Requesting Higher Level of Care (HLOC)

At Rula, we recognize that sometimes clients need different or more intensive services than can be provided by outpatient telehealth alone. That's why we have a dedicated Care coordination team that manages requests for higher level of care (HLOC) needs and helps connect your clients with supportive clinical resources and services outside of Rula.

A note on psych referrals

Please note, HLOC at Rula only means referring OUTSIDE of rula, not to Psych providers within Rula.

• Psychiatry Requests (also referred to as “Med Evals”) - Psychiatric Mental Health Nurse Practitioner services are available through Rula to active patients in select states. All other requests for psychiatric evaluations will be referred externally.  

Referring non-Rula patients to our psychiatric evaluation: You can refer non-Rula clients to receive psychiatry services at Rula by having them fill out an intake form that can be found on our website. Simply have the patient navigate to the following link: https://www.rula.com/psychiatry/

For information regarding Kaiser Psychiatry Referrals, see here.

*For patients who would like to switch/transfer to another NP, please reference the Psychiatric Transfer Request Process, linked here.  

What HLOC services/support can I request for my client? 

• Intensive Outpatient Programs (IOP) - The typical IOP program offers group and individual services of 10–12 hours a week and might require a visit with clinicians in the program multiple times a week.  IOP allows an individual some work/life balance to be able to maintain their daily routine and then participate in treatment at an appropriate facility in the morning or at the end of the day. IOP programs can be coordinated as part of a step-down from inpatient hospitalization or independent services per a licensed clinician’s recommendation.
  
• Partial Hospitalizations (PHP) - Partial hospitalization is an intensive alternative to inpatient psychiatric care which provides a structured program of outpatient psychiatric services. Each treatment program is customized to meet individual needs and the participation frequency can vary from person to person.  Treatment typically takes place 5 days a week for a set number of hours per day.
  
• Group therapy resources - While Rula does not currently offer group therapy, some clients would benefit from obtaining treatment in a group setting, often in conjunction with continued individual treatment.
  
• Psychological Testing - Psychological testing (also referred to as a psychological assessment) is a service performed by a Psychologist per the request of a licensed clinician looking for diagnostic clarity for their patient. 
  • Important to know:
    • It’s often difficult to prove medical necessity by insurance companies in order to cover this service.
    • Rula does not coordinate psychoeducational testing for learning disabilities, as this is not typically covered by commercial insurances.
    • ADHD diagnosis - Rula’s expectations regarding  initial assessments is that therapists provide an evaluation of their client based on the reported symptoms and data from any measurement based tools or other assessment tools (if applicable). All Rula therapists are licensed professionals and can make diagnostic decisions within their scope of practice. 
    • Since there is not an established diagnostic test for ASD in adults, not all psychological testing resources offer ASD testing
      

Care Coordination also supports the following requests, with some limitations:

• High-Acuity Rematching -  Mostly all rematch requests are facilitated by support. Care Coordination will help coordinate rematches if/when you feel a client’s needs are out of your scope of practice (e.g, psychosis, recent suicide attempt, domestic violence, threatening behavior).
  
  
• In-person treatment - At Rula, our philosophy of care is that telehealth is appropriate for most people seeking outpatient care, however we recognize there are clinical exceptions to that. If you believe a client would be better served in an in-person environment, the care coordination team can provide outside resources to assist the client in their search but cannot rematch them with an in-person provider. If the client is high risk or their symptoms are more persistent and severe, an IOP or PHP referral may be more appropriate.

What can I expect after I've submitted the request?

When you submit a higher level of care request, you'll receive a notification on the form that your referral was successfully submitted. Care coordination will then begin working with the patient to facilitate the request. Once the request is complete, usually between 3-5 days, our care coordination team will notify you via email. The care coordinator will add a care coordination note to the client's chart, where you can review the outcome details of the request.

Additional Resources

• Submit a rematch request - Detailed steps on how to access the Care Coordination Request Form and submit a rematch request.
• Psychiatric evaluation referral requests - Detailed steps on how to submit a psychiatric evaluation request, as well as information on submitting requests for Kaiser patients.

Rula does not coordinate HLOC for inpatient hospitalization or detox services during a crisis or emergency mental health situation.