Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 103 - QUALIFIED SCHOOLS AS PROVIDERS OF HEALTH-RELATED SERVICES › Section 317:30-5-1020 - General provisions

Current through Vol. 41, No. 20, July 1, 2024
(a) School-based
				  services are medically necessary health-related and rehabilitative services
				  that are provided by a qualified school provider to a student under the age of
				  twenty-one (21) pursuant to an Individualized Education Program (IEP), in
				  accordance with the Individuals with Disabilities Education Act (IDEA). Payment
				  is made to qualified school providers for delivery of school-based services,
				  provided that such services are, among other things, medically necessary and
				  sufficiently supported by medical records and/or other documentation, as
				  explained below.
(b) An IEP and all
				  relevant supporting documentation, including, but not limited to, the
				  documentation required by Oklahoma Administrative Code (OAC) 317:30-5-1020(c),
				  below, serves as the plan of care for consideration of reimbursement for
				  school-based services. The plan of care must contain, among other things, the
				  signatures, including credentials, of the provider(s) and the direct care staff
				  delivering services under the supervision of the professional; as well as a
				  complete, signed, and current IEP which clearly establishes the type,
				  frequency, and duration of the service(s) to be provided, the specific place of
				  services if other than the school (e.g., field trip, home), and measurable
				  goals for each of the identified needs. Goals must be updated to reflect the
				  current therapy, evaluation, or service that is being provided and billed to
				  SoonerCare.
(1) Except for those services,
				  referenced in OAC
				  317:30-5-1023(b)(2)(H),
				  a plan of care that meets the requirements of OAC 317:30-5-1020(b), above,
				  shall serve as a prior medical authorization for the purpose of providing
				  medically necessary and appropriate school-based services to students.
(2) For the purposes of
				  occupational therapy services, and services for members with speech, hearing,
				  and language disorders, a plan of care that meets the requirements of OAC
				  317:30-5-1020(b), above, may also, in accordance with sections (§§)
				  725.2(H) and 888.4(C) of Title 59 of the Oklahoma Statutes (O.S.) serve as a
				  valid prescription or referral for an initial evaluation and any subsequent
				  services, as is required by Title 42 of Code of Federal Regulations (C.F.R.),
				  § 440.110.
(3) Physical
				  therapy services, by contrast, shall require a signed and dated prescription
				  from the student's physician prior to that student's initial evaluation, in
				  accordance with OAC
				  317:30-5-291(1).
				  Prescriptions for school-based physical therapy must be reauthorized at least
				  annually, and documented within Oklahoma State Department of Education's (OSDE)
				  online IEP system, as set forth in subsection (c), below.