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OHCA Policies and Rules

 

Section 94 Definitions
Section 95 General provisions and eligible providers
Section 95.1 Medical necessity criteria and coverage for adults aged twenty-one (21) to sixty-four (64)
Section 95.2 Coverage for children [REVOKED]
Section 95.3 Medicare eligible individuals [REVOKED]
Section 95.4 Individual plan of care for adults aged twenty-one (21) to sixty-four (64)
Section 95.5 Physician review of prescribed medications for adults age 21 to 64
Section 95.6 Medical, psychiatric, and social evaluations for adults aged twenty-one (21) to sixty-four (64)
Section 95.7 Active treatment for adults age 21 to 64
Section 95.8 Nursing services for adults age 21 to 64
Section 95.9 Therapeutic services for adults aged 21 to 64
Section 95.10 Discharge plan for adults aged twenty-one (21) to sixty-four (64)
Section 95.11 Inpatient acute psychiatric services for persons sixty-five (65) years of age or older
Section 95.12 Utilization control requirements for inpatient acute psychiatric services for persons sixty-five (65) years of age or older
Section 95.13 Certification and recertification of need for inpatient care for inpatient acute psychiatric services for persons sixty-five (65) years of age or older
Section 95.14 Individual plan of care for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services
Section 95.15 Physician review of prescribed medications for persons over 65 years of age receiving inpatient acute psychiatric services
Section 95.16 Medical psychiatric and social evaluations for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services
Section 95.17 Active treatment for persons over 65 years of age receiving inpatient acute psychiatric services
Section 95.18 Nursing services for persons over 65 years of age receiving inpatient acute psychiatric services
Section 95.19 Therapeutic services for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services
Section 95.20 Discharge plan for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services
Section 95.21 Continued stay review for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services
Section 95.22 Coverage for children
Section 95.23 Individuals age 21
Section 95.24 Prior authorization of inpatient psychiatric services for individuals under twenty-one (21)
Section 95.25 Medical necessity criteria for acute psychiatric admissions for children
Section 95.26 Medical necessity criteria for continued stay - acute psychiatric admission for children
Section 95.27 Medical necessity criteria for admission - inpatient chemical dependency detoxification for children
Section 95.28 Medical necessity criteria for continued stay - inpatient chemical dependency detoxification program for children
Section 95.29 Medical necessity criteria Acute II and PRTF admissions for children
Section 95.30 Medical necessity criteria for Acute II and PRTF continued stay for children
Section 95.31 Prior authorization and extension procedures for children
Section 95.32 Quality of care requirements for children
Section 95.33 Individual plan of care for children
Section 95.34 Active treatment for children
Section 95.35 Certificate of need requirements for children in psychiatric hospitals and PRTFs
Section 95.36 Treatment team for inpatient children's services
Section 95.37 Medical, psychiatric and social evaluations for inpatient services for children
Section 95.38 Nursing services for children
Section 95.39 Restraint, seclusion, and serious occurrence reporting requirements for members under the age of twenty-one (21)
Section 95.40 Other required standards
Section 95.41 Documentation of records for children receiving inpatient services
Section 95.42 Service quality review (SQR) of psychiatric facilities
Section 95.43 Residential substance use disorder treatment
Section 95.44 Residential substance use disorder - Eligible providers and requirements
Section 95.45 Residential substance use disorder - Coverage by category
Section 95.46 Residential substance use disorder - Covered services and medical necessity criteria
Section 95.47 Residential substance use disorder - Individualized service plan requirements
Section 95.48 Staff training
Section 95.49 Residential substance use disorder – Reimbursement
Section 96 Reimbursement for inpatient services [REVOKED]
Section 96.1 Cost reports [REVOKED]
Section 96.2 Payments definitions
Section 96.3 Methods of payment
Section 96.4 Outlier intensity adjustment
Section 96.5 Disproportionate share hospitals (DSH)
Section 96.6 Payment for Medicare/Medicaid dual eligible individuals
Section 96.7 Cost reports
Section 96.8 Psychiatric Residential Treatment Facility payments to subcontractors
Section 97 Reporting abuse and/or neglect
Section 98 Claim Form [REVOKED]

 

 

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.

 

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