Service limitations on scope, amount, duration, frequency, location of service, and other specific criteria described in clinical coverage policies may be Individuals requiring care at this level may have insufficient resources or access to critical supports systems including family and community. 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. 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. Programs should consider the focus of some of their programming on maternal fetal attachment with bonding groups like infant massage, playing with baby, etc.)12. Medical oversight is necessary with additional daily, hourly structure to contain and monitor client movement. Additionally, systems may have ancillary features that will benefit an individual in treatment, such as mechanism to disallow inappropriate abbreviations in both medications and other information is also recommended. These types of services are provided by a single entity which may be included as part of a benefits package or purchased separately by/for a person needed assistance with navigating the complexity of the health system. 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. American Association for Partial Hospitalization, 1993. It's more intense than psychosocial rehabilitation or outpatient day treatment. residential programs. Because assessments completed soon after meeting a client or in the context of intoxication, withdrawal, or severe psychiatric symptoms are inaccurate, it is important to continue to gather information over time.9. This record should be available to the individual, follow-up prescribing professional, and primary care provider. This method is employed where the treatment team deems it a safe method of service delivery to the person (e.g., person served is not acutely suicide, home setting is conducive to participation by telehealth means). Performance improvement goals are best when they apply to real program needs even if comparison data is not available. We must continue to respect the role of PHP and IOP within the behavioral healthcare continuum. They are designed to identify best practices within programs. All participants in a telehealth session must be in a private, secure location to maintain HIPAA compliance for themselves (and for other group members). This final consideration is increasingly important in the world of accountable care. Some individuals are at risk for inpatient hospitalization and require the intensive services of partial hospitalization treatment due to acute debilitating symptoms and/or some risk of harm to self or others. 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. Due to the nature of individual need and program design, it is expected that all needs which are addressed during treatment will not show up on all treatment plans. Such conditions frequently follow serious crises, stressors, or newly diagnosed acute physical problems. Most regulatory bodies have a requirement that consumer feedback in an integral part of programming. 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. 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. 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. Important to have prescribers with expertise in prescribing during pregnancy and lactation. Second Edition. The individual is not judged to be in imminent danger of withdrawal or has recently undergone medical detoxification. Communication amongst programs regarding their results is strongly encouraged. Many programs are moving toward the inclusion of patient photographs due to an increase in the number of those served with similar names. CMS and other agencies expect to see individual sessions prescribed as a necessary component of treatment during each episode of care. The advent of the electronic medical record (EMR) or electronic health record (EHR)provides many new opportunities as well as challenges in the documentation process for intermediate levels of care. PHPs provide structured, comprehensive care while still allowing people to . American Association for Partial Hospitalization standards and guidelines for partial hospitalization This article reflects the first major revision in the standards for adult partial hospitalization which were developed by the American Association for Partial Hospitalization and initially published in Volume 1, Number 1 of this journal. Partial Hospitalization Program (Adult) Partial hospitalization is a nonresidential treatment program that may or may not be hospital-based. A complete medical record should include the following: The initial assessment addresses the individuals bio-psychosocial status and strengths including, but not limited to: Each assessment needs to include screenings for potential risks, needs, physical evaluations, or referrals. The primary goals of intensive outpatient programs are to monitor and maintain stability, decrease moderate symptomatology, increase functioning, and foster recovery. A new print edition will be pulled every 2 years for those who choose to purchase the e-document. To make a referral, have your doctor or therapist call 1-319-384-8449. 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. Recently, accreditation organizations have also begun to look closely at clinical indicators of quality in addition to health and safety. The record must be organized in a manner that makes it accessible to those treating the patient. 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. Within each discipline a licensed professional will have outlined what services they can provide. 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. Re-certifications are required by many payers within strict time guidelines. Structure of the Accreditation Requirements Establishment of a safety plan that allows for the child/adolescent to maintain safety in a community setting. In States where Medicaid is contracted out to other insurance providers, a program may find that guidelines are managed by the State and apply to all insurance companies contracted or the contracts may give the individual insurance providers the freedom to create their own guidelines. Finally, a new section of was added to address the role of regulatory bodies on programming and documentation. Treatment should include collaboration with school, involved community agencies and established providers. Participating in a peer-based benchmarking programs allows programs to evaluate how they compare to a larger group of programs. Partial Hospitalization Program Policy Number: SC14P0034A3 Effective Date: May 1, 2018 . 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. Partial hospitalization is a time- limited, structured program of multiple and intensive psychotherapy and other therapeutic services provided by a multidisciplinary team, as defined by Medicare, and provided in an outpatient hospital setting outpatient department facility or a Medicare-certified community mental health center (CMHC) that meets Comparing benchmark measures to those of peers offers a greater integration of performance within the industry and particular to these levels of care. Programs can usually expect to conduct program improvement planning following a review to address the issues discovered and highlighted as needing improvement. 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. Casarino, J., Wilner, M., and Maxey, J. The benchmark when no other exists can be a designated baseline of a measure within the program. Accreditation organizations are responsible for providing guidance to programs primarily on health and safety protocols for facilities. Women in the program should have the option to bring babies to group or leave in nursery. and Lefkovitz, P.M. Standards and Guidelines for Partial Hospitalization Adult Programs. Institutional Habilitation Facilities 0940-05-24 Minimum Program Requirements for Mental Retardation Residential Habilitation Facilities 0940-05-25 Minimum Program Requirements for Mental Retardation Boarding Home Facilities 0940-05-26 Minimum Program Requirements for Mental Retardation Placement Services Facilities The individual may require significant skills to make changes which prevent further deterioration between sessions. 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 role of physicians is typically not included in staff to client ratio. OAR 309-039-0500 to 309-039 . AABH maintains a table of clinical outcome measures that have been used in PHPs and IOPs and can be accessed HERE for members. People treated at this level of care are able to maintain their role functioning in the community and generally have adequate family/community support. Outcome measures should document progress towards meeting goals for discharge. Connellan, K., Bartholomaeus, C., Due, C., & Riggs, D. A systematic review of research on psychiatric Mother-Baby units. Are usually community-based and free. The need and staff time involved in case management can be significant, especially for those clients who are receiving treatment for the first time. Payment will not be made for compensable peer support 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. Many programs opt to divide the program leadership into two roles. % 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 individuals progress or lack thereof toward identified goals is to be clearly documented in the record. 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 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. Association for Ambulatory Behavioral Healthcare, 1998. The quality of therapeutic presence is even more important in telehealth than it is in Holding the space is much more challenging. The individuals family and/or legal caretakers must be involved. Subspecialty groups focus on the specifics of given targeted populations such as trauma, substance use, eating disorders, OCD, or cardiac/depressive conditions. Improvement in functioning and communication within the family system and/or home environment. For individual admitted to an IOP, recurring reviews should happen no less than once every 30 days, and again, may need to occure more frequently based on the symptoms present at the time of admission. Often programs will struggle with deciding if their data elements are outside the norm. See DSM-5 for details on these diagnostic categories, and the levels of severity. These standards include guidelines and consensus statements produced by professional specialty . Treatment planning is a progressive process that requires regular updates of all goals and services on the plan. Standards for the approval of providers of non-inpatient mental health treatment services. Intensive Outpatient Program or IOP is an addiction treatment that also does not require the client to spend full time or live in a rehab center. Specialty programs focus on a given age or diagnostic group. A significant improvement in functioning and symptom reduction is needed and achievable in order to resume role expectations and avert the loss of home, job, or family. This program typically lasts about 10 business days. Many of these scopes will include the specifics of topic areas that a discipline may be limited to in provision of services to a group or individual. Typically, a PHP is an option for treatment after a person has been hospitalized due to substance abuse issues, and the person is deemed fit to be discharged from the hospital. Creative/Expressive therapies are also significantly employed in PHP/IOP clinical settings. Patients are assessed to be medically stable with labs to include but not limited to: comprehensive serum metabolic profile, including phosphorus and magnesium, Electrocardiogram (ECG), if clinically indicated. 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. This type of program usually provides daily service that people will access at least one day a week and up to 11 or less services in any one week. 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. Mute participants and allow them to unmute when. Payment for peer support services is subject to the provisions of these requirements, 55 Pa. Code Chapter 1101 (relating to general provisions) and the limitations established in 55 Pa. Code Chapter 1150 (relating to the MA program payment policies) and the MA program fee schedule. A person is not appropriate for participation in a partial hospitalization program orintensive outpatient program if the individual: Following admission, recurring reviews should be conducted to determine whether individuals continue to meet medical necessity criteria and require ongoing services in a PHP. Medicare Advantage Plans are not obligated to cover these levels of care. Treatment can be 3-5 days a week for a few hours each time. Scheifler, P.L. Importantly, States vary in the scopes of work for many disciplines. 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. The treatment mission of PHP and IOP services is to develop a setting that provides the tools for recovery. This recommendation is especially relevant to specialty programs. Bill Type 12X (Hospital-Inpatient), 14X (Hospital-Other) is billed with Condition Code 41 (Partial Hospitalization). The individual is ready for discharge from a higher level of care but is judged to be in need of daily support, medication management, and intensive therapeutic interventions due to symptom acuity or functional impairment that cannot be provided in a traditional outpatient setting due to lack of comprehensive resources. Accessibility of an individuals data within the EMR is impacted by privacy and regulatory statutes and must be reflected in the EMR. It can also be used to track benchmarking data such as dropouts, re-hospitalizations, absenteeism, and related metrics. These organizations usually conduct surveys of facilities on a regular basis and provide detailed reports on the areas where programs excelandwhere programsneed improvement. In partial hospitalization, the patient continues to reside at home, but commutes to a treatment center up to seven days a week. 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. 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. Family work is crucial and should be a part of every clients treatment plan. The overall expected outcome is the achievement of symptom and functional improvement on the part of the child/adolescent and the family. 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. Examples of symptoms include high anxiety, sadness, depression, mood swings, elevated mood, irritability, intrusive thoughts, and more. Older Adult programs are an important means of delivering behavioral health treatment to adults age 55 and older. The value of these programs in clarifying diagnoses, assessing function, and determining ones capacity for independence or personal safety cannot be underestimated. This includes how the information within the EMR is accessed and utilized within a given program, and how. Association for Ambulatory Behavioral Healthcare, 2012. Individuals receiving PHP and IOP services vary in symptom intensity, clinical needs, and stages of readiness for change. 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. Coordinated (Integrated Care) services are provided to people who have complicated medical and/or behavioral health issues. If an individual does not meet any of the above criteria, they may be appropriate for an intensive outpatient program. The Institute of Medicine (IOM) published a 2011 report entitled Health IT and Patient Safety.5 This report suggests that a successful EMR is designed to enhance workflow without increasing workloads, allow for an easy transfer of information to and from other providers, and (hopefully) address the perils of unanticipated downtime. 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. Once decisions regarding confidentiality are made, the nature of the handoffs between components within the continuum is equally important. 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. Institute of Medicine of the National Academies. In this case, communication within the team is essential. Include programs such as Depressed Anonymous, Emotions Anonymous, and the National Alliance on Mental Illness (NAMI). Discharge from IOP programs is made to individual outpatient behavioral health specialists, integrated physical/behavioral settings, or primary care. The disorders are also commonly called Postpartum depression, perinatal mood disorders, or PMD. Each individual will present a unique array of strengths, skills, symptoms, and functional limitations. The plan should conform to guidelines set forth by accrediting bodies and regulatory agencies of local, state and federal government. 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. As providers have found it helpful to provide specialized programming for sub-populations dealing with similar behavioral health challenges, these guidelines outline unique factors related to some of those specialty populations, including: Necessary elements for documenting services provided include a discussion about electronic medical records. l) Services provided to more than one beneficiary at a time, unless specifically allowed in the service definition. Programs should create a plan that includes performance measures for the program as well as appropriate clinical outcome measures specific to eating disorders and clinical issues specific to any additional diagnoses for admitted participants. PHPs and IOPs are designed to help individuals understand their illness, reduce the impact of functionally debilitating symptoms, and cope with challenging situational crises. The program can also function as a first step to achieve a measure of sobriety, and to assist in determining a differential diagnosis once the individual has begun the recovery process. 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. State laws may apply. Partial hospitalization programs may either be free standing or integrated with a broader mental health or medical program. Portsmouth, Virginia. Also, the program expectations should be flexible in order to accommodate a decrease in the number of hours per day or days per week of individual participation over time as a person moves toward discharge. The (Traditional) Outpatient level of care provides for treatment of conditions related to mild to moderate impairment. Standards and Guidelines for Partial Hospitalization Programs. 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. Some regulators have requirements about education components in these programs. Initial Evaluation/Certification Our eating disorder partial hospitalization program in Dallas Texas addresses the physical, emotional, and spiritual aspects of our client's well-being. If my provider is concerned about my safety, I understand that they have the right to terminate the visit.". 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. Individual therapy within programs is designed to augment, clarify, or address issues which are considered by the clinician and client to be more appropriate for individual rather than a group focus. 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. 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. Women with postpartum psychosis will need referral into acute inpatient psychiatric treatment. The patient or legal guardian must provide written informed consent for partial hospitalization treatment. Alexandria, Virginia. Both performance and clinical measurement will be addressed. 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. The EMR further facilitates this opportunity for improved integration and information sharing. Association for Ambulatory Behavioral Healthcare, 1996. Cognitive and physical impairments may make day-long treatment services demanding for some individuals. Generally, the receiving program should have access to all aspects of the treatment in the previous program within the continuum, and accurately identify the source of information gathered while minimizing the difficulties for an individual to resume treatment. Each program is challenged to provide effective care within increasing time constraints and with limited resources. teacher on staff vs. A given programs metrics may vary significantly based on the diagnostic characteristics of those who attend program and may help direct changes to programming to better meet the needs of the population in program. Electronic record systems should reflect the clinical treatment process and allow the capture and representation of data in a user-friendly fashion. Client rights guidelines includes: Rights and Responsibilities, Compliant/Grievance process, confidentiality, access to emergency services if in crisis and must be signed . They may be part of educational or residential facilities. 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standards and guidelines for partial hospitalization programs