Whenever possible, programs should compare their results and findings through benchmarking with similar facilities. The use of electronic signatures (for the clinicians and patients) is a valuable option if available as it prevents the need to re-scan documents into the EMR and assures timely document review by the treatment team. These tools provide further input regarding the programs effectiveness in facilitating recovery steps and enhancing peer support for participating consumers. Kiser, J.L., Trachta, A.M., Bragman, J.I., Curley-Spadaro, K., Cooke, J.D., Ramsland, S.E., and Fitzhugh, K.E. For example, some States allow a psychiatric nurseto provide psychotherapy groups while others do not allow this. Coordinated (Integrated Care) services are provided to people who have complicated medical and/or behavioral health issues. Priorities are to monitor progress, review treatment planning, coordinate therapeutic team efforts, and facilitate discharge planning. Level 2 programs provide essential addiction education and treatment components and have two gradations of intensity. Typically, individuals 18 years of age and younger are 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 services and support provided by the ancillary staff and volunteers is not often reimbursable in fee for service models. State laws may apply. There must be a clinical determination that the additional treatment requested can result in improvement or stabilization of a documented persistent decline in functioning. The patient or legal guardian must provide written informed consent for partial hospitalization treatment. Programs providing primarily social, recreational, or diversionary activities are not considered partial hospitalization. This staff member should work consistently with the individual (and family as indicated) and follow the course of clinical treatment from admission through discharge. clinical judgment consistent with the standards of good medical practice will be used to . Document receipt of verbal acknowledgement for each statement: Document that the person has received this information and acknowledged it. 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. 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. Kiser, L., Lefkovitz, P., Kennedy, L., Knight, M., Moran, M., and Zimmer, C. The Continuum of Behavioral Healthcare Services. Portsmouth, Virginia. 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. Consider that each participant has differing levels of technical abilities or. (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 should include clinical measures that assess current status of the individuals symptoms and functioning. Yalom, Irvin D. Inpatient group psychotherapy. Partial Hospitalization Programs (PHP) - Partial hospital implies a daily psychosocial milieu treatment of generally four or more hours duration a day with group therapy, psycho-educational training, and other types of appropriate therapy as the primary treatment modalities. PHPs and IOPs are designed to help individuals understand their illness, reduce the impact of functionally debilitating symptoms, and cope with challenging situational crises. This program typically lasts about 10 business days. Organized as a continuum, this system of care enables the movement of individuals to the most clinically appropriate and cost-effective level of care. 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. Consider how staff will compensate. 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. Partial Hospitalization is a highly structured psychiatric treatment program which, in the case of substance abuse prevention, also offers some medical oversight. The downloadable version is created every three years from the information contained in the online version of the Standards and Guidelines. These standards include guidelines and consensus statements produced by professional specialty . 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 the time, Pamela Hyde, JD, SAMHSA Director, announced that partial hospitalization and intensive outpatient treatment were specifically included as essential intermediate behavioral healthcare treatment options.1 This landmark decision validates over 40 years of effort by behavioral health professionals throughout the country to provide intensive ambulatory treatment and avert or reduce hospitalizations while creating an environment of personal recovery for countless Americans. Each State should have an office that manages Medicaid. Partial Hospitalization Program (PHP) Definition A partial hospitalization program (PHP) is a time limited, ambulatory treatment program offered during the day or evening hours, and is considered an acute day hospital or a level 2.5 program per American Society of Addiction Medicine (ASAM) guidelines. 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. It is important to note that these Criteria are established as national standards. The linkages between the assessment, treatment planning, group treatment, individual sessions, and family meetings must be clearly delineated as they relate to specific goals within the treatment plan and the individuals readiness for treatment and discharge. 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. Partial Hospitalization is a short-term (average of four (4) to six (6) weeks), less than 24 hour, intensive treatment program for individuals experiencing significant impairment to daily functioning due to substance Currently Partial Hospitalization may be provided in a hospital or Community Mental Health Center (CMHC). Electronic record systems should reflect the clinical treatment process and allow the capture and representation of data in a user-friendly fashion. We hope this document will be used in concert with active dialogue on a local, regional and national level to improve care and individual recovery. the program. By Jacqueline LaPointe. Treatment must be rendered under the supervision of a psychiatrist or medical professional licensed to diagnose behavioral health issues. Services at this level are offered with some degree of coordination, but do not include cohesive community or structured programmatic activities. Ongoing clinical responsibility must continue and be clarified while individuals are awaiting follow up care. CMS and other agencies expect to see individual sessions prescribed as a necessary component of treatment during each episode of care. The primary therapist should be responsible for the quality reviews for their individual caseload and review their caseload regularly. Discharge from IOP programs is made to individual outpatient behavioral health specialists, integrated physical/behavioral settings, or primary care. Structure of the Accreditation Requirements This function is utilized clinically to prevent self-harm, reduce acute symptomatic exacerbation, restore baseline functioning, and increase recovery skills. Outpatient care can include 12-step programs, therapy, support groups, and partial hospitalization. The main objective is to receive feedback addressing the degree to which the program met the individuals needs and assisted in achieving their goals. PHPs and IOPs can be distinguished by their primary program function or treatment objective. Common problems related to symptoms, life situation, and skill deficits lead to group topics. It is believed that the services available in intermediate level of care is sufficient to reduce symptoms and/or restore the individuals functioning. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. 373-388, 2017. In many program settings, the inclusion of individuals in different phases of recovery can be used to good clinical advantage. This document has been designed to enable programs to: Partial hospitalization programs (PHP) and intensive outpatient programs (IOP) may differ from one region to another due to multiple factors such as specialized workforce availability, culture, resources, or health insurance coverage inconsistencies. Ifthatindividualhas completed a PHP or IOP and needs intervention prior to the transition to an outpatient appointment with a new psychiatrist, there must be a responsible party assigned to provide care in the interim. We have prepared this article to provide general guidelines for insurance billing for PHP. Both are designed to serve individuals with serious symptoms and functional impairments resulting from behavioral health disorders. Some regulators have requirements about education components in these programs. The following core areas are examples of data elements that can be reviewed regularly as part of a performance review plan: The tracking of specific diagnostic or other characteristics can be essential to program design or psycho-educational content. % 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. 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. Call Now to Begin the Recovery Process Today. Case reviews should be scheduled on a regular basis. All reviews should be documented in the record with agreement and signatures from the supervising medical professional, the treating staff and the person being treated. The fifth edition was completed in 2012. The achievement of clinical stability and a reduction in symptomatology must be considered in the context of realistic and achievable goals especially given the complex medical and psychosocial stressors that often impact the older adult population. Regulations, and Minimum Standards Authority: T.C.A. Intensive Outpatient Programs (IOP) Intensive Outpatient implies more than traditional single service outpatient service, yet not significant enough to meet the requirements of a partial hospitalization program. To manage medical and behavioral emergencies, policies should be developed to expedite admission for inpatient care if required and allow for timely pharmacological intervention. The goal is to contribute to patient safety. Examples include benchmarked metrics such as absenteeism, dropouts, and patient outcome data. 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. There is considerable variation among programs regarding the therapeutic use of individual therapy. 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. Each record section should conform to regulatory documentation requirements to assure that the notes meet billing requirements as well as clinical requirements. Example metrics include, but are not limited to: Tracking data related to who is coming to program, how services are used and how long they are in program is important in reviewing quality along with programming issues. Third Edition. Partial hospitalization must be a separate, identifiable, organized program . American Association for Partial Hospitalization, 1993. 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. It's more intense than psychosocial rehabilitation or outpatient day treatment. 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. Alexandria, Virginia. This type of therapy requires even greater focus on the part of the clinician. Portsmouth, Virginia: Association for Ambulatory Behavioral Healthcare, 2007. Programs serving pregnant women or new mothers typically care for women with some type of Perinatal Mood and Anxiety Disorders (PMAD). Facilities that provide treatment for both behavioral health conditions are not formally designated as a single treatment program in most areas. These are important things to address during the course of treatment in these programs. A separate progress note is required for each service delivered, whether billable or not. We must advocate for simplicity and consistency in the description of services offered in programs and the billing process. A less intensive level of care may have been insufficient to provide the treatment the individual requires to stabilize this decline. As other programs specific to a population grow to needing a national standard, they will be added to this section. Portsmouth, Virginia. Traditionally, substance abuse and mental health facilities are treated as separate programs and are often licensed and reviewed separately in many states. Please talk to your provider about whether this may be a good care option for you. The presence of comorbid physical illness must be addressed and often makes the frequency and duration of attendance more challenging. PHPs and IOPs should represent the core of psychosocial treatments. Peer support is encouraged in programs where applicable regulations allow the use of peers who have been trained to support the clinical efforts of the program. 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. 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. Psychiatrically trained medical professionals, including Physician Assistants and Nurse Practitioners may also be members of the physician team if regulations apply for such. However, any licensing conflicts and decision related to resolving the conflict should be reviewed by the compliance and legal departments or an organization. Clinicians should utilize language in documentation that notes telehealth use. 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. PHPs and IOPs are characterized by formalized efforts to promote and maintain a stable and cohesive therapeutic milieu or community. Archives of Womens Mental Health, 16. Considerable ongoing communication exists regarding the interface between residential non-hospital treatment facilities and PHPs and IOPs. Theme-based groups include a variety of specific topics that emerge from on-going team collaboration, client feedback, and ongoing reassessment of value. Ideally coordination services are managed by the same person/entity regardless of treatment level or location for that person. 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. Daily monitoring of medications, safety, symptoms, and functional level is deemed medically necessary. Theory/evidence-based groups are derived from cognitive-behavioral, dialectical, or other evidenced perspectives. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services (January 2003). 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. Additional benefits should include enhanced tracking and report writing functions that improves decision-making through the collection of timely, accurate information. These disorders are characterized by significant changes to mood during pregnancy and up to 3 years postpartum. 4. In the current healthcare environment, this level is also referred to as Primary Integrated Care and supported by the Center for Medicare and Medicaid Services (CMS) Integrated Health Model. Partial Hospitalization These programs are defined as structured and medically supervised day, evening and/or . 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. All treatment planning activity must continue. These departments are usually found somewhere within the State's health department and can often be found by searching for licensing. 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. Important information about regulatory coordination and program structure will also be provided. Creative/Expressive therapies are also significantly employed in PHP/IOP clinical settings. Each program is challenged to provide effective care within increasing time constraints and with limited resources. 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. Medically based/disease or illness management groups emerge from a more formalized rehabilitative illness management perspective which often aligns well with medically based continuums of care. In some cases, it may not be clear from diagnostic criteria alone which level of care is appropriate. To ensure effectiveness of co-occurring programs, it is important to not rely only on patient report but to utilize data from various sources to ensure ongoing recovery. 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