N.H. Admin. Code § He-M 426.11

Current through Register No. 50, December 12, 2024

Section He-M 426.11 - Partial Hospitalization Services

(a) Partial hospitalization shall be a covered service and shall consist of intensive partial hospitalization services and restorative partial hospitalization services as described in (e) and (f) below.

(b) Only individuals certified to receive long-term care services pursuant to He-M 426.19 shall be eligible for partial hospitalization services.

(c) Programs shall operate a minimum of 6 hours per day on weekdays and 4 hours per day on holidays and weekends for each day for which services are billed.

(d) Billing for partial hospitalization services shall be in half day or full day units, as follows:

(1) One half day of partial hospitalization shall be attendance at staff directed programs for at least 2 and less than 3 hours; and

(2) A full day of partial hospitalization shall be attendance at staff directed programs for 3 or more hours.

(e) Intensive partial hospitalization services shall be provided as follows:

(1) Placement into intensive partial hospitalization shall be made only with a written order from a psychiatrist, and be based on symptoms affecting the recipient's ability to function adequately in a community setting;

(2) Intensive partial hospitalization shall be offered no fewer than 5 days per week and be designed to provide short-term, structured, and active treatments which are problem-solving in nature and which are directed toward full or partial recovery from the prevailing crisis and the return of the recipient to a pre-crisis level of functioning;

(3) The provision of intensive partial hospitalization services shall be based on identified recipient needs as documented in the recipient's ISP;

(4) Intensive partial hospitalization services shall include:

a. Individual or group psychotherapy;

b. Psychological evaluations and testing;

c. Medication monitoring, evaluation, administration, and education;

d. Clinical assessments to assist in individual service planning;

e. Family or significant other psychotherapy; and

f. Psychologically supportive individual or group activities.

(5) The daily services and activities of an intensive partial hospitalization program shall consist of:

a. A minimum of 2 hours per day of any combination of activities contained in (e) (4) a. - e. above; and

b. The remainder of the day may consist of activities contained in (e) (4) f. above;

(6) Participation in this program shall not exceed 20 treatment days per acute episode without a written order from a psychiatrist and a documented service plan review; and

(7) There shall be no reimbursement from medicaid for any treatment exceeding 30 days per episode, or 90 days per state fiscal year.

(f) Restorative partial hospitalization shall be provided as follows:

(1) Services shall encourage the development of those skills necessary for transfer to a variety of community living environments, including employment settings, and, as much as possible, reduce a recipient's dependency on state or federally funded programs while enabling the recipient to become a productive member of society, earn a wage, and live as independently as possible;

(2) Placement and participation in restorative partial hospitalization services shall be based on the needs of the recipient as documented in the ISP and functional deficits identified in the eligibility determination process pursuant to He-M 401;

(3) Restorative treatment shall:

a. Promote emotional, behavioral, physical health, and psychological change;

b. Minimize the effects of mental disorders;

c. Promote health maintenance through clinical activities which foster the reduction of psychological stress;

d. Promote independent living;

e. Help maintain the individual in a community setting;

f. Teach skills necessary for an individual to function in the environments in which he or she lives and works; and

g. Utilize accepted principles of psychosocial rehabilitation;

(4) Restorative partial hospitalization services shall consist of the following components:

a. A comprehensive identification of the recipient's skills, strengths, and deficits in relation to the skill demands and supports required in the particular environment in which the recipient wants or needs to function, as such environment is consistent with the goals listed in the individual's ISP;

b. Active recipient involvement which requires that assessment and intervention procedures be explained to and understood by the recipient;

c. Teaching of skills necessary for the recipient to succeed in his or her chosen environments;

d. A crisis management plan which shall serve to avert crises or mobilize resources rapidly to respond to crises and be implemented by intensive partial hospitalization services staff, emergency services staff, or other appropriate staff within the CMHP; and

e. Case management to assure linkage with all necessary services and people involved in the recipients' care, coordinated service planning, and monitoring of progress toward goals;

(5) Restorative partial hospitalization services shall include the following services:

a. Individual or group counseling and psychotherapy;

b. Medication monitoring, evaluation, administration, and education;

c. Family or significant other services, counseling, and psychotherapy;

d. Teaching daily living skills, community living skills, and self-care skills;

e. Nutritional services;

f. Basic education;

g. Recreational services;

h. Psychological evaluations and testing; and

i. Psychologically supportive individual or group activities;

(6) Recreational activities such as bowling, swimming, and field trips shall be billable only when they are adjunct to, but not the only component of, the restorative partial hospitalization service; and

(7) Medicaid reimbursement for restorative partial hospitalization services shall not be made for a recipient for any day in which the recipient receives fewer than 2 hours of service, exclusive of recreational activities, unless in a given week the average per day participation in non-recreational activities exceeds 2 hours per day of service to the recipient.

(g) In addition to requirements listed in (e) and (f) above, reimbursement criteria for intensive and restorative partial hospitalization services shall include the following:

(1) Out-of-facility activities shall be covered under the following circumstances:

a. The activities shall be directed by the partial hospitalization staff as part of a program based in the CMHP; and

b. Stipends shall not be paid to recipients of partial hospitalization services in connection with the activities;

(2) The medicaid rate for partial hospitalization shall be all inclusive;

(3) On a day that a recipient receives partial hospitalization services, no reimbursement for other covered services shall be made except as allowed in (4) below;

(4) The following services shall be reimbursable on any day that a recipient receives partial hospitalization services:

a. Case management services when provided under an approved case management option of the medicaid program;

b. Emergency visits if they occur outside of the normal operating hours of the partial hospitalization program;

c. Services provided by an assertive community treatment team;

d. Individualized resiliency and recovery oriented services;

e. Medication checks for clozaril and clozapine management;

f. Psychiatric evaluation for medicaid eligibility; and

g. Services provided by a mobile crisis team, which is a multidisciplinary team that provides crisis stabilization and case management services as an alternative to hospitalization.

(5) Services provided on a day the recipient did not attend partial hospitalization shall be billed in the normal manner for the service; and

(6) Reimbursement for partial hospitalization services shall be limited to services for outpatients.

(h) Staff who provide partial hospitalization services shall meet the following criteria:

(1) A partial hospitalization program shall employ a partial hospitalization supervisor who performs the following duties:

a. Supervises all staff of the partial hospitalization program;

b. Provides program administration; and

c. Ensures partial hospitalization services are coordinated with other services to assure continuity of recipient service; and

(2) The supervisor of partial hospitalization services shall minimally have:

a. Full time employment equaling 3 years' experience in programs for persons with long term mental illness;

b. One year of supervisory, management, or administrative experience; and

c. A baccalaureate degree in social work, rehabilitation, psychology, education, or a related human services field.

(i) Each staff person providing partial hospitalization services shall at a minimum have:

(1) Either:

a. A baccalaureate degree in social work, rehabilitation, psychology, education, or a related human services field; or

b. An associate's degree in social work, rehabilitation, psychology, education, or a related human services field and the following experience:

1. Two years of experience working with persons who have severe mental disability; or

2. Two years of experience that provides an person with an understanding of mental illness and that was acquired as an adult in the provision of significant supports to persons with mental illness, including the experience acquired by family members of persons with mental illness or by other persons who have personal knowledge of mental illness; and

(2) Completed the training curriculum based on the Illness Management and Recovery Evidence Based Practice Kit (2010), available as listed in Appendix A, if the staff will be providing IMR services.

N.H. Admin. Code § He-M 426.11

(See Revision Note at part heading for He-M 426) #5433, eff 7-2-92; amd by #5971, eff 2-1-95; ss by #7088, eff 8-31-99; ss by #8867, eff 4-13-07; ss by #9285, eff 9-30-08 (from He-M 426.10 )

Amended by Volume XXXVI Number 41, Filed October 13, 2016, Proposed by #11182, Effective 9/29/2016, Expires 3/28/2017.

Amended by Volume XXXVII Number 15, Filed April 13, 2017, Proposed by #12154, Effective 3/28/2017, Expires 3/28/2027.