What Is an IOP, and What Does IOP Stand For?
IOP stands for intensive outpatient program. It is a scheduled treatment program for a mental health condition or a substance use disorder. You attend several days a week, for a few hours each time, and you live at home.
Medicare’s page on intensive outpatient program services places it between two other kinds of care: “Intensive outpatient programs offer a level of care for mental health conditions (including substance use disorders) between traditional once-weekly therapy or counseling, and inpatient or partial hospitalization psychiatric care.”
Federal regulations define it in one line. Under 42 CFR 410.2, intensive outpatient services are “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.”
You will also see it called intensive outpatient treatment or intensive outpatient therapy. The names describe the same level of care.
A word on the sources. Medicare’s pages and rules are quoted throughout this guide because they describe the service in plain, public language. They state Medicare’s own terms. Other health plans write their own, and the insurance section below covers Ohio.
How Many Hours a Week Is an IOP?
Nine or more. Medicare and Ohio Medicaid both use that number.
Medicare’s page 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.”
Ohio’s Medicaid rule on substance use disorder treatment, rule 5160-27-09 of the Ohio Administrative Code, reaches the same number from below. It limits standard outpatient services “to less than nine hours per week for adults.” The level above that is the one the rule calls “intensive outpatient/partial hospitalization.”
At Leora Behavioral Health, IOP is three hours of therapy group a day, three to five days a week. That comes to nine to fifteen hours a week, with individual appointments on top.
Programs arrange those hours in different ways, so ask any program for its weekly schedule before you start.
Is There an IOP for Mental Health, or Only for Addiction?
Both. Medicare’s description, quoted above, covers “mental health conditions (including substance use disorders).”
Leora runs the two as separate tracks. In person, intensive outpatient has a mental health track and a substance use track at both facilities. Virtual IOP has a daytime program for mental health and an evening program for substance use.
The pages on mental health treatment in Ohio and addiction treatment in Ohio describe each side. For people dealing with both at once, the page on co-occurring disorders describes the programs that treat them together.
IOP vs. PHP vs. Outpatient: What Is the Difference?
The levels differ in hours a week and in how much of the day they take. Here they are from the fewest hours to the most.
- Standard outpatient. Scheduled appointments. SAMHSA’s page on types of treatment says this type “is like a standard doctor’s visit.” Ohio Medicaid’s rule limits it to less than nine hours a week for adults. At Leora, outpatient care is one to two days a week with two hours of group each time.
- Intensive outpatient (IOP). At least nine hours a week in Medicare’s description. You sleep at home. At Leora it is three hours a day, three to five days a week.
- Partial hospitalization (PHP). The level above IOP. Medicare’s page on partial hospitalization says: “You may benefit from partial hospitalization if your care plan states that you require at least 20 hours of therapeutic services each week.” You still sleep at home. At Leora, partial hospitalization runs Monday to Friday, 9:00 am to 4:15 pm.
- Inpatient and residential. Care with an overnight stay. SAMHSA 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.
Medicare’s rules 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.”
People move between these levels. Some start in IOP. Others step down to it from partial hospitalization, or from a hospital or residential stay somewhere else, and later step down again to standard outpatient care.
What Happens in an IOP?
Group sessions and individual appointments, on a set weekly schedule.
Medicare’s page says the services “may include things like group and individual therapy sessions, mental health education, and medication management.” SAMHSA describes intensive outpatient and partial hospitalization together: “This can include one-on-one appointments, group sessions, and learning about coping skills.”
At Leora the parts are:
- Three hours of therapy group on each program day, led by licensed clinicians
- Separate tracks for mental health and for substance use, at both facilities
- One to two individual appointments alongside the groups, with your therapist, a case manager, peer support, a nurse or the nurse practitioner
- Medication management with a nurse practitioner every two to three weeks
Group work at Leora draws on cognitive behavioral therapy and dialectical behavior therapy. Case management and peer recovery support happen as needed, and family therapy can be arranged.
How Long Does an IOP Last?
None of the definitions quoted here sets a number of weeks. The length 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 requires a physician to recertify the need for the program “at intervals established by the provider, but no less frequently than every 60 days.”
So the useful question for any program is how it decides when you are ready to step down. At Leora, your team plans the next step with you before discharge: a lower level of care, outpatient therapy, and community recovery support such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).
Who Decides Whether IOP Is the Right Level?
An assessment does, and it comes before anything else.
For substance use treatment there is a published standard, the ASAM Criteria, 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.” It also 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.”
Ohio Medicaid writes that standard into its rule. Substance use disorder treatment services “shall be provided according to” the ASAM criteria “for admission, continued stay, discharge, or referral to each level of care (LOC).”
Medicare’s regulation, 42 CFR 410.44, lists who intensive outpatient programs are intended for. The list includes patients who:
- “Require a minimum of 9 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”
At Leora the assessment can point to a different level. Ambulatory detox comes first when withdrawal has to be managed. Partial hospitalization is the step up when more hours are needed. Someone who needs care overnight needs a hospital or a residential program, which Leora does not provide.
Can You Work or Go to School During an IOP?
The rules allow for it. 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.”
Each program sets its own times. At Leora, nine to fifteen hours a week leaves room for work or family care, and the evening program is virtual IOP for substance use. Tell admissions your working hours at the assessment.
If you need time away from work, the federal Family and Medical Leave Act may apply. USA.gov sums it up: “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.”
The leave does not always have to be taken all at once. The regulation, 29 CFR 825.202, describes two other ways: “Intermittent leave is FMLA leave taken in separate blocks of time due to a single qualifying reason. A reduced leave schedule is a leave schedule that reduces an employee’s usual number of working hours per workweek, or hours per workday.” For either one, the regulation says “there must be a medical need for leave.”
Treatment for substance use has its own section, 29 CFR 825.119. It covers treatment and nothing else: “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,” and “absence because of the employee’s use of the substance, rather than for treatment, does not qualify for FMLA leave.”
That section also protects the leave: “The employer may not take action against the employee because the employee has exercised his or her right to take FMLA leave for treatment.” It adds one caution. An employer with an established substance abuse policy, applied the same way to everyone and communicated to all employees, may still act under that policy whether or not the employee is on leave.
USA.gov is plain about the limits: “Not all employees are eligible for FMLA.” You need at least 12 months with your employer and at least 1,250 hours of work in the last 12 months, and your employer needs 50 employees within 75 miles of your worksite.
This section reports what the regulations say. It is not legal advice. Your HR office or the U.S. Department of Labor can tell you where you stand.
Does Insurance Cover IOP in Ohio?
Federal rules require some plans to cover mental health and substance use treatment. What a plan pays for IOP depends on the plan.
Marketplace plans. HealthCare.gov says: “All Marketplace plans cover mental health and substance abuse services as essential health benefits.” It adds that the details differ: “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.” 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 intensive outpatient and partial hospitalization for substance use disorder treatment. A plan can ask for approval before treatment starts, so have your coverage checked first.
Medicare. Part B covers intensive outpatient program services at certain kinds of facilities, which its 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 admissions can check your coverage while you are on the phone. The pages on insurance and Ohio Medicaid say more.
Is Virtual IOP the Same Thing?
Yes. It is intensive outpatient treatment delivered by telehealth. SAMHSA notes that “Outpatient programs can be in-person or using telehealth (meaning care online or over the phone).”
Leora’s virtual IOP is fully remote and available anywhere in Ohio. It runs as two programs: a daytime program for mental health and an evening program for substance use. Our guide to telehealth counseling in Ohio covers who can provide care by video, privacy and coverage.
One limit applies. Detox cannot be done by video, and ambulatory detox takes place on site in Columbus and Dayton.
IOP at Leora Behavioral Health in Columbus and Dayton
Leora Behavioral Health is an outpatient provider with facilities in Columbus and Dayton. It does not provide overnight or emergency care.
- Intensive outpatient in Columbus and intensive outpatient in Dayton run three to five days a week, three hours a day, in separate mental health and substance use tracks.
- Virtual IOP serves anyone in Ohio.
- The statewide page on Leora’s intensive outpatient program in Ohio has the full schedule and describes who the program suits.
Getting started takes an assessment. Both facilities welcome walk-ins, or you can call admissions first. Bring your ID, your insurance card, a current list of your medications and your discharge plan if you are coming from another program.
If You Need Help Right Now
An IOP 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.”
