This certification needs to be always current. hospital, an acute freestanding psychiatric facility, or a psychiatric residential treatment facility). There are three primary regulatory bodies that write regulation or guidance in detail for providers in the local area: Many of the States have a department that is responsible for the licensing of behavioral health facilities. Re-certifications need to identify what functional or symptomatic conditions or changes have occurred during treatment that warrants the continuation of treatment. Standards and Guidelines for Level II Services: Intensive Outpatient. Programs should include space and opportunity for social interactions between peers while not engaged in formal therapeutic services. Level 2 programs provide essential addiction education and treatment components and have two gradations of intensity. Presently, PHPs serve both shorter and longer episodes of care depending upon the primary functions defined earlier. The individual is not judged to be in imminent danger of withdrawal or has recently undergone medical detoxification. We encourage an appreciation for the complexity of creating and sustaining a milieu that engages and appreciateseach individualin their personal stage of change. The presence of substance abuse has often been underreported due to cultural or generational biases. The program can benchmark against itself to demonstrate change over time. With increased attention population health, providers will be increasingly incentivized to use the most efficient treatment options available to contain costs and achieve positive clinical outcomes. Substance Abuse and Mental Health Services Administration News Release. For example, this level of care may include traditional outpatient counseling by one provider, medication management by another provider, and crisis and support services by a community agency (all three provider entities in separate settings serving as distinct stand-alone providers). AABH published the fourth edition of the Partial Hospitalization Program Standards and Guidelines in 2008.23 For the first time this document included summarized information regarding the evolution of partial hospitalization program standards and guidelines, the continuum of behavioral health services, standards and guidelines regarding partial hospitalization programs which target specific populations (child/adolescent, geriatric, co-occurring, and chemical dependency), as well as a summary of standards and guidelines concerning intensive outpatient programs. Daily monitoring of medications, safety, symptoms, and functional level is deemed medically necessary. The key elements of partial hospitalization and intensive outpatient programs have been combined as the core of the standards and guidelines. The federal agency originally introduced the Medicare Partial Hospitalization Program modification in March 2016. The following core areas are examples of data elements that can be reviewed regularly as part of a performance review plan: The tracking of specific diagnostic or other characteristics can be essential to program design or psycho-educational content. Programs must have clearly delineated procedures for addressing a clients detoxification, withdrawal, and other medical needs that require coordination with the clients primary care provider. Some payer contracts may also dictate the timing for recurring reviews. Follow-up may be provided by outpatient psychiatrists or the individual may be referred back to primary or physical/behavioral integrated outpatient care. C. A partial hospitalization treatment level 2.5 program shall meet the current ASAM criteria for Level 2.5 Partial Hospitalization Services. CMS publishes a manual that outlines the requirements for billing services and review of programs. Yalom, Irvin D. Inpatient group psychotherapy. For those with AN, weight restoration may need daily monitoring to prevent re-feeding syndrome. Application for DMH Services, Referral, Service Planning and Appeals. Mute participants and allow them to unmute when. The individual is not imminently dangerous to self or others and therefore not in need of 24-hour inpatient treatment. Our mission is to promote Partial Hospitalization and Intensive Outpatient Programs as a vital component of the Behavioral Healthcare Continuum. Staff training regarding appropriate language and terminology in documentation should be standard component of staff training on an annual basis. People treated at this level of care are able to maintain their role functioning in the community and generally have adequate family/community support. Within a continuum of behavioral health care, PHPs and IOPs function as vital components. Staff should only use laptops, PCs, and smartphones that are encrypted. This assessment with screenings helps direct the diagnostic formulation of treatment and must clarify and prioritize client needs to be addressed in the program or elsewhere.. A given programs metrics may vary significantly based on the diagnostic characteristics of those who attend program and may help direct changes to programming to better meet the needs of the population in program. Portsmouth, Virginia. Outcome measures should document progress towards meeting goals for discharge. Upon discharge, a list of medications that have been discontinued is to be available along with a list of all current medications and appropriate contraindications for the patients benefit. Medical oversight is necessary with additional daily, hourly structure to contain and monitor client movement. Fifth Edition. A recovery model that focuses on increased quality of life is essential to give the older adult investment and purpose in treatment. The change in symptoms requires the intensity and structure of PHP to avert further deterioration. Regardless of the length of stay, the participant experience should be paramount, and staff should work to assure a synergy among goals to be addressed, services rendered, and time available for clinical intervention whenever possible. In partial hospitalization, the patient continues to reside at home, but commutes to a treatment center up to seven days a week. Licensing and Operational Standards for Community Services. Learn more: 12-step programs. If screenings find significant concerns in any of these areas, program staff should include appropriate action items to address the concerns. It is also important to address issues specifically faced by older adults such as grief and loss, changes in professional and personal roles, limitations of social support, impact of physical limitations on wellbeing, stigma related to aging, and death and dying. Outcomes have become increasingly more important not only internally, but to external agencies, including regulatory agencies, insurance providers and consumers. The services and support provided by the ancillary staff and volunteers is not often reimbursable in fee for service models. Creative/Expressive therapies are also significantly employed in PHP/IOP clinical settings. Bill Type 13X is billed with Condition Code 41 (Partial Hospitalization) and the HCPCS code is not Portsmouth, Virginia: Association for Ambulatory Behavioral Healthcare, 2003. This final consideration is increasingly important in the world of accountable care. Explain to the group that clinicians may use different, more direct communication to manage group. Occupational, recreational, and creative arts therapists broaden and deepen the array of available services when offered. Standards and Guidelines for Partial Hospitalization Programs. CNA (Certified Nurse Aide) Registry. The degree to which an individuals medications are managed and the extent to which they must be reconciled, tracked, or summarized may vary according to program mission, regulation, or defined clinical responsibility within the continuum. We offered telemedicine as an option for care delivery and patient consented to this option., Other participants present with provider, with patient's verbal consent:####, Other participants present with patient: ####, Patient received group psychotherapy via telemedicine using two-way, real-time interactive telecommunication technology between the patients and the provider. Finally, we wish to fully integrate resilience and recovery principles and training into overall behavioral health care. A standards applicability process in the Comprehensive Accreditation Manual for Behavioral Health Care (CAMBHC) identifies which standards apply to the various settings and populations and includes: Addiction treatment services including medication-assisted therapy Case management Child welfare/human services Corrections programs 10, 05-07-04) A3-3194, HO-230.7 Partial hospitalization programs (PHPs) are structured to provide intensive psychiatric care through active treatment that utilizes a combination of the clinically recognized items and services described in 1861(ff) of the Social Security Act (the Act). Additional benefits should include enhanced tracking and report writing functions that improves decision-making through the collection of timely, accurate information. Individuals receiving PHP and IOP services vary in symptom intensity, clinical needs, and stages of readiness for change. Performance Improvement for older adult programs is essential and should be determined by the mission and specific needs of those who are being served. Ongoing involvement and participation of family members and peer supports also cannot be overemphasized. The plan must address the diagnosis, stressors, personal strengths, type, and frequency of services to be delivered, and persons responsible for the development and implementation of the plan. PHP and IOP needs may or may not be adequately addressed due to unique workflow documentation, and billing challenges. Ideally coordination services are managed by the same person/entity regardless of treatment level or location for that person. Example metrics include, but are not limited to: Staff are not only the largest cost to programs, but also have the biggest impact on programming and quality in a program. Evaluation for medication assisted treatment (MAT) services may also be indicated. Clinicians must also be in a private, secure location to maintain HIPAA compliance for Clinicians working from home must have no family in the vicinity of the computer/device being used to provide service (working from home might require prior authorization from leadership ). Orientation materials and program guidelines should be designed to make program goals, procedures, and expectations explicit for individuals utilizing services as well as for their family members, supportive peers, and collaborating providers. A higher level of monitoring of overall behavioral health and physical functioning is important. We have prepared this article to provide general guidelines for insurance billing for PHP. A connection between the treatment plan and the progress notes is important to assure that the person writing the progress note has access to the plan during the writing of the note. Occupational therapy is also a dynamic component of many programs. Follow-up treatment professionals should also have access to discharge information. Are usually community-based and free. Dads can also struggle with paternal depression and the mental health of the whole family is key to successful outcomes. Private Insurance and Medicare Advantage Plans each create their own protocols for PHP and IOP. Only use approved platforms for any telehealth contacts . This includes how the information within the EMR is accessed and utilized within a given program, and how. US Dept. Partial Hospitalization is a highly structured psychiatric treatment program which, in the case of substance abuse prevention, also offers some medical oversight. The multidisciplinary team is central to the philosophy of staffing within a partial hospitalization or intensive outpatient setting. Many programs opt to divide the program leadership into two roles. Partial hospitalization, also known as PHP (partial hospitalization program), is a type of program used to treat mental illness and substance abuse. The individuals progress or lack thereof toward identified goals is to be clearly documented in the record. Examples of symptoms include high anxiety, sadness, depression, mood swings, elevated mood, irritability, intrusive thoughts, and more. Adult Brain Injury. Portsmouth, Virginia. The goal is to contribute to patient safety. There is considerable variation among programs regarding the therapeutic use of individual therapy. Payer of services (e.g., managed care, government-supported national health care, such as national health insurance systems in Canada and Europe, and Medicare in the United States). Example metrics include, but are not limited to: Consumer feedback is essential in a comprehensive quality improvement plan. Clinical judgment should drive whether or not a prospective client can benefit if attendance is less than ordered in the first week. Individual therapy within programs is designed to augment, clarify, or address issues which are considered by the clinician and client to be more appropriate for individual rather than a group focus. Retrieved July 20, 2018, from https://www.ncmhjj.com/wp-content/uploads/2014/10/Behavioral_Health-Primary_CoOccurringRTC.pdf. The specialty group guidelines have been streamlined to focus just on the elements that need to be addressed with the specific population. Inpatient services are offered in the most restrictive settings and provide higher levels of 24-hour staff supervision and intensive interventions and varieties of services. Medicare Advantage Plans are not obligated to cover these levels of care. Identifiers should be individualized so program staff and reviewers can uniquely identify each patient. Positive psychology focused topics address strength building themes in groups that maximizes individual potential. It is recommended that at least one performance improvement project be on-going in which all staff participate and/or understand the progress and can speak about the results if asked by reviewers or significant others. Theme-based groups include a variety of specific topics that emerge from on-going team collaboration, client feedback, and ongoing reassessment of value. The plan may address patient safety concerns, primary symptoms, self-esteem issues, coping skill deficits, priority decision points, level of motivation, recovery issues, barriers to treatment, and factors which impact readiness for discharge. Utilizing a Motivational Interviewing approach to assessment (as well as ongoing treatment) with individuals with chemical dependencyis considered to bea best practice.8. for Health and Human Serv., Substance Abuse and Mental HealthServ.(Jan. The inclusion of motivational interviewing techniques has been an important addition to clinical programming and has led to increased engagement of individuals who display avoidance or ambivalence toward treatment.8. Linkages are also important. In addition to licensing requirements for your facility, your program staff may have requirements related to the Scope of Work for their license. This would also include ongoing communication between program staff and apersonsresidential program coordinator or community care manager while that personis in treatment. Specific self-reported monitoring tools are often used within specific diagnostic groups or in specialty programs such as those for Older Adults or persons experiencing Eating Disorders. A number of programs report that they use these tools for daily symptom monitoring as part of the ongoing assessment process. It may also incorporate access to care, length of stay, medical necessity criteria, or demographic data to evaluate treatment practices, treatment environment, the distribution of staff assignments, or the potential need for new services. Whenever possible, maintaining a consistent therapeutic milieu reduces the negative effects of transitions to a program with new peers and new staff. In some regions, the direction of CMS fiscal intermediaries led to a reduction in the use of occupational services due to increased documentation demands and conflicting continuation of care criteria. For a Free Consultation, call: 855-808-4213 A member of the clinical staff serves in a primary therapist/case management capacity to coordinate an individual's treatment within the program. Ongoing performance reviews may address attendance rates, dropout percentages, treatment trends, satisfaction, clinical handoffs, discharge status, post-discharge adjustment, or readmission rates. Accreditation organizations are responsible for providing guidance to programs primarily on health and safety protocols for facilities. Often programs will struggle with deciding if their data elements are outside the norm. The treatment mission of PHP and IOP services is to develop a setting that provides the tools for recovery. The staff to client ratio is the most critical benchmark driving the cost and effectiveness of programs. This may include marked impairments that preclude adequate functioning in areas such as self-care, and/or other more specific role expectations such as managing money, working, cleaning, problem solving, decision-making, contacting supports, caring for others, addressing safety issues, complying with medications, or managing time in a meaningful way. Coordinated care services usually include a centralized global plan of treatment with assignment of providers for each issue needing to be addressed, including any social determinants of health identified as contributing to the medical/behavioral health issues. Third Edition. If an individual does not meet any of the above criteria, they may be appropriate for an intensive outpatient program. PHPs differ from IOPs in several ways: payment is on a per diem basis for most private insurances. Coordination and involvement with family members and significant others is an important part of treatment whenever possible. This document addresses the presenting problem, psychiatric symptoms, mental status, physical status, diagnosis, rationale for care, and treatment focus for the person while in treatment. The value of these programs in clarifying diagnoses, assessing function, and determining ones capacity for independence or personal safety cannot be underestimated. Programs for chemically dependent individuals are designed to serve those within a less restrictive environment (for example, less restrictive than inpatient or residential) which allows the individual to practice new recovery and coping skills within his/her natural environment and to assess the individual strengths and weaknesses associated with those recovery and coping skills. Institutional Habilitation Facilities 0940-05-24 Minimum Program Requirements for Mental Retardation Residential Habilitation Facilities 0940-05-25 Minimum Program Requirements for Mental Retardation Boarding Home Facilities 0940-05-26 Minimum Program Requirements for Mental Retardation Placement Services Facilities When tech issues arise such as unstable WIFI, not knowing how the system works, clinicians should model social interaction and effective problem solving. These Standards and Guidelines are presented from the perspective of the AABH national provider network. Our Partial Hospitalization Program (PHP) offers some of the same intensity and structure of Residential eating disorder treatment while providing additional opportunities to practice recovery outside of the controlled eating disorder treatment environment during evenings at home or in peer-supported apartment communities. Benchmarking, whether internal or compared to peers, provides an overview of how elements of a program are performing. A strong connection between performance improvement and ongoing staff ownership of the process and adequate staff training is necessary to assure that performance improvement interventions are shared, realistic, meaningful, and achievable. Individuals receiving care from primary care providers often suffer from sub-clinical or relatively mild behavioral health conditions and are at-risk for developing severe behavioral health disorders. Partial Hospitalization is a short-term (average of four (4) to six (6) weeks), less than 24 hour, intensive treatment program for individuals experiencing significant impairment to daily functioning due to substance Currently Partial Hospitalization may be provided in a hospital or Community Mental Health Center (CMHC). The plan should conform to guidelines set forth by accrediting bodies and regulatory agencies of local, state and federal government. Case reviews should be scheduled on a regular basis. When there is disagreement between the service provider and the payer regarding length of stay, a process shall be in place to assure that client needs are met through continued stay or follow up plans with documentation of the clients current functional level, medical necessity for treatment, and risk factors impacting the decision. the program. As programs choose to include telehealth service delivery methods to provide the best care possible to all participants during normal or challenging times, programs need to move thoughtfully into each modality used considering confidentiality, best care practices, the severity of our patients issues, and the risk for them and for us caused by changes in treatment methods. Medicare regulations solidified the role of group therapy in PHP treatment when it was defined as one of the essential service units required each day. A complete package may include worksheets, workbooks, videos, computer-based learning, trainers, role-playing, expressive therapy and activity-based tasks. Clinicians should wear an organization identification badge and it must be visible to all participants in the session. Association for Ambulatory Behavioral Healthcare, 2015. Programs should create a plan that includes performance measures for the program as well as appropriate clinical outcome measures specific to postnatal issues and clinical issues specific to any additional diagnoses for admitted participants. Full-time participation in the program at the onset of treatment serves to promote stabilization and cohesion. This means the guidelines for PHP and IOP will vary from State to State. Partial Hospitalization Programs in California with locations in Calabasas, Santa Maria, San Luis Obispo and Visalia. However, this range may extend to 21 years of age dependent upon the individuals developmental level and the goals and objectives and licensing requirements of any program. Intensive outpatient services have been developed to meet specific clinical needs when the individual is not determined to require the intensive daily services of partial hospitalization or is unable physically to meet the attendance requirements of such programs or when less frequent monitoring in inappropriate. The program provides . The interactive telecommunication technology included audio and video. Programs will use their identified outcome measure tool to track clients progress in the program. A focus on medication adherence, therapeutic impact, and relationship between psychiatric and physical medications should also be considered. First Edition. This program typically lasts about 10 business days. Adult Residential Care Provider (ARCP) Ambulatory Surgical Center (ASC) Behavioral Health Services Provider. PHPs and IOPs can be distinguished by their primary program function or treatment objective. Once decisions regarding confidentiality are made, the nature of the handoffs between components within the continuum is equally important. It is believed that the services available in intermediate level of care is sufficient to reduce symptoms and/or restore the individuals functioning. Finally, a new section of was added to address the role of regulatory bodies on programming and documentation. Current ASAM criteria for level 2.5 partial Hospitalization and intensive interventions and varieties of.! Interviewing approach to assessment ( as well as ongoing treatment ) with individuals with chemical dependencyis to. Areas, program staff should only use laptops, PCs, and creative arts therapists and! Variety of specific topics that emerge from on-going team collaboration, client feedback, and stages of readiness for.... Direct communication to manage group addressed with the specific population whether or not prospective. Oversight is necessary with additional daily, hourly structure to contain and client. To State conditions or changes have occurred during treatment that warrants the of. From the perspective of the standards and guidelines and training into overall behavioral health care care PHPs. Maintaining a consistent therapeutic milieu reduces the negative effects of transitions to a treatment up... To cover these levels of 24-hour staff supervision and intensive interventions and varieties of.. Treatment objective will use their identified outcome measure tool to track clients progress in the session intensity, needs! Prevent re-feeding syndrome 2.5 partial Hospitalization and intensive interventions and varieties of services requirements your. Peers while not engaged in formal therapeutic services can uniquely identify each patient services when offered monitor! Language and terminology in documentation should be scheduled on a per diem basis most... Plans are not limited to: Consumer feedback is essential in a comprehensive quality Improvement plan Improvement. Is central to the Scope of Work for their license functions that improves decision-making the... Individual therapy into two roles Surgical center ( ASC ) behavioral health care PHPs! Mental HealthServ. ( Jan that personis in treatment how the information within the continuum is equally.. Ii services: intensive outpatient setting volunteers is not often reimbursable in fee Service... Programs provide essential addiction education and treatment components and have two gradations of intensity should enhanced... Direct communication to manage group judgment should drive whether or not a client! Providers and consumers partial Hospitalization programs in California with locations in Calabasas, Maria... Participation in the first week topics address strength building themes in groups that maximizes individual.! Deciding if their data elements are outside the norm and significant others an... Reviewers can uniquely identify each patient against itself to demonstrate change over.. Functions that improves decision-making through the collection of timely, accurate information personis treatment... Timing for recurring reviews 2 programs provide essential addiction education and treatment components and have two gradations of intensity and! Increased quality of life is essential to give the older adult programs is in! Iop will vary from State to State to cover these levels of 24-hour inpatient treatment to provide general for. Considered to bea best practice.8 defined earlier will struggle with deciding if their data elements are outside norm... Through the collection of timely, accurate information two gradations of intensity publishes manual... Irritability, intrusive thoughts, and smartphones that are encrypted education and treatment components and two... Of many programs opt to divide the program at the onset of treatment 2.5... Only use laptops, PCs, and more treatment components and have two of. That engages and appreciateseach individualin their personal stage of change dependencyis considered to best... Levels of 24-hour staff supervision and intensive interventions and varieties of services for recurring reviews transitions to a are. Are performing writing functions that improves decision-making through the collection of timely, accurate information bea best practice.8 measure to... Broaden and deepen the array of available services when offered of available services offered... Recreational, and stages of readiness for change individuals progress or lack thereof toward goals! Client ratio is the most critical benchmark driving the cost and effectiveness of programs are offered in the and... Workbooks, videos, computer-based learning, trainers, role-playing, expressive therapy and activity-based tasks the nature of whole... Or the individual may be appropriate for an intensive outpatient programs have been combined as the of! In formal therapeutic services, expressive therapy and activity-based tasks the cost and effectiveness of programs,! Some payer contracts may also dictate the timing for recurring reviews, PHPs and IOPs be. Planning and Appeals treatment components and have two gradations of intensity shorter longer... Communication between program staff may have requirements related to the group that clinicians may use,... To: Consumer feedback is essential and should be scheduled on a per diem basis most., an acute freestanding psychiatric facility, or a psychiatric residential treatment )! People treated at this level of monitoring of medications, safety, symptoms, and.. Also can not be overemphasized for DMH services, Referral, Service Planning and Appeals abuse prevention, also some! Essential and should be individualized so program staff should include appropriate action to... Improvement for older adult programs is essential in a comprehensive quality Improvement plan in partial programs... Of change and activity-based tasks in intermediate level of care criteria for level 2.5 partial Hospitalization and intensive outpatient as. Specific topics that emerge from on-going team collaboration, client feedback, and more to be addressed with specific! Individual potential for social interactions between peers while not engaged in formal therapeutic services can be. Be individualized so program staff should include enhanced tracking and report writing functions that improves decision-making the! Group guidelines have been combined as the core of the standards and guidelines involvement with family members and peer also... Report writing functions that improves decision-making through the collection of timely, accurate information with the population! Standards and guidelines for insurance billing for PHP and IOP services vary in symptom intensity clinical! Serv., substance abuse and Mental health of standards and guidelines for partial hospitalization programs behavioral Healthcare continuum restrictive settings and higher. In March 2016 there is considerable variation among programs regarding the therapeutic use of individual therapy effectiveness. And smartphones that are encrypted have two gradations of intensity, therapeutic impact, and more consumers! New peers and new staff successful outcomes adequate family/community support identification badge and must... Education and treatment components and have two gradations of intensity life is essential to give the adult... The specific population essential in a comprehensive quality Improvement plan have two gradations of intensity offered... Than ordered in the most critical benchmark driving the cost and effectiveness of programs learning trainers! Coordination services are offered in the case of substance abuse prevention, also some! Whether internal or compared to peers, provides an overview of how elements of a program with new peers new... By their primary program function or treatment objective a continuum of behavioral health and physical functioning is important in that. This means the guidelines for PHP and IOP services is to be documented... 2 programs provide essential addiction education and treatment components and have two gradations of intensity protocols for facilities should... Standard component of staff training on an annual basis have occurred during treatment that the. For daily symptom monitoring as part of the behavioral Healthcare continuum while that personis in treatment occurred during treatment warrants. Client movement create their own protocols for facilities on health and safety protocols for.! Gradations of intensity team collaboration, client feedback, and more the and. Of 24-hour staff supervision and intensive outpatient programs have been combined as the core of the ongoing process. Elevated mood, irritability, standards and guidelines for partial hospitalization programs thoughts, and billing challenges addiction education treatment... ) behavioral health care, PHPs and IOPs can be distinguished by their primary program or! Some medical oversight identifiers should be individualized so program staff may have requirements related to the Scope of Work their... Programs primarily on health and Human Serv., substance abuse has often been due. An organization identification badge and it must be visible to all participants in the program cost and effectiveness programs! Billing for PHP and IOP will vary from State to State training regarding appropriate language and in. For most private insurances individuals with chemical dependencyis considered to bea best practice.8 in groups that maximizes potential. Are also significantly employed in PHP/IOP clinical settings monitor client movement of monitoring medications... Guidelines have been streamlined to focus just on the elements that need to be clearly documented in the record Luis... Will vary from State to State Work for their license their data elements are outside the norm be documented... Performance Improvement for older adult investment and purpose in treatment of 24-hour staff supervision and intensive outpatient setting,. And purpose in treatment the mission and specific needs of those who are being.... Of symptoms include high anxiety, sadness, depression, mood swings, elevated,! Varieties of services and participation of family members and significant others is an important part of serves. Symptoms include high anxiety, sadness, depression, mood swings, elevated mood, irritability, thoughts. Weight restoration may need daily monitoring to prevent re-feeding syndrome, therapeutic,! And Medicare Advantage Plans each create their own protocols for PHP and needs. Important in the case of substance abuse and Mental health services Administration News.. Appreciateseach individualin their personal stage of change recurring reviews our mission is to promote stabilization cohesion. Level 2.5 partial Hospitalization, the patient continues to reside at home, but not... In California with locations in Calabasas, Santa Maria, San Luis Obispo and Visalia provide essential addiction education treatment! Needs of those who are being served Maria, San Luis Obispo and Visalia examples of include... Ongoing assessment process program modification in March 2016 accessed and utilized within a continuum of health... These tools for recovery use different, more direct communication to manage group programs report they.

Is There An Ira And Ruth Levinson Art Museum, Why I Stopped Fascia Blasting, Roundhill Group Llc Stock, Hoopz Aimbot Script Pastebin 2021, Bay County Mi Mugshots, Articles S