Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 21 - OUTPATIENT BEHAVIORAL HEALTH AGENCY SERVICES › Section 317:30-5-240.1 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
The following words or terms, when used in this Part,
					 shall have the following meaning, unless the context clearly indicates
					 otherwise:
"Accrediting body"
means one (1) of the
					 following:
(A) Accreditation Association for Ambulatory Health Care
					 (AAAHC);
(B) American Osteopathic Association (AOA);
(C) Commission on Accreditation of Rehabilitation
					 Facilities (CARF);
(D) Council on Accreditation of Services for Families and
					 Children, Inc. (COA);
(E) The Joint Commission (TJC) formerly known as Joint
					 Commission on Accreditation of Healthcare Organizations;
(F) Accreditation Commission for Health Care (ACHC);
					 or
(G) Other OHCA approved accreditation.
"Adult"
means an individual twenty-one (21)
					 and over, unless otherwise specified.
"AOD"
means alcohol and other drug.
"AODTP"
means alcohol and other drug treatment
					 professional.
"ASAM"
means the American Society of Addiction
					 Medicine.
"ASAM patient placement criteria (ASAM PPC)"
means the most current edition of the American Society of Addiction Medicine's
					 published criteria for admission to treatment, continued services, and
					 discharge.
"Behavioral health (BH) services"
means a wide
					 range of diagnostic, therapeutic, and rehabilitative services used in the
					 treatment of mental illness, substance abuse, and co-occurring
					 disorders.
"BHAs"
means behavioral health aides.
"Certifying agency"
means the Oklahoma
					 Department of Mental Health and Substance Abuse Services (ODMHSAS).
" C.F.R."
means Code of Federal Regulations.
"Child"
means an individual younger than
					 twenty-one (21), unless otherwise specified.
"Client Assessment Record (CAR)"
means the
					 standardized tool recognized by OHCA and ODMHSAS to evaluate the functioning of
					 the member as per the OHCA prior authorization manual on the OHCA'S website at
www.oklahoma.gov/ohca
.
"CM"
means case management.
"Cultural competency"
means the ability to
					 recognize, respect, and address the unique needs, worth, thoughts,
					 communications, actions, customs, beliefs and values that reflect an
					 individual's racial, ethnic, age group, religious, sexual orientation, and/or
					 social group.
"DSM"
means the most current edition of the
					 Diagnostic and Statistical Manual of Mental Disorders published by the American
					 Psychiatric Association.
"EBP"
means an evidence-based practice per the
					 Substance Abuse & Mental Health Services Administration (SAMHSA).
"EPSDT"
means the Early and Periodic
					 Screening, Diagnostic and Treatment benefit for children. In addition to
					 screening services, EPSDT also covers the diagnostic and treatment services
					 necessary to ameliorate acute and chronic physical and mental health
					 conditions.
"FBCS"
means facility-based crisis
					 stabilization.
"FSPs"
means family support providers.
"ICF/IID"
means intermediate care facility for
					 individuals with intellectual disabilities.
"Institution"
means an inpatient hospital
					 facility or institution for mental disease (IMD).
"IMD"
means institution for mental disease as
					 per
					 42 C.F.R. §
											435.1009 as a hospital, nursing facility, or
					 other institution of more than sixteen (16) beds that is primarily engaged in
					 providing diagnosis, treatment, or care of persons with mental diseases,
					 including medical attention, nursing care and related services. The regulations
					 indicate that an institution is an IMD if its overall character is that of a
					 facility established and maintained primarily for the care and treatment of
					 individuals with mental diseases. Title XIX of the Social Security Act provides
					 that, except for individuals under age twenty-one (21) receiving inpatient
					 psychiatric care, Medicaid (Title XIX) does not cover services to IMD patients
					 under sixty-five (65) years of age [Section 1905(a)(24)(B) of the Social
					 Security Act].
"Level of functioning rating"
means a
					 standardized mechanism to determine the intensity or level of services needed
					 based upon the severity of the member's condition. The CAR level of function
					 rating scale is the tool that links the clinical assessment to the appropriate
					 level of Mental Health treatment. Either the Addiction Severity Index (ASI) or
					 the TeenAddiction Severity Index (TASI), based on age, is the tool that links
					 the clinical assessment to the appropriate level of Substance Abuse (SA)
					 treatment.
"LBHP"
means a licensed behavioral health
					 professional.
"MST"
means the EBP Multi-Systemic
					 Therapy.
"OAC"
means the publication authorized by 75
					 Oklahoma Statutes, Sec. 256 known as The Oklahoma Administrative Code, or,
					 prior to its publication, the compilation of codified rules authorized by 75
					 O.S. § 256(A)(1)(a) and maintained in the Office of Administrative
					 Rules.
"Objectives"
means a specific statement of
					 planned accomplishments or results that are specific, measurable, attainable,
					 realistic, and time limited.
"ODMHSAS"
means the Oklahoma Department of
					 Mental Health and Substance Abuse Services.
"ODMHSAS contracted facilities"
means those
					 providers that have a contract with the ODMHSAS to provide mental health or
					 substance use disorder treatment services, and contract directly with the
					 Oklahoma Health Care Authority to provide outpatient behavioral health
					 services.
"OHCA"
means the Oklahoma Health Care
					 Authority.
"OJA"
means the Office of Juvenile
					 Affairs.
"O.S."
means Oklahoma Statutes.
"RBMS"
means residential behavioral management
					 services within a group home or therapeutic foster home.
"Recovery"
means an ongoing process of
					 discovery and/or rediscovery that must be self defined, individualized and may
					 contain some, if not all, of the ten fundamental components of recovery as
					 outlined by SAMHSA.
"PRSS"
means peer recovery support
					 specialist.
"SAMHSA"
means the Substance Abuse and Mental
					 Health Services Administration.
"Serious emotional disturbance (SED)"
means a
					 condition experienced by persons from birth to eighteen (18) that show evidence
					 of points of (A), (B) and (C) below:
(A) The disability must have persisted for six (6) months
					 and be expected to persist for a year or longer.
(B) A condition or serious emotional disturbance as defined
					 by the most recently published version of the DSM or the International
					 Classification of Disease (ICD) equivalent with the exception of DSM "V" codes,
					 substance abuse, and developmental disorders which are excluded, unless they
					 co-occur with another diagnosable serious emotional disturbance.
(C) The child must exhibit either (i) or (ii) below:
(i) Psychotic symptoms of a serious mental illness (e.g.,
					 Schizophrenia characterized by defective or lost contact with reality, often
					 hallucinations or delusions); or
(ii) Experience difficulties that substantially interfere
					 with or limit a child or adolescent from achieving or maintaining one or more
					 developmentally appropriate social, behavioral, cognitive, communicative, or
					 adaptive skills. There is functional impairment in at least two (2) of the
					 following capacities (compared with expected developmental level):
(I) Impairment in self-care manifested by a person's
					 consistent inability to take care of personal grooming, hygiene, clothes and
					 meeting of nutritional needs.
(II) Impairment in community function manifested by a
					 consistent lack of age-appropriate behavioral controls, decision-making,
					 judgment and value systems which result in potential involvement or involvement
					 with the juvenile justice system.
(III) Impairment of social relationships manifested by the
					 consistent inability to develop and maintain satisfactory relationships with
					 peers and adults.
(IV) Impairment in family function manifested by a pattern
					 of disruptive behavior exemplified by repeated and/or unprovoked violence to
					 siblings and/or parents, disregard for safety and welfare or self or others
					 (e.g., fire setting, serious and chronic destructiveness, inability to conform
					 to reasonable limitations and expectations which may result in removal from the
					 family or its equivalent).
(V) Impairment in functioning at school manifested by the
					 inability to pursue educational goals in a normal time frame (e.g.,
					 consistently failing grades, repeated truancy, expulsion, property damage or
					 violence toward others).
"Serious mental illness (SMI)"
means a
					 condition experienced by persons age eighteen (18) and over that show evidence
					 of points of (A), (B) and (C) below:
(A) The disability must have persisted for six (6) months
					 and be expected to persist for a year or longer.
(B) A condition or serious mental illness as defined by the
					 most recently published version of the DSM or the International Classification
					 of Disease (ICD) equivalent with the exception of DSM "V" codes, substance
					 abuse, and developmental disorders which are excluded, unless they co-occur
					 with another diagnosable serious mental illness.
(C) The adult must exhibit either (i) or (ii) below:
(i) Psychotic symptoms of a serious mental illness (e.g.,
					 Schizophrenia characterized by defective or lost contact with reality, often
					 hallucinations or delusions); or
(ii) Experience difficulties that substantially interfere
					 with or limit an adult from achieving or maintaining one or more
					 developmentally appropriate social, behavioral, cognitive, communicative, or
					 adaptive skills. There is functional impairment in at least two (2) of the
					 following capacities (compared with expected developmental level):
(I) Impairment in self-care manifested by a person's
					 consistent inability to take care of personal grooming, hygiene, clothes and
					 meeting of nutritional needs.
(II) Impairment in community function manifested by a
					 consistent lack of appropriate behavioral controls, decision-making, judgment
					 and value systems which result in potential involvement or involvement with the
					 criminal justice system.
(III) Impairment of social relationships manifested by the
					 consistent inability to develop and maintain satisfactory relationships with
					 peers.
(IV) Impairment in family function manifested by a pattern
					 of disruptive behavior exemplified by repeated and/or unprovoked violence,
					 disregard for safety and welfare of self or others (e.g., fire setting, serious
					 and chronic destructiveness, inability to conform to reasonable limitations and
					 expectations).
(V) Impairment in functioning at school or work manifested
					 by the inability to pursue educational or career goals.
"Trauma informed"
means the recognition and
					 responsiveness to the presence of the effects of past and current traumatic
					 experiences in the lives of members.
Added at 26 Ok Reg 734, eff 4-1-09 (emergency) ; Added
						at 26 Ok Reg 2090, eff 6-25-09 ; Added at 27 Ok Reg 2753, eff 7-20-10
						(emergency) ; Added at 28 Ok Reg 1469, 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 ; Amended at 30
						Ok Reg 331, eff 1-14-13 (emergency) ; Amended at 30 Ok Reg 1146, eff
						7-1-13