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 24 - CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINICS › Section 317:30-5-265 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
(a)
Agency
				  requirements.
CCBHCs are responsible for providing services to
				  qualifying individuals within the provider's specified service area. Qualifying
				  providers must:
(1) Be certified by the
				  ODMHSAS as a community mental health center under OAC 450:17 and have provider
				  specific credentials from ODMHSAS for CCBHCs (OAC
				  450:17-5-170
				  et seq.);
(2) Be under the
				  direction of a licensed physician;
(3) Provide mobile crisis care twenty-four
				  (24) hours, seven (7) days a week and have a twenty-four (24) hours, seven (7)
				  days a week walk-in crisis clinic or a psychiatric urgent care, or have an
				  agreement in place with a State-sanctioned alternative;
(4) Actively use an Office of National
				  Coordinator (ONC) certified Electronic Health Record (EHR) as demonstrated on
				  the ONC Certified Health IT Product List;
(5) Have a contract with a Health Information
				  Exchange (HIE) and demonstrate staff use of obtaining and sending data through
				  the HIE as well as policy stating frequency of use and security protocols; and
(6) Report on encounter, clinical
				  outcomes, and quality improvement. This includes meeting all federal and State
				  specifications of the required CMS quality measure reporting, as well as
				  performance improvement reports outlining activities taken to improve outcomes.
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 317:30-5-266 - Covered services

Current through Vol. 41, No. 20, July 1, 2024
CCBHCs provide a comprehensive array of services that
					 create access, stabilize people in crisis, and provide the needed treatment and
					 recovery support services for those with the most serious and complex mental
					 health and substance use disorders. CCBHCs integrate additional services to
					 ensure an approach to health care that emphasizes recovery, wellness,
					 trauma-informed care, and physical-behavioral health integration. Initial
					 screening, assessment, and diagnosis must be completed in order to receive a
					 covered service. Services must be medically necessary and recommended by an
					 LBHP or licensure candidate (see OAC
					 317:30-5-263) .
					 Services are covered when provided in accordance with a person-centered and
					 family-centered service plan. Coverage includes the following services:
(1)
Crisis assessment and intervention
				  services.
(A)
Service
				  requirements.
This service is an immediately available service designed
				  to meet the psychological, physiological, and environmental needs of
				  individuals who are experiencing mental health and/or substance use disorder
				  crises. Services include the following:
(i)
				  Twenty-four (24) hours mobile crisis teams [see OAC
				  317:30-5-241.4(a)
				  for service definition]. Reimbursement is triggered by the LBHP/licensure
				  candidate crisis assessment;
(ii)
				  Emergency crisis intervention service [see OAC
				  317:30-5-241.4(a)
				  for service definition];
(iii)
				  Facility-based crisis stabilization [see OAC
				  317:30-5-241.4(b)
				  for service definition], provided directly by the CCBHC or by a
				  State-sanctioned alternative; and
(iv) Urgent recovery clinic (URC) services
				  provided in accordance with OAC
				  450:23-3-20 through
				  450:23-3-24.
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 317:30-5-267 - Reimbursement

Current through Vol. 41, No. 20, July 1, 2024
(a) In order to be
				  eligible for payment, CCBHCs must have an approved provider agreement on file
				  with the OHCA. Through this agreement, the CCBHC assures that OHCA's
				  requirements are met and assures compliance with all applicable federal and
				  state Medicaid law, including, but not limited to, OHCA administrative rules,
				  ODMHSAS administrative rules, the Code of Federal Regulations, and the Oklahoma
				  State Medicaid Plan. These agreements are renewed annually with each
				  provider.
(b) Reimbursement is made
				  using a provider-specific prospective payment system (PPS) rate developed based
				  on provider-specific cost report data. The PPS rate varies by category and
				  level of service intensity and is paid when a CCBH program delivers at least
				  one (1) CCBHC covered service, and when a valid individual procedure code is
				  reported for the calendar month. For reimbursement purposes, members are
				  categorized as follows, and are assigned to special populations by the State:
(1) Standard population;
(2) Special population 1. This population
				  includes individuals eighteen (18) years of age and over with SMI and complex
				  needs including those with co-occurring substance use disorder (SUD).
				  Individuals between eighteen (18) and twenty-one (21) years of age can be
				  served in either special population 1 or 2 depending on the member's
				  individualized needs; and
(3)
				  Special population 2. This population includes children and youth [ages six (6)
				  through twenty-one (21)] with SED and complex needs, including those with
				  co-occurring mental health and SUD.
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 317:30-5-268 - Limitations

Current through Vol. 41, No. 20, July 1, 2024
(a) The following
				  are non-billable opportunities for CCBHCs serving eligible members:
(1) Employment services;
(2) Personal care services;
(3) Childcare
(4) Respite services; and
(5) Care coordination.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 25 - PSYCHOLOGISTS › Section 317:30-5-275 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
(a) Licensed
				  Psychologist must be licensed to practice in the state in which services are
				  provided. Payment is made for compensable services to psychologists licensed in
				  the state in which face-to-face services are delivered.
(b) Psychologists employed in State and
				  Federal agencies, who are not permitted to engage in private practice, cannot
				  be reimbursed for services as an individually contracted provider.
(c) Services provided by practitioners, who
				  have completed education requirements to begin an internship or a post-doctoral
				  fellowship in an accredited clinical psychology academic training program and
				  are under current board approved supervision toward licensure, are eligible for
				  reimbursement. Each supervising psychologist must have a current contract with
				  the Oklahoma Health Care Authority (OHCA).
(d) For those licensure candidates who are
				  actively and regularly receiving board approved supervision, or extended
				  supervision by a fully licensed clinician and if the board's supervision
				  requirement is met but the individual is not yet licensed, each supervising
				  psychologist must have a current contract with the Oklahoma Health Care
				  Authority (OHCA).
(e) In order for
				  services provided by clinical psychology interns completing required
				  internships, post-doctoral fellows completing required supervision for
				  licensure to be reimbursed, the following conditions must be met:
(1) The licensed practitioner billing
				  SoonerCare must have a letter on file covering the dates of services of the
				  internship or post-doctoral fellowship;
(2) The psychology intern or post-doctoral
				  fellow must be under the direct supervision of the licensed psychologist who is
				  responsible for the member's care;
(3) The licensed psychologist responsible for
				  the member's care must:
(A) Staff the
				  member's case with the intern or fellow,
(B) Actively direct the services;
(C) Be available to the intern or fellow for
				  in-person consultation while they are providing services;
(D) Agree with the current plan for the
				  member; and
(E) Confirm that the
				  service provided by the intern or fellow was appropriate.
(4) The member's medical record must show
				  that the requirements for reimbursement were met and the licensed psychologist
				  responsible for the member's care has reviewed, countersigned, and dated the
				  notes in the medical record at least every week so that it is documented that
				  the licensed psychologist is responsible for the member's
				  care.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 25 - PSYCHOLOGISTS › Section 317:30-5-276 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
(a)
Outpatient Behavioral Health Services.
Outpatient behavioral
				  health services are covered as set forth in this Section, when provided in
				  accordance with a documented individualized service plan medical record,
				  developed to treat the identified behavioral health and/or substance use
				  disorder(s), unless specified otherwise.
(1)
				  All services are to be for the goal of improvement of functioning,
				  independence, or wellbeing of the member. The services and treatment plans are
				  to be recovery focused, trauma and co-occurring specific. The member must be
				  able to actively participate in the treatment. Active participation means that
				  the member must have sufficient cognitive abilities, communication skills, and
				  short-term memory to derive a reasonable benefit from the treatment.
(2) In order to be reimbursed for services,
				  providers must submit a completed Customer Data Core (CDC) to OHCA or its
				  designated agent. The CDC must be reviewed, updated and resubmitted by the
				  provider every six months. Reimbursement is made only for services provided
				  while a current CDC is on file with OHCA or its designated agent. For further
				  information and instructions regarding the CDC, refer to the Prior
				  Authorization Manual.
(3) Some
				  outpatient behavioral health services may require authorization. For
				  information regarding services requiring authorization and the process for
				  obtaining them, refer to the Prior Authorization Manual. Authorization of
				  services is not a guarantee of payment. The provider is responsible for
				  ensuring that the eligibility, medical necessity, procedural, coding, claims
				  submission, and all other state and federal requirements are met. OHCA does
				  retain the final administrative review over both authorization and review of
				  services as required by 42 Code of Federal Regulations 431.10.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 25 - PSYCHOLOGISTS › Section 317:30-5-277 - 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 768, eff 11-25-96 (emergency); Amended at 14 Ok
					 Reg 1780, eff 5-27-97; Amended at 18 Ok Reg 2959, eff 5-17-01 (emergency);
					 Amended at 19 Ok Reg 1067, eff 5-13-02; 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 25 - PSYCHOLOGISTS › Section 317:30-5-278 - Non-covered procedures

Current through Vol. 41, No. 20, July 1, 2024
The following procedures by psychologists are not
					 covered:
(1) sensitivity
				  training
(2) encounter
(3) workshops
(4) sexual competency training
(5) marathons or retreats for mental
				  disorders
(6) strictly education
				  training
(7) psychotherapy to
				  persons under three years of age unless specifically approved by OHCA, or its
				  designated 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 768, eff 11-25-96 (emergency); Amended at 14 Ok
					 Reg 1780, eff 5-27-97; Amended at 27 Ok Reg 1676, eff 7-10-10 (emergency);
					 Amended at 28 Ok Reg 1483, eff 6-25-11
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 25 - PSYCHOLOGISTS › Section 317:30-5-278.1 - Documentation of records

Current through Vol. 41, No. 20, July 1, 2024
All psychological services will be reflected by
					 documentation in the patient records.
(1) All assessment, testing, and treatment
				  services/units billed must include the following:
(A) date;
(B) start and stop time for each session/unit
				  billed;
(C) signature of the
				  provider;
(D) credentials of
				  provider;
(E) specific problem(s),
				  goals and/or objectives addressed;
(F) methods used to address problem(s), goals
				  and objectives;
(G) progress made
				  toward goals and objectives;
(H)
				  patient response to the session or intervention; and
(I) any new problem(s), goals and/or
				  objectives identified during the session.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 25 - PSYCHOLOGISTS › Section 317:30-5-279 - 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 26 - LICENSED BEHAVIORAL HEALTH PROVIDERS › Section 317:30-5-280 - Eligible Providers

Current through Vol. 41, No. 20, July 1, 2024
Licensed Behavioral Health Professionals (LBHP) are
					 defined as follows:
(1) Allopathic or
				  Osteopathic Physicians 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) Practitioners with a license to practice
				  in the state in which services are provided.
(A) Social Worker (clinical specialty
				  only),
(B) Professional
				  Counselor,
(C) Marriage and Family
				  Therapist,
(D) Behavioral
				  Practitioner, or
(E) Alcohol and
				  Drug Counselor.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 26 - LICENSED BEHAVIORAL HEALTH PROVIDERS › Section 317:30-5-281 - Coverage by Category

Current through Vol. 41, No. 20, July 1, 2024
(a)
Outpatient Behavioral Health Services.
Outpatient behavioral
				  health services are covered as set forth in this Section, and when provided in
				  accordance with a documented individualized service plan and/or medical record,
				  developed to treat the identified behavioral health and/or substance use
				  disorder(s), unless specified otherwise.
(1)
				  All services are to be for the goal of improvement of functioning,
				  independence, or wellbeing of the member. The services and treatment plans are
				  to be recovery focused, trauma and co-occurring specific. The member must be
				  able to actively participate in the treatment. Active participation means that
				  the member must have sufficient cognitive abilities, communication skills, and
				  short-term memory to derive a reasonable benefit from the treatment.
(2) In order to be reimbursed for services,
				  providers must submit a completed Customer Data Core (CDC) to OHCA or its
				  designated agent. The CDC must be reviewed, updated and resubmitted by the
				  provider every six (6) months. Reimbursement is made only for services provided
				  while a current CDC is on file with OHCA or its designated agent. For further
				  information and instructions regarding the CDC, refer to the Prior
				  Authorization Manual.
(3) Some
				  outpatient behavioral health services may require authorization. For
				  information regarding services requiring authorization and the process for
				  obtaining them, refer to the Prior Authorization Manual. Authorization of
				  services is not a guarantee of payment. The provider is responsible for
				  ensuring that the eligibility, medical necessity, procedural, coding, claims
				  submission, and all other state and federal requirements are met. OHCA does
				  retain the final administrative review over both authorization and review of
				  services as required by
				  42 CFR
				  431.10.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 26 - LICENSED BEHAVIORAL HEALTH PROVIDERS › Section 317:30-5-282 - Non-covered procedures

Current through Vol. 41, No. 20, July 1, 2024
The following procedures by LBHPs are not covered:
(1) sensitivity training
(2) encounter
(3) workshops
(4) sexual competency training
(5) marathons or retreats for mental
				  disorders
(6) strictly education
				  training
(7) psychotherapy to
				  persons under three years of age unless specifically approved by OHCA, or its
				  designated agent.
Added at 27 Ok Reg
					 1676, eff 7-10-10 (emergency); Added at 28 Ok Reg 1483, eff
					 6-25-11
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 26 - LICENSED BEHAVIORAL HEALTH PROVIDERS › Section 317:30-5-283 - Documentation of records

Current through Vol. 41, No. 20, July 1, 2024
All behavioral health services will be reflected by
					 documentation in the patient records.
(1) All assessment, testing, and treatment
				  services/units billed must include the following:
(A) date;
(B) start and stop time for each session/unit
				  billed;
(C) signature of the
				  provider;
(D) credentials of
				  provider;
(E) specific problem(s),
				  goals, and/or objectives addressed;
(F) methods used to address problem(s), goals
				  and objectives;
(G) progress made
				  toward goals and objectives;
(H)
				  patient response to the session or intervention; and
(I) any new problem(s), goals and/or
				  objectives identified during the session.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 27 - INDEPENDENT PHYSICAL THERAPISTS AND PHYSICAL THERAPIST ASSISTANTS › Section 317:30-5-290 - Payment for outpatient 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 25 Ok Reg 123, eff 8-1-07 (emergency); Revoked at 25 Ok Reg
					 112, eff 10-1-07 (emergency); Revoked at 25 Ok Reg 1192, 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 27 - INDEPENDENT PHYSICAL THERAPISTS AND PHYSICAL THERAPIST ASSISTANTS › Section 317:30-5-290.1 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
(a)
Physical therapists.
(1) Must be
				  appropriately licensed in good standing in the state in which they practice and
				  working in accordance with the Oklahoma Physical Therapy Practice Act or other
				  applicable statute(s); and
(2)
				  Entered into a provider agreement with the Oklahoma Health Care Authority
				  (OHCA) to provide physical therapy services.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 27 - INDEPENDENT PHYSICAL THERAPISTS AND PHYSICAL THERAPIST ASSISTANTS › Section 317:30-5-291 - Coverage by category; payment rates and procedure codes

Current through Vol. 41, No. 20, July 1, 2024
(a)
Coverage.
Payment is made to
				  registered physical therapists as set forth in this Section.
(1)
Children.
Initial therapy
				  evaluations do not require prior authorization and must be provided by a fully
				  licensed physical therapist. All therapy services following the initial
				  evaluation must be prior authorized for continuation of service. Prior to the
				  initial evaluation, the therapist must have on file a signed and dated
				  prescription or referral for the therapy services from the member's physician
				  or other licensed practitioner of the healing arts. The prescribing or
				  referring provider must be able to provide, if requested, clinical
				  documentation from the member's medical record that supports the medical
				  necessity for the evaluation and referral.
(2)
Adults.
There is no coverage
				  for adults for services rendered by individually contracted providers. Coverage
				  for adults is permitted in an outpatient hospital setting as described in
				  Oklahoma Administrative Code(OAC)
				  317:30-5-42.1.
(3)
Individuals eligible for Part B of
				  Medicare.
Services provided to Medicare eligible recipients are filed
				  directly with the fiscal agent.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 27 - INDEPENDENT PHYSICAL THERAPISTS AND PHYSICAL THERAPIST ASSISTANTS › Section 317:30-5-291.1 - Payment rates [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 25 Ok Reg
					 123, eff 8-1-07 (emergency); Added at 25 Ok Reg 1192, 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 27 - INDEPENDENT PHYSICAL THERAPISTS AND PHYSICAL THERAPIST ASSISTANTS › Section 317:30-5-291.2 - Procedure codes [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 25 Ok Reg
					 123, eff 8-1-07 (emergency); Added at 25 Ok Reg 1192, 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 27 - INDEPENDENT PHYSICAL THERAPISTS AND PHYSICAL THERAPIST ASSISTANTS › Section 317:30-5-292 - 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 27 - INDEPENDENT PHYSICAL THERAPISTS AND PHYSICAL THERAPIST ASSISTANTS › Section 317:30-5-293 - Team therapy (Co-treatment)

Current through Vol. 41, No. 20, July 1, 2024
Therapists, or therapy assistants, working together as a
					 team to treat one(1) or more members cannot bill separately for the same or
					 different service provided at the same time to the same member.
(1) Current Procedural Terminology (CPT)
				  codes are used for billing the services of one (1) therapist or therapy
				  assistant. The therapist cannot bill for his/her services and those of another
				  therapist or a therapy assistant, when both provide the same or different
				  services, at the same time, to the same member.
(2) If multiple therapies (physical therapy,
				  occupational therapy, and/or speech therapy) are provided to one(1) member at
				  the same time, only one(1) therapist can bill for the entire service, or each
				  therapist can divide the service units.
(3) Providers must report the CPT code for
				  the time actually spent in the delivery of the modality requiring constant
				  attendance and therapy services. Pre- and post-delivery services are not to be
				  counted in determining the treatment service time. The time counted must begin
				  when the therapist is directly working with the member to deliver treatment
				  services.
(4) The time counted is
				  the time the member is being treated. If the member requires both a therapist
				  and an assistant, or even two(2) therapists, each service unit of time the
				  member is being treated can count as only one(1) unit of each code. The service
				  units billed must equal the total time the member was receiving actual therapy
				  services. It is not allowable for each therapist or therapy assistant to bill
				  for the entire therapy session. The time the member spends not being treated,
				  for any reason, must not be billed.
Added at 28 Ok Reg 12,
					 eff 8-13-10 (emergency); Added at 28 Ok Reg 1475, eff
					 6-25-11
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 28 - OCCUPATIONAL THERAPISTS AND OCCUPATIONAL THERAPY ASSISTANTS › Section 317:30-5-295 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
(a)
Occupational therapists.
(1)
				  Must be appropriately licensed in good standing in the state in which they
				  practice and working in accordance with the Oklahoma Occupational Therapy
				  Practice Act or other applicable statute(s); and
(2) Entered into a provider agreement with
				  the Oklahoma Health Care Authority (OHCA) to provide occupational therapy
				  services.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 28 - OCCUPATIONAL THERAPISTS AND OCCUPATIONAL THERAPY ASSISTANTS › Section 317:30-5-296 - Coverage by category; payment rates and procedure codes

Current through Vol. 41, No. 20, July 1, 2024
(a)
Coverage.
Payment is made
				  for occupational therapy services as set forth in this Section.
(1)
Children.
Initial therapy
				  evaluations do not require prior authorization and must be provided by a fully
				  licensed occupational therapist. All therapy services following the initial
				  evaluation must be prior authorized for continuation of service. Prior to the
				  initial evaluation, the therapist must have on file a signed and dated
				  prescription or referral for the therapy services from the member's physician
				  or other licensed practitioner of the healing arts. The prescribing or
				  referring provider must be able to provide, if requested, clinical
				  documentation from the member's medical record that supports the medical
				  necessity for the evaluation and referral.
(2)
Adults.
There is no coverage
				  for adults for services rendered by individually contracted providers. Coverage
				  for adults is permitted in an outpatient hospital setting as described in
				  Oklahoma Administrative Code(OAC)
				  317:30-5-42.1.
(3)
Individuals eligible for Part B of
				  Medicare.
Services provided to Medicare eligible recipients are filed
				  directly with the fiscal agent.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 28 - OCCUPATIONAL THERAPISTS AND OCCUPATIONAL THERAPY ASSISTANTS › Section 317:30-5-297 - Payment rates [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 28 - OCCUPATIONAL THERAPISTS AND OCCUPATIONAL THERAPY ASSISTANTS › Section 317:30-5-298 - Procedure codes [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 25 Ok Reg
					 123, eff 8-1-07 (emergency); Added at 25 Ok Reg 1192, 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 28 - OCCUPATIONAL THERAPISTS AND OCCUPATIONAL THERAPY ASSISTANTS › Section 317:30-5-299 - Team therapy (Co-treatment)

Current through Vol. 41, No. 20, July 1, 2024
Therapists, or therapy assistants, working together as a
					 team to treat one(1) or more members cannot bill separately for the same or
					 different service provided at the same time to the same member.
(1) Current Procedural Terminology (CPT)
				  codes are used for billing the services of one (1) therapist or therapy
				  assistant. The therapist cannot bill for his/her services and those of another
				  therapist or a therapy assistant, when both provide the same or different
				  services, at the same time, to the same member.
(2) If multiple therapies (physical therapy,
				  occupational therapy, and/or speech therapy) are provided to one(1) member at
				  the same time, only one(1) therapist can bill for the entire service, or each
				  therapist can divide the service units.
(3) Providers must report the CPT code for
				  the time actually spent in the delivery of the modality requiring constant
				  attendance and therapy services. Pre- and post-delivery services are not to be
				  counted in determining the treatment service time. The time counted must begin
				  when the therapist is directly working with the member to deliver treatment
				  services.
(4) The time counted is
				  the time the member is being treated. If the member requires both a therapist
				  and an assistant, or even two(2) therapists, each service unit of time the
				  member is being treated can count as only one(1) unit of each code. The service
				  units billed must equal the total time the member was receiving actual therapy
				  services. It is not allowable for each therapist or therapy assistant to bill
				  for the entire therapy session. The time the member spends not being treated,
				  for any reason, must not be billed.
Added at 28 Ok Reg 12,
					 eff 8-13-10 (emergency); Added at 28 Ok Reg 1475, eff
					 6-25-11
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 29 - RENAL DIALYSIS FACILITIES › Section 317:30-5-305 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
Payment can be made to a Medicare certified Renal Dialysis
					 Center when its clinical services are under the medical direction of a
					 physician licensed by the Oklahoma State Board of Medical Licensure and
					 Supervision, the Oklahoma Board of Osteopathic Examiners, or the appropriate
					 licensing body of the state where the provider is located. Renal Dialysis
					 Centers must also 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
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 29 - RENAL DIALYSIS FACILITIES › Section 317:30-5-306 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
Payment is made to renal dialysis facilities as set forth
					 in this Section.
(1)
Adults.
Payment is made for outpatient renal dialysis for adults
				  at the PPS rate.
(2)
Children.
Coverage for children is the same as for
				  adults.
(3)
Individuals
				  eligible for Part B of Medicare.
Payment is made utilizing the Medicaid
				  allowable for comparable service.
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 19 Ok Reg 2922, eff 7-1-02 (emergency); Amended at 20 Ok
					 Reg 1193, eff 5-27-03; Amended at 29 Ok Reg 1106, eff
					 6-25-12
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 29 - RENAL DIALYSIS FACILITIES › Section 317:30-5-307 - Payment methodology

Current through Vol. 41, No. 20, July 1, 2024
Payment of in-facility dialysis treatments and home
					 dialysis treatment is made under the PPS rate reimbursement system.
(1) All items and services included under the
				  PPS rate must be furnished by the facility, either directly or under
				  arrangements, to all of its dialysis patients. If the facility fails to furnish
				  (either directly or under arrangements) any part of the items and services
				  covered under the rate, then the facility cannot be paid any amount for the
				  part of the items and services that the facility does furnish. These items and
				  services include:
(A) medically necessary
				  dialysis equipment and dialysis support equipment;
(B) home dialysis support services including
				  the delivery, installation, maintenance, repair, and testing of home dialysis
				  equipment, and home support equipment;
(C) purchase and delivery of all necessary
				  dialysis supplies;
(D) routine ESRD
				  related laboratory tests; and
(E)
				  all dialysis services furnished by the facility's staff.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 30 - APPLIED BEHAVIOR ANALYSIS (ABA) SERVICES › Section 317:30-5-310 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
The purpose of this Section is to establish guidelines for
					 the provision of ABA services under the Early and Periodic Screening,
					 Diagnostic and Treatment (EPSDT) benefit.
(1) ABA focuses on the analysis, design,
				  implementation, and evaluation of instructional and other environmental
				  modifications to produce meaningful changes in human behavior. ABA services
				  include the use of direct observation, measurement, and functional analysis of
				  the relations between the environment and behavior. Common ABA-based techniques
				  include but are not limited to; discrete trial training (DTT); naturalistic
				  developmental behavioral intervention (NDBI); and verbal behavioral
				  intervention.
(2) ABA may be
				  provided in a variety of settings, including home, community, or clinical. It
				  involves development of an individualized treatment plan that includes
				  transition and aftercare planning, and family/caregiver involvement.
(3) At an initial assessment, target symptoms
				  are identified. A treatment plan is developed to identify core deficits and
				  aberrant behaviors, and includes designated interventions intended to address
				  these deficits and behaviors and that are functional, meaningful, and connected
				  to the member's daily activities routines.
(4) ABA services require prior authorization
				  [refer to Oklahoma Administrative Code (OAC)
				  317:30-3-31
				  and 317:30-5-314] .
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 30 - APPLIED BEHAVIOR ANALYSIS (ABA) SERVICES › Section 317:30-5-311 - Eligible providers and requirements

Current through Vol. 41, No. 20, July 1, 2024
(a)
Eligible providers.
Eligible
				  ABA provider types include:
(1) Board
				  certified behavior analyst® (BCBA®) - A master's or doctoral level
				  independent practitioner who is certified by the national-accrediting Behavior
				  Analyst Certification Board, Inc.® (BACB®) and licensed by the Oklahoma
				  Human Services' (OKDHS) Developmental Disabilities Services Division (DDS) to
				  provide behavior analysis services. A BCBA may supervise the work of
				  board-certified assistant behavior analysts and registered behavior technicians
				  implementing behavior analytic interventions;
(2) Board-certified assistant behavior
				  analyst® (BCaBA®) - A bachelor's level practitioner who is certified by
				  the national-accrediting BACB and certified by OKDHS DDS to provide behavior
				  analysis services under the supervision of a BCBA;
(3) Registered behavior technician TM
				  (RBT®) - A high school level or higher paraprofessional who is certified by
				  the national-accrediting BACB and practices under the close and ongoing
				  supervision of a BCBA. The RBT works under the license number of a BCBA and is
				  primarily responsible for the direct implementation of BCBA designed and
				  prescribed behavior-analytic services;
(4) Licensed psychologist - An individual who
				  is licensed and in good standing with the Oklahoma State Board of Examiners of
				  Psychologists and has professional experience in the use of ABA therapy may
				  render behavior analysis services. Refer to OAC
				  317:30-5-275;
				  and
(5) Human services professional
				  - A practitioner who is licensed by the State of Oklahoma pursuant to (A) -
				  (G), and certified by the national-accrediting BACB, and who is working within
				  the scope of his or her practice, to include:
(A) A licensed physical therapist;
(B) A licensed occupational
				  therapist;
(C) A licensed clinical
				  social worker or social worker candidate under the supervision of a licensed
				  clinical social worker;
(D) A
				  licensed speech-language pathologist or licensed audiologist;
(E) A licensed professional counselor or
				  professional counselor candidate under the supervision of a licensed
				  professional counselor;
(F) A
				  licensed marital and family therapist or marital and family therapist candidate
				  under the supervision of a licensed marital and family therapist; or
(G) A licensed behavioral practitioner or
				  behavioral practitioner candidate under the supervision of a licensed
				  behavioral practitioner.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 30 - APPLIED BEHAVIOR ANALYSIS (ABA) SERVICES › Section 317:30-5-312 - Treatment plan components and documentation requirements

Current through Vol. 41, No. 20, July 1, 2024
(a)
Treatment plan.
The
				  treatment plan is developed by a BCBA or a licensed psychologist from the FBA.
				  The treatment plan shall:
(1) Be
				  person-centered and individualized;
(2) Delineate the baseline levels of target
				  behaviors;
(3) Specify long-term
				  and short-term objectives that are defined in observable, measurable behavioral
				  terms;
(4) Specify criteria that
				  will be used to determine achievement of objectives;
(5) Include assessment(s) and treatment
				  protocols for addressing each of the target behaviors such as including
				  antecedent and consequence interventions, and teaching of replacement skills
				  specific to the function of the identified maladaptive behaviors;
(6) Clearly identify the schedule of services
				  planned and the individuals responsible for delivering the services, including
				  frequent review of data on target behaviors and adjustments in the treatment
				  plan and/or protocols by the BCBA or licensed psychologist as needed;
(7) Include training and supervision to
				  enable board certified assistant behavior analysts (BCaBAs) and registered
				  behavior technicians (RBTs) to implement assessment and treatment
				  protocols;
(8) Include training and
				  support to enable parents and other caregivers to participate in treatment
				  planning and successfully reinforce the established treatment plan in the home
				  and community settings;
(9) Include
				  care coordination involving the parents or caregiver(s), school, state
				  disability programs, and others as applicable; and
(10) Ensure that services are consistent with
				  applicable professional standards and guidelines relating to the practice of
				  applied behavior analysis as well as state Medicaid laws and
				  regulations.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 30 - APPLIED BEHAVIOR ANALYSIS (ABA) SERVICES › Section 317:30-5-313 - Medical necessity criteria for members under twenty-one (21) years of age

Current through Vol. 41, No. 20, July 1, 2024
ABA services are considered medically necessary when all
					 the following conditions are met:
(1)
				  The member is under twenty-one (21) years of age with a definitive diagnosis of
				  an Autism Spectrum Disorder (ASD) from the following providers:
(A) Pediatric neurologist or
				  neurologist;
(B) Developmental
				  pediatrician;
(C) Licensed
				  psychologist;
(D) Psychiatrist or
				  neuropsychiatrist; or
(E) Other
				  licensed physician experienced in the diagnosis and treatment of ASD.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 30 - APPLIED BEHAVIOR ANALYSIS (ABA) SERVICES › Section 317:30-5-314 - Prior authorization

Current through Vol. 41, No. 20, July 1, 2024
Eligible providers must submit an initial prior
					 authorization request to the Oklahoma Health Care Authority (OHCA) or its
					 designated agent. Prior authorization requests shall be granted up to six (6)
					 months of ABA treatment services at one (1) time unless a longer duration of
					 treatment is clinically indicated. The number of hours authorized may differ
					 from the hours requested on the prior authorization request based on the review
					 by an OHCA reviewer and/or physician. If the member's condition necessitates a
					 change in the treatment plan, the provider must request a new prior
					 authorization. The prior authorization request must meet the following
					 SoonerCare criteria for ABA services.
(1) The criteria include a comprehensive
				  behavioral assessment, FBA, and other supporting assessment(s) outlining the
				  maladaptive behaviors consistent with the diagnosis of ASD and its associated
				  comorbidities. In addition to completing the initial request form, providers
				  will be required to submit documentation that will consist of the following:
(A) Information about relevant medical
				  status, prior assessment results, response to prior treatment, and other
				  relevant information gathered from review of records and past
				  assessments.
(B) Information
				  gathered from interview of family and/or caregivers, rating scales, and social
				  validity measures to assess perceptions of the client's skill deficits and
				  behavioral excesses, and the extent to which these deficits impede the daily
				  life of the member and the family.
(C) Direct assessment and observation,
				  including any data related to the identified problem behavior. The analysis of
				  such data serves as the primary basis for identifying pretreatment levels of
				  functioning, developing, and adapting treatment protocols, and evaluating
				  response to treatment and progress towards goals.
(D) Functional assessment of problem behavior
				  that includes antecedent factors, skill deficits, and consequences contributing
				  to the problem behavior. The treatment plan should address all three (3) areas,
				  including antecedent interventions, teaching replacement skills, and
				  modification of consequences. Other supporting assessments may be additionally
				  submitted for review.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 30 - APPLIED BEHAVIOR ANALYSIS (ABA) SERVICES › Section 317:30-5-315 - ABA extension requests

Current through Vol. 41, No. 20, July 1, 2024
Extension requests for ABA services must be submitted to
					 the OHCA or its designated agent. Extension requests must contain the
					 appropriate documentation validating the need for continued treatment and
					 establish the following:
(1)
				  Eligibility criteria in OAC 317:30-5-313;
(2) The frequency of the target behavior has
				  diminished since last review, or if not, there has been modification of the
				  treatment or additional assessments have been conducted;
(3) A functional analysis shall be completed
				  by the provider when no measurable progress has occurred, or it may be
				  requested by the OHCA. The functional analysis should record the member's
				  serious maladaptive target behavioral symptom(s) and precipitants, and document
				  the modifications of the current treatment plan to address progress, as well as
				  make a determination of the function a particular maladaptive behavior serves
				  for the member in the environmental context;
(4) Appropriate consultations from other
				  staff or experts have occurred (to optimize psychiatric medications and medical
				  treatments to include but not limited to psychiatric consults, pediatric
				  evaluation for other conditions, etc.) and interventions have been changed,
				  including the number of hours per week of service or setting (higher level of
				  care);
(5) The OHCA may suggest
				  appropriate consultation from other staff or experts during the process of
				  prior authorization;
(6)
				  Parent(s)/legal guardian(s) have received re-training on these changed
				  approaches; and
(7) The treatment
				  plan documents a gradual tapering of higher intensities of intervention and
				  transitioning to supports from other sources (i.e., schools) as progress
				  allows.