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

Universal Citation: OK Admin Code 317:30-5-241.5

Current through Vol. 42, No. 1, September 16, 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 cooccurring 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.

(b) Therapeutic Behavioral Services.

(1) Definition. Therapeutic behavioral services include behavior management and redirection and behavioral and life skills remedial training provided by qualified behavioral health aides. The behavioral health aide also provides monitoring and observation of the child's emotional/behavioral status and responses, providing interventions, support and social skills redirection when needed. Training is generally focused on behavioral, interpersonal, communication, self-help, safety and daily living skills.

(2) Target population. This service is limited to children with serious emotional disturbance who are in an ODMHSAS contracted systems of care community-based treatment program, or are under OKDHS or OJA custody residing within a RBMS level of care, who need intervention and support in their living environment to achieve or maintain stable successful treatment outcomes.

(3) Qualified practitioners. Qualified Behavioral Health Aides (QBHA) must possess certification as a Behavioral Health Case Manager I and be trained/credentialed through ODMHSAS.

(4) Limitations. The QBHA cannot bill for more than one individual during the same time period. Therapeutic behavioral services by a BHA, Treatment Parent Specialist (TPS) or Behavioral Health School Aide (BHSA) cannot be delivered during the same clock time.

(5) Documentation requirements. Providers must follow requirements listed in OAC 317:30-5-248.

(c) Peer Recovery Support Services (PRSS).

(1) Definition. Peer recovery support services are an EBP model of care which consists of a qualified Peer Recovery Support Specialist (PRSS) who assists individuals with their recovery from behavioral health disorders. Recovery Support is a service delivery role in the ODMHSAS public and contracted provider system where the provider understands what creates recovery and how to support environments conducive of recovery. The role is not interchangeable with traditional staff members who usually work from the perspective of their training and/or their status as a licensed behavioral health provider; rather, this provider works from the perspective of their experimental expertise and specialized training. They lend unique insight into mental illness and what makes recovery possible because they are in recovery. Family Peer Recovery Support Specialists (F-PRSS) focus on the family unit of a child or adolescent, ensuring the engagement and active participation of the family during treatment and guiding families toward taking a proactive role in their family member's recovery, for the benefit of the SoonerCare eligible child or adolescent. Services may include assisting the family with the acquisition of the skills and knowledge necessary to facilitate an awareness of their child's needs and the development and enhancement of the family's problem-solving skills, coping mechanisms, and strategies for the child's symptom/behavior management.

(2) Target population. Members age sixteen (16) years of age and over with SED and/or substance use disorders, adults 18 and over with SMI and/or substance use disorder(s), and family units with a child or adolescent experiencing an SED and/or substance use disorder.

(3) Qualified professionals. Peer Recovery Support Specialists (PRSS) and Family Peer Recovery Support Specialists (F-PRSS) must be certified through ODMHSAS pursuant to OAC 450:53. A PRSS may provide services to individuals sixteen (16) years of age or older. An F-PRSS may provide services to families with children and adolescents.

(4) Limitations. The PRSS and F-PRSS cannot bill for more than one individual service during the same time period. This service can be an individual or group service. Groups have no restriction on size.

(5) Documentation requirements. Providers must comply with requirements listed in OAC 317:30-5-248.

(6) Service requirements.
(A) PRSS staff utilizing their knowledge, skills and abilities will:
(i) teach and mentor the value of every individual's recovery experience;

(ii) model effective coping techniques and self-help strategies;

(iii) assist members or their family members in articulating personal goals for recovery; and

(iv) assist members or their family members in determining the objectives needed to reach his/her recovery goals.

(B) PRSS staff utilizing ongoing training must:
(i) proactively engage members or their family members using communication skills/ability to transfer new concepts, ideas, and insight to others;

(ii) facilitate peer support groups;

(iii) assist in setting up and sustaining self-help (mutual support) groups;

(iv) support members in using a Wellness Recovery Action Plan (WRAP);

(v) assist in creating a crisis plan/Psychiatric Advanced Directive;

(vi) utilize and teach problem solving techniques with members or their family members;

(vii) teach members how to identify and combat negative self-talk and fears;

(viii) support the vocational choices of members and assist him/her in overcoming job-related anxiety;

(ix) assist in building social skills in the community that will enhance quality of life. Support the development of natural support systems;

(x) assist other staff in identifying program and service environments that are conducive to recovery and;

(xi) attend treatment team and program development meetings to ensure the presence of the member's voice and to promote the use of self-directed recovery tools.

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

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