PRIMARY HEALTH CHOICE, INC
 A PRIMARY CHOICE, INC

  "Individuals' First Choice"

 - In God We Trust -
 

Coporate Office

219 West Broad Street

St Pauls, North Carolina 28384

 

910.865.3500

1.888.739.1445

Outpatient Therapy

    Outpatient Treatment is a service designed to meet the clinically significant behavior or psychological symptoms or patterns that have been identified as treatment needs of the recipient. This service is provided through scheduled therapeutic treatment sessions. The service may be provided to an individual, family, or group. Outpatient Treatment consists of multiple activities with the goal of meeting the clinical needs of service recipients. Outpatient services include: counseling, psychotherapy, medication therapy, assessment, psychological testing and collateral work with family (or substitute family) members of a service recipient of all ages. The purpose of Psychiatric Consultation is to provide sufficient psychiatric contact to access for potential usefulness of medication and ensure medical stabilization if medication is prescribed to recipients of all ages and funding sources.

II. Therapeutic Relationship and Interventions

There should be a supportive and therapeutic relationship between the provider and service recipient or primary caregiver which addresses and/or implements the interventions outlined in the service plan in any one of the following:

  • mental health therapy,
  • medication administration and monitoring,
  • behavioral counseling,
  • counseling for substance abuse issues including methadone treatment and outpatient detoxification services. Education about mental health and/or substance abuse

III. Cognitive and Behavioral Skill Acquisition

This service includes interventions that:

A.      address functional problems associated with affective or cognitive problems and/or the recipients diagnostic conditions;

B.      are strength-based and focused on improving the quality of the recipients life and/or providing assistance to the caregiver in better meeting the needs of the recipient in the most natural environment;

C.      prescribe to alleviating the identified need(s) as well as assistance with skill acquisition/or enhancement and support of functional gains.

 IV. Service Type and Setting

This is a periodic, professional level service that may be offered on an individual or group basis.  The service provides direct, face-to-face contact with the individual, the family or group in any location.

 

Outpatient-Group services may be reimbursed up to 2 hours and 45 minutes. This service is Medicaid billable.

 

This service is designed as a structured face-to-face therapeutic intervention to provide support and guidance in preventing, overcoming, or managing identified needs on the service plan to aid with improving level of functioning, increasing coping abilities or skills, or sustaining a successful level of functioning on an outpatient basis

 

Telemedicine and Telepsychiatry may be provided to recipients in situations where on-site services are not available due to distance, location, time of day, or availability of resources.  Telepsychiatry may be used when professional on-site services is not available, emergency services is needed, interim coverage when the psychiatrist/clinician is unavailable, or other situations which would prevent or delay service delivery to a recipient. (See Appendix C-Telemedicine and Telepsychiatry Policy & Procedure)

Recipients under the Age of 21

Place of service is limited to the provider's office, clinic, school, residential facilities, and home.

Recipients Aged 21 and Over

Place of service is limited to the provider's office, clinics, home, nursing facilities, assisted living facilities, and adult care homes.

 V. Resiliency/Environmental Intervention

This service may focus on assisting the individual, family or group to meet the treatment needs of the recipient in any location. This structured treatment modality targets developing, improving, or maintaining naturally occurring supports and relationships in the recipients natural environment, both formal and informal.

 VI. Eligible Recipients: All Medicaid-eligible recipients are eligible for services. General Provisions

Medicaid recipients may have service restrictions due to their eligibility category that would make them ineligible for this service.