Am J Psychiatry 1988; 145:1514-1520
Copyright © 1988 by American Psychiatric Association
Reimbursement for partial hospitalization: a survey and policy implications
E Leibenluft and RF Leibenluft
Department of Psychiatry, Georgetown University School of Medicine, Washington, D.C.
Lack of third-party reimbursement is frequently cited as a cause of
underutilization of partial hospitalization. The authors contacted a sample
of health maintenance organizations (HMOs) and public and private payers to
obtain information about their payment policies. They conclude that in the
private sector, reimbursement barriers are diminishing but that clinicians
frequently must obtain an extracontractual agreement for coverage. Partial
hospitalization is particularly attractive to HMOs and others that pay on a
capitated basis and can strictly control utilization. A recent
clarification of Medicare guidelines may facilitate reimbursement for
hospital-based programs, but there remain significant disincentives under
the Medicare statute for widespread utilization of partial hospitalization.
