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Behavioral health; long-term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem

HCPCS code

Name of the Procedure:

Behavioral Health Residential Treatment (H0019)
Common names: Long-term residential treatment, Residential behavioral health care
Technical/Medical term: Long-term residential behavioral health care without room and board, per diem

Summary

This procedure involves extended residential care in a treatment program for individuals grappling with behavioral health issues. It is a non-medical, non-acute level of care where patients stay in a residential facility for more than 30 days. Room and board are not included in this service.

Purpose

Medical Conditions/Problems Addressed:

  • Chronic mental health conditions
  • Substance use disorders
  • Severe emotional or behavioral issues

Goals/Expected Outcomes:

  • Stabilization of behavioral health conditions
  • Development of coping and life skills
  • Long-term improvement in mental health and quality of life
  • Reduction in hospitalizations and emergency room visits

Indications

Specific Symptoms or Conditions:

  • Persistent mental health issues unresponsive to outpatient treatment
  • Severe substance abuse requiring a structured environment
  • Situations where home environment is not conducive to recovery

Patient Criteria:

  • Patients who have completed detoxification if applicable
  • Individuals committed to long-term intensive therapy
  • Adequate self-care capability for daily needs

Preparation

Pre-Procedure Instructions:

  • Comprehensive health and psychological evaluation
  • Consent form completion and understanding of the treatment plan
  • Possible medication adjustments or discontinuation under medical supervision

Diagnostic Tests/Assessments:

  • Baseline mental and physical health assessment
  • Possible lab tests to ensure readiness for residential stay
  • Substance abuse screening if applicable

Procedure Description

  1. Admission:

    • Thorough intake process including documentation review and assessments
    • Orientation session to familiarize with facility rules, schedules, and resources
  2. Day-to-Day Care:

    • Individual therapy sessions with licensed therapists
    • Group therapy and support groups
    • Educational workshops on mental health, coping strategies, and life skills
    • Recreational and therapeutic activities (e.g., art therapy, exercise programs)
  3. Tools and Equipment:

    • Therapy rooms, recreational spaces
    • Assessment tools and diagnostic tests as needed
    • Medication management systems where applicable
  4. Anesthesia or Sedation: Not applicable

Duration

The residential stay typically exceeds 30 days, depending on individual progress and treatment goals.

Setting

The procedure is performed in a specialized residential treatment facility.

Personnel

  • Mental health therapists (counselors, psychologists)
  • Support staff (assistant counselors, residential coordinators)
  • Medical professionals for medication management (if needed)
  • Administrative staff

Risks and Complications

Common Risks:

  • Adjustment period discomfort
  • Potential for relapse or withdrawal symptoms

Rare Risks:

  • Adverse reaction to any prescribed medications
  • Interpersonal conflicts within the residential setting

Management of Complications:

  • Continuous monitoring and support
  • Adjustment of treatment plans
  • Referral to higher levels of care if necessary

Benefits

Expected Benefits:

  • Stabilization and improvement in behavioral health conditions
  • Acquiring new coping mechanisms and life skills
  • Better long-term prognosis and quality of life

Timeframe for Benefits:

  • Continuous improvement is expected over the course of the residential stay, with long-term benefits realized post-treatment.

Recovery

Post-Procedure Care:

  • Follow-up appointments with outpatient providers
  • Possible continuing care recommendations (e.g., halfway houses, outpatient therapy)

Recovery Time:

  • Varies by individual, but support is ongoing even after discharge to ensure sustained recovery.

Restrictions:

  • Participation in structured daily routines
  • Adherence to therapy schedules and guidelines

Alternatives

Other Treatment Options:

  • Outpatient therapy or counseling
  • Short-term residential treatment
  • Day programs or partial hospitalization programs

Pros and Cons:

  • Outpatient therapy may offer more flexibility but less intensive support
  • Short-term residential provides stabilization but may not be sufficient for chronic issues
  • Day programs offer structured support but lack the immersive environment of residential care

Patient Experience

During the Procedure:

  • Patients may experience an adjustment period with varying levels of comfort
  • Structured daily routines can provide stability and support

After the Procedure:

  • Continued support and aftercare for long-term maintenance of recovery
  • Possible emotional and psychological growth, leading to improved coping strategies

Pain Management and Comfort Measures:

  • Regular therapeutic support to address discomfort and challenges
  • Access to recreational and relaxation activities

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