Several factors have emerged since the 1999 Continuum of Behavioral Health Services paper was last revised. The program must then review the guidelines and determine how to proceed with programming and documentation. guidelines including the Level of Care Utilization System (LOCUS), hildren's Level of are . Number of hours of structured treatment provided per day, Individual assessment/therapy/intervention time needed, Management of potential for self-harm or other emergencies, Need for specialized nursing or case management services. Presently, PHPs serve both shorter and longer episodes of care depending upon the primary functions defined earlier. and Barry, A.D. Standards and Guidelines for Partial Hospitalization and Intensive Outpatient Co-occurring Disorders Programs. Bill Type 13X is billed with Condition Code 41 (Partial Hospitalization) and the HCPCS code is not These economic realities occur during a time of increased communication among providers and a renewed effort to achieve best practices. Coordinated care services usually include a centralized global plan of treatment with assignment of providers for each issue needing to be addressed, including any social determinants of health identified as contributing to the medical/behavioral health issues. Codes G0129 and G0176 are only used, and therefore reimbursable, for partial hospitalization programs. 343-351, 2013. A treatment plan is designed to provide insight, skills, support, and problem resolution to avert further symptom reduction or chaos. 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. This section contains specific considerations when developing a program for a population identified in the list. The development of a treatment plan, discussion of barriers to engagement, and intimate emotional issues are examples of the kinds of topics often reserved for individual time. achieve effectiveness and best practices in service delivery. 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. These are important things to address during the course of treatment in these programs. A connection between the treatment plan and the progress notes is important to assure that the person writing the progress note has access to the plan during the writing of the note. A reasonable understanding of responsibility or expectationsin the event thatthe individual does not follow through with the transition plan should be addressed between peer supports, practitioners, and/or care managers whenever possible. It is important to indicate the timing of data collection when the record includes updates on previously obtained material. The fifth edition was completed in 2012. . All other documentation standards for a clinical record remain the same for telehealth and in-person/on-site participants. 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. Archives of Womens Mental Health 20. Clinicians should utilize language in documentation that notes telehealth use. 2013) 10, 2013. When selecting outcome measures for the program, carefully consider the following: Programs should take caution that using a single outcome measure with all participants in a program could create problems unless that tool has established itself to be broadly applicable to multiple diagnostic groups. American Association for Partial Hospitalization, 1996. Cognitive and physical impairments may make day-long treatment services demanding for some individuals. Organizational Structure and Citizen Participation. The seventh edition (2018) guidelines provided a significant change in the guidelines. The following core areas are examples of data elements that can be reviewed regularly as part of a performance review plan: The tracking of specific diagnostic or other characteristics can be essential to program design or psycho-educational content. Intensive Outpatient Programs (IOP) Intensive Outpatient implies more than traditional single service outpatient service, yet not significant enough to meet the requirements of a partial hospitalization program. However, the individual often presents with an impaired willingness or capacity to positively connect with caretaker, family, friends, or community supports. These services may be present in a single organization such as a large community mental health center, a general hospital with comprehensive mental health services, or a free-standing provider location. Outpatient care can include 12-step programs, therapy, support groups, and partial hospitalization. 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. 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. If screenings find significant concerns in any of these areas, program staff should include appropriate action items to address the concerns. 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. Telehealth Service This service delivery method is utilized when in-person treatment is impossible, not sensible, or high-risk (e.g., a medical pandemic). If information gathered from sources does not agree with what the client tells you, ask the client to help resolve the discrepancy. Traditionally, substance abuse and mental health facilities are treated as separate programs and are often licensed and reviewed separately in many states. It is designed for patients . American Association for Partial Hospitalization, 1982. According to current practice guidelines, the treatment goals should be measurable, functional, time-framed, medically 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. 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. They should provide face-to-face services with each client upon admission for an evaluation and thereafter as clinically indicated. Partial Hospitalization Program Partial hospitalization and intensive outpatient programs are therapeutic treatment experiences for individuals who require more than the conventional outpatient level of care but do not need the security of a locked unit or 24-hour care. Co-occurring treatment providers must be well versed in the diagnosis and treatment of concurrent mental health and substance use disorders. Telehealth services in PHP and IOP are demonstrating to be useful as an additional service modality. Documentation of identified issues that will be addressed by others outside of program should be included as part of the assessment. However, this range may extend to 21 years of age dependent upon the individuals developmental level and the goals and objectives and licensing requirements of any program. Payment will not be made for compensable peer support These are often reviewed during site visits, but internal processes need to be in place to review health and safety processes regularly. Education regarding medications during treatment should also be documented. Licensing and Operational Standards for Mental Health Facilities. They may be part of educational or residential facilities. The latest medication advances, therapeutic techniques, and peer connections meet individuals where they are in a positive milieu that fosters support and change. Individuals receiving care from primary care providers often suffer from sub-clinical or relatively mild behavioral health conditions and are at-risk for developing severe behavioral health disorders. The overall expected outcome is the achievement of symptom and functional improvement on the part of the child/adolescent and the family. 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. Association for Ambulatory Behavioral Healthcare, 2015. To manage medical and behavioral emergencies, policies should be developed to expedite admission for inpatient care if required and allow for timely pharmacological intervention. 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. Programs may also bolster their treatment staff with paraprofessionals, non-degreed individuals, students, and interns. If the State is not using a managed Medicaid system, the guidelines should be requested from the State office that manages Medicaid. 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). 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. The organization recognizes that many local factors can contribute to the detailed implementation of these standards and guidelines. PHPs and IOPs should represent the core of psychosocial treatments. 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. Please read these statements before the first session and feel free to ask me any questions about this or other issues related to tele-psychotherapy. 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. A hospital is a licensed facility that offers services more intensive than those required for room, board, personal services and general nursing care, and offers facilities and beds for use beyond 24 hours by individuals requiring medical, surgical, psychiatric, testing, diagnosis, treatment, or care for illness, injury, deformity, infirmity, abnormality, disease, or pregnancy. Importantly, States vary in the scopes of work for many disciplines. In some cases, local and regional expectations and standards regarding documentation requirements may vary and programs are reminded that documentation requirements may need to change based on different state requirements.. This record should be available to the individual, follow-up prescribing professional, and primary care provider. 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). 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. 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. These tend to be associated with larger, urban, teaching based hospitals or community mental health centers (CMHCs) which serve a higher volume of people served and are therefore able to sub-group members into different tracks of specialty groups. If my provider is concerned about my safety, I understand that they have the right to terminate the visit.". Specific self-reported monitoring tools are often used within specific diagnostic groups or in specialty programs such as those for Older Adults or persons experiencing Eating Disorders. A number of programs report that they use these tools for daily symptom monitoring as part of the ongoing assessment process. Treatment modalities and techniques must be developmentally appropriate, and evidence-based for children and adolescents. 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. Whenever possible, programs should compare their results and findings through benchmarking with similar facilities. IOPs may be distinct service entities but are often included within applicable outpatient standards of operation. 8.320.2 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services 2/1/20 to 12/31/20. Outcomes have become increasingly more important not only internally, but to external agencies, including regulatory agencies, insurance providers and consumers. Policy and Standards: Partial Hospitalization Documentation . Each State has licensing agencies that regulate the licensing of professional staff. 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. A comprehensive program improvement plan should include an internal review process to assess the appropriate use of program services. 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. This staff member should work consistently with the individual (and family as indicated) and follow the course of clinical treatment from admission through discharge. 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. 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. Example metrics include, but are not limited to: Consumer feedback is essential in a comprehensive quality improvement plan. Partial Hospitalization Programs (PHPs) are more intensive programs for patients who might otherwise require inpatient psychiatric care. Each organization may also have criteria that must be included in the psychiatric assessment. Co-morbid substance use is common so drug screens should be administered upon admission and use assessed throughout the stay. Providers utilize a wide variety of therapeutic techniques such as different forms of individual, family, or group therapies, and/or medication management. Clinical judgment should drive whether or not a prospective client can benefit if attendance is less than ordered in the first week. 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 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. 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. 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. 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). In some cases, a summary of daily notes is optional, but do not serve to replace individual notes. Medicare reimburses for a given number of specific services per day. Programs can provide daily symptom management, while at the same time, necessary case management services are engaged to foster the highest level of functioning possible. Follow-up treatment professionals should also have access to discharge information. 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. When using comparisons to review programs, administrators should not penalize individual programs that have developed a plan to improve the program. 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. The EMR provides a unique opportunity to include other non-clinical pieces of treatment, such as linking to client education tools or treatment summaries that are easily accessed and printed off by patients when appropriate or necessary. Core clinical staff members come from diverse disciplines, such as psychiatry, psychology, social work, counseling, addictions, medicine, and nursing. 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. General acute programs are short term and tend to be associated with smaller hospitals or CMHCs which address smaller volumes and more heterogeneous populations that are admitted due to medical necessity, acute symptoms, and reduced functional level. Ifthatindividualhas completed a PHP or IOP and needs intervention prior to the transition to an outpatient appointment with a new psychiatrist, there must be a responsible party assigned to provide care in the interim. However, these planscan require pre-authorizations for both PHP and IOP services, and re-authorizations to continue services beyond the initial authorizations. The quality of the treatment we deliver is the value we offer to patients. Clinically, the intermediately level of care option may provide the best fit due to quick access, resource concentration, a recovery focus, and built-in peer support. Document receipt of verbal acknowledgement for each statement: Document that the person has received this information and acknowledged it. These four clinical profiles reflect individual scenarios that are appropriate for acute partial hospitalization program services. Recovery-based education builds upon steps designed to create self-monitoring and individual recovery. 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. 4. An effective monitoring strategy must be developed to assure accuracy and prevent errors in data submission and transmittal. 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. All participants in a telehealth session must be in a private, secure location to maintain HIPAA compliance for themselves (and for other group members). Section 115.120 Definitions. The American Society of Addiction Medicines (ASAM) Patient Placement Criteria (ASAM PPC-2R) (previously mentioned) is considered a best practice for assessing and determining level of care placement for individuals with substance use disorders.6, Psychoactive substance history & detoxification status, Emotional/behavioral/cognitive functioning. Association for Ambulatory Behavioral Healthcare, 2008. At times, a full participation during the first week may be impossible upon admission due to unavoidable personal responsibilities. Actual individual characteristics, monitors, and trends can be tracked through discrete clinical fields as well. It's more intense than psychosocial rehabilitation or outpatient day treatment. There must be a clinical determination that the additional treatment requested can result in improvement or stabilization of a documented persistent decline in functioning. 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standards and guidelines for partial hospitalization programs