Okla. Admin. Code § 317:30-5-241.2 - Psychotherapy
(a)
Individual psychotherapy.
(1)
Definition. Psychotherapy is a treatment for mental illnesses and
behavioral disturbances, in which the clinician, through definitive therapeutic
communication, attempts to alleviate the emotional disturbances, reverse, or
change maladaptive patterns of behavior, and encourage growth and development.
Insight oriented, behavior modifying and/or supportive psychotherapy refers to
the development of insight of affective understanding, the use of behavior
modification techniques, the use of supportive interactions, the use of
cognitive discussion of reality, or any combination of these items to provide
therapeutic change. Ongoing assessment of the member's status and response to
treatment as well as psycho-educational intervention are appropriate components
of individual therapy. The therapy must be goal directed, utilizing techniques
appropriate to the service plan and the member's developmental and cognitive
abilities.
(2)
Interactive
complexity. Psychotherapy is considered to involve "interactive
complexity" when there are communication factors during a visit that complicate
delivery of the psychotherapy by the qualified practitioner. Sessions typically
involve members who have other individuals legally responsible for their care
(i.e., minors or adults with guardians); members who request others to be
involved in their care during the session (i.e., adults accompanied by one or
more participating family members or interpreter or language translator); or
members that require involvement of other third parties (i.e., child welfare,
juvenile justice, parole/probation officers, schools, etc.). Psychotherapy
should only be reported as involving interactive complexity when at least one
(1) of the following communication factors is present:
(A) The need to manage maladaptive
communication (i.e., related to high anxiety, high reactivity, repeated
questions, or disagreement) among participants that complicate delivery of
care.
(B) Caregiver
emotions/behavior that interfere with implementation of the service
plan.
(C) Evidence/disclosure of a
sentinel event and mandated report to a third party (i.e., abuse or neglect
with report to state agency) with initiation of discussion of the sentinel
event and/or report with patient and other visit participants.
(D) Use of play equipment, physical devices,
interpreter, or translator to overcome barriers to therapeutic interaction with
a patient who is not fluent in the same language or who has not developed or
lost expressive or receptive language skills to use or understand typical
language.
(3)
Qualified practitioners. Psychotherapy must be provided by an
Licensed Behavioral Health Practitioner (LBHP) or licensure candidate in a
setting that protects and assures confidentiality.
(4)
Documentation requirements.
Providers must comply with documentation requirements in Oklahoma
Administrative Code (OAC)
317:30-5-248.
(5)
Limitations. A maximum of
four (4) units per day per member is compensable. A cumulative maximum of eight
(8) units of individual psychotherapy and family psychotherapy per week per
member is compensable. Except for psychotherapy involving interactive
complexity as described in this Section, only the member and the qualified
practitioner should be present during the session. Individual psychotherapy is
not reimbursable for a child younger than the age of thirty-six (36) months.
Limitations exclude outpatient behavioral health services provided in a foster
care setting.
(b)
Group psychotherapy.
(1)
Definition. Group psychotherapy is a method of treating behavioral
disorders using the face-to-face psychotherapeutic interaction between the
qualified practitioner and two (2) or more individuals to promote positive
emotional or behavioral change. The focus of the group must be directly related
to the goals and objectives in the individual member's current service plan.
This service does not include social or daily living skills development as
described under behavioral health rehabilitation services.
(2)
Group sizes. Group
psychotherapy is limited to a total of eight (8) adult [eighteen (18) and over]
individuals except when the individuals are residents of an Intermediate Care
Facility for Individuals with Intellectual Disabilities (ICF/IID) where the
maximum group size is six (6). For all children under the age of eighteen (18),
the total group size is limited to six (6).
(3)
Multi-family and conjoint family
therapy. Sessions are limited to a maximum of eight (8) families/units.
Billing is allowed once per family unit, though units may be divided amongst
family members.
(4)
Qualified
practitioners. Group psychotherapy must be provided by an LBHP or
licensure candidate. Group psychotherapy must take place in a confidential
setting limited to the qualified practitioner, an assistant or cotherapist, if
desired, and the group psychotherapy participants.
(5)
Documentation requirements.
Providers must comply with documentation requirements in OAC
317:30-5248.
(6)
Limitations. A maximum of six (6) units per day per member is
compensable, not to exceed twelve (12) units per week. Group psychotherapy is
not reimbursable for a child younger than the age of thirty-six (36) months.
Limitations exclude outpatient behavioral health services provided in a foster
care setting.
(c)
Family psychotherapy.
(1)
Definition. Family psychotherapy is a face-to-face
psychotherapeutic interaction between a qualified practitioner and the member's
family, guardian, and/or support system. It is typically inclusive of the
identified member but may be performed if indicated without the member's
presence. When the member is an adult, his/her permission must be obtained in
writing. Family psychotherapy must be provided for the direct benefit of the
SoonerCare member to assist him/her in achieving his/her established treatment
goals and objectives and it must take place in a confidential setting. This
service may include the evidence-based practice "Family Psychoeducation". For
children under the age of thirty-six (36) months, family psychotherapy is
focused on the infant/young child and parent (or primary caregiver)
interactions and the relationship needs of the infant/young child.
(2)
Qualified practitioners.
Family psychotherapy must be provided by an LBHP or licensure
candidate.
(3)
Documentation
requirements. Providers must comply with documentation requirements in
OAC 317:30-5248.
(4)
Limitations. A maximum of four (4) units per day per member/family
unit is compensable. A cumulative maximum of eight (8) units of individual
psychotherapy and family psychotherapy per week per member is compensable.
Family psychotherapy for a child younger than thirty-six (36) months must be
medically necessary and meet established child [zero (0) through thirty-six
(36) months of age] criteria as set forth in the Prior Authorization Manual.
Limitations exclude outpatient behavioral health services provided in a foster
care setting.
Notes
Added at 26 Ok Reg 734, eff 4-1-09 (emergency); Added at 26 Ok Reg 2090, eff 6-25-09 ; Amended at 27 Ok Reg 2753, eff 7-20-10 (emergency); Amended at 28 Ok Reg 459, eff 12-27-10 (emergency); Amended at 28 Ok Reg 1481, eff 6-25-11 ; Amended at 29 Ok Reg 413, eff 3-7-12 (emergency) ; Amended at 29 Ok Reg 1125, eff 6-25-12 ; Amended at 30 Ok Reg 1146, eff 7-1-13
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