A step below inpatient treatment, a partial hospitalization program concentrates on helping patients live a sober and mentally healthy lifestyle while being able to spend time at home. If you are interested in a partial hospitalization program and not sure of how it is covered, here are a few things you should know. We cover what a partial hospitalization program (PHP) is, who benefits, and how it is covered with private insurance as well as Medicare.

What is a Partial Hospitalization Program?

A partial hospitalization program or PHP is a type of hospitalization that does not require person to stay in residence or in-treatment. Instead, it is ideal for specific patients which we will address. The type of treatment a PHP is involves a structured program where a patient visits the center during the day. There, they will undergo therapy as well as groups focused on skill building and other helpful components of recovery and living sober. At night, the patient does not have to stay and can return home.

This is a program provided by the union of the American Association for Partial Hospitalization (AAPH) and the National Association of Private Psychiatric Hospitals (NAPPH). It was approved in 1988 by Congress and specifically designed for the diagnosis or active treatment of a serious mental disorder when there is a reasonable expectation for improvement or when it is necessary to maintain a patient’s functional level and prevent relapse or full hospitalization.

Some of the programs include things like skill-building exercises, group therapy, one-on-one therapy, family therapy, psychoeducation, and psychiatric medication assessments. The treatment goal is to provide patients with the care they need while reducing in-patient hospitalization.

What Are the Benefits?

The benefits of a PHP are many. And while everyone benefits from therapy, this type of program is best for specific types of patients. Those who use the PHP program fall into two categories:

1. Past In-house Patients. For those who have finished residential treatment or an in-patient situation, this may be the perfect next step. This treatment may have been for mental health or substance abuse but the patient is at the level where a structured program meets their needs without in-patient treatment for the rest of their recovery. This allows them to better make the transition to a lifestyle that is sober and healthy.
2. Low Risk Patients. Some patients thrive in a PHP environment because they do not have the same level of needs or severity of issues s others. These patients need rehabilitation but their needs are not as severe as someone who requires 24/7 care.

This is a structured program where a patient spends time at the facility during daytime hours – usually about six hours a day. There, they will undergo therapy as well as groups focused on skill-building and other helpful components of recovery and living sober. The patient then can leave the treatment center each day after the scheduled time.

A person ideal for this type of treatment must not require constant supervision. These patients must have a stable situation where they do not need a place to live or treatment after hours. This means that they should have a residence, transportation, and the ability to take care of their own meals during their time away from the facility. In some cases, transportation may be provided but this depends on the center and their specifications. Also, it is helpful to inquire with your insurance provider because they may provide transportation to the program while you are in treatment.

Who Qualifies?

There is specific criteria for qualifying for the partial hospitalization. These include:

• The patient has to be under the care of a doctor. This doctor must be certified in this program.
• There are 20 hours per week required for these therapeutic services.
• The treatment must be structured, comprehensive, and multi-model.
• The patient has to be able to meet the needs both emotionally and cognitively to participate in this program.
• Patients meeting benefit category requirements for partial hospitalization program (PHP) comprise two groups

How Does Partial Hospitalization Coverage Work?

If you have private insurance and a private hospitalization program is covered, you typically have a co-pay that has to be taken care of each visit. Some insurance companies reimburse you if you have Out-of-Network Reimbursement Benefits. Of course, to find out for sure you will need to inquire with your insurance company or discuss payment options with the program’s counselor.

Medicare is different. With their plan:

Medicare Part B (Medical Insurance) may provide partial hospitalization coverage if you meet certain requirements and your doctor certifies that you would otherwise need inpatient treatment. 

You pay a percentage of the Medicare-approved amount for each service you get from a doctor or certain other qualified mental health professionals if your health care professional accepts Assignment. You also pay Coinsurance for each day of partial hospitalization services provided in a hospital outpatient setting or community mental health center, and the Part B Deductible applies.

If you think this program is right for your needs. discuss the partial hospitalization program with your doctor. The two of you can make a decision based on various factors to ensure it is a good fit. Many people do well with this type of program and can successfully transition into a healthy lifestyle apart from hospitalization. To find out more about what we offer in a partial hospitalization program, check with our admissions team.