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 intent of this summary is to place PHPs and IOPs in the full context of available treatment services, arranged by relative level of intensity from traditional outpatient care to 24-hour inpatient treatment. Many programs also include consumer input groups as a formal part of programming that is led by peers. 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. Additional factors such as the presence of centralized intake, clinical complexity, medication challenges, family issues, insurance authorization procedures, and documentation needs, all impact staff-to-client ratio. Psychiatrically trained medical professionals, including Physician Assistants and Nurse Practitioners may also be members of the physician team if regulations apply for such. Hyde, Pamela S. "Report to congress on the nations substance abuse and mental health workforce issues." Each program should have a process in place to review EMR challenges that may interfere with the treatment process as well as the reimbursement 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. Each State should have an office that manages Medicaid. CNA (Certified Nurse Aide) Registry. Standards and Guidelines for Partial Hospitalization Programs. Health IT and Patient Safety: Building Safer Systems for Better Care. Washington, D.C., 2011. Programs may also bolster their treatment staff with paraprofessionals, non-degreed individuals, students, and interns. Our Partial Hospitalization Program (PHP) offers some of the same intensity and structure of Residential eating disorder treatment while providing additional opportunities to practice recovery outside of the controlled eating disorder treatment environment during evenings at home or in peer-supported apartment communities. Creative/Expressive therapies are also significantly employed in PHP/IOP clinical settings. As previously mentioned, individuals who have diagnoses for both mental health and substance use disorders of which only one is currently active, may be treated in a co-occurring (dual diagnosis) treatment setting, or in either an addictions or psychiatric treatment setting (depending upon which problem is currently active). and the progress described in measurable, behavioral, and functional terms. Block, B. and Lefkovitz, P. Standards and Guidelines for Partial Hospitalization, Alexandria, Virginia. State laws may apply. A. Medicare Advantage Plans are not obligated to cover these levels of care. The Standards and Guidelines will be updated as new reviews are completed in any of the areas addressed. PHP and IOP treatment allow persons served to stabilization more successfully while in their own community environment. 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 screenings also include risk for harm to self or others, pain, abuse, substance abuse, nutrition, vocational/financial need, legal concerns, housing, family issues, preferred learning style/methods, and any other ongoing unique individual concerns which may require consideration. Resources from Post-Partum Support Internation may be helpful in finding additional support for spouses. However, they should be a separate, identifiable unit and represent a continuum of therapeutic modalities that are evidence based for children and adolescents. A recovery model that focuses on increased quality of life is essential to give the older adult investment and purpose in treatment. Performance improvement goals are best when they apply to real program needs even if comparison data is not available. The final rules pertaining to the implementation of the parity legislation were presented in November of 2013. The primary therapist should be responsible for the quality reviews for their individual caseload and review their caseload regularly. Programs should include space and opportunity for social interactions between peers while not engaged in formal therapeutic services. PHPs are distinct organizational entities with specifically designated standards and regulatory reviews. Outcomes management processes should examine the impact of the program on the clinical status of the individuals served. A program willsometimesfind that it needs to create a program that meets the needs of the most restrictive protocols and design programming and billing to meet thosecriteria. Our mission is to promote Partial Hospitalization and Intensive Outpatient Programs as a vital component of the Behavioral Healthcare Continuum. To download the latest e-edition click here: 2021 Edition Standards and Guidelines. Types of diagnoses (e.g., psychotic, mood and anxiety disorders, personality disorders), Theoretical orientation (e.g., cognitive behavioral), Treatment objectives (e.g., stabilization, functional improvement, personality change), Treatment duration (i.e., length of stay), Treatment intensity (i.e., hours and days per week). Any additional laboratory testing, as determined by the organization and in accordance with the level of care provided. Sharing of the consumer feedback with internal program staff is essential and may often lead to the identification of performance improvement priorities and strategies which otherwise may have been unknown or overlooked. The change in symptoms requires the intensity and structure of PHP to avert further deterioration. 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. All sessions are to be conducted using video and audio wherever This allows clinicians to assess the participants using all their clinical skills. A comprehensive program improvement plan should include an internal review process to assess the appropriate use of program services. Even in specialty programs that serve a focused group of diagnostics, individuals may need to be tracked on different clinical measures. These should be conducted regularly throughout the treatment process to assess the impact of services at different stages of treatment. Level 2 programs provide essential addiction education and treatment components and have two gradations of intensity. Primary care services are generally delivered during a regular office visit. Many payers include these standards in their outpatient operations protocols and might be referenced as recurring outpatient services. All treatment planning activity must continue. 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. Kiser, J.L., Trachta, A.M., Bragman, J.I., Curley-Spadaro, K., Cooke, J.D., Ramsland, S.E., and Fitzhugh, K.E. 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. Each record section should conform to regulatory documentation requirements to assure that the notes meet billing requirements as well as clinical requirements. The record must be organized in a manner that makes it accessible to those treating the patient. Treatment Guidelines Care Based Guidelines 1. Examples include benchmarked metrics such as absenteeism, dropouts, and patient outcome data. Programs often have limited staff availability, so brief individual sessions may be the norm with more complex issues being reserved for follow-up outpatient treatment. Are usually community-based and free. Medicare Advantage Plans are obligated to follow the Medicare protocols for all Medicare coveredpeoplein PHP and IOP, including reimbursement rates. Some programs choose to identify guidelines for discharge based on a pre-determined number of relapses and/or other forms of treatment-interfering behaviors. A hospital is a licensed facility that offers services more intensive than those required for room, board, personal services and general nursing care, and offers facilities and beds for use beyond 24 hours by individuals requiring medical, surgical, psychiatric, testing, diagnosis, treatment, or care for illness, injury, deformity, infirmity, abnormality, disease, or pregnancy. Clinicians should self-check frequently. Many seniors live in isolation, so timely and appropriate aftercare is needed to ensure that gains made in the program remain. Abortion Facilities. Please talk to your provider about whether this may be a good care option for you. 343-351, 2013. All programs pursue the goals of stabilizing clinical conditions, reducing symptoms and impairments, averting or reducing inpatient hospitalization stays, and providing medically necessary treatment for individuals who cannot be effectively treated in a less intensive level of care. Additional certification, monitors, medications, or additional clinical data may be required due to internal organizational or regulatory requirements. Initially, the individual may only be able to agree to begin treatment and form a basic treatment plan, and may require close monitoring, support, and encouragement to achieve and sustain active and ongoing participation. Include programs such as Depressed Anonymous, Emotions Anonymous, and the National Alliance on Mental Illness (NAMI). 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. Some payer contracts may also dictate the timing for recurring reviews. The goal is to contribute to patient safety. The necessity of and rationale for continued stay must also be documented in the medical record including the revised treatment plan when needed. 2013) 10, 2013. Personalized Recovery Oriented Services (PROS) - A comprehensive recovery oriented program for individuals with severe and persistent mental illness. All measurements tools must continue. It is designed for patients with moderate to severe mental or emotional disorders. Organizational Structure and Citizen Participation. 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. This variation may offer unique program performance improvement options. This edition also included the launch of the Standards and Guidelines as a living document for association members. 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. 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. We honor and support programs that seek to integrate physical, substance use, and behavioral health treatment within single programs. Licensing and Operational Standards for Community Services. PHP treatment programs closely resemble a highly structured but short-term hospital inpatient program. These types of conflicts often require multiple discussions with payers and accreditation organizations and may result in the programsevering relations with one or moreof theorganizations. Discharge from IOP programs is made to individual outpatient behavioral health specialists, integrated physical/behavioral settings, or primary care. 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. The documentation of medical supervision and certificate of need must be completed upon entry to the program and updated periodically based on individual need, program policy, and payer expectations. By Jacqueline LaPointe. The downloadable version of the Standards and Guidelines reflects the most recent publication and may not accurately reflect the online version. The assessment and treatment plan should address improvement of social skills and functioning via the therapeutic milieu. Needs are identified based upon the findings of the comprehensive assessment and strategies are identified to address areas of concern. 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. 4-4-103, -5-4202, -5-4204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, . (Traditional) Outpatient care is typically site-based. While none of these focuses are mutually exclusive, a program tends to build their program from one of these perspectives. By peers substance abuse and mental health workforce issues. accurately reflect the online.. 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standards and guidelines for partial hospitalization programs