How a Partial Hospitalization Program (PHP) Works for Mental Health Treatment

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When outpatient therapy sessions aren't enough to manage your mental health, it's helpful to know your options.

You may have heard about inpatient hospitalization, where you stay overnight for round-the-clock care. But inpatient mental health care can be expensive. And it can also be hard to stay overnight in an unfamiliar, restrictive environment.

So what if you need more help but don't need (or want) to stay in the hospital? What you may not realize is that there are many other options in between typical inpatient and outpatient care - including what's called a partial hospitalization program (PHP). Let's take a closer look.

What's a partial hospitalization program (PHP)?

A partial hospitalization program (PHP) is a structured type of intensive outpatient mental health treatment program. In a PHP, you spend several hours a day in treatment - without being admitted to the hospital overnight. It can be a great option if you don't need 24-hour care, but still need more support than your regular doctor or therapist can provide.

Depending on your diagnosis, you might go to a condition-specific PHP. For example, you may decide to go to a trauma disorder, eating disorder, or obsessive-compulsive disorder PHP. Each treatment program is customized to meet your individual needs.

In a PHP, you also have the opportunity to work with a team of healthcare professionals. Your care team might include:

• Psychiatrist

• Therapist

• Clinical case manager

• Social worker

• Expressive art therapist or teacher

Partial hospitalization programs typically last anywhere from 4 to 8 hours each day, up to 5 days a week. You commute to and from your treatment program each day. Some programs also have a telehealth option so you can participate virtually. Depending on your symptoms, you may spend weeks to several months in a PHP.

Services offered in a PHP

PHPs can include many different types of services, including:

• One-on-one counseling/therapy

• Group therapy

• Skills training

• Medication management

• Educational classes

• Nursing or physical healthcare

• Care coordination

• Aftercare and relapse prevention planning

• Family therapy

• Creative therapies, such as music or art therapy

Who should consider a partial hospitalization program?

PHPs are for people with mental health conditions who need more structure and support than outpatient care can provide.

You might benefit from a PHP if:

• You need a higher level of care for your mental health condition.

• You're having trouble functioning in day-to-day life.

• You're at risk for a mental health relapse.

• Your symptoms aren't well-managed, or you're not improving from regular outpatient visits with a psychiatrist or therapist.

In some cases, a PHP may be an alternative to an inpatient hospitalization. A PHP can also serve as a "step-down" option after you're released from the hospital or a residential program. This can help you gradually adjust back to your everyday life with plenty of support.

What are the advantages of a PHP?

Compared to inpatient or outpatient care, a PHP can have some advantages. These may include:

• Comprehensive mental health care: PHPs are designed so you can access therapy, medication management, and other health services all in one place.

• More flexibility: Since you're not required to stay overnight, you have more flexibility to work or attend school. Inpatient programs are more restrictive and limit the outside activities you can participate in while in the program.

• Lower costs: A PHP usually costs less than inpatient care.

Conditions treated in a PHP

There are many types of PHPs. Examples of conditions that can be treated in a PHP setting include:

• Anxiety disorders

• Obsessive-compulsive disorder (OCD)

• Bipolar disorder

• Major depression

• Eating disorders

• Post-traumatic stress disorder (PTSD)

• Substance use disorders

• Suicidal thoughts or attempts

Your primary care provider or therapist may recommend a particular program based on your mental health diagnosis, and your current symptoms and needs.

How much does a partial hospitalization program cost?

The cost for PHPs can vary widely depending on the program and where you live. Many programs cost a few hundred dollars a day, but this can be higher at some facilities.

Some of the factors that impact the costs include:

• Length of the program

• Location of the facility

• Types of services offered

• Number of healthcare professionals on your treatment team

• Your insurance coverage

Does my insurance cover PHP?

Yes, health insurance usually covers PHPs. The Affordable Care Act (ACA) considers mental health an essential health benefit. This means health insurance companies must cover psychotherapy, inpatient services, and substance use disorder treatment. This also includes partial hospitalization.

However, your health insurance coverage will depend on the insurance plan you have. For example, your insurance company might not pay for PHP if you choose a program that's out of network. You may also have higher coinsurance and copayments depending on where you go.

Also, keep in mind that your health insurance company will often require preauthorization for a PHP. This means you will need a letter of medical necessity, usually from someone already on your healthcare team. The letter should state the diagnosis, treatment, or prevention of a condition.

Medicare coverage

Medicare provides coverage for partial hospitalization. But there are certain requirements. You must get a letter of medical necessity from your doctor's office. You must also confirm that the mental health professional you want to work with accepts Medicare.

You'll receive coverage through Medicare Part B. You'll pay an annual deductible and 20% coinsurance for each day. A Medicare supplement insurance policy, also known as Medigap, can help you pay for some of your out-of-pocket costs.

There's no insurance reimbursement for the following:

• Job training or testing

• Meals

• Support groups for socializing

• Transportation to the care center

Medicaid coverage

Medicaid programs (like Medi-Cal) also cover mental health services. But the services you're eligible for will depend on which state you live in.

To learn more about your coverage for a PHP, you can reach out to your state's Medicaid office. You can also contact programs directly to determine whether they accept Medicaid.

What are the requirements to be admitted to a PHP?

Partial hospitalization programs are considered voluntary treatment. However, you'll probably be asked to commit to certain requirements for admittance.

For example, you may need to commit to attending every day, on time, and for at least a certain number of weeks. In some cases, this might mean taking a break or leave of absence from your job, school, or your responsibilities at home.

Once you decide which type of PHP to apply to, you need to contact the program for admission. A PHP representative will ask you a series of screening questions to determine if the program is appropriate based on your individual situation.

Based on your answers, the PHP staff will recommend you for the program if they believe you're a good fit. Other factors that may determine your eligibility include:

• Having the time and commitment to attend the program

• Being willing to fully participate in the program

• Not having active suicidal thoughts

• Needing a more structured environment than regular outpatient care can provide

• Living in a stable residence

As mentioned above, you may also need support from your outpatient psychiatrist, therapist, or primary care provider. It's likely that you'll have to get prior authorization from your insurance provider, too.

Frequently asked questions

Co-contributor: Reneé Fabian, MA, India B. Gomez, PhD

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