Many programs opt to divide the program leadership into two roles. 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. At the time, Pamela Hyde, JD, SAMHSA Director, announced that partial hospitalization and intensive outpatient treatment were specifically included as essential intermediate behavioral healthcare treatment options.1 This landmark decision validates over 40 years of effort by behavioral health professionals throughout the country to provide intensive ambulatory treatment and avert or reduce hospitalizations while creating an environment of personal recovery for countless Americans. A solid aftercare plan is crucial for success with this population. Association for Ambulatory Behavioral Healthcare, 1996. An internal safety reporting mechanism is also advised to assure that types of problems such as medication errors, falls, injuries, or other critical data can be recorded and monitored. A growing body of evidence suggests that partial hospitalization outcomes are highly correlated with treatment intensity and that more successful programs involve patients at least 5 days/week for 8 hours/day. Partial Hospitalization Programs in California with locations in Calabasas, Santa Maria, San Luis Obispo and Visalia. Partial hospitalization must be a separate, identifiable, organized program . Retrieved July 20, 2018, from https://www.ncmhjj.com/wp-content/uploads/2014/10/Behavioral_Health-Primary_CoOccurringRTC.pdf. Individuals requiring care at this level may have insufficient resources or access to critical supports systems including family and community. With increased attention population health, providers will be increasingly incentivized to use the most efficient treatment options available to contain costs and achieve positive clinical outcomes. It is recommended that programs use a formal method to collect consumer feedback through perception of care surveys and/or care satisfaction surveys. For a Free Consultation, call: 855-808-4213 Accessibility of an individuals data within the EMR is impacted by privacy and regulatory statutes and must be reflected in the EMR. Actual individual characteristics, monitors, and trends can be tracked through discrete clinical fields as well. The individual must, however, have the capacity for minimum engagement in the identification of goals for treatment, and minimal willingness to participate actively in relevant components of the program. Gray, K., Michael, S., Lefkovitz, P., and Barry, A. Needs are identified based upon the findings of the comprehensive assessment and strategies are identified to address areas of concern. A less intensive level of care may have been insufficient to provide the treatment the individual requires to stabilize this decline. Programs will use their identified outcome measure tool to track clients progress in the program. require regular physician coverage that may vary depending upon local regulatory standards or payer requirements. Programs must also maintain strong linkages with emergency departments, inpatient psychiatric units, and chemical dependency programs in order to facilitate both admission and discharges. 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. We encourage a shift in the oversight focus from document analysis to a concern for outcomes and the overall client experience. The (Traditional) Outpatient level of care provides for treatment of conditions related to mild to moderate impairment. . Additionally, any exclusionary citeria must be clearly defined. This provider is often determined by the complexity of the illness, medications, and overall medical or case management needs; Some individuals display a relatively high baseline functioning prior to the onset of a behavioral health condition yet require treatment in a partial hospitalization program to provide medication stabilization, insight, and self-management skills to reduce symptoms and risk to self-harm. The medical care home model, with its focus on integrating medical and behavioral health treatment, provides hope and promise of greater early identification, primary prevention, improved treatment outcomes, and decreased healthcare costs. Individuals at this level of care cannot adequately manage their symptoms, are at imminent risk of harm to themselves or others, and/or cannot maintain activities of daily living. The presence of poor insight, skills, judgment, and/or awareness inhibits their return to baseline functioning that is considered to be clinically achievable. Standards and Guidelines for Partial Hospitalization Programs. Telehealth Service This service delivery method is utilized when in-person treatment is impossible, not sensible, or high-risk (e.g., a medical pandemic). Services may be provided during the day, evening, and/or on the weekend. Example metrics include, but are not limited to: All programs are evaluated on issues related to the health and safety of those people being served in a program. 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. Organized as a continuum, this system of care enables the movement of individuals to the most clinically appropriate and cost-effective level of care. Policy needs to dictate the availability of a psychiatrist (or other physician) for consultation to non-physician providers, face-to-face with individuals in treatment during program hours, and by telephone off hours to provide direction in the care for all enrolled clients 24 hours a day, seven days a week. Organizations may choose to provide a PHP or IOP for a specifically defined population. Identifiers should be individualized so program staff and reviewers can uniquely identify each patient. 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. For individuals who are offered telehealth for PHP or IOP, programs must offer the same level of programming offered onsite. Individuals receiving PHP and IOP services vary in symptom intensity, clinical needs, and stages of readiness for change. There are no guidelines for how a State should license behavioral health facilities, which may lead to a need to search carefully for the licensing requirements. 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. (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 . This program typically lasts about 10 business days. 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. The program provides . Archives of Womens Mental Health, 16. 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. Occupational, recreational, and creative arts therapists broaden and deepen the array of available services when offered. 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. 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. Payers may require different processes or timelines. Monitored study time vs. CMS and other agencies expect to see individual sessions prescribed as a necessary component of treatment during each episode of care. To make a referral, have your doctor or therapist call 1-319-384-8449. 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. The intensity of the partial hospitalization level of care is medically necessary and the individual is judged to have the capacity to make timely and practical improvement. Table 1 Levels of Care (Behavioral Health), Solo practices, Medical clinics, Medical care home, IOP, Psych rehab, Club House, Assertive Community Treatment. 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. 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]. If medications are dispensed on-site, appropriate staff must document medications that are administered on site. Partial Hospitalization Program Policy Number: SC14P0034A3 Effective Date: May 1, 2018 . In many program settings, the inclusion of individuals in different phases of recovery can be used to good clinical advantage. We encourage efforts by PHP and IOP staff to expand behavioral health techniques, skills, and resource libraries to overall health continuums and communities. This may include marked impairments that preclude adequate functioning in areas such as self-care, and/or other more specific role expectations such as managing money, working, cleaning, problem solving, decision-making, contacting supports, caring for others, addressing safety issues, complying with medications, or managing time in a meaningful way. Establishment of a safety plan that allows for the child/adolescent to maintain safety in a community setting. Example metrics include, but are not limited to: Consumer feedback is essential in a comprehensive quality improvement plan. There are three primary regulatory bodies that write regulation or guidance in detail for providers in the local area: Many of the States have a department that is responsible for the licensing of behavioral health facilities. The main objective is to receive feedback addressing the degree to which the program met the individuals needs and assisted in achieving their goals. The final rules pertaining to the implementation of the parity legislation were presented in November of 2013. Common problems related to symptoms, life situation, and skill deficits lead to group topics. 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. Verified address where they are at the time of the service (make note as it changes), Phone number of police station closest to patients location, "I agree to be treated via telehealth and acknowledge that I may be liable for any relevant copays or coinsurance depending on my insurance, I understand that this telehealth service is offered for my convenience and I am able to cancel and reschedule for an in-person service if I, I also acknowledge that sensitive medical information may be discussed during this telehealth service appointment and that it is my responsibility to locate myself in a location that ensures privacy to my own level of, I also acknowledge that I should not be participating in a telehealth service in a way that could cause danger to myself or to those around me (such as driving or walking). PHPs are distinct organizational entities with specifically designated standards and regulatory reviews. D. A program must have a clinical director who shall be approved as a supervisor by the Board of Professional Counselors and Therapists to supervise alcohol and drug counselors or trainees. The inclusion of educational aides, homework, and peer support are important adjuncts to the therapeutic process. Standards and Guidelines for Partial Hospitalization Programs. Only use approved platforms for any telehealth contacts . Mute participants and allow them to unmute when. Our Partial Hospitalization Program (PHP) offers some of the same intensity and structure of Residential eating disorder treatment while providing additional opportunities to practice recovery outside of the controlled eating disorder treatment environment during evenings at home or in peer-supported apartment communities. Whenever possible, maintaining a consistent therapeutic milieu reduces the negative effects of transitions to a program with new peers and new staff. These organizations usually conduct surveys of facilities on a regular basis and provide detailed reports on the areas where programs excelandwhere programsneed improvement. Women in the program should have the option to bring babies to group or leave in nursery. Follow-up treatment professionals should also have access to discharge information. Examples include benchmarked metrics such as absenteeism, dropouts, and patient outcome data. Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders. (November 2002). Licensing and Operational Standards for Community Services. Consults, evaluation summaries, absentee notes, results of collateral contacts, treatment team notes, and progress summaries may also be included. PHPs provide structured, comprehensive care while still allowing people to . CMS contracts with intermediaries to manage the requirements for PHP and IOP services. 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. A socially isolated person with serious debilitating symptoms may also benefit from treatment even though they may report virtually no support system at all. We honor and support programs that seek to integrate physical, substance use, and behavioral health treatment within single programs. Improvement in symptoms and functioning to allow the child/adolescent to return to a school setting. It should address the program's mission as well as the needs of individuals in treatment. Level 2: Intensive Outpatient and Partial Hospitalization Programs . Clinicians should pay attention to the need to ground themselves in this new environment - this may be another opportunity to model coping, Sitting in front of a screen for 45 minutes is very different from sitting in a group room in a chair- people are not shifting around and moving their bodies-staff and participants may need to take care to stretch and move around afterwards to reduce physical, Do not record sessions and make it clear that sessions are not. % 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. Basic Books, 1983. Clinical judgment should drive whether or not a prospective client can benefit if attendance is less than ordered in the first week. Participating in a peer-based benchmarking programs allows programs to evaluate how they compare to a larger group of programs. Presently, PHPs serve both shorter and longer episodes of care depending upon the primary functions defined earlier. Health IT and Patient Safety: Building Safer Systems for Better Care. Washington, D.C., 2011. Programs may also bolster their treatment staff with paraprofessionals, non-degreed individuals, students, and interns. These services are included as mandated essential behavioral healthcare benefits in insurance policies from 2014 onward. Bill Type 12X (Hospital-Inpatient), 14X (Hospital-Other) is billed with Condition Code 41 (Partial Hospitalization). 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. For example, some States allow a psychiatric nurseto provide psychotherapy groups while others do not allow this. 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. 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. The processes and results of access, engagement, treatment, and discharge should be considered. PHP and IOP needs may or may not be adequately addressed due to unique workflow documentation, and billing challenges. The specialty group guidelines have been streamlined to focus just on the elements that need to be addressed with the specific population. Programs should include clinical measures that assess current status of the individuals symptoms and functioning. Portsmouth, Virginia: Association for Ambulatory Behavioral Healthcare, 2007. Each individual will present a unique array of strengths, skills, symptoms, and functional limitations. Clear policies for determining assignments and duties are necessary. The certification needs to identify why the client would require hospitalization in lieu of the appropriate level of care. 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. The role of physicians is typically not included in staff to client ratio. Clinicians should self-check frequently. Full-time participation in the program at the onset of treatment serves to promote stabilization and cohesion. According to current practice guidelines, the treatment goals should be measurable, functional, time-framed, medically necessary, and directly related to the reason for admission. We wish to clarify the role and scope of service for Nurse Practitioners and Physician Assistants and assure their inclusion as valued professionals within Intermediate Behavioral Health. Each program is encouraged to identify other programs that are relevant to their individual target populations particularly if there are demographic or secondary diagnostic changes. 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. Many staff may not have this access either. IOPs may be distinct service entities but are often included within applicable outpatient standards of operation. To assist in establishing a sense of program identity and community, the schedule should have a flexible yet coordinated array of therapeutic services indicating the days and times that specific services are scheduled. PHPs and IOPs are characterized by formalized efforts to promote and maintain a stable and cohesive therapeutic milieu or community. Treatment modalities and techniques must be developmentally appropriate, and evidence-based for children and adolescents. Sometimes specific levels of care or programs are not available in certain markets. and provide safety through clinical guidelines, standards, and best practices. 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. Adult Brain Injury. 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. Casarino, J., Wilner, M., and Maxey, J. Level 2 programs provide essential addiction education and treatment components and have two gradations of intensity. Alexandria, Virginia. Within each discipline a licensed professional will have outlined what services they can provide. High quality performance plans will guide the success of utilizing all support levels as members of a fully reimbursed multidisciplinary team. 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. Procedures should be detailed to reduce missed days due to complications with transitions, especially those that can be caused by payer requirements for documenting the transition. This table is available to members HERE. 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. Important to have prescribers with expertise in prescribing during pregnancy and lactation. Each program is challenged to provide effective care within increasing time constraints and with limited resources. As a national provider organization, AABH advocates for the following objectives to improve systems of care and meet the needs of those we serve: The AABH Board of Directors appreciates the work of each behavioral health practitioner who is making a difference in partial hospital and intensive outpatient programs throughout the country. The overall expected outcome is the achievement of symptom and functional improvement on the part of the child/adolescent and the family. Licensing and Operational Standards for Mental Health Facilities. Programs that are planning to bill Medicarefor services must establish a relationship with their MAC by notifying them of their intentions to bill for PHP/IOP services if they already have a Medicare Part A Billing Number, or they must apply for aMedicare Part A Billing Number by submitting an 855A application to their MAC for their region and locate the MACs LCD (Local Coverage Determination) for PHP and IOP. The average length of stay in short-term acute PHP may range from 5 to 30 days, while longer-term acute PHP may exceed 30 treatment days. In general, a seamless flow between practitioners or facilities includes the sharing of clinical information, collaborative treatment planning, safety and recovery management, and discussion of potential financial or insurance related factors that may impact ona personsresponsibility for payment of services. Connellan, K., Bartholomaeus, C., Due, C., & Riggs, D. A systematic review of research on psychiatric Mother-Baby units. Each component of a comprehensive clinical record described above should be part of a quality electronic medical records. It is also important to address issues specifically faced by older adults such as grief and loss, changes in professional and personal roles, limitations of social support, impact of physical limitations on wellbeing, stigma related to aging, and death and dying. 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. the program. Service limitations on scope, amount, duration, frequency, location of service, and other specific criteria described in clinical coverage policies may be Hyde, Pamela S. "Report to congress on the nations substance abuse and mental health workforce issues." Formal agreements may not be necessary, but an agreed upon process is necessary to assure that crucial treatment information is shared in a confidential manner which also allows for verbal communication between providers when deemed appropriate. We must continue to respect the role of PHP and IOP within the behavioral healthcare continuum. Outcome measures should document progress towards meeting goals for discharge. The Level of Care Guidelines is derived from generally accepted standards of behavioral health practice. Codes G0129 and G0176 are only used, and therefore reimbursable, for partial hospitalization programs. In addition, programs need to acknowledge that not all individuals have the appropriate devices, the WIFI access and the privacy to engage in the multiple groups per day format that we must maintain. l) Services provided to more than one beneficiary at a time, unless specifically allowed in the service definition. The increased integration between physical and behavioral health care allows for new levels of cooperation in documenting and sharing information. Miller, T. Standards and Guidelines for Partial Hospitalization Programs. 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. for Health and Human Serv., Substance Abuse and Mental HealthServ.(Jan. Considerable ongoing communication exists regarding the interface between residential non-hospital treatment facilities and PHPs and IOPs. Partial hospitalization programs may either be free standing or integrated with a broader mental health or medical program. The capacity to update and refine the system in a timely manner must be assured where administrative, clinical, regulatory, and performance improvement matters are concerned. In 2005, SAMHSA surveyed the population and determined that 21% or 5.2 million adults experienced both serious mental illness and co-occurring substance abuse problems.21 SAMHSA experts emphasized that the treatment outcome for consumers is enhanced when both illnesses are addressed simultaneously using an integrated approach. The quality of therapeutic presence is even more important in telehealth than it is in Holding the space is much more challenging. They should provide face-to-face services with each client upon admission for an evaluation and thereafter as clinically indicated. The record must be organized in a manner that makes it accessible to those treating the patient. 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. Even in specialty programs that serve a focused group of diagnostics, individuals may need to be tracked on different clinical measures. The individual may require significant skills to make changes which prevent further deterioration between sessions. If suicide risk is present in the participant, take action immediately, including staying online with them until help and safety has been secured. Telehealth services in PHP and IOP are demonstrating to be useful as an additional service modality. American Association for Partial Hospitalization, 1991. 104 CMR 27. These outcome measures should measure change, so progress can be demonstrated. American Association for Partial Hospitalization, 1996. In other cases, an individual from a troubled or dysfunctional family may benefit as long as goals and interventions are designed to facilitate communication or reduce stress within the family unit, or even seek genuine supports outside of the identified family unit. Level 2.1 intensive outpatient programs provide 9-19 hours of weekly There arethreeaccreditation organizations used by behavioral health facilities: A key player in detailing programming and documentation will be the organizations that pay for services. The inclusion of two patient identifiers is helpful and often required on each document, such as a patient name and medical record number. It is designed for patients . As a person moves through the continuum of care, the coordinated care services usually increase or decrease as reflected in the level of care that person is receiving.
standards and guidelines for partial hospitalization programs
standards and guidelines for partial hospitalization programs
