Partial Hospitalization. Shelly Rhodes, LPC

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1 Partial Hospitalization Shelly Rhodes, LPC

2 Transition and Certification 2

3 Transition and Certification Current Rehabilitative Services for Persons with Mental Illness (RSPMI), Licensed Mental Health Practitioners (LMHP) and Substance Abuse Treatment Service (SATS) Providers: Transitioning to new Outpatient Behavioral Health Services began July 1, 2017 RSPMI, LMHP and SATS programs will sunset on June 30, 2018 and no Medicaid payments will occur for services after this date Partial Hospitalization must be provided by a facility that is certified as a Partial Hospitalization provider. 3

4 Transition and Certification The Department of Human Services Division of Provider Services and Quality Assurance will be responsible for certification of Medicaid Behavioral Health Providers. Behavioral Health Agency, Specialty Certifications & Independently Licensed Practitioners and Certification: Cindy Corbitt, Licensing & Certification Program Coordinator Division of Provider Services & Quality Assurance Alcohol and Substance Abuse Treatment Programs: Latrese Atkins, Program Coordinator Division of Provider Services & Quality Assurance *BH Certification applications can be submitted to: 4

5 Transition and Certification For full Certification Requirements please see the certification manual and forms listed at: 5

6 Coverage of Services 6

7 Eligibility Eligibility for services depends on the needs of the beneficiary. Counseling Level Services and Crisis Services can be provided to any beneficiary as long as the services are medically necessary. Beneficiaries will be deemed eligible for Rehabilitative Level Services and Intensive Level Services based upon the results of an Independent Assessment performed by an independent entity. The goal of the Independent Assessment is to determine the care, treatment, or services that will best meet the needs of the beneficiary initially and over time. Partial Hospitalization is a Rehabilitative Level Service 7

8 Rehabilitative Level Services Rehabilitative Level Services (Tier 2) Home and community based behavioral health services with care coordination for the purpose of treating mental health and/or substance abuse conditions. Services shall be rendered and coordinated through a team based approach. A standardized Independent Assessment to determine eligibility and a Treatment Plan is required. Rehabilitative Level Services home and community based settings shall include services rendered in a beneficiary s home, community, behavioral health clinic/ office, healthcare center, physician office, and/ or school. Partial Hospitalization is a Rehabilitative Level, or Tier 2, service. 8

9 Allowable Staff The allowable staff, as referenced in the Outpatient Behavioral Health Services Medicaid Manual, included in the staff-to-patient ratio of 1:5 are: Independently Licensed Clinicians Non-Independently Licensed Clinicians Registered Nurse Advanced Practice Nurse (APN) Physician 9

10 Service Code Definition 10

11 Partial Hospitalization Partial Hospitalization (H Partial Hospitalization): Is an intensive, nonresidential, therapeutic treatment program Can be used as an alternative to and/or a step-down service from inpatient residential treatment or to stabilize a deteriorating condition and avert hospitalization Provides clinical treatment services in a stable environment on a level equal to an inpatient program, but on a less than 24-hour basis Is highly structured and should maintain a staff-to-patient ratio of 1:5 to ensure necessary therapeutic services and professional monitoring, control, and protection Shall include at a minimum intake, individual therapy, group therapy, and psychoeducation 11

12 Partial Hospitalization Partial Hospitalization: Shall consist of a minimum (5) five hours per day Of those 5 hours, ninety (90) minutes must be a documented service provided by a Mental Health Professional. If a beneficiary receives other services during the week but also receives Partial Hospitalization, the beneficiary must receive, at a minimum, 20 documented hours of services on no less than (4) four days in that week. 12

13 Partial Hospitalization Benefit Limits: Unit-Per Diem Daily Maximum: 1 Yearly Maximum: 40 (extension of benefit can be requested) Special Billing Instructions: A provider may not bill for any other services on the same date of service. Applicable Populations: Children, Youth, and Adults Allowable Performing Providers *Partial Hospital Providers must be certified by DHS Certification Unit to provide this service 13

14 Documentation Requirements Start and stop times of actual program participation by beneficiary Place of service Diagnosis and pertinent interval history Brief mental status and observations Rationale for and treatment used that must coincide with the master treatment plan Beneficiary's response to the treatment must include current progress or lack of progress toward symptom reduction and attainment of goals Rationale for continued acute day service, including necessary changes to diagnosis, master treatment plan or medication(s) and plans to transition to less restrictive services All services provided must be clearly documented in the medical record Staff signature/credentials 14

15 Treatment Planning Treatment Planning (Section of Certification Manual): An individualized treatment plan shall be formulated by the beneficiary s treatment team. A treatment team shall consist of: Treatment team leader (must be a Mental Health Professional) A psychiatrist when the treatment team leader is not a psychiatrist Other appropriate staff 15

16 Treatment Planning Treatment Plan shall include the following: Be formulated to the extent possible, with the cooperation and consent of the beneficiary, or a person acting on his/her behalf. Be based upon diagnostic evaluation which includes examination of the medical, psychological, social, cultural, behavioral, familial, educational, vocational, and developmental aspects of the beneficiary s situation. Set forth treatment objectives and prescribe an integrated program of therapies, activities, experiences, and appropriate education designed to meet these objectives. Be maintained and updated with signed daily notes, and be kept in the beneficiary s medical record Be developed within the first 5 days of service and reviewed by the treatment team a minimum of once every 20 days of service and modified as appropriate. 16

17 Thank you 17