The document outlines 11 requirements for reimbursement of a therapy group, including that the group have appropriate diagnoses and demographics, be psychotherapy-based rather than psycho-educational, have a closed format, scheduled session times and duration, diagnosis-based goals, admission and discharge criteria, measurable objectives and outcomes, evidence-based literature support, and staff certification if specialized. It also notes the group name should be simple and clear, and that approved groups will need to provide outcome summaries after the first cycle and yearly thereafter.
The document outlines 11 requirements for reimbursement of a therapy group, including that the group have appropriate diagnoses and demographics, be psychotherapy-based rather than psycho-educational, have a closed format, scheduled session times and duration, diagnosis-based goals, admission and discharge criteria, measurable objectives and outcomes, evidence-based literature support, and staff certification if specialized. It also notes the group name should be simple and clear, and that approved groups will need to provide outcome summaries after the first cycle and yearly thereafter.
The document outlines 11 requirements for reimbursement of a therapy group, including that the group have appropriate diagnoses and demographics, be psychotherapy-based rather than psycho-educational, have a closed format, scheduled session times and duration, diagnosis-based goals, admission and discharge criteria, measurable objectives and outcomes, evidence-based literature support, and staff certification if specialized. It also notes the group name should be simple and clear, and that approved groups will need to provide outcome summaries after the first cycle and yearly thereafter.
The document outlines 11 requirements for reimbursement of a therapy group, including that the group have appropriate diagnoses and demographics, be psychotherapy-based rather than psycho-educational, have a closed format, scheduled session times and duration, diagnosis-based goals, admission and discharge criteria, measurable objectives and outcomes, evidence-based literature support, and staff certification if specialized. It also notes the group name should be simple and clear, and that approved groups will need to provide outcome summaries after the first cycle and yearly thereafter.
Proposal requirements include, but are not exclusive to,
the following for reimbursement of a therapy group:
1. The diagnoses, patient age range and gender are appropriate for treatment in the group 2. The group is psychotherapy-based and not psycho-educational
3. The group is close-ended
4. The scheduled amount of time per group session is listed and appropriate to the group
5. The scheduled duration of the group is appropriate, including frequency, number of
sessions and number of weeks (usually 8-12 weeks for most groups, including CBT and up to 26 weeks for a 4-module DBT Group)
6. Group goals are focused upon diagnosis-based, symptom clusters
7. Group admission and/or discharge criteria are submitted, and meet eligibility requirements for objective outcomes
8. The group objectives and outcomes are measurable
9. The therapy group is supported by evidence based literature
10. Staff certification (training for specialized group therapy, such as DBT) or facility privileging policy submitted
11. The group name should be simple, allowing not only the facility to clearly understand the name but others. (e.g., women’s anger management, CBT for anxiety, etc.)
The follow-up letter to a therapy group approval will include a request a brief summary of the outcome measurements at the end of the first cycle and brief year-end summaries thereafter. A nonprofit independent licensee of the Blue Cross Blue Shield Association
