Partial Hospitalization Programs

Partial hospitalization programs are covered when they provide intensive, physician-directed, multidisciplinary active psychiatric treatment for patients recently discharged from inpatient care or for those at reasonable risk of inpatient hospitalization due to acute onset or decompensation of an Axis I disorder. Coverage requires physician certification, an individualized measurable treatment plan, progress notes evidencing proactive treatment, documentation that less intensive care is insufficient, and that the patient does not require 24-hour supervision; custodial, recreational, or maintenance-only programs and certain ancillary items (meals, transportation, self-administered meds, vocational training) are not covered.

"Coverage is allowed when the patient is discharged from an inpatient psychiatric hospitalization and PHP is used in lieu of continued inpatient treatment with evidence of need for the acute, intens..."