and the progress described in measurable, behavioral, and functional terms. Medicare reimburses for a given number of specific services per day. Coordinated (Integrated Care) services are provided to people who have complicated medical and/or behavioral health issues. For instance, one might track the percentage of patients with housing issues, joblessness, or secondary substance abuse with minimal effort. The EMR should also allow multiple staff members to work within a record at the same time so efficiency can be gained while clinicians complete record reviews and notes concurrently. 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. Of equal importance is the capacity of the EMR to allow tracking within the report writing function that enables program staff to access and consider data that is related to program function and performance improvement. 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. hospital, an acute freestanding psychiatric facility, or a psychiatric residential treatment facility). 7. While all levels of care in the continuum are important in providing a full recovery, these cuts have limited the availability of parts of the continuum in many communities. However, any licensing conflicts and decision related to resolving the conflict should be reviewed by the compliance and legal departments or an organization. Mothers should never be left alone with a baby if they are diagnosed with postpartum psychosis. Kiser, L., Lefkovitz, P., Kennedy, L., Knight, M., Moran, M., and Zimmer, C. The Continuum of Behavioral Healthcare Services. Portsmouth, Virginia. Treatment can be 3-5 days a week for a few hours each time. The organization recognizes that many local factors can contribute to the detailed implementation of these standards and guidelines. Intermediate Behavioral Health is the term used to identify partial hospitalization and intensive outpatient programs which distinguishes them from inpatient and outpatient services as part of the behavioral health continuum required for the implementation of parity legislation. Standards and Guidelines for Partial Hospitalization Programs. Portsmouth, Virginia. More often the full array of services (when available) is delivered by a variety of organizations and individual providers within a given community. For a Free Consultation, call: 855-808-4213 . Miller, T.,Mol, J.M. 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. Therefore, it is important to collect a thorough substance abuse history. Service Planning An external audit should not be the impetus for utilization reviews. 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. Robakis, T. & Williams, K. Biologically based treatment approaches to the patient with resistant perinatal depression. When using comparisons to review programs, administrators should not penalize individual programs that have developed a plan to improve the program. These four clinical profiles reflect individual scenarios that are appropriate for acute partial hospitalization program services. An example of this type of individual is a young mother with anxiety and depression who is unable to work and care for young children following separation from her significant other and needs rapid improvement to resume responsibilities; Some individuals experiencing behavioral health symptoms or dysfunction due to a chronic mental illness that severely and persistently impairs their capacity to function adequately on a day-to-day basis, despite efforts to achieve these goals through treatment in a less intensive level of care. Payment will not be made for compensable peer support All other documentation standards for a clinical record remain the same for telehealth and in-person/on-site participants. Documentation of identified issues that will be addressed by others outside of program should be included as part of the assessment. Watch Video. American Association for Partial Hospitalization, 1996. The individual is not judged to be in imminent danger of withdrawal or has recently undergone medical detoxification. Progress toward or away from goals is to be addressed throughout the clinical record. Individuals requiring care at this level may have insufficient resources or access to critical supports systems including family and community. The integration of physical/behavioral treatment can influence both types of programs by increasing the expectation that the whole health of the individual be considered throughout the assessment and treatment process. Family sessions are designed to assist members in their understanding of the identified clients condition and increase coping skills and group behaviors that can assist the clients recovery. Archived Program Rules - Chapter 320 - Early and Periodic Screening, Diagnosis and Treatment. Inthesecases, a program might find that different guidelines are in conflict. CMS reviews claims and provides an opportunity to recommend changes to the PHP and IOP guidelines annually. Treatment Guidelines Care Based Guidelines 1. Groups that are structured to be repetitive, slower, and engage patients at multiple sensory levels are very important and can reduce the impact of physical and cognitive limitations on treatment. Archives of Womens Mental Health 20. The value of these programs in clarifying diagnoses, assessing function, and determining ones capacity for independence or personal safety cannot be underestimated. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services (January 2003). Partial Hospital Programs provide no less than 4 hours of direct, . Again, consider having another staff member, such as a behavioral health tech, present to handle these technical issues to reduce the impact on the group process. When ambiguity or conflict between scope of work and facility licensingexists, the facility licensing usually takes precedence. Program Criteria. Call Now to Begin the Recovery Process Today. 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). With recent changes to regulatory requirements in onsite visits, this document provides guidance in preparation for regulatory reviews. Accessibility of an individuals data within the EMR is impacted by privacy and regulatory statutes and must be reflected in the EMR. 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 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. Bill Type 12X (Hospital-Inpatient), 14X (Hospital-Other) is billed with Condition Code 41 (Partial Hospitalization). Follow-up treatment professionals should also have access to discharge information. 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. Ideally, the individual is or can be connected with a community-based support network and is able to function in their home environment. Utilizing a Motivational Interviewing approach to assessment (as well as ongoing treatment) with individuals with chemical dependencyis considered to bea best practice.8. Discharge summaries should be completed within a reasonable amount of time after discharge and reflect the protocol of applicable regulatory bodies or organizational standards. PHPs and IOPs may be free-standing programs, part of a distinct behavioral health organization, or a department within a general medical health care system. There arethreeaccreditation organizations used by behavioral health facilities: A key player in detailing programming and documentation will be the organizations that pay for services. Each accreditation organization will have protocol manuals that detail what they expect to see when they conduct onsite reviews. Individuals in treatment include both those who participate voluntarily, as well as those mandated by the legal system. A comprehensive program improvement plan should include an internal review process to assess the appropriate use of program services. 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. A separate progress note is required for each service delivered, whether billable or not. Kiser, L., Lefkovitz, P., Kennedy, L. and Knight, M. The Continuum of Ambulatory Mental Health Services. Alexandria, Virginia. Daily monitoring of medications, safety, symptoms, and functional level is deemed medically necessary. 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. Gather information from other sources (family, hospital records, and urine screens) in addition to the client. 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. Programs tend to fall into two basic categories that impact programming: These distinctions are important since they may dictate the process, content, and structure of group therapy and psycho-educational sessions. These services may be present in a single organization such as a large community mental health center, a general hospital with comprehensive mental health services, or a free-standing provider location. 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 Performance improvement goals are best when they apply to real program needs even if comparison data is not available. One focuses on the administration and operational functions of the program while the other focuses on the clinical aspects of programming and milieu. Children's Partial: 9. 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. 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. Examples of these symptoms may include negative self-talk, crying spells, severe anxiety, poor sleep, or panic attacks. Portsmouth, Virginia: Association for Ambulatory Behavioral Healthcare, 2007. 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. The need for 24-hour containment has been determined to be unnecessary. As a person moves through the continuum of care, the coordinated care services usually increase or decrease as reflected in the level of care that person is receiving. 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. The interactive telecommunication technology included audio and video. Retrieved July 20, 2018, from https://www.asam.org/docs/publications/asam_ppc_oversight_may_2011. To manage medical and behavioral emergencies, policies should be developed to expedite admission for inpatient care if required and allow for timely pharmacological intervention. Within each discipline a licensed professional will have outlined what services they can provide. All treatment planning activity must continue. As providers have found it helpful to provide specialized programming for sub-populations dealing with similar behavioral health challenges, these guidelines outline unique factors related to some of those specialty populations, including: Necessary elements for documenting services provided include a discussion about electronic medical records. All measurements tools must continue. l) Services provided to more than one beneficiary at a time, unless specifically allowed in the service definition. Staff training regarding appropriate language and terminology in documentation should be standard component of staff training on an annual basis. Additional benefits should include enhanced tracking and report writing functions that improves decision-making through the collection of timely, accurate information. Typically, individuals 18 years of age and younger are served. Sometimes specific levels of care or programs are not available in certain markets. Partial hospitalization is active treatment that incorporates an individualized treatment plan which describes a coordination of services wrapped around the particular needs of the patient and includes a multidisciplinary team approach to patient care under the direction of a physician. The individual may experience symptoms that produce significant personal distress and impairment in some aspects of overall functioning. The services and support provided by the ancillary staff and volunteers is not often reimbursable in fee for service models. Subspecialty groups focus on the specifics of given targeted populations such as trauma, substance use, eating disorders, OCD, or cardiac/depressive conditions. Partial Hospitalization is a highly structured psychiatric treatment program which, in the case of substance abuse prevention, also offers some medical oversight. Behavioral Health refers to the healthcare field concerned with mental health and substance use disorders and treatment. 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. Association for Ambulatory Behavioral Healthcare, 1999. 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. This would also include ongoing communication between program staff and apersonsresidential program coordinator or community care manager while that personis in treatment. Psycho-educational services represent another basic building block of PHP/IOP treatment. In some cases, local and regional expectations and standards regarding documentation requirements may vary and programs are reminded that documentation requirements may need to change based on different state requirements.. The inclusion of two patient identifiers is helpful and often required on each document, such as a patient name and medical record number. Provision of this method of service is appropriate when the persons served may be exposed to severe illness or attending in-person treatment may be impractical (e.g., transportation, distance, commute time, or no local expertise available to treat the impairment). These are often reviewed during site visits, but internal processes need to be in place to review health and safety processes regularly. The development of clinical pathways or treatment protocols offers the potential for systemic solutions to these issues. Consults, evaluation summaries, absentee notes, results of collateral contacts, treatment team notes, and progress summaries may also be included. AABH maintains a table of clinical outcome measures that have been used in PHPs and IOPs and can be accessed HERE for members. Treatment should include collaboration with school, involved community agencies and established providers. Oregon Administrative Rules. These Standards and Guidelines are presented from the perspective of the AABH national provider network. PHPs and IOPs can be distinguished by their primary program function or treatment objective. 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. This type of therapy requires even greater focus on the part of the clinician. Alexandria, Virginia. 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