While this section is not inclusive of all specific populations, these represent the populations in which there are a significant number of programs, enough to be establishing best practice. 4-4-103, -5-4202, -5-4204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, . Second Edition Revised of Patient Placement Criteria (ASAM PPC-2R). Family work is crucial and should be a part of every clients treatment plan. Mute participants and allow them to unmute when. Chemical dependency partial hospitalization programs and intensive outpatient programs serve populations who present primarily with substance use disorders that have relatively minimal or no mental health disorders impacting current functioning. A discharge instruction sheet should be made available to the individual summarizing medications, appointments, contraindications when appropriate such as driving, and emergency numbers, and other information deemed appropriate by the program or organization. In either case, the individual is unable to benefit from medication management or traditional outpatient therapy alone. Identifiers should be individualized so program staff and reviewers can uniquely identify each patient. Needs based groups evolve from the personal life content identified in the assessment process. Historically, the availability of an intact support system was a prerequisite for PHP services. 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. On the other hand, integrated occupational therapy programs complement other services and teach valuable skills within an evidence -based model that contributes significantly to positive clinical outcomes. Standards and Guidelines for Partial Hospitalization Child and Adolescent 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. 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. Individuals are invited and encouraged to adopt an active participant and partnership role in the treatment process. The plan may address patient safety concerns, primary symptoms, self-esteem issues, coping skill deficits, priority decision points, level of motivation, recovery issues, barriers to treatment, and factors which impact readiness for discharge. l) Services provided to more than one beneficiary at a time, unless specifically allowed in the service definition. 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. Fatigue, sensory impairment, decreased concentration ability, and discomfort with transitions or changes in programmatic structure are challenging factors to address in program development. Performance Improvement for older adult programs is essential and should be determined by the mission and specific needs of those who are being served. Outcomes management processes should examine the impact of the program on the clinical status of the individuals served. Intermediate Behavioral Health is the term used to identify partial hospitalization and intensive outpatient programs which distinguishes them from inpatient and outpatient services as part of the behavioral health continuum required for the implementation of parity legislation. Linkages are also important. In these cases, backup case management and peer support services can be essential. It should provide the capacity for narrative description to reflect unique client dynamics or circumstances. Subspecialty groups focus on the specifics of given targeted populations such as trauma, substance use, eating disorders, OCD, or cardiac/depressive conditions. Women with postpartum psychosis will need referral into acute inpatient psychiatric treatment. The format for documentation of progress may take different forms but must include clinical data that justifies the necessity of ongoing treatment at this level of care, including progress related to the illness, symptoms, and debilitated functioning. Service Planning Several factors have emerged since the 1999 Continuum of Behavioral Health Services paper was last revised. Confidentiality guidelines pertaining to individuals in chemical dependency treatment tend to be more restrictive than for those individuals in mental health treatment. Table 1 Levels of Care (Behavioral Health), Solo practices, Medical clinics, Medical care home, IOP, Psych rehab, Club House, Assertive Community Treatment. The individual may experience symptoms that produce significant personal distress and impairment in some aspects of overall functioning. Individuals appropriate for care at this level are generally able to sustain themselves between relatively infrequent behavioral health appointments and to adhere to treatment recommendations with minimal intervention. Patients admitted to a partial hospitalization program must be under the care of a physician who is knowledgeable about the patient and certifies the need for partial hospitalization. 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. Additional certification, monitors, medications, or additional clinical data may be required due to internal organizational or regulatory requirements. Clear policies for determining assignments and duties are necessary. 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. Individuals with co-occurring disorders tend to relapse frequently, placing them at greater jeopardy of a marginalized social existence. A treatment plan is designed to provide insight, skills, support, and problem resolution to avert further symptom reduction or chaos. The plan should conform to guidelines set forth by accrediting bodies and regulatory agencies of local, state and federal government. All co-occurring programs must have clearly delineated procedures and linkages for addressing clients detoxification, withdrawal, and other medical needs. These are often reviewed during site visits, but internal processes need to be in place to review health and safety processes regularly. Treatment planning for the individuals with co-occurring disorders incorporates knowledge of both the mental health and substance use components of the illness. Many payers include these standards in their outpatient operations protocols and might be referenced as recurring outpatient services. Staff members must be trained and experienced in child and adolescent behavioral health, family therapy, milieu therapy, and therapeutic crisis intervention. 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. Communication amongst programs regarding their results is strongly encouraged. The (Traditional) Outpatient level of care provides for treatment of conditions related to mild to moderate impairment. Full-time participation in the program at the onset of treatment serves to promote stabilization and cohesion. Portsmouth, Virginia. AABH published the fourth edition of the Partial Hospitalization Program Standards and Guidelines in 2008.23 For the first time this document included summarized information regarding the evolution of partial hospitalization program standards and guidelines, the continuum of behavioral health services, standards and guidelines regarding partial hospitalization programs which target specific populations (child/adolescent, geriatric, co-occurring, and chemical dependency), as well as a summary of standards and guidelines concerning intensive outpatient programs. If information gathered from sources does not agree with what the client tells you, ask the client to help resolve the discrepancy. The program must then review the guidelines and determine how to proceed with programming and documentation. CMS contracts with intermediaries to manage the requirements for PHP and IOP services. Residential services are provided to individuals who require greater support, monitoring, and intensity of services than can be offered in acute ambulatory settings. The individual may exhibit some identifiable risk for harm to self or others and may or may not admit to passive or active thoughts or inclinations toward harm to self or others yet is willing to work in program. 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. Partial Hospitalization Programs (PHPs) are more intensive programs for patients who might otherwise require inpatient psychiatric care. PHPs provide structured, comprehensive care while still allowing people to . 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. Re-certifications are required by many payers within strict time guidelines. However, any licensing conflicts and decision related to resolving the conflict should be reviewed by the compliance and legal departments or an organization. Discharge from IOP programs is made to individual outpatient behavioral health specialists, integrated physical/behavioral settings, or primary care. Often primary care physicians, OBGYNs and Pediatricians need additional help and consultation from a trained psychiatric provider if they are going to be a part of the aftercare plan for clients, especially if they are managing medications. and the progress described in measurable, behavioral, and functional terms. The structure is needed to monitor before, during and after eating meals and snacks. This program typically lasts about 10 business days. Consider that each participant has differing levels of technical abilities or. 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. 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. Many staff may not have this access either. The quality of therapeutic presence is even more important in telehealth than it is in Holding the space is much more challenging. The Standards and Guidelines will be updated as new reviews are completed in any of the areas addressed. 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. 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. 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). 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. Partial hospitalization programs may either be free standing or integrated with a broader mental health or medical program. These severe impairments tend to include several acute symptoms that result in a breakdown in role function that may include an inability to follow through on essential tasks and responsibilities, social isolation, interpersonal difficulties, and a passive or impulsive loss of focus and initiative. Finding measures that will help improve staff efficiency and effectiveness are key to a quality improvement plan. Telehealth services in PHP and IOP are demonstrating to be useful as an additional service modality. That edition included a discussion of the impact of electronic medical record, a focus on the recovery movement, and guidelines for eating disorder programs among other additions.24 The update in 2015 updated relevant information about PHPs and specialty group guidelines.25. The assessment and treatment plan should address improvement of social skills and functioning via the therapeutic milieu. 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. We must honor the role of peer support and counseling within the behavioral health continuum. The multidisciplinary team is central to the philosophy of staffing within a partial hospitalization or intensive outpatient setting. Each organization may also have criteria that must be included in the psychiatric assessment. These programs are available at inpatient or residential treatment facilities. Whenever possible, programs should compare their results and findings through benchmarking with similar facilities. and Lefkovitz, P.M. Standards and Guidelines for Partial Hospitalization Adult Programs. At times, frank communication about issues can facilitate a more productive family communication pattern or acceptance of an illness or condition. The record must be organized in a manner that makes it accessible to those treating the patient. The quality of the treatment we deliver is the value we offer to patients. Medical records must be maintained in accordance with the current requirements of the applicable licensing and/or accrediting bodies, and the laws of the state within which the program resides. 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. Traditional outpatient treatment lacks the needed intensity and range of interventions, while clients on inpatient units tend to lack the stability and focus to participate actively in a group educational setting. Recently, accreditation organizations have also begun to look closely at clinical indicators of quality in addition to health and safety. 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. All other documentation standards for a clinical record remain the same for telehealth and in-person/on-site participants. 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 section contains specific considerations when developing a program for a population identified in the list. While none of these focuses are mutually exclusive, a program tends to build their program from one of these perspectives. These intermediaries are referred to as MACs (Medicare Administrative Contractor) and each can develop their own interpretation of the CMS guidelines in determining appropriateness for services, documentation requirements and billing requirements. New York: Guilford, 2002. With regard to treatment within one organizational continuum, programs should also maintain liaisons with specific providers including psychiatrists and other physicians, psychologists, social workers, psychiatric nurses, occupational therapists, case managers, rehabilitation practitioners, educators, and substance abuse counselors. The provision of services allowed for each discipline is dictated by the scopes of work for a licensee in their particular State. Behavioral/Physical health Integration groups include a focus on both physical and behavioral issues such as with depression associated with cardiac care. -. Outpatient care may be short or long-term depending on the needs of the person. Kiser, L., Lefkovitz, P., Kennedy, L. and Knight, M. The Continuum of Ambulatory Mental Health Services. Alexandria, Virginia. Each component of a comprehensive clinical record described above should be part of a quality electronic medical records. 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. State laws may apply. In some cases, removal from a given residence or placement in a residence or residential treatment setting may be a precondition for treatment. Programs from around the country reveal the following clinical orientations or strategies that are reflected in their educational components: NOTE: Individual skills may be taught in each of these approaches. Standards and Guidelines for Level II Services: Intensive Outpatient. Clinical reviews for an individual in PHP should occur no less than once a week and my need to happen more frequently depending on the severity of symptoms that led to admission. It is important to note that these Criteria are established as national standards. With recent changes to regulatory requirements in onsite visits, this document provides guidance in preparation for regulatory reviews. Linkages or collaborations with primary care physicians, counselors, residential treatment personnel, case managers, or others may be necessary while the individual is in program to ensure that clinical information is accurate and that clinical initiatives are reasonable and relevant to the individuals home environment. The primary therapist should be responsible for the quality reviews for their individual caseload and review their caseload regularly. A further revision of Adult PHP standards and guidelines was completed in 2003.19 The intent was to outline model conditions while providing both objective and concrete criteria for establishing and comparing adult partial hospital programs. This table is available to members HERE. Partial hospitalization has long been a level of care offered by NABH members. 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. Kiser, L., Lefkovitz, P., Kennedy, L., Knight, M., Moran, M., and Zimmer, C. The Continuum of Behavioral Healthcare Services. Portsmouth, Virginia. PHPs and IOPs should represent the core of psychosocial treatments. 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. Moda Health Medical Necessity Criteria Mental Health Partial Hospitalization and Intensive Outpatient Treatment Page 1/5 . As programs choose to include telehealth service delivery methods to provide the best care possible to all participants during normal or challenging times, programs need to move thoughtfully into each modality used considering confidentiality, best care practices, the severity of our patients issues, and the risk for them and for us caused by changes in treatment methods. Sharing of the consumer feedback with internal program staff is essential and may often lead to the identification of performance improvement priorities and strategies which otherwise may have been unknown or overlooked. In the absence of detailed state licensing regulation, a program must pay attention to requirements for Payers and accrediting bodies. Within a continuum of behavioral health care, PHPs and IOPs function as vital components. Retrieved July 20, 2018, from https://www.ncmhjj.com/wp-content/uploads/2014/10/Behavioral_Health-Primary_CoOccurringRTC.pdf. There are also times during treatment when the rationale for non-attendance is legitimate and in the overall best interests of the indivduals welfare. A built-in method of updating treatment plans and clinical information (using a read and accept format) without deleting everything prior to completing an intake is also a useful time-saver and increases accuracy. For each person seen through telehealth, the staff providing a treatment service must have the following readily available: Any individual offered telehealth services must consent to telehealth services and should acknowledge consent before the first session of telehealth service: [Provide the statements through email or display on the screen during an intake or first session]. Bonari, L. P. Perinatal risks of untreated depression during pregnancy. Standards and Guidelines for Partial Hospitalization Programs. Learn more: 12-step programs. Behavioral Health refers to the healthcare field concerned with mental health and substance use disorders and treatment. Archived Program Rules - Chapter 320 - Early and Periodic Screening, Diagnosis and Treatment. It is recommended that programs use a formal method to collect consumer feedback through perception of care surveys and/or care satisfaction surveys. Additional benefits should include enhanced tracking and report writing functions that improves decision-making through the collection of timely, accurate information. 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. Ongoing involvement and participation of family members and peer supports also cannot be overemphasized. (1) Residential levels of care are mutually exclusive, therefore a patient can only receive services through one level of care at a time. Commission on Accreditation of Rehabilitation Facilities (CARF). Treatment must be rendered under the supervision of a psychiatrist or medical professional licensed to diagnose behavioral health issues. These standards include guidelines and consensus statements produced by professional specialty . The inclusion of motivational interviewing techniques has been an important addition to clinical programming and has led to increased engagement of individuals who display avoidance or ambivalence toward treatment.8. People treated at this level of care are able to maintain their role functioning in the community and generally have adequate family/community support. In some cases, a summary of daily notes is optional, but do not serve to replace individual notes. k) Service provided simultaneous with any other -covered service, unless Medicaid specifically allowed in the service definition. Services at this level are offered with some degree of coordination, but do not include cohesive community or structured programmatic activities. Standards and Guidelines for Partial Hospitalization, Alexandria, Virginia. Basic Books, 1983. Multidisciplinary staff members must possess appropriate academic degree(s), licensure, or certification, as well as experience with the particular population(s) treated as defined by program function and applicable state regulations. Watch Video. 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 program can last for a week or up to six months. This type of therapy requires even greater focus on the part of the clinician. achieve effectiveness and best practices in service delivery. The intent of this summary is to place PHPs and IOPs in the full context of available treatment services, arranged by relative level of intensity from traditional outpatient care to 24-hour inpatient treatment. 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. According to SAMHSA, While these disorders may interact differently in any one person (e.g., an episode of depression may trigger a relapse into alcohol abuse, or cocaine use may exacerbate schizophrenic symptoms), at least one disorder of each type can be diagnosed independently of the other.7. In this case, communication within the team is essential. The quality improvement plan constitutes a comprehensive and methodologically sound process for measuring treatment effectiveness, improving the delivery of care, and evaluating progress toward recovery. 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. There arethreeaccreditation organizations used by behavioral health facilities: A key player in detailing programming and documentation will be the organizations that pay for services. Any additional laboratory testing, as determined by the organization and in accordance with the level of care provided. This array of metrics provides a given program with potential access, treatment, and staffing goals. 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. 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. Licensing and Operational Standards for Mental Health Facilities. Effective Jan. 1, 2019, Public Act (PA)100-1024 created a new definition as follows: "Mental, emotional, . 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 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. (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; 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). A socially isolated person with serious debilitating symptoms may also benefit from treatment even though they may report virtually no support system at all. Programs may also bolster their treatment staff with paraprofessionals, non-degreed individuals, students, and interns. 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