Services may include group, individual, couples, family therapy and medication management for symptom management. This recommendation is especially relevant to specialty programs. Although an individual may have several pressing needs, those that are of so severe they require the intensity of services of an intermediate level of care should be the top priority of treatment. Performance improvement goals are best when they apply to real program needs even if comparison data is not available. Include programs such as Depressed Anonymous, Emotions Anonymous, and the National Alliance on Mental Illness (NAMI). Association for Ambulatory Behavioral Healthcare, 1998. Accreditation organizations are responsible for providing guidance to programs primarily on health and safety protocols for facilities. This certification needs to be always current. 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. More often the full array of services (when available) is delivered by a variety of organizations and individual providers within a given community. 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. Programs should monitor regular program related performance outcomes that focus on the overall health of the program. There is significant variation among states and within treatment continuums regarding the expectations and clinical resources and services provided by residential facilities. 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. Efforts to achieve best practices require analyses of critical data points, clinical outcomes, and treatment processes. In partial hospitalization, the patient continues to reside at home, but commutes to a treatment center up to seven days a week. Any time a program negotiates a contract with a private payer, including Medicare Advantage plans, the program should request the guidelines for PHP and IOP. Examples may include childcare demands, appointments for services such as housing, or employment interviews. 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. 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. 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. The individuals progress or lack thereof toward identified goals is to be clearly documented in the record. Dads can also struggle with paternal depression and the mental health of the whole family is key to successful outcomes. Basic Books, 1983. Examples of symptoms include high anxiety, sadness, depression, mood swings, elevated mood, irritability, intrusive thoughts, and more. 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 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. Partial Hospitalization is a highly structured psychiatric treatment program which, in the case of substance abuse prevention, also offers some medical oversight. Considerable ongoing communication exists regarding the interface between residential non-hospital treatment facilities and PHPs and IOPs. With regard to treatment within one organizational continuum, programs should also maintain liaisons with specific providers including psychiatrists and other physicians, psychologists, social workers, psychiatric nurses, occupational therapists, case managers, rehabilitation practitioners, educators, and substance abuse counselors. Finally, we wish to fully integrate resilience and recovery principles and training into overall behavioral health care. 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. Resources from Post-Partum Support Internation may be helpful in finding additional support for spouses. This section contains specific considerations when developing a program for a population identified in the list. 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. With Behavioral Health Care, you can help support compliance with federal . Block, B. M., Arney, K., Campbell, D.J., Lefkovitz, P.M., Speer, S.K., and Kiser, L.J. 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. Table 1 Levels of Care (Behavioral Health), Solo practices, Medical clinics, Medical care home, IOP, Psych rehab, Club House, Assertive Community Treatment. Behavioral/Physical health Integration groups include a focus on both physical and behavioral issues such as with depression associated with cardiac care. Actual individual characteristics, monitors, and trends can be tracked through discrete clinical fields as well. Once decisions regarding confidentiality are made, the nature of the handoffs between components within the continuum is equally important. The need and staff time involved in case management can be significant, especially for those clients who are receiving treatment for the first time. 4-4-103, -5-4202, -5-4204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, . 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. Programs should include space and opportunity for social interactions between peers while not engaged in formal therapeutic services. Common problems related to symptoms, life situation, and skill deficits lead to group topics. Ongoing performance reviews may address attendance rates, dropout percentages, treatment trends, satisfaction, clinical handoffs, discharge status, post-discharge adjustment, or readmission rates. We encourage the use of alternative modes of treatment delivery, such as telehealth, when newmodesare demonstrated to contribute to quality services. August 23, 2017 - CMS revoked Medicare reimbursement changes to its medical billing requirements and process for partial hospitalization services, according to a recent Medicare Learning Network announcement. This role is usually filled with a person who has advanced training in psychiatry, most notably a psychiatrist. Medicare Advantage Plans are obligated to follow the Medicare protocols for all Medicare coveredpeoplein PHP and IOP, including reimbursement rates. The increased integration between physical and behavioral health care allows for new levels of cooperation in documenting and sharing information. 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. Organizational Structure and Citizen Participation. Improvement in functioning and communication within the family system and/or home environment. The identification and achievement of clearly targeted and mutually understood and agreed upon objectives is more likely to lead to recovery. Postpartum Psychosis is a true psychiatric emergency. 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. Treatment at this level of care is usually limited to 1-4 sessions per month but may be provided less frequently in accordance with the individuals needs. In either case, the individual is unable to benefit from medication management or traditional outpatient therapy alone. The medical record should be designed to enhance accuracy, minimize recording duplication, eliminate inappropriate abbreviations, and minimize patient compliance errors.. At admission, a summary of all medications including psychiatric medications, non-psychiatric medications, over the counter medications and supplements must be completed, reconciled, and reviewed. Each program is encouraged to identify other programs that are relevant to their individual target populations particularly if there are demographic or secondary diagnostic changes. (2) Prior authorization is required for LOC 2.5 (partial hospitalization) which requires a minimum of twenty hours of services per week. Monitored study time vs. Archives of Womens Mental Health 20. Evaluation for medication assisted treatment (MAT) services may also be indicated. Clinicians should self-check frequently. A comprehensive program improvement plan should include an internal review process to assess the appropriate use of program services. Limited case management and group therapy or psycho-educational services may be included in this setting along with individual therapy and medication management. Some payer contracts may also dictate the timing for recurring reviews. Additional certification, monitors, medications, or additional clinical data may be required due to internal organizational or regulatory requirements. Programs must also maintain strong linkages with emergency departments, inpatient psychiatric units, and chemical dependency programs in order to facilitate both admission and discharges. AABH provides these standards and guidelines as a broad representation of best practices in providing PHP and IOP without regard for local areas. If the State is not using a managed Medicaid system, the guidelines should be requested from the State office that manages Medicaid. Performance Improvement for older adult programs is essential and should be determined by the mission and specific needs of those who are being served. 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. Program Criteria. Consults, evaluation summaries, absentee notes, results of collateral contacts, treatment team notes, and progress summaries may also be included. 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. Neuhaus, E. Fixed Values and a Flexible Partial Hospital Program Model. Harvard Review of Psychiatry, Jan-Feb; 14(1):1-14, 2006. Whenever possible, programs should compare their results and findings through benchmarking with similar facilities. 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). According to the American Psychiatric Associations Eating Disorder Guideline 2006, clients who are appropriate for partial hospitalization need daily supervision and structure from meal to meal to gain or prevent purgative and binge eating behaviors. 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. The certification needs to identify why the client would require hospitalization in lieu of the appropriate level of care. Propose to Inthesecases, a program might find that different guidelines are in conflict. Treatment planning for the individuals with co-occurring disorders incorporates knowledge of both the mental health and substance use components of the illness. Client rights guidelines includes: Rights and Responsibilities, Compliant/Grievance process, confidentiality, access to emergency services if in crisis and must be signed . Second Edition. The best way to find out about Medicaid guidelines is the first contact the State office responsible for guidelines and ask for guidance. Some flexibility in programming should always be considered given individual circumstances, Is uninterested or unable due to their illness to engage in identifying goals for treatment and/or declines participation as mutually agreed upon in the treatment plan, Is imminently at risk of suicide or homicide and lacks sufficient impulse/behavioral control and/or minimum necessary social support to maintain safety that requires hospitalization, Has cognitive dysfunction that precludes integration of newly learned material, skill enhancement, or behavioral change, Has a condition such as social phobia, severe mania, anxiety, or paranoid states in which the individual may become more symptomatic in a predominantly group treatment setting, Has primarily social, custodial, recreational, or respite needs. We must continue to respect the role of PHP and IOP within the behavioral healthcare continuum. People need to feel hope, find purpose, and care for others. The negotiation of this variance is an important part of treatment. Alexandria, Virginia. Theory/evidence-based groups are derived from cognitive-behavioral, dialectical, or other evidenced perspectives. Some programs choose to identify guidelines for discharge based on a pre-determined number of relapses and/or other forms of treatment-interfering behaviors. Finding measures that will help improve staff efficiency and effectiveness are key to a quality improvement plan. l) Services provided to more than one beneficiary at a time, unless specifically allowed in the service definition. Each component of a comprehensive clinical record described above should be part of a quality electronic medical records. Robakis, T. & Williams, K. Biologically based treatment approaches to the patient with resistant perinatal depression. In other cases, an individual from a troubled or dysfunctional family may benefit as long as goals and interventions are designed to facilitate communication or reduce stress within the family unit, or even seek genuine supports outside of the identified family unit. Typically, individuals 18 years of age and younger are served. Individuals receiving PHP and IOP services vary in symptom intensity, clinical needs, and stages of readiness for change. These regulations should be the primary guiding protocols followed for any program. 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. Partial hospitalization programs may either be free standing or integrated with a broader mental health or medical program. Co-Occurring Disorders: Integrated Dual Disorders Treatment Implementation Resource Kit. Retrieved July 20, 2018, from http://www.mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/cooccurring/. 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. Partial Hospital Programs provide no less than 4 hours of direct, . Initial Evaluation/Certification 8.320.6 School-Based Services for MAP Eligible Recipients Under Twenty-One Years of Age 7/1/15 to 1/31/20. 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. When acceptable to given payers or state reviewers, a comprehensive user-friendly synopsis of a persons progress through treatment may be provided. 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. 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. for Health and Human Serv., Substance Abuse and Mental HealthServ.(Jan. AABH has an ongoing national benchmarking project that enables individual programs to record data on multiple indices and compares them with similar programs across the country. For example, in a program that serves individuals with substance use issues, some may need to be tracked on depression, while others may need to be tracked for anxiety. Recovery oriented service evaluations may also be helpful for programs. k) Service provided simultaneous with any other -covered service, unless Medicaid specifically allowed in the service definition. 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. Mothers should never be left alone with a baby if they are diagnosed with postpartum psychosis. For a Free Consultation, call: 855-808-4213 . Partial Hospitalization These programs are defined as structured and medically supervised day, evening and/or . There arethreeaccreditation organizations used by behavioral health facilities: A key player in detailing programming and documentation will be the organizations that pay for services. The downloadable version of the Standards and Guidelines reflects the most recent publication and may not accurately reflect the online version. Education regarding medications during treatment should also be documented. All shifts to telehealth need approval of senior leadership, Each area must balance the needs of individuals that want to attend in person and those that wish to use. Scheifler, P.L. The services and support provided by the ancillary staff and volunteers is not often reimbursable in fee for service models. A phased continuum of care that progresses from management of active symptoms and problems to establishing recovery/relapse prevention plans best. For health and safety protocols for all Medicare coveredpeoplein PHP and IOP the! This variance is an important part of a quality improvement plan should include space and opportunity for social interactions peers. 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