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. 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. 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). The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Partial Hospitalization Programs L37633. This may include marked impairments that preclude adequate functioning in areas such as self-care, and/or other more specific role expectations such as managing money, working, cleaning, problem solving, decision-making, contacting supports, caring for others, addressing safety issues, complying with medications, or managing time in a meaningful way. 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. PHPs differ from IOPs in several ways: payment is on a per diem basis for most private insurances. Some regulators have requirements about education components in these programs. The need and staff time involved in case management can be significant, especially for those clients who are receiving treatment for the first time. DESCRIPTION A psychiatric partial hospitalization program is a treatment setting capable of providing Examples of symptoms include high anxiety, sadness, depression, mood swings, elevated mood, irritability, intrusive thoughts, and more. However, they should be a separate, identifiable unit and represent a continuum of therapeutic modalities that are evidence based for children and adolescents. 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. It is therefore necessary for providers of PHP and IOP services to familiarize themselves with all current applicable requirements and interpretations for their local environment. Clinicians should pay attention to the need to ground themselves in this new environment - this may be another opportunity to model coping, Sitting in front of a screen for 45 minutes is very different from sitting in a group room in a chair- people are not shifting around and moving their bodies-staff and participants may need to take care to stretch and move around afterwards to reduce physical, Do not record sessions and make it clear that sessions are not. When there is disagreement between the service provider and the payer regarding length of stay, a process shall be in place to assure that client needs are met through continued stay or follow up plans with documentation of the clients current functional level, medical necessity for treatment, and risk factors impacting the decision. 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. Program Criteria. Archives of Womens Mental Health 20. Actual individual characteristics, monitors, and trends can be tracked through discrete clinical fields as well. The federal agency originally introduced the Medicare Partial Hospitalization Program modification in March 2016. American Society of Addiction Medicine (ASAM) (April 2001). 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). 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. 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. A significant improvement in functioning and symptom reduction is needed and achievable in order to resume role expectations and avert the loss of home, job, or family. For the purpose of this Part, the following terms are defined: "Abuse." Any physical injury, sexual abuse or mental injury inflicted on an individual other than by accidental means. 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 from around the country reveal the following clinical orientations or strategies that are reflected in their educational components: NOTE: Individual skills may be taught in each of these approaches. 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. Partial hospitalization must be a separate, identifiable, organized program . These severe impairments tend to include several acute symptoms that result in a breakdown in role function that may include an inability to follow through on essential tasks and responsibilities, social isolation, interpersonal difficulties, and a passive or impulsive loss of focus and initiative. More often the full array of services (when available) is delivered by a variety of organizations and individual providers within a given community. 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. The processes and results of access, engagement, treatment, and discharge should be considered. Once decisions regarding confidentiality are made, the nature of the handoffs between components within the continuum is equally important. The physician provides supervision of the clinical needs of the individuals enrolled in the program. Private Insurance and Medicare Advantage Plans each create their own protocols for PHP and IOP. Treatment Guidelines Care Based Guidelines 1. C. A partial hospitalization treatment level 2.5 program shall meet the current ASAM criteria for Level 2.5 Partial Hospitalization Services. Programs serving pregnant women or new mothers typically care for women with some type of Perinatal Mood and Anxiety Disorders (PMAD). PHPs are distinct organizational entities with specifically designated standards and regulatory reviews. Association for Ambulatory Behavioral Healthcare, 1998. American Association for Partial Hospitalization, 1982. A recovery model that focuses on increased quality of life is essential to give the older adult investment and purpose in treatment. The intent of this summary is to place PHPs and IOPs in the full context of available treatment services, arranged by relative level of intensity from traditional outpatient care to 24-hour inpatient treatment. Generally speaking, a program's average length of stay should reflect the population treated and primary program function. The signing of treatment reviews is an indication of the agreement of all parties that the goals for treatment will move the individual toward recovery and discharge. They are designed to identify best practices within programs. Each State has licensing agencies that regulate the licensing of professional staff. If a PHP offers four groups per day on five days a week, tele-health needs to offer four groups per day on five days a week; If an IOP offers three groups per day on three days a week, tele-health needs to offer three groups per day on three days a week. guidelines for partial hospitalization program content, physician certification requirements, and . Each component of a comprehensive clinical record described above should be part of a quality electronic medical records. While none of these focuses are mutually exclusive, a program tends to build their program from one of these perspectives. 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 . Key definitions related to partial hospitalization and intensive outpatient programming will be presented. 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. It is important to note that these Criteria are established as national standards. 104 CMR 27. Retrieved July 20, 2018, from https://www.ncmhjj.com/wp-content/uploads/2014/10/Behavioral_Health-Primary_CoOccurringRTC.pdf. Programs might also include informal methods to collect consumer feedback, including individual, group, and community discussions, and the use of an anonymous approach such as a suggestion box. Programs should use clinical screenings that are appropriate for regular assessment that determine progress in treatment and can be used to help set up initial treatment planning and changes to treatment planning during treatment. CMS reviews claims and provides an opportunity to recommend changes to the PHP and IOP guidelines annually. Important information about regulatory coordination and program structure will also be provided. The value of these programs in clarifying diagnoses, assessing function, and determining ones capacity for independence or personal safety cannot be underestimated. 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. There are three primary regulatory bodies that write regulation or guidance in detail for providers in the local area: Many of the States have a department that is responsible for the licensing of behavioral health facilities. D. A program must have a clinical director who shall be approved as a supervisor by the Board of Professional Counselors and Therapists to supervise alcohol and drug counselors or trainees. Respect that some participants are comfortable using telehealth services and some are Make every effort to meet the needs of all participants. 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. In the absence of detailed state licensing regulation, a program must pay attention to requirements for Payers and accrediting bodies. Providers utilize a wide variety of therapeutic techniques such as different forms of individual, family, or group therapies, and/or medication management. The use of templated treatment plans by diagnostic category or group topic participation is discouraged and may lead to denial of payment for services. Re-certifications are required by many payers within strict time guidelines. Encourage all clinicians to Be their best clinical self. -. Partial Hospitalization Programs (PHPs) are more intensive programs for patients who might otherwise require inpatient psychiatric care. 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. Intermediate Behavioral Health is the term used to identify partial hospitalization and intensive outpatient programs which distinguishes them from inpatient and outpatient services as part of the behavioral health continuum required for the implementation of parity legislation. Substance Abuse and Mental Health Services Administration News Release. These meetings are critical to achieve continuity of client care, address the identified needs of the therapeutic community, assure appropriate utilization of services, and maintain necessary operational efficiencies. Regular staff meetings should occur to address clinical needs, milieu issues, changing programming features, and relevant administrative issues. The specialty group guidelines have been streamlined to focus just on the elements that need to be addressed with the specific population. 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 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. Full-time participation in the program at the onset of treatment serves to promote stabilization and cohesion. PHPs have their own set of rules and guidelines that are not discussed here ( click here to read more about PHPs). Your compliance officer is usually the best person to advise on any licensing requirements at the State level. When possible, it is important that comparisons or benchmarks be used to enhance performance. If suicide risk is present in the participant, take action immediately, including staying online with them until help and safety has been secured. The certification needs to identify why the client would require hospitalization in lieu of the appropriate level of care. In many program settings, the inclusion of individuals in different phases of recovery can be used to good clinical advantage. Identifiers should be individualized so program staff and reviewers can uniquely identify each patient. (2) Prior authorization is required for LOC 2.5 (partial hospitalization) which requires a minimum of twenty hours of services per week. 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. Staff should only use laptops, PCs, and smartphones that are encrypted. A description of the essential treatment services such as group, occupational, and psycho-educational therapies will be provided. Group process theory has been based primarily on specific process dynamics over a course of time in an outpatient setting with relatively high-functioning individuals. The staff to client ratio is the most critical benchmark driving the cost and effectiveness of programs. Program and quality improvement measurements may include, but are not limited to selective case studies, clinical peer review, negative incident reporting, and goal attainment of programmatic, clinical, and administrative quality indicators. 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. The services and support provided by the ancillary staff and volunteers is not often reimbursable in fee for service models. Association for Ambulatory Behavioral Healthcare, 2007. As many EMR systems were initially designed for inpatient non-psychiatric care, data processes may be challenging. Codes G0129 and G0176 are only used, and therefore reimbursable, for partial hospitalization programs. 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 Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) has refined the diagnostic categories of eating disorders, defining them as Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Avoidant/Restrictive Food Intake Disorder (ARFID) and eating disorder not otherwise specified, which include a wide range of subclinical symptoms. Daily monitoring of medications, safety, symptoms, and functional level is deemed medically necessary. Finding measures that will help improve staff efficiency and effectiveness are key to a quality improvement plan. Bill Type 13X is billed with Condition Code 41 (Partial Hospitalization) and the HCPCS code is not For individuals who are offered telehealth for PHP or IOP, programs must offer the same level of programming offered onsite. Mothers should never be left alone with a baby if they are diagnosed with postpartum psychosis. These services are included as mandated essential behavioral healthcare benefits in insurance policies from 2014 onward. 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. Standards and Guidelines for Partial Hospitalization Geriatric Programs. The advent of the electronic medical record (EMR) or electronic health record (EHR)provides many new opportunities as well as challenges in the documentation process for intermediate levels of care. PHPs and IOPs must have a written plan for quality improvement which includes both process/performance outcomes and clinical outcomes management. As a person moves through the continuum of care, the coordinated care services usually increase or decrease as reflected in the level of care that person is receiving. The EMR should also allow multiple staff members to work within a record at the same time so efficiency can be gained while clinicians complete record reviews and notes concurrently. Our eating disorder partial hospitalization program in Dallas Texas addresses the physical, emotional, and spiritual aspects of our client's well-being. Telehealth services in PHP and IOP are demonstrating to be useful as an additional service modality. To accomplish this, programs should develop and maintain liaison relationships with organizations such as hospitals, crisis stabilization units, primary care physicians, community therapists, supportive living programs, community support programs, self-help groups, crime victim councils, vocational assistance programs, employee assistance programs, home health services, and various other social service agencies and organizations. Group therapy is an important part of treatment as research indicates that group therapy for women with postpartum depression led to a reduction in depression scores (Byrnes, 2018). In some cases, removal from a given residence or placement in a residence or residential treatment setting may be a precondition for treatment. Individuals at this level of care cannot adequately manage their symptoms, are at imminent risk of harm to themselves or others, and/or cannot maintain activities of daily living. AABH provides these standards and guidelines as a broad representation of best practices in providing PHP and IOP without regard for local areas. 4. 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. Movement needs to be monitored hourly, determining how much movement or exercise is medically safe for each clients stability. Encourage use of the raise hand feature if available on the platform. All treatment planning activity must continue. PHPs and IOPs are characterized by formalized efforts to promote and maintain a stable and cohesive therapeutic milieu or community. 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. 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. The treatment mission of PHP and IOP services is to develop a setting that provides the tools for recovery. The individual must, however, have the capacity for minimum engagement in the identification of goals for treatment, and minimal willingness to participate actively in relevant components of the program. Kiser, J.L., Trachta, A.M., Bragman, J.I., Curley-Spadaro, K., Cooke, J.D., Ramsland, S.E., and Fitzhugh, K.E. This role also includes developing operational management plans which address key financial considerations including contracting issues, insurance verification, pre-certification procedures, re-certification tracking, record management as per insurance expectations, retrospective appeal procedures, and productivity management. 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. Considerable ongoing communication exists regarding the interface between residential non-hospital treatment facilities and PHPs and IOPs. Individuals are invited and encouraged to adopt an active participant and partnership role in the treatment process. A higher level of monitoring of overall behavioral health and physical functioning is important. Licensing and Operational Standards for Community Services. 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. When developing program schedule, consider your population and how you will structure school (i.e. 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. We advocate for unified medical necessity guidelines among payers. 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. A further revision of Adult PHP standards and guidelines was completed in 2003.19 The intent was to outline model conditions while providing both objective and concrete criteria for establishing and comparing adult partial hospital programs. Many programs opt to divide the program leadership into two roles. In these cases, backup case management and peer support services can be essential. We have prepared this article to provide general guidelines for insurance billing for PHP. Association for Ambulatory Behavioral Healthcare, 1999. Table 1 Levels of Care (Behavioral Health), Solo practices, Medical clinics, Medical care home, IOP, Psych rehab, Club House, Assertive Community Treatment. Examples of these symptoms may include negative self-talk, crying spells, severe anxiety, poor sleep, or panic attacks. Residential Treatment Position Statements . These programs often allow children and adolescents to avoid inpatient hospitalization, decrease lengths of stay otherwise required in inpatient or residential settings, or to support the child/adolescent with any transitions such as foster care when needed. The CARES Act of 2021 mandates that all providers of treatment make the full medical record, including behavioral health records, available to any individual who received services in that organization. We encourage a shift in the oversight focus from document analysis to a concern for outcomes and the overall client experience. The primary goals of intensive outpatient programs are to monitor and maintain stability, decrease moderate symptomatology, increase functioning, and foster recovery. Older Adult programs are an important means of delivering behavioral health treatment to adults age 55 and older. However, the individual often presents with an impaired willingness or capacity to positively connect with caretaker, family, friends, or community supports. Services may include group, individual, couples, family therapy and medication management for symptom management. Mol, J.M. Standards and Guidelines for Partial Hospitalization Programs. Block, B. and Lefkovitz, P. Standards and Guidelines for Partial Hospitalization, Alexandria, Virginia. Each program is challenged to provide effective care within increasing time constraints and with limited resources. 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. 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. Even in specialty programs that serve a focused group of diagnostics, individuals may need to be tracked on different clinical measures. A comprehensive program improvement plan should include an internal review process to assess the appropriate use of program services. 2013) 10, 2013. Specific self-reported monitoring tools are often used within specific diagnostic groups or in specialty programs such as those for Older Adults or persons experiencing Eating Disorders. A number of programs report that they use these tools for daily symptom monitoring as part of the ongoing assessment process. There are no guidelines for how a State should license behavioral health facilities, which may lead to a need to search carefully for the licensing requirements. Learn more: 12-step programs. residential programs. A less intensive level of care may have been insufficient to provide the treatment the individual requires to stabilize this decline. Facilities that provide treatment for both behavioral health conditions are not formally designated as a single treatment program in most areas. Archived Program Rules - Chapter 320 - Early and Periodic Screening, Diagnosis and Treatment. Dads can also struggle with paternal depression and the mental health of the whole family is key to successful outcomes. Within a continuum of behavioral health care, PHPs and IOPs function as vital components. To make a referral, have your doctor or therapist call 1-319-384-8449. People need to feel hope, find purpose, and care for others. Services at this level are offered with some degree of coordination, but do not include cohesive community or structured programmatic activities. Important to have prescribers with expertise in prescribing during pregnancy and lactation. Initially, the individual may only be able to agree to begin treatment and form a basic treatment plan, and may require close monitoring, support, and encouragement to achieve and sustain active and ongoing participation. Treatment should include collaboration with school, involved community agencies and established providers. 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