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. (a) Partial hospitalization services are services that - (1) Are reasonable and necessary for the diagnosis or active treatment of the individual's condition; (2) Are reasonably expected to improve or maintain the individual's condition and functional level and to prevent relapse or hospitalization; (3) Are furnished in accordance with a physician certification and plan of care as specified . Final determination of changes is usually published in November of each year. Participating in a peer-based benchmarking programs allows programs to evaluate how they compare to a larger group of programs. Monitored study time vs. A comprehensive program improvement plan should include an internal review process to assess the appropriate use of program services. Some clients are reluctant to talk about behaviors that they believe others disapprove of, such as drug use or illegal activities. l) Services provided to more than one beneficiary at a time, unless specifically allowed in the service definition. For example, this level of care may include traditional outpatient counseling by one provider, medication management by another provider, and crisis and support services by a community agency (all three provider entities in separate settings serving as distinct stand-alone providers). American Society of Addiction Medicine (ASAM) (April 2001). As with individual treatment, time is limited, and staff needs to maximize the experience often leaving some issues for more extensive family treatment following discharge. Programs serving pregnant women or new mothers typically care for women with some type of Perinatal Mood and Anxiety Disorders (PMAD). Therapists are challenged within each type program to adapt techniques, goals, expectations, and member autonomy to achieve clinical success. Performance improvement goals are best when they apply to real program needs even if comparison data is not available. Recovery oriented service evaluations may also be helpful for programs. Staff training regarding appropriate language and terminology in documentation should be standard component of staff training on an annual basis. Coordination and involvement with family members and significant others is an important part of treatment whenever possible. We offered telemedicine as an option for care delivery and patient consented to this option., Other participants present with provider, with patient's verbal consent:####, Other participants present with patient: ####, Patient received group psychotherapy via telemedicine using two-way, real-time interactive telecommunication technology between the patients and the provider. 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. Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders. (November 2002). 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. Fourth Edition. To make a referral, have your doctor or therapist call 1-319-384-8449. Discharge from IOP programs is made to individual outpatient behavioral health specialists, integrated physical/behavioral settings, or primary care. A solid aftercare plan is crucial for success with this population. 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. Postpartum Psychosis is a true psychiatric emergency. The eighth edition addresses the changing environment of care resulting from the COVID pandemic and includes guidelines for alternative service delivery such as telehealth. The plan of treatment is developed with the active participation and input of the individual in treatment and by the treatment team under the supervision of the treating psychiatrist. Between 10-25% of women experience some form of PMAD during pregnancy or after the birth of a child. 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. Staff members assume responsibility for and control of the individuals safety due to the individuals severe, disabling symptoms. Behavioral Health refers to the healthcare field concerned with mental health and substance use disorders and treatment. The quality of the treatment we deliver is the value we offer to patients. 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. One focuses on the administration and operational functions of the program while the other focuses on the clinical aspects of programming and milieu. 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. Residential Treatment Position Statements . Consider how staff will compensate. People need to feel hope, find purpose, and care for others. We must honor the role of peer support and counseling within the behavioral health continuum. The plan must be available to the clinical staff at the time-of-service to assure that interventions are focused and relevant. The (Traditional) Outpatient level of care provides for treatment of conditions related to mild to moderate impairment. Kiser, J.L., Trachta, A.M., Bragman, J.I., Curley-Spadaro, K., Cooke, J.D., Ramsland, S.E., and Fitzhugh, K.E. Persons meeting Severe and Extreme level of severity should be treated within a Partial Hospital Psychiatric level of care setting, as long as the patient is medically stable. The infusion of peer counselors is a dynamic that is also enhancing the experience for many individuals and should be encouraged by authorities and continuum leaders whenever possible. CMS and other agencies expect to see individual sessions prescribed as a necessary component of treatment during each episode of care. The presence of significant denial or unwillingness to address change may often be inevitable due to the acute circumstances surrounding an admission especially from an emergency department or crisis worker. Can help as you work to achieve good, stable mental health. Improvement in symptoms and functioning as evidenced by outcomes measurement tools that are evidence based for children and adolescents. As other programs specific to a population grow to needing a national standard, they will be added to this section. All shifts to telehealth need approval of senior leadership, Each area must balance the needs of individuals that want to attend in person and those that wish to use. While none of these focuses are mutually exclusive, a program tends to build their program from one of these perspectives. IOPs may be distinct service entities but are often included within applicable outpatient standards of operation. We encourage the use of alternative modes of treatment delivery, such as telehealth, when newmodesare demonstrated to contribute to quality services. These tools provide further input regarding the programs effectiveness in facilitating recovery steps and enhancing peer support for participating consumers. 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. The inclusion of two patient identifiers is helpful and often required on each document, such as a patient name and medical record number. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services (January 2003). 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. Gray, K., Michael, S., Lefkovitz, P., and Barry, A. Importantly, States vary in the scopes of work for many disciplines. The downloadable version is created every three years from the information contained in the online version of the Standards and Guidelines. PHP and IOP treatment allow persons served to stabilization more successfully while in their own community environment. Level 2: Intensive Outpatient and Partial Hospitalization Programs . Peer support is encouraged in programs where applicable regulations allow the use of peers who have been trained to support the clinical efforts of the program. Examples of evidence of such participation at the programmatic level often include community meetings, formal involvement in planning, assessing the value of therapeutic activities, and serving as agents of change within the therapeutic milieu. The main objective is to receive feedback addressing the degree to which the program met the individuals needs and assisted in achieving their goals. Transition between PHP and IOP, especially in facilities that offer these as a continuum of care, should be as seamless to the client as possible. Individuals requiring care at this level may have insufficient resources or access to critical supports systems including family and community. 104 CMR 30. Programs may also bolster their treatment staff with paraprofessionals, non-degreed individuals, students, and interns. Relevant factors such as relapse and recidivism, attendance at self-help meetings, level of sobriety, post-discharge adjustment (including improvement in housing status, use of recovery-oriented peer or social support, and vocational training/placement), and legal issues pre- and post-treatment may be measured. 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). Services at this level are offered with some degree of coordination, but do not include cohesive community or structured programmatic activities. Respect that some participants are comfortable using telehealth services and some are Make every effort to meet the needs of all participants. High quality performance plans will guide the success of utilizing all support levels as members of a fully reimbursed multidisciplinary team. Examples of symptoms include high anxiety, sadness, depression, mood swings, elevated mood, irritability, intrusive thoughts, and more. Outcomes management processes should examine the impact of the program on the clinical status of the individuals served. 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. 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. 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. If medications are changed during treatment, the types and dosages, clinician responsibility, and timing should be clearly documented with the rationale for the medication changes. 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. The patient or legal guardian must provide written informed consent for partial hospitalization treatment. Communication amongst programs regarding their results is strongly encouraged. Full-time participation in the program at the onset of treatment serves to promote stabilization and cohesion. Partial Hospital Programs provide no less than 4 hours of direct, . The necessity of and rationale for continued stay must also be documented in the medical record including the revised treatment plan when needed. Association for Ambulatory Behavioral Healthcare, 2012. Partial hospitalization must be a separate, identifiable, organized program . All treatment planning activity must continue. 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. Intensive outpatient services have been developed to meet specific clinical needs when the individual is not determined to require the intensive daily services of partial hospitalization or is unable physically to meet the attendance requirements of such programs or when less frequent monitoring in inappropriate. Any additional laboratory testing, as determined by the organization and in accordance with the level of care provided. People treated at this level of care are able to maintain their role functioning in the community and generally have adequate family/community support. Payer of services (e.g., managed care, government-supported national health care, such as national health insurance systems in Canada and Europe, and Medicare in the United States). Partial Hospitalization Program (Adult) Partial hospitalization is a nonresidential treatment program that may or may not be hospital-based. Many staff may not have this access either. Considerable ongoing communication exists regarding the interface between residential non-hospital treatment facilities and PHPs and IOPs. 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. 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. Each accreditation organization will have protocol manuals that detail what they expect to see when they conduct onsite reviews. If a PHP offers four groups per day on five days a week, tele-health needs to offer four groups per day on five days a week; If an IOP offers three groups per day on three days a week, tele-health needs to offer three groups per day on three days a week. The program director is a mental health professional with a minimum of 3 years of . With Behavioral Health Care, you can help support compliance with federal . Multi-modal Outpatient or Community-based services are differentiated from traditional outpatient care by the greater number of hours of involvement, the multi-modal approach, and the availability of specified crisis intervention services 24 hours per day. % 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. The disorders are also commonly called Postpartum depression, perinatal mood disorders, or PMD. Admission to these programs may be determined by functional level, specificity of the population (such as OCD), or treatment specialty such as DBT or CBT. 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. The interactive telecommunication technology included audio and video. If possible, consider a nursery onsite. Association for Ambulatory Behavioral Healthcare, 1998. 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]. Subspecialty groups focus on the specifics of given targeted populations such as trauma, substance use, eating disorders, OCD, or cardiac/depressive conditions. 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. Medicare Advantage Plans are obligated to follow the Medicare protocols for all Medicare coveredpeoplein PHP and IOP, including reimbursement rates. The individual is not judged to be in imminent danger of withdrawal or has recently undergone medical detoxification. Children and youth partial hospitalization program A program licensed by the Department, Office of Mental Health and Substance Abuse Services, to provide partial hospitalization services to individuals under 15 years of age. These departments are usually found somewhere within the State's health department and can often be found by searching for licensing. Electronic record systems should reflect the clinical treatment process and allow the capture and representation of data in a user-friendly fashion. In some States, treatment planning may be supervised by a Physician Assistant or Nurse Practitioner with psychiatric licensing approved by the State. All chemical dependency PHP and IOP programs must have clearly delineated procedures for addressing clients detoxification, withdrawal, and other medical needs. guidelines for partial hospitalization program content, physician certification requirements, and . PHPs and IOPs are designed to help individuals understand their illness, reduce the impact of functionally debilitating symptoms, and cope with challenging situational crises. As many EMR systems were initially designed for inpatient non-psychiatric care, data processes may be challenging. The individual is not imminently dangerous to self or others and therefore not in need of 24-hour inpatient treatment. The presence of comorbid physical illness must be addressed and often makes the frequency and duration of attendance more challenging. A brief description and examples of each level of care follows: Primary Care is first line health care providing screening, early identification, education, and often pharmacotherapy. Association for Ambulatory Behavioral Healthcare, 2015. Staff in settings providing integrated substance abuse and psychiatric treatment should be fully oriented in each others disciplines. 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. All programs should consult with compliance officers in their organization to determine if there are specific staff-to-client ratios included within contracts. The identification of target populations with criteria for admission to, continuation of, and exclusion from each level of care will be delineated. A certain measure of relapse is to be expected and treatment remains appropriate to client needs after clinical review. in a partial hospitalization program (PHP), intensive outpatient program (IOP) or residential program. Traditionally, substance abuse and mental health facilities are treated as separate programs and are often licensed and reviewed separately in many states. While these tools are helpful in guiding the treatment process, they do not qualify as clinical outcome measures until they have been validated. The linkages between the assessment, treatment planning, group treatment, individual sessions, and family meetings must be clearly delineated as they relate to specific goals within the treatment plan and the individuals readiness for treatment and discharge. 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. Basic Books, 1983. This program typically lasts about 10 business days. 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. These programs are both community- and hospital-based and may be structured with after school or full day services. Clinicians should utilize language in documentation that notes telehealth use. These services are included as mandated essential behavioral healthcare benefits in insurance policies from 2014 onward. A new print edition will be pulled every 2 years for those who choose to purchase the e-document. We offered telemedicine as an option for care delivery and the patient consented to this option.. Clinicians working from home need to carefully review their environment for any unintended personal disclosures that can occur such as visual clues about the location of your home, family information. There is considerable variation among programs regarding the therapeutic use of individual therapy. Family work is crucial and should be a part of every clients treatment plan. If a program accepts payments from multiple organizations, keeping the different requirements for each payer up to date can be a challenging task. Organized as a continuum, this system of care enables the movement of individuals to the most clinically appropriate and cost-effective level of care. 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. For instance, one might track the percentage of patients with housing issues, joblessness, or secondary substance abuse with minimal effort. PHPs and IOPs are characterized by formalized efforts to promote and maintain a stable and cohesive therapeutic milieu or community. Each program is challenged to provide effective care within increasing time constraints and with limited resources. Providers utilize a wide variety of therapeutic techniques such as different forms of individual, family, or group therapies, and/or medication management. 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. Medical personnel address ongoing medical and physical health issues and assess and manage medication therapies. Many programs also include consumer input groups as a formal part of programming that is led by peers. CNA (Certified Nurse Aide) Registry. 10, 05-07-04) A3-3194, HO-230.7 Partial hospitalization programs (PHPs) are structured to provide intensive psychiatric care through active treatment that utilizes a combination of the clinically recognized items and services described in 1861(ff) of the Social Security Act (the Act). Accreditation organizations are responsible for providing guidance to programs primarily on health and safety protocols for facilities. II. 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. The Level of Care Guidelines is derived from generally accepted standards of behavioral health practice. 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. Clinicians should wear an organization identification badge and it must be visible to all participants in the session. Psychiatrically trained medical professionals, including Physician Assistants and Nurse Practitioners may also be members of the physician team if regulations apply for such. Association for Ambulatory Behavioral Healthcare, 1996. Limited case management and group therapy or psycho-educational services may be included in this setting along with individual therapy and medication management. Association for Ambulatory Behavioral Healthcare, 2007. These are often reviewed during site visits, but internal processes need to be in place to review health and safety processes regularly. 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