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§ 5210.11. Organization and structure. Staffing and how to communicate nature of program (4 items)
- 1. Separate identifiable organizational unit own staffing pattern.
- 2. The organizational structure of the unit shall be described in an organizational chart.
- 3. A written description of all services provided by the unit shall be on file and available to the Department.
- 4. The Department shall be notified of any major change in the organizational structure or services.
§ 5210.12. Linkages with other parts of the service system.
Links to IP, other county services, MH/MR documented. Need for service in community.
(a) Partial hospitalization program requires a close relationship with an acute psychiatric inpatient service. A written statement as to the availability of these services to patients is required and shall be maintained on file at the facility.
- (b) Partial hospitalization program shall also assure linkages
- with other appropriate treatment and rehabilitative services including emergency services, outpatient services, and vocational rehabilitation programs. A written statement documenting such linkages shall be maintained on file at the facility.
(c) The partial hospitalization program shall participate in the overall system of care as defined in the County Mental Health/Mental Retardation (MH/MR) plan. A letter of agreement with the county program is required specifying the relationship of the partial program with the county program case management system and shall be included in its application for a certificate of compliance.
- (d) New partial hospitalizaton programs or new sites of
- existing programs established after the effective date of this chapter shall document the need in the proposed service area for the expansion of partial hospitalization services. County MH/MR authorities shall review this documentation and make recommendation to the Department. The Department may deny approval of such expansion where inadequate justification is provided.
Staffing (Child Programs) (staff to patient ratio, physician time per patient)
- 1:5 Staff to patient Ratio
- Based on Program Capacity
- 2 Hours of Psychiatric time for every 5 pts of program capacity
- (b) 1 FTE for every 5 patients. Staff/patient ratio shall be prorated on the basis of capacity of the program. When there are changes in program capacity, appropriate
- staffing changes shall be made as required. Staff shall be of
- appropriate professional disciplines and shall include at least one member, other than the program director, who is a mental health professional or one member who is a psychiatric nurse. Any clinical staff time devoted specifically to the partial program including that of program director and medical staff shall be calculated in the patient/staff ratio.
- (c) Psychiatric staff. Children and youth partial hospitalization programs shall have a minimum of 2
- hours of assigned psychiatric time per week for every five patients of program capacity.
§ 5210.32. Psychiatric supervision. (basic description) (child)
Monitor tx plan and head treatment team
- At a minimum, the psychiatric supervision of a
- children and youth partial hospitalization program shall be by a psychiatrist who shall monitor each treatment plan on a regular basis as defined in § 5210.33 (relating to treatment planning and records) and clinically supervise the treatment of all patients.
§ 5210.33. Treatment planning and records. (Description of tx team and involvement of family in tx plan process) (child)
- An individual treatment plan shall be formulated for
- all patients in children and youth partial hospitalization programs by the patient’s treatment team. A treatment team shall consist of a treatment team leader, a psychiatrist and other appropriate staff of the treatment program. The treatment team leader shall be a mental health
- professional. For patients undergoing involuntary treatment, the treatment team leader shall be a physician or psychologist. Treatment plans shall be reviewed with parents or guardians of persons in children and youth partial programs if appropriate.
§ 5210.34. Treatment team leader responsibilities (5 things) (child)
- 1. members trained appropriately
- 2. coordinate implement tx plan
- 3. coordinate services with other providers
- 4. review progress notes and dc summary
- 5. encourage pt involvement in tx
- (a) The treatment team leader shall ensure that
- staff trained and experienced in the use of the modalities proposed in the treatment plan shall participate in its development, implementation and review.
- (b) The treatment team leader is responsible for the
- implementation and review of the individualized treatment plan, for the coordination of service delivery from other service providers, and for the review of progress notes and discharge summary.
(c) The treatment team leader shall ensure that the child or youth in treatment is encouraged to become increasingly involved in the treatment planning process.
§ 5210.35. Contents and review of a comprehensive treatment plan. (child)
- 1. Be formulated with pt input
- 2. Based on a diag eval which includes medical, psychological, social, cultural, behavioral, family, developmental, vocational aspects
- 3. Objectives, interventions, staff assignments
- 4. Updated daily with signed notes
- (1) Be formulated to the extent possible, with the cooperation and consent of the patient or a person acting on his behalf.
- (2) Be based upon diagnostic evaluation which includes
- examination of the medical, psychological, social, cultural, behavioral, familial, educational, vocational, and developmental aspects of the patient’s situation.
- (3) Set forth treatment objectives and prescribe an
- integrated program of therapies, activities, experiences and appropriate education designed to meet these objectives and staff assignments.
- (4) Be maintained and updated with signed daily notes, and be kept in the patient’s medical record on a form developed by the facility.
Tx Plan time frames
(Initial and updates) (child)
- Initial = within 5 days
- Update = Every 20 days
- (b) Treatment plans for children and youth partial
- hospitalization programs shall be developed within the first 5 days of
- service and reviewed by the treatment team and psychiatrist a minimum of
- once every 20 days of service and modified as appropriate. Such
- modification shall be recorded in the patient’s record.
Policies and Procedures Must Include the Following: (5 policies that have to be there)
(1) The services to be provided and the scope of such services.
(2) Intake policy and procedures.
(3) Admissions and discharge policies.
(4) Policies providing for continuity of care for patients.
(5) There shall be a regular ongoing program for staff development.
§ 5210.37. Linkages with educational programs. (child) - Statement about reimbursement
- Basic education and, in particular, special education are an essential and required part of service for emotionally
- disturbed children and youth. By law, such education is to be provided by the Department of Education or its agent. The education program may be provided at the same site as the partial hospitalization program, but is considered a separate, though complimentary, program and shall not be included as part of the partial hospitalization program for reimbursement purposes.
§ 5210.38. Size of program. (child) - how many days a week and what is the minimum capacity
Must operate 3.5 days per week and have a minimum capacity of 10
Tx Regime per day (child) - how many hours of hardcore tx is mandated
At least 3 hours per day
- Patients in partial hospitalization programs shall
- receive a minimum of 3 hours of planned treatment programs per hospitalization day. These programs shall emphasize a therapeutic milieu, and include therapeutic, recreational, social and vocational activities, individual, group, or family psychotherapy, psychiatric, psychological and social evaluations, medication evaluations and other
- activities as determined by the treatment team.
§ 5210.51. Fee schedule.
Must be available to all patients
- Each partial hospitalization program shall maintain a
- schedule of uniform basic charges for services which is available to all patients. Fee schedules shall be submitted to the Department for information purposes.
§ 5210.52. Quality assurance. (2 things)
- 1. Must have audit process
- 2. Must demonstrate patients are discharged when better
- All partial hospitalization programs shall have a
- utilization review and clinical audit process designed to ensure that
- the most appropriate treatment is delivered to the patient. Patients
- shall be discharged when the identified benefit, as reflected in the
- initial evaluation, goals, objectives, and treatment plan has been
§ 5210.53. Physical facility. (8 things)
- 1. Adequate space and readily avail. (met)
- 2. Furniture is well maintained and meets code
- 3. A waiting room that is neat and cheerful is furnished
- 4. Office space for staff
- 5. Conference rooms
- 6. Privacy in interview rooms
- 7. Appropriate to age of pt
- 8. Only one license is given to an organization and incorporates all sites (suggests all PHP programs should be doing the same stuff)
- (a) Adequate space, equipment and supplies shall
- be provided in order that the partial hospitalization services can be provided effectively and efficiently. Functional surroundings shall be readily accessible to the patient and community served.
(b) All space and equipment shall be well maintained and shall meet applicable Federal, State and local requirements for safety, fire and health.
(c) A waiting room which is neat, cheerful and comfortably furnished shall be provided.
- (d) There shall be office space for the clinical staff suitably
- equipped with chairs, desks, tables and other necessary equipment.
(e) There shall be an adequate number of suitably equipped conference rooms to provide for staff conferences and therapy.
(f) There shall be adequate provisions for the privacy of the patient in interview rooms.
(g) The facility shall be appropriate to the age and developmental needs of the persons served.
- (h) A partial hospitalization program is
- defined by its staff and organizational structure rather than by a
- specific building or facility. It may operate at more than one site if
- the respective sites meet all physical facility standards and the sites
- operate as a portion of a total partial hospitalization program. The
- Department will issue a single certificate of compliance to the parent
- organization which will list all operational sites.
§ 5210.58. Drugs and medications (need a written policy related to drug/medication dispensing in PHP)
- (a) If medication is prescribed or dispensed by
- the facility, the requirements of applicable Federal and State drug statutes and regulations shall be met.
- (b) Written policies and procedures providing for the safe
- dispensing and administration of drugs by the medical and nursing staff shall be in writing and on file. The policies shall include the following:
(1) Prescriptions shall be written only by the physician.
(2) Drugs shall be dispensed only on the order of a physician.
(3) Drugs shall be kept in a secure place.
(4) Each dose of medication administered by the facility shall be properly recorded in the patient’s medical record.
§ 5210.58a. Medication prescription—statement of policy.
- Prescriptions for medications may be written by and
- dispensed on the order of a certified registered nurse practitioner in partial hospitalization facilities as authorized under 49 Pa. Code Chapter 18, Subchapter C (relating to certified registered nurse practitioners) and Chapter 21, Subchapter C (relating to certified registered nurse practitioners).