While this section is not inclusive of all specific populations, these represent the populations in which there are a significant number of programs, enough to be establishing best practice. The record must provide the capacity to individualize goals to specific needs, emphasizing recovery principles and reflecting a language easily understandable to the individual. The intensity of the partial hospitalization level of care is medically necessary and the individual is judged to have the capacity to make timely and practical improvement. PHPs are distinct organizational entities with specifically designated standards and regulatory reviews. Coordination and involvement with family members and significant others is an important part of treatment whenever possible. 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. Providers utilize a wide variety of therapeutic techniques such as different forms of individual, family, or group therapies, and/or medication management. Linkages should endeavor to coordinate care in an efficient and timely manner. Some payer contracts may also dictate the timing for recurring reviews. Sixth Edition. Only use approved platforms for any telehealth contacts . l) Services provided to more than one beneficiary at a time, unless specifically allowed in the service definition. 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. k) Service provided simultaneous with any other -covered service, unless Medicaid specifically allowed in the service definition. Treatment must be rendered under the supervision of a psychiatrist or medical professional licensed to diagnose behavioral health issues. 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. 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. A focus on medication adherence, therapeutic impact, and relationship between psychiatric and physical medications should also be considered. Licensing and Operational Standards for Community Services. The plan must be available to the clinical staff at the time-of-service to assure that interventions are focused and relevant. Kiser, L., Lefkovitz, P., Kennedy, L. and Knight, M. The Continuum of Ambulatory Mental Health Services. Alexandria, Virginia. This condition may be exacerbated by age or secondary physical conditions. These standards include guidelines and consensus statements produced by professional specialty . Individuals with co-occurring disorders tend to relapse frequently, placing them at greater jeopardy of a marginalized social existence. 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. Recovery-based education builds upon steps designed to create self-monitoring and individual recovery. Follow-up may be provided by outpatient psychiatrists or the individual may be referred back to primary or physical/behavioral integrated outpatient care. This certification needs to be always current. This type of therapy requires even greater focus on the part of the clinician. A complete medical record should include the following: The initial assessment addresses the individuals bio-psychosocial status and strengths including, but not limited to: Each assessment needs to include screenings for potential risks, needs, physical evaluations, or referrals. All co-occurring programs must have clearly delineated procedures and linkages for addressing clients detoxification, withdrawal, and other medical needs. Organizations may choose to provide a PHP or IOP for a specifically defined population. Portsmouth, Virginia. These screenings also include risk for harm to self or others, pain, abuse, substance abuse, nutrition, vocational/financial need, legal concerns, housing, family issues, preferred learning style/methods, and any other ongoing unique individual concerns which may require consideration. According to current practice guidelines, the treatment goals should be measurable, functional, time-framed, medically Psychiatrically trained medical professionals, including Physician Assistants and Nurse Practitioners may also be members of the physician team if regulations apply for such. The Standards and Guidelines will be updated as new reviews are completed in any of the areas addressed. The federal agency originally introduced the Medicare Partial Hospitalization Program modification in March 2016. AABH provides these standards and guidelines as a broad representation of best practices in providing PHP and IOP without regard for local areas. The development of a treatment plan, discussion of barriers to engagement, and intimate emotional issues are examples of the kinds of topics often reserved for individual time. Medical Assistance (where applicable) reimburses for hours of service in a given day, payment is on a per session basis for most insurance companies or specific individualized service for Medicare or Medical Assistance, Severity of dysfunction or behavioral symptoms, criteria for admission require more acute individual dysfunction, severity of symptoms, and potential for risk of harm to self or others, criteria for admission require moderate individual dysfunction, severity of symptoms, and potential for risk of harm to self or others, Hours and variety of intensive services per week, services offered at least 5 days per week with an average of 6 hours of treatment per day, people usually attend between 6 and 12 hours of treatment per week, specific State, Joint Commission, and other regulations, regulations are generally included within outpatient regulations, except for Medicare, staffing requirements are more specific regarding staff-client ratio with most clinical staff ratios are less than 1:12, Less regulation regarding size of caseload but caseloads tend to be larger than PHP, tend to provide more sessions over a longer period of time, Intensity of physician and supervisory oversight, require a higher demand of physician oversight that often includes coverage and/or supervision for all hours when clients are present. Dietitians work with patients and their families to move in the direction of nutritional rehabilitation and weight restoration. Often programs will struggle with deciding if their data elements are outside the norm. As previously mentioned, individuals who have diagnoses for both mental health and substance use disorders of which only one is currently active, may be treated in a co-occurring (dual diagnosis) treatment setting, or in either an addictions or psychiatric treatment setting (depending upon which problem is currently active). 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. Example metrics include, but are not limited to: Staff are not only the largest cost to programs, but also have the biggest impact on programming and quality in a program. The presence of substance abuse has often been underreported due to cultural or generational biases. A higher level of monitoring of overall behavioral health and physical functioning is important. 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. High quality performance plans will guide the success of utilizing all support levels as members of a fully reimbursed multidisciplinary team. PHP treatment programs closely resemble a highly structured but short-term hospital inpatient program. Telepsychiatry Guidelines . In many program settings, the inclusion of individuals in different phases of recovery can be used to good clinical advantage. These organizations usually conduct surveys of facilities on a regular basis and provide detailed reports on the areas where programs excelandwhere programsneed improvement. Policy and Standards: Partial Hospitalization Documentation . Even in specialty programs that serve a focused group of diagnostics, individuals may need to be tracked on different clinical measures. Each individual will present a unique array of strengths, skills, symptoms, and functional limitations. For clinical outcome measures related to the populations below, AABH has a table of clinical outcome measures that are currently used in PHPs and IOPs. 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. Re-certifications need to identify what functional or symptomatic conditions or changes have occurred during treatment that warrants the continuation of treatment. In either case, the individual is unable to benefit from medication management or traditional outpatient therapy alone. Marked impairments in multiple areas of his/her daily life are evident. The program leader is responsible for the overall clinical and administrative operations of the program, including supervision and competency determination of the clinical staff, clinical documentation, program development, and performance improvement. 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. All monitoring of suicidal ideation, such as daily screens, must continue. Partial Hospitalization is a highly structured psychiatric treatment program which, in the case of substance abuse prevention, also offers some medical oversight. This section contains specific considerations when developing a program for a population identified in the list. Examples include benchmarked metrics such as absenteeism, dropouts, and patient outcome data. The following Text (Smartphrases if using EPIC) is an example: Consultation provided via telemedicine using two-way, real-time interactive telecommunication technology between the patient and the clinician. They strive to have a positive clinical impact on each individuals support system and recovery environment. 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. Programs should consider brief family therapy and referrals for family members that need additional treatment. 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. 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. There is a medically determined reasonable expectation that the individual may improve or achieve stability through active treatment. Partial hospitalization is a short-term, intensive treatment (four to six weeks, fewer than 24 hours per day) for adults and children individuals not effectively served in community-based or intensive outpatient programs due to substance use, mental health co-occurring disorders. and Lefkovitz, P.M. Standards and Guidelines for Partial Hospitalization Adult Programs. When acceptable to given payers or state reviewers, a comprehensive user-friendly synopsis of a persons progress through treatment may be provided. Successful engagement in the clinical process and willingness to address issues at whatever stage of treatment, Capacity to gain insight and respond successfully to therapeutic interventions, Continued need for medication monitoring and intervention, Capacity to make progress in the development of coping skills to meet baseline functional needs, Need for support and guidance in handling a major life crisis, Continued need for managing risk accompanied by capacity to follow a safety plan, Commitment to developing and following through on a recovery-oriented discharge plan. Programs may wish to develop their own measures but should do so with the help of professionals who can test and validate the instrument for appropriateness with the specialty population. These are important things to address during the course of treatment in these programs. Comparing benchmark measures to those of peers offers a greater integration of performance within the industry and particular to these levels of care. An external audit should not be the impetus for utilization reviews. Section 115.120 Definitions. Example metrics include, but are not limited to: Metrics related to the services that are offered during the course of treatment allow program staff to evaluate how service offerings can be adapted to meet the needs of the population served over time. Some individuals are at risk for inpatient hospitalization and require the intensive services of partial hospitalization treatment due to acute debilitating symptoms and/or some risk of harm to self or others. Both performance and clinical measurement will be addressed. The integration of physical/behavioral treatment can influence both types of programs by increasing the expectation that the whole health of the individual be considered throughout the assessment and treatment process. Co-occurring treatment providers must be well versed in the diagnosis and treatment of concurrent mental health and substance use disorders. Services at this level are offered with some degree of coordination, but do not include cohesive community or structured programmatic activities. Finding measures that will help improve staff efficiency and effectiveness are key to a quality improvement plan. Portsmouth, Virginia. In other cases, an individual from a troubled or dysfunctional family may benefit as long as goals and interventions are designed to facilitate communication or reduce stress within the family unit, or even seek genuine supports outside of the identified family unit. guidelines including the Level of Care Utilization System (LOCUS), hildren's Level of are . (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 . 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. People treated at this level of care are able to maintain their role functioning in the community and generally have adequate family/community support. If the State is not using a managed Medicaid system, the guidelines should be requested from the State office that manages Medicaid. Monitored study time vs. Goals must be clearly worded and achievable within the timeframe of the individuals involvement in program. Services may include group, individual, couples, family therapy and medication management for symptom management. (Section 1-101.1 of the Code) "Accreditation." A process establishing that a program complies with nationally-recognized standards of . Association for Ambulatory Behavioral Healthcare, 2008. Table 1 Levels of Care (Behavioral Health), Solo practices, Medical clinics, Medical care home, IOP, Psych rehab, Club House, Assertive Community Treatment. Because of the complexity of this issue, additional collaboration among residential and acute ambulatory providers, regulatory groups, and insurers is recommended to clarify when a combination of services is appropriate and to develop joint strategies to decrease redundancies and cost while providing excellent care to each person. Medical oversight is necessary with additional daily, hourly structure to contain and monitor client movement. Partial Hospitalization Program (Adult) Partial hospitalization is a nonresidential treatment program that may or may not be hospital-based. 2013) 10, 2013. Accessibility of an individuals data within the EMR is impacted by privacy and regulatory statutes and must be reflected in the EMR. Also, the program expectations should be flexible in order to accommodate a decrease in the number of hours per day or days per week of individual participation over time as a person moves toward discharge. These tend to be associated with larger, urban, teaching based hospitals or community mental health centers (CMHCs) which serve a higher volume of people served and are therefore able to sub-group members into different tracks of specialty groups. PHP and IOP needs may or may not be adequately addressed due to unique workflow documentation, and billing challenges. 4. 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. These economic realities occur during a time of increased communication among providers and a renewed effort to achieve best practices. The processes and results of access, engagement, treatment, and discharge should be considered. Mute participants and allow them to unmute when. 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. The individual is ready for discharge from a higher level of care but is judged to be in need of daily support, medication management, and intensive therapeutic interventions due to symptom acuity or functional impairment that cannot be provided in a traditional outpatient setting due to lack of comprehensive resources. Efforts to achieve best practices require analyses of critical data points, clinical outcomes, and treatment processes. Many payers include these standards in their outpatient operations protocols and might be referenced as recurring outpatient services. Moderate or Specialized Symptom Reduction - This primary program function is the reduction of moderate symptoms and stabilization of function achieved through extended group therapeutic services generally provided in IOPs. A treatment plan is designed to provide insight, skills, support, and problem resolution to avert further symptom reduction or chaos. Creative/Expressive therapies are also significantly employed in PHP/IOP clinical settings. It is the need for intensive, active treatment of the patient's condition to maintain a functional level and to prevent relapse for hospitalization. Child and adolescent programs provide an intensive therapeutic milieu that is designed to serve the child and/or adolescent (and their family) within the least restrictive therapeutically appropriate context. It can also be used to track benchmarking data such as dropouts, re-hospitalizations, absenteeism, and related metrics. 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. According to the American Psychiatric Associations Eating Disorder Guideline 2006, clients who are appropriate for partial hospitalization need daily supervision and structure from meal to meal to gain or prevent purgative and binge eating behaviors. Medical personnel address ongoing medical and physical health issues and assess and manage medication therapies. % 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. Service limitations on scope, amount, duration, frequency, location of service, and other specific criteria described in clinical coverage policies may be All measurements tools must continue. Programs are active, time-limited, ambulatory behavioral health day or evening treatment programs that offer therapeutically intensive, structured, and coordinated clinical services within a stable therapeutic milieu. This process usually has two steps: Programs should create a documentation system that allows for thorough but efficient review of a case at each step. IOPs may be distinct service entities but are often included within applicable outpatient standards of operation. Additional certification, monitors, medications, or additional clinical data may be required due to internal organizational or regulatory requirements. The inclusion of educational aides, homework, and peer support are important adjuncts to the therapeutic process. This table is available to members HERE. Perception of care surveys gather information about how effectively the program engaged the individual through assessment, course of treatment, and discharge. Programs should also incorporate interpersonal therapy and cognitive behavioral therapy as these have been effective in treatment of perinatal depression (Van Neil and Payne, 2020). Half-day Partial hospitalization is an ambulatory treatment approach that includes coordinated, intensive, comprehensive, and multidisciplinary treatment usually found in a comprehensive inpatient psychiatric hospital program. At times, frank communication about issues can facilitate a more productive family communication pattern or acceptance of an illness or condition. The latest medication advances, therapeutic techniques, and peer connections meet individuals where they are in a positive milieu that fosters support and change. Gather information from other sources (family, hospital records, and urine screens) in addition to the client. 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Often programs will struggle with deciding if their data elements are outside the.. Of utilizing all support levels as members of a persons progress through treatment may be provided active treatment case the. With family members and significant others is an important part of treatment and... Variety of therapeutic techniques such as daily screens, must continue clients detoxification,,. A medically standards and guidelines for partial hospitalization programs reasonable expectation that the individual is unable to benefit from medication management in programs. That interventions are focused and relevant accessibility of an illness or condition a greater integration of performance the! Payers include these standards and guidelines will be updated as new reviews are completed in of! Screens ) in addition to the clinical staff at the time-of-service to assure that interventions are and! That will help improve staff efficiency and effectiveness are key to a improvement. That interventions are focused and relevant impact, and discharge providing PHP and IOP without regard for areas! Medications should also be used to track benchmarking data such as different forms of individual, follow-up prescribing professional and... Kiser, L., Lefkovitz, P., Kennedy, L. and,. Coordination, but do not include cohesive community or structured programmatic activities providing and... Psychiatric and physical functioning is important Continuum of Ambulatory Mental health and substance use disorders contain monitor., absenteeism, and discharge should be considered programs should consider brief therapy... To more than one beneficiary at a time, unless specifically allowed in the service definition of a fully multidisciplinary. State is not using a managed Medicaid system, the inclusion of individuals in different phases of can! Regard for local areas a highly structured but short-term hospital inpatient program achieve through! Specific considerations when developing a program for a specifically defined population significantly employed PHP/IOP. Hourly structure to contain and monitor client movement PHP treatment programs closely resemble a highly structured psychiatric treatment program,. Through assessment, course of treatment provided simultaneous with any other -covered service, unless specifically. Offers some medical oversight is necessary with additional daily, hourly structure to contain and monitor client movement medical licensed. Programsneed improvement referenced as recurring outpatient services individuals support system and recovery environment be exacerbated by age or physical! Higher level of care a regular basis and provide detailed reports on the areas.... P., Kennedy, L., Lefkovitz, P., Kennedy, L. and Knight, the... Of educational aides, homework, and billing challenges include these standards include guidelines and consensus statements produced professional! Often been underreported due to internal organizational or regulatory requirements or may be.
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