standards and guidelines for partial hospitalization programs

This means the guidelines for PHP and IOP will vary from State to State. First Edition. Consider providing a staff member for each telehealth group for technical assistance, administrative duties, and telephone follow up on participants who drop or disappear from the screen. When a given benchmark is not being addressed nationally, a program is advised to track their own metrics that are relevant to their specific population. Partial hospitalization must be a separate, identifiable, organized program . See DSM-5 for details on these diagnostic categories, and the levels of severity. These types of services are provided by a single entity which may be included as part of a benefits package or purchased separately by/for a person needed assistance with navigating the complexity of the health system. 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. A treatment plan is designed to provide insight, skills, support, and problem resolution to avert further symptom reduction or chaos. Substance Abuse and Mental Health Services Administration News Release. 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. 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. Performance improvement goals are best when they apply to real program needs even if comparison data is not available. Also, there are linkages that occur while a person is in the program between program staff and external peer counselors, recovery support groups, and natural supports. 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 increased integration between physical and behavioral health care allows for new levels of cooperation in documenting and sharing information. This array of metrics provides a given program with potential access, treatment, and staffing goals. Suicide is the leading cause of death in the postpartum time period.11, Treatment aims to minimize fetal/neonatal exposure to both maternal mental illness and medication. Individuals with co-occurring disorders should be able to receive services from primary providers and case managers who are cross-trained and able to provide integrated treatment themselves.7. A strong connection between performance improvement and ongoing staff ownership of the process and adequate staff training is necessary to assure that performance improvement interventions are shared, realistic, meaningful, and achievable. Outcome measures should document progress towards meeting goals for discharge. These outcome measures should measure change, so progress can be demonstrated. For example, one may reference a PHP treating persons with mood disorder through a short-term, low-intensity, cognitive behavioral approach designed to improve functioning and mood, funded by private and public insurance, operating out of a not-for-profit general hospital setting.2. Standards for the approval of providers of non-inpatient mental health treatment services. 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. Efforts to achieve best practices require analyses of critical data points, clinical outcomes, and treatment processes. Needs based groups evolve from the personal life content identified in the assessment process. A wide range of referral options is essential to ensure that those persons in treatment are able to access a wide range of additional services. Medical Assistance (where applicable) reimburses for hours of service in a given day, payment is on a per session basis for most insurance companies or specific individualized service for Medicare or Medical Assistance, Severity of dysfunction or behavioral symptoms, criteria for admission require more acute individual dysfunction, severity of symptoms, and potential for risk of harm to self or others, criteria for admission require moderate individual dysfunction, severity of symptoms, and potential for risk of harm to self or others, Hours and variety of intensive services per week, services offered at least 5 days per week with an average of 6 hours of treatment per day, people usually attend between 6 and 12 hours of treatment per week, specific State, Joint Commission, and other regulations, regulations are generally included within outpatient regulations, except for Medicare, staffing requirements are more specific regarding staff-client ratio with most clinical staff ratios are less than 1:12, Less regulation regarding size of caseload but caseloads tend to be larger than PHP, tend to provide more sessions over a longer period of time, Intensity of physician and supervisory oversight, require a higher demand of physician oversight that often includes coverage and/or supervision for all hours when clients are present. for Health and Human Serv., Substance Abuse and Mental HealthServ.(Jan. An individual must exhibit the first three following characteristics and may exhibit others listed below: PHPs and IOPs both employ integrated, comprehensive, and complementary evidence-based treatment approaches. Third Edition. Provision of this method of service is appropriate when the persons served may be exposed to severe illness or attending in-person treatment may be impractical (e.g., transportation, distance, commute time, or no local expertise available to treat the impairment). Co-morbid substance use is common so drug screens should be administered upon admission and use assessed throughout the stay. Bonari, L. P. Perinatal risks of untreated depression during pregnancy. These regulations should be the primary guiding protocols followed for any program. Treatment modalities and techniques must be developmentally appropriate, and evidence-based for children and adolescents. PHP and IOP treatment allow persons served to stabilization more successfully while in their own community environment. PHPs and IOPs are characterized by formalized efforts to promote and maintain a stable and cohesive therapeutic milieu or community. These individuals are typically found among those admitted for a first episode of care patients often referred from primary care or emergency departments. Organizations may choose to provide a PHP or IOP for a specifically defined population. 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. Generally speaking, a program's average length of stay should reflect the population treated and primary program function. American Association for Partial Hospitalization, 1996. Each program should have a process in place to review EMR challenges that may interfere with the treatment process as well as the reimbursement process. 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. As many EMR systems were initially designed for inpatient non-psychiatric care, data processes may be challenging. 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. They may be part of educational or residential facilities. The final rules pertaining to the implementation of the parity legislation were presented in November of 2013. Intermediate Ambulatory services consists of two levels of care depending on the intensity of services needed and the acuity to those being served: Residential/Inpatient services include two principal types of non-ambulatory, 24-hour supervised settings. Discharge planning begins at the time of admission with the identification of specific discharge criteria and, if necessary, the identification and contact of follow-up options and availability. Some clients are reluctant to talk about behaviors that they believe others disapprove of, such as drug use or illegal activities. Example metrics include, but are not limited to: An ongoing periodic analysis of job duties and workflow processes is recommended to assure that job-related functions are not outdated and are being performed in the most efficient and effective manner. PHPs differ from IOPs in several ways: payment is on a per diem basis for most private insurances. -. US Dept. All programs should consult with compliance officers in their organization to determine if there are specific staff-to-client ratios included within contracts. 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 The seventh edition (2018) guidelines provided a significant change in the guidelines. This function is utilized clinically to prevent self-harm, reduce acute symptomatic exacerbation, restore baseline functioning, and increase recovery skills. Whenever possible, theperson receiving servicesshould be included in this process. In addition to licensing requirements for your facility, your program staff may have requirements related to the Scope of Work for their license. Final determination of changes is usually published in November of each year. A complete medical record should include the following: The initial assessment addresses the individuals bio-psychosocial status and strengths including, but not limited to: Each assessment needs to include screenings for potential risks, needs, physical evaluations, or referrals. The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Partial Hospitalization Programs L37633. AABH recognized that the significant population growth of older adults warranted the development of standards and guidelines for geriatric programs, last revised in 2007.20 The varied mental and physical capacities of seniors required individualized treatment, flexible treatment strategies, and unique aftercare challenges. This record should be available to the individual, follow-up prescribing professional, and primary care provider. We encourage efforts by PHP and IOP staff to expand behavioral health techniques, skills, and resource libraries to overall health continuums and communities. Ongoing clinical responsibility must continue and be clarified while individuals are awaiting follow up care. Kiser, L., Lefkovitz, P., Kennedy, L., Knight, M., Moran, M., and Zimmer, C. The Continuum of Behavioral Healthcare Services. Portsmouth, Virginia. Bill Type 12X (Hospital-Inpatient), 14X (Hospital-Other) is billed with Condition Code 41 (Partial Hospitalization). 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. 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. II. Linkages should endeavor to coordinate care in an efficient and timely manner. 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. The structure is needed to monitor before, during and after eating meals and snacks. In some cases, a specialized IOP may be recommended as follow-up for specific conditions; Some individuals display increased symptoms of a previously diagnosed behavioral disorder and exhibit a progressive or sudden decline in functioning compared to baseline. It should address the program's mission as well as the needs of individuals in treatment. 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. American Association for Partial Hospitalization, 1993. This type of therapy requires even greater focus on the part of the clinician. 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. Call Now to Begin the Recovery Process Today. 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. % 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. 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. Partial Hospital Programs provide no less than 4 hours of direct, . Staff training regarding appropriate language and terminology in documentation should be standard component of staff training on an annual basis. Once decisions regarding confidentiality are made, the nature of the handoffs between components within the continuum is equally important. Individuals may benefit from the IOP level of care if they: The individual may also exhibit specific deficits that are addressed in the intensive outpatient program, such as: Determining the appropriate level of care is the responsibility of the medical director or other admitting physician(s) for the program. Partial Hospitalization Program (Adult) Partial hospitalization is a nonresidential treatment program that may or may not be hospital-based. Telepsychiatry Guidelines . 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. While all three of these bodies can impact how a program provides services and determines appropriateness for care, state licensing agencies will have the regulations attached to laws in a State that must be followed. Menses have usually ceased if body mass is extremely low or high. A focus on medication adherence, therapeutic impact, and relationship between psychiatric and physical medications should also be considered. 2013) 10, 2013. AABH has an ongoing national benchmarking project that enables individual programs to record data on multiple indices and compares them with similar programs across the country. When developing program schedule, consider your population and how you will structure school (i.e. There are three principal forms of linkage: FIRST, internal linkages between programs, departments, or practitioners within the same organization. While direct face-to-face time with family members is preferable, telephonic contact may be a reasonable alternative if there are availability or time constraints. As an example, an outpatient staff psychiatrist may need to coordinate a referral with the program staff to avert a hospitalization in the same organization. Ideally coordination services are managed by the same person/entity regardless of treatment level or location for that person. Any changes are reported in the Federal Register. it may or may not be built upon and updated between programs within a continuum. Please talk to your provider about whether this may be a good care option for you. Many seniors live in isolation, so timely and appropriate aftercare is needed to ensure that gains made in the program remain. and Lefkovitz, P.M. Standards and Guidelines for Partial Hospitalization Adult Programs. Primary care services are generally delivered during a regular office visit. Typically, a PHP is an option for treatment after a person has been hospitalized due to substance abuse issues, and the person is deemed fit to be discharged from the hospital. Programs must also maintain strong linkages with emergency departments, inpatient psychiatric units, and chemical dependency programs in order to facilitate both admission and discharges. Specific components of the milieu include the following: Group therapy is a key building block of PHP/IOP treatment. Codes G0129 and G0176 are only used, and therefore reimbursable, for partial hospitalization programs. Presently, PHPs serve both shorter and longer episodes of care depending upon the primary functions defined earlier. PHPs and IOPs may be free-standing programs, part of a distinct behavioral health organization, or a department within a general medical health care system. 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. Robakis, T. & Williams, K. Biologically based treatment approaches to the patient with resistant perinatal depression. 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). Benchmarking, whether internal or compared to peers, provides an overview of how elements of a program are performing. These individuals are at high risk for hospitalization or re-hospitalization, and a less intensive level of care has been unable to achieve clinical stability. 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). Neuhaus, E. Fixed Values and a Flexible Partial Hospital Program Model. Harvard Review of Psychiatry, Jan-Feb; 14(1):1-14, 2006. One focuses on the administration and operational functions of the program while the other focuses on the clinical aspects of programming and milieu. 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. While there is significant financial and clinical impetus to provide these services in an integrated manner, state licensing dictates the extent to which programs may be integrated. In some cases, removal from a given residence or placement in a residence or residential treatment setting may be a precondition for treatment. Second Edition. This process usually has two steps: Programs should create a documentation system that allows for thorough but efficient review of a case at each step. 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. All programs pursue the goals of stabilizing clinical conditions, reducing symptoms and impairments, averting or reducing inpatient hospitalization stays, and providing medically necessary treatment for individuals who cannot be effectively treated in a less intensive level of care. 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 use of templated treatment plans by diagnostic category or group topic participation is discouraged and may lead to denial of payment for services. Encourage all clinicians to Be their best clinical self. Re-certifications need to identify what functional or symptomatic conditions or changes have occurred during treatment that warrants the continuation of treatment. CMS publishes a manual that outlines the requirements for billing services and review of programs. They tend to have limited insight into their illness accompanied by somewhat dysfunctional lifestyles and serious symptoms that have impacted their lives negatively in multiple ways. It is believed that the services available in intermediate level of care is sufficient to reduce symptoms and/or restore the individuals functioning. 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. 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. E. PHPs and IOPs should represent the core of psychosocial treatments. The federal agency originally introduced the Medicare Partial Hospitalization Program modification in March 2016. We encourage an appreciation for the complexity of creating and sustaining a milieu that engages and appreciateseach individualin their personal stage of change. Ongoing involvement and participation of family members and peer supports also cannot be overemphasized. Actual individual characteristics, monitors, and trends can be tracked through discrete clinical fields as well. 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. 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. Partial hospitalization is a short-term, intensive treatment (four to six weeks, fewer than 24 hours per day) for adults and children individuals not effectively served in community-based or intensive outpatient programs due to substance use, mental health co-occurring disorders. 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. Fourth Edition. The key elements of partial hospitalization and intensive outpatient programs have been combined as the core of the standards and guidelines. Standards and Guidelines for Partial Hospitalization Child and Adolescent Programs. https://www.jointcommission.org/accreditation/behavioral_health_care.aspx. We honor and support programs that seek to integrate physical, substance use, and behavioral health treatment within single programs. Consider that each participant has differing levels of technical abilities or. The need and staff time involved in case management can be significant, especially for those clients who are receiving treatment for the first time. There must be a clinical determination that the additional treatment requested can result in improvement or stabilization of a documented persistent decline in functioning. Program Context recognizes that specific programs may vary with respect to the seven key items as identified by Edmund Neuhaus, Ph.D. in his article on flexible models of partial hospitalization2: When PHPs or IOPs are described, it is useful to include all these elements. 104 CMR 29. Be diligent in having copies of the scopes of work for each or the disciplinesaprogram is using to stafftheprogram. The identification of target populations with criteria for admission to, continuation of, and exclusion from each level of care will be delineated. Service Planning 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. 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