Okla. Admin. Code § 317:30-5-95.26
Medical necessity criteria for continued stay - acute psychiatric admission for children
Effective Sep 1, 201734 Ok Reg 714Added at 23 Ok Reg 2508, eff 6-25-06; Amended at 27 Ok Reg 2737, eff 7-20-10 (emergency); Amended at 28 Ok Reg 1452, eff 6-25-11; Amended at 29 Ok Reg 413, eff 3-7-12 (emergency); Amended at 29 Ok Reg 1125, eff 6-25-12; Amended at 33 Ok Reg 885, eff 9-1-16; Amended at 34 Ok Reg 714, eff 9-1-17Oklahoma Health Care Authority
For continued stay acute psychiatric admissions for children must meet all of the conditions set forth in (1) to (5) of this subsection.
- (1) A primary diagnosis from the most recent edition of "The Diagnostic and Statistical Manual of Mental Disorders" (DSM) with the exception of V-Codes, adjustment disorders, and substance abuse related disorders, accompanied by a detailed description of the symptoms supporting the diagnosis. In lieu of a qualifying diagnosis, children 18-20 years of age may have a diagnosis of any personality disorder. Adjustment or substance related disorders may be a secondary diagnosis.
(2) Patient continues to manifest a severity of illness that requires an acute level of care as defined in the admission criteria and which could not be provided in a less restrictive setting.
- (A) Documentation of regression is measured in behavioral terms.
- (B) If condition is unchanged, evidence of re-evaluation of treatment objectives and therapeutic interventions.
- (3) Conditions are directly attributable to a mental disorder as the primary need for professional attention (this does not include placement issues, criminal behavior, status offenses).
- (4) Documented efforts of working with the child's family, legal guardians and/or custodians and other human service agencies toward a tentative discharge date.
(5) Requires secure 24-hour nursing/medical supervision as evidenced by:
- (A) Stabilization of acute psychiatric symptoms;
- (B) Need for extensive treatment under the direction of a physician; and
- (C) Physiological evidence or expectation of withdrawal symptoms which require 24-hour medical supervision.
Added at 23 Ok Reg 2508, eff 6-25-06
Amended at 27 Ok Reg 2737, eff 7-20-10 (emergency)
Amended at 28 Ok Reg 1452, eff 6-25-11
Amended at 29 Ok Reg 413, eff 3-7-12 (emergency)
Amended at 29 Ok Reg 1125, eff 6-25-12
Amended at 33 Ok Reg 885, eff 9-1-16
Amended at 34 Ok Reg 714, eff 9-1-17