Current through Vol. 41, No. 20, July 1, 2024
CCBHCs provide a comprehensive array of services that
create access, stabilize people in crisis, and provide the needed treatment and
recovery support services for those with the most serious and complex mental
health and substance use disorders. CCBHCs integrate additional services to
ensure an approach to health care that emphasizes recovery, wellness,
trauma-informed care, and physical-behavioral health integration. Initial
screening, assessment, and diagnosis must be completed in order to receive a
covered service. Services must be medically necessary and recommended by an
LBHP or licensure candidate (see OAC
317:30-5-263) .
Services are covered when provided in accordance with a person-centered and
family-centered service plan. Coverage includes the following services:
(1)
Crisis assessment and intervention
services.
(A)
Service
requirements. This service is an immediately available service designed
to meet the psychological, physiological, and environmental needs of
individuals who are experiencing mental health and/or substance use disorder
crises. Services include the following:
(i)
Twenty-four (24) hours mobile crisis teams [see OAC
317:30-5-241.4(a)
for service definition]. Reimbursement is triggered by the LBHP/licensure
candidate crisis assessment;
(ii)
Emergency crisis intervention service [see OAC
317:30-5-241.4(a)
for service definition];
(iii)
Facility-based crisis stabilization [see OAC
317:30-5-241.4(b)
for service definition], provided directly by the CCBHC or by a
State-sanctioned alternative; and
(iv) Urgent recovery clinic (URC) services
provided in accordance with OAC
450:23-3-20 through
450:23-3-24.
(B)
Qualified professionals.
Twenty-four (24) hours mobile crisis intervention is provided by either a team
consisting of an LBHP/licensure candidate and a CM II or CADC, or just an
LBHP/licensure candidate. Emergency crisis intervention is provided by an
LBHP/licensure candidate. Facility-based crisis stabilization is provided by a
team, directed by a physician, and consisting of an LBHP/licensure candidate,
licensed nurses, CM II or CADC, and PRSS staff. URC services are provided by an
LBHP/licensure candidate with supervision from a physician or APRN with
prescribing authority.
(2)
Behavioral health integrated (BHI)
services.
(A)
Service
requirements. This service includes activities provided that have the
purpose of coordinating and managing the care and services furnished to each
member, assuring a fixed point of responsibility for providing treatment,
rehabilitation, and support services. This service includes, but is not limited
to:
(i) Care coordination for primary health
care, specialty health care, and transitional care from emergency departments,
hospitals, and PRTFs;
(ii) Ensuring
integration and compatibility of mental health and physical health
activities;
(iii) Providing
on-going service coordination and linking members to resources;
(iv) Tracking completion of mental and
physical health goals in member's comprehensive care plan;
(v) Coordinating with all team members to
ensure all objectives of the comprehensive care plan are progressing;
(vi) Appointment scheduling;
(vii) Conducting referrals and follow-up
monitoring;
(viii) Participating in
hospital discharge processes; and
(ix) Communicating with other providers and
members/family.
(B)
Qualified professionals. This service is performed by an
LBHP/licensure candidate, nurse, CM II or CADC, and/or PRSS staff.
(3)
Person-centered and
family-centered treatment planning.
(A)
Service requirements. This service is a process in which the
information obtained in the initial screenings and assessments are used to
develop a treatment plan that has individualized goals, objectives, activities,
and services that will enable the member to improve. For children assessed as
SED with significant behavioral needs, treatment planning is a wraparound
process consistent with System of Care values. A wraparound planning process
supports children and youth in returning to or remaining in the
community.
(B)
Qualified
professionals. This service is conducted by LBHPs/licensure candidates,
nurses, CM II or CADC, and/or PRSS staff. Treatment planning must include the
member and involved practitioners.
(4)
Psychotherapy (individual / group /
family).
(A)
Service
requirements. See OAC
317:30-5-241.2 for
service definitions and requirements. Fee-for-service billing limitations do
not apply.
(B)
Qualified
professionals. This service is conducted by an LBHP/licensure
candidate.
(5)
Medication training and support.
(A)
Service requirements. This
service includes:
(i) A review and
educational session focused on the member's response to medication and
compliance with the medication regimen and/or medication
administration;
(ii) Prescription
administration and ordering of medication by appropriate medical
staff;
(iii) Assisting the member
in accessing medications;
(iv)
Monitoring medication response and side effects; and
(v) Assisting members with developing the
ability to take medications with greater independence.
(B)
Qualified professionals.
This service is performed by an RN, APRN, or a physician assistant (PA) as a
direct service under the supervision of a physician.
(6)
Psychosocial rehabilitation
services (PSR).
(A)
Service
requirements.(i)
Adult.
PSR services are face-to-face behavioral health rehabilitation (BHR) services
which are necessary to improve the member's ability to function in the
community. They are performed to improve the skills and abilities of members to
live independently in the community, improve self-care and social skills, and
promote lifestyle change and recovery practices. Rehabilitation services may be
provided individually or in group sessions through the format of
curriculum-based education and skills training. This service is generally
performed with only the member and the qualified provider, but may include a
member and the member's family/support system when providing educational
services from a curriculum that focuses on the member's diagnosis, symptom
management, and recovery. A member who, at the time of service, is not able to
cognitively benefit from the treatment due to active hallucinations, substance
abuse, or other impairments, is not suitable for this service. Family
involvement is allowed for support of the member and education regarding
his/her recovery but does not constitute family therapy, which requires a
licensed provider. Eligibility requirements and billing limits found in OAC
317:30-5-241.3
do not apply.
(ii)
Children. PSR services are an array of services that are provided
in the child's home, in the location where behavioral challenges are most
likely to occur such as school, or in community settings for all children,
youth, and young adults ages zero (0) to twenty (20). PSR services must be
provided in a context that is child-centered, family-focused, strength-based,
culturally competent, and responsive to each child's psychosocial,
developmental, and treatment care needs. PSR service array includes:
(I) Intensive in-home services;
(II) Therapeutic behavioral
services;
(III) Intensive family
intervention; and
(IV) Intensive
outpatient substance abuse rehabilitation.
(B)
Qualified professionals.
This service is solely restorative in nature and may be performed by a
behavioral health CM II, CADC, LBHP, or licensure candidate, following
development of a service plan and treatment curriculum approved by an LBHP or
licensure candidate. For children, services are typically provided by a team
that can offer a combination of therapy from a LBHP or licensure candidate and
skills training and support from a paraprofessional [CM II, behavioral health
aide (BHA)]. The behavioral health CM II, CADC, and BHA must have immediate
access to an LBHP who can provide clinical oversight and collaborate with the
qualified PSR provider in the provision of services.
(7)
Psychoeducation and
counseling.
(A)
Service
requirements. This service is designed to restore, rehabilitate, and
support the individual's overall health and wellness. Services are intended for
members to provide purposeful and ongoing psychoeducation and counseling that
are specified in the individual's person-centered, individualized plan of care.
For children and their families, treatment services are an array of therapeutic
strategies and services designed to ameliorate or reduce the risk of social,
emotional, and behavioral disorders and disruptions in the relationship between
an infant and parent/caregiver. Such disorders and disruptions may be due to
infant/toddler and/or parent/caregiver vulnerabilities and/or negative
environmental factors that are significantly impacting the infant and/or
parent/caregiver-infant relationship. Treatment services are grounded in
attachment theory and are relationship focused. Components include:
(i) Delivery of manualized wellness
management interventions via group and individual work such as WRAP or IMR/WMR;
and
(ii) Emotional support,
education, resources during periods of crisis, and problem-solving
skills.
(B)
Qualified professionals. For children, zero (0) to five (5) years
old, this service is provided by an LBHP or licensure candidate. For all other
ages, this service is provided by a licensed nurse, licensed nutritionist, or
CM II or CADC within the scope of their licensure, certification, and/or
training.
(8)
Peer
recovery support services.
(A)
Service requirements. See OAC
317:30-5-241.5(d)
for service requirements.
(B)
Qualified professionals. PRSS must be certified through ODMHSAS
pursuant to OAC 450:53.
(9)
Family support and training.
(A)
Service requirements. See
OAC
317:30-5-241.5(c)
for service requirements.
(B)
Qualified professionals. Family support providers must be
trained/credentialed through ODMHSAS.
(10)
Screening, assessment, and service
planning.
(A)
Service
requirements. See OAC
317:30-5-241.1
for service requirements. Service billing limitations found in OAC
317:30-5-241.1
do not apply.
(B)
Qualified
professionals. Screenings can be performed by any qualified team member
as listed in OAC
317:30-5-265(b).
Assessment and service planning can only be performed by an LBHP or licensure
candidate.
(11)
Occupational therapy.
(A)
Service requirements. This service includes the therapeutic use of
everyday life activities (occupations) with an individual or groups for the
purpose of participation in roles and situations in home, school, workplace,
community, and other settings for the purpose of promoting health and wellness.
Occupational therapy services are provided to those who have developed an
illness, injury, disease, disorder, condition, impairment, disability, activity
limitation, or participation restrictions. Occupational therapy addresses the
physical, cognitive, psychosocial, sensory, and other aspects of performance in
a variety of contexts to support engagement in everyday life activities that
affect health, well-being, and quality of life.
(B)
Qualified professionals.
This service is solely restorative in nature and provided by a qualified
occupational therapist who is contracted with the OHCA or an occupational
therapist assistant who is working under the supervision of a licensed
occupational therapist (see OAC
317:30-5-295)
.
(C)
Coverage
limitations. In order to be eligible for SoonerCare reimbursement,
occupational therapy services must be prior authorized and/or prescribed by a
physician or other licensed practitioner of the healing arts, in accordance
with State and federal law, including, but not limited to, OAC
317:30-5-296,
OAC
317:30-5-1020,
and
42
C.F.R. §
440.110.
(12)
Behavioral health targeted case
management.
(A)
Service
requirements. See OAC
317:30-5-241.6
for service requirements.
(B)
Qualified professionals. This service is provided by a CM II
certified in accordance with OAC 450:50.
(C)
Coverage limitations.
Services are provided to individuals of all ages who meet medical necessity
criteria.
(13)
Outpatient substance abuse prevention counseling.
(A)
Service requirements. This
service provides counseling to enable individuals to successfully resist social
and other pressures to engage in destructive activities.
(B)
Qualified professionals.
This service must be recommended by a physician or licensed practitioner and
provided by LBHP/licensure candidate.
(C)
Coverage limitations.
Services are provided to individuals under age twenty-one (21) who meet medical
necessity criteria.