive-behavioral, dialectical, or other evidenced perspectives. Each organization may also have criteria that must be included in the psychiatric assessment. For example, some States allow a psychiatric nurseto provide psychotherapy groups while others do not allow this. More often the full array of services (when available) is delivered by a variety of organizations and individual providers within a given community. We hope this document will be used in concert with active dialogue on a local, regional and national level to improve care and individual recovery. Even in specialty programs that serve a focused group of diagnostics, individuals may need to be tracked on different clinical measures. In these cases, backup case management and peer support services can be essential. Partial Hospitalization is a highly structured psychiatric treatment program which, in the case of substance abuse prevention, also offers some medical oversight. During the assessment period, each program should complete clinical assessments, outcome measures or screenings that have been verified as appropriate for the population that an individual fits into as determined by the attending physician. When acceptable to given payers or state reviewers, a comprehensive user-friendly synopsis of a persons progress through treatment may be provided. Bill Type 13X is billed with Condition Code 41 (Partial Hospitalization) and the HCPCS code is not Along with the advent of the medical care home, the number of mental health professionals providing screening, consultation, limited counseling, and other behavioral health services on site in primary care settings has been growing rapidly in recent years. The Indiana Health Coverage Programs (IHCP) provides coverage for inpatient and outpatient behavioral health services - including mental health and addiction treatment services - in accordance with the coverage, prior authorization (PA), billing and reimbursement guidelines presented in this document. A treatment plan is designed to provide insight, skills, support, and problem resolution to avert further symptom reduction or chaos. Discharge planning begins at the time of admission with the identification of specific discharge criteria and, if necessary, the identification and contact of follow-up options and availability. Clinicians must also be in a private, secure location to maintain HIPAA compliance for Clinicians working from home must have no family in the vicinity of the computer/device being used to provide service (working from home might require prior authorization from leadership ). In a perinatal program it is important to understand that the baby in utero also needs consideration from the program and moms that breastfeed who are using substances are also putting their babies at risk. Resources from Post-Partum Support Internation may be helpful in finding additional support for spouses. Ongoing performance reviews may address attendance rates, dropout percentages, treatment trends, satisfaction, clinical handoffs, discharge status, post-discharge adjustment, or readmission rates. The value of these programs in clarifying diagnoses, assessing function, and determining ones capacity for independence or personal safety cannot be underestimated. Regulatory agencies will often assess the use of outcome measures as a core part of a quality improvement plan for programming. Improvement in symptoms and functioning as evidenced by outcomes measurement tools that are evidence based for children and adolescents. Availability of a nursery is critical for new moms. Moda Health Medical Necessity Criteria Mental Health Partial Hospitalization and Intensive Outpatient Treatment Page 1/5 . The interactive telecommunication technology included audio and video. To manage medical and behavioral emergencies, policies should be developed to expedite admission for inpatient care if required and allow for timely pharmacological intervention. One of the strengths of PHP and IOP programs is the applicability to a diverse array of client populations, clinical conditions, treatment settings, and formats. Greet each person individually in the group if providing a group service. Yalom, Irvin D. Inpatient group psychotherapy. According to current practice guidelines, the treatment goals should be measurable, functional, time-framed, medically Please talk to your provider about whether this may be a good care option for you. Formal agreements may not be necessary, but an agreed upon process is necessary to assure that crucial treatment information is shared in a confidential manner which also allows for verbal communication between providers when deemed appropriate. All shifts to telehealth need approval of senior leadership, Each area must balance the needs of individuals that want to attend in person and those that wish to use. Patients are assessed to be medically stable with labs to include but not limited to: comprehensive serum metabolic profile, including phosphorus and magnesium, Electrocardiogram (ECG), if clinically indicated. Dietitians work with patients and their families to move in the direction of nutritional rehabilitation and weight restoration. Family work is crucial and should be a part of every clients treatment plan. Partial Hospitalization Program Partial hospitalization and intensive outpatient programs are therapeutic treatment experiences for individuals who require more than the conventional outpatient level of care but do not need the security of a locked unit or 24-hour care. The presence of comorbid physical illness must be addressed and often makes the frequency and duration of attendance more challenging. Many payers will have a requirement that a program meet the requirements of an accrediting body as a rule for program approval and reimbursement for services. Individuals in treatment include both those who participate voluntarily, as well as those mandated by the legal system. Additionally, liaison with outpatient services of less intensity is necessary in order to facilitate admissions and continuity of care, as well as to arrange for adequate continued treatment when partial hospitalization services are no longer necessary. We offered telemedicine as an option for care delivery and the patient consented to this option.. PHPs and IOPs must have a written plan for quality improvement which includes both process/performance outcomes and clinical outcomes management. Transition between PHP and IOP, especially in facilities that offer these as a continuum of care, should be as seamless to the client as possible. Programs should include space and opportunity for social interactions between peers while not engaged in formal therapeutic services. A. Any additional laboratory testing, as determined by the organization and in accordance with the level of care provided. We meet five days a week from 9 a.m. to 3 p.m. Standards for the approval of providers of non-inpatient mental health treatment services. Programs can usually expect to conduct program improvement planning following a review to address the issues discovered and highlighted as needing improvement. (a) Partial hospitalization services are services that - ( 1 ) Are reasonable and necessary for the diagnosis or active treatment of the individual's condition; ( 2 ) Are reasonably expected to improve or maintain the individual's condition and functional level and to prevent relapse or hospitalization; Partial Hospitalization - A program for adults or adolescents which provides active treatment designed to stabilize or ameliorate acute symptoms in a person who would otherwise need hospitalization. The achievement of clinical stability and a reduction in symptomatology must be considered in the context of realistic and achievable goals especially given the complex medical and psychosocial stressors that often impact the older adult population. Programs that are planning to bill Medicarefor services must establish a relationship with their MAC by notifying them of their intentions to bill for PHP/IOP services if they already have a Medicare Part A Billing Number, or they must apply for aMedicare Part A Billing Number by submitting an 855A application to their MAC for their region and locate the MACs LCD (Local Coverage Determination) for PHP and IOP. Policy and Standards: Partial Hospitalization Documentation . Within each discipline a licensed professional will have outlined what services they can provide. Retrieved July 20, 2018, from https://www.asam.org/docs/publications/asam_ppc_oversight_may_2011. clinical judgment consistent with the standards of good medical practice will be used to . PHPs differ from IOPs in several ways: payment is on a per diem basis for most private insurances. Children's Partial: 9. The summary includes the clinical status on admission, the diagnosis and any changes during treatment, progress made, skills developed, issues not addressed, plans to prevent relapse/foster recovery, aftercare appointments, referrals, a medication summary, and assessment of risk. Comparing benchmark measures to those of peers offers a greater integration of performance within the industry and particular to these levels of care. As a national provider organization, AABH advocates for the following objectives to improve systems of care and meet the needs of those we serve: The AABH Board of Directors appreciates the work of each behavioral health practitioner who is making a difference in partial hospital and intensive outpatient programs throughout the country. Payers may require different processes or timelines. Some programs choose to identify guidelines for discharge based on a pre-determined number of relapses and/or other forms of treatment-interfering behaviors. Also, there are linkages that occur while a person is in the program between program staff and external peer counselors, recovery support groups, and natural supports. Admission to these programs may be determined by functional level, specificity of the population (such as OCD), or treatment specialty such as DBT or CBT. Staff members assume responsibility for and control of the individuals safety due to the individuals severe, disabling symptoms. Chemical dependency partial hospitalization programs and intensive outpatient programs serve populations who present primarily with substance use disorders that have relatively minimal or no mental health disorders impacting current functioning. If the State is not using a managed Medicaid system, the guidelines should be requested from the State office that manages Medicaid. A socially isolated person with serious debilitating symptoms may also benefit from treatment even though they may report virtually no support system at all. Treatment Guidelines Care Based Guidelines 1. 10, 05-07-04) A3-3194, HO-230.7 Partial hospitalization programs (PHPs) are structured to provide intensive psychiatric care through active treatment that utilizes a combination of the clinically recognized items and services described in 1861(ff) of the Social Security Act (the Act). Many programs also include consumer input groups as a formal part of programming that is led by peers. Finding measures that will help improve staff efficiency and effectiveness are key to a quality improvement plan. Although an individual may have several pressing needs, those that are of so severe they require the intensity of services of an intermediate level of care should be the top priority of treatment. Generally speaking, a program's average length of stay should reflect the population treated and primary program function. Linkages related to successful treatment will be considered. Whenever possible, they want to keep their job and maintain their homes. The Co-Occurring Disorders: Integrated Dual Diagnosis Treatment Implementation Resource Kit provides the following four key principles for gathering information about mental health and addiction disorders: Because many clients with severe mental illness have substance use disorders and vice versa, it is important to ask all clients about substances and mental health issues. Peer support is encouraged in programs where applicable regulations allow the use of peers who have been trained to support the clinical efforts of the program. . Family sessions are designed to assist members in their understanding of the identified clients condition and increase coping skills and group behaviors that can assist the clients recovery. All co-occurring programs must have clearly delineated procedures and linkages for addressing clients detoxification, withdrawal, and other medical needs. Staff members must be trained and experienced in child and adolescent behavioral health, family therapy, milieu therapy, and therapeutic crisis intervention. Treatment at this level of care is usually limited to 1-4 sessions per month but may be provided less frequently in accordance with the individuals needs. As partial hospitalization continued to evolve within the context of a continuum of services, the 1996 revision was intended to incorporate contemporary views of this specialized level of care.16 Specific standards and guidelines for child and adolescent programs were also completed at that time which attempt to delineate both similarities to adult programs and unique challenges.17 Intensive Outpatient Services were first addressed in a 1998 edition.18. These services are included as mandated essential behavioral healthcare benefits in insurance policies from 2014 onward. For example, one may reference a PHP treating persons with mood disorder through a short-term, low-intensity, cognitive behavioral approach designed to improve functioning and mood, funded by private and public insurance, operating out of a not-for-profit general hospital setting.2. Children and youth partial hospitalization program A program licensed by the Department, Office of Mental Health and Substance Abuse Services, to provide partial hospitalization services to individuals under 15 years of age. Structure of the Accreditation Requirements Casarino, J., Wilner, M., and Maxey, J. Additional factors such as the presence of centralized intake, clinical complexity, medication challenges, family issues, insurance authorization procedures, and documentation needs, all impact staff-to-client ratio. The downloadable version of the Standards and Guidelines reflects the most recent publication and may not accurately reflect the online version. 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