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Last Modified: 10/16/2024 Location: FL, PR, USVI Business: Part A

Checklist: Community Mental Health Centers (CMHC) or Partial Hospitalization Program (PHP)

This checklist is intended to provide Healthcare providers with a reference to use when responding to medical documentation requests pertaining to Community Mental Health Centers (CMHC) or Partial Hospitalization Program (PHP). It is not intended to replace published guidelines. Healthcare providers retain responsibility to submit complete and accurate documentation.

Check
Documentation description
 
Documentation is for the correct beneficiary and date of service.
 
Documentation is complete, legible, signed and dated by the physician or clinician.
 
Physical examination upon admission (if not done within the past 30 days and/or not available from another provider) must be included in the medical record.
 
A referral source (if applicable)
 
Initial psychiatric evaluation, including history and mental status examination.
 
Physician certification/recertification and documentation of physician supervision.
Signature – The physician recertification must be signed by a physician who is treating the patient and has knowledge of the patient’s response to treatment.
 
The patient’s response to the therapeutic interventions provided by the PHP/CMHC
 
Treatment goals for coordination of services to facilitate discharge from the PHP/CMHC
 
Treatment Plan
 
Progress Notes
 
Psychotherapy notes
 
Group notes
 
Behavior monitoring flow sheets if applicable
 
Treatment team, person-centered active treatment plan, and coordination of services
 
Evidenced that an advanced beneficiary notice of non-coverage (ABN) was provided to the beneficiary, if applicable.
Disclaimer
This checklist was created as an aid to assist providers. This aid is not intended as a replacement for the documentation requirements published in national or local coverage determinations, or the CMS documentation guidelines. It is the responsibility of the provider of services to ensure the correct, complete, and thorough submission of documentation.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.