News Flash: Acute Partial Hospitalization Programs

Beginning July 1, 2010, Acute Partial Hospitalization programs (PHP) became a covered behavioral health benefit for State of Indiana Hoosier Healthwise members. Partial Hospital programs are provided separately for children/adolescents and adults.

The State of Indiana defines Acute Partial Hospital programs as “highly intensive, time limited medical services intended to either provide a transition from inpatient psychiatric hospitalization to community based care or, in some cases, substitute for an inpatient admission.” The admission criteria are essentially the same as inpatient level of care with the exception that the patient does not require 24 hour nursing supervision. The definition also states that patients “with clear intent to seriously harm self or others are not candidates for Partial Hospitalization.”

The authorization process includes contacting the applicable health plan at the time of admission to a partial hospital program to request authorization for services. The services may be authorized for up to 5 days (dependent upon patient’s condition), with re-authorization criteria being applied to stays that exceed 5 days.

For much more detailed information on Acute Partial Hospital programs such as target population, programming standards, treatment plan content, exclusions, authorization and re-authorization criteria, service code, provider qualifications, etc. please refer to the Indiana Health Coverage programs bulletin, (number BT201019) dated June 15, 2010 which is located on the IHCP website (www.indianamedicaid.com/ihcp/index.asp) , or contact Stacy Veach at Sveach@intecare.org.