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 317:30-5-241.5 - Support services

Current through Vol. 41, No. 20, July 1, 2024
(a)
Program
				  of Assertive Community Treatment (PACT) Services.
(1)
Definition.
PACT is provided
				  by an interdisciplinary team that ensures service availability 24 hours a day,
				  seven days a week and is prepared to carry out a full range of treatment
				  functions wherever and whenever needed. An individual is referred to the PACT
				  team service when it has been determined that his/her needs are so pervasive
				  and/or unpredictable that it is unlikely that they can be met effectively by
				  other combinations of available community services, or in circumstances where
				  other levels of outpatient care have not been successful to sustain stability
				  in the community.
(2)
Target
				  population.
Individuals 18 years of age or older with serious and
				  persistent mental illness and co-occurring disorders. PACT services are those
				  services delivered within an assertive community-based approach to provide
				  treatment, rehabilitation, and essential behavioral health supports on a
				  continuous basis to individuals 18 years of age or older with serious mental
				  illness with a self-contained multi-disciplinary team. The team must use an
				  integrated service approach to merge essential clinical and rehabilitative
				  functions and staff expertise. This level of service is to be provided only for
				  persons most clearly in need of intensive ongoing services.
(3)
Qualified practitioners.
Providers of PACT services are specific teams within an established
				  organization and must be operated by or contracted with and certified by the
				  ODMHSAS in accordance with 43A O.S. 319 and OAC 450:55. The team leader must be
				  an LBHP or Licensure Candidate.
(4)
Limitations.
PACT services are billable in 15 minute units. A
				  maximum of 105 hours per member per year in the aggregate is allowed. All PACT
				  compensable SoonerCare services are required to be face-to-face. The following
				  services are separately billable: Case management, facility-based crisis
				  stabilization, physician and medical services.
(5)
Service requirements.
PACT
				  services must include the following:
(A) PACT
				  assessments (initial and comprehensive);
(i)
Initial assessment
- is the initial evaluation of the member based
				  upon available information, including self-reports, reports of family members
				  and other significant parties, and written summaries from other agencies,
				  including police, court, and outpatient and inpatient facilities, where
				  applicable, culminating in a comprehensive initial assessment. Member
				  assessment information for admitted members shall be completed on the day of
				  admission to the PACT. The start and stop times for this service should be
				  recorded in the chart.
(ii)
Comprehensive assessment
- is the organized process of gathering
				  and analyzing current and past information with each member and the family
				  and/or support system and other significant people to evaluate:
1) mental and functional status;
2) effectiveness of past treatment;
3) current treatment,
				  rehabilitation and support needs to achieve individual goals and support
				  recovery; and
4) the range of
				  individual strengths (e.g., knowledge gained from dealing with adversity or
				  personal/professional roles, talents, personal traits) that can act as
				  resources to the member and his/her recovery planning team in pursuing goals.
				  Providers must bill only the face-to-face service time with the member.
				  Non-face to face time is not compensable. The start and stop times for this
				  service should be recorded in the chart.
(B) Behavioral health service plan (moderate
				  and low complexity by a non-physician treatment planning and review) is a
				  process by which the information obtained in the comprehensive assessment,
				  course of treatment, the member, and/or treatment team meetings is evaluated
				  and used to develop a service plan that has individualized goals, objectives,
				  activities and services that will enable a member to improve. The initial
				  assessment serves as a guide until the comprehensive assessment is completed.
				  It is to focus on recovery and must include a discharge plan. It is performed
				  with the direct active participation by the member. SoonerCare compensation for
				  this service includes only the face to face time with the member. The start and
				  stop times for this service should be recorded in the chart.
(C) Treatment team meetings (team conferences
				  with the member present) is a billable service. This service is conducted by
				  the treatment team, which includes the member and all involved practitioners.
				  For a complete description of this service, see OAC
				  450:55-5-6
				  Treatment Team Meetings. This service can be billed to SoonerCare only when the
				  member is present and participating in the treatment team meeting. The
				  conference starts at the beginning of the review of an individual member and
				  ends at the conclusion of the review. Time related to record keeping and report
				  generation is not reported. The start and stop times should be recorded in the
				  member's chart. The participating psychiatrist/physician should bill the
				  appropriate CPT code; and the agency is allowed to bill one treatment team
				  meeting per member as medically necessary.
(D) Individual and family
				  psychotherapy;
(E) Individual
				  rehabilitation;
(F) Recovery
				  support services;
(G) Group
				  rehabilitation;
(H) Group
				  psychotherapy;
(I) Crisis
				  Intervention;
(J) Medication
				  training and support services;
(K)
				  Blood draws and /or other lab sample collection services performed by the
				  nurse.