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

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

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Revised 6-1-07

The APS Healthcare inpatient reviewer facilitates all inpatient mental health services for children in the custody of the Oklahoma Department of Human Services (OKDHS) 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. If the inpatient reviewer denies inpatient mental health treatment for the child, the Child Welfare (CW) worker may request reconsideration of the decision by APS Healthcare. • 3
(3) Admission. When APS Healthcare 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. • 4
- (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, is:
  - (i) completed by a licensed mental health professional at the inpatient facility and a report provided to the district attorney within 48 hours of admission, excluding weekends and holidays; and
  - (ii) attached to the petition requesting inpatient treatment. • 5
(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 for no longer than necessary for a hearing on the petition as provided by Section 5-510 of Title 43A of the Oklahoma Statutes.
- (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) Individualized treatment plan. An individualized treatment plan is submitted by the facility within ten days after the order authorizing inpatient treatment. • 6
(7) Progress report. The inpatient facility submits a report on progress and recommendations three days prior to any review hearing. • 7
(8) 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 6-1-07

1. The Child Welfare (CW) worker contacts an inpatient reviewer with APS Healthcare at 1-800-762-1560 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, as defined in OAC 317:30-5-95.2, require 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); 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) RTC medical necessity criteria. Medical necessity criteria for admission to residential treatment centers (RTC), as defined in OAC 317:30-5-95.2, require that a child meets the terms and conditions of:

(1) (2)(A) through (D); and

(2) one item in (E)(i) through (iv) and one item in (F)(i) through (iii).

(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 milieu; or

(iii) treatment in preparation for re-entry into the community.

3. Reconsideration request for inpatient treatment denial. The CW worker initiates a reconsideration request when the inpatient reviewer makes a treatment decision based on incomplete data, and the CW worker or the inpatient facility staff has additional information that may warrant an admission or continued admission to an inpatient treatment facility.

(1) The CW worker refers to the Inpatient Procedures Manual for Children's Psychiatric Services that is located on the Internet at www.soonerpro.com and submits a request for reconsideration to APS Healthcare within ten working days of notification of denial.

(2) Additional clinical documentation and other supporting data are attached to the reconsideration request form and a copy of the reconsideration request is faxed to the inpatient reviewer.

(3) Within five working days of the receipt of the written reconsideration request, the materials are reviewed by APS Healthcare for approval or denial. The results of the review of the reconsideration request are sent to the person who requested the reconsideration of the decision.

(4) When the denial is upheld, the denial may be appealed to the Oklahoma Health Care Authority (OHCA) within 20 working days of notification of the denial by APS Healthcare. OHCA has the final authority on the decision.

4. Admission to mental health treatment facility.

(1) Locating a mental health treatment facility. The CW worker makes arrangements for admission of the child into a mental health treatment facility appropriate for the inpatient treatment needs of the child in close geographic proximity to the parent(s)' home, unless the court specifically orders placement into a certain hospital.

(2) Parental notification. The CW worker notifies the parent(s) of the child's admission prior to the admission, if possible, when the child is in emergency or temporary Oklahoma Department of Human Services (OKDHS) custody. When the CW worker is unable to locate the parent(s) prior to admission, the CW worker ensures the parent(s) is notified within 24 hours of the child's admission.

(3) Facility liaison contact. The CW worker contacts the CW facility liaison within 24 hours after admission to advise of the child's admission. Discharge planning begins at the time of admission. The CW county of jurisdiction worker on the deprived case has the primary case responsibility.

5. Mental health evaluation report. The CW worker 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 04KI010E, Court Report, to the court requesting commitment of the child for inpatient mental health treatment.

6. Notification of commitment order. The CW worker immediately notifies the inpatient facility of the date of the commitment order.

7. Notification of review hearing. The CW worker immediately 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.

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