Reminder: Qualifying facilities can enroll to provide psychiatric residential treatment

We’d like to remind you that qualifying facilities can enroll as psychiatric residential treatment facilities. Blue Cross began covering psychiatric residential treatment on July 1, 2014, in alignment with the requirements of the federal mental health parity law.

Qualifying as a psychiatric residential treatment facility

To enroll with Blue Cross, a psychiatric residential facility must be licensed by the state of Michigan as a child caring institution, an adult foster-care facility or a nonhospital, psychiatric facility for individuals who:

• Require psychiatric treatment that is longer-term than the traditional inpatient program
• No longer require the intensity of service provided in a traditional psychiatric inpatient facility
• Require psychiatric treatment that is more intensive than outpatient psychiatric treatment
• Continue to require supervision 24 hours a day, seven days a week because they cannot safely be treated in a less restrictive setting, such as a day treatment program

The facility must also use the services of a multidisciplinary treatment team.

Treatment requirements

The facility must be able to provide supervision and treatment as outlined below, as well as room and board for patients:

• A face-to-face evaluation by the attending psychiatrist must occurwithin 72 hours of admission.
  
• Supervision is provided 24/7.
• Nursing care is on-site or on call and no more than 15 minutes away 24/7.
• A psychiatrist is on call 24/7.
• A psychiatrist is on-site a minimum of two days per week.
• An individualized plan of active psychiatric treatment and residential living support is provided in a timely manner. Initial treatment plan should be developed within 72 hours of admission and a more robust treatment plan should be developed by the end of week two. Treatment plans should be updated at least weekly.
  
  At minimum, the plan includes the following elements:
• A weekly face-to-face meeting must be scheduled with the patient and his or her caretaker, guardian, or family members unless there is an identified, valid reason why it is not clinically appropriate or feasible.
• Medication management by a board-certified psychiatrist must be provided a minimum of twice per week.
• There must be ongoing medical services to evaluate and manage co-morbid medical conditions.
• Integrated treatment, rehabilitation and support must be provided by a multidisciplinary team. There should be linkage and coordination with the patient’s community resources with the goal of returning the patient to his or her regular social environment as soon as possible.
• There should be individual therapy twice a week.
• Group therapy should comprise a minimum of 12.5 hours a week.
• Group sessions should be from 60 and 90 minutes in length.
• At least two group therapy sessions should be “psychological” sessions, such as process groups and dialectal behavior therapy.
• The remaining groups may be expressive, such as art, dance, psychodrama therapy and psycho-educational groups.
• Recreational activities should be available for those able to participate and there should be a minimum of four hours of treatment or activities planned each weekend day.
• Therapies such as equestrian therapy or “ropes” exercises may be included but not at an additional cost to the member. Wilderness programs are excluded.
• Clinical judgment should be used to determine whether the patient can tolerate the designated amount of group activity. If the patient is unable to participate to the extent described above, the reason should be documented in the chart for each activity.
• For children and adolescents, a certified school program must be provided.
• For geriatric facilities, the care is expected to include availability of activities and resources to meet the social needs of older patients with chronic mental illness. These needs would typically include, at a minimum, company (either external visitors or individuals inside the facility), daily activities and having a close confidant.

If you have questions regarding this program or how to enroll, contact Rose Zidzik at rzidzik@bcbsm.com. Also, check future issues of The Record and web-DENIS for updates.