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Reimbursement for partial hospitalization: a survey and policy implications
1Department of Psychiatry, Georgetown University School of Medicine, Washington, D.C.
The American Journal of Psychiatry
|December 1, 1988
Summary
Reimbursement barriers for partial hospitalization are decreasing, but clinicians often need special agreements for coverage. Medicare policies still present challenges for widespread use of this mental health service.
Area of Science:
- Health Services Research
- Mental Health Policy
- Healthcare Economics
Background:
- Partial hospitalization is underutilized, often attributed to inadequate third-party reimbursement.
- Understanding payer policies is crucial for expanding access to partial hospitalization services.
Purpose of the Study:
- To investigate the reimbursement policies of various payers for partial hospitalization services.
- To identify barriers and facilitators to coverage for partial hospitalization programs.
Main Methods:
- Survey of health maintenance organizations (HMOs), public, and private insurance providers.
- Analysis of payment policies and coverage requirements for partial hospitalization.
Main Results:
- Reimbursement barriers in the private sector are lessening, though extracontractual agreements are often necessary.
- Partial hospitalization is appealing to capitated payers like HMOs due to utilization controls.
- Medicare reimbursement for hospital-based programs may improve, but statutory disincentives persist.
Conclusions:
- While private payer reimbursement is improving, challenges remain, particularly with Medicare.
- Extracontractual agreements are a common workaround for obtaining coverage.
- Policy adjustments are needed to fully support the widespread adoption of partial hospitalization.