Services & Programs
Partial Hospitalization

Outreach Management Services, LLC will provide partial hospitalization services to acutely mentally ill children or adults. OMS will provide a broad range of intensive therapeutic approaches which may include: group activities/ therapy, individual therapy, recreational therapy, community living skills/training, increases the individual’s ability to relate to others and to function appropriately, coping skills, and medical services.

The goal of this service will be to prevent hospitalization or to serve as an interim step for those leaving an inpatient facility. A physician will participate in diagnosis, treatment planning, and admission/discharge decisions.

Therapeutic Relationship and Interventions
OMS will offer face-to-face therapeutic interventions and will provide support and guidance in preventing, overcoming, or managing identified needs on the service plan. These interventions will aid with improving the client’s level of functioning in all domains, increasing coping abilities or skills, or sustaining the achieved level of functioning.

Structure of Daily Living
This service will offer a variety of structured therapeutic activities and will include medication monitoring. This is designed to support a consumer who remains in the community and is provided under the direction of a physician. This program is not hospital based. Other PH staff will carry out the identified individual or group interventions and will be under the direction of the physician.

This service will offer support and structure to assist the consumer with coping and functioning on a day-to-day basis to prevent hospitalization or to step down into a lower level of care from inpatient setting.

Cognitive and Behavioral Skill Acquisition
Partial Hospitalization will include interventions that will address the functional deficits associated with affective or cognitive problems and/or the consumer’s diagnostic conditions. This may include training in community living, and specific coping skills, and medication management. This assistance will allow the consumer to develop their strength and establish peer and community relationships.

Service Type
Partial Hospitalization (PH) will be a day/night service and will be provided at a minimum of (3) three hours per day, (5) five days per week, and (12) twelve months per year. Utilization management will be done by the state vendor or the DHHS approved LME contracted with the Medicaid agency. All service standards and licensure requirements outlined in 10A NCAC 27G .1100 will be upheld.

Resiliency/Environmental Intervention
This service will assist the consumer in transitioning from one service to another (an inpatient setting to a community-based service) or preventing hospitalization. This service will provide a broad array of intensive approaches, which may include group and individual activities.

Service Delivery Setting
This service will be provided in a licensed facility that offers a structured, therapeutic program under the direction of a physician that is not hospital based.

Admission Criteria/Medical Necessity
All consumers receiving Partial Hospitalization must have an Axis I or II diagnosis and will meet the level of care criteria or Level C/NCSNAP. The consumer must be experiencing difficulties in at least one of the following areas: functional impairment, crisis intervention/diversion/aftercare needs, and/or at risk for placement outside the natural home setting. In addition, the consumer’s level of functioning has not been restored or improved and may indicate a need for clinical interventions in a natural setting if any one of the following apply:

1. Being unable to remain in family or community setting due to
symptoms associated with diagnosis, therefore being at risk for out
of home placement, hospitalizations, and/or institutionalization.
2. Presenting with intensive, verbal and limited physical aggression
due to symptoms associated with diagnosis, which are
sufficient to create functional problems in a community setting.
3. Being at risk of exclusion from services, placement or significant community support system as a result of functional behavioral
problems associated with diagnosis.
4. Required a structured setting to monitor mental stability and symptomology, and foster successful integration into the
community through individualized interventions and activities.
5. Service is a part of an aftercare planning process (time limited or transitioning) and is required to avoid returning to a higher or more restrictive level of service.

Service Order Requirement
A service order must be obtained by a Physician, PhD, Psychiatric Nurse Practitioners, or a Psychiatric Clinical Nurse Specialist within their scope of practice. The service order must be ordered prior to or on the day the service is initiated.

Continuation/Utilization Review Criteria
Consumers receiving Partial Hospitalization from OMS may continue to receive this service if the desired outcome or level of functioning has not been restored, improved, or sustained over the time frame outlined in the consumer’s service plan. Also the consumer may continue to be at risk for relapse based on history of the tenuous nature of the functional gains or any one of the following apply:

1. Consumer has achieved initial service plan goals
and additional goals are indicated,
2. Consumer is making satisfactory progress toward meeting goals.
3. Consumer is making some progress, but the service plan (specific interventions) need to be modified so that greater gains
which are consistent with the consumer’s premorbid level of
functioning are possible or can be achieved.
4. Consumer is not making progress; the service plan must be
modified to identify more effective interventions.
5. Consumer is regressing; the service plan must be modified
to identify more effective interventions.

Discharge Criteria
Consumers may be discharged from PH services once the consumer’s level of functioning has improved with respect to the goals outlined in the service plan, inclusive of a transition plan to step down, or no longer benefits, or has the ability to function at this level of care and any of the following apply:

Consumer has achieved goals, discharged to a lower level of care is indicated or Consumer is not making progress, or is regressing and all realistic treatment options with this modality have been exhausted. If a denial, reduction, suspension, or termination of service occurs the consumer and/or legal guardian will be notified about their appeal rights.

Service Maintenance Criteria
If the consumer is functioning effectively with this service and discharge would otherwise be indicated, PH should be maintained when it can be reasonably anticipated that regression is likely to occur if the service is withdrawn. The decision will be based on any one of the following: Past history of regression in the absence of PH is documented in the consumer record. OR The presence of a DSM-IV diagnosis that would necessitate a disability management approach.

In the event there is epidemiological sound expectations that symptoms will persist and that ongoing treatment interventions are needed to sustain functional gains.

Provider Requirement and Supervision
This service will be provided by a team, which may have the following configuration: social workers, psychologists, therapists, case managers, or other MH/SA paraprofessional staff. The partial hospital milieu is directed under the supervision of a physician. All staffing requirements outlined in 10A NCAC 27G .1102 will be upheld.

Documentation Requirements
A weekly service note at a minimum will occur and will include the purpose of contact, interventions, and the effectiveness of the interventions.

 

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