reglab/statecodes huggingface dataset:
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 1 - Health Plan Competitive Bid Requirements › Section 317:25-1-8 - Award of bid [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg 745,
				  eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3125, eff 7-27-95;
				  Revoked at 21 Ok Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 1 - Health Plan Competitive Bid Requirements › Section 317:25-1-9 - Best and final offer (BFO) or additional negotiation processes [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg 745,
				  eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3125, eff 7-27-95;
				  Revoked at 21 Ok Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 1 - Health Plan Competitive Bid Requirements › Section 317:25-1-10 - Terms and conditions for acceptable bids [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg 745,
				  eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3125, eff 7-27-95;
				  Revoked at 21 Ok Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 1 - Health Plan Competitive Bid Requirements › Section 317:25-1-11 - Challenge of award [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg 745,
				  eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3125, eff 7-27-95;
				  Revoked at 21 Ok Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 1 - Health Plan Competitive Bid Requirements › Section 317:25-1-12 - Administrative review [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg 745,
				  eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3125, eff 7-27-95;
				  Amended at 13 Ok Reg 3465, eff 7-16-96 (emergency); Amended at 14 Ok Reg 1766,
				  eff 5-27-97; Revoked at 21 Ok Reg 2149, eff
				  6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 1 - Health Plan Competitive Bid Requirements › Section 317:25-1-13 - Confidentiality [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 585,
				  eff 9-8-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Revoked at 21 Ok
				  Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 3 - Health Maintenance Organizations › Section 317:25-3-1 - Health Maintenance Organizations [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg 1319,
				  eff 3-20-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Revoked at 21 Ok
				  Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 3 - Health Maintenance Organizations › Section 317:25-3-2 - Public managed care plans [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg 1319,
				  eff 3-20-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at 16 Ok
				  Reg 3495, eff 7-1-99 (emergency); Amended at 17 Ok Reg 1191, eff 5-11-00;
				  Revoked at 21 Ok Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 3 - Health Maintenance Organizations › Section 317:25-3-2.1 - Reinsurance [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg 3630,
				  eff 9-8-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at 13 Ok
				  Reg 3465, eff 7-16-96 (emergency); Amended at 14 Ok Reg 1766, eff 5-27-97;
				  Revoked at 14 Ok Reg 3061, eff 7-1-97 (emergency); Revoked at 15 Ok Reg 1511,
				  eff 5-11-98
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 3 - Health Maintenance Organizations › Section 317:25-3-2.2 - Health Care Authority Risk Control Program [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 16 Ok Reg 1707,
				  eff 3-15-99 (emergency); Added at 17 Ok Reg 1191, eff 5-11-00; Revoked at 21 Ok
				  Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 3 - Health Maintenance Organizations › Section 317:25-3-3 - Quality Assurance credentialing and recredentialing requirements [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg 1319,
				  eff 3-20-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at 14 Ok
				  Reg 3061, eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98;
				  Revoked at 21 Ok Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 1 - GENERAL PROVISIONS › Section 317:25-5-1 - Purpose [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 37,
					 eff 5-12-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at 13 Ok
					 Reg 3565, eff 7-16-96 (emergency); Amended at 14 Ok Reg 1766, eff 5-27-97;
					 Amended at 14 Ok Reg 3061, eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511,
					 eff 5-11-98; Amended at 15 Ok Reg 3778, eff 7-1-98 (emergency); Amended at 16
					 Ok Reg 1422, eff 5-27-99; Amended at 16 Ok Reg 3495, eff 7-1-99 (emergency);
					 Amended at 17 Ok Reg 1191, eff 5-11-00; Revoked at 21 Ok Reg 2149, eff
					 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 1 - GENERAL PROVISIONS › Section 317:25-5-2 - SoonerCare Plus overview [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 37,
					 eff 5-12-95 (emergency); Added at 13 Ok Reg 43, eff 6-21-95 (emergency); Added
					 at 13 Ok Reg 2307, eff 4-10-96 (emergency); Added at 13 Ok Reg 1633, eff
					 5-27-96; Amended at 13 Ok Reg 3577, eff 6-18-96 (emergency); Amended at 13 Ok
					 Reg 3565, eff 7-16-96 (emergency); Amended at 14 Ok Reg 1766, eff 5-27-97;
					 Amended at 14 Ok Reg 3061, eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511,
					 eff 5-11-98; Amended at 15 Ok Reg 3778, eff 7-1-98 (emergency); Amended at 16
					 Ok Reg 1422, eff 5-27-99; Amended at 16 Ok Reg 3495, eff 7-1-99 (emergency);
					 Amended at 17 Ok Reg 1191, eff 5-11-00; Revoked at 21 Ok Reg 2149, eff
					 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 1 - GENERAL PROVISIONS › Section 317:25-5-3 - Definitions [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 43,
					 eff 6-21-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at 14 Ok
					 Reg 3061, eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98;
					 Amended at 16 Ok Reg 3495, eff 7-1-99 (emergency); Amended at 17 Ok Reg 1191,
					 eff 5-11-00; Revoked at 21 Ok Reg 2149, eff
					 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 1 - GENERAL PROVISIONS › Section 317:25-5-4 - Health Plan proposals to the Oklahoma Health Care Authority and the DUR for modifying medication coverage [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 3632, eff 9-8-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at
					 13 Ok Reg 3565, eff 7-16-96 (emergency); Amended at 14 Ok Reg 1766, eff
					 5-27-97; Revoked at 21 Ok Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 1 - GENERAL PROVISIONS › Section 317:25-5-5 - Contractor payments to providers [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 15 Ok Reg
					 536, eff 9-18-97 (emergency); Added at 15 Ok Reg 1511, eff 5-11-98; Amended at
					 16 Ok Reg 3495, eff 7-1-99 (emergency); Amended at 17 Ok Reg 1191, eff 5-11-00;
					 Amended at 19 Ok Reg 530, eff 12-27-01 (emergency); Amended at 19 Ok Reg 2123,
					 eff 6-27-02; Revoked at 21 Ok Reg 2149, eff
					 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 3 - ENROLLMENT CRITERIA › Section 317:25-5-10 - Enrollment in SoonerCare Plus [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 37,
					 eff 5-12-95 (emergency); Added at 13 Ok Reg 2309, eff 4-10-96 (emergency);
					 Added at 13 Ok Reg 1633, eff 5-27-96; Amended at 13 Ok Reg 3577, eff 6-18-96
					 (emergency); Amended at 13 Ok Reg 3565, eff 7-16-96; Amended at 14 Ok Reg 1766,
					 eff 5-27-97; Amended at 14 Ok Reg 3061, eff 7-1-97 (emergency); Amended at 15
					 Ok Reg 1511, eff 5-11-98; Amended at 15 Ok Reg 3778, eff 7-1-98 (emergency);
					 Amended at 16 Ok Reg 1422, eff 5-27-99; Amended at 16 Ok Reg 3495, eff 7-1-99
					 (emergency); Amended at 17 Ok Reg 1191, eff 5-11-00; Revoked at 21 Ok Reg 2149,
					 eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 3 - ENROLLMENT CRITERIA › Section 317:25-5-11 - Geographic Coverage Areas [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 37,
					 eff 5-12-95 (emergency); Added at 13 Ok Reg 43, eff 6-21-95 (emergency); Added
					 at 13 Ok Reg 1633, eff 5-27-96; Amended at 13 Ok Reg 3565, eff 7-16-96
					 (emergency); Amended at 14 Ok Reg 1766, eff 5-27-97; Amended at 14 Ok Reg 3061,
					 eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98; Amended at 15
					 Ok Reg 3778, eff 7-1-98 (emergency); Amended at 16 Ok Reg 1422, eff 5-27-99;
					 Amended at 16 Ok Reg 3495, eff 7-1-99 (emergency); Amended at 17 Ok Reg 1191,
					 eff 5-11-00; Amended at 18 Ok Reg 244, eff 11-21-00 (emergency); Amended at 18
					 Ok Reg 1128, eff 5-11-01; Revoked at 21 Ok Reg 2149, eff
					 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 3 - ENROLLMENT CRITERIA › Section 317:25-5-12 - Enrollment requirements [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 37,
					 eff 5-12-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at 13 Ok
					 Reg 3565, eff 7-16-96 (emergency); Amended at 14 Ok Reg 1766, eff 5-27-97;
					 Amended at 14 Ok Reg 3061, eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511,
					 eff 5-11-98; Amended at 15 Ok Reg 3778, eff 7-1-98 (emergency); Amended at 16
					 Ok Reg 1422, eff 5-27-99; Amended at 16 Ok Reg 3495, eff 7-1-99 (emergency);
					 Amended at 17 Ok Reg 1191, eff 5-11-00; Revoked at 21 Ok Reg 2149, eff
					 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 3 - ENROLLMENT CRITERIA › Section 317:25-5-13 - Enrollment ineligibility [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 37,
					 eff 5-12-95 (emergency); Added at 13 Ok Reg 43, eff 6-21-95 (emergency); Added
					 at 13 Ok Reg 47, eff 9-8-95 (emergency); Added at 13 Ok Reg 2307, eff 4-10-96
					 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at 13 Ok Reg 3581,
					 eff 6-18-96 (emergency); Amended at 13 Ok Reg 3565, eff 7-16-96 (emergency);
					 Amended at 14 Ok Reg 1766, eff 5-27-97; Amended at 14 Ok Reg 3061, eff 7-1-97
					 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98; Amended at 15 Ok Reg 3778,
					 eff 7-1-98 (emergency); Amended at 16 Ok Reg 1422, eff 5-27-99; Amended at 16
					 Ok Reg 3495, eff 7-1-99 (emergency); Amended at 17 Ok Reg 1191, eff 5-11-00;
					 Amended at 20 Ok Reg 2759, eff 7-1-03 (emergency); Revoked at 21 Ok Reg 2149,
					 eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 3 - ENROLLMENT CRITERIA › Section 317:25-5-14 - Availability of plan choices [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 37,
					 eff 5-12-95 (emergency); Added at 13 Ok Reg 43, eff 6-12-95 (emergency); Added
					 at 13 Ok Reg 1633, eff 5-27-96; Amended at 14 Ok Reg 3061, eff 7-1-97
					 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98; Amended at 15 Ok Reg 3778,
					 eff 7-1-98 (emergency); Amended at 16 Ok Reg 1422, eff 5-27-99; Revoked at 21
					 Ok Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 5 - ENROLLMENT PROCESS › Section 317:25-5-25 - Recipient enrollment process [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 37,
					 eff 5-12-95 (emergency); Added at 12 Ok Reg 3634, eff 9-8-95 (emergency); Added
					 at 13 Ok Reg 1633, eff 5-27-96; Amended at 13 Ok Reg 3566, eff 7-16-96
					 (emergency); Amended at 14 Ok Reg 2392, eff 2-5-97 (emergency); Amended at 14
					 Ok Reg 2926, eff 7-11-97; Amended at 14 Ok Reg 3061, eff 7-15-97 (emergency);
					 Amended at 15 Ok Reg 1511, eff 5-11-98; Amended at 15 Ok Reg 3778, eff 7-1-98
					 (emergency); Amended at 16 Ok Reg 1422, eff 5-27-99; Amended at 16 Ok Reg 3495,
					 eff 7-1-99 (emergency); Amended at 17 Ok Reg 1191, eff 5-11-00; Revoked at 21
					 Ok Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 5 - ENROLLMENT PROCESS › Section 317:25-5-26 - Automatic re-enrollment. [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 37,
					 eff 5-12-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at 13 Ok
					 Reg 2517, eff 6-27-96; Amended at 13 Ok Reg 3565, eff 7-16-96 (emergency);
					 Amended at 14 Ok Reg 1766, eff 5-27-97; Amended at 14 Ok Reg 3061, eff 7-1-97
					 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98; Amended at 15 Ok Reg 3778,
					 eff 7-1-98 (emergency); Amended at 16 Ok Reg 1422, eff 5-27-99; Revoked at 21
					 Ok Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 5 - ENROLLMENT PROCESS › Section 317:25-5-27 - Primary care provider selection or assignment [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 37,
					 eff 5-12-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at 14 Ok
					 Reg 3061, eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98;
					 Amended at 16 Ok Reg 3495, eff 7-1-99 (emergency); Amended at 17 Ok Reg 1191,
					 eff 5-11-00; Revoked at 21 Ok Reg 2149, eff
					 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 5 - ENROLLMENT PROCESS › Section 317:25-5-28 - Disenrollment from a Health Plan by the client [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 43,
					 eff 6-21-95 (emergency); Added at 13 Ok Reg 37, eff 5-12-96 (emergency); Added
					 at 13 Ok Reg 1633, eff 5-27-96; Amended at 13 Ok Reg 3565, eff 7-16-96
					 (emergency); Amended at 14 Ok Reg 1766, eff 5-27-97; Amended at 14 Ok Reg 3061,
					 eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98; Amended at 15
					 Ok Reg 3778, eff 7-1-98 (emergency); Amended at 16 Ok Reg 1422, eff 5-27-99;
					 Revoked at 21 Ok Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 5 - ENROLLMENT PROCESS › Section 317:25-5-29 - Termination of a client's enrollment by the Health Plan [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 37,
					 eff 5-12-95 (emergency); Added at 13 Ok Reg 43, eff 6-21-95 (emergency); Added
					 at 13 Ok Reg 1633, eff 5-27-96; Amended at 13 Ok Reg 3565, eff 7-16-96
					 (emergency); Amended at 14 Ok Reg 1766, eff 5-27-97; Amended at 14 Ok Reg 3061,
					 eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98; Revoked at 21
					 Ok Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 5 - ENROLLMENT PROCESS › Section 317:25-5-30 - Plan benefit package [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 37,
					 eff 5-12-95 (emergency); Added at 13 Ok Reg 2307, eff 4-10-96 (emergency);
					 Added at 13 Ok Reg 1633, eff 5-27-96; Amended at 13 Ok Reg 3581, eff 6-18-96
					 (emergency); Amended at 13 Ok Reg 3565, eff 7-16-96 (emergency); Amended at 14
					 Ok Reg 1766, eff 5-27-97; Amended at 14 Ok Reg 3061, eff 7-1-97 (emergency);
					 Amended at 15 Ok Reg 1511, eff 5-11-98; Amended at 15 Ok Reg 3778, eff 7-1-98
					 (emergency); Amended at 15 Ok Reg 138, eff 10-14-98 (emergency); Amended at 16
					 Ok Reg 1422, eff 5-27-99; Amended at 16 Ok Reg 3495, eff 7-1-99 (emergency);
					 Amended at 17 Ok Reg 1191, eff 5-11-00; Revoked at 21 Ok Reg 2149, eff
					 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 5 - ENROLLMENT PROCESS › Section 317:25-5-31 - Obtaining Medicaid services not covered under the plan [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 37,
					 eff 5-12-95 (emergency); Added at 13 Ok Reg 43, eff 6-21-95 (emergency); Added
					 at 13 Ok Reg 1633, eff 5-27-96; Amended at 13 Ok Reg 3581, eff 6-18-96
					 (emergency); Amended at 13 Ok Reg 3565, eff 7-16-96 (emergency); Amended at 14
					 Ok Reg 1766, eff 5-27-97; Amended at 14 Ok Reg 3061, eff 7-1-97 (emergency);
					 Amended at 15 Ok Reg 1511, eff 5-11-98; Amended at 15 Ok Reg 3778, eff 7-1-98
					 (emergency); Amended at 16 Ok Reg 1422, eff 5-27-99; Amended at 16 Ok Reg 3495,
					 eff 7-1-99 (emergency); Amended at 17 Ok Reg 1191, eff 5-11-00; Revoked at 21
					 Ok Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 5 - ENROLLMENT PROCESS › Section 317:25-5-32 - Emergency and family planning services [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 37,
					 eff 5-12-95 (emergency); Added at 13 Ok Reg 43, eff 6-21-95 (emergency); Added
					 at 13 Ok Reg 1633, eff 5-27-96; Amended at 13 Ok Reg 3581, eff 6-18-96
					 (emergency); Amended at 13 Ok Reg 3565, eff 7-16-96 (emergency); Amended at 14
					 Ok Reg 1766, eff 5-27-97; Amended at 14 Ok Reg 3061, eff 7-1-97 (emergency);
					 Amended at 15 Ok Reg 1511, eff 5-11-98; Amended at 15 Ok Reg 3778, eff 7-1-98
					 (emergency); Amended at 16 Ok Reg 1422, eff 5-27-99; Revoked at 21 Ok Reg 2149,
					 eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 7 - PLAN REQUIREMENTS › Section 317:25-5-40 - Health Plan Qualifications for Participation [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 37,
					 eff 5-12-95 (emergency); Added at 13 Ok Reg 43, eff 6-21-95 (emergency); Added
					 at 13 Ok Reg 1633, eff 5-27-96; Amended at 13 Ok Reg 3565, eff 7-16-96
					 (emergency); Amended at 14 Ok Reg 1766, eff 5-27-97; Amended at 14 Ok Reg 3061,
					 eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98; Amended at 15
					 Ok Reg 3778, eff 7-1-98 (emergency); Amended at 16 Ok Reg 1422, eff 5-27-99;
					 Revoked at 21 Ok Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 7 - PLAN REQUIREMENTS › Section 317:25-5-41 - Primary Care Provider (PCP) [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg 37,
					 eff 5-12-95 (emergency); Added at 13 Ok Reg 43, eff 6-21-95 (emergency); Added
					 at 13 Ok Reg 3883, eff 4-30-96 (emergency); Added at 13 Ok Reg 1633, eff
					 5-27-96; Amended at 13 Ok Reg 3565, eff 7-16-96 (emergency); Amended at 14 Ok
					 Reg 1766, eff 5-27-97; Amended at 14 Ok Reg 3061, eff 7-1-97 (emergency);
					 Amended at 15 Ok Reg 1511, eff 5-11-98; Amended at 16 Ok Reg 138, eff 10-14-98
					 (emergency); Amended at 16 Ok Reg 1422, eff 5-27-99; Amended at 16 Ok Reg 3495,
					 eff 7-1-99 (emergency); Amended at 17 Ok Reg 1191, eff 5-11-00; Revoked at 21
					 Ok Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 7 - PLAN REQUIREMENTS › Section 317:25-5-41.1 - Medical residents serving as primary care providers [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg
					 3883, eff 4-30-96 (emergency); Added at 14 Ok Reg 1766, eff 5-27-97; Amended at
					 14 Ok Reg 3061, eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98;
					 Amended at 16 Ok Reg 3495, eff 7-1-99 (emergency); Amended at 17 Ok Reg 1191,
					 eff 5-11-00; Revoked at 21 Ok Reg 2149, eff
					 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 5 - Soonercare Plus › Part 9 - SPECIAL PROVISIONS › Section 317:25-5-50 - Supplemental payments to medical schools [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg
					 1199, eff 1-9-96 (emergency); Added at 13 Ok Reg 2519, eff 6-27-96; Amended at
					 13 Ok Reg 3565, eff 7-16-96 (emergency); Amended at 14 Ok Reg 1766, eff
					 5-27-97; Revoked at 15 Ok Reg 3678, eff 5-18-98 (emergency); Revoked at 16 Ok
					 Reg 1422, eff 5-27-99
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 7 - Soonercare › Part 1 - GENERAL PROVISIONS › Section 317:25-7-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
The purpose of this Subchapter is to describe the rules
					 governing the statewide SoonerCare program. The rules provide assurances that
					 SoonerCare members have adequate access to primary care, while reducing costs
					 and preventing unnecessary and inappropriate utilization.
Added at 13 Ok Reg
					 823, eff 10-20-95 (emergency); Added at 13 Ok Reg 587, eff 11-21-95
					 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at 14 Ok Reg 3061,
					 eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98; Amended at 21
					 Ok Reg 2149, eff 6-25-04; Amended at 26 Ok Reg 401, eff 1-1-09 (emergency);
					 Amended at 26 Ok Reg 2074, eff 6-25-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 7 - Soonercare › Part 1 - GENERAL PROVISIONS › Section 317:25-7-2.1 - Medical residents [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg
					 3883, eff 4-30-96 (emergency); Added at 14 Ok Reg 1766, eff 5-27-97; Revoked at
					 14 Ok Reg 3061, eff 7-1-97 (emergency); Revoked at 15 Ok Reg 1511, eff
					 5-11-98
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 7 - Soonercare › Part 1 - GENERAL PROVISIONS › Section 317:25-7-3 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
The following words and terms, when used in this
					 Subchapter, have the following meaning, unless the context clearly indicates
					 otherwise:
"Aged, Blind and Disabled (ABD)"
means the
					 Medicaid covered populations under 42 United States Code (U.S.C.) Section 1396a
					 (a)(10)(A)(i) and (F).
"Board"
means the board designated by the
					 Oklahoma legislature to establish policies and adopt and promulgate rules for
					 the Oklahoma Health Care Authority.
"Custody"
means the custodial status, as
					 reported by the Oklahoma Department of Human Services.
"Medicaid"
means the medical assistance
					 program authorized by
					 42 U.S.C., Section
					 1396a et seq. The program provides medical
					 benefits for certain low-income persons. It is jointly administered by the
					 federal and state governments.
"Medicare"
means the program defined at
					 42 U.S.C. §
											1395 et seq.
"OHCA"
means the Oklahoma Health Care
					 Authority.
"OKDHS"
means the Oklahoma Department of Human
					 Services.
"PCCM"
means Primary Care Case Management.
"Primary Care Case Management"
means a managed
					 care health service delivery system in which health services are delivered and
					 coordinated by Primary Care Providers.
"Primary care provider (PCP)"
means a Primary
					 Care Provider, including a provider or physician group, under contract with the
					 OHCA to provide primary care services and case management, including securing
					 all medically-necessary referrals for specialty services and prior
					 authorizations.
"Provider "
or
"
physician
					 group"
means a partnership, limited partnership, limited liability
					 company, corporation or professional corporation, composed of doctors of
					 medicine and/or doctors of osteopathy and/or advanced practice registered
					 nurses, and/or physician assistants who provide health care of the nature
					 provided by independent practitioners and are permitted by state and federal
					 law and regulations to receive SoonerCare provider payments.
"SoonerCare"
means the Medicaid program
					 administered by the OHCA.
"SoonerCare Choice"
means a comprehensive
					 medical benefit plan featuring a medical home including a PCP for each member.
Added at 13 Ok Reg
					 587, eff 11-21-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at
					 14 Ok Reg 3061, eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98;
					 Amended at 17 Ok Reg 425, eff 11-2-99 (emergency); Amended at 17 Ok Reg 1191,
					 eff 5-11-00; Amended at 21 Ok Reg 2149, eff 6-25-04; Amended at 26 Ok Reg 401,
					 eff 1-1-09 (emergency); Amended at 26 Ok Reg 2074, eff
					 6-25-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 7 - Soonercare › Part 1 - GENERAL PROVISIONS › Section 317:25-7-4 - Credentialling and re-credentialling [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 14 Ok Reg
					 3061, eff 7-1-97 (emergency); Added at 15 Ok Reg 1511, eff 5-11-98; Revoked at
					 16 Ok Reg 3612, eff 8-3-99 (emergency); Revoked at 17 Ok Reg 1191, eff
					 5-11-00
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 7 - Soonercare › Part 1 - GENERAL PROVISIONS › Section 317:25-7-5 - Primary care providers (PCPs)

Current through Vol. 41, No. 20, July 1, 2024
For provision of health care services, the OHCA contracts
					 with qualified PCPs. All providers serving as PCPs must have a valid SoonerCare
					 Fee-for-Service contract as well as an exercised SoonerCare Choice addendum.
					 Additionally, all PCPs, excluding provider or physician groups must agree to
					 accept a minimum capacity of fifty (50) patients; provided, however, this does
					 not guarantee PCPs a minimum patient volume. PCPs are limited to:
(1)
Physicians.
Any physician
				  licensed to practice medicine in the state in which he or she practices who is
				  engaged in a general practice or in family medicine, general internal medicine
				  or general pediatrics may serve as a PCP. Out-of-state PCPs are required to
				  comply with all access standards imposed on Oklahoma physicians, as well as
				  Oklahoma Administrative Code (OAC)
				  317:30-3-89 through
				  317:30-3-92.
(2)
Advanced Practice Registered Nurses
				  (APRNs).
APRNs who have prescriptive authority may serve as PCPs for the
				  Primary Care Case Management delivery system if licensed to practice in the
				  state in which he or she practices.
(3)
Physician Assistants (PAs).
PAs may serve as PCPs if licensed to practice in the state in which he or she
				  practices.
(4)
Indian Health
				  Service (IHS) Facilities and Federally Qualified Health Center (FQHC) provider
				  groups and Rural Health Clinics (RHC).
(A) IHS facilities whose professional staff
				  meet the general requirements in paragraphs (1) through (3) of this Section and
				  the provider participation requirements at OAC
				  317:30-5-1088 may serve as
				  PCPs.
(B) FQHCs whose professional
				  staff meet the general requirements in paragraphs (1) through (3) of this
				  Section and the provider participation requirements in OAC 317:30- 5-660.2 may
				  serve as PCPs.
(C) RHCs whose
				  professional staff meet the general requirements in paragraphs (1) through (3)
				  of this Section and the provider participation requirements in OAC 317:30-
				  5-355 may serve as PCPs.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 7 - Soonercare › Part 1 - GENERAL PROVISIONS › Section 317:25-7-6 - Primary Care Provider responsibilities

Current through Vol. 41, No. 20, July 1, 2024
(a) Under the provisions of the SoonerCare
				  Choice Contract, the contractor is responsible for providing care coordination
				  services for all enrolled members on his/her panel.
(b) PCPs must provide access to medical care
				  twenty-four hours per day, seven days a week, either directly or through
				  coverage arrangements made with other providers, clinics, and/or local
				  hospitals.
Added at 15 Ok Reg
					 536, eff 9-18-97 (emergency); Added at 15 Ok Reg 1511, eff 5-11-98; Amended at
					 19 Ok Reg 530, eff 12-27-01 (emergency); Amended at 19 Ok Reg 2123, eff
					 6-27-02; Amended at 21 Ok Reg 2149, eff 6-25-04; Amended at 26 Ok Reg 401, eff
					 1-1-09 (emergency); Amended at 26 Ok Reg 2074, eff
					 6-25-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 7 - Soonercare › Part 3 - ENROLLMENT CRITERIA › Section 317:25-7-10 - Enrollment with a Primary Care Provider (PCP)

Current through Vol. 41, No. 20, July 1, 2024
(a) All SoonerCare Choice members described
				  in Oklahoma Administrative Code (OAC)
				  317:25-7-12
				  may enroll with a PCP. SoonerCare Choice applicants have the opportunity to
				  select a PCP during the application process. Enrollment with a PCP may begin
				  any day of the month.
(1) The OHCA offers all
				  members the opportunity to choose a PCP from a directory which lists available
				  PCPs.
(2) When a notice of PCP
				  enrollment is sent to a member, the member is advised of the right to change a
				  PCP at any time.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 7 - Soonercare › Part 3 - ENROLLMENT CRITERIA › Section 317:25-7-11 - Geographic coverage areas

Current through Vol. 41, No. 20, July 1, 2024
The PCCM managed care program is
					 statewide.
Added at 13 Ok Reg
					 587, eff 11-21-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at
					 14 Ok Reg 3061, eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98;
					 Amended at 21 Ok Reg 2149, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 7 - Soonercare › Part 3 - ENROLLMENT CRITERIA › Section 317:25-7-12 - Enrollment/eligibility requirements

Current through Vol. 41, No. 20, July 1, 2024
(a)
				  Eligible SoonerCare members mandatorily enrolled in SoonerCare Choice include
				  persons categorically related to AFDC; pregnancy-related services; expansion
				  adult; and aged, blind or disabled who are not dually-eligible for SoonerCare
				  and Medicare.
(b) Children in
				  foster care may voluntarily enroll into SoonerCare Choice.
Added at 13 Ok Reg
					 587, eff 11-21-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at
					 14 Ok Reg 3061, eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98;
					 Amended at 17 Ok Reg 425, eff 11-2-99 (emergency); Amended at 17 Ok Reg 1191,
					 eff 5-11-00; Amended at 26 Ok Reg 401, eff 1-1-09 (emergency); Amended at 26 Ok
					 Reg 2074, eff 6-25-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 7 - Soonercare › Part 3 - ENROLLMENT CRITERIA › Section 317:25-7-13 - Enrollment ineligibility

Current through Vol. 41, No. 20, July 1, 2024
Members in certain categories are excluded from
					 participation in the SoonerCare Choice program. All other members may be
					 enrolled in the SoonerCare Choice program and subject to the provisions of this
					 Subchapter. Members excluded from participation in SoonerCare Choice include:
(1) Individuals receiving services in
				  a long-term care facility, in an Intermediate Care Facility for Individuals
				  with Intellectual Disabilities (ICF/IID), or through a Home and Community Based
				  Waiver;
(2) Individuals in the
				  former foster care children's group [see Oklahoma Administrative Code (OAC)
				  317:35-5-2]
				  ;
(3) Individuals in benefit
				  programs with limited scope, such as Tuberculosis, Family Planning, or
				  pregnancy only;
(4) Non-qualified
				  or ineligible aliens;
(5) Children
				  in subsidized adoptions;
(6)
				  Individuals who are dually-eligible for SoonerCare and Medicare;and/or
(7) Individuals who have other
				  creditable coverage.
Added at 13 Ok Reg
					 587, eff 11-21-95 (emergency); Added at 13 Ok Reg 2313, eff 4-10-96
					 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at 13 Ok Reg 3581,
					 eff 6-18-96 (emergency); Amended at 13 Ok Reg 3565, eff 7-16-96 (emergency);
					 Amended at 14 Ok Reg 1766, eff 5-27-97; Amended at 14 Ok Reg 3061, eff 7-1-97
					 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98; Amended at 17 Ok Reg 425,
					 eff 11-2-99 (emergency); Amended at 17 Ok Reg 1191, eff 5-11-00; Amended at 20
					 Ok Reg 2759, eff 7-1-03 (emergency); Amended at 21 Ok Reg 2149, eff 6-25-04;
					 Amended at 24 Ok Reg 75, eff 8-2-06 (emergency); Amended at 24 Ok Reg 879, eff
					 5-11-07; Amended at 26 Ok Reg 401, eff 1-1-09 (emergency); Amended at 26 Ok Reg
					 2074, eff 6-25-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 7 - Soonercare › Part 5 - ENROLLMENT PROCESS › Section 317:25-7-25 - Member enrollment process

Current through Vol. 41, No. 20, July 1, 2024
(a)
				  SoonerCare eligible individuals whose eligibility is based on one(1) of the aid
				  categories defined in Oklahoma Administrative Code (OAC)
				  317:25-7-12
				  are eligible to enroll with a primary care physician (PCP). Parents or
				  guardians will choose on behalf of minor members in the household. Families
				  with more than one(1) enrollee may choose a different PCP for each family
				  member.
(b) Until the effective
				  date of enrollment with a PCP, services for a newborn are reimbursed at a
				  fee-for-service rate. Upon eligibility determination, newborns may enroll with
				  a PCP who is in general practice, family practice, or general pediatrics.
				  Enrollment materials will advise the parent or guardian of the right to change
				  a PCP after the effective date of enrollment.
(c) A description of the PCCM program and the
				  PCP directory are available on the Oklahoma Health Care Authority's (OHCA)
				  website.
(d) For purposes of
				  determining the member's choice of PCP, the most recent PCP selection received
				  by the OHCA determines the PCP with which the member is enrolled, as long as
				  capacity is available. If capacity is not available or the member does not
				  choose, the member is assigned according to the assignment mechanism as defined
				  by the OHCA. A member who is eligible for SoonerCare Choice but is not
				  assigned, may request enrollment with a PCP by contacting the SoonerCare Help
				  line or through the member's my SoonerCare. org account, if applicable.
(e) PCPs may not refuse an
				  assignment, seek to disenroll a member, or otherwise discriminate against a
				  member on the basis of age, sex, race, physical or mental disability, national
				  origin, or type of illness or condition, unless that condition can be better
				  treated by another provider type, except that Indian Health Service, tribal or
				  urban Indian programs may provide services to members consistent with federal
				  law.
Added at 13 Ok Reg
					 587, eff 11-21-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at
					 13 Ok Reg 3566, eff 7-16-96 (emergency); Amended at 14 Ok Reg 2392, eff 2-5-97
					 (emergency); Amended at 14 Ok Reg 2926, eff 7-11-97; Amended at 14 Ok Reg 3061,
					 eff 7-15-97 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98; Amended at 16
					 Ok Reg 3612, eff 8-3-99 (emergency); Amended at 17 Ok Reg 1191, eff 5-11-00;
					 Amended at 21 Ok Reg 2149, eff 6-25-04; Amended at 26 Ok Reg 401, eff 1-1-09
					 (emergency); Amended at 26 Ok Reg 2074, eff
					 6-25-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 7 - Soonercare › Part 5 - ENROLLMENT PROCESS › Section 317:25-7-26 - Automatic re-enrollment

Current through Vol. 41, No. 20, July 1, 2024
SoonerCare members who become disenrolled from a PCP
					 solely by virtue of becoming temporarily [for three hundred and sixty-five
					 (365) days or less] ineligible for SoonerCare services, may be re-enrolled with
					 their previously-selected PCP, subject to capacity. The member is notified of
					 the enrollment and any right to disenroll from that PCP or change to another
					 PCP.
Added at 13 Ok Reg
					 587, eff 11-21-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at
					 13 Ok Reg 2517, eff 6-27-96; Amended at 13 Ok Reg 3565, eff 7-16-96
					 (emergency); Amended at 14 Ok Reg 1766, eff 5-27-97; Amended at 14 Ok Reg 3061,
					 eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98; Amended at 21
					 Ok Reg 2149, eff 6-25-04; Amended at 26 Ok Reg 401, eff 1-1-09 (emergency);
					 Amended at 26 Ok Reg 2074, eff 6-25-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 7 - Soonercare › Part 5 - ENROLLMENT PROCESS › Section 317:25-7-27 - Changing Primary care providers (PCPs)

Current through Vol. 41, No. 20, July 1, 2024
(a) The Oklahoma Health Care Authority (OHCA)
				  is responsible for changing a member's enrollment from one(1) PCP to another:
(1) Without cause upon the member's request;
				  or
(2) Upon demonstration of good
				  cause. For purposes of this paragraph, good cause means:
(A) Those members who are habitually
				  non-compliant with the documented medical directions of the provider; or
(B) Those members who pose a
				  threat to employees, or other patients of the PCP; or
(C) As a result of a grievance determination
				  by the OHCA; or
(D) In those cases
				  where reliable documentation demonstrates that the physician-patient
				  relationship has so deteriorated that continued service would be detrimental to
				  the member, the provider or both; or
(E) The member's illness or condition would
				  be better treated by another type of provider; or
(3) when the state imposes an intermediate
				  sanction.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 7 - Soonercare › Part 5 - ENROLLMENT PROCESS › Section 317:25-7-28 - Disenrolling a member from SoonerCare Choice

Current through Vol. 41, No. 20, July 1, 2024
(a) The Oklahoma Health Care Authority (OHCA)
				  may disenroll a member from SoonerCare Choice if:
(1) The member is no longer eligible for
				  SoonerCare Choice services;
(2)
				  The member is incarcerated;
(3)
				  The member dies;
(4) Disenrollment
				  is determined to be necessary by the OHCA;
(5) The status of the member changes,
				  rendering him/her ineligible for SoonerCare;
(6) The member is authorized to receive
				  services in a nursing facility, in an Intermediate Care Facility for
				  Individuals with Intellectual Disabilities (ICF/IID) or through a Home and
				  Community Based Waiver;
(7) The
				  member becomes dually-eligible for SoonerCare and Medicare; or
(8) The member becomes covered under other
				  creditable coverage.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 7 - Soonercare › Part 7 - COORDINATION AND CONTINUITY OF CARE › Section 317:25-7-29 - Screening, diagnosis and preventive benefits [Revoked]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg
					 587, eff 11-21-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at
					 13 Ok Reg 3565, eff 7-16-96 (emergency); Amended at 14 Ok Reg 745, eff 12-24-96
					 (emergency); Amended at 14 Ok Reg 1776, eff 5-27-97; Amended at 14 Ok Reg 3061,
					 eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98; Amended at 21
					 Ok Reg 2149, eff 6-25-04; Amended at 26 Ok Reg 401, eff 1-1-09 (emergency);
					 Amended at 26 Ok Reg 2074, eff 6-25-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 7 - Soonercare › Part 7 - COORDINATION AND CONTINUITY OF CARE › Section 317:25-7-30 - Obtaining SoonerCare Choice services

Current through Vol. 41, No. 20, July 1, 2024
(a) Medical services which are not the
				  responsibility of the primary care provider (PCP) to authorize under the care
				  coordination component of SoonerCare Choice, as described in Oklahoma
				  Administrative Code (OAC)
				  317:25-7-10(b),
				  are obtained in the same manner as under the regular SoonerCare fee-for-service
				  program.
(b) For policy regarding
				  out-of-state transportation for primary and specialty care, refer to OAC
				  317:30-3-89 through
				  317:30-3-92.
(c) An American Indian/Alaska
				  Native (AI/AN) eligible SoonerCare member may choose a PCP from the provider
				  directory, including the Indian Health Service (IHS), tribal and urban Indian
				  clinics that participate as SoonerCare PCPs. An AI/AN member in SoonerCare may
				  enroll with a PCP who is not an IHS, tribal, or urban Indian clinic and still
				  use the IHS, tribal, or urban Indian clinic for medical care. A referral from a
				  PCP is needed for services that the clinic cannot provide, except for
				  self-referred services.
(d) If an
				  IHS, tribal, or urban Indian clinic is unable to deliver a service to a
				  SoonerCare enrollee and must refer the member for the service to a non-IHS,
				  tribal, or urban Indian clinic, SoonerCare reimbursement is made only to the
				  specialist when the service has been referred by a PCP, unless PCP
				  authorization is not required under OAC
				  317:25-7-2(c).
(e) A PCP is not obligated to
				  provide emergency services and is not responsible for authorization or approval
				  for payment for members seen in the emergency room. A PCP may not require
				  members to seek prior authorization (PA) for emergency services. However, a PCP
				  may provide emergency care in an emergency setting, within his/her legal scope
				  of practice.
(f) A PA is required
				  for some medical procedures, equipment, medications, and specialty services.
				  The PCP and/or requesting provider are responsible for submitting the PA
				  request to SoonerCare. The member and requesting provider will be notified of
				  SoonerCare's decision to authorize the requested services. A PA is not a
				  guarantee of payment.
Added at 13 Ok Reg
					 587, eff 11-21-95 (emergency); Added at 13 Ok Reg 1633, eff 5-27-96; Amended at
					 13 Ok Reg 3565, eff 7-16-96 (emergency); Amended at 14 Ok Reg 745, eff 12-24-96
					 (emergency); Amended at 14 Ok Reg 1776, eff 5-27-97; Amended at 14 Ok Reg 3061,
					 eff 7-1-97 (emergency); Amended at 15 Ok Reg 1511, eff 5-11-98; Amended at 21
					 Ok Reg 2149, eff 6-25-04; Amended at 26 Ok Reg 401, eff 1-1-09 (emergency);
					 Amended at 26 Ok Reg 2074, eff 6-25-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 7 - Soonercare › Part 9 - REIMBURSEMENT › Section 317:25-7-40 - SoonerCare Choice reimbursement

Current through Vol. 41, No. 20, July 1, 2024
(a)
Care coordination component.
Participating primary care providers
				  (PCPs) are paid a monthly care coordination payment to assure the delivery of
				  medically-necessary preventive and primary care medical services, including
				  referrals for specialty services for an enrolled group of eligible members. The
				  PCP assists the member in gaining access to the health care system and monitors
				  the member's condition, health care needs and service delivery.
(b)
Visit-based fee-for-service
				  component.
SoonerCare Choice covered services provided by a PCP are
				  reimbursed at the SoonerCare fee schedule rate under the procedure code
				  established for each individual service. To the extent services are authorized
				  by a PCP, the Oklahoma Health Care Authority (OHCA) does not make SoonerCare
				  Choice payments for services delivered outside the scope of coverage of the
				  SoonerCare Choice program. In other words, a referral by a PCP does not
				  guarantee payment.
(c)
Incentive program component.
Subject to the availability of funds,
				  OHCA will develop a bonus payment program to encourage coordination of
				  services, to reward improvement in health outcome and promote efficiency.
(d)
SoonerCare
				  networks.
For every PCP who participates in an OHCA approved Health
				  Access Network, a per-member-per-month payment is established by OHCA and paid
				  to the network.
Added at 26 Ok Reg
					 401, eff 1-1-09 (emergency); Added at 26 Ok Reg 2074, eff
					 6-25-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 9 - Health Access Networks › Section 317:25-9-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
The purpose of this Subchapter is to describe the rules
				  governing the Health Access Networks (HANs) participating in the statewide
				  SoonerCare program. The rules provide assurances that HANs will work with
				  providers to coordinate and improve the quality of care for SoonerCare members.
Added at 28 Ok Reg 8,
				  eff 8-13-10 (emergency); Added at 28 Ok Reg 1389, eff
				  6-25-11
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 25 - Soonercare Choice › Subchapter 9 - Health Access Networks › Section 317:25-9-2 - Requirements

Current through Vol. 41, No. 20, July 1, 2024
Health Access Networks (HANs) are non-profit, administrative
				  entities that work with providers to coordinate and improve the quality of care
				  for SoonerCare members. The HAN must:
(1) Be organized for the purpose of
				restructuring and improving the access, quality, and continuity of care to
				SoonerCare members;
(2) Facilitate
				members' access to all levels of care, including primary, outpatient,
				specialty, certain ancillary services, and acute inpatient care, within a
				community or across a broad spectrum of providers across a service region or
				the state through improved access to specialty care, telehealth, and expended
				quality improvement strategies;
(3) Offer care management/care coordination
				to persons with complex health care needs as specified in the state-HAN
				provider agreement.
Added at 28 Ok Reg 8,
				  eff 8-13-10 (emergency); Added at 28 Ok Reg 1389, eff
				  6-25-11