It's more intense than psychosocial rehabilitation or outpatient day treatment. Initial discharge criteria are formulated upon admission and are based on objective data such as achievement of a certain percentage of ideal body weight or targeted weight gain, or weight loss (if binge eating) as well as ability to function with less structure daily. Association for Ambulatory Behavioral Healthcare, 1998. 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. Longer-term programs develop increased group continuity due to the familiarity gained through more extended treatment yet work with more pronounced symptoms and decreased functional levels with lower baselines. https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance.html?redirect=/home/regsguidance.asp, https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Who-are-the-MACs.html. The Continuum of Behavioral Health Services Described: Table 1 provides a graphic representation of the Continuum of Behavioral Health Services, highlighting the six levels of care along the continuum. Accreditation of a program provides the community with increased confidence that a program meets minimum standards for safety and quality for the people the program serves. PHP programs may still meet appropriate standards as a distinct service while blending treatment staff and space with another level of care such as an IOP so long as they adhere to appropriate and applicable guidelines and maintain clear distinctions regarding the clinical impact of services rendered to participating individuals. 1 TRICARE POLICY MANUAL 6010.54-M, AUGUST 1, 2002 PROVIDERS CHAPTER 11 SECTION 2.5 PSYCHIATRIC PARTIAL HOSPITALIZATION PROGRAM CERTIFICATION STANDARDS ISSUE DATE: July 14, 1993 AUTHORITY: 32 CFR 199.6(b)(4)(xii) I. The American Society of Addiction Medicines (ASAM) Patient Placement Criteria (ASAM PPC-2R) (previously mentioned) is considered a best practice for assessing and determining level of care placement for individuals with substance use disorders.6, Psychoactive substance history & detoxification status, Emotional/behavioral/cognitive functioning. Important information about regulatory coordination and program structure will also be provided. Programs should create a plan that includes performance measures for the program as well as appropriate clinical outcome measures specific to postnatal issues and clinical issues specific to any additional diagnoses for admitted participants. 7. The final rules pertaining to the implementation of the parity legislation were presented in November of 2013. Association for Ambulatory Behavioral Healthcare, 2007. Partial Hospitalization Program (Adult) Partial hospitalization is a nonresidential treatment program that may or may not be hospital-based. 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. Many programs opt to divide the program leadership into two roles. Because assessments completed soon after meeting a client or in the context of intoxication, withdrawal, or severe psychiatric symptoms are inaccurate, it is important to continue to gather information over time.9. Examples include benchmarked metrics such as absenteeism, dropouts, and patient outcome data. Therapists are challenged within each type program to adapt techniques, goals, expectations, and member autonomy to achieve clinical success. Occupational therapy is also a dynamic component of many programs. They provide therapy and education in an intensive group environment that cannot be provided through either an outpatient individual therapy model or a crisis-oriented inpatient unit. The federal agency originally introduced the Medicare Partial Hospitalization Program modification in March 2016. Medical oversight is necessary with additional daily, hourly structure to contain and monitor client movement. Partial hospitalization A nonresidential treatment modality which includes psychiatric, psychological, social and vocational elements under medical supervision. This would also include ongoing communication between program staff and apersonsresidential program coordinator or community care manager while that personis in treatment. Theme-based groups include a variety of specific topics that emerge from on-going team collaboration, client feedback, and ongoing reassessment of value. If medically unstable, inpatient hospitalization is necessary, stepping down to a PHP level of care. As an example, an outpatient staff psychiatrist may need to coordinate a referral with the program staff to avert a hospitalization in the same organization. A number of clinical factors may impact staff-to-client ratios in programs: For example, the direct treatment staff-to-client ratio in some acute PHPs may need to be 1:3, while in other less intensive programs, a ratio of 1:12 may be appropriate. II. Initial Evaluation/Certification We encourage the use of alternative modes of treatment delivery, such as telehealth, when newmodesare demonstrated to contribute to quality services. 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. Portsmouth, Virginia. 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. Partial Hospital Programs provide no less than 4 hours of direct, . 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. Standards and Guidelines for Level II Services: Intensive Outpatient. % of individuals within a diagnostic category, % of individuals with secondary substance abuse issues, % of individuals with first episode of care, Amount of time spent in specific functions, Insurance certification/communication time, Individual therapy time (based on program goals), Shifting functions from one type of staff to another, Increase or decrease the overall availability or amount of given services, Shift the % of a given service within a specific day, Increase in engagement with program participants, Client satisfaction with specific groups or program elements, Development of clinical pathways related to specific diagnostic groups, Increased follow-up with outpatient services following discharge, # of medication changes during episode of care, Specific disease monitoring such as Tuberculosis or Asthma, Provision of written medication education. Improvement in symptoms and functioning to allow the child/adolescent to return to a school setting. Staff should only use laptops, PCs, and smartphones that are encrypted. Programs should consider the focus of some of their programming on maternal fetal attachment with bonding groups like infant massage, playing with baby, etc.)12. 45/123 An individual's length of stay is dependent upon the nature of presenting problems, an ongoing review of the clinical necessity for participation in the program, and review of the individuals response to services provided. Movement needs to be monitored hourly, determining how much movement or exercise is medically safe for each clients stability. Example metrics include, but are not limited to: All programs are evaluated on issues related to the health and safety of those people being served in a program. Primary care services are generally delivered during a regular office visit. This means the guidelines for PHP and IOP will vary from State to State. Most regulatory bodies have a requirement that consumer feedback in an integral part of programming. We advocate for unified medical necessity guidelines among payers. achieve effectiveness and best practices in service delivery. Medicare Advantage Plans are not obligated to cover these levels of care. A clinical record must document what information is gathered, considered, or developed throughout treatment for each individual admitted. Structure of the Accreditation Requirements Regular staff meetings should occur to address clinical needs, milieu issues, changing programming features, and relevant administrative issues. Whenever possible, maintaining a consistent therapeutic milieu reduces the negative effects of transitions to a program with new peers and new staff. A mixed group means mixed level of attention to participants. In addition to licensing requirements for your facility, your program staff may have requirements related to the Scope of Work for their license. A growing body of evidence suggests that partial hospitalization outcomes are highly correlated with treatment intensity and that more successful programs involve patients at least 5 days/week for 8 hours/day. Examples of symptoms include high anxiety, sadness, depression, mood swings, elevated mood, irritability, intrusive thoughts, and more. The key elements of partial hospitalization and intensive outpatient programs have been combined as the core of the standards and guidelines. Key definitions related to partial hospitalization and intensive outpatient programming will be presented. The assigned medical professional certifies that the individual would require a higher level of care if the partial hospitalization program or intensive outpatient program were not available. People treated at this level of care are able to maintain their role functioning in the community and generally have adequate family/community support. (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; (3) Are furnished in accordance with a physician certification and plan of care as specified . Due to the nature of individual need and program design, it is expected that all needs which are addressed during treatment will not show up on all treatment plans. Historically, the availability of an intact support system was a prerequisite for PHP services. The results of quality improvement and outcomes management are to be documented and incorporated into administrative, programmatic, and clinical decision-making processes. Upon discharge, a list of medications that have been discontinued is to be available along with a list of all current medications and appropriate contraindications for the patients benefit. Call Now to Begin the Recovery Process Today. Individuals with co-occurring disorders should be able to receive services from primary providers and case managers who are cross-trained and able to provide integrated treatment themselves.7. This certification needs to be always current. Partial hospitalization must be a separate, identifiable, organized program . According to current practice guidelines, the treatment goals should be measurable, functional, time-framed, medically 343-351, 2013. Connellan, K., Bartholomaeus, C., Due, C., & Riggs, D. A systematic review of research on psychiatric Mother-Baby units. Progress toward or away from goals is to be addressed throughout the clinical record. There are three principal forms of linkage: FIRST, internal linkages between programs, departments, or practitioners within the same organization. For those with AN, weight restoration may need daily monitoring to prevent re-feeding syndrome. This record should be available to the individual, follow-up prescribing professional, and primary care provider. This staff member should work consistently with the individual (and family as indicated) and follow the course of clinical treatment from admission through discharge. 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. Specific programs may pursue one or more of the following major functions within a given organization: Acute Crisis Stabilization - The acute PHP function focuses on providing intensive, short-term programming in a structured therapeutic milieu. guidelines including the Level of Care Utilization System (LOCUS), hildren's Level of are . A complete package may include worksheets, workbooks, videos, computer-based learning, trainers, role-playing, expressive therapy and activity-based tasks. Evaluation for medication assisted treatment (MAT) services may also be indicated. We must advocate for simplicity and consistency in the description of services offered in programs and the billing process. The plan of treatment is developed with the active participation and input of the individual in treatment and by the treatment team under the supervision of the treating psychiatrist. Some programs choose to identify guidelines for early administrative discharge based on pre-determined number of relapses and other forms of treatment-interfering behaviors. Confidentiality guidelines pertaining to individuals in chemical dependency treatment tend to be more restrictive than for those individuals in mental health treatment. Greet each person individually in the group if providing a group service. The benchmark when no other exists can be a designated baseline of a measure within the program. PHPs and IOPs should represent the core of psychosocial treatments. Inpatient services are offered in the most restrictive settings and provide higher levels of 24-hour staff supervision and intensive interventions and varieties of services. Many programs also include consumer input groups as a formal part of programming that is led by peers. National Survey on Drug Use and Health, 2013. The main objective is to receive feedback addressing the degree to which the program met the individuals needs and assisted in achieving their goals. Payer of services (e.g., managed care, government-supported national health care, such as national health insurance systems in Canada and Europe, and Medicare in the United States). Programs serving pregnant women or new mothers typically care for women with some type of Perinatal Mood and Anxiety Disorders (PMAD). PHP and IOP treatment allow persons served to stabilization more successfully while in their own community environment. Scheifler, P.L. A less intensive level of care may have been insufficient to provide the treatment the individual requires to stabilize this decline. We encourage an appreciation for the complexity of creating and sustaining a milieu that engages and appreciateseach individualin their personal stage of change. Miller, W.R. and Rollnick, S. Motivational Interviewing: Preparing People for Change, (2nd ed.). Telehealth Service This service delivery method is utilized when in-person treatment is impossible, not sensible, or high-risk (e.g., a medical pandemic). Second Edition. 8.320.2 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services 2/1/20 to 12/31/20. While there is significant financial and clinical impetus to provide these services in an integrated manner, state licensing dictates the extent to which programs may be integrated. The quality of the treatment we deliver is the value we offer to patients. Portsmouth, Virginia. Partial Hospitalization Programs (PHPs) are more intensive programs for patients who might otherwise require inpatient psychiatric care. These individuals may be unable to achieve dramatic degrees of functional improvement but may be able to make significant progress in the achievement of personal self-respect, quality of life, and increased independence despite debilitating symptoms that may otherwise be intolerable. The tool should be tested, standardized, and validated; The tool should be appropriate for the individual being treated; The tool should be able to be used for repeated measures to document change; The tool should be consumer friendly and easy for the individual to understand. The inclusion of educational aides, homework, and peer support are important adjuncts to the therapeutic process. Examples of these symptoms may include negative self-talk, crying spells, severe anxiety, poor sleep, or panic attacks. Each program should have an identified medical director. 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. AABH recognized that the significant population growth of older adults warranted the development of standards and guidelines for geriatric programs, last revised in 2007.20 The varied mental and physical capacities of seniors required individualized treatment, flexible treatment strategies, and unique aftercare challenges. Traditionally, substance abuse and mental health facilities are treated as separate programs and are often licensed and reviewed separately in many states. In some cases, a summary of daily notes is optional, but do not serve to replace individual notes. Outcomes management processes should examine the impact of the program on the clinical status of the individuals served. Individuals receiving care from primary care providers often suffer from sub-clinical or relatively mild behavioral health conditions and are at-risk for developing severe behavioral health disorders. A hospital is a licensed facility that offers services more intensive than those required for room, board, personal services and general nursing care, and offers facilities and beds for use beyond 24 hours by individuals requiring medical, surgical, psychiatric, testing, diagnosis, treatment, or care for illness, injury, deformity, infirmity, abnormality, disease, or pregnancy. Programs must also maintain strong linkages with emergency departments, inpatient psychiatric units, and chemical dependency programs in order to facilitate both admission and discharges. 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. Association for Ambulatory Behavioral Healthcare, 1999. Programs may also bolster their treatment staff with paraprofessionals, non-degreed individuals, students, and interns. Occupational, recreational, and creative arts therapists broaden and deepen the array of available services when offered. Moda Health Medical Necessity Criteria Mental Health Partial Hospitalization and Intensive Outpatient Treatment Page 1/5 . DESCRIPTION A psychiatric partial hospitalization program is a treatment setting capable of providing This will require a program to review the criteria and make a decision that is in the best interest of the program and the individuals being served. In this case, communication within the team is essential. Final determination of changes is usually published in November of each year. The capacity to update and refine the system in a timely manner must be assured where administrative, clinical, regulatory, and performance improvement matters are concerned. 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. Each organization may also have criteria that must be included in the psychiatric assessment. Acute Symptom Reduction - This intensive PHP function focuses on the provision of sustained, goal-directed, clinical services to reduce the persons acute symptoms and severe functional impairments as an exacerbation of a more chronic condition. Marketplace forces and cost containment efforts have often resulted in a decrease in service availability, more restrictive eligibility (medical necessity) requirements, and reduced lengths of stay. As programs choose to include telehealth service delivery methods to provide the best care possible to all participants during normal or challenging times, programs need to move thoughtfully into each modality used considering confidentiality, best care practices, the severity of our patients issues, and the risk for them and for us caused by changes in treatment methods. Any changes are reported in the Federal Register. Codes G0129 and G0176 are only used, and therefore reimbursable, for partial hospitalization programs. Clinical outcome measures should help guide the treatment process for each individual, but also be used in aggregate to guide the adaptation of services to meet the needs of the program. They strive to have a positive clinical impact on each individuals support system and recovery environment. Ideally, the individual is or can be connected with a community-based support network and is able to function in their home environment. The quality improvement plan constitutes a comprehensive and methodologically sound process for measuring treatment effectiveness, improving the delivery of care, and evaluating progress toward recovery. The primary goals of intensive outpatient programs are to monitor and maintain stability, decrease moderate symptomatology, increase functioning, and foster recovery. Be diligent in having copies of the scopes of work for each or the disciplinesaprogram is using to stafftheprogram. We must honor the role of peer support and counseling within the behavioral health continuum. A connection between the treatment plan and the progress notes is important to assure that the person writing the progress note has access to the plan during the writing of the note. 104 CMR 30. PHP treatment programs closely resemble a highly structured but short-term hospital inpatient program. Patients admitted to a partial hospitalization program must be under the care of a physician who is knowledgeable about the patient and certifies the need for partial hospitalization. The record must provide the capacity to individualize goals to specific needs, emphasizing recovery principles and reflecting a language easily understandable to the individual. Programs can provide daily symptom management, while at the same time, necessary case management services are engaged to foster the highest level of functioning possible. A partial hospitalization program may be more appropriate in lieu of an intensive outpatient program if a number of these conditions are present: The following clinical presentations must be considered to admit a person to intermediate behavioral health services: Behavioral Health Symptoms: The individual exhibits serious and/or disabling symptoms related to an acute behavioral health condition or the exacerbation of symptoms from a severe and persistent mental disorder that has not improved or cannot be adequately addressed in a less intensive level of care. The quality of therapeutic presence is even more important in telehealth than it is in Holding the space is much more challenging. The increased integration between physical and behavioral health care allows for new levels of cooperation in documenting and sharing information. We meet five days a week from 9 a.m. to 3 p.m. Association for Ambulatory Behavioral Healthcare, 2015. To make a referral, have your doctor or therapist call 1-319-384-8449. An internal safety reporting mechanism is also advised to assure that types of problems such as medication errors, falls, injuries, or other critical data can be recorded and monitored. Licensing and Operational Standards for Community Services. Treatment is best conceptualized as a phased continuum of care that progresses from management of active symptoms and problems to establishing recovery/relapse prevention plans. The individuals family and/or legal caretakers must be involved. Organized as a continuum, this system of care enables the movement of individuals to the most clinically appropriate and cost-effective level of care. Individuals receiving PHP and IOP services vary in symptom intensity, clinical needs, and stages of readiness for change. Archived Program Rules - Chapter 320 - Early and Periodic Screening, Diagnosis and Treatment. guidelines for partial hospitalization program content, physician certification requirements, and . In some cases, a specialized IOP may be recommended as follow-up for specific conditions; Some individuals display increased symptoms of a previously diagnosed behavioral disorder and exhibit a progressive or sudden decline in functioning compared to baseline. The plan must address the diagnosis, stressors, personal strengths, type, and frequency of services to be delivered, and persons responsible for the development and implementation of the plan. As with individual treatment, time is limited, and staff needs to maximize the experience often leaving some issues for more extensive family treatment following discharge. All sessions are to be conducted using video and audio wherever This allows clinicians to assess the participants using all their clinical skills. 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