Current through Vol. 42, No. 1, September 16, 2024
(a) In order for
services to be covered, services in psychiatric units of general hospitals,
psychiatric hospitals, and PRTF programs must meet the requirements in OAC
317:30-5-95.25
through
317:30-5-95.30.
OHCA rules that apply to inpatient psychiatric coverage for individuals aged
twenty-one (21) and under are found in Sections OAC 317:30-5-95.22 through
317:30-5-95.42.
(b) The following words and terms, when used
in OAC 317:30-5-95.22 through
317:30-5-95.42,
shall have the following meaning, unless the context clearly indicates
otherwise:
(1)
"Acute" means
care delivered in a psychiatric unit of a general hospital or psychiatric
hospital that provides assessment, medical management and monitoring, and
short-term intensive treatment and stabilization to individuals experiencing
acute episodes of behavioral health disorders.
(2)
"Acute II" means care
delivered in a psychiatric unit of a general hospital or psychiatric hospital;
however, services at this level of care are designed to serve individuals under
twenty-one (21) who need longer-term, more intensive treatment, and a more
highly-structured environment than they can receive in family and other
community-based alternatives to hospitalization. However, care delivered in
this setting is less intense than the care provided in Acute.
(3)
"Border placement" means
placement in an inpatient psychiatric facility that is in one (1) of the states
that borders Oklahoma (Arkansas, Colorado, Kansas, Missouri, New Mexico, and
Texas).
(4)
"Border
status" means placement in a facility in a state that does not border
Oklahoma, but which facility routinely provides inpatient psychiatric services
to SoonerCare members.
(5)
"Chemical dependency/substance abuse services/detoxification"
means services offered to individuals with a substance-related disorder whose
biomedical and emotional/behavioral problems are sufficiently severe to require
inpatient care.
(6)
"Enhanced
treatment unit or specialized treatment" means an intensive residential
treatment unit that provides a program of care to a population with special
needs or issues requiring increased staffing requirements, co-morbidities,
environmental accommodations, specialized treatment programs, and longer
lengths of stay.
(7)
"Evidence-based practice (EBP)" means programs or practices that
are supported by research methodology and have produced consistently positive
patterns of results in accordance with the Substance Abuse and Mental Health
Services Administration (SAMHSA).
(8)
"Out-of-state placement"
means a placement for intensive or specialized services not available in
Oklahoma requiring additional authorization procedures and approval by the OHCA
Behavioral Health Unit.
(9)
"Public facilities" means Oklahoma government owned or operated
facilities.
(10)
"Trauma-informed" means the recognition and responsiveness to the
presence of the effects of past and current traumatic experiences in the lives
of members.
Added at 23 Ok Reg
2508, eff 6-25-06; Amended at 24 Ok Reg 2880, eff 7-1-07 (emergency); Amended
at 25 Ok Reg 1161, eff 5-25-08; Amended at 27 Ok Reg 2737, eff 7-20-10
(emergency); Amended at 28 Ok Reg 1452, eff
6-25-11