Section 1153.2. Definitions

The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

Adult partial hospitalization program—A program licensed by the Department, Office of Mental Health, to provide partial hospitalization services to individuals 15 years of age or older.

Children and youth partial hospitalization program—A program licensed by the Department Office of Mental Health, to provide partial hospitalization services to individuals 14 years of age or younger.

Clinical staff—A psychiatrist or a mental health professional or mental health worker under the direct supervision of a psychiatrist.

Collateral family psychotherapy—Psychotherapy provided to the family members of a clinic patient in the absence of that patient.

Department—The Department of Human Services.

Family—A person living alone or the following persons: spouses; parents and their unemancipated minor children and other unemancipated minor children who are related by blood or marriage; or other adults or emancipated minor children living in the household who are dependent upon the head of the household.

Family psychotherapy—Psychotherapy provided to two or more members of a family. At least one family member shall have a diagnosed mental disorder. Sessions shall be at least 1/2 hour in duration and shall be conducted by a clinical staff person.

Group psychotherapy—Psychotherapy provided to no less than two and no more than ten persons with diagnosed mental disorders for a period of at least 1 hour. These sessions shall be conducted by a clinical staff person.

Home visit—A visit made to an eligible recipient’s place of residence, other than a treatment institution or nursing home, for the purpose of observing the patient in the home setting or providing a compensable outpatient psychiatric service.

Individual psychotherapy—Psychotherapy provided to one person with a diagnosed mental disorder for a minimum of 1/2 hour. These sessions shall be conducted by a clinical staff person.

Inpatient—A patient who has been admitted to a treatment institution or an acute care hospital or psychiatric hospital on the recommendation of a physician and is receiving room, board and professional services in the facility on a continuous 24-hour-a-day basis.

Intake—The first contact with a patient for initiation or renewal of services.

Mental disorder—Conditions characterized as mental disorders by the International Classification of Diseases—ICD-9-CM—including mental retardation with associated psychiatric conditions (ICD-9-CM codes 317 to 319) and excluding drug/alcohol conditions (ICD-9-CM codes 291—292.9).

Mental health professional—A person trained in a generally recognized clinical discipline including but not limited to psychiatry, social work, psychology or nursing, rehabilitation or activity therapies who has a graduate degree and clinical experience.

Mental health worker—A person who does not have a graduate degree in a clinical discipline but who by training and experience has achieved recognition as a mental health worker, or a person with a graduate degree in a clinical discipline.

Outpatient—A person who is not a resident of a treatment institution and who is receiving covered medical and psychiatric services at an approved or licensed outpatient psychiatric clinic or partial hospitalization facility which is not providing him with room and board and professional services on a continuous 24-hour-a-day basis.

Psychiatric clinic clozapine monitoring and evaluation visit—A minimum 15-minute visit for the monitoring and evaluation of a patient’s physical and mental condition during the course of treatment with clozapine. The term includes only a visit provided to an eligible recipient receiving clozapine therapy, and only by a psychiatrist, physician, registered nurse (RN) or physician assistant.

Psychiatric clinic medication visit—A minimum 15-minute visit only for administration of a drug and evaluation of a patient’s physical and mental condition during the course of prescribed medication. This visit is provided to an eligible recipient only by a psychiatrist, physician, registered nurse or licensed practical nurse who is a graduate of a school approved by the State Board of Nursing or who has successfully completed a course in the administration of medication approved by the State Board of Nursing.

Psychiatric evaluation—An initial mental status examination and evaluation of a patient provided only by a psychiatrist in a face-to-face interview with the patient. It shall include a comprehensive history and evaluation of pertinent diagnostic information necessary to arrive at a diagnosis and treatment plan, recommendations for treatment or further diagnostic studies or consultation. The history shall include individual, social, family, occupational, drug, medical and previous psychiatric diagnostic and treatment information.

Psychiatric outpatient clinic provider—A facility approved by the Department, Office of Medical Assistance, and fully approved/licensed by the Department, Office of Mental Health, to provide specific medical, psychiatric and psychological services for the diagnosis and treatment of mental disorders. Treatment is provided to eligible Medical Assistance outpatient recipients who are not residents of a treatment institution or receiving similar treatment elsewhere.

Psychiatric outpatient clinic services—Outpatient medical, psychiatric and psychological services listed in the MA Program Fee Schedule furnished to a mentally disordered outpatient while the person is not a resident of a treatment institution, provided by or under the supervision of a psychiatrist in a facility organized and operated to provide medical care to outpatients.

Psychiatric outpatient partial hospitalization provider—A facility approved by the Department of Human Services, Office of Medical Assistance, to provide partial hospitalization services and fully approved/licensed by the Department, Office of Mental Health, to provide psychiatric, medical, psychological and psychosocial services as partial hospitalization for the diagnosis and treatment of mental disorders. Treatment is provided to eligible MA outpatient recipients who are not residents of a treatment institution or receiving similar treatment elsewhere.

Psychiatric partial hospitalization—An active outpatient psychiatric day or evening treatment session including medical, psychiatric, psychological, and psychosocial treatment listed in the MA Program Fee Schedule. This service shall be provided to mentally disordered outpatients in a supervised, protective setting for a minimum of 3 hours and a maximum of 6 hours in a 24-hour period. The session shall be provided by a psychiatrist or by psychiatric partial hospitalization personnel under the supervision of a psychiatrist.

Psychologist in preparation for licensure—A person who has completed the educational requirements for licensure and is accruing the required postdegree experience for licensing.

Psychotherapy—The treatment, by psychological means, of the problems of an emotional nature in which a trained person deliberately establishes a professional relationship with the patient with the object of removing, modifying or retarding existing symptoms, of mediating disturbed patterns of behavior, and of promoting positive personality growth and development.

Supervision by a psychiatrist—The psychiatrist personally provides or orders, guides and oversees compensable medical, psychiatric and psychological services provided to recipients by psychiatric outpatient clinic or partial hospitalization personnel as specified in § 1153.52(a) (relating to payment conditions for various services).

Treatment institution—A facility approved or licensed by the Department or its agents that provides full- or part-time psychiatric treatment services for resident patients with mental disorders—mental retardation residential facilities or community residential rehabilitation services are not considered to be mental health institutions.

The provisions of this § 1153.2 adopted January 25, 1980, effective February 1, 1980, 10 Pa.B. 267; amended October 2, 1981, effective October 3, 1981, 11 Pa.B. 3387; amended November 13, 1981, effective November 15, 1981, 11 Pa.B. 4046; amended December 23, 1983, effective January 1, 1983, 13 Pa.B. 3932; amended September 30, 1988, effective October 1, 1988, 18 Pa.B. 4418; amended January 24, 1992, effective November 9, 1991, 22 Pa.B. 361. Immediately preceding text appears at serial pages (131000) to (131003).

Notation

Cross References

This section cited in 55 Pa. Code § 1153.52 (relating to payment conditions for various services).