Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 6 - INPATIENT PSYCHIATRIC AND SUBSTANCE USE DISORDER SERVICES › Section 317:30-5-94 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
The following words and terms, when used in this Part,
					 shall have the following meaning, unless the context clearly indicates
					 otherwise:
"Adult"
means an individual twenty-one (21)
					 and over, unless otherwise specified. Refer to Oklahoma Administrative Code
					 (OAC) 317:30-1-4.
"C.F.R."
means Code of Federal Regulations.
"Child"
means an individual under the age of
					 twenty (21) in an inpatient psychiatric setting as per 42 C.F.R. § 441.
					 151(a)(3). If an individual is receiving services before he or she reaches
					 twenty-one (21), then the individual can continue to receive services until the
					 individual no longer requires the services or the date the individual turns
					 twenty-two (22), whichever comes first. For services other than inpatient
					 psychiatric services or otherwise specified by statute, regulation, and/or
					 policy adopted by the Oklahoma Health Care Authority (OHCA), refer to OAC
					 317:30-1-4.
"C.M.S"
means Centers for Medicare and
					 Medicaid Services.
"General hospital"
means a general medical
					 surgical hospital, as defined by Section
					 1-701(2)
					 of Title 63 of the Oklahoma Statutes.
"Institution for Mental Diseases (IMD)"
means
					 a hospital, nursing facility, or other institution of more than sixteen (16)
					 beds that is primarily engaged in providing diagnosis, treatment, or care of
					 persons with mental diseases, including medical attention, nursing care, and
					 related services, as defined by
					 42 C.F.R. §
											435.1010.
"Licensed behavioral health professional
					 (LBHP)"
means any of the following practitioners:
(A) An allopathic or osteopathic physician with a current
					 license and board certification in psychiatry or board eligible in the state in
					 which services are provided, or a current resident in psychiatry practicing as
					 described in OAC
					 317:30-5-2.
(B) A practitioner with a current license to practice in
					 the state in which services are provided, within one (1) of the areas of
					 practice listed in (i) through (vi).
(i) Psychology;
(ii) Social work (clinical specialty only);
(iii) Professional counselor;
(iv) Marriage and family therapist;
(v) Behavioral practitioner; or
(vi) Alcohol and drug counselor.
(C) An advanced practice registered nurse certified in a
					 psychiatric mental health specialty, and licensed as a registered nurse (RN)
					 with a current certification of recognition from the board of nursing in the
					 state in which services are provided.
(D) A physician assistant who is licensed and in good
					 standing in the state and has received specific training for and is experienced
					 in performing mental health therapeutic, diagnostic, or counseling functions.
"Licensure candidate"
means a practitioner
					 actively and regularly receiving board approved supervision, and extended
					 supervision by a fully licensed clinician if board's supervision requirement is
					 met but the individual is not yet licensed, to become licensed by one (1) of
					 the areas of practice listed in (B)(i) through (vi) above. The supervising LBHP
					 responsible for the member's care must:
(A) Staff the member's case with the candidate;
(B) Be personally available, or ensure the availability of
					 an LBHP to the candidate for consultation while they are providing services;
(C) Agree with the current plan for the member;
(D) Confirm that the service provided by the candidate was
					 appropriate; and
(E) The member's medical record must show that the
					 requirements for reimbursement were met and the LBHP responsible for the
					 member's care has reviewed, countersigned, and dated the service plan and any
					 updates thereto so that it is documented that the licensed professional is
					 responsible for the member's care.
"OHCA"
means Oklahoma Health Care Authority.
"OAC"
means Oklahoma Administrative Code.
"O.S."
means Oklahoma Statutes.
"Psychiatric hospital"
means an institution
					 which is primarily engaged in providing, by or under the supervision of a
					 physician, psychiatric services for the diagnosis and treatment of mentally ill
					 persons, as defined by Section 1395x(f) of Title 42 of the United States Code.
"Psychiatric residential treatment facility
					 (PRTF)"
means a non-hospital facility contracted with the OHCA to
					 provide inpatient psychiatric services to SoonerCare-eligible members under the
					 age of twenty-one (21), as defined by
					 42
					 C.F.R. §
											483.352.
"U.S.C."
means United States Code.