A partial hospitalization program (PHP) is a structured mental health program and type of addiction treatment where clients participate in activities during the day and return home at night. Consider how staff will compensate. 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. These are often times when a given individuals clear need (such as for new housing due to an imminent spousal separation) may not coincide with the individuals actual desire for an appropriate referral. Programs operate under the direction of a physician and a program leader. Occupational, recreational, and creative arts therapists broaden and deepen the array of available services when offered. These intermediaries are referred to as MACs (Medicare Administrative Contractor) and each can develop their own interpretation of the CMS guidelines in determining appropriateness for services, documentation requirements and billing requirements. The infusion of peer counselors is a dynamic that is also enhancing the experience for many individuals and should be encouraged by authorities and continuum leaders whenever possible. Recently in behavioral health, a few payers are developing protocols that are not in line with Medicare guidelines, which again can create challenges in programming and billing. PHP and IOP treatment allow persons served to stabilization more successfully while in their own community environment. Addictive Signs and Symptoms: The individual exhibits serious or disabling symptoms related to an acute substance use disorder or relapse following a period of sobriety. Most regulatory bodies have a requirement that consumer feedback in an integral part of programming. The development of clinical pathways or treatment protocols offers the potential for systemic solutions to these issues. Re-certifications are required by many payers within strict time guidelines. . Types of diagnoses (e.g., psychotic, mood and anxiety disorders, personality disorders), Theoretical orientation (e.g., cognitive behavioral), Treatment objectives (e.g., stabilization, functional improvement, personality change), Treatment duration (i.e., length of stay), Treatment intensity (i.e., hours and days per week). An individual must exhibit the first three following characteristics and may exhibit others listed below: PHPs and IOPs both employ integrated, comprehensive, and complementary evidence-based treatment approaches. As other programs specific to a population grow to needing a national standard, they will be added to this section. In some regions, the direction of CMS fiscal intermediaries led to a reduction in the use of occupational services due to increased documentation demands and conflicting continuation of care criteria. American Association for Partial Hospitalization, 1993. For instance, one might track the percentage of patients with housing issues, joblessness, or secondary substance abuse with minimal effort. The individuals progress or lack thereof toward identified goals is to be clearly documented in the record. 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. They may be part of educational or residential facilities. Debilitating symptoms may also accompany a life change, significant loss, or even the current ineffectiveness of previous coping skills. If left untreated, there is significant impact on women and their families.10 This includes depression, psychosis, bipolar disorder, anxiety, panic, obsessive compulsive disorders, and post-traumatic stress disorders. Each program should have an identified medical director. Yalom, Irvin D. Inpatient group psychotherapy. A brief description and examples of each level of care follows: Primary Care is first line health care providing screening, early identification, education, and often pharmacotherapy. Partial hospitalization programs (PHPs) differ from inpatient hospitalization in the lack of 24-hour observation, and outpatient management in day programs in 1) the intensity of the treatment programs and frequency . achieve effectiveness and best practices in service delivery. Standards for Intensive Outpatient Treatment: 22258025: Effective: 08/29/2019 Change 65D-30.002 Definitions, Certifications and Recognitions Required by Statute, Display of Licenses, License Types, Change in Status of License, Required Fees, Licensure Application and Renewal, Department Licensing .. 22030172: 6/25/2019 Vol. 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. Connellan, K., Bartholomaeus, C., Due, C., & Riggs, D. A systematic review of research on psychiatric Mother-Baby units. Provide at least 4 days, but not more than 5 out of 7 calendar days, of partial hospitalization program services Ensure a minimum of 20 service components and a minimum of 20 hours in a 7 calendar-day period Provide a minimum of 5 to 6 hours of services per day for an adult aged 18 years or older The organization recognizes that many local factors can contribute to the detailed implementation of these standards and guidelines. Individual therapy within programs is designed to augment, clarify, or address issues which are considered by the clinician and client to be more appropriate for individual rather than a group focus. 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. The primary goals of intensive outpatient programs are to monitor and maintain stability, decrease moderate symptomatology, increase functioning, and foster recovery. Programs should include clinical measures that assess current status of the individuals symptoms and functioning. Third Edition. Always start with a tech check to make sure everyone can navigate the platform and feels, Suggest participants prepare for sessions by spending 5-10 minutes of calm quiet time prior to meeting- people are used to internet time being about work or leisure and this is. First Edition. A treatment plan is designed to provide insight, skills, support, and problem resolution to avert further symptom reduction or chaos. A person is not appropriate for participation in a partial hospitalization program orintensive outpatient program if the individual: Following admission, recurring reviews should be conducted to determine whether individuals continue to meet medical necessity criteria and require ongoing services in a PHP. PHPs differ from IOPs in several ways: payment is on a per diem basis for most private insurances. Treatment modalities and techniques must be developmentally appropriate, and evidence-based for children and adolescents. Regulatory agencies will often assess the use of outcome measures as a core part of a quality improvement plan for programming. Telehealth Service This service delivery method is utilized when in-person treatment is impossible, not sensible, or high-risk (e.g., a medical pandemic). We meet five days a week from 9 a.m. to 3 p.m. These are important things to address during the course of treatment in these programs. 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. Improvement in symptoms and functioning to allow the child/adolescent to return to a school setting. While all three of these bodies can impact how a program provides services and determines appropriateness for care, state licensing agencies will have the regulations attached to laws in a State that must be followed. The federal agency originally introduced the Medicare Partial Hospitalization Program modification in March 2016. The EMR provides a unique opportunity to include other non-clinical pieces of treatment, such as linking to client education tools or treatment summaries that are easily accessed and printed off by patients when appropriate or necessary. Kiser, L., Lefkovitz, P., Kennedy, L. and Knight, M. The Continuum of Ambulatory Mental Health Services. Alexandria, Virginia. Therapists are challenged within each type program to adapt techniques, goals, expectations, and member autonomy to achieve clinical success. When possible, it is important that comparisons or benchmarks be used to enhance performance. This role is usually filled with a person who has advanced training in psychiatry, most notably a psychiatrist. In some cases, local and regional expectations and standards regarding documentation requirements may vary and programs are reminded that documentation requirements may need to change based on different state requirements.. Persons meeting Severe and Extreme level of severity should be treated within a Partial Hospital Psychiatric level of care setting, as long as the patient is medically stable. All programs pursue the goals of stabilizing clinical conditions, reducing symptoms and impairments, averting or reducing inpatient hospitalization stays, and providing medically necessary treatment for individuals who cannot be effectively treated in a less intensive level of care. The negotiation of this variance is an important part of treatment. Learn more: 12-step programs. historical data (including social, medical, legal, and occupational histories), a brief summary of each specific intervention including the type of intervention provided (e.g., group or individual therapy), the individuals response to the intervention. 8.320.2 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services 2/1/20 to 12/31/20. Treatment plans should be reviewed on a regular and consistent basis based on the assessment of the team and approved by the psychiatric supervisor and reflect changes based on feedback from the individual, staff members who provide services and medical professionals supervising treatment. Partial Hospitalization is a highly structured psychiatric treatment program which, in the case of substance abuse prevention, also offers some medical oversight. They should provide face-to-face services with each client upon admission for an evaluation and thereafter as clinically indicated. These tools provide further input regarding the programs effectiveness in facilitating recovery steps and enhancing peer support for participating consumers. 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. Creative/Expressive therapies are also significantly employed in PHP/IOP clinical settings. To make a referral, have your doctor or therapist call 1-319-384-8449. Performance Improvement for older adult programs is essential and should be determined by the mission and specific needs of those who are being served. The downloadable version of the Standards and Guidelines reflects the most recent publication and may not accurately reflect the online version. Psycho-educational services represent another basic building block of PHP/IOP treatment. It is also important to address issues specifically faced by older adults such as grief and loss, changes in professional and personal roles, limitations of social support, impact of physical limitations on wellbeing, stigma related to aging, and death and dying. Treatment Guidelines Care Based Guidelines 1. A less intensive level of care may have been insufficient to provide the treatment the individual requires to stabilize this decline. 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. In addition, programs need to acknowledge that not all individuals have the appropriate devices, the WIFI access and the privacy to engage in the multiple groups per day format that we must maintain. IOPs may see staff-to-client ratios from 1:12 to 1:20 depending on the focus of the program or the acuity level of individuals in the program. The interactive telecommunication technology included audio and video. Orientation materials and program guidelines should be designed to make program goals, procedures, and expectations explicit for individuals utilizing services as well as for their family members, supportive peers, and collaborating providers. This comprehensive approach focuses on the following areas, or dimensions: Co-occurring behavioral illness (dual diagnosis) is defined as conditions experienced by individuals with concurrent DSM mental health and substance use disorder diagnoses. In general, the Centers for Medicare and Medicaid Services (CMS) sets the standard for payer requirements, and most payers start with the Medicare guidelines when developing their own requirements. CMS and other agencies expect to see individual sessions prescribed as a necessary component of treatment during each episode of care. Generally speaking, a program's average length of stay should reflect the population treated and primary program function. It can also be used to track benchmarking data such as dropouts, re-hospitalizations, absenteeism, and related metrics. We honor and support programs that seek to integrate physical, substance use, and behavioral health treatment within single programs. Partial hospitalization is active treatment that incorporates an individualized treatment plan which describes a coordination of services wrapped around the particular needs of the patient and includes a multidisciplinary team approach to patient care under the direction of a physician. Establishment of a safety plan that allows for the child/adolescent to maintain safety in a community setting. Consumers should also be informed as to where to direct additional feedback or complaints, such as quality management departments, local, state, and federal authorities, etc. All measurements tools must continue. 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. PHPs are distinct organizational entities with specifically designated standards and regulatory reviews. The program can benchmark against itself to demonstrate change over time. Recovery-based education builds upon steps designed to create self-monitoring and individual recovery. Ongoing clinical responsibility must continue and be clarified while individuals are awaiting follow up care. Access, treatment, and discharge data are key areas for tracking. The assessment tools in the record must include all relevant information and have the capacity to go beyond documentation of the presence or absence of specific criteria through checklists or drop-down boxes. The increased integration between physical and behavioral health care allows for new levels of cooperation in documenting and sharing information. These regulations should be the primary guiding protocols followed for any program. 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. Telehealth services in PHP and IOP are demonstrating to be useful as an additional service modality. In view of PHPs and IOPs positions in the continuum of behavioral health services, programs must maintain liaison relationships with multiple behavioral health providers, physical health care providers, and others. Partial Hospitalization Program (Adult) Partial hospitalization is a nonresidential treatment program that may or may not be hospital-based. There arethreeaccreditation organizations used by behavioral health facilities: A key player in detailing programming and documentation will be the organizations that pay for services. American Society of Addiction Medicine (ASAM) (April 2001). 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. Clients with eating disorders may enter PHP level of care with a body mass index (BMI) which measures the relationship between height and weight, of 17.5 (adults) or less with a diagnosis of anorexia nervosa or may be of normal weight with a bulimia nervosa diagnosis, while they may be obese with a BMI of 30 or more or morbidly obese with a BMI or 40 or more. 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. Effective communication and coordination in each of these primary linkages or connections is especially vital during handovers or level of care changes. While none of these focuses are mutually exclusive, a program tends to build their program from one of these perspectives. Clinical judgment should drive whether or not a prospective client can benefit if attendance is less than ordered in the first week. August 23, 2017 - CMS revoked Medicare reimbursement changes to its medical billing requirements and process for partial hospitalization services, according to a recent Medicare Learning Network announcement. Programs must have clearly delineated procedures for addressing a clients detoxification, withdrawal, and other medical needs that require coordination with the clients primary care provider. 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). When developing program schedule, consider your population and how you will structure school (i.e. Any changes are reported in the Federal Register. The presence of significant denial or unwillingness to address change may often be inevitable due to the acute circumstances surrounding an admission especially from an emergency department or crisis worker. 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. Participating in a peer-based benchmarking programs allows programs to evaluate how they compare to a larger group of programs. PHPs and IOPs should represent the core of psychosocial treatments. Key definitions related to partial hospitalization and intensive outpatient programming will be presented. They strive to have a positive clinical impact on each individuals support system and recovery environment. If my provider is concerned about my safety, I understand that they have the right to terminate the visit.". Facilities that provide treatment for both behavioral health conditions are not formally designated as a single treatment program in most areas. These services may be present in a single organization such as a large community mental health center, a general hospital with comprehensive mental health services, or a free-standing provider location. Policy and Standards: Partial Hospitalization Documentation . It is recommended that programs use a formal method to collect consumer feedback through perception of care surveys and/or care satisfaction surveys. Even in specialty programs that serve a focused group of diagnostics, individuals may need to be tracked on different clinical measures. Movement needs to be monitored hourly, determining how much movement or exercise is medically safe for each clients stability. Coordinated care services aims to keep a key person/entity involved in the entire treatment process as a proxy for a person who may struggle with the complexities of the health system. Modifying the treatment techniques may be necessary in terms of presenting information more slowly and concretely and with a narrower focus than may be necessary with young and middle adults. However, we recognize that many states have established state-specific standards and expectations for care, and have codified these into state laws, regulations and licensing rules. Intermediate Ambulatory services consists of two levels of care depending on the intensity of services needed and the acuity to those being served: Residential/Inpatient services include two principal types of non-ambulatory, 24-hour supervised settings. Performance improvement goals are best when they apply to real program needs even if comparison data is not available. % 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. Partial Hospital Programs provide no less than 4 hours of direct, . However, they should be a separate, identifiable unit and represent a continuum of therapeutic modalities that are evidence based for children and adolescents. For example, in a program that serves individuals with substance use issues, some may need to be tracked on depression, while others may need to be tracked for anxiety. For each person seen through telehealth, the staff providing a treatment service must have the following readily available: Any individual offered telehealth services must consent to telehealth services and should acknowledge consent before the first session of telehealth service: [Provide the statements through email or display on the screen during an intake or first session]. 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. The format for documentation of each individuals level of functioning, services needed and provided, response to treatment, and coordination of care can take varied forms but must be clearly delineated. The documentation of medical supervision and certificate of need must be completed upon entry to the program and updated periodically based on individual need, program policy, and payer expectations. (2) Prior authorization is required for LOC 2.5 (partial hospitalization) which requires a minimum of twenty hours of services per week. These persons may have been screened by primary care physicians, individual therapists, or other healthcare professionals and require the coordinated treatment interventions available in a PHP in order to facilitate engagement and acceptance of the impact the illness has had on their day-to-day functioning. 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 new print edition will be pulled every 2 years for those who choose to purchase the e-document. These services are provided primarily by medical practitioners within the context of treatment of general medical conditions. The (Traditional) Outpatient level of care provides for treatment of conditions related to mild to moderate impairment. Groups that are structured to be repetitive, slower, and engage patients at multiple sensory levels are very important and can reduce the impact of physical and cognitive limitations on treatment. Suicide is the leading cause of death in the postpartum time period.11, Treatment aims to minimize fetal/neonatal exposure to both maternal mental illness and medication. The multidisciplinary team is central to the philosophy of staffing within a partial hospitalization or intensive outpatient setting. Association for Ambulatory Behavioral Healthcare, 1998. PHPs have their own set of rules and guidelines that are not discussed here ( click here to read more about PHPs). OAR 309-039-0500 to 309-039 . Standards and Guidelines for Partial Hospitalization Child and Adolescent Programs. An example of this type of individual is a young mother with anxiety and depression who is unable to work and care for young children following separation from her significant other and needs rapid improvement to resume responsibilities; Some individuals experiencing behavioral health symptoms or dysfunction due to a chronic mental illness that severely and persistently impairs their capacity to function adequately on a day-to-day basis, despite efforts to achieve these goals through treatment in a less intensive level of care. The goal is to contribute to patient safety. Some flexibility in programming should always be considered given individual circumstances, Is uninterested or unable due to their illness to engage in identifying goals for treatment and/or declines participation as mutually agreed upon in the treatment plan, Is imminently at risk of suicide or homicide and lacks sufficient impulse/behavioral control and/or minimum necessary social support to maintain safety that requires hospitalization, Has cognitive dysfunction that precludes integration of newly learned material, skill enhancement, or behavioral change, Has a condition such as social phobia, severe mania, anxiety, or paranoid states in which the individual may become more symptomatic in a predominantly group treatment setting, Has primarily social, custodial, recreational, or respite needs. Portsmouth, Virginia. With increased attention population health, providers will be increasingly incentivized to use the most efficient treatment options available to contain costs and achieve positive clinical outcomes. All other documentation standards for a clinical record remain the same for telehealth and in-person/on-site participants. hospital, an acute freestanding psychiatric facility, or a psychiatric residential treatment facility). Structure of the Accreditation Requirements Ongoing performance reviews may address attendance rates, dropout percentages, treatment trends, satisfaction, clinical handoffs, discharge status, post-discharge adjustment, or readmission rates. For example, some States allow a psychiatric nurseto provide psychotherapy groups while others do not allow this. 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. Additionally, any exclusionary citeria must be clearly defined. Therefore, it is important to collect a thorough substance abuse history. THIRD, medical care linkages between the primary care providers including medical homes that shift the relationship toward integration or increased collaboration between specialized behavioral health programs and the ongoing medical management of thepeoplein many healthcare models. C. A partial hospitalization treatment level 2.5 program shall meet the current ASAM criteria for Level 2.5 Partial Hospitalization Services. 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