Partial hospitalization
The Commission on Accreditation of Rehabilitation Facilities (CARF) identifies Partial Hospitalization Programs as
"time limited, medically supervised programs that offer comprehensive, therapeutically intensive, coordinated, and structured clinical services. Partial hospitalization programs are available at least five days per week but may also offer half-day, weekend, or evening hours. Partial hospitalization programs may be freestanding or part of a broader system but should be identifiable as a distinct and separately organized unit.
A partial hospitalization program consists of a series of structured, face-to-face therapeutic sessions organized at various levels of intensity and frequency. Partial hospitalization programs are typically designed for persons who are experiencing increased symptomatology, disturbances in behavior, or other conditions that negatively impact the mental or behavioral health of the person served. The program must be able to address the presenting problems in a setting that is not residential or inpatient. Given this, the persons served in partial hospitalization do not pose an immediate risk to themselves or others. Services are provided for the purpose of diagnostic evaluation; active treatment of a person’s condition; or to prevent relapse, hospitalization, or incarceration. Such a program functions as an alternative to inpatient care, as transitional care following an inpatient stay in lieu of continued hospitalization, as a step-down service, or when the severity of symptoms is such that success in a less acute level of care is tenuous."[1]
Medicare Part B will potentially reimburse for these services if there is agreement between the PHP and referring doctor.[2] The Office of the Inspector General in the United States of (North) America issued report that outlines nine characteristics of questionable billing in PHPs based on past input from the Centers for Medicare & Medicaid Services (CMS) staff. Data was used from Medicare claims between 2009 to 2010 and were from the National Claims History File. The first sentence of each of the nine characteristics:
1. Beneficiaries who received only group psychotherapy during their PHP participation.
2. Beneficiaries who were not referred to PHPs by health care facilities.
3. Beneficiaries who were not evaluated by physicians during their PHP participation.
4. Beneficiaries with no mental health diagnoses a year prior to participating in PHPs.
5. Beneficiaries who participated in PHPs at CMHCs outside their communities.
6. Beneficiaries who participated in PHPs at more than one CMHC.
7. Beneficiaries with cognitive disorders who participated in PHPs.
8. Beneficiaries with long durations of PHP participation.
9. Beneficiaries who were readmitted to inpatient treatment.
The report that authored these nine characteristics also determined if the percentage of Community Mental Health Centers with questionable billing changed based on whether states had 'license or certification requirements'.[3][4]
