Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 24 - CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINICS › Section 317:30-5-263 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
The following words or terms, when used in this Part, shall
					 have the following meaning, unless the context clearly indicates otherwise:
"Advanced practice registered nurse (APRN)"
means a registered nurse in good standing with the board of nursing in the
					 state in which services are provided, who has completed an accredited graduate
					 level advanced practice registered nursing education program approved by the
					 board of nursing in the state in which services are provided, and possesses a
					 current national certification by a national certifying body recognized by the
					 board of nursing in the state in which services are provided. APRN services are
					 limited to the scope of their practice as defined in Title 59 of the Oklahoma
					 Statutes (O.S.) §
										567.3a and
					 corresponding rules and regulations at Oklahoma Administrative Code (OAC)
					 485:10-5-1
					 through
					 485:10-16-9.
"Behavioral health rehabilitation (BHR)
					 services"
means goal-oriented outpatient interventions that target the
					 maximum reduction of mental and/or behavioral health impairments and strive to
					 restore the members to their best possible mental and/or behavioral health
					 functioning.
"Centers for Medicare and Medicaid Services
					 (CMS)"
means the federal agency within the United States Department of
					 Health and Human Services (HHS) that administers the Medicare program and works
					 in partnership with state governments to administer Medicaid.
"Certified alcohol and drug counselor (CADC)"
means an individual with an Oklahoma certification as an alcohol and drug
					 counselor.
"Certified behavioral health case manager
					 (CM)"
means an individual who is certified by the ODMHSAS as a
					 behavioral health case manager pursuant to OAC, Title 450, Chapter 50. Refer to
					 OAC
					 317:30-5-240.3(h).
"Certified community behavioral health clinics
					 (CCBHC)"
means a service delivery model designed to provide a
					 comprehensive range of mental health and/or substance abuse rehabilitative
					 services. Services are furnished by an interdisciplinary and mobile mental
					 health team that functions interchangeably.
"C.F.R."
means the Code of Federal
					 Regulations.
"Facility-based crisis stabilization (FBCS)"
means emergency psychiatric and substance abuse services aimed at resolving
					 crisis situations. The services provided are emergency stabilization, which
					 includes a protected environment, chemotherapy, detoxification, individual and
					 group treatment, and medical assessment.
"Family support and training provider (FSP)"
means an individual who provides a system of care that is child-centered with
					 the needs of the child and family dictating the types and mix of services
					 provided, to assist in keeping the family together and preventing an
					 out-of-home placement. FSP providers must:
(A) Have a high school diploma or equivalent;
(B) Be twenty-one (21) years of age and have a successful
					 experience as a family member of a child or youth with serious emotional
					 disturbance, or have lived experience as the primary caregiver of a child or
					 youth who has received services for substance use disorder and/or co-occurring
					 substance use and mental health, or have lived experience being the caregiver
					 for a child with Child Welfare/Child Protective Services involvement;
(C) Successfully complete family support training according
					 to a curriculum approved by the Oklahoma Department of Mental Health and
					 Substance Abuse Services (ODMHSAS) and pass the examination with a score of
					 eighty percent (80%) or better;
(D) Pass Oklahoma State Bureau of Investigation (OSBI)
					 background check;
(E) Have treatment plans be overseen and approved by a
					 licensed behavioral health professional (LBHP) or licensure candidate; and
(F) Function under the general direction of an LBHP,
					 licensure candidate or systems of care team, with an LBHP or licensure
					 candidate available at all times to provide back up, support, and/or
					 consultation.
"Illness/wellness management and recovery
					 (IMR/WMR)"
means evidence-based practice models designed to help people
					 who have experienced psychiatric symptoms. Elements include: developing
					 personalized strategies for managing their mental illness and moving forward
					 with their lives; setting and pursuing personal goals; learning information and
					 skills to develop a sense of mastery over their psychiatric illness; and
					 helping clients put strategies into action in their everyday lives.
"Institution for mental disease (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.
"Intermediate care facility for individuals with
					 intellectual disabilities (ICF/IID)"
means a facility which primarily
					 provides health-related care and services above the level of custodial care to
					 intellectually disabled individuals but does not provide the level of care
					 available in a hospital or skilled nursing facility.
"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 medical resident in psychiatry;
(B) A practitioner with a current license to practice in
					 the state in which services are provided, within one (1) of the following areas
					 of practice:
(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 APRN, certified in a psychiatric mental health
					 specialty, and licensed as a registered nurse with a current certification of
					 recognition from the board of nursing in the state in which services are
					 provided; or
(D) A physician assistant (PA) with a current license to
					 practice and in good standing in the state in which services are provided and
					 has received specific training for and is experienced in performing mental
					 health therapeutic, diagnostic, or counseling functions.
"Licensure candidate"
means a practitioner who
					 is actively and regularly receiving board approved supervision, and extended
					 supervision by a fully licensed clinician if the board's supervision
					 requirement is met but the individual is not yet licensed, to become licensed
					 in a specific area of practice as outlined 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) Show that the member's medical record meet the
					 requirements for reimbursement 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.
"OAC"
means Oklahoma Administrative Code, the
					 publication authorized by Section
					 256
					 of Title 75 of the Oklahoma Statutes known as The Oklahoma Administrative Code,
					 or, prior to its publication, the compilation of codified rules authorized by
					 75 O.S. § 256(A)(1)(a) and maintained in the Office of Administrative
					 Rules.
"ODMHSAS"
means the Oklahoma Department of
					 Mental Health and Substance Abuse Services.
"OHCA"
means the Oklahoma Health Care
					 Authority.
"O.S."
means Oklahoma Statutes.
"Peer recovery support specialist (PRSS)"
means an individual certified by ODMHSAS as a peer recovery support specialist
					 pursuant to requirements found in OAC 450:53.
"Program of All-Inclusive Care for the Elderly
					 (PACE)"
means a home and community based acute and long-term care
					 services program for eligible individuals who meet the medical requirements for
					 nursing facility care and can be served safely and appropriately in the
					 community.
"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.
"Psychosocial rehabilitation services (PSR)"
means face-to-face Behavioral Health Rehabilitation services which are
					 necessary to improve the member's ability to function in the community. They
					 are performed to improve the skills and abilities of members to live
					 independently in the community, improve self-care and social skills, and
					 promote lifestyle change and recovery practices.
"Qualified behavioral health aide (QBHA)"
means a behavioral health aide who must meet requirements described in OAC
					 317:30-5-240.3.
"Registered nurse (RN)"
means an individual
					 who is a graduate of an approved school of nursing and is appropriately
					 licensed in the state in which he or she practices.
"Serious emotional disturbance (SED)"
means a
					 condition experienced by persons from birth to eighteen (18) who have a
					 diagnosable mental, behavioral, or emotional disorder of sufficient duration to
					 meet diagnostic criteria outlined in OAC
					 317:30-5-240.1.
"Serious mental illness (SMI)"
means a
					 condition experienced by persons age eighteen (18) and over that have a
					 diagnosable mental, behavior, or emotional disorder that causes serious
					 functional impairment that substantially interferes with or limits one or more
					 major life activities. Specific diagnostic criteria is outlined in OAC
					 317:30-5-240.1.
"System of care values"
means a philosophy,
					 which embraces a family-driven, child-centered model of care that integrates
					 and coordinates the efforts of different agencies and providers to
					 individualize care in the least restrictive setting that is clinically
					 appropriate.
"Wellness recovery action plans (WRAP)"
means
					 a self- management and recovery system designed to:
(A) Decrease intrusive or troubling feelings and behaviors;
(B) Increase personal empowerment;
(C) Improve quality of life; and
(D) Assist people in achieving their own life goals and
					 dreams.
"Wraparound approach"
means a team-based
					 planning and implementation process to improve the lives of children with
					 complex needs and their families by developing individualized plans of care.
					 The key characteristics of the process are that the plan is developed by a
					 family centered team, is individualized based on the strengths and culture of
					 the child and his or her family, and is driven by needs rather than services.