The following words and terms, when used in this Subchapter, shall have the following meanings unless the context clearly indicates otherwise:

"Acute psychiatric care"per Oklahoma Administrative Code 317:30-5-95.22 means care that provides inpatient behavioral health treatment including assessment, medical management, and monitoring to children requiring short-term, intensive treatment and stabilization. Acute psychiatric care:

1. (A) is delivered in a psychiatric unit of a general hospital or a free-standing psychiatric hospital;
2. (B) is secure; and

3. (C) may use:

   1. (i) physical or drug restraint ordered by a physician, in conjunction with treatment modalities; and
   2. (ii) seclusion.

"Age-appropriate" or "developmentally-appropriate" per Section 1-1-105 of Title 10A of the Oklahoma Statutes (10A O.S. § 1-1-105) means:

1. (A) activities or items that are generally accepted as suitable for children of the same age or level of maturity or that are determined to be developmentally-appropriate for a child, based on the development of cognitive, emotional, physical, and behavioral capacities that are typical for an age or age group; and
2. (B) in the case of a specific child, activities or items that are suitable for that child based on the developmental stages attained by the child with respect to the cognitive, emotional, physical, and behavioral capacities of the specific child.

"Behavioral health" means mental health, substance use or abuse, or co-occurring mental health and substance use or abuse diagnoses, and the continuum of mental health, substance use or abuse, or co-occurring mental health and substance use or abuse treatment.

"Corrective action plan (CAP)" means steps, actions, or strategies taken to correct or address behaviors or conditions associated with abuse, neglect, or areas of concern related to an individual employee of a facility.

"Designated agent" means the entity contracted with the Oklahoma Health Care Authority (OHCA) to provide certain services to meet federal and state statutory obligations of the OHCA.

"Facility" means a place, an institution, a building or part thereof, a set of buildings, or an area whether or not enclosing a building or set of buildings used for the lawful custody and treatment of children.

"Facility action step (FAS)" means all actions, steps, or strategies to correct or address areas of concern identified within a facility including, but not limited to, the culture of care, services, or contract compliance.

"Facility services plan (FSP)" means a yearly, progressive document specific to each facility identifying issues that impact child safety within the facility's culture of care including, but not limited to, hiring, training, supervision, services, or contract compliance. The FSP includes all CAPs and FASs related to the specific facility.

"Institution" means a residential facility offering care and treatment for more than 20 residents.

"Medical necessity review" means an assessment of current and recent behaviors and symptoms to determine whether an admission for inpatient behavioral health or drug or alcohol dependence treatment constitutes the least restrictive level of care necessary. The review is performed by a licensed behavioral health professional.

"Minor" means any unmarried person younger than 18 years of age.

"Minor in need of treatment" means a person younger than 18 years of age who is in need of treatment, per 43A O.S. § 5-502, and who:

1. (A) has a demonstrable mental illness or who is drug or alcohol dependent and as a result of that mental illness or dependency is expected within the near future to inflict or attempt to inflict serious bodily harm to himself or herself or another person and engaged in one or more recent overt acts or made significant recent threats that substantially support that expectation; or

2. (B) has a demonstrable mental illness or is drug or alcohol dependent of sufficient severity to cause substantial impairment or disability in at least two of the major areas of functioning in the minor's:

   1. (i) family relations;
   2. (ii) school performance;
   3. (iii) social interactions;
   4. (iv) ability to perform independently the basic tasks of personal hygiene, hydration and nutrition; or
   5. (v) self-protection. A determination regarding the ability of the minor to perform independently, such tasks is based upon the age of the minor and the reasonable and appropriate expectation of the minor's ability to perform such tasks.

"Normalcy" means the emotional developmental growth of the child is encouraged by allowing the child to participate in age-appropriate and developmentally-appropriate extracurricular, enrichment, cultural, and social activities using a reasonable and prudent parent standard.

"Notice to comply" means a formal written notice sent to a facility to indicate a CAP or FAS was not completed within agreed upon timeframes.

"Oklahoma Health Care Authority (OHCA)" means the state agency that administers medical programs reimbursed by the Title XIX Medicaid program; and is responsible for the establishment of medical necessity criteria and prior and continued authorization that determine whether an inpatient psychiatric service facility is reimbursed by Title XIX Medicaid.

"Plan for immediate safety" means actions taken to immediately control any significant and clearly observable condition that is present and endangering or threatening to endanger a child in a residential facility.

"Prior-authorization" means pre-approval by OCHA or its designated agent for inpatient behavioral health treatment for a child in Oklahoma Department of Human Services custody for an approved length of stay.

"Reasonable and prudent parent standard" means the standard characterized by careful and sensible parental decisions that maintain the health, safety, and best interests of a child while at the same time encouraging the emotional and developmental growth of the child. This standard is used by the child's caregiver when determining whether to allow a child to participate in extracurricular, enrichment, cultural, and social activities, per 10A O.S. § 1-1-105.

1. (A) For purposes of this definition, the term "caregiver" means a foster parent with whom a child in foster care has been placed, a representative of a group home where a child has been placed, or a designated official for a residential child care facility where a child in foster care has been placed.
2. (B) Each facility must assure that at least one employee is designated and authorized to apply the reasonable and prudent parent standard to decisions involving the participation of a child in age-appropriate or developmentally-appropriate activities. The authorized facility employee is provided with training on how to use and apply the reasonable and prudent parent standard.

"Residential child care facility" means a 24-hour residential facility where children live together with or are supervised by adults who are not their parents or relatives.

"Residential treatment center (RTC)" means a facility that provides residential behavioral health treatment to children who need longer term, more intensive treatment, and a more highly structured environment than is available in a family environment or other community-based alternatives. The RTC:

1. (A) may be located in a hospital or non-hospital setting;
2. (B) must provide adequate supervision for residents because the RTC is not a secure facility; and

3. (C) may use:

   1. (i) physical or drug restraint ordered by a physician, in conjunction with treatment modalities; and
   2. (ii) seclusion.

"Restraint" means a physical method or drug used to manage the child's behavior or restrict the child's freedom of movement and is not the standard treatment or dosage for the child's condition per OAC 317:30-5-95.

"Seclusion" means the involuntary confinement of a child alone in a room or area from which leaving is prevented and may only be used for management of behavior that jeopardizes the immediate safety of the child or others per OAC 317:30-5-95.

"Written plan of compliance" means the formal accountability process for facilities that when not adhered to within 30-calendar days, results in adverse contract actions.

Added at 19 Ok Reg 2208, eff 6-27-02

Amended at 20 Ok Reg 2643, eff 7-1-03 (emergency)

Amended at 21 Ok Reg 246, eff 11-7-03 (emergency)

Amended at 21 Ok Reg 880, eff 4-26-04

Amended at 24 Ok Reg 1044, eff 6-1-07

Amended at 27 Ok Reg 1092, eff 3-26-10 (emergency)

Amended at 27 Ok Reg 1865, eff 7-1-10

Amended at 33 Ok Reg 477, eff 2-29-16 (emergency)

Amended at 34 Ok Reg 1550, eff 9-15-17