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. 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.
(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. Behavioral Health Aides must be trained/credentialed
through ODMHSAS.
(4)
Limitations. The Behavioral Health Aide 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) Family Support and Training.
(1)
Definition.
This service provides the training and support necessary to ensure engagement
and active participation of the family in the service plan development process
and with the ongoing implementation and reinforcement of skills learned
throughout the treatment process. Child Training is provided to family members
to increase their ability to provide a safe and supportive environment in the
home and community for the child. Parent Support ensures the engagement and
active participation of the family in the service plan development process and
guides families toward taking a proactive role in their child's treatment.
Parent Training is 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 specific problem-solving skills,
coping mechanisms, and strategies for the child's symptom/behavior
management.
(2)
Target
population. Family Support and Training is designed to benefit the
SoonerCare eligible child experiencing a serious emotional disturbance who is
in an ODMHSAS contracted systems of care community based treatment program, are
diagnosed with a pervasive developmental disorder, or are under OKDHS or OJA
custody, are residing within a RBMS level of care or are at risk for out of
home placement, and who without these services would require psychiatric
hospitalization.
(3)
Qualified practitioners. Family Support Providers (FSPs) must be
trained/credentialed through ODMHSAS.
(4)
Limitations. The FSP cannot
bill for more than one individual during the same time period.
(5)
Documentation requirements.
Providers must comply with requirements listed in OAC
317:30-5-248.
(d) 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 provider
(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 throughout the behavioral health care 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 credential training. They lend unique insight into mental illness
and what makes recovery possible because they are in recovery.
(2)
Target population. Children
16 and over with SED and/or substance use disorders and adults 18 and over with
SMI and/or substance use disorder(s).
(3)
Qualified professionals.
Peer Recovery Support Specialists (PRSS) must be certified through ODMHSAS
pursuant to OAC 450:53.
(4)
Limitations. The PRSS cannot bill for more than one individual
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 in articulating personal goals for recovery; and
(iv) assist members in determining the
objectives needed to reach his/her recovery goals.
(B) PRSS staff utilizing ongoing training
must:
(i) proactively engage members and
possess 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;
(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
Disclaimer: These regulations may not be the most recent version. Oklahoma may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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