340:75-16-30. Admission to inpatient mental health treatment
The Oklahoma Health Care Authority (OHCA) or its designated agent facilitates all inpatient behavioral health treatment for children in Oklahoma Department of Human Services (DHS) custody prior to admission.
(1) Prior authorization.Prior authorization is required for Title XIX Medicaid reimbursement of inpatient behavioral health treatment for children in DHS custody.
(A) OHCA or its designated agent is responsible for determining if the child meets medical necessity criteria for inpatient behavioral health treatment. • 1
(B) prior authorization is a phone review or face-to-face evaluation to determine the level of inpatient behavioral health treatment needed by the child, based on the medical necessity criteria developed for each level of treatment, acute and residential. • 2
(2) Authorization and denial.Authorization for the length of services is approved at the time of admission for treatment.When OHCA or its designated agent denies inpatient behavioral health treatment for the child, the assigned child welfare (CW) specialist may request OHCA reconsideration of the decision.
(3) Admission.When OHCA or its designated agent authorizes inpatient behavioral health treatment based on the facility assessment, the child is admitted to an inpatient behavioral health treatment facility on an emergency basis.
(A) The assigned CW specialist notifies the child's attorney, court-appointed special advocate (CASA), guardian ad litem, post adjudication review board (PARB), judge, and district attorney of the emergency, inpatient admission, no later than the next business day following the child's admission to the facility.
(B) A behavioral health evaluation, per Section 5-507 of Title 43A of the Oklahoma Statutes (43A O.S. § 5-507), is:
(i) completed by a licensed, behavioral health professional at the inpatient facility and a report is provided to the district attorney within 48 hours of admission, excluding weekends and holidays; and
(ii) attached to the petition requesting inpatient treatment. • 3
(4) Petition.After filing the petition, the district attorney obtains a pre-hearing commitment order authorizing the child to remain inpatient pending the hearing.
(A) The hearing is set within one to three judicial days from the petition filing.
(B) The child is detained in the behavioral health treatment facility no longer than necessary for a hearing on the petition per 43A O.S. § 5-510.
(C) The inpatient facility submits a proposed individualized treatment plan to the court 24-hours in advance of the scheduled hearing.
(5) Hearing.At the hearing, the court determines whether by clear and convincing evidence the child is a minor in need of treatment.When the court:
(A) finds the child is not a minor in need of treatment, the court dismisses the commitment case;
(B) finds the child is a minor in need of treatment, but does not require inpatient treatment, the court may order behavioral health treatment or services through a less restrictive alternative;
(C) finds the child is a minor in need of treatment and requires inpatient treatment in an inpatient behavioral health treatment facility, the court orders the commitment of the child to a behavioral health treatment facility for not more than 30-calendar days; or
(D) commits a child to a behavioral health treatment facility for inpatient treatment, the court sets the case for review every 30-calendar days from the date of the commitment hearing provided the child receives inpatient treatment.
(6) Telephonic or teleconference hearing. Per 43A O.S. 5-511, when authorized by the court, any proceeding held pursuant to the Inpatient Mental Health and Substance Abuse Treatment of Minors Act may be conducted via teleconference communication; provided, that when a parent or child appears for a proceeding via teleconference, the attorney representing the parent or child personally appears at the hearing.Teleconference communication means participation in the hearing by interactive telecommunication, including telephonic communication, by the absent party, parties present in court, the attorneys, and other participants deemed necessary to the proceeding including, but not limited to, foster parents and facility staff where the child may be receiving care or treatment.
(7) Individualized treatment plan.Per 43A O.S. § 5-513, an individualized treatment plan is submitted by the facility within 10-calendar days after the order authorizing inpatient treatment.
(8) Progress report.The inpatient facility submits a report on progress and recommendations three-calendar days prior to any review hearing.
(9) Child's rights.The child's rights during the commitment process include:
(A) notice of hearing;
(B) representation by an attorney;
(C) right to a private hearing unless the judge directs otherwise according to the statute;
(D) right to a jury trial; and
INSTRUCTIONS TO STAFF 340:75-16-30
1.Prior authorization.The assigned child welfare (CW) specialist contacts the Oklahoma Health Care Authority (OHCA) at 1-800-522-0114, its designated agent, or the nearest inpatient behavioral health facility, and provides information relevant to the child's treatment history, concerning the child's:
(1) current and specific behaviors, including intensity and frequency;
(2) current mood and affect;
(3) intellectual functioning; and
(4) substance use or abuse issues, when any.
2.(a) Acute medical necessity criteria.Medical necessity criteria for admission to acute inpatient behavioral health treatment, per Oklahoma Administrative Code (OAC) 317:30-5-95.25 requires that a child meets the terms and conditions of (1) through (4) and two items in (5)(A) through (D) and(6)(A) through (C)of this paragraph:
(1) The child was diagnosed with an Axis I primary diagnosis from the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), except V-Codes, adjustment disorders, and substance-related disorders, accompanied by a detailed description of the symptoms supporting the diagnosis.
(2) Conditions are directly attributable to a behavioral health disorder as the primary need for professional attention.This does not include placement issues, criminal behavior, or status offenses.Adjustment or substance-related disorders may be a secondary Axis I diagnosis.
(3) OHCA or its designated agent determines that the current disabling symptoms could not be managed, or were not manageable in a less intensive treatment program.
(4) The child is medically stable.
(5) Within the past 48 hours, the child's behaviors present an imminent life-threatening emergency as evidenced by specifically described:
(A) suicide attempt(s), suicide intent, or serious threat;
(B) patterns of escalating incidents of self-mutilating behaviors;
(C) episodes of unprovoked, significant, physical aggression and patterns of escalating physical aggression in intensity and duration; or
(D) episodes of incapacitating depression or psychosis that result in an inability to function or care for basic needs.
(6) The child requires secure 24-hour nursing or medical supervision as evidenced by:
(A) stabilization of acute psychiatric symptoms;
(B) need for extensive treatment under physician direction; or
(C) physiological evidence or expectation of withdrawal symptoms that require 24-hour medical supervision.
(b) Residential treatment centers (RTC) medical necessity criteria.Medical necessity criteria for admission to RTC, per OAC 317:30-5-95.29 requires that a child meet the terms and conditions of:
(1) Subparagraph (A) through (D) of paragraph (2); and
(2) one item in (E)(i) through (iv) and one item in (F)(i) through (iii) of this paragraph.
(A) The child was diagnosed with a primary diagnosis from the most recent edition of the DSM, except V-Codes, adjustment disorders, and substance related disorders, accompanied by a detailed description of the symptoms supporting the diagnosis.
(B) The child's conditions are directly attributed to a mental disorder as the primary reason for professional attention.This does not include placement issues, criminal behavior, or status offenses.
(C) The child either received treatment in an acute care setting, or OHCA or its designated agent determines the current disabling symptoms could not be managed or were not manageable in a less intensive treatment program.
(D) The child is medically stable.
(E) Within the past 14-calendar days, the child demonstrated an escalating pattern of self-injurious or assaultive behaviors as evidenced by:
(i) suicidal ideation, threat, or both;
(ii) history of or current self-injurious behavior;
(iii) serious threats or evidence of physical aggression; or
(iv) current incapacitating psychosis or depression.
(F) The child requires 24-hour observation and treatment as evidenced by intensive:
(i) behavioral management;
(ii) treatment with the family or guardian, and child in a structured environment; or
(iii) treatment in preparation for re-entry into the community.
3.Admission to acute care or RTC inpatient behavioral health facility.The assigned CW specialist:
(1) locates an inpatient psychiatric service facility with the assistance of OHCA or its designated reviewer;
(2) arranges for the child's admission:
(A) into an inpatient behavioral health facility as available and appropriate for the child's inpatient treatment needs;
(B) in the closest possible geographic proximity to the child's home; and
(C) when consistent with the child's treatment needs;
(3) calls the facility with clinical information about the child and estimated time of arrival, prior to transporting the child;
(4) transports or arranges transportation for the child to the inpatient behavioral health facility or meets the transportation officer at the facility to complete the assessment process for admission;
(5) remains at the facility to provide information for the assessment and awaits the assessment results;
(6) participates in the child's admission when admission is approved by OHCA or its designated agent;
(7) ensures the inpatient facility's licensed, mental health professional's evaluation report is submitted to the district attorney within 48 hours of the child's admission, excluding weekends and holidays, to the court requesting the child's commitment for inpatient behavioral health treatment;
(8) notifies the inpatient facility of the date of the commitment order and the adjudicatory hearing;
(9) notifies the inpatient facility of the date of the review hearing to allow preparation time for the facility's submission of the report three-business days prior to the review hearing;
(10) notifies the parent(s) of the child's admission prior to admission when possible, when the child is in Oklahoma Department of Human Services (DHS) emergency or temporary custody or within 24 hours of admission when the parent cannot be located prior to the child's admission;
(11) ensures the child has adequate clothing at the time of admission.When the child does not have adequate clothing, an emergency clothing voucher is obtained within 24 hours of admission, excluding weekends and holidays.Every 90-calendar days, the assigned CW specialist provides emergency clothing vouchers to the facility for the child as long as the child remains in the inpatient facility, per OAC 340:75-13-45;
(12) contacts the CW facility liaison within 24 hours after admission to advise of the child's admission;
(13) begins the discharge planning process at the time of admission;
(14) immediately consults the CW supervisor to determine the most appropriate placement when admission is not approved for acute or RTC; and
(15) secures outpatient, behavioral health services for the child at the earliest opportunity, but no later than the next business day.
4.The assigned CW specialist responsibilities while child is inpatient.The involvement of OHCA or its designated agent does not diminish the assigned CW specialist's involvement in and responsibility for court hearings, treatment planning, discharge planning, and placement arrangements while the child is temporarily in either an acute or RTC inpatient behavioral health facility.The assigned CW specialist has case responsibility and specific responsibilities to the child, who is in an inpatient behavioral health facility, including:
(1) requesting the district attorney file a petition when the evaluation indicates the child requires inpatient behavioral health services;
(2) participating in the development of the individual plan of care that is prepared by the treating facility; and
(3) ensuring the individual plan of care is submitted to the court 24 hours prior to the inpatient behavioral health service adjudicatory hearing;
(4) ensuring the court receives a written report from the facility regarding the child's progress in inpatient behavioral health services and recommendations three-business days prior to any review hearing;
(5) visiting the child in inpatient and RTC behavioral health services per OAC 340:75-6-48;
(6) approving any leave or visitation for the child;
(7) facilitating the assignment of an active Medicaid number when the child does not have a number assigned at the time of admission;
(8) ensuring the CW facility liaison is timely informed of upcoming court dates;
(9) having on-site interaction with the child in residential, behavioral health services per OAC 340:75-6-48;
(10) notifying the court when the facility discharges the child without a court order;
(11) transporting or arranging for transportation of the child to the inpatient mental health hearing when the court requests the child be present.When the child requires transportation by law enforcement officials, transportation is arranged by the county of jurisdiction or the county of placement sheriff's office.The court may issue an order, per Section 1-8-107 of Title 10A of the Oklahoma Statutes, directing the county sheriff or designee, of the county where the court is located to provide transportation for a child who is the subject of a deprived proceeding, regardless of where the child is placed within the state, for the purposes of transferring the child from:
(A) his or her current placement to a designated inpatient treatment facility;
(B) the inpatient facility to a court hearing;
(C) an out-of-county placement to court for hearing and returning the child to the out-of-county placement; and
(D) any location to placement when requested by DHS for the purpose of ensuring the safekeeping of the child and the DHS employee.The assigned CW specialist:
(i) provides the sheriff's office with the mailing address to Child Welfare Services (CWS) Specialized Placements and Partnerships Unit (SPPU) administration to file the claim for mileage, meals, and hourly wage when the sheriff's staff transports the child to inpatient care; and
(ii) submits Form 23CO106E, Authority to Purchase, to the CWS SPPU administration with all necessary identifying information for reimbursement to the sheriff's office for transportation services;
(12) ensuring appropriate outpatient services are arranged for the child upon the child's discharge from the inpatient behavioral health treatment facility; and
(13) following procedures for requesting reconsideration of a decision regarding inpatient treatment per OAC 340:75-16-37.