standards and guidelines for partial hospitalization programs
This certification needs to be always current. These meetings are critical to achieve continuity of client care, address the identified needs of the therapeutic community, assure appropriate utilization of services, and maintain necessary operational efficiencies. We encourage the use of alternative modes of treatment delivery, such as telehealth, when newmodesare demonstrated to contribute to quality services. Substance Abuse and Mental Health Services Administration News Release. 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. Standards and Guidelines for Partial Hospitalization Programs. The staff to client ratio is the most critical benchmark driving the cost and effectiveness of programs. Clinicians should self-check frequently. The development of clinical pathways or treatment protocols offers the potential for systemic solutions to these issues. Retrieved July 20, 2018, from https://www.asam.org/docs/publications/asam_ppc_oversight_may_2011. 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. Programs serving pregnant women or new mothers typically care for women with some type of Perinatal Mood and Anxiety Disorders (PMAD). A certain measure of relapse is to be expected and treatment remains appropriate to client needs after clinical review. Partial Hospitalization Programs (PHPs) are more intensive programs for patients who might otherwise require inpatient psychiatric care. Considerable ongoing communication exists regarding the interface between residential non-hospital treatment facilities and PHPs and IOPs. A. When developing program schedule, consider your population and how you will structure school (i.e. Acute Symptom Reduction - This intensive PHP function focuses on the provision of sustained, goal-directed, clinical services to reduce the persons acute symptoms and severe functional impairments as an exacerbation of a more chronic condition. 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. 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. If possible, consider a nursery onsite. Standards and Guidelines for Level II Services: Intensive Outpatient. If suicide risk is present in the participant, take action immediately, including staying online with them until help and safety has been secured. Improvement in symptoms and functioning to allow the child/adolescent to return to a school setting. In this case, communication within the team is essential. Linkages related to successful treatment will be considered. Priorities are to monitor progress, review treatment planning, coordinate therapeutic team efforts, and facilitate discharge planning. 104 CMR 27. Benchmarking, whether internal or compared to peers, provides an overview of how elements of a program are performing. 104 CMR 30. We meet five days a week from 9 a.m. to 3 p.m. Occupational, recreational, and creative arts therapists broaden and deepen the array of available services when offered. Key definitions related to partial hospitalization and intensive outpatient programming will be presented. Therapists are challenged within each type program to adapt techniques, goals, expectations, and member autonomy to achieve clinical success. A member of the clinical staff serves in a primary therapist/case management capacity to coordinate an individual's treatment within the program. Dads can also struggle with paternal depression and the mental health of the whole family is key to successful outcomes. Primary care services are generally delivered during a regular office visit. 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. Initial discharge criteria are formulated upon admission and are based on objective data such as achievement of a certain percentage of ideal body weight or targeted weight gain, or weight loss (if binge eating) as well as ability to function with less structure daily. These disorders are characterized by significant changes to mood during pregnancy and up to 3 years postpartum. Accessibility of an individuals data within the EMR is impacted by privacy and regulatory statutes and must be reflected in the EMR. The assessment tools in the record must include all relevant information and have the capacity to go beyond documentation of the presence or absence of specific criteria through checklists or drop-down boxes. Improvement in functioning and communication within the family system and/or home environment. 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. 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 ). Example metrics include, but are not limited to: Consumer feedback is essential in a comprehensive quality improvement plan. Treatment can be 3-5 days a week for a few hours each time. A built-in method of updating treatment plans and clinical information (using a read and accept format) without deleting everything prior to completing an intake is also a useful time-saver and increases accuracy. Eating disorder partial programs provide staff- supervised meal and snack groups, regular monitoring of weight and vital signs, and a variety of groups aimed at addressing symptom management and augmenting patients coping skills and strategies (as they relate to both the eating disorder and other behavioral health co-morbidities). Mol, J.M. Because these services are often expected as part of the contracts or regulatory reviews, it is necessary to better understand when participation in both services is appropriate and when one or the other should be the sole behavioral health provider. These individuals are typically found among those admitted for a first episode of care patients often referred from primary care or emergency departments. Fourth Edition. Many payers include these standards in their outpatient operations protocols and might be referenced as recurring outpatient services. Comparing benchmark measures to those of peers offers a greater integration of performance within the industry and particular to these levels of care. residential programs. 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 Staff training regarding appropriate language and terminology in documentation should be standard component of staff training on an annual basis. This condition may be exacerbated by age or secondary physical conditions. The overall performance improvement plan must be meaningful to actual program practitioners and include consumer feedback whenever possible. The defining characteristic of this function is the fact that PHP services are provided in lieu of inpatient hospitalization.. Institute of Medicine of the National Academies. PHPs and IOPs can be distinguished by their primary program function or treatment objective. However, the individual often presents with an impaired willingness or capacity to positively connect with caretaker, family, friends, or community supports. the program. For instance, one might track the percentage of patients with housing issues, joblessness, or secondary substance abuse with minimal effort. Yalom, Irvin D. Inpatient group psychotherapy. Along with the advent of the medical care home, the number of mental health professionals providing screening, consultation, limited counseling, and other behavioral health services on site in primary care settings has been growing rapidly in recent years. . Standards and Guidelines for Partial Hospitalization Geriatric Programs. II. 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]. 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. Block, B. M., Arney, K., Campbell, D.J., Lefkovitz, P.M., Speer, S.K., and Kiser, L.J. 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 must be a separate, identifiable, organized program . Confidentiality guidelines pertaining to individuals in chemical dependency treatment tend to be more restrictive than for those individuals in mental health treatment. This variation may offer unique program performance improvement options. 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. 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. 343-351, 2013. Additionally, liaison with outpatient services of less intensity is necessary in order to facilitate admissions and continuity of care, as well as to arrange for adequate continued treatment when partial hospitalization services are no longer necessary. Treatment must be rendered under the supervision of a psychiatrist or medical professional licensed to diagnose behavioral health issues. and Barry, A.D. Standards and Guidelines for Partial Hospitalization and Intensive Outpatient Co-occurring Disorders Programs. However, measures for physician involvement should be a part of all performance plans. Resources from Post-Partum Support Internation may be helpful in finding additional support for spouses. Sixth Edition. 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. If medications are dispensed on-site, appropriate staff must document medications that are administered on site. This final consideration is increasingly important in the world of accountable care. Medical personnel address ongoing medical and physical health issues and assess and manage medication therapies. The program leader is responsible for the overall clinical and administrative operations of the program, including supervision and competency determination of the clinical staff, clinical documentation, program development, and performance improvement. Individuals with co-occurring disorders tend to relapse frequently, placing them at greater jeopardy of a marginalized social existence. In either case, the individual is unable to benefit from medication management or traditional outpatient therapy alone. Third Edition. 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. Payers may require different processes or timelines. Each accreditation organization will have protocol manuals that detail what they expect to see when they conduct onsite reviews. 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. Linkages are also important. Once decisions regarding confidentiality are made, the nature of the handoffs between components within the continuum is equally important. By providing an intensive level of care that spans the gap between traditional inpatient and outpatient levels of care, Child and Adolescent Partial Programs are an important part of the continuum of behavioral healthcare. https://www.jointcommission.org/accreditation/behavioral_health_care.aspx. A description of the essential treatment services such as group, occupational, and psycho-educational therapies will be provided. Kiser, L., Lefkovitz, P., Kennedy, L., Knight, M., Moran, M., and Zimmer, C. The Continuum of Behavioral Healthcare Services. Portsmouth, Virginia. 2013) 10, 2013. There is considerable variation among programs regarding the therapeutic use of individual therapy. Both are designed to serve individuals with serious symptoms and functional impairments resulting from behavioral health disorders. Each State should have an office that manages Medicaid. PHP treatment programs closely resemble a highly structured but short-term hospital inpatient program. The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Partial Hospitalization Programs L37633. Co-occurring treatment providers must be well versed in the diagnosis and treatment of concurrent mental health and substance use disorders. Programming after school hours). While none of these focuses are mutually exclusive, a program tends to build their program from one of these perspectives. 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. Medicare regulations solidified the role of group therapy in PHP treatment when it was defined as one of the essential service units required each day. in a partial hospitalization program (PHP), intensive outpatient program (IOP) or residential program. Greet each person individually in the group if providing a group service. it may or may not be built upon and updated between programs within a continuum. Treatment planning for the individuals with co-occurring disorders incorporates knowledge of both the mental health and substance use components of the illness. We must maintain it. 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. Adult Day Health Care. Partial hospitalization services must be vigorous and proactive as opposed to passive and custodial. The treatment mission of PHP and IOP services is to develop a setting that provides the tools for recovery. 10, 05-07-04) A3-3194, HO-230.7 Partial hospitalization programs (PHPs) are structured to provide intensive psychiatric care through active treatment that utilizes a combination of the clinically recognized items and services described in 1861(ff) of the Social Security Act (the Act). These services engage individuals in a non-talk therapy mode and can result in behavior clarity, new insights, and meaningful options for emotional expression and life balance. Programs are encouraged to be ready for medical emergencies related to substance abuse such as narcotic withdrawalcrises 9 some programs keep medications onsite for emergency use and have staff competent inadmistration. 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. They are designed to identify best practices within programs. Programs may also bolster their treatment staff with paraprofessionals, non-degreed individuals, students, and interns. They should provide face-to-face services with each client upon admission for an evaluation and thereafter as clinically indicated. Each program is challenged to provide effective care within increasing time constraints and with limited resources. Medicaid is a federal health insurance benefit that is managed at the State level. Archives of Womens Mental Health 20. The disorders are also commonly called Postpartum depression, perinatal mood disorders, or PMD. Archived Program Rules - Chapter 320 - Early and Periodic Screening, Diagnosis and Treatment. Programs for chemically dependent individuals are designed to serve those within a less restrictive environment (for example, less restrictive than inpatient or residential) which allows the individual to practice new recovery and coping skills within his/her natural environment and to assess the individual strengths and weaknesses associated with those recovery and coping skills. There are three principal forms of linkage: FIRST, internal linkages between programs, departments, or practitioners within the same organization. In some cases, a summary of daily notes is optional, but do not serve to replace individual notes. Partial hospitalization is a short-term, intensive treatment (four to six weeks, fewer than 24 hours per day) for adults and children individuals not effectively served in community-based or intensive outpatient programs due to substance use, mental health co-occurring disorders. Persons meeting Severe and Extreme level of severity should be treated within a Partial Hospital Psychiatric level of care setting, as long as the patient is medically stable. CNA (Certified Nurse Aide) Registry. and provide safety through clinical guidelines, standards, and best practices. Outcomes management processes should examine the impact of the program on the clinical status of the individuals served. 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. 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. 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. 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. 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. 1 TRICARE POLICY MANUAL 6010.54-M, AUGUST 1, 2002 PROVIDERS CHAPTER 11 SECTION 2.5 PSYCHIATRIC PARTIAL HOSPITALIZATION PROGRAM CERTIFICATION STANDARDS ISSUE DATE: July 14, 1993 AUTHORITY: 32 CFR 199.6(b)(4)(xii) I. Daily monitoring of medications, safety, symptoms, and functional level is deemed medically necessary. Limited case management and group therapy or psycho-educational services may be included in this setting along with individual therapy and medication management. 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