Psychiatric Partial Hospitalization Programs
A psychiatric partial hospitalization program (PHP) provides an appropriate setting for crisis stabilization or treatment of partially stabilized behavioral health disorders and serves as a transition from an inpatient program when medically necessary.
All psychiatric PHPs must be TRICARE-authorized by the NQMC, Maximus. Providers may contact Maximus by the following means:
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Mail
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NQMC—Maximus
1600 E. Northern Avenue
Suite 100
Phoenix, AZ 85020 |
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Phone
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1-602-308-7160 |
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E-mail
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nqmc@maximus.com |
Additionally, psychiatric PHP facilities must be capable of providing an interdisciplinary program of medically therapeutic services at least three hours per day, up to five days per week, including day, evening, or weekend treatment.
PHP coverage details include:
- Prior authorization is required for all PHP admissions, without exception.
- The beneficiary must be evaluated by a psychiatrist (for psychiatric PHPs) or by a physician or other allied health professional with admitting privileges (for chemical dependency PHPs).
- PHP care is limited to a maximum of 60 treatment days (whether a full-day or half-day program) in a fiscal year (October 1–September 30) or for any single admission. The limit may be waived if the treatment is determined to be medically necessary.
- The 60 PHP treatment days are not offset by, nor counted toward, the inpatient limit of 30 days for beneficiaries age 19 years and older or 45 days for beneficiaries age 18 years and younger.
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