BCBSM extends partial hospitalization programs to include selected outpatient psychiatric centers

Beginning April 1, 2013, outpatient psychiatric care facilities will be reimbursed for psychiatric partial hospitalization day treatment.

To be eligible for reimbursement, outpatient psychiatric centers must hold a current partial hospitalization program license from the state of Michigan and meet minimum qualifications and standards (for example, program content and length of sessions). Please refer to the OPC Provider Manual on web-DENIS for more information.

Partial hospitalization programs require precertification by the appropriate customer-specific review organization.

OPCs will be reimbursed a per diem fee for partial hospitalization programs, which will be inclusive of all psychiatric services. OPCs will bill these services on a CMS-1500 professional claim using HCPCS procedure code S0201, partial hospitalization services, less than 24 hours, per diem.

OPCs not licensed to provide (or that do not provide) partial hospitalization programs are not affected by this change.

The BCBSM Outpatient Psychiatric Care Participation Agreement is amended effective April 1, 2013, to reflect these changes (qualification requirements for partial hospitalization). In addition, the OPC Participation Agreement has been updated to the newer participation agreement format.  This includes (but is not limited to) consistent definitions, standard hold harmless provisions, updated BCBSA disclosure language, moving the detailed description of the appeals process to the provider manual, etc. The revised agreement will be available for your review on Jan. 1 by accessing the link found in the participation chapter of the OPC provider manual on web-DENIS.