Our Behavioral Health Care guidelinesbuilt on the same principles of evidence-based medicine used to create our medical/surgical guidelines address medical necessity screening criteria to help make informed, consistent care decisions with confidence. Acute Symptom Reduction - This intensive PHP function focuses on the provision of sustained, goal-directed, clinical services to reduce the persons acute symptoms and severe functional impairments as an exacerbation of a more chronic condition. It is believed that the services available in intermediate level of care is sufficient to reduce symptoms and/or restore the individuals functioning. 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. For individuals who don't require a hospital stay or constant supervision, partial hospitalization programs can be an excellent alternative that allows them to dedicate time and attention to addressing their mental health condition while staying at home or with family members. The necessity of and rationale for continued stay must also be documented in the medical record including the revised treatment plan when needed. While some of the same presenting symptoms may be seen, individuals treated in partial hospitalization programs require daily monitoring and exhibit a more severe debilitation of overall functioning, as evidenced by multiple symptoms, significant emotional distress, risk of self-harm, passivity or impulsivity, and incapacity to cope with multiple stressors. There must be a clinical determination that the additional treatment requested can result in improvement or stabilization of a documented persistent decline in functioning. Residential services are provided to individuals who require greater support, monitoring, and intensity of services than can be offered in acute ambulatory settings. 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. The federal agency originally introduced the Medicare Partial Hospitalization Program modification in March 2016. Additionally, any exclusionary citeria must be clearly defined. 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. The fifth edition was completed in 2012. Scheifler, P.L. Association for Ambulatory Behavioral Healthcare, 1996. The assessment tools in the record must include all relevant information and have the capacity to go beyond documentation of the presence or absence of specific criteria through checklists or drop-down boxes. 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. Behavioral/Physical health Integration groups include a focus on both physical and behavioral issues such as with depression associated with cardiac care. 104 CMR 28. 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. Partial Hospital Programs provide no less than 4 hours of direct, . The presence of substance abuse has often been underreported due to cultural or generational biases. Staff training regarding appropriate language and terminology in documentation should be standard component of staff training on an annual basis. Children's Partial: 9. Partial hospitalization programs (PHPs) differ from inpatient hospitalization in the lack of 24-hour observation, and outpatient management in day programs in 1) the intensity of the treatment programs and frequency . These programs are available at inpatient or residential treatment facilities. the program. for Health and Human Serv., Substance Abuse and Mental HealthServ.(Jan. Examples include benchmarked metrics such as absenteeism, dropouts, and patient outcome data. Private Insurance and Medicare Advantage Plans each create their own protocols for PHP and IOP. The organization recognizes that many local factors can contribute to the detailed implementation of these standards and guidelines. Historically, the availability of an intact support system was a prerequisite for PHP services. In 1999, AABH revised its continuum of care model to include 6 levels of ambulatory behavioral health services.3 The continuum model was designed to assist in the process of determining the appropriate level of care given the needs of the individual, and to advocate that this placement decision take precedence over cost or other non-clinical considerations. The use of templated treatment plans by diagnostic category or group topic participation is discouraged and may lead to denial of payment for services. Outpatient care may be short or long-term depending on the needs of the person. Association for Ambulatory Behavioral Healthcare, 2012. Eating disorder partial programs provide staff- supervised meal and snack groups, regular monitoring of weight and vital signs, and a variety of groups aimed at addressing symptom management and augmenting patients coping skills and strategies (as they relate to both the eating disorder and other behavioral health co-morbidities). Section 115.120 Definitions. Considerable ongoing communication exists regarding the interface between residential non-hospital treatment facilities and PHPs and IOPs. New York: Guilford, 2002. There are three principal forms of linkage: FIRST, internal linkages between programs, departments, or practitioners within the same organization. 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. 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. Given the overall potential to improve patient safety through error reduction and enhanced treatment through continuity of care, the EMR has become a permanent part of nearly all programs. If my provider is concerned about my safety, I understand that they have the right to terminate the visit.". Irvin D. Yalom provides relevant material from his book entitled In-Patient Group Therapy, which shares some insights regarding similarities to group therapy in an acute intermediate setting.4 Open-ended admissions, relatively heterogeneous client populations, and the crisis nature of the content of discussion are relevant. Telepsychiatry Guidelines . 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. Programs should include clinical measures that assess current status of the individuals symptoms and functioning. 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. If medically unstable, inpatient hospitalization is necessary, stepping down to a PHP level of care. Orientation materials and program guidelines should be designed to make program goals, procedures, and expectations explicit for individuals utilizing services as well as for their family members, supportive peers, and collaborating providers. These are often times when a given individuals clear need (such as for new housing due to an imminent spousal separation) may not coincide with the individuals actual desire for an appropriate referral. The program can benchmark against itself to demonstrate change over time. The presence of comorbid physical illness must be addressed and often makes the frequency and duration of attendance more challenging. 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. Recovery-based education builds upon steps designed to create self-monitoring and individual recovery. The program provides . As providers have found it helpful to provide specialized programming for sub-populations dealing with similar behavioral health challenges, these guidelines outline unique factors related to some of those specialty populations, including: Necessary elements for documenting services provided include a discussion about electronic medical records. 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. 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. k) Service provided simultaneous with any other -covered service, unless Medicaid specifically allowed in the service definition. 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). 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. These standards include guidelines and consensus statements produced by professional specialty . Programs operate under the direction of a physician and a program leader. PHPs and IOPs are characterized by formalized efforts to promote and maintain a stable and cohesive therapeutic milieu or community. Health IT and Patient Safety: Building Safer Systems for Better Care. Washington, D.C., 2011. American Association for Partial Hospitalization, 1982. US Dept. 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). Surveys should be user-friendly, relevant to the mission of the treatment program, and routinely completed by all participants during program and at discharge. Bonari, L. P. Perinatal risks of untreated depression during pregnancy. Initial Evaluation/Certification This final consideration is increasingly important in the world of accountable care. 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). 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. A less intensive level of care may have been insufficient to provide the treatment the individual requires to stabilize this decline. Adult Residential Care Provider (ARCP) Ambulatory Surgical Center (ASC) Behavioral Health Services Provider. Encourage use of the raise hand feature if available on the platform. and provide safety through clinical guidelines, standards, and best practices. 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. These outcome measures should measure change, so progress can be demonstrated. In general, a seamless flow between practitioners or facilities includes the sharing of clinical information, collaborative treatment planning, safety and recovery management, and discussion of potential financial or insurance related factors that may impact ona personsresponsibility for payment of services. As other programs specific to a population grow to needing a national standard, they will be added to this section. It's more intense than psychosocial rehabilitation or outpatient day treatment. Clinicians should utilize language in documentation that notes telehealth use. For example, in a program that serves individuals with substance use issues, some may need to be tracked on depression, while others may need to be tracked for anxiety. 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. l) Services provided to more than one beneficiary at a time, unless specifically allowed in the service definition. Several factors have emerged since the 1999 Continuum of Behavioral Health Services paper was last revised. 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. The degree to which an individuals medications are managed and the extent to which they must be reconciled, tracked, or summarized may vary according to program mission, regulation, or defined clinical responsibility within the continuum. Miller, W.R. and Rollnick, S. Motivational Interviewing: Preparing People for Change, (2nd ed.). Recently, accreditation organizations have also begun to look closely at clinical indicators of quality in addition to health and safety. The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Partial Hospitalization Programs L37633. Our mission is to promote Partial Hospitalization and Intensive Outpatient Programs as a vital component of the Behavioral Healthcare Continuum. Co-occurring treatment providers must be well versed in the diagnosis and treatment of concurrent mental health and substance use disorders. Formal agreements may not be necessary, but an agreed upon process is necessary to assure that crucial treatment information is shared in a confidential manner which also allows for verbal communication between providers when deemed appropriate. We encourage the use of alternative modes of treatment delivery, such as telehealth, when newmodesare demonstrated to contribute to quality services. 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. The individual may require significant skills to make changes which prevent further deterioration between sessions. Partial Hospitalization - A program for adults or adolescents which provides active treatment designed to stabilize or ameliorate acute symptoms in a person who would otherwise need hospitalization. There is a medically determined reasonable expectation that the individual may improve or achieve stability through active treatment. All programs should consult with compliance officers in their organization to determine if there are specific staff-to-client ratios included within contracts. 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. All sessions are to be conducted using video and audio wherever This allows clinicians to assess the participants using all their clinical skills. Portsmouth, Virginia. Consider that each participant has differing levels of technical abilities or. Mothers should never be left alone with a baby if they are diagnosed with postpartum psychosis. 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. 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. Individuals in treatment include both those who participate voluntarily, as well as those mandated by the legal system. Some of the core benchmarking metrics that directly impact the financial or operational success of PHPs and IOPs include: AABH holds process benchmarking workshops to assist program leaders and clinicians in better understanding the specific factors that contribute to superior outcomes. Coordinated care services aims to keep a key person/entity involved in the entire treatment process as a proxy for a person who may struggle with the complexities of the health system. State laws may apply. 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. The treatment mission of PHP and IOP services is to develop a setting that provides the tools for recovery. Medicare Advantage Plans are not obligated to cover these levels of care. It is designed for patients . For instance, one might track the percentage of patients with housing issues, joblessness, or secondary substance abuse with minimal effort. achieve effectiveness and best practices in service delivery. CNA (Certified Nurse Aide) Registry. However, the individual often presents with an impaired willingness or capacity to positively connect with caretaker, family, friends, or community supports. It is important for programs to provide lactation consultation in the program as working through difficulties with breastfeeding is a common treatment goal with this population. Some flexibility in programming should always be considered given individual circumstances, Is uninterested or unable due to their illness to engage in identifying goals for treatment and/or declines participation as mutually agreed upon in the treatment plan, Is imminently at risk of suicide or homicide and lacks sufficient impulse/behavioral control and/or minimum necessary social support to maintain safety that requires hospitalization, Has cognitive dysfunction that precludes integration of newly learned material, skill enhancement, or behavioral change, Has a condition such as social phobia, severe mania, anxiety, or paranoid states in which the individual may become more symptomatic in a predominantly group treatment setting, Has primarily social, custodial, recreational, or respite needs. 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. Perception of care surveys gather information about how effectively the program engaged the individual through assessment, course of treatment, and discharge. ISSUE Psychiatric Partial Hospitalization Program Certification Standards. Adult Day Health Care. 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. An external audit should not be the impetus for utilization reviews. Gather information from other sources (family, hospital records, and urine screens) in addition to the client. Propose to IOPs may see staff-to-client ratios from 1:12 to 1:20 depending on the focus of the program or the acuity level of individuals in the program. PHP and IOP treatment allow persons served to stabilization more successfully while in their own community environment. 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 results of quality improvement and outcomes management are to be documented and incorporated into administrative, programmatic, and clinical decision-making processes. 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. 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. For individuals who are offered telehealth for PHP or IOP, programs must offer the same level of programming offered onsite. Each organization may also have criteria that must be included in the psychiatric assessment. In some cases, a summary of daily notes is optional, but do not serve to replace individual notes. Each component of a comprehensive clinical record described above should be part of a quality electronic medical records. Occupational therapy is also a dynamic component of many programs. The individual exhibits acute symptoms or loss of function that necessitates an intermediate level of care or has relapsed and failed to make significant clinical gains in a less intensive level of care yet does not need 24-hour containment. Establishment of a safety plan that allows for the child/adolescent to maintain safety in a community setting. Ongoing performance reviews may address attendance rates, dropout percentages, treatment trends, satisfaction, clinical handoffs, discharge status, post-discharge adjustment, or readmission rates. These standards and guidelines focus on best practice for care in PHP and IOP settings; however, AABH acknowledges that some contracts with payers may override the standards in this document. The downloadable version of the Standards and Guidelines reflects the most recent publication and may not accurately reflect the online version. Regular staff meetings should occur to address clinical needs, milieu issues, changing programming features, and relevant administrative issues. 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. American Association for Partial Hospitalization, 1996. 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. The advent of the recovery model has influenced the treatment continuum, expanding the role of the consumer in determining services availability and design. The plan must be available to the clinical staff at the time-of-service to assure that interventions are focused and relevant. The services and support provided by the ancillary staff and volunteers is not often reimbursable in fee for service models. 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. Regulations, and Minimum Standards Authority: T.C.A. Generally, the receiving program should have access to all aspects of the treatment in the previous program within the continuum, and accurately identify the source of information gathered while minimizing the difficulties for an individual to resume treatment. Respect that some participants are comfortable using telehealth services and some are Make every effort to meet the needs of all participants. Whenever possible, they want to keep their job and maintain their homes. 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. The overall expected outcome is the achievement of symptom and functional improvement on the part of the child/adolescent and the family. Can help as you work to achieve good, stable mental health. See DSM-5 for details on these diagnostic categories, and the levels of severity. As many EMR systems were initially designed for inpatient non-psychiatric care, data processes may be challenging. Traditionally, substance abuse and mental health facilities are treated as separate programs and are often licensed and reviewed separately in many states. Consults, evaluation summaries, absentee notes, results of collateral contacts, treatment team notes, and progress summaries may also be included. As partial hospitalization continued to evolve within the context of a continuum of services, the 1996 revision was intended to incorporate contemporary views of this specialized level of care.16 Specific standards and guidelines for child and adolescent programs were also completed at that time which attempt to delineate both similarities to adult programs and unique challenges.17 Intensive Outpatient Services were first addressed in a 1998 edition.18. This would also include ongoing communication between program staff and apersonsresidential program coordinator or community care manager while that personis in treatment. 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. Programs often have limited staff availability, so brief individual sessions may be the norm with more complex issues being reserved for follow-up outpatient treatment. 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. Debilitating symptoms may also accompany a life change, significant loss, or even the current ineffectiveness of previous coping skills. The assessment and treatment plan should address improvement of social skills and functioning via the therapeutic milieu. 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. Participating in a peer-based benchmarking programs allows programs to evaluate how they compare to a larger group of programs. 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. This document addresses the presenting problem, psychiatric symptoms, mental status, physical status, diagnosis, rationale for care, and treatment focus for the person while in treatment. 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 Finding measures that will help improve staff efficiency and effectiveness are key to a quality improvement plan. These are often reviewed during site visits, but internal processes need to be in place to review health and safety processes regularly. This method is employed where the treatment team deems it a safe method of service delivery to the person (e.g., person served is not acutely suicide, home setting is conducive to participation by telehealth means). It includes measurable goals and objectives that addressthe problems identified in the clinical assessment and should be updated periodically., A listing of all known public and . 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. Standards and Guidelines for Partial Hospitalization Geriatric Programs. Licensing and Operational Standards for Mental Health Facilities. 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Clinical record described above should be part of a quality electronic medical records intact support system was a for... You work to achieve good, stable mental health programs are available at inpatient or residential treatment and... There is a medically determined reasonable expectation that the individual requires to stabilize this.... Health Integration groups include a focus on both physical and Behavioral issues such with! Individuals to the client telehealth use the percentage of patients with housing issues, programming... Compliance officers in their own protocols for PHP or IOP, programs an! Stabilization more successfully while in their own community environment Center ( ASC ) Behavioral health services paper was revised... Develop a setting that provides the tools for recovery current status of the child/adolescent and the levels of.... Technology, programs have an opportunity to address clinical needs, milieu issues, joblessness or... The necessity of and rationale for continued stay must also be included in the psychiatric assessment right...