Our mission is to promote Partial Hospitalization and Intensive Outpatient Programs as a vital component of the Behavioral Healthcare Continuum. A reasonable understanding of responsibility or expectationsin the event thatthe individual does not follow through with the transition plan should be addressed between peer supports, practitioners, and/or care managers whenever possible. Any time a program negotiates a contract with a private payer, including Medicare Advantage plans, the program should request the guidelines for PHP and IOP. This plan facilitates efficient service delivery, an expeditious return to improved functioning in the individual's community, and a transition to less intensive levels of care. Given a focus on healthcare integration, illness prevention, and the improvement of health outcomes, linkages between behavioral health and primary care providers is particularly important. We must advocate for simplicity and consistency in the description of services offered in programs and the billing process. The defining characteristic of this function is the fact that PHP services are provided in lieu of inpatient hospitalization.. AABH provides these standards and guidelines as a broad representation of best practices in providing PHP and IOP without regard for local areas. While the use of an EMR is required for hospital systems and most community providers are adopting them, the challenge of product selection can be significant. Evaluation for medication assisted treatment (MAT) services may also be indicated. However, they should be a separate, identifiable unit and represent a continuum of therapeutic modalities that are evidence based for children and adolescents. Treatment must be rendered under the supervision of a psychiatrist or medical professional licensed to diagnose behavioral health issues. A given programs metrics may vary significantly based on the diagnostic characteristics of those who attend program and may help direct changes to programming to better meet the needs of the population in program. Table 1 Levels of Care (Behavioral Health), Solo practices, Medical clinics, Medical care home, IOP, Psych rehab, Club House, Assertive Community Treatment. When possible, it is important that comparisons or benchmarks be used to enhance performance. Portsmouth, Virginia. The role of physicians is typically not included in staff to client ratio. Programs will use their identified outcome measure tool to track clients progress in the program. This finding served as the basis for the development by AABH of specific standards and guidelines for co-occurring disorder programs, most recently revised in 2007.22. Access, treatment, and discharge data are key areas for tracking. Programs should consider brief family therapy and referrals for family members that need additional treatment. 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. If suicide risk is present in the participant, take action immediately, including staying online with them until help and safety has been secured. Occupational, recreational, and creative arts therapists broaden and deepen the array of available services when offered. PHP and IOP needs may or may not be adequately addressed due to unique workflow documentation, and billing challenges. Initial discharge criteria are formulated upon admission and are based on objective data such as achievement of a certain percentage of ideal body weight or targeted weight gain, or weight loss (if binge eating) as well as ability to function with less structure daily. 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. 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. A designated staff person without direct clinical responsibility for managing a case should review cases to determine if the document supports the individual being in the program. This section contains specific considerations when developing a program for a population identified in the list. Commission on Accreditation of Rehabilitation Facilities (CARF). Both are designed to serve individuals with serious symptoms and functional impairments resulting from behavioral health disorders. It is recommended that at least one performance improvement project be on-going in which all staff participate and/or understand the progress and can speak about the results if asked by reviewers or significant others. In partial hospitalization, the patient continues to reside at home, but commutes to a treatment center up to seven days a week. Treatment Guidelines Care Based Guidelines 1. 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. Finally, we wish to fully integrate resilience and recovery principles and training into overall behavioral health care. Yalom, Irvin D. Inpatient group psychotherapy. Standards for the approval of providers of non-inpatient mental health treatment services. State laws may apply. Treatment planning is a progressive process that requires regular updates of all goals and services on the plan. Enforce the same etiquette as at an in-person group meeting no food, no checking phones. 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. Organization should be clear for those who are less familiar with individualized medical recording formats and procedures like reviewers who conduct surveys through the observation of clinical records. Progress notes reflect, but are not limited to: Specific individual skills training, client generated progress sheets, participation in milieu activities, peer support building activities, family sessions, and case management meetings should also be documented regardless of whether the service is billable. Mothers should never be left alone with a baby if they are diagnosed with postpartum psychosis. Policy needs to dictate the availability of a psychiatrist (or other physician) for consultation to non-physician providers, face-to-face with individuals in treatment during program hours, and by telephone off hours to provide direction in the care for all enrolled clients 24 hours a day, seven days a week. 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. Fatigue, sensory impairment, decreased concentration ability, and discomfort with transitions or changes in programmatic structure are challenging factors to address in program development. Please read these statements before the first session and feel free to ask me any questions about this or other issues related to tele-psychotherapy. Payment will not be made for compensable peer support Consults, evaluation summaries, absentee notes, results of collateral contacts, treatment team notes, and progress summaries may also be included. 70.3 - Partial Hospitalization Services (Rev. Medicare Advantage Plans are not obligated to cover these levels of care. 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. Priorities are to monitor progress, review treatment planning, coordinate therapeutic team efforts, and facilitate discharge planning. Miller, T. Standards and Guidelines for Partial Hospitalization Programs. With the increased use of technology, programs have an opportunity to address needs of those they serve through methods other than in-person/on-site programming. Treatment is best conceptualized as a phased continuum of care that progresses from management of active symptoms and problems to establishing recovery/relapse prevention plans. Please talk to your provider about whether this may be a good care option for you. The patient or legal guardian must provide written informed consent for partial hospitalization 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. Texas Administrative Code Texas Administrative Code TITLE 28 INSURANCE PART 1 TEXAS DEPARTMENT OF INSURANCE CHAPTER 3 LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES SUBCHAPTER HH STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS Rules 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 programs are both community- and hospital-based and may be structured with after school or full day services. The following criteria should be considered as part of the clinical presentation to determine ongoing need for the level of care being provided: In addition to diagnostic criteria above, there needs to be a demonstrated benefit from this level of active treatment. These economic realities occur during a time of increased communication among providers and a renewed effort to achieve best practices. The need for 24-hour containment has been determined to be unnecessary. The benchmark when no other exists can be a designated baseline of a measure within the program. With recent changes to regulatory requirements in onsite visits, this document provides guidance in preparation for regulatory reviews. 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. Marketplace forces and cost containment efforts have often resulted in a decrease in service availability, more restrictive eligibility (medical necessity) requirements, and reduced lengths of stay. These services engage individuals in a non-talk therapy mode and can result in behavior clarity, new insights, and meaningful options for emotional expression and life balance. However, this range may extend to 21 years of age dependent upon the individuals developmental level and the goals and objectives and licensing requirements of any program. Programs for chemically dependent individuals are designed to serve those within a less restrictive environment (for example, less restrictive than inpatient or residential) which allows the individual to practice new recovery and coping skills within his/her natural environment and to assess the individual strengths and weaknesses associated with those recovery and coping skills. teacher on staff vs. Ongoing involvement and participation of family members and peer supports also cannot be overemphasized. A program willsometimesfind that it needs to create a program that meets the needs of the most restrictive protocols and design programming and billing to meet thosecriteria. The inclusion of report writing functions is important since it can be used to send letters to primary care providers, and to extract relevant clinical data from the record and organize it into referral forms or reports. 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. There are also times during treatment when the rationale for non-attendance is legitimate and in the overall best interests of the indivduals welfare. Individuals are invited and encouraged to adopt an active participant and partnership role in the treatment process. Availability of a nursery is critical for new moms. PHPs work best as part of a community continuum of mental health services which range from the most restrictive inpatient hospital setting to less restrictive outpatient care and support. This type of therapy requires even greater focus on the part of the clinician. All sessions are to be conducted using video and audio wherever This allows clinicians to assess the participants using all their clinical skills. The concept of partial hospitalization programs (PHPs) was developed before the 1950s.1 However, in the United States, PHPs did not take hold until Congress passed the Community Mental Health Act of 1963, which required that PHPs must be a core component of Community Mental Health Centers (CMHCs). 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. This assessment with screenings helps direct the diagnostic formulation of treatment and must clarify and prioritize client needs to be addressed in the program or elsewhere.. These standards include guidelines and consensus statements produced by professional specialty . Recently, accreditation organizations have also begun to look closely at clinical indicators of quality in addition to health and safety. Both performance and clinical measurement will be addressed. Programs should provide easy access to grievance procedures as required by regulatory agencies. Historically, the availability of an intact support system was a prerequisite for PHP services. Kiser, L., Lefkovitz, P., Kennedy, L., Knight, M., Moran, M., and Zimmer, C. The Continuum of Behavioral Healthcare Services. Portsmouth, Virginia. Daily monitoring of medications, safety, symptoms, and functional level is deemed medically necessary. Providers utilize a wide variety of therapeutic techniques such as different forms of individual, family, or group therapies, and/or medication management. While none of these focuses are mutually exclusive, a program tends to build their program from one of these perspectives. 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. Basic Books, 1983. A solid aftercare plan is crucial for success with this population. In addition to licensing requirements for your facility, your program staff may have requirements related to the Scope of Work for their license. Treatment planning for the individuals with co-occurring disorders incorporates knowledge of both the mental health and substance use components of the illness. Staff in settings providing integrated substance abuse and psychiatric treatment should be fully oriented in each others disciplines. Linkages related to successful treatment will be considered. 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 medications are dispensed on-site, appropriate staff must document medications that are administered on site. Level 2: Intensive Outpatient and Partial Hospitalization Programs . Coordinated (Integrated Care) services are provided to people who have complicated medical and/or behavioral health issues. 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 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). 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. They are designed to identify best practices within programs. Institute of Medicine of the National Academies. Substance Abuse and Mental Health Services Administration News Release. 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. Programs tend to fall into two basic categories that impact programming: These distinctions are important since they may dictate the process, content, and structure of group therapy and psycho-educational sessions. 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. 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. Actual individual characteristics, monitors, and trends can be tracked through discrete clinical fields as well. The specialty group guidelines have been streamlined to focus just on the elements that need to be addressed with the specific population. According to current practice guidelines, the treatment goals should be measurable, functional, time-framed, medically necessary, and directly related to the reason for admission. 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. 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 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. Many payers will have a requirement that a program meet the requirements of an accrediting body as a rule for program approval and reimbursement for services. PHPs and IOPs can be distinguished by their primary program function or treatment objective. It is recommended that programs use a formal method to collect consumer feedback through perception of care surveys and/or care satisfaction surveys. Psycho-educational services represent another basic building block of PHP/IOP treatment. Again, consider having another staff member, such as a behavioral health tech, present to handle these technical issues to reduce the impact on the group process. In 2005, SAMHSA surveyed the population and determined that 21% or 5.2 million adults experienced both serious mental illness and co-occurring substance abuse problems.21 SAMHSA experts emphasized that the treatment outcome for consumers is enhanced when both illnesses are addressed simultaneously using an integrated approach. Verified address where they are at the time of the service (make note as it changes), Phone number of police station closest to patients location, "I agree to be treated via telehealth and acknowledge that I may be liable for any relevant copays or coinsurance depending on my insurance, I understand that this telehealth service is offered for my convenience and I am able to cancel and reschedule for an in-person service if I, I also acknowledge that sensitive medical information may be discussed during this telehealth service appointment and that it is my responsibility to locate myself in a location that ensures privacy to my own level of, I also acknowledge that I should not be participating in a telehealth service in a way that could cause danger to myself or to those around me (such as driving or walking). The latest medication advances, therapeutic techniques, and peer connections meet individuals where they are in a positive milieu that fosters support and change. Ideally coordination services are managed by the same person/entity regardless of treatment level or location for that person. 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. Additional certification, monitors, medications, or additional clinical data may be required due to internal organizational or regulatory requirements. First Edition. Partial hospitalization is a time- limited, structured program of multiple and intensive psychotherapy and other therapeutic services provided by a multidisciplinary team, as defined by Medicare, and provided in an outpatient hospital setting outpatient department facility or a Medicare-certified community mental health center (CMHC) that meets In some cases, it may not be clear from diagnostic criteria alone which level of care is appropriate. Programs operate under the direction of a physician and a program leader. Re-certifications need to identify what functional or symptomatic conditions or changes have occurred during treatment that warrants the continuation of treatment. The certification needs to identify why the client would require hospitalization in lieu of the appropriate level of care. We encourage efforts by PHP and IOP staff to expand behavioral health techniques, skills, and resource libraries to overall health continuums and communities. Of all goals and services on the elements that need additional treatment of Rehabilitation Facilities ( CARF ) must for. Among providers and a renewed standards and guidelines for partial hospitalization programs to achieve best practices measure within the program participant and partnership role the. 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standards and guidelines for partial hospitalization programs