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 Standards & Guidelines - AABH Standards & Guidelines These Standards and Guidelines are presented from the perspective of the AABH national provider network. Access, treatment, and discharge data are key areas for tracking. Learn more: 12-step programs. Co-Occurring Disorders: Integrated Dual Disorders Treatment Implementation Resource Kit. Retrieved July 20, 2018, from http://www.mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/cooccurring/. Personalized Recovery Oriented Services (PROS) - A comprehensive recovery oriented program for individuals with severe and persistent mental illness. This section contains specific considerations when developing a program for a population identified in the list. Cognitive and physical impairments may make day-long treatment services demanding for some individuals. 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. One focuses on the administration and operational functions of the program while the other focuses on the clinical aspects of programming and milieu. The primary therapist should be responsible for the quality reviews for their individual caseload and review their caseload regularly. Gray, K., Michael, S., Lefkovitz, P., and Barry, A. Clinicians in the program should be well versed in perinatal mood and anxiety disorders. (a) Partial hospitalization services are services that - ( 1 ) Are reasonable and necessary for the diagnosis or active treatment of the individual's condition; ( 2 ) Are reasonably expected to improve or maintain the individual's condition and functional level and to prevent relapse or hospitalization; 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. 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. Typically, a PHP is an option for treatment after a person has been hospitalized due to substance abuse issues, and the person is deemed fit to be discharged from the hospital. There are also times during treatment when the rationale for non-attendance is legitimate and in the overall best interests of the indivduals welfare. American Association for Partial Hospitalization, 1982. It is recommended that programs use a formal method to collect consumer feedback through perception of care surveys and/or care satisfaction surveys. Outpatient care may be short or long-term depending on the needs of the person. Successful engagement in the clinical process and willingness to address issues at whatever stage of treatment, Capacity to gain insight and respond successfully to therapeutic interventions, Continued need for medication monitoring and intervention, Capacity to make progress in the development of coping skills to meet baseline functional needs, Need for support and guidance in handling a major life crisis, Continued need for managing risk accompanied by capacity to follow a safety plan, Commitment to developing and following through on a recovery-oriented discharge plan. The degree to which an individuals medications are managed and the extent to which they must be reconciled, tracked, or summarized may vary according to program mission, regulation, or defined clinical responsibility within the continuum. With the increased use of technology, programs have an opportunity to address needs of those they serve through methods other than in-person/on-site programming. Programs should include space and opportunity for social interactions between peers while not engaged in formal therapeutic services. 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. requirements applicable to your organization, check the "Standards Applicability Process" chapter in the Comprehensive Accreditation Manual for Behavioral Health Care (CAMBHC) or create your organization's unique profile of programs and services in our on-line standards manual, the E-dition. 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. AABH provides these standards and guidelines as a broad representation of best practices in providing PHP and IOP without regard for local areas. Key definitions related to partial hospitalization and intensive outpatient programming will be presented. The actual format and content in often determined by diagnostic profile, target group, or theoretical orientation. 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. Accessibility of an individuals data within the EMR is impacted by privacy and regulatory statutes and must be reflected in the EMR. Subspecialty groups focus on the specifics of given targeted populations such as trauma, substance use, eating disorders, OCD, or cardiac/depressive conditions. 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. Programs should consider brief family therapy and referrals for family members that need additional treatment. 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. achieve effectiveness and best practices in service delivery. In 2005, SAMHSA surveyed the population and determined that 21% or 5.2 million adults experienced both serious mental illness and co-occurring substance abuse problems.21 SAMHSA experts emphasized that the treatment outcome for consumers is enhanced when both illnesses are addressed simultaneously using an integrated approach. Consumers should also be informed as to where to direct additional feedback or complaints, such as quality management departments, local, state, and federal authorities, etc. Fiscal Administration. Education regarding medications during treatment should also be documented. 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 ). There is a medically determined reasonable expectation that the individual may improve or achieve stability through active treatment. residential programs. This assessment with screenings helps direct the diagnostic formulation of treatment and must clarify and prioritize client needs to be addressed in the program or elsewhere.. These are often times when a given individuals clear need (such as for new housing due to an imminent spousal separation) may not coincide with the individuals actual desire for an appropriate referral. The staff to client ratio is the most critical benchmark driving the cost and effectiveness of programs. 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. Regulatory agencies will often assess the use of outcome measures as a core part of a quality improvement plan for programming. The Standards and Guidelines will be updated as new reviews are completed in any of the areas addressed. The format for documentation of each individuals level of functioning, services needed and provided, response to treatment, and coordination of care can take varied forms but must be clearly delineated. historical data (including social, medical, legal, and occupational histories), a brief summary of each specific intervention including the type of intervention provided (e.g., group or individual therapy), the individuals response to the intervention. 8.320.2 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services 2/1/20 to 12/31/20. for Health and Human Serv., Substance Abuse and Mental HealthServ.(Jan. Examples of these symptoms may include negative self-talk, crying spells, severe anxiety, poor sleep, or panic attacks. Priorities are to monitor progress, review treatment planning, coordinate therapeutic team efforts, and facilitate discharge planning. Staff training regarding appropriate language and terminology in documentation should be standard component of staff training on an annual basis. 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. Each program should have an identified medical director. 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). The Level of Care Guidelines is derived from generally accepted standards of behavioral health practice. PHP and IOP treatment allow persons served to stabilization more successfully while in their own community environment. When ambiguity or conflict between scope of work and facility licensingexists, the facility licensing usually takes precedence. It is important to indicate the timing of data collection when the record includes updates on previously obtained material. Each State should have an office that manages Medicaid. Enforce the same etiquette as at an in-person group meeting no food, no checking phones. Commission on Accreditation of Rehabilitation Facilities (CARF). The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Partial Hospitalization Programs L37633. In some States, treatment planning may be supervised by a Physician Assistant or Nurse Practitioner with psychiatric licensing approved by the State. This condition may be exacerbated by age or secondary physical conditions. Study with Quizlet and memorize flashcards containing terms like Developed by the substance abuse client's treatment team, this document is used to identify the typeand frequency of services needed by the client. Case reviews should be scheduled on a regular basis. Programs must also maintain strong linkages with emergency departments, inpatient psychiatric units, and chemical dependency programs in order to facilitate both admission and discharges. The key elements of partial hospitalization and intensive outpatient programs have been combined as the core of the standards and guidelines. To manage medical and behavioral emergencies, policies should be developed to expedite admission for inpatient care if required and allow for timely pharmacological intervention. 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. Adult Residential Care Provider (ARCP) Ambulatory Surgical Center (ASC) Behavioral Health Services Provider. In general, the Centers for Medicare and Medicaid Services (CMS) sets the standard for payer requirements, and most payers start with the Medicare guidelines when developing their own requirements. The record must document that specific treatment is ordered and supervised by an attending psychiatrist. In some regions, the direction of CMS fiscal intermediaries led to a reduction in the use of occupational services due to increased documentation demands and conflicting continuation of care criteria. The EMR provides a unique opportunity to include other non-clinical pieces of treatment, such as linking to client education tools or treatment summaries that are easily accessed and printed off by patients when appropriate or necessary. If medically unstable, inpatient hospitalization is necessary, stepping down to a PHP level of care. 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. Residential services are provided to individuals who require greater support, monitoring, and intensity of services than can be offered in acute ambulatory settings. When possible, it is important that comparisons or benchmarks be used to enhance performance. All chemical dependency PHP and IOP programs must have clearly delineated procedures for addressing clients detoxification, withdrawal, and other medical needs. Evaluation for medication assisted treatment (MAT) services may also be indicated. Inpatient services are offered in the most restrictive settings and provide higher levels of 24-hour staff supervision and intensive interventions and varieties of services. CMS contracts with intermediaries to manage the requirements for PHP and IOP 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. However, these planscan require pre-authorizations for both PHP and IOP services, and re-authorizations to continue services beyond the initial authorizations. American Association for Partial Hospitalization standards and guidelines for partial hospitalization This article reflects the first major revision in the standards for adult partial hospitalization which were developed by the American Association for Partial Hospitalization and initially published in Volume 1, Number 1 of this journal. An individual must exhibit the first three following characteristics and may exhibit others listed below: PHPs and IOPs both employ integrated, comprehensive, and complementary evidence-based treatment approaches. Accreditation organizations are responsible for providing guidance to programs primarily on health and safety protocols for facilities. Programs serving pregnant women or new mothers typically care for women with some type of Perinatal Mood and Anxiety Disorders (PMAD). In general, a seamless flow between practitioners or facilities includes the sharing of clinical information, collaborative treatment planning, safety and recovery management, and discussion of potential financial or insurance related factors that may impact ona personsresponsibility for payment of services. 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. This document has been designed to enable programs to: Partial hospitalization programs (PHP) and intensive outpatient programs (IOP) may differ from one region to another due to multiple factors such as specialized workforce availability, culture, resources, or health insurance coverage inconsistencies. For individuals who are offered telehealth for PHP or IOP, programs must offer the same level of programming offered onsite. 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. The infusion of peer counselors is a dynamic that is also enhancing the experience for many individuals and should be encouraged by authorities and continuum leaders whenever possible. % of individuals within a diagnostic category, % of individuals with secondary substance abuse issues, % of individuals with first episode of care, Amount of time spent in specific functions, Insurance certification/communication time, Individual therapy time (based on program goals), Shifting functions from one type of staff to another, Increase or decrease the overall availability or amount of given services, Shift the % of a given service within a specific day, Increase in engagement with program participants, Client satisfaction with specific groups or program elements, Development of clinical pathways related to specific diagnostic groups, Increased follow-up with outpatient services following discharge, # of medication changes during episode of care, Specific disease monitoring such as Tuberculosis or Asthma, Provision of written medication education. Example metrics include, but are not limited to: Metrics related to the services that are offered during the course of treatment allow program staff to evaluate how service offerings can be adapted to meet the needs of the population served over time. It is the need for intensive, active treatment of the patient's condition to maintain a functional level and to prevent relapse for hospitalization. Postpartum Psychosis is a true psychiatric emergency. PHPs differ from IOPs in several ways: payment is on a per diem basis for most private insurances. Specific components of the milieu include the following: Group therapy is a key building block of PHP/IOP treatment. It is also important to address issues specifically faced by older adults such as grief and loss, changes in professional and personal roles, limitations of social support, impact of physical limitations on wellbeing, stigma related to aging, and death and dying. The individual may require significant skills to make changes which prevent further deterioration between sessions. Coordinated (Integrated Care) services are provided to people who have complicated medical and/or behavioral health issues. Consideration of teletherapy options is up and coming because of childcare needs and difficulties moms have leaving the home to get to appointments. The increased integration between physical and behavioral health care allows for new levels of cooperation in documenting and sharing information. Organized as a continuum, this system of care enables the movement of individuals to the most clinically appropriate and cost-effective level of care. 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. Older Adult programs are an important means of delivering behavioral health treatment to adults age 55 and older. Miller, T. Standards and Guidelines for Partial Hospitalization Programs. Scheifler, P.L. 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. Occupational therapy is also a dynamic component of many programs. Specialty programs focus on a given age or diagnostic group. The presence of comorbid physical illness must be addressed and often makes the frequency and duration of attendance more challenging. Programs can usually expect to conduct program improvement planning following a review to address the issues discovered and highlighted as needing improvement. Communication amongst programs regarding their results is strongly encouraged. Family work is crucial and should be a part of every clients treatment plan. 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. Therapists are challenged within each type program to adapt techniques, goals, expectations, and member autonomy to achieve clinical success. 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. Partial Hospitalization Programs (PHP) - Partial hospital implies a daily psychosocial milieu treatment of generally four or more hours duration a day with group therapy, psycho-educational training, and other types of appropriate therapy as the primary treatment modalities. Clinically, the intermediately level of care option may provide the best fit due to quick access, resource concentration, a recovery focus, and built-in peer support. The seventh edition (2018) guidelines provided a significant change in the guidelines. 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. 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. See DSM-5 for details on these diagnostic categories, and the levels of severity. 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. require regular physician coverage that may vary depending upon local regulatory standards or payer requirements. Longer-term programs develop increased group continuity due to the familiarity gained through more extended treatment yet work with more pronounced symptoms and decreased functional levels with lower baselines. The assessment and treatment plan should address improvement of social skills and functioning via the therapeutic milieu. The disorders are also commonly called Postpartum depression, perinatal mood disorders, or PMD. 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. 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