Okla. Admin. Code § 450:17-5-181

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

Section 450:17-5-181 - Comprehensive care plan, content

(a) The CCBHC team must develop a consumer directed, comprehensive care plan for each enrolled consumer that reflects input of the interdisciplinary team, and others the consumer chooses to involve.

(b) The comprehensive care plan shall clearly address physical and behavioral health goals, consumer preferences, and the overall health and wellness needs of the consumer. The plan shall address the services necessary to assist the client in meeting his or her mental health and physical health goals, and include the following:

(1) Consumer diagnoses, relative to behavioral and physical health conditions assessed by and addressed in terms of direct services provided and/or conditions for which the individual is referred and linked elsewhere for treatment;

(2) Consumer integrated care service needs, relative to behavioral and physical health conditions assessed by and addressed in terms of direct services provided and/or conditions for which the individual is referred and linked elsewhere for treatment;

(3) One to three treatment goals for the upcoming six (6) months, including preventive, primary care, and wellness services;

(4) Interventions, including identification of and follow up with necessary medical providers, and identification of any specific care pathways for chronic conditions; and

(5) The interdisciplinary treatment team's documentation of the consumer's or representative's and/or primary caregiver's (if any) understanding, involvement, and agreement with the integrated care plan.

(c) The CCBHC must provide for each consumer and primary caregiver(s), as applicable, education and training consistent with the consumer and caregiver responsibilities as identified in the plan and relative to their participation in implementing the plan.

(d) The comprehensive care plan must be signed by an LBHP or licensure candidate in accordance with OAC 450:17-7-8, with participation by the interdisciplinary team performing within each team member's scope of practice consistent with each consumer's immediate needs.

(e) Compliance with this Section will be determined by on-site review of clinical records and supported documentation. The ODMHSAS or its contractor may utilize site observation, staff surveys and/or interviews to assist Provider Certification with determining compliance.

Okla. Admin. Code § 450:17-5-181

Adopted by Oklahome Register, Volume 33, Issue 23, August 15, 2016, eff. 9/1/2016

Amended by Oklahoma Register, Volume 38, Issue 23, August 16, 2021, eff. 9/15/2021