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 6 - INPATIENT PSYCHIATRIC AND SUBSTANCE USE DISORDER SERVICES › Section 317:30-5-95.9 - Therapeutic services for adults aged 21 to 64

Current through Vol. 41, No. 20, July 1, 2024
An interdisciplinary team of a physician, licensed
					 behavioral health professional(s) (LBHP), Registered Nurse, and other staff who
					 provide services to adult members aged twenty-one (21) to sixty-four (64) in
					 the facility oversee all components of the active treatment and provide
					 services appropriate to each team member's respective discipline. The team
					 developing the individual plan of care must include, at a minimum, the
					 following:
(1) Allopathic or
				  Osteopathic Physician with a current license and a board certification/eligible
				  in psychiatry, or a current resident in psychiatry practicing as described in
				  OAC
				  317:30-5-2(a)(1)(U);
				  and
(2) An LBHP licensed to
				  practice by one of the boards in (A) through (F):
(A) Psychology (health service specialty
				  only);
(B) Social Work (clinical
				  specialty only);
(C) Licensed
				  Professional Counselor;
(D)
				  Licensed Behavioral Practitioner;
(E) Licensed Marital and Family
				  Therapist;
(F) Licensed Alcohol and
				  Drug Counselor; or
(G) Advanced
				  Practice Registered Nurse (APRN) (certified in a psychiatric mental health
				  specialty, licensed as a Registered Nurse with a current certification of
				  recognition from the Board of Nursing in the state in which the services are
				  provided);
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 317:30-5-95.10 - Discharge plan for adults aged twenty-one (21) to sixty-four (64)

Current through Vol. 41, No. 20, July 1, 2024
Each adult member aged twenty-one (21) to sixty-four (64)
					 must have a discharge plan that includes a recapitulation of the member's
					 hospitalization; recommendations for follow-up and aftercare, to include
					 referral to medication management, outpatient behavioral health counseling,
					 and/or case management, to include the specific appointment information (time,
					 date, and name, address, and telephone number of provider and related community
					 services); and a summary of the member's condition at discharge. All discharge
					 and aftercare plans must be documented in the member's medical
					 records.
Added at 23 Ok Reg
					 2508, eff 6-25-06; Amended at 27 Ok Reg 2737, eff 7-20-10 (emergency); Amended
					 at 28 Ok Reg 1452, 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 6 - INPATIENT PSYCHIATRIC AND SUBSTANCE USE DISORDER SERVICES › Section 317:30-5-95.11 - Inpatient acute psychiatric services for persons sixty-five (65) years of age or older

Current through Vol. 41, No. 20, July 1, 2024
Payment is made for medically necessary inpatient acute
					 psychiatric services for persons sixty-five (65) years of age or older. OHCA
					 rules that apply to inpatient acute psychiatric coverage for persons sixty-five
					 (65) years of age or older are found in Sections OAC
					 317:30-5-95.12
					 through
					 317:30-5-95.21.
Added at 23 Ok Reg
					 2508, eff 6-25-06
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 317:30-5-95.12 - Utilization control requirements for inpatient acute psychiatric services for persons sixty-five (65) years of age or older

Current through Vol. 41, No. 20, July 1, 2024
As set forth in
					 42 C.F.R.
					 §§
											456.50 and
					 456.150, general hospitals
					 and psychiatric hospitals must maintain medical records and other documentation
					 sufficient to show that all requirements concerning certification of need for
					 care, plan of care, and utilization review plans have been met. Psychiatric
					 hospitals must also maintain medical records and other documentation sufficient
					 to show that all requirements concerning medical evaluation and admission
					 review have been met, in accordance with
					 42 C.F.R.
					 §
											456.150.
Added at 23 Ok Reg
					 2508, eff 6-25-06
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 317:30-5-95.13 - Certification and recertification of need for inpatient care for inpatient acute psychiatric services for persons sixty-five (65) years of age or older

Current through Vol. 41, No. 20, July 1, 2024
The certification and recertification of need for inpatient
					 care for persons sixty-five (65) years of age or older must be in writing and
					 must be signed and dated by the physician who has knowledge of the case and the
					 need for continued inpatient psychiatric care. The certification and
					 recertification documents for all SoonerCare members must be maintained in the
					 member's medical records or in a central file at the facility where the member
					 is or was a resident.
(1)
Certification.
A physician must certify for each applicant or
				  member that inpatient services in an acute care setting are or were needed. The
				  certification must be made at the time of admission or, if an individual
				  applies for assistance while hospitalized, before OHCA, or its designated
				  agent, authorizes payment.
(2)
Recertification.
A physician must recertify for each applicant or
				  member that inpatient services in the acute care setting are needed.
				  Recertification must be made at least every sixty (60) days after
				  certification.
Added at 23 Ok Reg
					 2508, eff 6-25-06; Amended at 27 Ok Reg 2737, eff 7-20-10 (emergency); Amended
					 at 28 Ok Reg 1452, 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 6 - INPATIENT PSYCHIATRIC AND SUBSTANCE USE DISORDER SERVICES › Section 317:30-5-95.14 - Individual plan of care for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services

Current through Vol. 41, No. 20, July 1, 2024
(a) Before admission to a psychiatric
				  hospital or psychiatric unit of a general hospital or immediately after
				  admission, the attending physician or staff physician must establish a written
				  plan of care for each applicant or member. The plan of care must include:
(1) Diagnoses, symptoms, complaints, and
				  complications indicating the need for admission;
(2) A description of the functional level of
				  the individual;
(3) Objectives;
(4) Any order for medication,
				  treatments, restorative and rehabilitative services, activities, therapies,
				  social services, diet, and special procedures recommended for the health and
				  safety of the member;
(5) Plans
				  for continuing care, including review and modification to the plan of care; and
(6) Plans for discharge.
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 317:30-5-95.15 - Physician review of prescribed medications for persons over 65 years of age receiving inpatient acute psychiatric services

Current through Vol. 41, No. 20, July 1, 2024
All prescribed medications for persons over 65 years of age
					 receiving inpatient acute psychiatric services must be reviewed by the
					 physician at least every seven days; the review must be documented in the
					 member's medical record by the physician signing his/her name and title and
					 dating the orders.
Added at 23 Ok Reg
					 2508, eff 6-25-06; Amended at 27 Ok Reg 2737, eff 7-20-10 (emergency); Amended
					 at 28 Ok Reg 1452, 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 6 - INPATIENT PSYCHIATRIC AND SUBSTANCE USE DISORDER SERVICES › Section 317:30-5-95.16 - Medical psychiatric and social evaluations for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services

Current through Vol. 41, No. 20, July 1, 2024
The record of a member sixty-five (65) years of age or
					 older receiving inpatient acute psychiatric services must contain complete
					 medical, psychiatric, and social evaluations.
(1) The evaluations must be completed as
				  follows:
(A) History and physical must be
				  completed within twenty-four (24) hours of admission by a licensed independent
				  practitioner [Allopathic Doctor, Osteopathic Doctor, Advanced Practice
				  Registered Nurse (APRN), or Physician Assistant (PA)].
(B) Psychiatric evaluation must be completed
				  within sixty (60) hours of admission by an Allopathic or Osteopathic physician
				  with a current license and a board certification/eligible in psychiatry, an
				  APRN with a psychiatric certification or a PA.
(C) Psychosocial evaluation must be completed
				  within seventy-two (72) hours of admission by a licensed independent
				  practitioner (Allopathic Doctor, Osteopathic Doctor, APRN, or PA), an LBHP, or
				  licensure candidate as defined in OAC
				  317:30-5-240.3.
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 317:30-5-95.17 - Active treatment for persons over 65 years of age receiving inpatient acute psychiatric services

Current through Vol. 41, No. 20, July 1, 2024
Active treatment must be provided to each member over 65
					 years of age who is receiving inpatient acute psychiatric services. The active
					 treatment program must be appropriate to the needs of the member and be
					 directed toward restoring and maintaining optimal levels of physical and
					 psychiatric-social functioning. The services and individual plan of care must
					 be recovery focused, trauma informed, and specific to culture, age and
					 gender.
Added at 23 Ok Reg
					 2508, eff 6-25-06; Amended 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 6 - INPATIENT PSYCHIATRIC AND SUBSTANCE USE DISORDER SERVICES › Section 317:30-5-95.18 - Nursing services for persons over 65 years of age receiving inpatient acute psychiatric services

Current through Vol. 41, No. 20, July 1, 2024
Each facility providing inpatient acute psychiatric
					 services to adults over 65 must have a qualified Director of Psychiatric
					 Nursing. In addition to the Director of Nursing, there must be adequate numbers
					 of registered nurses, licensed practical nurses, and mental health workers to
					 provide nursing care necessary under the active treatment program and to
					 maintain progress notes on each member. A registered nurse must document member
					 progress at least weekly. The progress notes must contain recommendations for
					 revisions in the treatment plan, as needed, as well as an assessment of the
					 member's progress as it relates to the treatment plan goals and
					 objectives.
Added at 23 Ok Reg
					 2508, eff 6-25-06; Amended at 27 Ok Reg 2737, eff 7-20-10 (emergency); Amended
					 at 28 Ok Reg 1452, 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 6 - INPATIENT PSYCHIATRIC AND SUBSTANCE USE DISORDER SERVICES › Section 317:30-5-95.19 - Therapeutic services for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services

Current through Vol. 41, No. 20, July 1, 2024
An interdisciplinary team of a physician, licensed
					 behavioral health professional(s) (LBHP), Registered Nurse, and other staff who
					 provide services to members sixty-five (65) years of age or older who are
					 receiving inpatient acute psychiatric services in the facility oversee all
					 components of the active treatment and provide services appropriate to each
					 team member's respective discipline. The team developing the individual plan of
					 care must include, at a minimum, the following:
(1) Allopathic or Osteopathic Physician with
				  a current license and a board certification/eligible in psychiatry, or a
				  current resident in psychiatry practicing as described in OAC
				  317:30-5-2(a)(1)(U);
				  and
(2) An LBHP licensed to
				  practice by one of the boards in (A) through (F):
(A) Psychology (health service specialty
				  only);
(B) Social Work (clinical
				  specialty only);
(C) Licensed
				  Professional Counselor;
(D)
				  Licensed Behavioral Practitioner;
(E) Licensed Marital and Family
				  Therapist;
(F) Licensed Alcohol and
				  Drug Counselor; or
(G) Advanced
				  Practice Registered Nurse (APRN) (certified in a psychiatric mental health
				  specialty, licensed as a Registered Nurse with a current certification of
				  recognition from the Board of Nursing in the state in which the services are
				  provided);
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 317:30-5-95.20 - Discharge plan for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services

Current through Vol. 41, No. 20, July 1, 2024
Each member sixty-five (65) years of age or older receiving
					 inpatient acute psychiatric services must have a discharge plan that includes a
					 recapitulation of the member's hospitalization; recommendations for follow-up
					 and aftercare, to include referral to medication management, outpatient
					 behavioral health counseling, and/or case management, to include the specific
					 appointment information (time, date, and name, address, and telephone number of
					 provider and related community services); and a summary of the member's
					 condition at discharge. All discharge and aftercare plans must be documented in
					 the member's medical records.
Added at 23 Ok Reg
					 2508, eff 6-25-06; Amended at 27 Ok Reg 2737, eff 7-20-10 (emergency); Amended
					 at 28 Ok Reg 1452, 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 6 - INPATIENT PSYCHIATRIC AND SUBSTANCE USE DISORDER SERVICES › Section 317:30-5-95.21 - Continued stay review for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services

Current through Vol. 41, No. 20, July 1, 2024
The facility must complete a continued stay review at least
					 every ninety (90) days each time the facility utilization review committee
					 determines that the continued inpatient psychiatric hospital stay is required
					 for persons sixty-five (65) years of age or older.
(1) The methods and criteria for continued
				  stay review must be contained in the facility utilization review
				  plan.
(2) Documentation of the
				  continued stay review must be clearly identified as such, signed, and dated by
				  the committee chairperson, and must clearly state the continued stay dates and
				  time period approved.
Added at 23 Ok Reg
					 2508, eff 6-25-06
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 317:30-5-95.23 - Individuals age 21

Current through Vol. 41, No. 20, July 1, 2024
Individuals eligible for SoonerCare may be covered for
					 inpatient psychiatric services before the member reaches age 21 or, if the
					 member was receiving inpatient psychiatric services at the time he or she
					 reached age 21. Services may continue until the member no longer requires the
					 services or the member becomes 22 years of age, whichever comes first. Sections
					 OAC
					 317:30-5-95.24
					 through
					 317:30-5-95.42
					 apply to coverage for inpatient services in acute care hospitals, freestanding
					 psychiatric hospitals, and PRTFs.
Added at 23 Ok Reg
					 2508, eff 6-25-06; Amended at 27 Ok Reg 2737, eff 7-20-10 (emergency); Amended
					 at 28 Ok Reg 1452, 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 6 - INPATIENT PSYCHIATRIC AND SUBSTANCE USE DISORDER SERVICES › Section 317:30-5-95.25 - Medical necessity criteria for acute psychiatric admissions for children

Current through Vol. 41, No. 20, July 1, 2024
Acute psychiatric admissions for children must meet the
					 terms or conditions contained in (1), (2), (3), (4) and one of (5)(A) to
					 (5)(D), and one of (6)(A) to (6)(C) of this subsection.
(1) A primary diagnosis from the most recent
				  edition of "The Diagnostic and Statistical Manual of Mental Disorders" (DSM)
				  with the exception of V-codes, adjustment disorders, and substance related
				  disorders, accompanied by a detailed description of the symptoms supporting the
				  diagnosis. In lieu of a qualifying diagnosis, children 18-21 years of age may
				  have a diagnosis of any personality disorder.
(2) Conditions are directly attributable to a
				  psychiatric disorder as the primary need for professional attention (this does
				  not include placement issues, criminal behavior, status offenses). Adjustment
				  or substance related disorder may be a secondary diagnosis.
(3) It has been determined by the OHCA
				  designated agent that the current disabling symptoms could not have been
				  managed or have not been manageable in a lesser intensive treatment program.
(4) Child must be medically
				  stable.
(5) Within the past 48
				  hours, the behaviors present an imminent life threatening emergency such as
				  evidenced by:
(A) Specifically described
				  suicide attempts, suicide intent, or serious threat by the patient.
(B) Specifically described patterns of
				  escalating incidents of self-mutilating behaviors.
(C) Specifically described episodes of
				  unprovoked significant physical aggression and patterns of escalating physical
				  aggression in intensity and duration.
(D) Specifically described episodes of
				  incapacitating depression or psychosis that result in an inability to function
				  or care for basic needs.
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 317:30-5-95.26 - Medical necessity criteria for continued stay - acute psychiatric admission for children

Current through Vol. 41, No. 20, July 1, 2024
For continued stay acute psychiatric admissions for
					 children must meet all of the conditions set forth in (1) to (5) of this
					 subsection.
(1) A primary diagnosis
				  from the most recent edition of "The Diagnostic and Statistical Manual of
				  Mental Disorders" (DSM) with the exception of V-Codes, adjustment disorders,
				  and substance abuse related disorders, accompanied by a detailed description of
				  the symptoms supporting the diagnosis. In lieu of a qualifying diagnosis,
				  children 18-20 years of age may have a diagnosis of any personality disorder.
				  Adjustment or substance related disorders may be a secondary diagnosis.
(2) Patient continues to manifest
				  a severity of illness that requires an acute level of care as defined in the
				  admission criteria and which could not be provided in a less restrictive
				  setting.
(A) Documentation of regression is
				  measured in behavioral terms.
(B)
				  If condition is unchanged, evidence of re-evaluation of treatment objectives
				  and therapeutic interventions.
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 317:30-5-95.27 - Medical necessity criteria for admission - inpatient chemical dependency detoxification for children

Current through Vol. 41, No. 20, July 1, 2024
Inpatient chemical dependency detoxification admissions for
					 children must meet the terms and conditions contained in (1), (2), (3), and one
					 of (4)(A) through (D) of this subsection.
(1) Any psychoactive substance dependency
				  disorder described in the most recent edition of "The Diagnostic and
				  Statistical Manual of Mental Disorders" (DSM) with detailed symptoms supporting
				  the diagnosis and need for medical detoxification, except for cannabis,
				  nicotine, or caffeine dependencies.
(2) Conditions are directly attributable to a
				  substance dependency disorder as the primary need for professional attention
				  (this does not include placement issues, criminal behavior, or status
				  offenses).
(3) It has been
				  determined by the OHCA designated agent that the current disabling symptoms
				  could not be managed or have not been manageable in a lesser intensive
				  treatment program.
(4) Requires
				  secure 24-hour nursing/medical supervision as evidenced by:
(A) Need for active and aggressive
				  pharmacological interventions.
(B)
				  Need for stabilization of acute psychiatric symptoms.
(C) Need extensive treatment under physician
				  direction.
(D) Physiological
				  evidence or expectation of withdrawal symptoms which require 24-hour medical
				  supervision.
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 317:30-5-95.28 - Medical necessity criteria for continued stay - inpatient chemical dependency detoxification program for children

Current through Vol. 41, No. 20, July 1, 2024
Authorization for admission to a chemical dependency
					 detoxification program is limited to up to five days. Exceptions to this limit
					 may be made up to eight days based on a case-by-case review, per medical
					 necessity criteria as described in OAC
					 317:30-5-95.27.
Added at 23 Ok Reg
					 2508, eff 6-25-06; 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 413, eff 3-7-12
					 (emergency); Amended at 29 Ok Reg 1125, 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 6 - INPATIENT PSYCHIATRIC AND SUBSTANCE USE DISORDER SERVICES › Section 317:30-5-95.29 - Medical necessity criteria Acute II and PRTF admissions for children

Current through Vol. 41, No. 20, July 1, 2024
Acute II and PRTF admissions for individuals under
					 twenty-one (21) must meet the terms and conditions in (1), (2), (3), (4), (5)
					 and one (1) of the terms and conditions of (6)(A) through (D) of this
					 subsection.
(1) A primary diagnosis
				  from the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) with the
				  exception of V-codes, adjustment disorders, and substance-related disorders,
				  accompanied by detailed symptoms supporting the diagnosis. Members eighteen
				  (18) to twenty (20) years of age may have a diagnosis of any personality
				  disorder. Adjustment or substance-related disorders may be a secondary
				  diagnosis.
(2) Conditions are
				  directly attributed to a mental disorder as the primary reason for professional
				  attention (this does not include placement issues, criminal behavior, or status
				  offenses).
(3) Patient has either
				  received treatment in an acute setting or it has been determined by the OHCA,
				  or its designated agent, that the current disabling symptoms could not or have
				  not been manageable in a less-intensive treatment program.
(4) Member must be medically
				  stable.
(5) Requires twenty-four
				  (24) hour observation and treatment as evidenced by:
(A) Intensive behavioral
				  management;
(B) Intensive treatment
				  with the family/guardian and child in a structured milieu; and
(C) Intensive treatment in preparation for
				  re-entry into community.
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 317:30-5-95.30 - Medical necessity criteria for Acute II and PRTF continued stay for children

Current through Vol. 41, No. 20, July 1, 2024
For continued stay in Acute II and PRTF programs, members
					 must meet the terms and conditions contained in (1), (2), (3), (4), and either
					 (5) or (6) of this subsection:
(1) A
				  primary diagnosis from the Diagnostic and Statistical Manual of Mental
				  Disorders (DSM-V) with the exception of V codes, adjustment disorders, and
				  substance abuse-related disorders, accompanied by detailed symptoms supporting
				  the diagnosis. In lieu of a qualifying primary diagnosis, members eighteen (18)
				  to twenty (20) years of age may have a secondary diagnosis of any personality
				  disorder.
(2) Conditions are
				  directly attributed to a psychiatric disorder as the primary reason for
				  continued stay (this does not include placement issues, criminal behavior, or
				  status offenses).
(3) There is
				  documented continuing need for twenty-four (24) hour observation and treatment
				  as evidenced by:
(A) Intensive behavioral
				  management.
(B) Intensive treatment
				  with the family/guardian and child in a structured milieu.
(C) Intensive treatment in preparation for
				  re-entry into community.
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 317:30-5-95.31 - Prior authorization and extension procedures for children

Current through Vol. 41, No. 20, July 1, 2024
(a) Prior
				  authorization for inpatient psychiatric services for members must be requested
				  from the OHCA or its designated agent. The OHCA or its designated agent will
				  evaluate and render a decision within twenty-four (24) hours of receiving the
				  request. A prior authorization will be issued by the OHCA or its designated
				  agent, if the member meets medical necessity criteria. For the safety of
				  SoonerCare members, additional approval from OHCA, or its designated agent, is
				  required for placement on specialty units or in special population programs or
				  for members with special needs such as very low intellectual functioning.
(b) Extension requests
				  (psychiatric) must be made through OHCA or its designated agent. All requests
				  are made prior to the expiration of the approved extension. Requests for the
				  continued stay of a member who has been in an Acute psychiatric program for a
				  period of fifteen (15) days and an Acute II or PRTF program for three (3)
				  months will require a review of all treatment documentation completed by the
				  OHCA, or its designated agent, to determine the efficiency of treatment.
(c) Providers seeking prior
				  authorization will follow OHCA's, or its designated agent's, prior
				  authorization process guidelines for submitting behavioral health case
				  management requests on behalf of the SoonerCare member.
(d) In the event a member disagrees with the
				  decision by OHCA, or its designated agent, the member may request an
				  evidentiary hearing under OAC
				  317:2-1-2(b).
				  The member's request for such an appeal must be received within thirty (30)
				  calendar days of the date of the notice of the initial decision.
Added at 23 Ok Reg
					 2508, eff 6-25-06; 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 413,
					 eff 3-7-12 (emergency); Amended at 29 Ok Reg 1125, 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 6 - INPATIENT PSYCHIATRIC AND SUBSTANCE USE DISORDER SERVICES › Section 317:30-5-95.32 - Quality of care requirements for children

Current through Vol. 41, No. 20, July 1, 2024
(a) At the time of admission of the child to
				  an inpatient psychiatric program, the admitting facility will provide the
				  member and their family or guardian with written explanation of the facility's
				  policy regarding the following:
(1) Member
				  rights.
(2) Behavior Management of
				  members in the care of the facility.
(3) Member Grievance procedures.
(4) Information for contact with the Office
				  of Client Advocacy.
(5) Seclusion
				  and Restraint policy.
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 317:30-5-95.33 - Individual plan of care for children

Current through Vol. 41, No. 20, July 1, 2024
(a) An individual plan of care (IPC) is a
				  written plan developed for each member within four (4) calendar days of
				  admission to an Acute, Acute II, or a PRTF that directs the care and treatment
				  of that member. The IPC must be recovery-focused, trauma-informed, and specific
				  to culture, age, and gender and include:
(1)
				  A primary diagnosis from the Diagnostic and Statistical Manual of Mental
				  Disorders (DSM-V) with the exception of V-codes, adjustment disorders, and
				  substance abuse-related disorders, accompanied by a detailed description of the
				  symptoms supporting the diagnosis. Members eighteen (18) to twenty (20) years
				  of age may have a diagnosis of any personality disorder. Adjustment or
				  substance-related disorders may be a secondary diagnosis;
(2) The current functional level of the
				  individual;
(3) Treatment goals and
				  measurable, time-limited objectives;
(4) Any orders for psychotropic medications,
				  treatments, restorative and rehabilitative services, activities, therapies,
				  social services, diet, and special procedures recommended for the health and
				  safety of the member;
(5) Plans for
				  continuing care, including review and modification to the IPC; and
(6) Plan for discharge, all of which is
				  developed to improve the member's condition to the extent that the inpatient
				  care is no longer necessary.
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 317:30-5-95.35 - Certificate of need requirements for children in psychiatric hospitals and PRTFs

Current through Vol. 41, No. 20, July 1, 2024
(a)
General
				  requirements.
This Section establishes the requirements for
				  certification of the need for inpatient psychiatric services provided to
				  individuals under twenty-one (21) years of age in psychiatric hospitals, in
				  accordance with Section 1905(a) 16 and (h) of the Social Security Act, and in
				  PRTFs, in accordance with
				  42
				  C.F.R. §
											483.354. Pursuant to this
				  federal law, a team, consisting of physicians and other qualified personnel,
				  shall determine that inpatient services are necessary and can reasonably be
				  expected to improve the member's condition. These requirements do not apply to
				  an admission to a psychiatric unit of a general hospital.
(b)
Definitions.
The following
				  words and terms, when used in this chapter, shall have the following meanings
				  unless the context clearly indicates otherwise.
(1)
"Independent team"
means a
				  team that is not associated with the facility, such that no team member has an
				  employment or consultant relationship with the admitting facility. The
				  independent team shall include a licensed physician who has competence in
				  diagnosis and treatment of mental illness, preferably child psychiatry, and who
				  has knowledge of the member's clinical condition and situation. The independent
				  team shall also include at least one (1) other LBHP.
(2)
"Interdisciplinary team"
means, as defined by
				  42 C.F.R. §
												441.156, a team of physicians and other
				  personnel who are employed by, or who provide services to, SoonerCare members
				  in the facility or program. The interdisciplinary team must include, at a
				  minimum, either a board-eligible or board-certified psychiatrist; or, a
				  licensed physician and a psychologist licensed by the Oklahoma State Board of
				  Examiners of Psychologists (OSBEP) who has a doctoral degree in clinical
				  psychology; or, a licensed physician with specialized training and experience
				  in the diagnosis and treatment of mental diseases, and a psychologist licensed
				  by the OSBEP. The interdisciplinary team must also include one (1) of the
				  following:
(A) A licensed clinical social
				  worker;
(B) A registered nurse
				  (RN) with specialized training or one (1) year of experience in treating
				  mentally ill individuals;
(C) A
				  psychologist licensed by the OSBEP who has a doctoral degree in clinical
				  psychology; or
(D) An occupational
				  therapist who is licensed by the state in which the individual is practicing,
				  if applicable, and who has specialized training or one (1) year of experience
				  in treating mentally ill individuals.
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 317:30-5-95.36 - Treatment team for inpatient children's services

Current through Vol. 41, No. 20, July 1, 2024
An interdisciplinary team of a physician, licensed
					 behavioral health professionals, registered nurse, member, parent/legal
					 guardian for members under the age of 18, and other personnel who provide
					 services to members in the facility must develop the individual plan of care,
					 oversee all components of the active treatment and provide the services
					 appropriate to their respective discipline. Based on education and experience,
					 preferably including competence in child psychiatry, the teams must be:
(1) capable of assessing the member's
				  immediate and long range therapeutic needs, developmental priorities and
				  personal strengths and liabilities;
(2) capable of assessing the potential
				  resources of the member's family, and actively involving the family of members
				  under the age of 18 in the ongoing plan of care;
(3) capable of setting treatment
				  objectives;
(4) capable of
				  prescribing therapeutic modalities to achieve the plan objectives;
(5) capable of developing appropriate
				  discharge criteria and plans; and
(6) trained in a recognized
				  behavioral/management intervention program such as MANDT System, Controlling
				  Aggressive Patient Environment (CAPE), SATORI, Professional Assault Crisis
				  Training (PRO-ACT), or a trauma informed methodology with the utmost focus on
				  the minimization of seclusion and restraints.
Added at 23 Ok Reg
					 2508, eff 6-25-06; 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
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 317:30-5-95.37 - Medical, psychiatric, and social evaluations for inpatient services for children

Current through Vol. 41, No. 20, July 1, 2024
The member's medical record must contain complete medical,
					 psychiatric, and social evaluations.
(1) These evaluations are considered critical
				  documents to the integrity of care and treatment and must be completed as
				  follows:
(A) History and physical evaluation
				  must be completed within twenty-four (24) hours of admission by a licensed
				  independent practitioner [Allopathic Doctor, Osteopathic Doctor, Advanced
				  Practice Registered Nurse (APRN), or Physician Assistant (PA)] in Acute, Acute
				  II, and PRTFs.
(B) Psychiatric
				  evaluation must be completed within sixty (60) hours of admission by an
				  Allopathic or Osteopathic physician with a current license and a board
				  certification/eligible in psychiatry. APRN with a psychiatric certification or
				  PA in Acute, Acute II, and PRTFs.
(C) Psychosocial evaluation must be completed
				  within seventy-two (72) hours of an Acute admission, and within seven (7)
				  calendar days of admission to Acute II and PRTFs by a licensed independent
				  practitioner (Allopathic Doctor, Osteopathic Doctor, APRN, or PA), LBHP, or
				  licensure candidate.
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 317:30-5-95.38 - Nursing services for children

Current through Vol. 41, No. 20, July 1, 2024
Each facility must have a qualified director of
					 psychiatric nursing. In addition to the director of nursing, there must be
					 adequate numbers of registered nurses (RNs), licensed practical nurses (LPNs),
					 and mental health workers to provide nursing care necessary under the active
					 treatment program and to maintain progress notes on each member. The progress
					 note must contain recommendations for revisions in the individual plan of care
					 (IPC), as needed, as well as an assessment of the member's progress as it
					 relates to the IPC goals and objectives.
Added at 23 Ok Reg
					 2508, eff 6-25-06; Amended at 27 Ok Reg 2737, eff 7-20-10 (emergency); Amended
					 at 28 Ok Reg 1452, 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 6 - INPATIENT PSYCHIATRIC AND SUBSTANCE USE DISORDER SERVICES › Section 317:30-5-95.39 - Restraint, seclusion, and serious occurrence reporting requirements for members under the age of twenty-one (21)

Current through Vol. 41, No. 20, July 1, 2024
(a) All PRTFs must comply with the condition
				  of participation for restraint or seclusion, as is established by
				  42 C.F.R. §§
											483.350 through
				  483.376,
				  which is hereby incorporated by reference in its entirety. All general and
				  psychiatric hospitals must comply with the standard for restraint or seclusion,
				  as is established by
				  42 C.F.R. §
											482.13(e) - (g), which is
				  hereby incorporated by reference in its entirety. In the case of any
				  inconsistency or duplication between these federal regulations and OAC
				  317:30-5-95.39, the federal regulations shall prevail, except where OAC
				  317:30-5-95.39 and/or other Oklahoma law is more protective of a member's
				  health, safety, or well-being.
(b)
				  Restraint or seclusion may only be used when less restrictive interventions
				  have been determined to be ineffective to protect the member, a staff member,
				  or others from harm and may only be imposed to ensure the immediate physical
				  safety of the member, a staff member, or others. The use of restraint or
				  seclusion must be in accordance with a written modification to the member's
				  individual plan of care. The type or technique of restraint or seclusion used
				  must be the least restrictive intervention that will be effective to protect
				  the member or others from harm. Restraint or seclusion must be discontinued at
				  the earliest possible time, regardless of the length of time identified in the
				  order. Mechanical restraints will not be used on children under age eighteen
				  (18).
(1) Each facility must have policies
				  and procedure to describe the conditions in which restraint or seclusion would
				  be utilized, the behavioral/management intervention program followed by the
				  facility, and the documentation required. Restraint or seclusion may only be
				  ordered by the following individuals trained in the use of emergency safety
				  interventions: a Physician; a Physician Assistant (PA); or an Advanced Practice
				  Registered Nurse (APRN) with prescriptive authority. If, however, the member's
				  treatment team physician is available, then only he or she can order restraint
				  or seclusion. Each order for restraint or seclusion may only be renewed in
				  accordance with the following limits for up to a total of twenty-four (24)
				  hours:
(A) four (4) hours for adults eighteen
				  (18) to twenty-one (21) years of age;
(B) two (2) hours for children and
				  adolescents nine (9) to seventeen (17) years of age; or
(C) one (1) hour for children under nine (9)
				  years of age.
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 317:30-5-95.40 - Other required standards

Current through Vol. 41, No. 20, July 1, 2024
The provider is required to maintain all programs and
					 services according to applicable C.F.R. requirements, the Joint Commission
					 (TJC) and American Osteopathic Association (AOA) standards for behavioral
					 health care, Oklahoma State Department of Health's (OSDH) hospital standards
					 for psychiatric care, and Oklahoma Department of Human Services (OKDHS)
					 licensing standards for residential treatment facilities. PRTFs may substitute
					 the Commission on Accreditation of Rehabilitation Facilities (CARF)
					 accreditation in lieu of TJC or AOA accreditation. In addition to federal
					 requirements, out-of-state inpatient psychiatric facilities must adhere to OAC
					 317:30-5-95 and
					 317:30-5-95.24.
Added at 23 Ok Reg
					 2508, eff 6-25-06; Amended at 27 Ok Reg 2737, eff 7-20-10 (emergency); Amended
					 at 28 Ok Reg 1452, 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 6 - INPATIENT PSYCHIATRIC AND SUBSTANCE USE DISORDER SERVICES › Section 317:30-5-95.41 - Documentation of records for children receiving inpatient services

Current through Vol. 41, No. 20, July 1, 2024
(a) All
				  documentation for services provided under active treatment must be documented
				  in an individual note and reflect the content of each session provided.
				  Individual, family, process group, expressive group, individual rehabilitative,
				  and group rehabilitative services documentation must include, at a minimum, the
				  following:
(1) Date;
(2) Start and stop time for each session;
(3) Dated signature of the
				  therapist and/or staff that provided the service;
(4) Credentials of the therapist;
(5) Specific problem(s) addressed (problems
				  must be identified on the plan of care);
(6) Method(s) used to address problems;
(7) Progress made towards goals;
(8) Member's response to the
				  session or intervention; and
(9)
				  Any new problem(s) 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 6 - INPATIENT PSYCHIATRIC AND SUBSTANCE USE DISORDER SERVICES › Section 317:30-5-95.44 - Residential substance use disorder (SUD) - Eligible providers and requirements

Current through Vol. 41, No. 20, July 1, 2024
(a)
				  Eligible providers shall:
(1) Have and
				  maintain current certification from the Oklahoma Department of Mental Health
				  and Substance Abuse Services (ODMHSAS) as a residential level of care provider
				  of SUD treatment services, unless exempt from state jurisdiction or an exempted
				  entity as defined in Section 3-415 of Title 43A of the Oklahoma Statutes;
(2) Have a contract with the OHCA;
(3) Have a Certificate of Need, if
				  required by ODMHSAS in accordance with OAC 450:18-17-2 or OAC 450:24-27-2.
(4) Have a current accreditation
				  status appropriate to provide residential behavioral health services from:
(A) The Joint Commission; or
(B) The Commission on Accreditation of
				  Rehabilitative Facilities (CARF); or
(C) The Council on Accreditation (COA).
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 317:30-5-95.45 - Residential substance use disorder (SUD) - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
(a)
Adults.
Members age twenty-one (21) to sixty-four (64) who meet
				  eligibility and clinical criteria may receive medically necessary residential
				  treatment for SUD.
(1) The member must meet
				  residential level of care as determined through completion of the designated
				  ASAM placement tool no more than seven (7) days prior to a SUD admission and/or
				  extension request and as required in the Oklahoma Department of Mental Health
				  and Substance Abuse Services (ODMHSAS) Prior Authorization Manual.
(2) Each presenting member for SUD treatment
				  shall be assessed, according to ASAM criteria, which includes a list of
				  symptoms for all six (6) dimensions and each level of care to determine a
				  clinically appropriate placement in the least restrictive level of
				  care.