Outpatient care
This level of care is the least intensive level of treatment and represents the majority of care delivered. Psychiatric medication management visits are typically 15 minutes in length. Individual psychotherapy sessions occur for up to 50-60 minutes and group psychotherapy sessions for up to 90 minutes. This service is conducted in an office setting.
A. Medical necessity
All 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 must be met to recommend treatment.
- As a consequence of a DSM-IV diagnosis, the individual is experiencing significant impairment in functioning in one or more of the following areas:
- Social
- Occupational
- Educational
- Family role
- The proposed treatment plan is focused on:
- Adaptive responses to present impairments
- Clearly defined and measurable goals
- A defined time frame
- The patient has the requisite cognitive and emotional skills necessary to benefit from the proposed treatment plan.
C. Continuing care criteria
All must be met to recommend continuing care.
- There is evidence that the patient is working to complete treatment goals and is attending sessions as scheduled.
- The patient continues to exhibit impairment (GAF <70) requiring further treatment.
- The treatment plan clearly addresses the impairments necessitating ongoing care.
- If the GAF is >70, the patient has a diagnosis of a persistent DSM-IV disorder that requires maintenance treatment to avoid recurrence of symptoms.
