Okla. Admin. Code § 340:75-16-30

Current through Vol. 42, No. 7, December 16, 2024

Section 340:75-16-30 - Admission to inpatient behavioral 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.

(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)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.

(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, anindividualized 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

(E) right to cross examine.

Okla. Admin. Code § 340:75-16-30

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 28 Ok Reg 375, eff 12-1-10 (emergency); Amended at 28 Ok Reg 894, eff 7-1-11; Amended at 29 Ok Reg 635, eff 6-1-12

Amended by Oklahoma Register, Volume 33, Issue 24, September 1, 2016, eff. 9/15/2016