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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by SLS on May 2, 2008, at 17:31:12
New Jersey recently passed a regulation limiting Medicaid to pay for no more than two years of a partial hospitalization program for psychiatric patients.
I wrote a letter to be sent to NJ politicians and other personages of influence. Enjoy:
http://www.slschofield.com/medicine/medicaid_regulation.html
- Scott
Posted by Phillipa on May 2, 2008, at 21:03:55
In reply to Letter regarding NJ Medicaid regulations., posted by SLS on May 2, 2008, at 17:31:12
Scott excellent letter will this effect you since you're in remission? Love Phillipa
Posted by SLS on May 3, 2008, at 2:37:56
In reply to Re: Letter regarding NJ Medicaid regulations. » SLS, posted by Phillipa on May 2, 2008, at 21:03:55
Hi Phillipa.
> Scott excellent letter will this effect you since you're in remission? Love Phillipa
It won't affect me personally, but it is an important issue that I thought should be addressed.
- Scott
Posted by Phillipa on May 3, 2008, at 13:43:00
In reply to Re: Letter regarding NJ Medicaid regulations., posted by SLS on May 3, 2008, at 2:37:56
And if it is in NJ will eventurally be all over the USA. Phillipa
Posted by SLS on May 4, 2008, at 15:25:00
In reply to Letter regarding NJ Medicaid regulations., posted by SLS on May 2, 2008, at 17:31:12
> New Jersey recently passed a regulation limiting Medicaid to pay for no more than two years of a partial hospitalization program for psychiatric patients.
>
> I wrote a letter to be sent to NJ politicians and other personages of influence.http://www.slschofield.com/medicine/medicaid_regulation.html
Any comments?
How does this compare to the Medicaid program in your state regarding partial hospitalization and partial care programs for the mentally ill?
- Scott
Posted by Linus on May 22, 2008, at 19:55:51
In reply to Medicaid regulations - Any Comments?, posted by SLS on May 4, 2008, at 15:25:00
Hi,
I am new to this forum, but wanted to post a follow-up to Partial Care Programs vs. Partial Hospitalization in New Jersey.
In my opinion, I think it was appropriate for Medicaid to impose the two year limit on Partial Hospitalization programs. The cost of treatment is astronomical at a Partial Hospialization Program compared to that of a Partial Care Program and the services offered are very comparable.
For example, a Partial Hospitalization Program can bill State Medicaid close to $400 a day,(maybe more) whereas a Partial Care Program offering similar services for a full 5 hour day is only reimbursed at a rate of $77 a day.
Both programs offer similar treatment:
Individual & Group therapy, ADL Skills, Social skills, Psycho-educational, Medication education/monitoring, MICA services, Anger Management, Symptom management, Case Management, Pre-vocational training...etc.
Both programs are required to have qualified Psychiatrists & Nurses on staff for medication management and comprehensive psychiatric evaluations as well as Social Workers.
I think it is unfair to say it is not the mission of the partial care programs to establish effective medical treatment. It seems to me that many partial care programs are the only entities that address the medical needs of the vulnerable population they treat.
Of course, I think it's fair to say that not all partial care programs are created equal. There are programs that are severely deficient in the services they provide and yet the State continues to allow them to remain open.
However, there are many partial care programs that go above and beyond what is required and yet the Medicaid reimbursement rate for partial care has not been increased in close to 20 years. Yet, with every passing year Partial Care programs, must creatively find ways to pay for increases in salaries, utilities, rents, insurance premiums, client transportation, meals, supplies..etc..etc..etc.
The backbone of the mental health delivery system in NJ resides with the partial care program. It is here that the patients are able to learn the necessary skills to function in the community. The learning that takes place within a partial care program is significantly easier to transfer to the real world than that in a partial hospitalization program.
> > New Jersey recently passed a regulation limiting Medicaid to pay for no more than two years of a partial hospitalization program for psychiatric patients.
> >
> > I wrote a letter to be sent to NJ politicians and other personages of influence.
>
> http://www.slschofield.com/medicine/medicaid_regulation.html
>
> Any comments?
>
> How does this compare to the Medicaid program in your state regarding partial hospitalization and partial care programs for the mentally ill?
>
>
> - Scott
Posted by SLS on May 22, 2008, at 22:00:58
In reply to Re: Medicaid regulations - Any Comments?, posted by Linus on May 22, 2008, at 19:55:51
> Program compared to that of a Partial Care Program and the services offered are very comparable.
Thank you for pointing out a weakness in my letter. I did not describe very well the differences between a partial hospitalization program and a partial care program.
They are not comparable.
First of all, and perhaps most importantly, a psychiatrist can be seen as often as is needed to treat an acutely ill individual. Partial care programs offer a patient an office visit with a psychiatrist once every three months.
> For example, a Partial Hospitalization Program can bill State Medicaid close to $400 a day,(maybe more) whereas a Partial Care Program offering similar services for a full 5 hour day is only reimbursed at a rate of $77 a day.As was pointed out in the letter, it is cheaper to keep someone in a more thorough clinical treatment program than to allow for frequent hospitalizations at a cost of well over $1000 a day. It is the job of the partial care program to treat an individual so that they can remain stable enough to maintain the higher level of functioning required in a partial care facility. For instance, partial care facilities are not equipped to handle actively psychotic individuals, whether it be schizoid or manic in nature.
I have personally been involved in both types of programs. They are not comparable, as the goal of PH is to treat the acute illness, while PC is geared towards an individual's return to the community with the emphasis on vocational rehabilitation.
- Scott
Posted by SLS on May 23, 2008, at 5:23:00
In reply to Re: Medicaid regulations - Any Comments?, posted by SLS on May 22, 2008, at 22:00:58
Oops. Poor proofreading:
Should be:
It is the job of the partial HOSPITALIZATION program to treat an individual so that they can remain stable enough to maintain the higher level of functioning required in a partial care facility.
- Scott
Posted by Linus on May 23, 2008, at 6:49:58
In reply to Re: Medicaid regulations - Any Comments?, posted by SLS on May 22, 2008, at 22:00:58
Thank you, for clarifying one important difference in both programs. Partial Hospitalization programs are supposed to work with the more acute populations..ie., actively psychotic individuals.
However, I think the reason why Medicaid has felt the need to issue some restrictions is because aside from actively psychotic individuals there are many consumers that are functioning at higher levels that would be very well suited in partial care programs, but have remained at Partial Hospitalization programs for years on end.
It should be the Partial Hospitalization programs responsibility to identify these individuals that are not acutely psychotic and refer them to an appropriate Partial Care Program for a cost savings to Medicaid of up to $60,000 a year per person.
In addition, a Partial Care Program will provide for clients to be seen as often as necessary by the programs Psychiatrist to accomodate medication adjustments and psychiatric intervention for the stabilization of the acute phase of an illness.
> > Program compared to that of a Partial Care Program and the services offered are very comparable.
>
> Thank you for pointing out a weakness in my letter. I did not describe very well the differences between a partial hospitalization program and a partial care program.
>
> They are not comparable.
>
> First of all, and perhaps most importantly, a psychiatrist can be seen as often as is needed to treat an acutely ill individual. Partial care programs offer a patient an office visit with a psychiatrist once every three months.
>
> > For example, a Partial Hospitalization Program can bill State Medicaid close to $400 a day,(maybe more) whereas a Partial Care Program offering similar services for a full 5 hour day is only reimbursed at a rate of $77 a day.
>
> As was pointed out in the letter, it is cheaper to keep someone in a more thorough clinical treatment program than to allow for frequent hospitalizations at a cost of well over $1000 a day. It is the job of the partial care program to treat an individual so that they can remain stable enough to maintain the higher level of functioning required in a partial care facility. For instance, partial care facilities are not equipped to handle actively psychotic individuals, whether it be schizoid or manic in nature.
>
> I have personally been involved in both types of programs. They are not comparable, as the goal of PH is to treat the acute illness, while PC is geared towards an individual's return to the community with the emphasis on vocational rehabilitation.
>
>
> - Scott
Posted by SLS on May 23, 2008, at 7:20:51
In reply to Re: Medicaid regulations - Any Comments?, posted by Linus on May 23, 2008, at 6:49:58
Hi Linus.
I agree with you completely.
I would just add that there are other mental illnesses besides those expressing psychosis that can reduce someone's ability to function so as to prevent them from entering a partial care program.
Maybe there can be some sort of Medicaid scrutinization or oversight program to review individual cases and make determinations based on documentation. It would certainly be cost-effective.
I appreciate the cost figures you posted. To my knowledge, they are accurate.
- Scott
********************************************************
> Thank you, for clarifying one important difference in both programs. Partial Hospitalization programs are supposed to work with the more acute populations..ie., actively psychotic individuals.
> However, I think the reason why Medicaid has felt the need to issue some restrictions is because aside from actively psychotic individuals there are many consumers that are functioning at higher levels that would be very well suited in partial care programs, but have remained at Partial Hospitalization programs for years on end.
>
> It should be the Partial Hospitalization programs responsibility to identify these individuals that are not acutely psychotic and refer them to an appropriate Partial Care Program for a cost savings to Medicaid of up to $60,000 a year per person.
This is the end of the thread.
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