Oklahoma Administrative Code
Title 317 - Oklahoma Health Care Authority
Chapter 30 - Medical Providers-Fee for Service
Subchapter 5 - Individual Providers and Specialties
Part 6 - INPATIENT PSYCHIATRIC AND SUBSTANCE USE DISORDER SERVICES
Section 317:30-5-95.45 - Residential substance use disorder (SUD) - Coverage by category
Universal Citation: OK Admin Code 317:30-5-95.45
Current through Vol. 42, No. 1, September 16, 2024
(a) Adults. Members age twenty-one (21) to sixty-four (64) who meet eligibility and clinical criteria may receive medically necessary residential treatment for SUD.
(1) The member must meet
residential level of care as determined through completion of the designated
ASAM placement tool no more than seven (7) days prior to a SUD admission and/or
extension request and as required in the Oklahoma Department of Mental Health
and Substance Abuse Services (ODMHSAS) Prior Authorization Manual.
(2) Each presenting member for SUD treatment
shall be assessed, according to ASAM criteria, which includes a list of
symptoms for all six (6) dimensions and each level of care to determine a
clinically appropriate placement in the least restrictive level of
care.
(b) Children. Children are covered according to their age group as described in OAC 317:30-5-95.46 and 317:30-5-95.47 and as specified by ODMHSAS.
(c) Individuals with dependent children. Coverage for individuals with dependent children is the same as adults and/or children.
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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