Oklahoma Administrative Code
Title 317 - Oklahoma Health Care Authority
Chapter 30 - Medical Providers-Fee for Service
Subchapter 5 - Individual Providers and Specialties
Part 84 - INTENSIVE TREATMENT FAMILY CARE
Section 317:30-5-751 - Coverage by category
Current through Vol. 41, No. 20, July 1, 2024
(a) Adults. Behavioral health services in ITFC settings are not covered for adults.
(b) Children. Behavioral health services are allowed in ITFC settings for children under twenty-one (21) as medically necessary. Members receiving services in this setting have severe behavioral and emotional health needs and may also present a secondary physical, developmental, intellectual, and/or social disorder that is supported alongside the mental health needs. ITFC homes provide the higher level of care needed for these children and help prevent placement in an inpatient or more restrictive setting. The designated members must continually meet medical necessity criteria to be eligible for coverage in this setting. Requests for behavioral health services in an ITFC setting must be prior authorized and may be approved up to a maximum of three (3) month extensions.
(c) Medical necessity criteria. In order to satisfy medical necessity criteria, all of the following conditions must be met: