Inpatient Psychiatric and Substance Use Disorder Services | Midpage

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Oklahoma Administrative Code

Part 6

Inpatient Psychiatric and Substance Use Disorder Services

Oklahoma Health Care Authority

317:30-5-94Definitions 317:30-5-95General provisions and eligible providers 317:30-5-95.1Medical necessity criteria and coverage for adults aged twenty-one (21) to sixty-four (64)317:30-5-95.4Individual plan of care for adults aged twenty-one (21) to sixty-four (64)317:30-5-95.5Physician review of prescribed medications for adults age 21 to 64 317:30-5-95.6Medical, psychiatric, and social evaluations for adults aged twenty-one (21) to sixty-four (64)317:30-5-95.7Active treatment for adults age 21 to 64 317:30-5-95.8Nursing services for adults age 21 to 64 317:30-5-95.9Therapeutic services for adults aged 21 to 64 317:30-5-95.10Discharge plan for adults aged twenty-one (21) to sixty-four (64)317:30-5-95.11Inpatient acute psychiatric services for persons sixty-five (65) years of age or older 317:30-5-95.12Utilization control requirements for inpatient acute psychiatric services for persons sixty-five (65) years of age or older 317:30-5-95.13Certification and recertification of need for inpatient care for inpatient acute psychiatric services for persons sixty-five (65) years of age or older 317:30-5-95.14Individual plan of care for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services 317:30-5-95.15Physician review of prescribed medications for persons over 65 years of age receiving inpatient acute psychiatric services 317:30-5-95.16Medical psychiatric and social evaluations for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services 317:30-5-95.17Active treatment for persons over 65 years of age receiving inpatient acute psychiatric services 317:30-5-95.18Nursing services for persons over 65 years of age receiving inpatient acute psychiatric services 317:30-5-95.19Therapeutic services for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services 317:30-5-95.20Discharge plan for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services 317:30-5-95.21Continued stay review for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services 317:30-5-95.22Coverage for children 317:30-5-95.23Individuals age 21 317:30-5-95.24Prior authorization of inpatient psychiatric services for individuals under twenty-one (21)317:30-5-95.25Medical necessity criteria for acute psychiatric admissions for children 317:30-5-95.26Medical necessity criteria for continued stay - acute psychiatric admission for children 317:30-5-95.27Medical necessity criteria for admission - inpatient chemical dependency detoxification for children 317:30-5-95.28Medical necessity criteria for continued stay - inpatient chemical dependency detoxification program for children 317:30-5-95.29Medical necessity criteria Acute II and PRTF admissions for children 317:30-5-95.30Medical necessity criteria for Acute II and PRTF continued stay for children 317:30-5-95.31Prior authorization and extension procedures for children 317:30-5-95.32Quality of care requirements for children 317:30-5-95.33Individual plan of care for children 317:30-5-95.34Active treatment for children 317:30-5-95.35Certificate of need requirements for children in psychiatric hospitals and PRTFs 317:30-5-95.36Treatment team for inpatient children's services 317:30-5-95.37Medical, psychiatric, and social evaluations for inpatient services for children 317:30-5-95.38Nursing services for children 317:30-5-95.39Restraint, seclusion, and serious occurrence reporting requirements for members under the age of twenty-one (21)317:30-5-95.40Other required standards 317:30-5-95.41Documentation of records for children receiving inpatient services 317:30-5-95.42Service quality review (SQR) of psychiatric facilities and residential substance use disorder (SUD) facilities 317:30-5-95.43Residential substance use disorder treatment 317:30-5-95.44Residential substance use disorder (SUD) - Eligible providers and requirements 317:30-5-95.45Residential substance use disorder (SUD) - Coverage by category 317:30-5-95.46Residential substance use disorder (SUD) - Covered services and medical necessity criteria 317:30-5-95.47Residential substance use disorder (SUD) - Individualized service plan requirements 317:30-5-95.48Staff training 317:30-5-95.49Medication policies and records 317:30-5-95.50Residential substance use disorder (SUD) - Reimbursement 317:30-5-95.51Residential substance use disorder (SUD) - reporting of suspected child abuse/neglect 317:30-5-95.52Documentation of records for adults receiving inpatient services 317:30-5-96.2Payments definitions 317:30-5-96.3Methods of payment 317:30-5-96.4Outlier intensity adjustment 317:30-5-96.5Disproportionate share hospitals (DSH)317:30-5-96.6Payment for Medicare/Medicaid dual eligible individuals 317:30-5-96.7Cost reports 317:30-5-96.8Psychiatric Residential Treatment Facility payments to subcontractors 317:30-5-97Reporting abuse and/or neglect