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317:30-5-95.31.Prior Authorization and extension procedures for children

[Revised 09-01-19]
(a) Prior authorization for inpatient psychiatric services for children must be requested from the Oklahoma Health Care Authority (OHCA) or its designated agent.  The OHCA or its designated agent will evaluate and render a decision within twenty-four (24) hours of receiving the request.  A prior authorization will be issued by the OHCA or its designated agent, if the member meets medical necessity criteria.  For the safety of SoonerCare members, additional approval from OHCA, or its designated agent is required for placement on specialty units or in special population programs or for members with special needs such as very low intellectual functioning.

(b) Extension requests (psychiatric) must be made through OHCA, or its designated agent.  All requests are made prior to the expiration of the approved extension.  Requests for the continued stay of a child who has been in an acute psychiatric program for a period of fifteen (15) days and in a psychiatric residential treatment facility for three (3) months will require a review of all treatment documentation completed by the OHCA designated agent to determine the efficiency of treatment.

(c) Providers seeking prior authorization will follow OHCA's, or its designated agent's, prior authorization process guidelines for submitting behavioral health case management requests on behalf of the SoonerCare member.

(d) In the event a member disagrees with the decision by OHCA, or its designated agent, the member receives an evidentiary hearing under Oklahoma Administrative Code 317:2-1-2(b).  The member's request for such an appeal must be received within thirty (30) calendar days of the initial decision.

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.