Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 32 - SOONERRIDE NON-EMERGENCY TRANSPORTATION (NEMT) › Section 317:30-5-326.1 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
The following words and terms, when used in this Part
					 shall have the following meaning, unless context clearly indicates otherwise.
"Attendant"
means one (1) of the following:
(1) An employee of a long-term care
				  facility who is provided by and trained by the long-term care facility at the
				  long-term care facility's expense; or
(2) A provider of private duty nursing (PDN)
				  services.
"Emergency /Emergent "
means a serious
					 situation or occurrence that happens unexpectedly and demands immediate action
					 such as a medical condition manifesting itself by acute symptoms of sufficient
					 severity (including severe pain) such that the absence of immediate medical
					 attention could reasonably be expected, by a reasonable and prudent layperson,
					 to result in placing the members' health in serious jeopardy, serious
					 impairment to bodily function, or serious dysfunction of any bodily organ or
					 part.
"Medical escort"
means a family member, legal
					 guardian, or volunteer whose presence is required and medically necessary to
					 assist a member during transport and while at the place of treatment. A medical
					 escort voluntarily accompanies the member during transport and leaves the
					 vehicle at its destination and remains with the member. A medical escort must
					 be of an age of legal majority recognized under Oklahoma State law, an
					 emancipated minor, or a minor who is escorting his or her child to treatment .
"Medically necessary"
means services that meet
					 the criteria described in Oklahoma Administrative Code
					 317:30-3-1(f)
					 (1) - (6), and are not primarily for the convenience of the member.
"Member/eligible member"
means any person
					 eligible for SoonerCare and individuals considered to be Medicare/SoonerCare
					 dual eligible .
"Nearest appropriate facility"
means a medical
					 facility that is generally equipped and legally permitted to provide the needed
					 care for the illness or injury involved that is the closest in geographical
					 proximity to the members' residence with exceptions. In the case of approved
					 hospital services, it also means that a physician or physician specialist is
					 available to provide the necessary care required to treat the member's
					 condition. The fact that a particular physician does or does not have staff
					 privileges in a hospital is not a consideration in determining whether the
					 hospital has appropriate facilities.
"Non-ambulance"
means a carrier that is not an
					 ambulance.
"Non-emergency"
means all reasons for
					 transportation that are not an emergency as defined above.
"Service animal"
means an animal individually
					 trained to work or perform tasks for an individual with a disability. The work
					 or task an animal has been trained to provide must be directly related to the
					 individual's disability.
"SoonerRide Non-Emergency Transportation (NEMT)
					 "
means non-emergency non-ambulance transportation provided statewide
					 within the geographical boundaries of the State of Oklahoma.
"Standing appointments"
means recurring
					 appointments that are scheduled over a significant period of time. Examples
					 include, but are not limited to, dialysis and chemotherapy.
Added at 24 Ok Reg
					 2095, eff 6-25-07; Amended at 29 Ok Reg 1104, eff
					 6-25-12