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Hospital Services

Section 46 - Psychiatric Hospital Services

Psychiatric Hospital is a hospital that is primarily engaged in providing psychiatric services for the diagnosis, treatment and care of persons with mental illness. A psychiatric hospital must be licensed as a psychiatric hospital by the Department of Health and Human Services (DHHS).


Inpatient Psychiatric Hospital Services

Covered services include those services ordinarily provided in a psychiatric hospital for the 24 hour care and treatment of an inpatient under the supervision of a psychiatrist and in accordance with the member's plan of care.


Partial Hospitalization Services

The provider shall provide an intensive and structured service of alcohol and drug assessment, diagnosis, including co-occurring mental health and substance abuse diagnoses, and treatment services in a non-residential setting aimed at members who meet ASAM placement criteria level II.1 or level II.5. IOP may include individual, group, or family counseling as part of a comprehensive treatment plan. The provider will make provisions for the utilization of community resources to supply client services when the program is unable to deliver them. Each program shall have a written agreement with, or, shall employ, a physician and other professional personnel to assure appropriate supervision and medical review and approval of services provided.