Library: Policy

317:30-5-95.45. Residential substance use disorder (SUD) - Coverage by category

Revised 9-1-21

(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 level of care tool 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. Coverage for children is the same as adults.

(c) Individuals with dependent children. Coverage for individuals with dependent children is the same as adults and/or children.