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 317:30-5-95.43 - Residential substance use disorder treatment

Current through Vol. 41, No. 20, July 1, 2024
(a)
Purpose.
The purpose of sections OAC
				  317:30-5-95.43 -
				  317:30-5-95.49 is to establish
				  the procedures and requirements for residential treatment facilities providing
				  SUD treatment services.
(b)
Definitions.
The following words and terms, when used in the
				  aforementioned sections, shall have the following meanings unless the context
				  clearly indicates otherwise.
(1)
"ASAM"
means the American Society of Addiction Medicine.
(2)
"ASAM criteria"
means the
				  most recent edition of the American Society of Addiction Medicine's published
				  criteria for admission to treatment, continued services, and
				  discharge.
(3)
"ASAM levels
				  of care"
means the different options for treatment as described below
				  and in the current edition of the ASAM criteria that vary according to the
				  intensity of the services offered. Each treatment option is a level of care.
(A)
"ASAM level 3"
means
				  residential and inpatient services and encompasses ASAM levels 3.1, 3.3, 3.5
				  and 3.7.
(B)
"ASAM level
				  3.1"
means clinically managed low-intensity residential services for
				  adolescents and adults. This level of care typically provides at least five (5)
				  hours of clinical services a week and provides a twenty-four (24) hour living
				  support and structure with trained personnel. The corresponding service
				  description for this level of care is halfway house services.
(C)
"ASAM level 3.3"
means
				  clinically managed population-specific high-intensity residential services.
				  This level of care is for adults only and typically offers twenty-four (24)
				  hour care with trained personnel and is designed to accommodate individuals
				  with cognitive or other impairments. The corresponding service description for
				  this level of care is residential treatment for adults with co-occurring
				  disorders.
(D)
"ASAM level
				  3.5"
means clinically managed medium-intensity residential services for
				  adolescents and clinically managed high-intensity residential services for
				  adults. This level of care provides twenty-four (24) hour care and offers a
				  wide range of therapeutic services. The corresponding service descriptions for
				  this level of care are residential treatment and intensive residential
				  treatment.
(E)
"ASAM level
				  3.7"
means medically monitored high-intensity inpatient services for
				  adolescents and medically monitored intensive inpatient withdrawal management
				  for adults. This level of care provides twenty-four (24) hour nursing care with
				  physician supervision and medication availability. This level of care is
				  appropriate for individuals withdrawing from alcohol or other drugs with
				  subacute biomedical and emotional, behavioral, or cognitive problems severe
				  enough to require inpatient treatment but for whom hospitalization is not
				  necessary. The corresponding service description for this level of care is
				  medically supervised withdrawal management.
(4)
"Care management services"
means an assessment of a member, development of a care plan, and referral and
				  linkage to SUD community supports and community-based or lower level of care
				  services to promote continued recovery after the individual discharges from the
				  treatment facility.
(5)
"Co-occurring disorder (COD)"
means any combination of mental
				  health symptoms and SUD symptoms or diagnoses that affect a member and are
				  typically determined by the Diagnostic and Statistical Manual of Mental
				  Disorders (DSM).
(6)
"DSM"
means the most recent edition of the Diagnostic and
				  Statistical Manual of Mental Disorders (DSM) published by the American
				  Psychiatric Association.
(7)
"ODMHSAS"
means the Oklahoma Department of Mental Health and
				  Substance Abuse Services (ODMHSAS).
(8)
"Per diem"
means an
				  all-inclusive rate for covered SUD treatment services provided each day during
				  a facility stay.
(9)
"Rehabilitation services"
means face-to-face individual or group
				  services provided by qualified staff to develop skills necessary to perform
				  activities of daily living and successful integration into community life.
				  Rehabilitation services for substance use disorders are also referred to as
				  skill development services.
(10)
"Service plan"
means the document used during the process by which
				  an LBHP or a licensure candidate and the member together and jointly identify
				  and rank problems, establish agreed-upon immediate short-term and long-term
				  goals, and decide on the treatment process and resources to be
				  utilized.
(11)
"Substance use
				  disorder (SUD)"
means alcohol or drug dependence, or psychoactive SUD as
				  defined by the most recent DSM criteria.
(12)
"Therapeutic services"
means professional services during which members engage in identifying,
				  addressing and/or resolving issues identified in the member's service
				  plan.
(13)
"Treatment hours B
				  residential"
means the structured hours in which a member is involved in
				  receiving professional services to assist in achieving
				  recovery.