Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 35 - RURAL HEALTH CLINICS › Section 317:30-5-354 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
The following words and terms, when used in this Chapter,
					 shall have the following meaning, unless the context clearly indicates
					 otherwise:
"APRN"
means advanced practice registered
					 nurse.
"C.F.R."
means the U.S. Code of Federal
					 Regulations.
"CLIA"
means the Clinical Laboratory
					 Improvement Amendments.
"CMS"
means the Centers for Medicare and
					 Medicaid Services.
"CNM"
means certified nurse midwife.
"Core services"
means outpatient services that
					 may be covered when furnished to a patient at the rural health clinic (RHC) or
					 other location, including the patient's place of residence.
"CP"
means clinical psychologist.
"CPT"
means current procedural
					 terminology.
"CSW"
means clinical social worker.
"EPSDT"
means the Early and Periodic
					 Screening, Diagnostic and Treatment program for members under twenty-one
					 (21).
"FFS"
means the current OHCA's fee-for-service
					 reimbursement rate.
"HCPCS"
means Healthcare Common Procedure
					 Coding System.
"OAC"
means the Oklahoma Administrative
					 Code.
"OHCA"
means the Oklahoma Health Care
					 Authority.
"Other ambulatory services"
means other
					 outpatient health services covered under the Oklahoma Medicaid State Plan other
					 than core services.
"PA"
means physician assistant.
"Physician"
means:
(A) A doctor of medicine or osteopathy
				  legally authorized to practice medicine and surgery by the State in which the
				  function is performed or who is a licensed physician employed by the Public
				  Health Service;
(B) Within
				  limitations as to the specific services furnished, a doctor of dentistry or
				  dental, a doctor of optometry, or a doctor of podiatry.
"Physicians' services"
means professional
					 services that are performed by a physician at the RHC (or are performed away
					 from the Center, excluding inpatient hospital services) whose agreement with
					 the RHC provides that he or she will be paid by the RHC for such
					 services.
"PPS"
means prospective payment system
					 all-inclusive per visit rate method specified in the Oklahoma Medicaid State
					 Plan.
"RHC"
means rural health clinic.
"Visit"
means a face-to-face encounter between
					 a clinic patient and a physician, Physician Assistant (PA), Advanced Practice
					 Registered Nurse (APRN), Certified Nurse Midwife (CMN), Clinical Psychologist
					 (CP), or Clinical Social Worker whose services are reimbursed under the RHC PPS
					 payment method. Encounters with more than one (1) health care professional and
					 multiple encounters with the same health care professional that take place on
					 the same day and at a single location constitute a single visit, except when
					 the patient, after the first encounter, suffers illness or injury requiring
					 additional diagnosis or treatment. Services delivered via audio-only
					 telecommunications and reimbursed pursuant to the fee-for-service (FFS) fee
					 schedule do not constitute a visit and/or an encounter.