Definitions for levels of care
Priority Health recognizes the following distinct levels of care. Click any title to go to the criteria for that level.
Definitions for levels of care: Psychiatric disorders
- Acute inpatient - The highest intensity of medical and nursing services provided within a structured environment providing 24-hour skilled nursing and medical care. Full and immediate access to ancillary medical care must be available for those programs not housed within general medical centers.
- Crisis residential treatment - A non-medical, supervised, structured living arrangement for patients in a partial hospital program. The residential program is used for short-term crisis stabilization and provides supervised overnight care in a non-medical setting.
- Residential treatment - Care provided at a sub-acute level with skilled nursing care. These services can be provided in intermediate care facilities (ICF) or have other licensing designations that may vary by state.
- Partial hospital - An intensive non-residential level of service where multidisciplinary medical and nursing services are required. This care is provided in a structured setting, similar in intensity to inpatient, meeting for more than 4 hours (and, generally, less than 8 hours) daily.
- Intensive outpatient - Multidisciplinary, structured services provided at a greater frequency and intensity than routine outpatient treatment. These are generally up to 4 hours per day, up to 5 days per week. Common treatment modalities include individual, family, and group psychotherapy and medication management.
- Outpatient - The least intensive level of service, provided in an office setting. Individual psychotherapy sessions last for up to 60 minutes per day and group psychotherapy sessions for up to 90 minutes per day.
- 23-hour observation - "23-hour beds" are defined as a period of up to 23 hours during which services are provided at less than an acute level of care. It is indicated for those situations where full criteria are not met because of external factors relative to information gathering or risk assessment yet the patient clearly at risk for harm to self or others.
Definitions of levels of care: Substance use disorders
Priority Health recognizes the following as distinct levels of care and follows the ASAM PPC-2R for authorization decision-making.
- Inpatient detoxification – Detoxification services provided in an inpatient setting with full skilled nursing and medical care. Generally, services are provided on inpatient or sub-acute units. They can also be provided on a medical/surgical unit or other medical hospital unit when needed for safety or in the absence of adequate services elsewhere.
- Inpatient rehabilitation – Care provided at an inpatient facility or sub-acute level with skilled nursing care after a patient has fully or partially recovered from acute detoxification symptoms and no longer requires intensive medical monitoring. These services can be provided in intermediate care facilities (ICFs) or have other licensing designations that may vary by state.
- Residential treatment – Twenty-four-hour-per-day supervised care for a substance use disorder diagnosis not requiring full nursing and medical services.
- Outpatient/ambulatory detoxification – Detoxification services delivered within a structured program having medical and nursing supervision where physiological consequences of substance withdrawal do not have life-threatening potential.
- Partial hospital – An intensive, non-residential level of care where multidisciplinary medical and nursing services are required. This care is provided in a structured setting, similar in intensity to an inpatient setting, meeting for more than four hours (and, generally, less than eight hours) daily. Such care is appropriate for substance use disorder treatment when provided in conjunction with ambulatory detoxification or when medical co-morbidity or other complications make less intensive levels of care unsafe or inadequate.
- Intensive outpatient– Multidisciplinary, structured services provided at a frequency of up to four hours daily, up to five days per week, for the treatment of a substance use disorder.
- Outpatient –The least intensive level of service, provided in an office setting. Individual psychotherapy sessions occur for up to 60 minutes per day and group psychotherapy sessions for up to 90 minutes per day.