1. KIDS placement recommendation. The Child Welfare (CW) worker enters a placement recommendation on the KIDS Placement screen and obtains approval from the CW supervisor.
2. Reconsideration request for inpatient treatment procedures are outlined in OAC 340:75-16-30 Instructions to Staff # 3.
3. (a) Reconsideration request for inpatient treatment denial. A request for reconsideration of the decision of the inpatient reviewer is made to APS Healthcare for the child in Oklahoma Department of Human Services custody who is denied continued inpatient mental health treatment or no longer meets medical necessity criteria for inpatient treatment, but the therapist or physician does not agree to the child's discharge. 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 http://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.
(b) Reconsideration request upheld. When APS Healthcare upholds the reconsideration request, the child remains inpatient.
(c) Reconsideration request denied. When APS Healthcare denies the reconsideration request, the CW county of jurisdiction worker requests a court order, with notice to the child's attorney, ordering the child to remain in the specific facility for continued inpatient mental health treatment.
(1) When the court agrees to continued inpatient mental health treatment, the child remains inpatient until the court rules the child no longer requires inpatient treatment. A copy of the court order is faxed to the program staff of Children and Family Services Division Residential and Placement Services.
(2) When the court does not agree to continued inpatient mental health treatment, the CW worker arranges placement, considering the therapist's or physician's recommendation that the child remain in inpatient mental health treatment even though the child no longer meets medical necessity criteria.
(3) 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.