Inpatient Psychiatric Care – Community and State Facilities

​​​See Clinical Coverage Policy for full service definition information.

Inpatient psychiatric care occurs in hospital settings and has 24/7/365 physician and nursing access. This service provides intensive evaluation and treatment for those with acute psychiatric needs, typically when an individual is unable to maintain safety or wellbeing outside of this level of care. Individual and group-based interventions are designed to reduce acute, severe psychiatric symptoms such as dangerousness to self or others, and psychosis such that the member can safely step down to and participate in lower levels of care, preferably community-based whenever possible.

Intended Population

  • Members with severe psychiatric symptoms leading to acute danger to self or others, inability to cooperate with evaluation and treatment, and/or those for whom treatments require close medical observation and monitoring.

  • Members with severe and persistent behavior health diagnoses whose symptoms are treatment resistant or who display particularly dangerous behaviors, admission to State operated facilities for longer periods of time (months) may be the preferred level of care.

Recommended Best Practices

Expected Outcomes

  • Core Expected Outcomes

  • High level of member engagement in services upon discharge

  • High rates of members with kept discharge appointments within 48 hours of discharge

  • Low rates of crisis system use and readmission post-discharge

  • Low rates of legal system involvement post discharge

Management

  • Core Management Strategies

  • Authorization Guidelines​

  • Facilities will be monitored for average length of stay (expected eight days or less for community facilities), readmission rates, and for excellence in the above expected outcomes; facilities that fall below community standards will receive focused utilization and quality reviews.

  • Members meeting various different criteria will receive care coordination and other assistance in discharge planning to assist with transitioning into community-based settings.

  • Cardinal Innovations' Inpatient Liaisons partner with higher volume psychiatric facilities to assist with disposition planning and coordination of care.