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 317:30-5-96.2 - Payments definitions

Current through Vol. 41, No. 20, July 1, 2024
The following words and terms, when used in OAC
					 317:30-5-96.3
					 through
					 317:30-5-96.7, shall
					 have the following meaning, unless the context clearly indicates otherwise:
"Add-on payment"
means an additional payment
					 added to the per diem to recognize the increased cost of serving members with
					 complex needs in a PRTF or Acute II.
"Allowable costs"
means costs necessary for
					 the efficient delivery of member care.
"Ancillary services"
means the services for
					 which charges are customarily made in addition to routine services. Ancillary
					 services include, but are not limited to, physical therapy, speech therapy,
					 laboratory, radiology, and prescription drugs.
"Border status"
means a placement in a state
					 that does not border Oklahoma. Reimbursement for out-of-state services is made
					 in accordance with OAC
					 317:30-3-89 through
					 317:30-3-92
					 and the Oklahoma Medicaid State Plan.
"Developmentally disabled child"
means a child
					 with deficits in adaptive behavior originating during the developmental period.
					 This condition may exist concurrently with a significantly subaverage general
					 intellectual functioning.
"Eating disorder programs"
means acute or
					 intensive residential behavioral, psychiatric, and medical services provided in
					 a discreet unit to individuals experiencing an eating disorder.
"Professional services"
means services of a
					 physician, psychologist, or dentist legally authorized to practice medicine
					 and/or surgery by the state in which the function is performed.
"Routine services"
means services that are
					 considered routine in the Acute II and PRTF levels of care setting. Routine
					 services include, but are not limited to:
(A) Room and board;
(B) Treatment program components;
(C) Psychiatric treatment;
(D) Professional consultation;
(E) Medical management;
(F) Crisis intervention;
(G) Transportation;
(H) Rehabilitative services;
(I) Case management;
(J) Interpreter services (if applicable);
(K) Routine health care for individuals in good physical
					 health; and
(L) Laboratory services for a substance
					 abuse/detoxification program.
"Specialty treatment program/specialty unit"
means Acute or other intensive behavioral, psychiatric, and medical services
					 that provide care to a population with special needs or issues such as
					 developmentally disabled, intellectually disabled, autistic/Asperger's, eating
					 disorders, sexual offenders, or reactive attachment disorders. These members
					 require a higher level of care and staffing ratio than a standard PRTF and
					 typically have multiple problems.
"Treatment program components"
means
					 therapies, activities of daily living, and rehabilitative services furnished by
					 physician/psychologist or other licensed mental health professionals.
"Usual and customary charges"
means the
					 uniform charges listed in a provider's established charge schedule which is in
					 effect and applied consistently to most members and recognized for program
					 reimbursement. To be considered "customary" for reimbursement, a provider's
					 charges for like services must be imposed on most members regardless of the
					 type of member treated or the party responsible for payment of such services.
Added at 23 Ok Reg
					 2508, eff 6-25-06; Amended at 24 Ok Reg 678, eff 2-1-07 (emergency); Amended at
					 24 Ok Reg 2113, eff 6-25-07; Amended at 24 Ok Reg 2880, eff 7-1-07 (emergency);
					 Amended at 25 Ok Reg 1161, eff 5-25-08; Amended at 27 Ok Reg 2737, eff 7-20-10
					 (emergency); Amended at 28 Ok Reg 1452, eff 6-25-11; Amended at 29 Ok Reg 1076,
					 eff 6-25-12