Current through Register Vol. 46, No. 39, September 25, 2024
(a) Partial
hospitalization visits shall be reimbursed on the basis of duration of hours
provided as follows:
(1) Reimbursement shall
be provided for visits of at least four hours in duration and not more than
seven hours per recipient per day.
(2) Reimbursement for partial hospitalization
shall be limited to no more than 180 hours per course of treatment per
recipient within a partial hospitalization program. A course of treatment shall
not exceed six calendar weeks, unless, during the course of treatment, the
recipient is admitted to an inpatient psychiatric facility. Such course of
treatment may be extended to include the number of days of inpatient treatment,
up to a maximum of 30 days. Each course of treatment is a new
admission.
(3) Reimbursement shall
be limited to 360 hours per calendar year per recipient.
(4) Collateral visit: shall be reimbursed for
clinical support services of at least 30 minutes in duration but not more than
two hours of face-to-face interaction between one or more collaterals and one
therapist with or without a recipient.
(5) Group collateral visit: shall be
reimbursed for clinical support services, in accordance with section
587.4(c)
of this Part, of at least 60 minutes in duration but not more than two hours
and shall represent services to more than one recipient and/or his or her
collaterals. Such visits need not include recipients but shall not include more
than 12 collaterals and/or recipients in a face-to face interaction with a
therapist.
(b) The
utilization review authority designated pursuant to section
587.6
of this Title shall conduct the following reviews regarding, at a minimum, a
random 25 percent sample of recipients:
(1) a
review of the appropriateness of admission to a partial hospitalization program
by the fourth visit after admission;
(2) a review of the need for continued
treatment in a partial hospitalization program every two weeks.
(c) The determination of need for
admission to or continued treatment in a partial hospitalization program shall
be reviewable by the Office of Mental Health or its designated agent, and shall
take the following criteria into account:
(1)
the recipient's history, diagnosis, prognosis, progress or lack thereof;
and
(2) whether the recipient
requires services at that level of care, or would be more appropriately
discharged or referred to another program.
(d) The treatment plan required pursuant to
section
587.16
of this Title shall be completed prior to the fourth visit after admission.
Review of the treatment plan shall be every two weeks.
