What Is a PHP, and What Does PHP Stand For?
PHP stands for partial hospitalization program. It is a scheduled treatment program for a mental health condition or a substance use disorder. You attend for several hours a day, and you sleep at home.
Medicare’s page on partial hospitalization describes it in one sentence: “Partial hospitalization is a structured program that provides outpatient psychiatric services as an alternative to inpatient psychiatric care.”
The name can mislead, because there is no overnight stay. Federal regulations define the service, under 42 CFR 410.2, as “a distinct and organized intensive ambulatory treatment program that offers less than 24-hour daily care other than in an individual’s home or in an inpatient or residential setting.” Ambulatory here means outpatient: you come in for care and go home.
The regulation that sets out the service, 42 CFR 410.43, lists the conditions services must meet to count as partial hospitalization under Medicare. One is that they are “reasonably expected to improve or maintain the individual’s condition and functional level and to prevent relapse or hospitalization.”
You will also see it written as partial hospitalization, without the word program, and PHP is sometimes called day treatment.
A word on the sources. Medicare’s pages and rules are quoted throughout this guide because they describe the service in plain, public language. The figures in them are Medicare’s. The cost section below covers Ohio.
What Is PHP in Mental Health?
In mental health care, PHP means a partial hospitalization program: a day program that is more intensive than weekly appointments and has no overnight stay. Medicare’s description, quoted above, is written for mental health. It calls the service “outpatient psychiatric services.”
PHP is also a level of care in substance use treatment. Medicare’s regulation counts among a program’s services “Individual and group therapy with physicians or psychologists or other mental health professionals (including substance use disorder professionals) to the extent authorized under State law.” Ohio’s Medicaid rule covers partial hospitalization as substance use disorder treatment, and the sections below quote it.
Leora runs PHP in three tracks at both facilities: a mental health track, a dual diagnosis track for a mental health condition and substance use together, and a substance use track.
The pages on mental health treatment in Ohio and addiction treatment in Ohio describe each side. The page on co-occurring disorders covers treatment for the two together.
How Many Hours a Week Is a PHP?
A PHP takes 20 hours a week or more. Medicare and Ohio Medicaid both use that number.
Medicare’s page says the services “usually include between 4-8 hours of care each day.” It goes on: “You may benefit from partial hospitalization if your care plan states that you require at least 20 hours of therapeutic services each week.”
Ohio’s Medicaid rule on substance use disorder treatment, rule 5160-27-09 of the Ohio Administrative Code, describes partial hospitalization as a level “which requires a minimum of twenty hours of services per week.”
At Leora Behavioral Health, PHP runs Monday to Friday, 9:00 am to 4:15 pm.
Programs arrange their hours in different ways, so ask any program for its weekly schedule before you start.
PHP vs. IOP vs. Inpatient: What Is the Difference?
The levels differ in hours a week and in where you sleep. Here they are from the most care to the least.
- Inpatient and residential. Care with an overnight stay. SAMHSA’s page on types of treatment describes inpatient as “meaning you stay at a hospital or treatment program overnight for a few days or weeks” and residential as “meaning you live at a treatment program.” Leora does not provide either one.
- Partial hospitalization (PHP). At least 20 hours a week in Medicare’s description. You sleep at home. At Leora it runs Monday to Friday, 9:00 am to 4:15 pm.
- Intensive outpatient (IOP). The level below PHP. Medicare’s page on intensive outpatient program services says: “You may benefit from intensive outpatient program services if your care plan states you require at least 9 hours of therapeutic services each week.” At Leora, intensive outpatient is three hours of therapy group a day, three to five days a week. Our guide What Is an IOP? covers that level.
- Standard outpatient. Scheduled appointments. Ohio Medicaid’s rule for substance use disorder treatment limits it “to less than nine hours per week for adults.” At Leora, outpatient care is one to two days a week with two hours of group each time.
Medicare’s pages separate PHP and IOP in one more way. For partial hospitalization, “Your provider must certify that you would otherwise need inpatient treatment.” For intensive outpatient, “You don’t need to qualify for inpatient treatment to get intensive outpatient program services.” Both sentences describe Medicare’s own coverage.
People move between these levels. Some start in PHP. Others come to it after ambulatory detox, step down to it from a hospital or residential stay somewhere else, or step up when intensive outpatient has not held. At Leora the path down from PHP runs through intensive outpatient and then outpatient.
What Level of Care Is PHP?
In substance use treatment the levels of care have numbers. They come from the ASAM Criteria, a standard from the American Society of Addiction Medicine. ASAM describes it as “the most widely used and comprehensive set of standards for placement, continued service, and transfer of patients with addiction and co-occurring conditions.”
Ohio Medicaid writes those levels into rule 5160-27-09. The rule lists level of care 1 as outpatient services, level 2 as “intensive outpatient/partial hospitalization,” and level 3 as residential and inpatient services. Paragraph (F)(2) of the rule, which requires prior authorization for partial hospitalization, gives the service a number of its own: “LOC 2.5 (partial hospitalization).”
So under Ohio’s rule, PHP is level of care 2.5. It shares level 2 with intensive outpatient and sits below residential and inpatient services at level 3.
The numbers belong to substance use treatment. Medicare’s pages, which are written for mental health care, use the same names without them.
What Happens in a Partial Hospitalization Program?
SAMHSA describes intensive outpatient and partial hospitalization together: “This can include one-on-one appointments, group sessions, and learning about coping skills.” It adds that these programs “help coordinate your care more intensively than standard visits and usually last for at least a few hours.”
Medicare’s regulation lists the services a program can include. Besides individual and group therapy, the list names “Family counseling, the primary purpose of which is treatment of the individual’s condition” and “Patient training and education, to the extent the training and educational activities are closely and clearly related to the individual’s care and treatment.”
At Leora, partial hospitalization includes:
- Therapeutic and psychoeducational groups through the program day, led by licensed clinicians
- Separate tracks for mental health, dual diagnosis and substance use, at both facilities
- An individual session with a licensed therapist every week
- Medication management with a nurse practitioner at least once a week
- Registered nurses on staff for clinical support
The groups cover recovery, emotional regulation, coping skills, relapse prevention, mental health education and building healthier habits. They draw on cognitive behavioral therapy and dialectical behavior therapy. Medication assisted treatment is available for substance use disorders, and your treatment plan is built individually with you.
Leora does not provide transportation, so you need a reliable way to get to the facility each day.
How Long Does a PHP Last?
The definitions quoted in this guide set no number of weeks for a PHP. How long it lasts is part of each person’s plan.
Medicare’s rule, 42 CFR 424.24, requires a written plan of treatment that sets out “The type, amount, duration, and frequency of the services.” It also says when a physician has to confirm that the program is still needed: “The first recertification is required as of the 18th day of partial hospitalization services. Subsequent recertifications are required at intervals established by the provider, but no less frequently than every 30 days.”
So the useful question for any program is how it decides when you are ready to step down. At Leora, how long you stay depends on your progress toward the goals you set with your treatment team in the first few days. You and the team plan the discharge date and the next step together: a lower level of care, outpatient therapy, and community recovery support such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).
Who Decides Whether PHP Is the Right Level?
An assessment decides, and it happens before treatment starts.
Medicare’s regulation, 42 CFR 410.43, lists who partial hospitalization programs are intended for. The list includes patients who:
- “Require a minimum of 20 hours per week of therapeutic services as evidenced in their plan of care”
- “Are likely to benefit from a coordinated program of services and require more than isolated sessions of outpatient treatment”
- “Do not require 24-hour care”
- “Have an adequate support system while not actively engaged in the program”
For substance use treatment, Ohio Medicaid’s rule says services “shall be provided according to” the ASAM criteria “for admission, continued stay, discharge, or referral to each level of care (LOC).” ASAM explains how a level is chosen: “Level of care recommendations and treatment plans are developed based on multidimensional patient assessments that consider the patient’s biomedical, psychological, and social needs.”
At Leora the assessment can point to a different level. Ambulatory detox comes first when mild to moderate withdrawal has to be managed; the assessment decides whether it is safe. Intensive outpatient may fit when a job cannot spare the weekdays. Someone who needs care overnight needs a hospital or a residential program, which Leora does not provide. PHP also depends on a safe place to stay each night, because Leora has no beds and no housing.
Can You Work During a PHP?
Programs set their own hours. Ohio’s Medicaid rule says of intensive outpatient and partial hospitalization services: “They can be rendered during the day, before or after work or school, in the evening, and/or on weekends.”
At Leora, PHP is a daytime program. It runs Monday to Friday, 9:00 am to 4:15 pm, which is hard to combine with a full-time job. Intensive outpatient and virtual IOP leave more of the week free.
The federal Family and Medical Leave Act may apply to time off work for treatment. USA.gov summarizes it: “FMLA allows up to 12 weeks of unpaid leave in a 12-month period for qualifying life events. Your employer must protect your job and access to your group health benefits while you are on leave.”
USA.gov also sets out the limits: “Not all employees are eligible for FMLA.” To qualify, you must have worked for your employer for at least 12 months and for at least 1,250 hours in the last 12 months, and your employer must have 50 employees within 75 miles of your worksite.
Leave for substance use treatment has its own section of the regulations, 29 CFR 825.119. The leave is for treatment only: “FMLA leave may only be taken for treatment for substance abuse by a health care provider or by a provider of health care services on referral by a health care provider.”
The same section also says an employer may not act against an employee for taking FMLA leave for treatment, and it adds one caution. If an employer has an established policy under which an employee may be dismissed for substance abuse, applies it the same way to everyone and has communicated it to all employees, the employer may still end someone’s employment under that policy, whether or not they are on FMLA leave at the time. Our guide to IOP goes through the leave rules in more detail, including leave taken in separate blocks of time.
This section reports what the regulations say and is not legal advice. Your HR office or the U.S. Department of Labor can tell you how the rules apply to you.
How Much Does Partial Hospitalization Cost With Insurance?
That depends on your plan, your deductible and how much of it you have met, so this guide gives no dollar figure. Under federal rules, some plans must cover mental health and substance use treatment. Ohio Medicaid’s rule for substance use disorder treatment requires prior authorization for PHP, and the Ohio Medicaid paragraph below quotes it.
Marketplace plans. According to HealthCare.gov, “All Marketplace plans cover mental health and substance abuse services as essential health benefits.” What each plan covers varies: “Your specific behavioral health benefits will depend on your state and the health plan you choose.”
Parity. A plan generally cannot make its mental health or substance use coverage stricter than its medical coverage. HealthCare.gov explains the rule for Marketplace plans: “This generally means limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services.” The limits it names include financial ones, “like deductibles, copayments, coinsurance, and out-of-pocket limits.” For group health plans, such as coverage through an employer, the Centers for Medicare & Medicaid Services describes the parity law as “a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.”
Ohio Medicaid. Rule 5160-27-09 says “Medicaid will reimburse for the services provided under the following ASAM levels of care,” and the list includes partial hospitalization for substance use disorder treatment. The rule asks for approval first: “Prior authorization is required for LOC 2.5 (partial hospitalization) which requires a minimum of twenty hours of services per week.” Leora’s page on Ohio Medicaid says more about it.
Medicare. Medicare’s page describes the cost in two parts. The first: “You pay a percentage of the Medicare-approved amount for each service you get from a qualified mental health professional if they accept assignment.” The second: “After you meet the Part B deductible you also pay coinsurance for each day of partial hospitalization services you get in a hospital outpatient setting or community mental health center.” Those are the two kinds of facility the page lists. If you have Medicare, ask admissions whether Leora can bill it.
At Leora. Leora accepts every Ohio Medicaid plan and every commercial carrier, and it does not publish prices. Admissions can check your coverage while you are on the phone. Ask your insurance provider what your share is likely to be and whether prior authorization is needed before you start. The insurance page says more.
PHP at Leora Behavioral Health in Columbus and Dayton
Leora Behavioral Health is an outpatient provider, with one facility in Columbus and one in Dayton. It provides no overnight or emergency care.
- Partial hospitalization in Columbus and partial hospitalization in Dayton run the mental health, dual diagnosis and substance use tracks, all on the weekday schedule given above.
- The statewide page on Leora’s partial hospitalization program in Ohio has the schedule and describes who the program suits.
The first step is an assessment. You can walk in at either facility or call admissions first. Bring your ID, your insurance card, a current list of your medications and, if you are coming from another program, your discharge plan.
If You Need Help Right Now
A PHP is scheduled care and cannot respond to an emergency.
If someone is in immediate danger, call 911. For a mental health or substance use crisis, call or text 988. The 988 Lifeline says of itself: “The 988 Lifeline is available 24/7/365.”
