Current through Vol. 41, No. 20, July 1, 2024
(a)
Accreditation and certification
status. Any agency may participate as an Outpatient Behavioral Health
(OPBH) provider if the agency is qualified to render a covered service and
meets the OHCA requirements for provider participation.
(1) Private, Community-based Organizations
must be accredited as a provider of outpatient behavioral health services from
one of the accrediting bodies listed in (c)(1) below and be an incorporated
organization governed by a board of directors or be certified by the certifying
agency in accordance with 43A O.S. §§ 3-317, 3-323A, 3-306.1, or
3-415;
(2) State-operated programs
under the direction of ODMHSAS must be accredited by one of the accrediting
bodies or be certified by the certifying agency in accordance with 43A O.S.
§§ 3-317, 3-323A, 3-306.1 or 3-415;
(3) Freestanding Psychiatric Hospitals must
be licensed and certified by the State Survey Agency as meeting Medicare
psychiatric hospital standards and JCAHO accreditation;
(4) General Medical Surgical Hospitals must
be appropriately licensed and certified by the State Survey Agency as meeting
Medicare standards, including a JCAHO or AOA accreditation;
(5) Federally Qualified Health
Centers/Community Health Centers facilities that qualify under OAC
317:30-5-660;
(6) Indian Health Services/Tribal
Clinics/Urban Tribal Clinics facilities that qualify under federal
regulation;
(7) Rural Health
Clinics facilities that qualify under OAC
317:30-5-355;
(8) Public Health Clinics and County Health
Departments;
(9) Public School
Systems.
(b)
Certifications. In addition to the accreditation in paragraph (a)
above or ODMHSAS certification in accordance with 43A O.S. §§ 3-317,
3-323A, 3-306.1 or 3-415, provider specific credentials are required for the
following:
(1) Substance Abuse agencies (OAC
450:18-1-1 );
(2) Evidence Based Best Practices but not
limited to:
(A) Assertive Community Treatment
(OAC
450:55-1-1 );
(B) Multi-Systemic Therapy (Office of
Juvenile Affairs); and
(C) Peer
Support/Community Recovery Support;
(3) Systems of Care (OAC
340:75-16-46
);
(4) Mobile and Facility-based
Crisis Intervention (OAC
450:23-1-1 );
(5) Case Management (OAC
450:50-1-1 );
(6) RBMS in group homes (OAC 377:10-7) or
therapeutic foster care settings (OAC
340:75-8-4
);
(7) Day Treatment - CARF, JCAHO,
ACHC or COA for Day Treatment Services; and
(8) Partial Hospitalization/Intensive
Outpatient CARF, JCAHO, ACHC or COA for Partial Hospitalization
services.
(c)
Provider enrollment and contracting.
(1) Organizations who have JCAHO, CARF, COA,
ACHC or AOA accreditation or ODMHSAS certification in accordance with 43A O.S.
§§ 3-317, 3-323A, 3-306.1 or 3-415 will supply the documentation from
the accrediting body or certifying agency, along with other information as
required for contracting purposes to the OHCA. The contract must include copies
of all required state licenses, accreditation and certifications.
(2) If the contract is approved, a separate
provider identification number for each outpatient behavioral health service
site will be assigned. Each site operated by an outpatient behavioral health
facility must have a separate provider contract and site-specific accreditation
and/or certification as applicable. A site is defined as an office, clinic, or
other business setting where outpatient behavioral health services are
routinely performed. When services are rendered at the member's residence, a
school, or when provided occasionally at an appropriate community based
setting, a site is determined according to where the professional staff perform
administrative duties and where the member's chart and other records are kept.
Failure to obtain and utilize site specific provider numbers will result in
disallowance of services.
(3) All
behavioral health providers are required to have an individual contract with
OHCA in order to receive SoonerCare reimbursement. This requirement includes
outpatient behavioral health agencies and all individual rendering providers
who work within an agency setting. Individual contracting rendering provider
qualification requirements are set forth in OAC
317:30-3-2
and
317:30-5-240.3.
(d)
Standards and criteria.
Eligible organizations must meet each of the following:
(1) Have a well-developed plan for
rehabilitation services designed to meet the recovery needs of the individuals
served.
(2) Have a
multi-disciplinary, professional team. This team must include all of the
following:
(A) One of the LBHPs;
(B) A Certified Behavioral Health Case
Manager II (CM II) or CADC, if individual or group rehabilitative services for
behavioral health disorders are provided, and the designated LBHP(s) or
licensure candidate(s) on the team will not be providing rehabilitative
services;
(C) An AODTP, if
treatment of substance use disorders is provided;
(D) A registered nurse, advanced practice
nurse, or physician assistant, with a current license to practice in the state
in which the services are delivered if Medication Training and Support Service
is provided;
(E) The member for
whom the services will be provided, and parent/guardian for those under
eighteen (18) years of age.
(F) A
member treatment advocate if desired and signed off on by the member.
(3) Demonstrate the ability to
provide each of the following outpatient behavioral health treatment services
as described in OAC
317:30-5-241 et
seq., as applicable to their program. Providers must provide proper referral
and linkage to providers of needed services if their agency does not have
appropriate services.
(A) Assessments and
Service Plans;
(B)
Psychotherapies;
(C) Behavioral
Health Rehabilitation services;
(D)
Crisis Intervention services;
(E)
Support Services; and
(F) Day
Treatment/Intensive Outpatient.
(4) Be available twenty-four (24) hours a
day, seven (7) days a week, for Crisis Intervention services.
(5) Provide or have a plan for referral to
physician and other behavioral health services necessary for the treatment of
the behavioral disorders of the population served.
(6) Comply with all applicable federal and
state regulations.
(7) Have
appropriate written policy and procedures regarding confidentiality and
protection of information and records, member grievances, member rights and
responsibilities, and admission and discharge criteria, which shall be posted
publicly and conspicuously.
(8)
Demonstrate the ability to keep appropriate records and documentation of
services performed.
(9) Maintain
and furnish, upon request, a current report of fire and safety inspections of
facilities clear of any deficiencies.
(10) Maintain and furnish, upon request, all
required staff credentials including certified transcripts documenting required
degrees.
Added at 26 Ok Reg 734, eff 4-1-09 (emergency) ; Added
at 26 Ok Reg 2090, eff 6-25-09 ; Amended at 27 Ok Reg 2753, eff 7-20-10
(emergency) ; Amended 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 1146, eff 7-1-13