OKDHS - OAC 340:75-16-30. Admission to inpatient mental health treatment

340:75-16-30. Admission to inpatient mental health treatment

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Revised 12-1-10

The inpatient reviewer facilitates all inpatient mental health services for children in Oklahoma Department of Human Services (OKDHS) custody prior to admission.

(1) Inpatient review. An inpatient review is required for Title XIX Medicaid reimbursement of acute inpatient mental health treatment and residential mental health treatment for children in OKDHS custody.
- (A) The inpatient reviewer is responsible for:
  - (i) determining whether the child meets medical necessity criteria for inpatient treatment; and • 1
  - (ii) completing the medical necessity review form at APS Healthcare and submitting to the facility.
- (B) The inpatient review is a phone review to determine the level of inpatient mental health treatment needed by the child, based on the medical necessity criteria developed for each level of treatment, acute and residential, per OAC 317:30-5-95.2. • 2
- (2) Authorization and denial. Authorization for the length of services is approved at the time of admission for treatment. When the inpatient reviewer denies inpatient mental health treatment for the child, the Child Welfare (CW) worker may request reconsideration of the decision by the inpatient reviewer.
(3) Admission. • 3 When the inpatient reviewer authorizes inpatient mental health treatment based on the facility assessment, the child is admitted to an inpatient mental health treatment facility on an emergency basis for up to five days from the time of admission, excluding weekends and holidays.
- (A) The CW worker gives notification of the emergency inpatient admission to the child's attorney, court-appointed special advocate (CASA), guardian ad litem, post adjudication review board (PARB), judge, and district attorney no later than the next business day following the child's admission to the facility.
- (B) A mental health evaluation, per Section 5-507 of Title 43A of the Oklahoma Statutes (43A O.S. § 5-507), is:
  - (i) completed by a licensed mental 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 detention order authorizing the child to remain inpatient pending the hearing.
- (A) The hearing is set within one to three judicial days from the filing of the petition.
- (B) The child is detained in the mental health treatment facility no longer than necessary for a hearing on the petition as provided by 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 mental health and substance abuse treatment. When the court:
- (A) finds the child is not a minor in need of mental health and substance abuse treatment, the court dismisses the commitment case;
- (B) finds the child is a minor in need of mental health and substance abuse treatment, but does not require inpatient treatment, the court may order mental health and substance abuse treatment or services through a less restrictive alternative;
- (C) finds the child is a minor in need of mental health and substance abuse treatment and requires inpatient treatment in an inpatient mental health treatment facility, the court orders the commitment of the child to a mental health treatment facility for not more than 30 days; or
- (D) commits a child to a mental health treatment facility for inpatient treatment, the court sets the case for review every 30 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 that 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 a child may be receiving care or treatment.
(7) Individualized treatment plan. An individualized treatment plan is submitted by the facility within ten days after the order authorizing inpatient treatment.
(8) Progress report. The inpatient facility submits a report on progress and recommendations three 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.

INSTRUCTIONS TO STAFF 340:75-16-30

Revised 12-15-11

1. Inpatient review. The Child Welfare (CW) specialist contacts an inpatient reviewer with Optum Health Behavioral Solutions at 1-800-854-0833 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 abuse issues, if any.

2. (a) Acute medical necessity criteria. Medical necessity criteria for admission to acute inpatient mental health treatment, per OAC 317:30-5-95.2 requires that a child:

(1) 13 years of age or older meets the terms and conditions of (2)(A) through (D) and two items in (2)(E)(i) through (iv) and (2)(F)(i) through (iii) of this paragraph; or

(2) 12 years of age or younger meets the terms and conditions of (A) through (D), one item in (E)(i) through (iv), and one item in (F)(i) through (iii).

(A) The child has been diagnosed with any DSM-IV-R Axis I primary diagnosis from the Diagnostic and Statistical Manual of Mental Disorders, 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 attributable to a mental 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.

(C) The inpatient reviewer determines that the current disabling symptoms cannot be managed, or have not been managed, in a less intensive treatment program.

(D) The child is medically stable as determined by a physician.

(E) Within the past 48 hours, the child's behaviors present an imminent life-threatening emergency as evidenced by specifically described:

(i) suicide attempt(s), suicide intent, or serious threat;

(ii) patterns of escalating incidents of self-mutilating behaviors;

(iii) episodes of unprovoked significant physical aggression and patterns of escalating physical aggression in intensity and duration; or

(iv) episodes of incapacitating depression or psychosis that result in an inability to function or care for basic needs.

(F) The child requires secure 24-hour nursing or medical supervision as evidenced by:

(i) stabilization of acute psychiatric symptoms;

(ii) need for extensive treatment under physician direction; or

(iii) 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 317:30-5-95.2 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 has been diagnosed with any DSM-IV-R Axis I primary diagnosis from the Diagnostic and Statistical Manual of Mental Disorders, 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 has either received treatment in an acute care setting, or the inpatient reviewer determines that the current disabling symptoms cannot be managed, or have not been managed in a less intensive treatment program.

(D) The child is medically stable as determined by a physician.

(E) The child demonstrates 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 or RTC mental health treatment facility. The county of jurisdiction CW specialist:

(1) locates a mental health treatment facility with the assistance of the inpatient reviewer;

(2) arranges for admission of the child:

(A) into a mental health treatment facility as available and appropriate for the inpatient treatment needs of the child;

(B) in the closest geographic proximity to the parent's home possible; and

(C) when consistent with the child's treatment needs unless the court specifically orders placement into a certain facility;

(3) calls the facility with clinical information on the child and estimated time of arrival prior to transporting the child;

(4) transports or arranges transportation for the child to the mental health facility or meets the transportation officer at the facility to complete the assessment process by the licensed mental health facility staff for admission;

(5) remains at the facility to provide information for the assessment and awaits the results of the assessment;

(6) participates in admission of the child when admission is approved by the Optim Health reviewer;

(7) ensures that 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, along with Form 04KI009E, Court Report, to the court requesting commitment of the child for inpatient mental health treatment;

(8) notifies the inpatient facility of the date of the commitment order;

(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 days prior to the review hearing;

(10) notifies the parent(s) of the child's admission prior to the admission, when possible, when the child is in Oklahoma Department of Human Services (OKDHS) 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 days the CW specialist provides emergency clothing vouchers to the facility for the child as long as the child remains in inpatient care, per OAC 340:75-13-4;

(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. CW responsibilities while child is inpatient. The involvement of the inpatient reviewer does not diminish the CW specialist's involvement in and responsibility for court hearings, treatment planning, discharge planning, and placement arrangements while the child is temporarily in either acute or RTC mental health care. The CW specialist in the county of jurisdiction of the deprived petition has the primary case responsibility and specific responsibilities to the child, who is in inpatient mental health treatment, including:

(1) requesting the district attorney file a petition when the evaluation indicates the child requires inpatient mental health treatment;

(2) participating in the development of the treatment plan that is prepared by the treating facility; and

(3) ensuring the treatment plan is submitted to the court 24 hours prior to the inpatient mental health adjudicatory hearing;

(4) ensuring the court receives a written report from the facility regarding the child's progress in inpatient mental health treatment and recommendations three days prior to any review hearing;

(5) visiting the child in acute inpatient mental health treatment per OAC 340:75-6-48;

(6) having on-site interaction with the child in residential mental health treatment per OAC 340:75-6-48;

(7) notifying the court when the facility discharges the child without a court order;

(8) transporting or arranging for transportation of the child to the inpatient mental health hearing when the court requests the child to 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 in which 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 back to the out-of-county placement; and

(D) any location to placement when requested by OKDHS for the purpose of ensuring the safekeeping of the child and the OKDHS employee. The CW specialist:

(i) provides the sheriff's office with the mailing address to Children and Family Services Division (CFSD) Community-Based Residential Center (CBRC) programs manager 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 CFSD CBRC programs field representative with all necessary identifying information for reimbursement to the sheriff's office for transportation services;

(9) ensuring appropriate outpatient services are arranged for the child upon the child's discharge from the inpatient mental health treatment facility; and

(10) following procedures for requesting reconsideration of a decision regarding inpatient treatment per OAC 340:75-16-37.

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