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 317:30-5-95.22 - Coverage for children

Current through Vol. 41, No. 20, July 1, 2024
(a) In
				  order for services to be covered, services in psychiatric units of general
				  hospitals, psychiatric hospitals, and PRTF programs must meet the requirements
				  in OAC
				  317:30-5-95.25
				  through
				  317:30-5-95.30.
				  OHCA rules that apply to inpatient psychiatric coverage for individuals aged
				  twenty-one (21) and under are found in Sections OAC 317:30-5-95.22 through
				  317:30-5-95.42.
(b) The following words and terms, when used
				  in OAC 317:30-5-95.22 through
				  317:30-5-95.42,
				  shall have the following meaning, unless the context clearly indicates
				  otherwise:
(1)
"Acute"
means
				  care delivered in a psychiatric unit of a general hospital or psychiatric
				  hospital that provides assessment, medical management and monitoring, and
				  short-term intensive treatment and stabilization to individuals experiencing
				  acute episodes of behavioral health disorders.
(2)
"Acute II"
means care
				  delivered in a psychiatric unit of a general hospital or psychiatric hospital;
				  however, services at this level of care are designed to serve individuals under
				  twenty-one (21) who need longer-term, more intensive treatment, and a more
				  highly-structured environment than they can receive in family and other
				  community-based alternatives to hospitalization. However, care delivered in
				  this setting is less intense than the care provided in Acute.
(3)
"Border placement"
means
				  placement in an inpatient psychiatric facility that is in one (1) of the states
				  that borders Oklahoma (Arkansas, Colorado, Kansas, Missouri, New Mexico, and
				  Texas).
(4)
"Border
				  status"
means placement in a facility in a state that does not border
				  Oklahoma, but which facility routinely provides inpatient psychiatric services
				  to SoonerCare members.
(5)
"Chemical dependency/substance abuse services/detoxification"
means services offered to individuals with a substance-related disorder whose
				  biomedical and emotional/behavioral problems are sufficiently severe to require
				  inpatient care.
(6)
"Enhanced
				  treatment unit or specialized treatment"
means an intensive residential
				  treatment unit that provides a program of care to a population with special
				  needs or issues requiring increased staffing requirements, co-morbidities,
				  environmental accommodations, specialized treatment programs, and longer
				  lengths of stay.
(7)
"Evidence-based practice (EBP)"
means programs or practices that
				  are supported by research methodology and have produced consistently positive
				  patterns of results in accordance with the Substance Abuse and Mental Health
				  Services Administration (SAMHSA).
(8)
"Out-of-state placement"
means a placement for intensive or specialized services not available in
				  Oklahoma requiring additional authorization procedures and approval by the OHCA
				  Behavioral Health Unit.
(9)
"Public facilities"
means Oklahoma government owned or operated
				  facilities.
(10)
"Trauma-informed"
means the recognition and responsiveness to the
				  presence of the effects of past and current traumatic experiences in the lives
				  of members.