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 317:30-5-753 - Individual plan of care (IPC) requirements
Universal Citation: OK Admin Code 317:30-5-753
Current through Vol. 41, No. 20, July 1, 2024
All behavioral health services in an ITFC setting are provided as a result of an individual assessment of the member's needs and documented in the IPC.
(1) Assessment.
(A)
Definition. Gathering and assessment of historical and current
bio-psychosocial information which includes face-to-face contact with the
member and the member's foster parent(s) or legal guardian or other person,
including biological parent(s) when applicable, who have pertinent information
about the member resulting in a written summary report, diagnosis, and
recommendations. All ITFC agencies must assess each individual to determine
whether they could be an appropriate candidate for ITFC services.
(B)
Qualified professional. This
service is performed by a licensed behavioral health professional (LBHP).
(C)
Limitations.
Assessments are compensable on behalf of a member who is seeking services for
the first time from the ITFC agency. This service is not compensable if the
member has previously received or is currently receiving services from the
agency, unless there has been a gap in service of more than six (6) months and
it has been more than one (1) year since the previous assessment.
(D)
Documentation requirements.
The assessment must include all elements and tools required by the Oklahoma
Health Care Authority (OHCA). In the case of members under the age of eighteen
(18), it is performed with the direct, active, face-to-face participation of
the member and foster parent(s) or legal guardian or other persons, including
biological parent(s) when applicable. The member's level of participation is
based on age, developmental, and clinical appropriateness. The assessment must
include all related diagnoses from the Diagnostic and Statistical Manual of
Mental Disorders (DSM-V). The assessment must contain, but is not limited to,
the following:
(i) Date, including month,
day, and year of the assessment session(s);
(ii) Source of information;
(iii) Member's first name, middle initial,
and last name;
(iv) Gender;
(v) Birth date;
(vi) Home address;
(vii) Telephone number;
(viii) Referral source;
(ix) Reason for referral;
(x) Person to be notified in case of
emergency;
(xi) Presenting reason
for seeking services;
(xii) Start
and stop time for each unit billed;
(xiii) Dated signature of foster parent(s) or
legal guardian [Oklahoma Department of Human Services (OKDHS) or Oklahoma
Office of Juvenile Affairs (OJA)] or other persons, including biological
parent(s) (when applicable) participating in the face-to-face assessment.
Signatures are required for members fourteen (14) years of age and over;
(xiv) Bio-psychosocial
information, which must include:
(I)
Identification of the member's strengths, needs, abilities, and preferences;
(II) History of the presenting
problem;
(III) Previous
psychiatric treatment history, including treatment of psychiatric issues,
substance use, drug and alcohol addiction, and other addictions;
(IV) Health history and current biomedical
conditions and complications;
(V)
Trauma, abuse, neglect, violence, and/or sexual assault history of self and/or
others, including OKDHS involvement;
(VI) Family and social history, including
psychiatric, substance use, drug and alcohol addiction, other addictions, and
trauma/abuse/neglect;
(VII)
Educational attainment, difficulties, and history;
(VIII) Cultural and religious orientation;
(IX) Vocational, occupational, and
military history;
(X) Sexual
history, including human immunodeficiency virus (HIV), acquired immune
deficiency syndrome (AIDS), other sexually transmitted diseases (STDs), and
at-risk behaviors;
(XI) Marital or
significant other relationship history;
(XII) Recreation and leisure history;
(XIII) Legal or criminal record,
including the identification of key contacts (e.g. attorneys, probation
officers);
(XIV) Present living
arrangements;
(XV) Economic
resources; and
(XVI) Current
support system, including peer and other recovery supports.
(xv) Mental status and level of
functioning information, including, but not limited to, questions regarding the
following:
(I) Physical presentation, such as
general appearance, motor activity, attention, and alertness;
(II) Affective process, such as mood, affect,
manner, and attitude;
(III)
Cognitive process, such as intellectual ability, social-adaptive behavior,
thought processes, thought content, and memory; and
(IV) All related diagnoses from the DSM-V.
(xvi) Pharmaceutical
information for both current and past medications, to include the following;
(I) Name of medication;
(II) Strength and dosage of medication;
(III) Length of time on the
medication; and
(IV) Benefit(s)
and side effects of medication.
(xvii) LBHP's interpretation of findings and
diagnosis; and
(xviii) Dated
signature and credentials of the LBHP who performed the face-to-face behavioral
assessment.
(2) IPC requirements.
(A)
Signature requirement. A
written IPC following a comprehensive evaluation for each member must be
formulated by the ITFC agency staff within thirty (30) days of admission to the
program with documented input from the member, the legal guardian (OKDHS/OJA),
the foster parent(s), the treatment provider(s), and the biological parent(s)
when applicable. An IPC is not valid until all dated signatures are present,
including signatures from the member [if fourteen (14) years of age and over],
the legal guardian, the foster parent, and the treatment provider(s). This plan
must be reviewed every thirty (30) days with documented involvement of the
legal guardian and member. The review includes an evaluation of the member's
progress in the treatment setting, as well as in other environments, such as
home, school, social engagements, etc.
(B)
Individualization. The IPC
must be individualized and take into account the member's age, history,
diagnosis, functional levels, culture, and the effect of past and current
traumatic experiences in the life of the member. It includes the member's
documented diagnosis, appropriate goals, corresponding reasonable and
attainable treatment objectives, and action steps within the expected
timelines. Each member's IPC needs to address the ITFC agency's plans with
regard to the provision of services. Each plan of care must clearly identify
the type of services required to meet the member's treatment needs and
frequency over a given period of time.
(C)
Qualified professional. This
service is performed by an LBHP.
(D)
Time requirements. IPC
updates must be conducted face-to-face and are required at least every ninety
(90) days during active treatment. However, updates can be conducted whenever
it is clinically needed, as determined by an LBHP. Updates should reflect
changes to treatment based on the members' progress or lack thereof.
(E)
Documentation requirements.
Comprehensive and integrated service plan content must address the following:
(i) Member strengths, needs, abilities, and
preferences (SNAP);
(ii)
Identified presenting challenges, problems, needs and diagnosis;
(iii) Specific goals for the member;
(iv) Objectives that are specific,
attainable, realistic, and time-limited;
(v) Each type of service and estimated
frequency to be received;
(vi) The
name and credentials of all the practitioners who will be providing and
responsible for each service;
(vii) Any needed referrals for service;
(viii) Specific discharge
criteria; and
(ix) Description of
the member's involvement in, and responses to, the treatment plan, and his/her
signature and date [if fourteen (14) years of age and older].
(F)
Amendments and
updates. Amendment of an existing IPC to revise or add goals,
objectives, service provider(s), service type, and service frequency must be
documented in the existing IPC through an addendum until the review/update is
due. Any changes must, prior to implementation, be signed and dated by the
member [if fourteen (14) years of age and over], the legal guardian, the foster
parent, as well as the primary LBHP and any new provider(s). IPC updates must
address the following:
(i) Update to the
bio-psychosocial assessment, re-evaluation of diagnosis, and IPC goals and/ or
objectives;
(ii) Progress, or lack
of, on previous IPC goals and/or objectives;
(iii) A statement documenting a review of the
current IPC, and, if no changes are needed, an explanation and a statement
addressing the status of identified problem behaviors that led to ITFC
placement must be included;
(iv)
Change in goals and/or objectives (including target dates) based upon member's
progress or identification of new needs, challenges, and problems;
(v) Change in frequency and/or type of
services provided;
(vi) Change in
practitioner(s) who will be responsible for providing services on the plan;
(vii) Change in discharge
criteria; and
(viii) Description
of the member's involvement in, and responses to, the treatment plan, and
his/her signature and date [if fourteen (14) years of age and older].
(3) Description of services. Agency services include:
(A)
Individual, family, and/or group
therapy. See OAC
317:30-5-241.2(a), (b), and
(c). The number of units of individual,
family, and/or group therapy within the ITFC setting differ from the number of
units available in the outpatient setting. A member must receive two (2) hours
of individual, family, and/or group therapy each week that is provided by an
LBHP, and may receive up to three (3) hours each week, if medically needed.
(B)
Crisis
intervention. The provider agency must provide crisis intervention by
ITFC agency staff as needed twenty-four (24) hours per day, seven (7) days per
week. The agency must ensure staff is available to respond to the ITFC foster
parent(s) in a crisis to stabilize a member's behavior and prevent placement
disruption. This service is to be provided to the member by an LBHP.
(C)
Discharge planning. The ITFC
agency must develop a discharge plan for each member. The discharge plan must
be individualized, member-specific, and include an after-care plan that is
appropriate to the member's needs, identifies the member's needs, includes
specific recommendations for follow-up care, and outlines plans that are in
place at the time of discharge. The plan for members in parental custody must
include, when appropriate, reunification plans with the parent(s)/legal
guardian. The plan for members who remain in the custody of OKDHS or OJA must
be developed in collaboration with the case worker and be finalized at the time
of discharge. The discharge plan is to include, at a minimum, recommendations
for continued treatment services, educational services, and other appropriate
community resources. Appointments for outpatient therapy and medication
management (when applicable) should be scheduled prior to discharge. Discharge
planning provides a transition from ITFC placement into a lesser restrictive
setting within the community. Discharge planning is performed in partnership
between Child Welfare Services (CWS) of the Oklahoma Department of Human
Services (OKDHS) and an LBHP within the ITFC agency.
(D)
Substance use/chemical dependency
use therapy. Substance use/chemical dependency therapy can be provided
if a member is identified by diagnosis or documented social history as having
emotional or behavioral problems directly related to substance use and/or
chemical dependency. The modalities employed are provided in order to begin,
maintain, and/or enhance recovery from problem drinking, alcoholism, nicotine
use and addiction, and/or drug use, drug dependency, and/or drug addiction.
This service is provided to the member by an LBHP.
(E)
Substance use rehabilitation
services. Covered substance use rehabilitation services are provided in
non-residential settings in regularly scheduled sessions intended for
individuals not requiring a more intensive level of care or those who require
continuing services following more intensive treatment regimes. The purpose of
substance use rehabilitation services is to begin, maintain, and/or enhance
recovery from problem drinking, alcoholism, nicotine use and addiction, and/or
drug use, drug dependency, and/or drug addiction. Rehabilitation services may
be provided individually or in group sessions, and they take the format of an
agency-approved, curriculum-based education and skills training. This service
is provided to the member by a certified behavioral health case manager (CM)
II, a certified alcohol drug counselor (CADC), or an LBHP.
(F)
Psychosocial rehabilitation
(PSR).
(i)
Definition.
PSR services are face-to-face behavioral health rehabilitation 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, and they take the format of an
agency-approved, curriculum-based education and skills training.
(ii)
Clinical restrictions. This
service is generally performed with only the member and the qualified provider,
but may also include the member's family/support system group that focuses on
the member's diagnosis, symptom management, and recovery-based curriculum. A
member who, at the time of service, is not able to benefit from the treatment
due to active hallucinations and/or substance use, or other impairment, 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 an LBHP.
(iii)
Qualified practitioners. A
CM II or an LBHP may perform PSR, following development of an IPC curriculum.
The CM II must have immediate access to an LBHP who can provide clinical
oversight of the CM II and collaborate with the CM II in the provision of
services. A minimum of one (1) monthly face-to-face consultation with an LBHP
is required.
(iv)
Group
sizes. The maximum staffing ratio is eight (8) members to one (1)
service provider for members under the age of twenty-one (21).
(v)
Limitations.
(I) In order to develop and improve the
member's community and interpersonal functioning and self-care abilities, PSR
services may take place in settings away from the behavioral health agency site
as long as the setting protects and assures confidentiality. When this occurs,
the qualified provider must be present and interacting, teaching, or supporting
the defined learning objectives of the member for the entire claimed time.
(II) PSR services are intended for
members with Serious Emotional Disturbance (SED), and members with severe
behavioral and emotional health needs who may also have a secondary physical,
developmental, intellectual, and/or social disorder that is supported alongside
the mental health needs. Members, ages four (4) and five (5), are not eligible
for PSR services unless a prior authorization has been granted by OHCA or its
designated agent, based on a finding of medical necessity.
(III) PSR services are time-limited services
designed to be provided over the briefest and most effective period possible
and as adjunct (enhancing) interventions to complement more intensive
behavioral health therapies. Service limits are based on the member's needs
according to the Client Assessment Record (CAR) or other approved tools.
Service limitations are designed to maximize efficacy by remaining within
reasonable age and developmentally appropriate daily limits.
(vi)
Progress notes.
In accordance with OAC
317:30-5-241.1,
the behavioral health IPC developed by the LBHP must include the member's
strengths, functional assets, weaknesses or liabilities, treatment goals,
objectives, and methodologies that are specific and time-limited, and defines
the services to be performed by the practitioners and others who comprise the
treatment team. When PSR services are prescribed, the plan must address
objectives that are specific, attainable, realistic, measurable, and
time-limited. The plan must include the appropriate treatment coordination to
achieve the maximum reduction ofthe severe behavioral and emotional health
conditions, and any other secondary physical, developmental, intellectual,
and/or social disorders and to restore the member to his or her best possible
functional level. Progress notes for PSR services must include:
(I) Start and stop times for each day
attended and the physical location in which the service was rendered;
(II) Specific goal(s) and
objectives addressed during the session/group;
(III) Type of skills training provided each
day and/or during the week including the specific curriculum used with the
member;
(IV) Member satisfaction
with staff intervention(s);
(V)
Progress towards attaining, or barriers affecting the attainment of, goals and
objectives;
(VI) New goal(s) or
objective(s) identified;
(VII)
Dated signature of the qualified provider; and
(VIII) Credentials of the qualified provider.
(vii)
Additional
documentation requirements. Documentation of ongoing consultation and/or
collaboration with an LBHP related to the provision of PSR services.
(G)
Therapeutic behavioral
services (TBS). Goal-directed social skills redevelopment activities for
each member to restore, retain, and improve the self-help, communication,
socialization, and adaptive skills necessary to reside successfully in home and
community based settings. These will be daily activities that are age
appropriate, culturally sensitive, and relevant to the goals of the IPC. These
may include self-esteem enhancement, violence alternatives, communication
skills, or other related skill development. This service is to be provided to
the member by the treatment parent specialist (TPS). Services rendered by the
TPS are limited to one and a half (1.5) hours daily.
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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.