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Medicare Partial Hospital Program Regulations

According to the National Alliance on Mental Health, the United States Congress created the Medicare partial hospitalization program for individuals with acute mental illnesses and substance abuse problems. The partial hospitalization program provides outpatient care in instances of bipolar disorder, depression, schizophrenia, anorexia, Alzheimer's disease, bulimia, and anxiety disorders. This program was added to the Social Security Act in the late 1980's and provides funding for mental outpatient programs designed to improve overall health without requiring full hospitalization.

  1. Qualifications

    • Section 1861 and 1835 of the Social Security Act clearly describes what kind of hospital services qualify for the Medicare partial hospital program. Patients must experience illness that lasts for a period of 60 consecutive days. These illnesses must not require full-time care by a hospital staff, which falls under a different section of Medicare. Services must be responsibly expected to improve the living conditions or functionality of the patient. All services rendered by a medical institution must be approved by a physician before a patient can receive benefits. Outpatient hospitalization services will only be approved as a substitute for full hospitalization.

    Therapy

    • Section 1835(2)(C) of the Social Security Act provides outpatient physical therapy benefits to mentally ill patients, as well as occupational therapy services. Occupational therapy can help those with substance abuse issues or mental illness find a job. Physical therapy can offer a number of health benefits to patients, including reduced pain and mobility. In order to qualify, these therapies must be approved by a doctor and considered necessary to the patient's well being.

    Rehabilitation

    • According to Section 1835(2)(E) of the Social Security Act, patients may be covered by Medicare, if they require the services of an outpatient rehabilitation facility. Rehabilitation facilities can help patients get off of drugs. The mentally ill may use outpatient rehabilitation services in order to manage chronic mood swings or illness, which involves meeting with a psychiatrist regularly. Such a plan must be periodically reviewed by the patient's doctor in order to justify continued use of rehabilitation services.

    Home Health Services

    • According to Section 1835(2)(A) of the Medicare partial hospitalization program, patients who cannot travel to receive medical care due a serious mental condition such as Alzheimer's qualify for home health services. Home health services allow a nurse or a doctor to provide treatment at a patient's residence. These services also apply to individuals who are indigent, represent a danger to others or are not physically able to visit a hospital for treatment.

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