OHCA Policies and Rules

Search Entire Policy
OHCA Policies and Rules Main Page


317:30-5-204.General Information
[Issued 11-01-07]
The emphasis of maternal and infant health licensed clinical social work services is on providing psychosocial support, health and behavior assessment and intervention focused on biopsycho-social factors related to the member's perinatal health status. These services are intended for women who are at risk due to drug/alcohol use, domestic violence, lack of stable food/shelter, have high risk medical conditions, problems in the post partum environment that interfere with the infant health and bonding and/or other psychosocial concerns.

317:30-5-205.Eligible Providers
[Issued 11-01-07]
Eligible providers are Licensed Clinical Social Workers (LCSWs) with a minimum of six hours of continuing education or technical assistance in the area of Maternal and Infant Health. LCSWs must have a current contract on file with the Oklahoma Health Care Authority and be licensed in the state in which the service is being provided. Services may also be provided through the Department of Health or other county health departments. Services provided through the health departments must be provided by a LCSW. In the event of a post-payment audit, LCSWs providing Maternal and Infant Health Clinical Social Work services must be able to demonstrate that they have completed at least six hours of continuing education or technical assistance for each calendar year of providing care to SoonerCare members. The continuing education or technical assistance must be in the area of Maternal and Infant Health relevant to the provision of Social Work Services.

[Issued 11-01-07]
Maternal and infant health social work services are covered for pregnant and postpartum women for whom a psychosocial condition exists that may negatively impact the pregnancy and/or well being of the newborn infant. SoonerCare members may self-refer or be referred by any provider. Identification of the condition may be based on a CH-16 or the Licensed Clinical Social Worker's initial assessment. Psychosocial assessment/counseling is appropriate in order to develop a social work care plan based upon the health risks due to psychosocial factors.

[Issued 11-01-07]
Coverage limitations for maternal and infant health social work services are as follows:
(1) Services are only covered when performed in the LCSWs' office setting, patient's home or other confidential clinic setting.
(2) No separate reimbursement will be made to a facility.
(3)Services billed by a contracted LCSW must be provided face-to-face and in an individual setting.

[Issued 11-01-07]
(a) Maternal and infant health social work services must be billed using appropriate CPT codes and guidelines.
(b) SoonerCare does not allow more than 32 units (15 minutes = 1 unit) during the pregnancy which includes 60 days postpartum.
(c) LCSWs that are employed by or remunerated by another provider may not bill the SoonerCare program directly for services if that billing would result in duplicate payment for the same service.
(d) Only the LCSW directly performing the care or a county health department may bill the SoonerCare Program.
(e) The time indicated on the claim form must be the time actually spent with the member.

[Issued 11-01-07]
All services must be reflected by documentation in the patient records. All assessment and treatment services must include the following:
(1) date;
(2) start and stop time for each timed treatment session;
(3) signature of the service provider;
(4) credentials of service provider;
(5) documentation of the referral source;
(6) problems(s), goals and/or objectives identified on the treatment plan;
(7) methods used to address the problem(s), goals and objectives;
(8) progress made toward goals and objectives;
(9) patient response to the session or intervention; and
(10) any new problem(s), goals and/or objectives identified during the session.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.