Okla. Admin. Code § 317:30-5-95.45

Current through Vol. 42, No. 4, November 1, 2024

Section 317:30-5-95.45 - Residential substance use disorder (SUD) - Coverage by category

(a)Adults. Members age twenty-one (21) to sixty-four (64) who meet eligibility and clinical criteria may receive medically necessary residential treatment for SUD.

(1) The member must meet residential level of care as determined through completion of the designated ASAM placement tool no more than seven (7) days prior to a SUD admission and/or extension request and as required in the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) Prior Authorization Manual.

(2) Each presenting member for SUD treatment shall be assessed, according to ASAM criteria, which includes a list of symptoms for all six (6) dimensions and each level of care to determine a clinically appropriate placement in the least restrictive level of care.

(b)Children. Children are covered according to their age group as described in OAC 317:30-5-95.46 and 317:30-5-95.47 and as specified by ODMHSAS.

(c)Individuals with dependent children. Coverage for individuals with dependent children is the same as adults and/or children.

Okla. Admin. Code § 317:30-5-95.45

Adopted by Oklahoma Register, Volume 38, Issue 09, January 15, 2021, eff. 12/18/2020

Adopted by Oklahoma Register, Volume 38, Issue 23, August 16, 2021, eff. 9/1/2021

Amended by Oklahoma Register, Volume 40, Issue 24, September 1, 2023, eff. 9/11/2023