reglab/statecodes huggingface dataset:
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 18 - GENETIC COUNSELORS › Section 317:30-5-221 - Coverage

Current through Vol. 41, No. 20, July 1, 2024
(a) Genetic
				  counseling services are covered for SoonerCare members who meet the criteria
				  for receiving medically necessary genetic testing as set forth in
				  317:30-5-2(a)(1)(FF)
				  and for pregnant/postpartum SoonerCare members as set forth in this section.
				  Services for pregnant/postpartum SoonerCare members must be referred by a
				  provider involved in the provision of obstetric or pediatric care. Members are
				  eligible for genetic counseling during pregnancy which includes twelve (12)
				  months postpartum. Reasons for genetic counseling include but are not limited
				  to the following:
(1) Advanced maternal
				  age;
(2) Abnormal maternal serum
				  first or second screening;
(3)
				  Previous child or current fetus/infant with an abnormality;
(4) Consanguinity/incest;
(5) Parent is a known carrier or has a family
				  history of a genetic condition;
(6)
				  Parent was exposed to a known or suspected reproductive hazard;
(7) Previous fetal demise, stillbirth, or
				  neonatal death involving known/suspected abnormalities;
(8) History of recurrent pregnancy loss;
				  or
(9) Parent(s) are in an ethnic
				  or racial group associated with an increased risk for specific genetic
				  conditions.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 18 - GENETIC COUNSELORS › Section 317:30-5-222 - Reimbursement

Current through Vol. 41, No. 20, July 1, 2024
(a) Counseling
				  services must be billed using appropriate CPT codes and guidelines and must be
				  medically necessary. SoonerCare does not allow more than six units [thirty (30)
				  minutes = one (1) unit] per pregnancy including twelve (12) months postpartum
				  care.
(b) Genetic Counselors who
				  are employed by or remunerated by another provider may not bill the SoonerCare
				  program directly for services if that billing would result in duplicate payment
				  for the same service.
Added at 25 Ok Reg
					 428, eff 11-1-07 (emergency); Added at 25 Ok Reg 1161, eff
					 5-25-08
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 18 - GENETIC COUNSELORS › Section 317:30-5-223 - Documentation

Current through Vol. 41, No. 20, July 1, 2024
All services must be documented in the member's medical
					 record. All genetic counseling sessions must, at a minimum, include the
					 following:
(1) date of
				  service;
(2) start and stop time
				  for each treatment session;
(3)
				  practitioner's signature;
(4)
				  pedigree, and/or review and interpretation of family history; and
(5) recommendation and plan of
				  care.
Added at 25 Ok Reg 428, eff 11-1-07 (emergency) ; Added
						at 25 Ok Reg 1161, eff 5-25-08 ; Amended at 30 Ok Reg 1143, eff
						7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 19 - CERTIFIED NURSE MIDWIVES › Section 317:30-5-225 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
The Certified Nurse-Midwife must be a qualified
					 professional nurse registered with the Oklahoma Board of Nurse Registration and
					 Nursing Education who possesses evidence of certification according to the
					 requirement of the American College of Nurse-Midwives, and has the right to use
					 the title Certified Nurse-Midwife and the abbreviation C.N.M. Nurse Midwives
					 who practice in states other than Oklahoma must be appropriately licensed in
					 the state in which they practice. The certified nurse midwife accepts
					 responsibility, accountability, and obligation to practice in accordance with
					 usual and customary advanced practice nursing standards and functions as
					 defined by the scope of practice/role definition statements for the certified
					 nurse midwife. In addition, all providers must have a current contract on file
					 with the Oklahoma Health Care Authority.
Added at 12 Ok Reg 751, eff 1-5-95 through 7-14-95
						(emergency) ; Added at 12 Ok Reg 3131, eff 7-27-95 ; Amended at 23 Ok Reg 264,
						eff 10-3-05 (emergency) ; Added at 23 Ok Reg 1359, eff 5-25-06 ; Amended at 30
						Ok Reg 1143, eff 7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 19 - CERTIFIED NURSE MIDWIVES › Section 317:30-5-226 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
(a)
Adults.
Payment is made for certified nurse midwife services
				  within the scope of practice as defined by state law including obstetrical care
				  such as antepartum care, delivery, postpartum care, and care of the normal
				  newborn during the first 28 days of life.
(1)
				  Obstetrical care should be billed using the appropriate CPT codes for Maternity
				  Care and Delivery. The date of delivery should be used as the date of service
				  for charges for total obstetrical care. Inclusive dates of care should be
				  indicated on the claim form as part of the description. The date the patient
				  was first seen must be on the claim form. Payment for total obstetrical care
				  includes all routine care. Ultrasounds and other procedures reimbursed
				  separately from total obstetrical care are paid in accordance with provisions
				  found at OAC
				  317:30-5-22(b).
(2) For payment of total OB care, the
				  provider must have provided care for more than one trimester. To bill for
				  prenatal care only, the claim is filed after the member leaves the provider's
				  care. Payment for routine or minor medical problems will not be made separately
				  to the OB provider outside of antepartum visits. The antepartum care during the
				  prenatal care period includes all care by the OB provider except major illness
				  distinctly unrelated to the pregnancy.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 19 - CERTIFIED NURSE MIDWIVES › Section 317:30-5-227 - Procedure codes [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 14 Ok Reg 2397, eff 2-5-97 (emergency); Amended at 14 Ok
					 Reg 2928, eff 7-11-97; Amended at 16 Ok Reg 151, eff 10-14-98 (emergency);
					 Amended at 16 Ok Reg 1429, eff 5-27-99; Amended at 16 Ok Reg 3413, eff 7-1-99
					 (emergency); Amended at 17 Ok Reg 1204, eff 5-11-00; Revoked at 18 Ok Reg 109,
					 eff 10-7-00; Revoked at 18 Ok Reg 1130, eff
					 5-11-01
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 19 - CERTIFIED NURSE MIDWIVES › Section 317:30-5-228 - Billing [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Revoked at 19 Ok Reg 2134, eff 6-27-02
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 19 - CERTIFIED NURSE MIDWIVES › Section 317:30-5-229 - Reimbursement

Current through Vol. 41, No. 20, July 1, 2024
In accordance with the Omnibus Budget Reconciliation Act of
					 1993, effective October 1, 1993, certified nurse midwife services include
					 maternity services, as well as services outside the maternity cycle within the
					 scope of their practice under state law.
(1) Medical verification of pregnancy is
				  required. A written statement from the physician or certified nurse midwife
				  verifying the applicant is pregnant and the expected date of delivery is
				  acceptable. Pregnancy may also be verified by submission of a copy of a
				  laboratory report indicating the individual is pregnant.
(2) Newborn charges billed on the mother's
				  person code will be denied.
(3)
				  Providers must use OKDHS Form FSS-NB-1 or the eNB1 application on the Secure
				  Website to notify the county DHS office of the child's birth.
(4) Obstetrical care should be billed using
				  the appropriate CPT codes for Maternity Care and Delivery. The date of delivery
				  should be used as the date of service for charges for total obstetrical care.
				  Inclusive dates of care should be indicated on the claim form as part of the
				  description. The date the patient was first seen must be on the claim form.
				  Payment for total obstetrical care includes all routine care performed by the
				  attending provider. For payment of total OB care, the provider must have
				  provided care for more than one trimester. To bill for prenatal care only, the
				  claim is filed after the member leaves the provider's care. Payment for routine
				  or minor medical problems will not be made separately to the OB provider
				  outside of antepartum visits. The antepartum care during the prenatal care
				  period includes all care by the OB provider except major illness distinctly
				  unrelated to the pregnancy.
Added at 30 Ok Reg 1143, eff
						7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 20 - LACTATION CONSULTANTS › Section 317:30-5-230 - General information

Current through Vol. 41, No. 20, July 1, 2024
The primary focus of this service is member-specific
					 support and education regarding breastfeeding, addressing particular issues,
					 and/or managing lactation crisis.
Added at 25 Ok Reg
					 429, eff 12-1-07 through 7-14-08 (emergency)1; Added
					 at 25 Ok Reg 2639, eff 7-25-08
1This emergency action expired
					 before being superseded by a permanent action. Upon expiration of an emergency
					 action enacting a new Section, the Section is no longer effective. Therefore,
					 on 7-15-08 (after the 7-14-08 expiration of this emergency action), Section
					 317:30-5-230 was no longer effective, and remained as such until added again by
					 permanent action on 7-25-08.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 20 - LACTATION CONSULTANTS › Section 317:30-5-231 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
Eligible providers must be licensed by the state as a nurse
					 or dietician and be an International Board Certified Lactation Consultants
					 (IBCLCs). Providers must have a current contract on file with the Oklahoma
					 Health Care Authority.
Added at 25 Ok Reg
					 429, eff 12-1-07 through 7-14-08 (emergency)1; Added
					 at 25 Ok Reg 2639, eff 7-25-08
1This emergency action expired
					 before being superseded by a permanent action. Upon expiration of an emergency
					 action enacting a new Section, the Section is no longer effective. Therefore,
					 on 7-15-08 (after the 7-14-08 expiration of this emergency action), Section
					 317:30-5-231 was no longer effective, and remained as such until added again by
					 permanent action on 7-25-08.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 20 - LACTATION CONSULTANTS › Section 317:30-5-232 - Coverage

Current through Vol. 41, No. 20, July 1, 2024
Lactation Consultant services are covered for pregnant
					 women and women up to twelve (12) months postpartum. SoonerCare members may
					 self-refer or be referred by any provider. Reasons for lactation services
					 include but are not limited to the following:
(1) Prenatal education/training for
				  first-time mothers;
(2) Women who
				  have not previously breastfed, have a history of breastfeeding difficulty, have
				  identified risk factors for breastfeeding difficulty or lactation insufficiency
				  (e.g., history of breast surgery, infertility, hormonal imbalance, diabetes,
				  obesity);
(3) Women expecting an
				  infant with risk factors for ineffective breastfeeding (e.g., preterm,
				  multiples, congenital birth defects);
(4) Latch-on difficulties;
(5) Low milk supply;
(6) Breastfeeding a premature baby
				  (thirty-six (36) weeks or less gestation);
(7) Breastfeeding multiples; and
(8) A baby with special needs (e.g., Down
				  Syndrome, cleft lip/or palate).
Added at 25 Ok Reg
					 429, eff 12-1-07 through 7-14-08 (emergency)1; Added
					 at 25 Ok Reg 2639, eff 7-25-08
1This emergency action expired
					 before being superseded by a permanent action. Upon expiration of an emergency
					 action enacting a new Section, the Section is no longer effective. Therefore,
					 on 7-15-08 (after the 7-14-08 expiration of this emergency action), Section
					 317:30-5-232 was no longer effective, and remained as such until added again by
					 permanent action on 7-25-08.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 20 - LACTATION CONSULTANTS › Section 317:30-5-233 - Limitations

Current through Vol. 41, No. 20, July 1, 2024
(a) Services billed
				  by a contracted IBCLC are only covered when performed in the IBCLC's office
				  setting, patient's home, or other confidential outpatient setting. Payment for
				  inpatient services provided by a Lactation Consultant is included in the
				  hospital's per diem rate.
(b) No
				  separate reimbursement will be made to a facility.
(c) Services are not to duplicate any basic
				  breastfeeding education/training a member may have received through another
				  program such as WIC or the Children's First Program and services must be
				  problem focused.
(d) Services
				  provided by a contracted IBCLC must be provided face-to-face and in an
				  individual setting.
(e)
				  Reimbursement is limited to not more than 6 sessions per pregnancy and must be
				  objectively documented as medically necessary.
Added at 25 Ok Reg
					 429, eff 12-1-07 through 7-14-08 (emergency)1; Added
					 at 25 Ok Reg 2639, eff 7-25-08
1This emergency action expired
					 before being superseded by a permanent action. Upon expiration of an emergency
					 action enacting a new Section, the Section is no longer effective. Therefore,
					 on 7-15-08 (after the 7-14-08 expiration of this emergency action), Section
					 317:30-5-233 was no longer effective, and remained as such until added again by
					 permanent action on 7-25-08.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 20 - LACTATION CONSULTANTS › Section 317:30-5-234 - Reimbursement

Current through Vol. 41, No. 20, July 1, 2024
IBCLCs who are employed by or remunerated by another
					 provider may not bill the SoonerCare program directly for services if that
					 billing would result in duplicate payment for the same
					 service.
Added at 25 Ok Reg
					 429, eff 12-1-07 through 7-14-08 (emergency)1; Added
					 at 25 Ok Reg 2639, eff 7-25-08
1This emergency action expired
					 before being superseded by a permanent action. Upon expiration of an emergency
					 action enacting a new Section, the Section is no longer effective. Therefore,
					 on 7-15-08 (after the 7-14-08 expiration of this emergency action), Section
					 317:30-5-234 was no longer effective, and remained as such until added again by
					 permanent action on 7-25-08.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 20 - LACTATION CONSULTANTS › Section 317:30-5-235 - Documentation

Current through Vol. 41, No. 20, July 1, 2024
All services must be documented in the member's medical
					 record. All prenatal and postpartum lactation sessions must, at a minimum,
					 include the following:
(1) date of
				  service;
(2) start and stop time
				  for each session;
(3) documentation
				  of services provided;
(4)
				  practitioner's signature; and
(5)
				  recommendation and plan of care.
Added at 25 Ok Reg
					 429, eff 12-1-07 through 7-14-08 (emergency)1; Added
					 at 25 Ok Reg 2639, eff 7-25-08
1This emergency action expired
					 before being superseded by a permanent action. Upon expiration of an emergency
					 action enacting a new Section, the Section is no longer effective. Therefore,
					 on 7-15-08 (after the 7-14-08 expiration of this emergency action), Section
					 317:30-5-235 was no longer effective, and remained as such until added again by
					 permanent action on 7-25-08.
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 317:30-5-240 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
All outpatient behavioral health providers eligible for
					 reimbursement under OAC 317:30-5-240 et seq. must be an accredited or Oklahoma
					 Department of Mental Health and Substance Abuse Services (ODMHSAS) certified
					 organization/agency in accordance with Section(s) 3-317, 3-323A, 3-306.1 or
					 3-415 of Title 43A of the Oklahoma Statutes and have a current contract on file
					 with the Oklahoma Health Care Authority. Eligibility requirements for
					 independent professionals (e.g., physicians and Licensed Behavioral Health
					 Professionals), who provide outpatient behavioral health services and bill
					 under their own national provider identification (NPI) number are covered under
					 OAC
					 317:30-5-1 and
					 OAC
					 317:30-5-275.
					 Other outpatient ambulatory clinics (e.g. Federally Qualified Health Centers,
					 Indian Health Clinics, school-based clinics) that offer outpatient behavioral
					 health services are covered elsewhere in the agency rules.
Added at 12 Ok Reg 751, eff 1-5-95 through 7-14-95
						(emergency) ; Added at 12 Ok Reg 3131, eff 7-27-95 ; Amended at 14 Ok Reg 1221,
						eff 8-7-96 (emergency) ; Amended at 14 Ok Reg 158, eff 10-24-96 (emergency) ;
						Amended at 14 Ok Reg 2125, eff 4-4-97 (emergency) ; Amended at 15 Ok Reg 1528,
						eff 5-11-98 ; Amended at 16 Ok Reg 2839, eff 7-12-99 ; Amended at 18 Ok Reg
						3459, eff 6-28-01 (emergency) ; Amended at 19 Ok Reg 1067, eff 5-13-02 ;
						Amended at 22 Ok Reg 156, eff 10-6-04 (emergency) ; Amended at 21 Ok Reg 2473,
						eff 7-11-05 ; Amended at 23 Ok Reg 2540, eff 6-25-06 ; Amended at 24 Ok Reg
						2830, eff 7-1-07 (emergency) ; Amended at 25 Ok Reg 1200, eff 5-25-08 ; Amended
						at 26 Ok Reg 734, eff 4-1-09 (emergency) ; Amended at 26 Ok Reg 2090, eff
						6-25-09 ; Amended at 27 Ok Reg 2753, eff 7-20-10 (emergency) ; Amended at 28 Ok
						Reg 1469, eff 6-25-11 ; Amended at 29 Ok Reg 413, eff 3-7-12 (emergency) ;
						Amended at 29 Ok Reg 1125, eff 6-25-12 ; Amended at 30 Ok Reg 1146, eff
						7-1-13
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 317:30-5-240.2 - Provider participation standards

Current through Vol. 41, No. 20, July 1, 2024
(a)
Accreditation and certification
				  status.
Any agency may participate as an Outpatient Behavioral Health
				  (OPBH) provider if the agency is qualified to render a covered service and
				  meets the OHCA requirements for provider participation.
(1) Private, Community-based Organizations
				  must be accredited as a provider of outpatient behavioral health services from
				  one of the accrediting bodies listed in (c)(1) below and be an incorporated
				  organization governed by a board of directors or be certified by the certifying
				  agency in accordance with 43A O.S. §§ 3-317, 3-323A, 3-306.1, or
				  3-415;
(2) State-operated programs
				  under the direction of ODMHSAS must be accredited by one of the accrediting
				  bodies or be certified by the certifying agency in accordance with 43A O.S.
				  §§ 3-317, 3-323A, 3-306.1 or 3-415;
(3) Freestanding Psychiatric Hospitals must
				  be licensed and certified by the State Survey Agency as meeting Medicare
				  psychiatric hospital standards and JCAHO accreditation;
(4) General Medical Surgical Hospitals must
				  be appropriately licensed and certified by the State Survey Agency as meeting
				  Medicare standards, including a JCAHO or AOA accreditation;
(5) Federally Qualified Health
				  Centers/Community Health Centers facilities that qualify under OAC
				  317:30-5-660;
(6) Indian Health Services/Tribal
				  Clinics/Urban Tribal Clinics facilities that qualify under federal
				  regulation;
(7) Rural Health
				  Clinics facilities that qualify under OAC
				  317:30-5-355;
(8) Public Health Clinics and County Health
				  Departments;
(9) Public School
				  Systems.
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 317:30-5-240.3 - Staff credentials

Current through Vol. 41, No. 20, July 1, 2024
(a)
Licensed behavioral health professional (LBHPs).
LBHPs are defined
				  as any of the following practitioners :
(1)
				  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.
(2) 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 (A) through (F). The exemptions from
				  licensure under 59 O.S. § 1353(4) and (5), 59O.S. § 1903(C) and (D),
				  59O.S. § 1925.3(B) and (C), and 59O.S. § 1932(C) and (D) do not apply
				  to outpatient behavioral health services .
(A) Psychology;
(B) Social work (clinical specialty only);
(C) Professional counselor;
(D) Marriage and family therapist;
(E) Behavioral practitioner; or
(F) Alcohol and drug counselor .
(3) An advanced
				  practice registered nurse (APRN) 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.
(4) A physician
				  assistant who is licensed 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.
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 317:30-5-241.1 - Screening, assessment and service plan

Current through Vol. 41, No. 20, July 1, 2024
All providers must comply with the requirements as set
					 forth in this Section.
(1)
Screening.
(A)
Definition.
Screening is for the purpose of determining whether
				  the member meets basic medical necessity and need for further behavioral health
				  (BH) assessment and possible treatment services.
(B)
Qualified professional.
Screenings can be performed by any credentialed staff members as listed under
				  OAC
				  317:30-5-240.3.
(C)
Target population and
				  limitations.
Screening is compensable on behalf of a member who is
				  seeking services for the first time from the contracted agency. This service is
				  not compensable if the member has previously received or is currently receiving
				  services from the agency, unless there has been a gap in service of more than
				  six (6) months. To qualify for reimbursement, the screening tools used must be
				  evidence-based or otherwise approved by Oklahoma Health Care Authority (OHCA)
				  and Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS)
				  and appropriate for the age and/or developmental stage of the
				  member.
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 317:30-5-241.4 - Crisis Intervention

Current through Vol. 41, No. 20, July 1, 2024
(a)
Onsite
				  and Mobile Crisis Intervention Services (CIS).
(1)
Definition.
CIS are
				  face-to-face services for the purpose of responding to acute behavioral or
				  emotional dysfunction as evidenced by psychotic, suicidal, homicidal severe
				  psychiatric distress, and/or danger of AOD relapse. The crisis situation
				  including the symptoms exhibited and the resulting intervention or
				  recommendations must be clearly documented.
(A) Onsite CIS is the provision of CIS to the
				  member at the treatment facility, either in-person or via telehealth.
(B) Mobile CIS is the provision of CIS by at
				  least one (1) professional at the location of a member who is not at the
				  treatment facility (e.g., services provided at the member's
				  home).
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 317:30-5-241.7 - Medication-assisted treatment (MAT) services for eligible individuals with opioid use disorder (OUD)

Current through Vol. 41, No. 20, July 1, 2024
(a)
Definitions.
The following words and terms, when used in this
				  section, shall have the following meaning, unless the context clearly indicates
				  otherwise:
(1)
"Medication-assisted
				  treatment (MAT)"
means an evidence-based practice approved by the Food
				  and Drug Administration (FDA) to treat opioid use disorder, including methadone
				  and all biological products licensed under federal law for such purpose. MAT
				  also includes the provision of counseling and behavioral therapy.
(2)
"Office-based opioid treatment
				  (OBOT)"
means a fully contracted SoonerCare provider that renders MAT
				  services in OBOT settings. OBOT providers must have capacity to provide all
				  drugs approved by the FDA for the treatment of opioid use disorder, directly or
				  by referral, including for maintenance, detoxification, overdose reversal, and
				  relapse prevention, and appropriate counseling and other appropriate ancillary
				  services.
(3)
"Opioid
				  treatment program (OTP)"
means a program or provider:
(A) Registered under federal law;
(B) Certified by the Substance Abuse and
				  Mental Health Services Administration (SAMHSA);
(C) Certified by ODMHSAS, unless deemed an
				  exempted entity as defined by federal law;
(D) Registered by the Drug Enforcement Agency
				  (DEA);
(E) Registered by the
				  Oklahoma Bureau of Narcotics and Dangerous Drugs (OBNDD); and
(F) Engaged in opioid treatment of
				  individuals by use of an opioid agonist treatment medication, including
				  methadone.
(4)
"Opioid use disorder (OUD)"
means a cluster of cognitive,
				  behavioral, and physiological symptoms in which the individual continues use of
				  opioids despite significant opioid-induced problems.
(5)
"Phase I"
means the first
				  ninety (90) days of treatment.
(6)
"Phase II"
means the second ninety (90) days of
				  treatment.
(7)
"Phase
				  III"
means the third ninety (90) days of treatment.
(8)
"Phase IV"
means the last
				  ninety (90) days of the first year of treatment.
(9)
"Phase V"
means the phase of
				  treatment for members who have been receiving continuous treatment for more
				  than one (1) year.
(10)
"Phase VI"
means the phase of treatment for members who have been
				  receiving continuous treatment for more than two (2) years.
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 317:30-5-241.8 - Multi-systemic therapy (MST)

Current through Vol. 41, No. 20, July 1, 2024
MST intensive outpatient program services are limited to
					 children within an Office of Juvenile Affairs (OJA) MST treatment program which
					 provides an intensive, family and community-based treatment targeting specific
					 BH disorders in children with SED who exhibit chronic, aggressive, antisocial,
					 and/or substance abusing behaviors, and are at risk for out of home placement.
					 Caseloads are kept low due to the intensity of the services provided.
(1)
Qualified professionals.
All
				  MST services are provided by LBHPs or licensure candidates. Licensure candidate
				  signatures must be co-signed by a fully-licensed LBHP in good standing.
				  Additional team support services may be provided by a behavioral health case
				  manager II (CM II) and/or peer recovery support specialist (PRSS) per OAC
				  317:30-5-240.3.
(2)
Documentation requirements.
Providers must comply with documentation requirements in OAC
				  317:30-5-248.
(3)
Limitations.
Services are
				  subject to the following:
(A) Partial billing
				  is not allowed. When only one (1) service is provided in a day, providers
				  should not bill for services performed for less than eight (8)
				  minutes.
(B) MST cannot be billed
				  in conjunction with the following:
(i)
				  Children's psychosocial rehabilitation;
(ii) Partial hospitalization/intensive
				  outpatient treatment;
(iii)
				  Targeted case management;
(iv)
				  Individual, family, and group therapy;
(v) Mobile crisis intervention;
(vi) Peer-to-peer services.
(C) Duration of MST services is
				  between three (3) to six (6) months. Weekly interventions may range from three
				  (3) to twenty (20) hours per week. Weekly hours may be lessened as case nears
				  closure.
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 317:30-5-241.9 - Partial hospitalization program (PHP) - Children/Adolescent

Current through Vol. 41, No. 20, July 1, 2024
(a)
Definition.
Partial hospitalization is an intermediary,
				  stabilizing step for children and adolescents who have had inpatient
				  psychiatric hospitalization prior to returning to school and community supports
				  or as a less restrictive alternative when inpatient treatment may not be
				  indicated. PHP services are:
(1) Reasonable
				  and necessary for the diagnosis or active treatment of the member's condition;
				  and
(2) Reasonably expected to
				  improve the member's condition and functional level and to prevent relapse or
				  hospitalization.
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 317:30-5-241.10 - Partial hospitalization program (PHP) - Adults

Current through Vol. 41, No. 20, July 1, 2024
(a)
Definition.
PHP is an
				  intensive nonresidential, structured therapeutic treatment for individuals with
				  substance use disorder, mental health diagnoses, and/or co-occurring disorders.
				  It can be used as an alternative to and/or a step-down from inpatient or
				  residential treatment, or to stabilize a deteriorating condition that may
				  result in a need for inpatient or residential care. PHP services are:
(1) Reasonable and necessary for the
				  diagnosis or active treatment of the individual's condition; and
(2) Reasonably expected to improve the
				  individual's condition and functional level and to prevent relapse or
				  hospitalization/residential care.
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 317:30-5-241.11 - Day treatment program

Current through Vol. 41, No. 20, July 1, 2024
Day treatment programs are for the stabilization of
					 children and adolescents with severe emotional and/or behavioral disturbances.
					 Treatment is designed for children who have difficulty functioning in
					 mainstream community settings such as classrooms, and who need a higher
					 intensity of services than outpatient counseling provides. Treatment is time
					 limited and includes therapeutically intensive clinical services geared towards
					 reintegration to the home, school, and community.
(1)
Qualified practitioners.
All
				  services in day treatment are provided by a team, which must be composed of one
				  (1) or more of the following participants: physician, registered nurse,
				  licensed behavioral health professional (LBHP) or licensure candidate, a case
				  manager, or other certified behavioral health/substance abuse paraprofessional
				  staff. Services are directed by an LBHP.
(2)
Qualified providers.
Provider agencies for day treatment must be accredited to provide day treatment
				  services by The Joint Commission (TJC), the Commission on Accreditation of
				  Rehabilitation Facilities (CARF), the Accreditation Commission for Health Care
				  (ACHC) or The Council on Accreditation (COA).
(3)
Limitations.
Services must
				  be offered at a minimum of four (4) days per week at least three (3) hours per
				  day. Behavioral health rehabilitation group size is limited to a maximum of
				  eight (8) individuals as clinically appropriate given diagnostic and
				  developmental functioning. Children under age six (6) are not eligible for
				  behavioral health rehabilitation services unless a prior authorization for
				  children ages four (4) and five (5) has been granted by OHCA or its designated
				  agent based on a finding of medical necessity.
(4)
Service requirements.
On-call crisis intervention services must be available twenty-four (24) hours a
				  day, seven (7) days a week (When members served have psychiatric needs,
				  psychiatric services are available which include the availability of a
				  psychiatrist twenty-four (24) hours a day, seven (7) days a week. A
				  psychiatrist can be available either on site or on call but must be available
				  at all times). Day treatment program will provide assessment and diagnostic
				  services and/or medication monitoring, when necessary.
(A) Treatment activities are to include the
				  following every week:
(i) Family therapy at
				  least one (1) hour per week (additional hours of family therapy may be
				  substituted for other day treatment services);
(ii) Group therapy at least two (2) hours per
				  week; and
(iii) Individual therapy
				  at least one (1) hour per week.
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 317:30-5-242 - Coverage for children [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 14 Ok Reg 1221, eff 8-7-96 (emergency); Amended at 14 Ok
					 Reg 2125, eff 4-4-97 (emergency); Amended at 15 Ok Reg 1528, eff 5-11-98;
					 Revoked at 16 Ok Reg 2839, eff 7-12-99
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 317:30-5-243 - Vocational rehabilitation coverage [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 14 Ok Reg 2125, eff 4-4-97 (emergency); Amended at 15 Ok
					 Reg 1528, eff 5-11-98; Revoked at 22 Ok Reg 156, eff 10-6-04 (emergency);
					 Revoked at 21 Ok Reg 2473, eff 7-11-05
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 317:30-5-244 - Individuals eligible for Part B of Medicare

Current through Vol. 41, No. 20, July 1, 2024
Outpatient Behavioral Health services provided to Medicare
					 eligible members are filed directly with the fiscal agent.
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 14 Ok Reg 2125, eff 4-4-97 (emergency); Amended at 15 Ok
					 Reg 1528, eff 5-11-98; Amended at 26 Ok Reg 734, eff 4-1-09 (emergency);
					 Amended at 26 Ok Reg 2090, eff 6-25-09
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 317:30-5-245 - Reimbursement

Current through Vol. 41, No. 20, July 1, 2024
Payment is made for Outpatient Behavioral Health services
					 at the lower of the provider's usual and customary charge or the OHCA fee
					 schedule for SoonerCare compensable services.
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 14 Ok Reg 1221, eff 8-7-96 (emergency); Amended at 14 Ok
					 Reg 2125, eff 4-4-97 (emergency); Amended at 15 Ok Reg 1528, eff 5-11-98;
					 Amended at 16 Ok Reg 2839, eff 7-12-99; Amended at 25 Ok Reg 2674, eff
					 7-25-08
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 317:30-5-246 - Covered services [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 14 Ok Reg 1221, eff 8-7-96 (emergency); Amended at 14 Ok
					 Reg 2125, eff 4-4-97 (emergency); Amended at 15 Ok Reg 139, eff 11-1-97
					 (emergency); Amended at 15 Ok Reg 1528, eff 5-11-98; Amended at 16 Ok Reg 2839,
					 eff 7-12-9; Revoked at 19 Ok Reg 2134, eff
					 6-27-02
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 317:30-5-247 - Billing [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 14 Ok Reg 1221, eff 8-7-96 (emergency); Amended at 14 Ok
					 Reg 2125, eff 4-4-97 (emergency); Amended at 15 Ok Reg 1528, eff 5-11-98;
					 Revoked at 22 Ok Reg 156, eff 10-6-04 (emergency); Revoked at 22 Ok Reg 2473,
					 eff 7-11-05
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 317:30-5-248 - Documentation of records

Current through Vol. 41, No. 20, July 1, 2024
All outpatient behavioral health services must be reflected
					 by documentation in the member's records.
(1) For Behavioral Health Assessments (see
				  OAC
				  317:30-5-241 ),
				  no progress notes are required.
(2)
				  For Behavioral Health Services Plan (see OAC
				  317:30-5-241 ),
				  no progress notes are required.
(3)
				  Treatment Services must be documented by progress notes.
(A) Progress notes shall chronologically
				  describe the services provided, the member's response to the services provided
				  and the member's progress, or lack of, in treatment and must include the
				  following:
(i) Date;
(ii) Person(s) to whom services were
				  rendered;
(iii) Start and stop time
				  for each timed treatment session or service;
(iv) Original signature of the
				  therapist/service provider; in circumstances where it is necessary to fax a
				  service plan to someone for review and then have them fax back their signature,
				  this is acceptable; however, the provider must obtain the original signature
				  for the clinical file within 30 days and no stamped or photocopied signatures
				  are allowed. Electronic signatures are acceptable following OAC
				  317:30-3-4.1
				  and
				  317:30-3-15;
(v) Credentials of therapist/service
				  provider;
(vi) Specific service
				  plan need(s), goals and/or objectives addressed;
(vii) Services provided to address need(s),
				  goals and/or objectives;
(viii)
				  Progress or barriers to progress made in treatment as it relates to the goals
				  and/or objectives;
(ix) Member (and
				  family, when applicable) response to the session or intervention;
(x) Any new need(s), goals and/or objectives
				  identified during the session or service.
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 317:30-5-249 - Non-covered services

Current through Vol. 41, No. 20, July 1, 2024
In addition to the general program exclusions [OAC
					 317:30-5-2(a)(2)
					 ] the following are excluded from coverage. Work and education services:
(1) Talking about the past and current and
				  future employment goals, going to various work sites to explore the world of
				  work, and assisting client in identifying the pros and cons of working.
(2) Development of an ongoing
				  educational and employment rehabilitation plan to help each individual
				  establish job specific skills and credentials necessary to achieve ongoing
				  employment. Psycho-social skills training however would be covered.
(3) Work/school specific supportive services,
				  such as assistance with securing of appropriate clothing, wake-up calls,
				  addressing transportation issues, etc. These would be billed as Case Management
				  following 317:30-5-241.6.
(4) Job
				  specific supports such as teaching/coaching a job task.
Added at 26 Ok Reg
					 734, eff 4-1-09 (emergency); Added at 26 Ok Reg 2090, eff
					 6-25-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 23 - PODIATRISTS › Section 317:30-5-260 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
Payment can be made to a podiatrist licensed in the state
					 where they practice, who has a current contract on file with the Oklahoma
					 Health Care Authority.
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 16 Ok Reg 3449, eff 7-1-99 (emergency); Amended at 17 Ok
					 Reg 1204, eff 5-11-00
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 23 - PODIATRISTS › Section 317:30-5-261 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
Payment is made to podiatrists as set forth in this
					 Section:
(1)
Adults.
Payment is made for medically necessary surgical procedures, x-rays, and
				  outpatient visits. Procedures which are generally considered as preventative
				  foot care, i.e. cutting or removal of corns, warts, callouses, or nails, are
				  not covered unless the diagnoses on the claim, i.e. diabetes, multiple
				  sclerosis, cerebral vascular accident, peripheral vascular disease establishes
				  the medical necessity for the service. The patient must be under the active
				  care of a doctor of medicine or osteopathy who documents the condition. All
				  services must be medically appropriate and related to systemic disease for
				  which foot care is viewed as preventative in nature. Nursing home visits must
				  be ordered by the attending physician. The nursing home record must contain
				  appropriate documentation that the visit was not performed for screening
				  purposes. A specific foot ailment, symptom or complaint must be documented. In
				  instances where the examination is performed in response to specific symptoms
				  or complaints which suggests the need for care, the visit is compensable
				  regardless of the resulting diagnosis. All outpatient visits are subject to
				  existing visit limitations.
(2)
Children.
Coverage of podiatric services for children is the same
				  as for adults. Refer to OAC
				  317:30-3-57(13)
				  for additional coverage under the Early and Periodic Screening, Diagnosis and
				  Treatment Program.
(3)
Individuals eligible for Part B of Medicare.
Payment for podiatric
				  services is made utilizing the Medicaid allowable for comparable services.
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 16 Ok Reg 3449, eff 7-1-99 (emergency); Amended at 17 Ok
					 Reg 1204, eff 5-11-00; Amended at 19 Ok Reg 2922, eff 7-1-02 (emergency);
					 Amended at 20 Ok Reg 1193, eff 5-27-03
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 23 - PODIATRISTS › Section 317:30-5-262 - Claim form [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Revoked at 19 Ok Reg 2134, eff 6-27-02
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 317:30-5-264 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
Certified community behavioral health clinic is a service
					 delivery model designed to provide a comprehensive range of mental health and
					 substance use disorder services. Services are furnished by an interdisciplinary
					 and mobile mental health team that functions interchangeably to provide the
					 rehabilitation and treatment designed to enable the member to live successfully
					 in the community.