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 317:30-5-241.2 - Psychotherapy

Current through Vol. 41, No. 20, July 1, 2024
(a)
Individual psychotherapy.
(1)
Definition.
Psychotherapy is a treatment for mental illnesses and
				  behavioral disturbances, in which the clinician, through definitive therapeutic
				  communication, attempts to alleviate the emotional disturbances, reverse, or
				  change maladaptive patterns of behavior, and encourage growth and development.
				  Insight oriented, behavior modifying and/or supportive psychotherapy refers to
				  the development of insight of affective understanding, the use of behavior
				  modification techniques, the use of supportive interactions, the use of
				  cognitive discussion of reality, or any combination of these items to provide
				  therapeutic change. Ongoing assessment of the member's status and response to
				  treatment as well as psycho-educational intervention are appropriate components
				  of individual therapy. The therapy must be goal directed, utilizing techniques
				  appropriate to the service plan and the member's developmental and cognitive
				  abilities.
(2)
Interactive
				  complexity.
Psychotherapy is considered to involve "interactive
				  complexity" when there are communication factors during a visit that complicate
				  delivery of the psychotherapy by the qualified practitioner. Sessions typically
				  involve members who have other individuals legally responsible for their care
				  (i.e., minors or adults with guardians); members who request others to be
				  involved in their care during the session (i.e., adults accompanied by one or
				  more participating family members or interpreter or language translator); or
				  members that require involvement of other third parties (i.e., child welfare,
				  juvenile justice, parole/probation officers, schools, etc.). Psychotherapy
				  should only be reported as involving interactive complexity when at least one
				  (1) of the following communication factors is present:
(A) The need to manage maladaptive
				  communication (i.e., related to high anxiety, high reactivity, repeated
				  questions, or disagreement) among participants that complicate delivery of
				  care.
(B) Caregiver
				  emotions/behavior that interfere with implementation of the service
				  plan.
(C) Evidence/disclosure of a
				  sentinel event and mandated report to a third party (i.e., abuse or neglect
				  with report to state agency) with initiation of discussion of the sentinel
				  event and/or report with patient and other visit participants.
(D) Use of play equipment, physical devices,
				  interpreter, or translator to overcome barriers to therapeutic interaction with
				  a patient who is not fluent in the same language or who has not developed or
				  lost expressive or receptive language skills to use or understand typical
				  language.
(3)
Qualified practitioners.
Psychotherapy must be provided by an
				  Licensed Behavioral Health Practitioner (LBHP) or licensure candidate in a
				  setting that protects and assures confidentiality.
(4)
Documentation requirements.
Providers must comply with documentation requirements in Oklahoma
				  Administrative Code (OAC)
				  317:30-5-248.
(5)
Limitations.
A maximum of
				  four (4) units per day per member is compensable. A cumulative maximum of eight
				  (8) units of individual psychotherapy and family psychotherapy per week per
				  member is compensable. Except for psychotherapy involving interactive
				  complexity as described in this Section, only the member and the qualified
				  practitioner should be present during the session. Individual psychotherapy is
				  not reimbursable for a child younger than the age of thirty-six (36) months.
				  Limitations exclude outpatient behavioral health services provided in a foster
				  care setting.