(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.
Added at 38 Ok Reg 428, eff 12-18-20 (emergency)
Added at 38 Ok Reg 1023, eff 9-1-21
Amended at 40 Ok Reg 2236, eff 9-11-23