Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 21 - OUTPATIENT BEHAVIORAL HEALTH AGENCY SERVICES › Section 317:30-5-241.2 - Psychotherapy

Current through Vol. 41, No. 20, July 1, 2024
(a)
Individual psychotherapy.
(1)
Definition.
Psychotherapy is a face-to-face treatment for mental
				  illnesses and behavioral disturbances, in which the clinician, through
				  definitive therapeutic communication, attempts to alleviate the emotional
				  disturbances, reverse, or change maladaptive patterns of behavior, and
				  encourage growth and development. Insight oriented, behavior modifying and/or
				  supportive psychotherapy refers to the development of insight of affective
				  understanding, the use of behavior modification techniques, the use of
				  supportive interactions, the use of cognitive discussion of reality, or any
				  combination of these items to provide therapeutic change. Ongoing assessment of
				  the member's status and response to treatment as well as psycho-educational
				  intervention are appropriate components of individual therapy. The therapy must
				  be goal directed, utilizing techniques appropriate to the service plan and the
				  member's developmental and cognitive abilities.
(2)
Interactive complexity.
Psychotherapy is considered to involve "interactive complexity" when there are
				  communication factors during a visit that complicate delivery of the
				  psychotherapy by the qualified practitioner. Sessions typically involve members
				  who have other individuals legally responsible for their care (i.e., minors or
				  adults with guardians); members who request others to be involved in their care
				  during the session (i.e., adults accompanied by one or more participating
				  family members or interpreter or language translator); or members that require
				  involvement of other third parties (i.e., child welfare, juvenile justice,
				  parole/probation officers, schools, etc.). Psychotherapy should only be
				  reported as involving interactive complexity when at least one (1) of the
				  following communication factors is present:
(A) The need to manage maladaptive
				  communication (i.e., related to high anxiety, high reactivity, repeated
				  questions, or disagreement) among participants that complicate delivery of
				  care.
(B) Caregiver
				  emotions/behavior that interfere with implementation of the service
				  plan.
(C) Evidence/disclosure of a
				  sentinel event and mandated report to a third party (i.e., abuse or neglect
				  with report to state agency) with initiation of discussion of the sentinel
				  event and/or report with patient and other visit participants.
(D) Use of play equipment, physical devices,
				  interpreter, or translator to overcome barriers to therapeutic interaction with
				  a patient who is not fluent in the same language or who has not developed or
				  lost expressive or receptive language skills to use or understand typical
				  language.
(3)
Qualified practitioners.
Psychotherapy must be provided by an LBHP
				  or licensure candidate in a setting that protects and assures
				  confidentiality.
(4)
Documentation requirements.
Providers must comply with
				  documentation requirements in OAC
				  317:30-5-248.
(5)
Limitations.
A maximum of
				  four (4) units per day per member is compensable. A cumulative maximum of eight
				  (8) units of individual psychotherapy and family psychotherapy per week per
				  member is compensable. Except for psychotherapy involving interactive
				  complexity as described in this Section, only the member and the qualified
				  practitioner should be present during the session. Individual psychotherapy is
				  not reimbursable for a child younger than the age of thirty-six (36) months.
				  Limitations exclude outpatient behavioral health services provided in a foster
				  care setting.