Medicare Part B covers partial hospitalization for mental health treatment. Partial hospitalization programs offer outpatient care in a hospital setting on a part-time basis, which can mean only during the day, only at night, or only during weekends. Partial hospitalization programs provide care that is more intensive than other forms of outpatient mental health care, but less intensive than inpatient care. In such a program, you will follow a plan of care A plan of care is a doctor’s written plan describing the type and frequency of health services a particular patient needs. tailored to your needs. Services may include the following:
- Individual or group therapy
- Occupational therapy Occupational therapy is therapy that helps you regain the ability to do usual daily activities by yourself, such as eating and putting on clothes.
- Activity therapies, such as art, dance, or music therapy, when they are used to help you meet the goals of your plan of care
- Prescription drugs that you cannot administer yourself
- Training and education closely related to your plan of care
- Family counseling that primarily supports your treatment (not if it primarily promotes the general wellbeing of the family)
- Services needed to diagnose your condition and evaluate your care
Partial hospitalization programs may be offered by hospital outpatient departments and by community mental health centers. Medicare covers your partial hospitalization care if both of the following apply:
- A doctor certifies that:
- You would otherwise need inpatient treatment, or have recently been discharged from inpatient care and need partial hospitalization to avoid a relapse in your condition
- And, less intensive treatment options (such as outpatient therapy) would not be enough to help you avoid hospitalization
- You receive care from a Medicare-certified Medicare-certified means offering services at a level of quality approved by Medicare. Medicare will not pay for services received from a health care provider that is not Medicare-certified. program
For more information on Medicare coverage of partial hospitalization care, contact your State Health Insurance Assistance Program (SHIP).