standards and guidelines for partial hospitalization programs

Ideally coordination services are managed by the same person/entity regardless of treatment level or location for that person. 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. 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. Accessibility of an individuals data within the EMR is impacted by privacy and regulatory statutes and must be reflected in the EMR. As an example, an outpatient staff psychiatrist may need to coordinate a referral with the program staff to avert a hospitalization in the same organization. 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. This edition also included the launch of the Standards and Guidelines as a living document for association members. While these tools are helpful in guiding the treatment process, they do not qualify as clinical outcome measures until they have been validated. That edition included a discussion of the impact of electronic medical record, a focus on the recovery movement, and guidelines for eating disorder programs among other additions.24 The update in 2015 updated relevant information about PHPs and specialty group guidelines.25. 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. residential programs. Your compliance officer is usually the best person to advise on any licensing requirements at the State level. Oregon Administrative Rules. The provision of services allowed for each discipline is dictated by the scopes of work for a licensee in their particular State. The plan should conform to guidelines set forth by accrediting bodies and regulatory agencies of local, state and federal government. 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. Improvement in symptoms and functioning as evidenced by outcomes measurement tools that are evidence based for children and adolescents. They may be part of educational or residential facilities. Sometimes specific levels of care or programs are not available in certain markets. 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. Each program should have an identified medical director. All treatment planning activity must continue. The American Society of Addiction Medicines (ASAM) Patient Placement Criteria (ASAM PPC-2R) (previously mentioned) is considered a best practice for assessing and determining level of care placement for individuals with substance use disorders.6, Psychoactive substance history & detoxification status, Emotional/behavioral/cognitive functioning. 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. Service utilization during each acute episode of care will become the focus of overall continuum management. Policy needs to dictate the availability of a psychiatrist (or other physician) for consultation to non-physician providers, face-to-face with individuals in treatment during program hours, and by telephone off hours to provide direction in the care for all enrolled clients 24 hours a day, seven days a week. Portsmouth, Virginia. Re-certifications are required by many payers within strict time guidelines. 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. The multidisciplinary team is central to the philosophy of staffing within a partial hospitalization or intensive outpatient setting. Association for Ambulatory Behavioral Healthcare, 1996. In addition to licensing requirements for your facility, your program staff may have requirements related to the Scope of Work for their license. 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. Please talk to your provider about whether this may be a good care option for you. 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. Standards and Guidelines for Partial Hospitalization 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. Treatment modalities and techniques must be developmentally appropriate, and evidence-based for children and adolescents. Outcomes management processes should examine the impact of the program on the clinical status of the individuals served. These should be conducted regularly throughout the treatment process to assess the impact of services at different stages of treatment. The organization recognizes that many local factors can contribute to the detailed implementation of these standards and guidelines. Individuals may benefit from the IOP level of care if they: The individual may also exhibit specific deficits that are addressed in the intensive outpatient program, such as: Determining the appropriate level of care is the responsibility of the medical director or other admitting physician(s) for the program. Children and youth partial hospitalization program A program licensed by the Department, Office of Mental Health and Substance Abuse Services, to provide partial hospitalization services to individuals under 15 years of age. 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. This program requires patients to attend treatment for even less time than the PHP option. The specialty group guidelines have been streamlined to focus just on the elements that need to be addressed with the specific population. Programs can usually expect to conduct program improvement planning following a review to address the issues discovered and highlighted as needing improvement. Table 1 Levels of Care (Behavioral Health), Solo practices, Medical clinics, Medical care home, IOP, Psych rehab, Club House, Assertive Community Treatment. Programs should include space and opportunity for social interactions between peers while not engaged in formal therapeutic services. 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. Linkages are also important. 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. 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. Menses have usually ceased if body mass is extremely low or high. Specialty programs focus on a given age or diagnostic group. The eighth edition addresses the changing environment of care resulting from the COVID pandemic and includes guidelines for alternative service delivery such as telehealth. While the use of an EMR is required for hospital systems and most community providers are adopting them, the challenge of product selection can be significant. We must continue to respect the role of PHP and IOP within the behavioral healthcare continuum. 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. Residential services are provided to individuals who require greater support, monitoring, and intensity of services than can be offered in acute ambulatory settings. Primary care services are generally delivered during a regular office visit. When using comparisons to review programs, administrators should not penalize individual programs that have developed a plan to improve the program. 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. 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. Priorities are to monitor progress, review treatment planning, coordinate therapeutic team efforts, and facilitate discharge planning. Consider that each participant has differing levels of technical abilities or. If a PHP offers four groups per day on five days a week, tele-health needs to offer four groups per day on five days a week; If an IOP offers three groups per day on three days a week, tele-health needs to offer three groups per day on three days a week. 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. The record must document that specific treatment is ordered and supervised by an attending psychiatrist. For instance, one might track the percentage of patients with housing issues, joblessness, or secondary substance abuse with minimal effort. The Standards and Guidelines will be updated as new reviews are completed in any of the areas addressed. Medical Assistance (where applicable) reimburses for hours of service in a given day, payment is on a per session basis for most insurance companies or specific individualized service for Medicare or Medical Assistance, Severity of dysfunction or behavioral symptoms, criteria for admission require more acute individual dysfunction, severity of symptoms, and potential for risk of harm to self or others, criteria for admission require moderate individual dysfunction, severity of symptoms, and potential for risk of harm to self or others, Hours and variety of intensive services per week, services offered at least 5 days per week with an average of 6 hours of treatment per day, people usually attend between 6 and 12 hours of treatment per week, specific State, Joint Commission, and other regulations, regulations are generally included within outpatient regulations, except for Medicare, staffing requirements are more specific regarding staff-client ratio with most clinical staff ratios are less than 1:12, Less regulation regarding size of caseload but caseloads tend to be larger than PHP, tend to provide more sessions over a longer period of time, Intensity of physician and supervisory oversight, require a higher demand of physician oversight that often includes coverage and/or supervision for all hours when clients are present. This means the guidelines for PHP and IOP will vary from State to State. With increased attention population health, providers will be increasingly incentivized to use the most efficient treatment options available to contain costs and achieve positive clinical outcomes. Family work is crucial and should be a part of every clients treatment plan. Kiser, J.L., Trachta, A.M., Bragman, J.I., Curley-Spadaro, K., Cooke, J.D., Ramsland, S.E., and Fitzhugh, K.E. Final determination of changes is usually published in November of each year. Facilities that provide treatment for both behavioral health conditions are not formally designated as a single treatment program in most areas. Partial Hospitalization Program Policy Number: SC14P0034A3 Effective Date: May 1, 2018 . We meet five days a week from 9 a.m. to 3 p.m. Treatment should include collaboration with school, involved community agencies and established providers. They provide therapy and education in an intensive group environment that cannot be provided through either an outpatient individual therapy model or a crisis-oriented inpatient unit. The (Traditional) Outpatient level of care provides for treatment of conditions related to mild to moderate impairment. Examples of symptoms include high anxiety, sadness, depression, mood swings, elevated mood, irritability, intrusive thoughts, and more. The presence of significant denial or unwillingness to address change may often be inevitable due to the acute circumstances surrounding an admission especially from an emergency department or crisis worker. Intensive outpatient services have been developed to meet specific clinical needs when the individual is not determined to require the intensive daily services of partial hospitalization or is unable physically to meet the attendance requirements of such programs or when less frequent monitoring in inappropriate. This section contains specific considerations when developing a program for a population identified in the list. 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. Clinicians should wear an organization identification badge and it must be visible to all participants in the session. Many of these scopes will include the specifics of topic areas that a discipline may be limited to in provision of services to a group or individual. 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. Positive psychology focused topics address strength building themes in groups that maximizes individual potential. Example metrics include, but are not limited to: Staff are not only the largest cost to programs, but also have the biggest impact on programming and quality in a program. These standards include guidelines and consensus statements produced by professional specialty . Scheifler, P.L. A certain measure of relapse is to be expected and treatment remains appropriate to client needs after clinical review. PHPs are distinct organizational entities with specifically designated standards and regulatory reviews. 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. Each State should have an office that manages Medicaid. Respect that some participants are comfortable using telehealth services and some are Make every effort to meet the needs of all participants. Association for Ambulatory Behavioral Healthcare, 2015. However, measures for physician involvement should be a part of all performance plans. Whenever possible, programs should compare their results and findings through benchmarking with similar facilities. When ambiguity or conflict between scope of work and facility licensingexists, the facility licensing usually takes precedence. 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. 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. The primary goals of intensive outpatient programs are to monitor and maintain stability, decrease moderate symptomatology, increase functioning, and foster recovery. We must honor the role of peer support and counseling within the behavioral health continuum. At times, a full participation during the first week may be impossible upon admission due to unavoidable personal responsibilities. Co-occurring treatment providers must be well versed in the diagnosis and treatment of concurrent mental health and substance use disorders. A partial hospitalization program (PHP) is a structured mental health program and type of addiction treatment where clients participate in activities during the day and return home at night. 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. Initial Evaluation/Certification Medical records must be maintained in accordance with the current requirements of the applicable licensing and/or accrediting bodies, and the laws of the state within which the program resides. A wide range of referral options is essential to ensure that those persons in treatment are able to access a wide range of additional services. To assist in establishing a sense of program identity and community, the schedule should have a flexible yet coordinated array of therapeutic services indicating the days and times that specific services are scheduled. The development of a treatment plan, discussion of barriers to engagement, and intimate emotional issues are examples of the kinds of topics often reserved for individual time. Medicare Advantage Plans are not obligated to cover these levels of care. Provide at least 4 days, but not more than 5 out of 7 calendar days, of partial hospitalization program services Ensure a minimum of 20 service components and a minimum of 20 hours in a 7 calendar-day period Provide a minimum of 5 to 6 hours of services per day for an adult aged 18 years or older This recommendation is especially relevant to specialty programs. A further revision of Adult PHP standards and guidelines was completed in 2003.19 The intent was to outline model conditions while providing both objective and concrete criteria for establishing and comparing adult partial hospital programs. Neuhaus, E. Fixed Values and a Flexible Partial Hospital Program Model. Harvard Review of Psychiatry, Jan-Feb; 14(1):1-14, 2006. Goals must be clearly worded and achievable within the timeframe of the individuals involvement in program. This array of metrics provides a given program with potential access, treatment, and staffing goals. 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. 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 best way to find out about Medicaid guidelines is the first contact the State office responsible for guidelines and ask for guidance. Number of hours of structured treatment provided per day, Individual assessment/therapy/intervention time needed, Management of potential for self-harm or other emergencies, Need for specialized nursing or case management services. They tend to have limited insight into their illness accompanied by somewhat dysfunctional lifestyles and serious symptoms that have impacted their lives negatively in multiple ways. Partial Hospitalization is a highly structured psychiatric treatment program which, in the case of substance abuse prevention, also offers some medical oversight. Our mission is to promote Partial Hospitalization and Intensive Outpatient Programs as a vital component of the Behavioral Healthcare Continuum. 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 treatment programs closely resemble a highly structured but short-term hospital inpatient program. 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). Co-Occurring Disorders: Integrated Dual Disorders Treatment Implementation Resource Kit. 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