Intensive outpatient therapy - psychiatric
This level of care includes services at lesser levels of acuity than partial hospitalization. It is intended to be provided less than 4 hours daily but may be offered up to 7 days weekly.
A. Medical necessity
All criteria are required to consider for treatment.
- The patient must have been diagnosed with a psychiatric disorder by a licensed mental health professional.
- Symptoms of this illness must accord with those described in the Diagnostic and Statistical Manual of Mental Disorders, Edition IV (DSM-IV).
- The diagnosis must have been arrived at prior to admission in a face-to-face encounter between the professional and the patient.
B. Admission criteria
All criteria must be met to recommend treatment.
- There is documentation of significant and acute deterioration in social, occupational, educational or family functioning.
- The proposed treatment plan addresses the signs and symptoms consistent with the observed deterioration in functioning.
- The patient's condition will benefit from the proposed intervention.
- There is at least moderate impairment (a GAF less than 70).
C. Continuing care criteria
All criteria must be met to recommend continuing care.
- The patient continues to exhibit signs and symptoms consistent with admission criteria.
- The treatment plan reflects ongoing interventions to alleviate these impairments.
- Clinical documentation supports that attempts to transition to a lower level of care would likely result in decompensation or exacerbation of the illness.
- Additional criterion for children/adolescents: There is clear documented evidence of significant family involvement with and adherence to treatment or clear evidence that this is medically contraindicated.
