Current through Vol. 42, No. 1, September 16, 2024
(a) The following
words and terms, when used in this Section, shall have the following meaning,
unless the context clearly indicates otherwise:
(1)
"Active treatment" means
implementation of a professionally developed and supervised individual plan of
care (IPC) that involves the member and his or her family or guardian from the
time of an admission, and through the treatment and discharge
process.
(2)
"Discharge/transition planning" means a patient-centered,
interdisciplinary process that begins with an initial assessment of the
member's needs at the time of admission and continues throughout the member's
stay. Active collaboration with the member, family, and all involved outpatient
practitioners and agencies should be ongoing throughout treatment so that
effective connections remain intact. Needed services may consist of the
wraparound process through Systems of Care, counseling, case management, and
other supports in the member's community. The linkages with these supports
should be made prior to discharge to allow for a smooth transition.
(3)
"Expressive group therapy"
means art, music, dance, movement, poetry, drama, psychodrama, structured
therapeutic physical activities, and experiential (e.g., ropes course),
recreational, or occupational therapies that encourage the member to express
themselves emotionally and psychologically.
(4)
"Family therapy" means
interaction between an LBHP or licensure candidate, member, and family
member(s) to facilitate emotional, psychological, or behavioral changes and
promote successful communication and understanding.
(5)
"Group rehabilitative
treatment" means behavioral health remedial services, as specified in
the individual care plan, which are necessary for the treatment of the existing
primary behavioral health disorders and/or any secondary alcohol and other drug
(AOD) disorders in order to increase the skills necessary to perform activities
of daily living (ADL).
(6)
"Individual rehabilitative treatment" means a face-to-face,
one-on-one interaction which is performed to assist a member who is
experiencing significant functional impairment due to the existing primary
behavioral health disorder and/or any secondary AOD disorder, in order to
increase the skills necessary to perform ADL.
(7)
"Individual therapy" means a
method of treating existing primary behavioral health disorders and/or any
secondary AOD disorders using face-to-face, one-on-one interaction between an
LBHP or licensure candidate and a member to promote emotional or psychological
change to alleviate disorders.
(8)
"Process group therapy" means a method of treating existing
primary behavioral health disorders and/or secondary AOD disorders using the
interaction between an LBHP or licensure candidate, and two (2) or more members
to promote positive emotional and/or behavioral change.
(b) Inpatient psychiatric programs must
provide "active treatment". Families and/or guardians must be notified of the
dates and times of treatment team meetings and be welcomed to attend. Family
members must attend family therapy weekly for continued SoonerCare
reimbursement. Reasons for exceptions to this requirement must be
well-documented in the member's treatment plan. Family therapy attendance by
family members is not a requirement for individuals in the age range of
eighteen (18) up to twenty-one (21). Active treatment also includes ongoing
assessment, diagnosis, intervention, evaluation of care and treatment, and
planning for discharge and aftercare under the direction of a
physician.
(c) For individuals ages
eighteen (18) up to twenty-one (21), the active treatment program must be
appropriate to the needs of the member and be directed toward restoring and
maintaining optimal levels of physical and psychiatric-social functioning. The
services and the IPC must be recovery-focused, trauma-informed, specific to
culture, age, and gender, and provided face to face. Services, including type
and frequency, will be specified in the IPC.
(d) A treatment week consists of seven (7)
calendar days. In an Acute setting, the treatment week begins the day of
admission. In Acute II and PRTF, the treatment week starts on Sunday and ends
on Saturday. Active treatment service components are provided as per item (e)
below if the services are provided within a seven (7) day treatment week. A
chart outlining active treatment component requirements and timelines may also
be found at www.okhca.org. If a member has a
length of stay of less than seven (7) days, the treatment week is considered a
partial treatment week. Active treatment requirements, when provided during a
partial treatment week, are delivered as per item (f) below. An hour of
treatment must be sixty (60) minutes. When appropriate to meet the needs of the
child, the sixty (60) minute timeframe may be split into sessions of no less
than fifteen (15) minutes each, on the condition that the active treatment
requirements are fully met by the end of the treatment week.
(e) For individuals under age eighteen (18),
the components of active treatment consist of face-to-face integrated therapies
that are provided on a regular basis and will remain consistent with the
member's ongoing need for care. The services and IPC must be recovery-focused,
trauma-informed, and specific to culture, age, and gender. Individuals
receiving services in an Acute setting must receive seventeen (17) hours of
documented active treatment services each week, with seven (7) of those hours
dedicated to core services as described in (1) below. Individuals in Acute II
and PRTFs must receive fourteen (14) hours of documented active treatment
services each week, with four and a half (4.5) of those hours dedicated to core
services as described in (1) below. Upon fulfilling the core service hours
requirement, the member may receive either the elective services listed in (2)
below or additional core services to complete the total required hours of
active treatment. The following components meet the minimum standards required
for active treatment, although an individual child's needs for treatment may
exceed this minimum standard:
(1)
Core
services.
(A)
Individual
treatment provided by the physician, Advanced Practice Registered Nurse (APRN),
or Physician Assistant (PA). Individual treatment provided by the
physician, APRN with psychiatric certification or PA is required three (3)
times per week for Acute and one (1) time a week in Acute II and PRTFs.
Individual treatment provided by the physician, APRN with psychiatric
certification or PA will never exceed ten (10) calendar days between sessions
in Acute II and PRTFs, and never exceed seven (7) calendar days in a specialty
Acute II and specialty PRTF. Individual treatment provided by the physician,
APRN with psychiatric certification or PA may consist of therapy or medication
management intervention for Acute, Acute II, and PRTF programs.
(B)
Individual therapy. LBHPs or
licensure candidates performing this service must use and document an approach
to treatment such as cognitive behavioral treatment, narrative therapy,
solution-focused brief therapy, or another widely accepted theoretical
framework for treatment. Ongoing assessment of the member's status and response
to treatment, as well as psycho-educational intervention, are appropriate
components of individual therapy. Individual therapy must be provided in a
confidential setting. The therapy must be goal-directed, utilizing techniques
appropriate to the member's plan of care and the member's developmental and
cognitive abilities. Individual therapy must be provided two (2) hours per week
in Acute and one (1) hour per week in Acute II and PRTFs by an LBHP or
licensure candidate. One (1) hour of family therapy may be substituted for one
(1) hour of individual therapy at the treatment team's discretion.
(C)
Family therapy. The focus of
family therapy must be directly related to the goals and objectives on the
individual member's plan of care. Family therapy must be provided one (1) hour
per week in Acute, Acute II, and PRTFs. One (1) hour of individual therapy
addressing relevant family issues may be substituted for a family session in an
instance in which the family is unable to attend a scheduled session by an LBHP
or licensure candidate.
(D)
Process group therapy. The focus of process group therapy must be
directly related to goals and objectives on the individual member's plan of
care. The individual member's behavior and the focus of the group must be
included in each member's medical record. This service does not include social
skills development or daily living skills activities and must take place in an
appropriate confidential setting, limited to the therapist, appropriate
hospital staff, and group members. Group therapy must be provided three (3)
hours per week in Acute and two (2) hours per week in Acute II and PRTFs by an
LBHP or licensure candidate. In lieu of one (1) hour of process group therapy,
one (1) hour of expressive group therapy provided by an LBHP, licensure
candidate, or licensed therapeutic recreation specialist may be
substituted.
(E)
Transition/discharge planning. Transition/discharge planning must
be provided one (1) hour per week in Acute and thirty (30) minutes per week in
Acute II and PRTFs. Transition/discharge planning can be provided by any level
of inpatient staff.
(2)
Elective services.
(A)
Expressive group therapy. Through active expression, inner
strengths are discovered that can help the member deal with past experiences
and cope with present life situations in more beneficial ways. The focus of the
group must be directly related to goals and objectives on the individual
member's plan of care. Documentation must include how the member is processing
emotions/feelings. Expressive therapy must be a planned therapeutic activity,
facilitated by staff with a relevant bachelor's degree and/or staff with
relevant training, experience, or certification to facilitate the
therapy.
(B)
Group
rehabilitative treatment. Examples of educational and supportive
services, which may be covered under the definition of group rehabilitative
treatment services, are basic living skills, social skills (re)development,
interdependent living, self-care, lifestyle changes, and recovery principles.
Each service provided under group rehabilitative treatment services must have
goals and objectives directly related to the IPC.
(C)
Individual rehabilitative
treatment. Services are provided to reduce psychiatric and behavioral
impairment and to restore functioning consistent with the requirements of
independent living and enhanced self-sufficiency. This service includes
educational and supportive services regarding independent living, self-care,
social skills (re)development, lifestyle changes, and recovery principles and
practices. Each individual rehabilitative treatment service provided must have
goals and objectives directly related to the IPC and the member's
diagnosis.
(D)
Recreation
therapy. Services are provided to reduce psychiatric and behavioral
impairment and to restore, remediate, and rehabilitate an individual's level of
functioning and independence in life activities. Services are provided to
promote health and wellness, as well as reduce or eliminate barriers caused by
illness or disabling conditions that limit or restrict a member from
participating in life activities. Recreational therapy can be provided in an
individual or group setting. If the only activities prescribed for the
individual are primarily diversional in nature, (i.e., to provide some social
or recreational outlet for the individual), it will not be regarded as active
treatment. If provided, recreational therapy must be a planned therapeutic
activity, facilitated by a licensed therapeutic recreation
specialist.
(E)
Occupational
therapy. Services are provided to address developmental and/or
functional needs related to the performance of self-help skills, adaptive
behavioral, and/or sensory, motor, and postural development. Services include
therapeutic goal-directed activities and/or exercises used to improve mobility
and ADL functions when such functions have been impaired due to illness or
injury. Services must be provided by an occupational therapist appropriately
licensed in the state in which he or she practices.
(F)
Wellness resource skills
development. Services include providing direction and coordinating
support activities that promote physical health. The focus of these activities
should include areas such as nutrition, exercise, support to avert and manage
physical health concerns like heart disease, diabetes, and cholesterol, and
guidance on the effects that medications have on physical health. Services can
include individual/group support, exercise groups, and individual physical
wellness plan development, implementation, and assistance.
(3)
Modifications to active
treatment. When a member is too physically ill, or his or her acuity
level precludes him or her from active behavioral health treatment,
documentation must demonstrate that alternative clinically-appropriate services
were provided.
(f) Active
treatment components, furnished during a partial treatment week, are provided
as per item (1) through (4) below. A chart outlining active treatment component
requirements and timelines may also be found at www.okhca.org. Assessments/evaluations may serve as
the initial individual or family session if completed by an LBHP or licensure
candidate. Start and stop time must be documented. Active treatment begins the
day of admission. Days noted are calendar days.
(1)
Individual treatment provided by
the physician, APRN or PA.
(A) In
Acute, by day two (2), one (1) visit is required. By day four (4), two (2)
visits are required. By day seven (7), three (3) visits are required.
(B) In Acute II and PRTFs, one (1) visit
during admission week is required. In PRTFs, one (1) visit during the admission
week is required, then once a week thereafter. Individual treatment provided by
the physician, APRN with psychiatric certification or PA will never exceed ten
(10) days between sessions in Acute II and PRTFs, never exceed seven (7) days
in specialty Acute II and specialty PRTFs. The completion of a psychiatric
evaluation or a combined psychiatric evaluation and a history and physical
(H&P) evaluation may count as the first visit if the evaluation was
personally rendered by the psychiatrist, APRN with psychiatric certification or
PA. If the member is admitted on the last day of the admission week, then the
member must be seen by a physician, APRN with psychiatric certification or PA
within sixty (60) hours of admission time.
(2)
Individual therapy.
(A) In Acute, by day three (3), thirty (30)
minutes of treatment are required. By day five (5), one (1) hour of treatment
is required. Beginning on day seven (7), two (2) hours of treatment are
required each week. This does not include admission assessments/evaluations or
psychosocial evaluations unless personally (face to face) rendered by the LBHP
or licensure candidate.
(B) In
Acute II and PRTFs, by day six (6), thirty (30) minutes of treatment must be
documented. Beginning on day seven (7), one (1) hour of treatment is required
each week. The treatment week is defined as Sunday through Saturday. Individual
therapy may not exceed a total of ten (10) days between sessions. This does not
include admission assessment/evaluation or psychosocial evaluations unless
personally (face to face) rendered by the LBHP or licensure
candidate.
(3)
Family therapy.
(A) In Acute, by
day six (6), thirty (30) minutes of treatment must be documented. Beginning on
day seven (7), one (1) hour of treatment is required each week. This does not
include admission assessments/evaluation or psychosocial evaluations unless
personally (face to face) rendered by the LBHP or licensure candidate and the
assessments/evaluation or psychosocial evaluation has not been used to
substitute the initial individual therapy requirement.
(B) In Acute II and PRTFs, by day six (6),
thirty (30) minutes of treatment must be documented. Beginning on day seven
(7), one (1) hour of treatment is required each week. This does not include
admissions assessment/evaluation or psychosocial evaluation unless personally
(face to face) rendered by the LBHP or licensure candidate and the
assessment/evaluation or psychosocial evaluation has not been used to
substitute the initial individual therapy requirement. Family therapy provided
by the LBHP or licensure candidate should not exceed ten (10) days in between
sessions.
(4)
Process group therapy.
(A) In
Acute, by day three (3), one (1) hour of treatment is required. By day five
(5), two (2) hours of treatment are required. Beginning on day seven (7), three
(3) hours of treatment are required each week.
(B) In Acute II and PRTFs, by day five (5),
one (1) hour of treatment is required. Beginning on day seven (7), two (2)
hours of treatment are required each week.
(g) When an individual is determined to be
too ill to participate in treatment, as determined by medical/nursing staff
[registered nurse (RN)/licensed practical nurse (LPN)], documentation must be
in the record clearly indicating the reason, limitations, and timeframe for
those services to be excused without penalty.
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 ; Amended at 30 Ok Reg 1203, eff
7-1-13
