Intensive Outpatient Program (IOP) Accreditation Guidelines
Provider Administrative Policy
Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts
Purpose and Statement of Intent
The intent of this policy is to promote reasonable and consistent quality requirements for providers of intensive outpatient program services (IOP). We established these requirements to describe the accreditation and certification conditions often found in successful IOP programs in hopes of establishing appropriate clinical guidelines and techniques for qualified clinicians to perform IOP services.
These requirements apply to all non-hospital providers of IOP services. They supplement the requirements for providers contained in Attachment B to the clinic agreement.
Program Administrative Requirements for IOP Providers
Providers must have the following policy, procedures and documents available upon written request for Blue Cross of Idaho’s review.
- Policies and procedures addressing life safety
- Quality assessment and improvement information
- Current annual quality assessment and improvement plan
- Samples of QA and QI monitors for each program
- Staffing information
- Number of staff by discipline in each program
- Copy of license, diploma, and certification for each staff member
- Utilization review plan
- Risk management plan
- Material or brochure describing each program
- Accreditation letter or certificate, if applicable
- State license or certificate of operation
- State fire inspection certificate
- Documentation of owner/financial responsibility
Clinical Requirements for IOP Service Providers
Substance Abuse Intensive Outpatient Treatment
A concentrated, nonresidential program of individual and group therapy, education and activities for detoxified individuals and their families. Blue Cross of Idaho characterizes the treatment primarily by a group approach, which has didactic and process components. A critical component is focus on relapse prevention. The SA-IOP must provide nine or more hours per week of structured programming; three or more days per week. The treatment modality used by the SA-IOP must be an approved evidenced based treatment program as defined by SAMHSA’s National Registry of Evidenced based Programs and Practices.
Eating Disorder Intensive Outpatient Treatment
Services provided to individuals with eating disorders who function well during the day but may need structure and support during evening hours. Services provided include participation in nutrition and therapy sessions, individual therapy and family therapy, weekly needs assessment and education. Medical/psychiatric consultations or referrals as clinically appropriate to the individuals functioning level. The eating disorder-IOP must provide nine or more hours per week of structured programming; three or more days per week.
Psychiatric Intensive Outpatient Treatment
A concentrated treatment program that includes extended periods of therapy sessions, several times a week for a minimum of three hours per day, a minimum of three days per week and a minimum of nine hours per week. The individual must have a DSM-IV diagnosis and quality for this level of care based on their psychiatric functioning level.
Covered IOP Service Providers
Blue Cross of Idaho does not recognize IOP as a provider typer or contract directly with IOP service providers. These are services that qualified contracting providers can offer in addition to the standard agreement. Alcohol and drug counselor certified by the Idaho Board of Alcohol/Drug Counselor’s Certification, Inc. (CADC or Advanced CADC) and licensed social worker licensed in Idaho by the State Board of Social Work Examiners under Title 54, Chapter 32, Idaho Code who, must have specialized training, education and experience treating persons with problems related to alcohol or substance use disorders may see members participating in substance abuse IOP programs only. A psychiatrist, psychologist or master level clinician compliant with PAP900 must supervise these providers at all times.
Medical Policy 3.01.99 covers additional clinical requirements.
|July 2013||Revised||Content update for "Covered IOP Service Providers" section|