Library: Policy
317:30-5-595. Eligible providers
Revised 9-1-15
Services are provided by outpatient behavioral health agencies established for the purpose of providing behavioral health outpatient and case management services.
(1) Provider agency requirements. Services are provided by outpatient behavioral health agencies contracted with OHCA that meet the requirements under OAC 317:30-5-240. The agency must demonstrate its capacity to deliver behavioral health case management services in terms of the following items:
(A) OHCA reserves the right to obtain a copy of any accreditation audit and/or site visit reports from the provider and/or the accreditation agency.
(B) Agencies that are eligible to contract with OHCA to provide behavioral health case management services to eligible individuals must be community based.
(C) The agency must be able to demonstrate the ability to develop and maintain appropriate patient records including but not limited to assessments, service plans, and progress notes.
(D) An agency must agree to follow the Oklahoma Department of Mental Health and Substance Abuse Services established behavioral health case management rules found in OAC 450:50.
(E) An agency's behavioral health case management staff must serve the target group on a 24 hour on call basis.
(F) Each site operated by a behavioral health outpatient and case management facility must have a separate provider number, per OAC 317:30-5-240.2.
(2) Provider Qualifications. For behavioral health case management services to be compensable by SoonerCare, the provider performing the service must be an LBHP, Licensure Candidate, CADC, or have and maintain a current certification as a Case Manager II (CM II) or Case Manager I (CM I) from the ODMHSAS. The requirements for obtaining these certifications are as follows:
(A) Certified Behavioral Health Case Manager II (CM II) must meet the requirements in (i), (ii), (iii) or (iv) below:
(i) Possess a Bachelor's or Master's degree in a behavioral health related field earned from a regionally accredited college or university recognized by the United States Department of Education (USDE) or a Bachelor's or Master's degree in education; and complete web-based training for behavioral health case management and behavioral health rehabilitation as specified by ODMHSAS; and complete one day of face-to-face behavioral health case management training and two days of face-to-face behavioral health rehabilitation training as specified by ODMHSAS; and pass web-based competency exams in behavioral health case management and behavioral health rehabilitation.
(ii) Possess a current license as a registered nurse in the State of Oklahoma with experience in behavioral health care; complete web-based training for behavioral health case management and behavioral health rehabilitation as specified by ODMHSAS; complete one day of face-to-face behavioral health case management training and two days of face-to-face behavioral health rehabilitation training as specified by ODMHSAS; and pass web-based competency exams for behavioral health case management and behavioral health rehabilitation.
(iii) Possess a Bachelor's or Master's degree in any field earned from a regionally accredited college or university recognized by the USDE and a current certification or Children's Certificate in Psychiatric Rehabilitation from the US Psychiatric Rehabilitation Association (USPRA); complete the behavioral health case management web-based training as specified by ODMHSAS; complete one day of face-to-face behavioral health case management training; and pass web-based competency exams for behavioral health case management. Applicants who have not received a certificate in children's psychiatric rehabilitation from the US Psychiatric Association (USPRA) must also complete the behavioral health rehabilitation web-based training as specified by ODMHSAS.
(iv) Possess a Bachelor's or Master's degree in any field and proof of active progression toward obtaining a clinical licensure Master's or Doctoral degree at a regionally accredited college or university recognized by the USDE and complete web-based training for behavioral health case management and behavioral health rehabilitation as specified by ODMHSAS; complete one day of face-to-face behavioral health case management training and two days of face-to-face behavioral health rehabilitation training as specified by ODMHSAS; and pass web-based competency exams in behavioral health case management and behavioral health rehabilitation.
(B) Certified Behavioral Health Case Manager I meets the requirements in either (i) or (ii), and (iii):
(i) completed 60 college credit hours; or
(ii) has a high school diploma with 36 total months of experience working with persons who have a mental illness and/or substance abuse. Documentation of experience on file with ODMHSAS; and
(iii)Completes two days of ODMHSAS specified behavioral health case management training and passes a web-based competency exam for behavioral health case management.
(C) Wraparound Facilitator Case Manager. LBHP, Licensure Candidate, CADC, or meets the qualifications for CM II and has the following:
(i) Successful completion of the ODMHSAS training for wraparound facilitation within six months of employment; and
(ii) Participate in ongoing coaching provided by ODMHSAS and employing agency; and
(iii) Successfully complete wraparound credentialing process within nine months of beginning process; and
(iv) Direct supervision or immediate access and a minimum of one hour weekly clinical consultation with a Qualified Mental Health Professional, as required by ODMHSAS.
(D) Intensive Case Manager. LBHP, Licensure Candidate, CADC or meets the provider qualifications of a Case Manager II and has the following:
(i) A minimum of two years Behavioral Health Case Management experience, crisis diversion experience, and
(ii) must have attended the ODMHSAS six hours Intensive case management training.
(E) All certified case managers must fulfill the continuing education requirements as outlined under OAC 450:50-5-4.
