Regulations allow approval of partial hospitalization programs by Tricare authority.
Tricare is the single-pay health-care program of the Department of Defense, formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). It uses a variety of providers to offer plan benefits. Hospitals that provide Tricare psychiatric partial hospitalization programs (PHP) follow Tricare regulations. The programs offer a comprehensive and integrated schedule for partially stabilized mental health disorders. Hospitals providing PHPs must be certified according to Tricare certification standards.
Eligibility
All freestanding PHPs certification prior to Tricare approval. They must meet criteria set forth by the Director of Tricare Management Activity. A PHP at a Tricare-certified hospital is not required to be separately certified. Tricare approval of a hospital is sufficient for its PHP to be authorized as a Tricare provider.
Treatment Program
The treatment program of either a freestanding PHP or a hospital PHP must be operated by the psychiatrist employed by the PHP. This certifies the needs of the patients for medication and physical therapy. The primary or attending provider must have authorization as a mental health provider operating within the standards of the provider's license. Providers include clinical psychologists, clinical social workers, certified psychiatric nurse specialists, clinical psychologists, pastoral counselors, and mental health counselors.
Participation Agreement
Certified programs must have a participation agreement with Tricare/CHAMPUS and must have the required pre-authorization before patients can be admitted. A participation agreement application can be obtained from the National Quality Monitoring Contractor (NQMC).
Requirements
PHPs have to follow authorization requirements and keep their accreditation by following the standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) under the Mental Health Manual. The PHP must be fully operational and have treated patients for at least six months (with a 30 percent minimum patient census) before submitting an application to the NQMC for approval. Prior to the date the facility receives approval, no PHP shall be considered an authorized provider or be paid benefits.
Tags: , mental health, clinical psychologists, hospitalization programs, partial hospitalization