Upon discharge, a list of medications that have been discontinued is to be available along with a list of all current medications and appropriate contraindications for the patients benefit. In these cases, backup case management and peer support services can be essential. 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. All sessions are to be conducted using video and audio wherever This allows clinicians to assess the participants using all their clinical skills. Several factors have emerged since the 1999 Continuum of Behavioral Health Services paper was last revised. For those with AN, weight restoration may need daily monitoring to prevent re-feeding syndrome. A clinical record must document what information is gathered, considered, or developed throughout treatment for each individual admitted. 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. For individuals who don't require a hospital stay or constant supervision, partial hospitalization programs can be an excellent alternative that allows them to dedicate time and attention to addressing their mental health condition while staying at home or with family members. In this case, communication within the team is essential. Portsmouth, Virginia. Regardless of the length of stay, the participant experience should be paramount, and staff should work to assure a synergy among goals to be addressed, services rendered, and time available for clinical intervention whenever possible. 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. Many payers will have a requirement that a program meet the requirements of an accrediting body as a rule for program approval and reimbursement for services. 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. If the State is not using a managed Medicaid system, the guidelines should be requested from the State office that manages Medicaid. Facilities that provide treatment for both behavioral health conditions are not formally designated as a single treatment program in most areas. A member of the clinical staff serves in a primary therapist/case management capacity to coordinate an individual's treatment within the program. Table 1 Levels of Care (Behavioral Health), Solo practices, Medical clinics, Medical care home, IOP, Psych rehab, Club House, Assertive Community Treatment. To ensure effectiveness of co-occurring programs, it is important to not rely only on patient report but to utilize data from various sources to ensure ongoing recovery. On the other hand, integrated occupational therapy programs complement other services and teach valuable skills within an evidence -based model that contributes significantly to positive clinical outcomes. E. 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. Performance Improvement for older adult programs is essential and should be determined by the mission and specific needs of those who are being served. The individual is not imminently dangerous to self or others and therefore not in need of 24-hour inpatient treatment. This includes how the information within the EMR is accessed and utilized within a given program, and how. This role is usually filled with a person who has advanced training in psychiatry, most notably a psychiatrist. Movement needs to be monitored hourly, determining how much movement or exercise is medically safe for each clients stability. Each individual will present a unique array of strengths, skills, symptoms, and functional limitations. Presently, PHPs serve both shorter and longer episodes of care depending upon the primary functions defined earlier. Gather information from other sources (family, hospital records, and urine screens) in addition to the client. An external audit should not be the impetus for utilization reviews. 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. 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. Some payer contracts may also dictate the timing for recurring reviews. It is believed that the services available in intermediate level of care is sufficient to reduce symptoms and/or restore the individuals functioning. 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 While none of these focuses are mutually exclusive, a program tends to build their program from one of these perspectives. This edition also included the launch of the Standards and Guidelines as a living document for association members. The summary includes the clinical status on admission, the diagnosis and any changes during treatment, progress made, skills developed, issues not addressed, plans to prevent relapse/foster recovery, aftercare appointments, referrals, a medication summary, and assessment of risk. Service limitations on scope, amount, duration, frequency, location of service, and other specific criteria described in clinical coverage policies may be Programs might also include informal methods to collect consumer feedback, including individual, group, and community discussions, and the use of an anonymous approach such as a suggestion box. The disorders are also commonly called Postpartum depression, perinatal mood disorders, or PMD. Recovery oriented service evaluations may also be helpful for programs. 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. Can help as you work to achieve good, stable mental health. Level 2 programs provide essential addiction education and treatment components and have two gradations of intensity. There arethreeaccreditation organizations used by behavioral health facilities: A key player in detailing programming and documentation will be the organizations that pay for services. 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. 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. 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. These programs are available at inpatient or residential treatment facilities. 8.320.6 School-Based Services for MAP Eligible Recipients Under Twenty-One Years of Age 7/1/15 to 1/31/20. The development of clinical pathways or treatment protocols offers the potential for systemic solutions to these issues. Organized as a continuum, this system of care enables the movement of individuals to the most clinically appropriate and cost-effective level of care. Payers may require different processes or timelines. The processes and results of access, engagement, treatment, and discharge should be considered. 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. For example, this level of care may include traditional outpatient counseling by one provider, medication management by another provider, and crisis and support services by a community agency (all three provider entities in separate settings serving as distinct stand-alone providers). The quality of the treatment we deliver is the value we offer to patients. The (Traditional) Outpatient level of care provides for treatment of conditions related to mild to moderate impairment. The fifth edition was completed in 2012. 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. Menses have usually ceased if body mass is extremely low or high. 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. Often primary care physicians, OBGYNs and Pediatricians need additional help and consultation from a trained psychiatric provider if they are going to be a part of the aftercare plan for clients, especially if they are managing medications. 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. Debilitating symptoms may also accompany a life change, significant loss, or even the current ineffectiveness of previous coping skills. Improvement in symptoms and functioning to allow the child/adolescent to return to a school setting. 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. 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. Respect that some participants are comfortable using telehealth services and some are Make every effort to meet the needs of all participants. https://www.jointcommission.org/accreditation/behavioral_health_care.aspx. By Jacqueline LaPointe. When a given benchmark is not being addressed nationally, a program is advised to track their own metrics that are relevant to their specific population. Licensing and Operational Standards for Mental Health Facilities. Abortion Facilities. Considerable ongoing communication exists regarding the interface between residential non-hospital treatment facilities and PHPs and IOPs. Standards and Guidelines for Partial Hospitalization Child and Adolescent Programs. Medical personnel address ongoing medical and physical health issues and assess and manage medication therapies. 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. State laws may apply. 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). Services may include group, individual, couples, family therapy and medication management for symptom management. The patient or legal guardian must provide written informed consent for partial hospitalization treatment. Retrieved July 20, 2018, from https://www.ncmhjj.com/wp-content/uploads/2014/10/Behavioral_Health-Primary_CoOccurringRTC.pdf. The use of electronic signatures (for the clinicians and patients) is a valuable option if available as it prevents the need to re-scan documents into the EMR and assures timely document review by the treatment team. 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. A brief description and examples of each level of care follows: Primary Care is first line health care providing screening, early identification, education, and often pharmacotherapy. 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. Second Edition. Family work is crucial and should be a part of every clients treatment plan. 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. 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. Individuals are invited and encouraged to adopt an active participant and partnership role in the treatment process. In the current healthcare environment, this level is also referred to as Primary Integrated Care and supported by the Center for Medicare and Medicaid Services (CMS) Integrated Health Model. Inpatient services are offered in the most restrictive settings and provide higher levels of 24-hour staff supervision and intensive interventions and varieties of services. Initial Evaluation/Certification Perception of care surveys gather information about how effectively the program engaged the individual through assessment, course of treatment, and discharge. 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. A minimal ability and willingness to set goals to work toward the development of social support is often a requirement for participation. Monitored study time vs. Telehealth services in PHP and IOP are demonstrating to be useful as an additional service modality. The value of these programs in clarifying diagnoses, assessing function, and determining ones capacity for independence or personal safety cannot be underestimated. Examples of symptoms include high anxiety, sadness, depression, mood swings, elevated mood, irritability, intrusive thoughts, and more. 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. The achievement of clinical stability and a reduction in symptomatology must be considered in the context of realistic and achievable goals especially given the complex medical and psychosocial stressors that often impact the older adult population. 8.320.2 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services 2/1/20 to 12/31/20. Coordination and involvement with family members and significant others is an important part of treatment whenever possible. 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. We have prepared this article to provide general guidelines for insurance billing for PHP. Outpatient care may be short or long-term depending on the needs of the person. 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. Resources from Post-Partum Support Internation may be helpful in finding additional support for spouses. Programs will use their identified outcome measure tool to track clients progress in the program. 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. Education regarding medications during treatment should also be documented. Linkages related to successful treatment will be considered. The presence of comorbid physical illness must be addressed and often makes the frequency and duration of attendance more challenging. Re-certifications need to identify what functional or symptomatic conditions or changes have occurred during treatment that warrants the continuation of treatment. We offered telemedicine as an option for care delivery and the patient consented to this option.. 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. Mol, J.M., Miller, T., Lefkovitz, P.M., Michael, S., and Scheifler, P.L. 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 ). There are three principal forms of linkage: FIRST, internal linkages between programs, departments, or practitioners within the same organization. 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. Examples of evidence of such participation at the programmatic level often include community meetings, formal involvement in planning, assessing the value of therapeutic activities, and serving as agents of change within the therapeutic milieu. 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. However, measures for physician involvement should be a part of all performance plans. Whenever possible, theperson receiving servicesshould be included in this process. To accomplish this, programs should develop and maintain liaison relationships with organizations such as hospitals, crisis stabilization units, primary care physicians, community therapists, supportive living programs, community support programs, self-help groups, crime victim councils, vocational assistance programs, employee assistance programs, home health services, and various other social service agencies and organizations. They strive to have a positive clinical impact on each individuals support system and recovery environment. Symptoms continue to impair multiple areas of daily functioning and medications are being adjusted, Impaired insight and skill deficits place one at a significant risk for further functional deterioration, Individual displays willingness yet difficulty understanding or coping with significant crises or stressors, There is a continued significant risk for harm to self or others. For clinical outcome measures related to the populations below, AABH has a table of clinical outcome measures that are currently used in PHPs and IOPs. The plan may address patient safety concerns, primary symptoms, self-esteem issues, coping skill deficits, priority decision points, level of motivation, recovery issues, barriers to treatment, and factors which impact readiness for discharge. Consider that each participant has differing levels of technical abilities or. 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. PHPs and IOPs are characterized by formalized efforts to promote and maintain a stable and cohesive therapeutic milieu or community. All programs should consult with compliance officers in their organization to determine if there are specific staff-to-client ratios included within contracts. Examples include benchmarked metrics such as absenteeism, dropouts, and patient outcome data. These are often reviewed during site visits, but internal processes need to be in place to review health and safety processes regularly. Accreditation organizations are responsible for providing guidance to programs primarily on health and safety protocols for facilities. Many staff may not have this access either. The rationale for this variation should be supported by client need and clinical judgment. These persons may have been screened by primary care physicians, individual therapists, or other healthcare professionals and require the coordinated treatment interventions available in a PHP in order to facilitate engagement and acceptance of the impact the illness has had on their day-to-day functioning. Compiles and analyzes data and prepares case records, reports, and documents that comply with state and federal standards in providing case notes, treatment plans, and evaluations. 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. Mol, J.M. Sometimes the primary treatment and the case management functions may be separated within a program. Additional certification, monitors, medications, or additional clinical data may be required due to internal organizational or regulatory requirements. 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. Ideally, the individual is or can be connected with a community-based support network and is able to function in their home environment. Portsmouth, Virginia. Identifiers should be individualized so program staff and reviewers can uniquely identify each patient. 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. Case reviews should be scheduled on a regular basis. Commission on Accreditation of Rehabilitation Facilities (CARF). Block, B. M., Arney, K., Campbell, D.J., Lefkovitz, P.M., Speer, S.K., and Kiser, L.J. Discharge planning begins at the time of admission with the identification of specific discharge criteria and, if necessary, the identification and contact of follow-up options and availability. 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. Programs should create a plan that includes performance measures for the program as well as appropriate clinical outcome measures specific to postnatal issues and clinical issues specific to any additional diagnoses for admitted participants. It is the need for intensive, active treatment of the patient's condition to maintain a functional level and to prevent relapse for hospitalization. Level 2: Intensive Outpatient and Partial Hospitalization Programs . Examples may include childcare demands, appointments for services such as housing, or employment interviews. Both performance and clinical measurement will be addressed. Bill Type 12X (Hospital-Inpatient), 14X (Hospital-Other) is billed with Condition Code 41 (Partial Hospitalization). Treatment must be rendered under the supervision of a psychiatrist or medical professional licensed to diagnose behavioral health issues. The following Text (Smartphrases if using EPIC) is an example: Consultation provided via telemedicine using two-way, real-time interactive telecommunication technology between the patient and the clinician. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services (January 2003). Programs providing primarily social, recreational, or diversionary activities are not considered partial hospitalization. The assessment and treatment plan should address improvement of social skills and functioning via the therapeutic milieu. The Indiana Health Coverage Programs (IHCP) provides coverage for inpatient and outpatient behavioral health services - including mental health and addiction treatment services - in accordance with the coverage, prior authorization (PA), billing and reimbursement guidelines presented in this document. The Continuum of Behavioral Health Services Described: Table 1 provides a graphic representation of the Continuum of Behavioral Health Services, highlighting the six levels of care along the continuum. Theme-based groups include a variety of specific topics that emerge from on-going team collaboration, client feedback, and ongoing reassessment of value. Progress notes reflect, but are not limited to: Specific individual skills training, client generated progress sheets, participation in milieu activities, peer support building activities, family sessions, and case management meetings should also be documented regardless of whether the service is billable. Addictive Signs and Symptoms: The individual exhibits serious or disabling symptoms related to an acute substance use disorder or relapse following a period of sobriety. Many payers include these standards in their outpatient operations protocols and might be referenced as recurring outpatient services. These regulations should be the primary guiding protocols followed for any program. Consider a preparatory contact over the platform prior to the first meeting, especially for groups. Our Behavioral Health Care guidelinesbuilt on the same principles of evidence-based medicine used to create our medical/surgical guidelines address medical necessity screening criteria to help make informed, consistent care decisions with confidence. If possible, consider a nursery onsite. Cognitive and physical impairments may make day-long treatment services demanding for some individuals. The increased integration between physical and behavioral health care allows for new levels of cooperation in documenting and sharing information. Encourage use of the raise hand feature if available on the platform. Key definitions related to partial hospitalization and intensive outpatient programming will be presented. 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. . 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