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. Miller, W.R. and Rollnick, S. Motivational Interviewing: Preparing People for Change, (2nd ed.). E. Yalom, Irvin D. Inpatient group psychotherapy. Staff training regarding appropriate language and terminology in documentation should be standard component of staff training on an annual basis. AABH provides these standards and guidelines as a broad representation of best practices in providing PHP and IOP without regard for local areas. Second Edition Revised of Patient Placement Criteria (ASAM PPC-2R). The eighth edition addresses the changing environment of care resulting from the COVID pandemic and includes guidelines for alternative service delivery such as telehealth. 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. The provision of services allowed for each discipline is dictated by the scopes of work for a licensee in their particular State. Many programs also include consumer input groups as a formal part of programming that is led by peers. (2) Prior authorization is required for LOC 2.5 (partial hospitalization) which requires a minimum of twenty hours of services per week. According to current practice guidelines, the treatment goals should be measurable, functional, time-framed, medically necessary, and directly related to the reason for admission. . Services are offered to individuals whose medical condition, including the possibility of severe withdrawal, is not as dangerous or severe as to warrant 24-hour inpatient or residential monitoring. This plan facilitates efficient service delivery, an expeditious return to improved functioning in the individual's community, and a transition to less intensive levels of care. 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. Second Edition. 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. Standards and Guidelines for Partial Hospitalization Programs. Ongoing performance reviews may address attendance rates, dropout percentages, treatment trends, satisfaction, clinical handoffs, discharge status, post-discharge adjustment, or readmission rates. l) Services provided to more than one beneficiary at a time, unless specifically allowed in the service definition. All treatment planning activity must continue. This will require a program to review the criteria and make a decision that is in the best interest of the program and the individuals being served. Can demonstrate limited ability to function and handle basic life tasks/responsibilities, Can achieve reasonable outcomes through actions, Can demonstrate some capacity to identify, set, and follow through on treatment plan without daily monitoring, Can prioritize tasks and function independently between sessions, Can respond adequately to negative consequences of behaviors, The presence of moderate symptoms of a serious psychiatric diagnosis, A significant impairment in one or more spheres of personal functioning, The clear potential to regress further without specific IOP services, The need for direct monitoring less than daily but more than weekly, Identified deficits that can be addressedthrough IOP services, A significant variability in daily capacity to cope with life situations, Therapy-interfering or self-destructive behaviors, Specific interpersonal skill deficits such as assertiveness, Borderline, or other challenging personality traits, Early recovery from Chemical Dependency or dually diagnosed, Daily medication and overall symptom monitoring is needed, Immediate behavioral activation and monitoring is needed, Potential for self-harm is significant and requires daily observation and safety planning, Coping skill deficits are severe and require daily reinforcement, A crisis situation is present and requires daily monitoring, Family situation is volatile and requires daily observation, client instruction and support, Mood lability is extreme with potential to create destructive relationships or environmental consequences, Hopelessness or isolation is a dominant feature of clinical presentation with minimal current supports, Daily substance abuse monitoring is needed, Need for rapid improvement to return to necessary role expectations is present. Additional elements include opinions related to the programs use of effective treatment methods, relevance of therapeutic subject matter, cultural sensitivity, teamwork, and the overall quality of care. 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. 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. The specialty group guidelines have been streamlined to focus just on the elements that need to be addressed with the specific population. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. Outcomes have become increasingly more important not only internally, but to external agencies, including regulatory agencies, insurance providers and consumers. In view of PHPs and IOPs positions in the continuum of behavioral health services, programs must maintain liaison relationships with multiple behavioral health providers, physical health care providers, and others. The patient or legal guardian must provide written informed consent for partial hospitalization treatment. 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. It should provide the capacity for narrative description to reflect unique client dynamics or circumstances. Programs should provide easy access to grievance procedures as required by regulatory agencies. 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. These services are provided primarily by medical practitioners within the context of treatment of general medical conditions. Texas Administrative Code Texas Administrative Code TITLE 28 INSURANCE PART 1 TEXAS DEPARTMENT OF INSURANCE CHAPTER 3 LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES SUBCHAPTER HH STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS Rules 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. The individual exhibits acute symptoms or loss of function that necessitates an intermediate level of care or has relapsed and failed to make significant clinical gains in a less intensive level of care yet does not need 24-hour containment. The program must then review the guidelines and determine how to proceed with programming and documentation. Treatment modalities and techniques must be developmentally appropriate, and evidence-based for children and adolescents. The quality improvement plan constitutes a comprehensive and methodologically sound process for measuring treatment effectiveness, improving the delivery of care, and evaluating progress toward recovery. Whenever possible, theperson receiving servicesshould be included in this process. 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. These disorders are characterized by significant changes to mood during pregnancy and up to 3 years postpartum. 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. 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 individuals progress or lack thereof toward identified goals is to be clearly documented in the record. The key elements of partial hospitalization and intensive outpatient programs have been combined as the core of the standards and guidelines. All programs should consult with compliance officers in their organization to determine if there are specific staff-to-client ratios included within contracts. Many programs opt to divide the program leadership into two roles. By Jacqueline LaPointe. When tech issues arise such as unstable WIFI, not knowing how the system works, clinicians should model social interaction and effective problem solving. Child and adolescent programs provide an intensive therapeutic milieu that is designed to serve the child and/or adolescent (and their family) within the least restrictive therapeutically appropriate context. Mute participants and allow them to unmute when. Partial hospitalization programs (PHPs) differ from inpatient hospitalization in the lack of 24-hour observation, and outpatient management in day programs in 1) the intensity of the treatment programs and frequency . Clinicians must also be in a private, secure location to maintain HIPAA compliance for Clinicians working from home must have no family in the vicinity of the computer/device being used to provide service (working from home might require prior authorization from leadership ). In either case, the individual is unable to benefit from medication management or traditional outpatient therapy alone. As many EMR systems were initially designed for inpatient non-psychiatric care, data processes may be challenging. Some programs choose to identify guidelines for early administrative discharge based on pre-determined number of relapses and other forms of treatment-interfering behaviors. Staff members assume responsibility for and control of the individuals safety due to the individuals severe, disabling symptoms. Payers may require different processes or timelines. 8.320.6 School-Based Services for MAP Eligible Recipients Under Twenty-One Years of Age 7/1/15 to 1/31/20. 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. https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance.html?redirect=/home/regsguidance.asp, https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Who-are-the-MACs.html. Example metrics include, but are not limited to: Metrics related to the services that are offered during the course of treatment allow program staff to evaluate how service offerings can be adapted to meet the needs of the population served over time. Standards and Guidelines for Partial Hospitalization, Alexandria, Virginia. Co-morbid substance use is common so drug screens should be administered upon admission and use assessed throughout the stay. Standards for Intensive Outpatient Treatment: 22258025: Effective: 08/29/2019 Change 65D-30.002 Definitions, Certifications and Recognitions Required by Statute, Display of Licenses, License Types, Change in Status of License, Required Fees, Licensure Application and Renewal, Department Licensing .. 22030172: 6/25/2019 Vol. Each program should have an identified medical director. Between 10-25% of women experience some form of PMAD during pregnancy or after the birth of a child. Second Edition. Are usually community-based and free. The record must be organized in a manner that makes it accessible to those treating the patient. Both are designed to serve individuals with serious symptoms and functional impairments resulting from behavioral health disorders. Some regulators have requirements about education components in these programs. For the purpose of this Part, the following terms are defined: "Abuse." Any physical injury, sexual abuse or mental injury inflicted on an individual other than by accidental means. 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. Individuals requiring care at this level may have insufficient resources or access to critical supports systems including family and community. Partial Hospitalization Program (Adult) Partial hospitalization is a nonresidential treatment program that may or may not be hospital-based. The degree to which an individuals medications are managed and the extent to which they must be reconciled, tracked, or summarized may vary according to program mission, regulation, or defined clinical responsibility within the continuum. American Association for Partial Hospitalization, 1991. The plan must be available to the clinical staff at the time-of-service to assure that interventions are focused and relevant. When possible, it is important that comparisons or benchmarks be used to enhance performance. 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. Association for Ambulatory Behavioral Healthcare, 2012. With the increased use of electronic health records, staff need to be reminded that the electronic health record cannot substitute for direct verbal handoffs in many cases. All other documentation standards for a clinical record remain the same for telehealth and in-person/on-site participants. A new print edition will be pulled every 2 years for those who choose to purchase the e-document. Ongoing clinical responsibility must continue and be clarified while individuals are awaiting follow up care. guidelines including the Level of Care Utilization System (LOCUS), hildren's Level of are . Clients with eating disorders may enter PHP level of care with a body mass index (BMI) which measures the relationship between height and weight, of 17.5 (adults) or less with a diagnosis of anorexia nervosa or may be of normal weight with a bulimia nervosa diagnosis, while they may be obese with a BMI of 30 or more or morbidly obese with a BMI or 40 or more. Gray, K., Michael, S., Lefkovitz, P., and Barry, A. American Association for Partial Hospitalization, 1982. DESCRIPTION A psychiatric partial hospitalization program is a treatment setting capable of providing 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. Fifth Edition. Hyde, Pamela S. "Report to congress on the nations substance abuse and mental health workforce issues." In many program settings, the inclusion of individuals in different phases of recovery can be used to good clinical advantage. A focus on medication adherence, therapeutic impact, and relationship between psychiatric and physical medications should also be considered. We hope this document will be used in concert with active dialogue on a local, regional and national level to improve care and individual recovery. Recently in behavioral health, a few payers are developing protocols that are not in line with Medicare guidelines, which again can create challenges in programming and billing. Outcome measures should document progress towards meeting goals for discharge. While all three of these bodies can impact how a program provides services and determines appropriateness for care, state licensing agencies will have the regulations attached to laws in a State that must be followed. Regulations, and Minimum Standards Authority: T.C.A. Programs from around the country reveal the following clinical orientations or strategies that are reflected in their educational components: NOTE: Individual skills may be taught in each of these approaches. If medications are dispensed on-site, appropriate staff must document medications that are administered on site. 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. Our eating disorder partial hospitalization program in Dallas Texas addresses the physical, emotional, and spiritual aspects of our client's well-being. 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. PHP and IOP treatment allow persons served to stabilization more successfully while in their own community environment. 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. These individuals are typically found among those admitted for a first episode of care patients often referred from primary care or emergency departments. The presence of comorbid physical illness must be addressed and often makes the frequency and duration of attendance more challenging. While all levels of care in the continuum are important in providing a full recovery, these cuts have limited the availability of parts of the continuum in many communities. The main objective is to receive feedback addressing the degree to which the program met the individuals needs and assisted in achieving their goals. A. As value-base contracts grow in behavioral health, payers may be influenced to reimburse programs that include ancillary staff for treatment support. 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. Third Edition. Historically, the availability of an intact support system was a prerequisite for PHP services. Both performance and clinical measurement will be addressed. Partial hospitalization, also known as PHP (partial hospitalization program), is a type of program used to treat mental illness and substance abuse. Your compliance officer is usually the best person to advise on any licensing requirements at the State level. The signing of treatment reviews is an indication of the agreement of all parties that the goals for treatment will move the individual toward recovery and discharge. If a program accepts payments from multiple organizations, keeping the different requirements for each payer up to date can be a challenging task. The individual may exhibit some identifiable risk for harm to self or others and may or may not admit to passive or active thoughts or inclinations toward harm to self or others yet is willing to work in program. At times, a full participation during the first week may be impossible upon admission due to unavoidable personal responsibilities. Programs that include ancillary staff for treatment support and functional impairments resulting from the pandemic... 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