A. Acute Partial
Hospitalization Programs (APHPs) - SED/SMI and Partial Hospital Hospitalization
Programs (PHPs) - SUD provide medical supervision, nursing services, structured
therapeutic activities, and intensive psychotherapy (individual, family, and/or
group) to people who are experiencing a period of such acute distress that
their ability to cope with typical life circumstances is severely impaired.
These programs are designed to provide an alternative to inpatient
hospitalization. Service content may vary based on need but must include close
observation/supervision and intensive support with a focus on the
reduction/elimination of acute symptoms.
APHPs may be provided to children/youth with serious
emotional disturbance or adults with serious and persistent mental illness.
PHPs may be provided to children and youth or adults with substance use
disorders. For people with substance use disorders, Level 2.5 PHPs can be
utilized as a step-down from an inpatient or residential level of care or as an
initial level of care as determined by an ASAM Level of Care Placement
assessment.
B. APHPs/PHPs
must be a part of a written comprehensive plan of Crisis Stabilization and
Community-Based Support Services offered to people participating in the
program. At a minimum, services include family intervention, Targeted Case
Management, medication monitoring, Crisis Response Services, and Community
Support Services. The program must be designed to assist people in making the
transition from acute inpatient services, and/or serve as an alternative to
inpatient care.
C. There must be
written policies and procedures implemented for providing an APHP/PHP that
include at a minimum:
1. Admission criteria
and procedures. These procedures must require that a physician conduct an
admission evaluation and certify that the service is required to reduce or
prevent the need for inpatient services.
2. Procedures requiring documented medical
supervision and follow along with on-going evaluation of the medical status of
the person.
3. Procedures requiring
documented support services for families and significant others.
4. Procedures implementing and documenting
discharge criteria to include follow-up planning.
D. Programs must include at each service
location a full-time director who plans, coordinates, and evaluates the
service.
E. Program personnel must
meet the following minimum requirements:
1. At
least one (1) employee with a minimum of a master's degree in a mental health
or related field must be on-site for six (6) or fewer people for which the
service is certified to serve. The employee can be the on-site Service Director
if they are actively engaged in programmatic activities with people during all
service hours.
2. At least one (1)
employee with a minimum of a master's degree in a mental health or related
field and at least one (1) employee with a minimum of a bachelor's degree in a
mental health or related field when seven (7) through 12 participants are
served.
3. At least one (1)
employee with a minimum of a master's degree in a mental health or related
field, at least one (1) employee with a minimum of a bachelor's degree in a
mental health or related field, and at least one (1) support employee when 13
through 18 participants are served.
F. Programs must provide adequate nursing and
psychiatric services to all people served. At a minimum, these services must be
provided weekly (and more often if clinically indicated). Provision of these
services must be documented through an implemented written procedure carried
out by the agency provider or through contractual agreement.
G. Medical supervision and nursing services
must be immediately available and accessible to the service during all hours of
operation.
H. Persons served must
receive a minimum of 20 hours of service per week. Programs can be operated
seven (7) days per week, but must at minimum:
1. Operate at least three (3) days per
week;
2. Operate at least four (4)
hours per day, excluding transportation time; and
3. Be available 12 months per year.
I. Programs must be designed for a
maximum number of 18 people. People placed in a Level 2.5 Partial
Hospitalization level of care must be assessed every seven (7) calendar days to
ensure level of care appropriateness. For people with substance use disorders,
the length of stay will be determined based on the results of an ASAM LOC
Assessment.
J. The service provider
must maintain a daily schedule of therapeutic activities to include individual,
group, family, and other activities that are designed to provide intensive
support to the people in the service and reduce acute symptomology.
K. The service location must have sufficient
space to accommodate the full range of service activities and services and must
provide a minimum of 50 square feet of multipurpose space for each person
served.
L. Programs must be located
in their own physical space, separated from other substance use services, and
impermeable to use by other services/service locations during hours-of-service
operation.