reglab/statecodes huggingface dataset:
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 83 - THERAPEUTIC FOSTER CARE › Section 317:30-5-745 - Documentation of records

Current through Vol. 41, No. 20, July 1, 2024
Providers must maintain an appropriate records system.
					 Current individual plans of care, case files, and progress notes are maintained
					 in the provider's files during the time the member is receiving services. All
					 services must be reflected by documentation in the records. Documentation of
					 services must include all of the following:
(1) The date the service was provided;
(2) The beginning and ending time
				  the service was provided;
(3) A
				  description of the member's response to the service;
(4) The type of service provided (individual,
				  group, or family session; group rehabilitative treatment; social skills
				  (re)development; basic living skills (re)development; crisis behavior
				  management and redirection; or discharge planning); and
(5) The dated signature with credentials of
				  the person providing the service. If the service is performed by a licensure
				  candidate, it must be countersigned by the licensed behavioral health
				  professional (LBHP) who is responsible for the member's care. Refer to Oklahoma
				  Administrative Code (OAC)
				  317:30-5-742.2.
				  (2)(A).
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 17 Ok Reg 2402, eff 6-26-00; Amended at 20 Ok Reg 523, eff
					 12-1-02 (emergency); Amended at 20 Ok Reg 1216, eff 5-27-03; Amended at 23 Ok
					 Reg 2566, eff 6-25-06; Amended at 27 Ok Reg 1360, eff 4-21-10 (emergency);
					 Amended at 28 Ok Reg 1419, eff 6-25-11
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 83 - THERAPEUTIC FOSTER CARE › Section 317:30-5-746 - Prior authorization and appeal of prior authorization decision

Current through Vol. 41, No. 20, July 1, 2024
(a) All behavioral
				  health services must be prior authorized by the Oklahoma Health Care Authority
				  (OHCA) or its designated agent before the service is rendered by an eligible
				  provider. Without prior authorization, payment is not authorized.
(b) If a denial decision is made, an appeal
				  may be initiated by the member or the member's legal guardian. The denial can
				  be appealed to the OHCA within thirty (30) calendar days of the receipt of the
				  notification of the denial by the OHCA or its designated agent.
Added at 17 Ok Reg
					 2402, eff 6-26-00; Amended at 23 Ok Reg 771, eff 3-9-06 (emergency); Amended at
					 23 Ok Reg 2440, eff 6-25-06; Amended at 24 Ok Reg 2857, eff 7-1-07 (emergency);
					 Amended at 25 Ok Reg 1200, eff 5-25-08
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 84 - INTENSIVE TREATMENT FAMILY CARE › Section 317:30-5-750 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
The following words or terms used in this Part shall have
					 the following meaning, unless the context clearly indicates otherwise:
"Intensive treatment family care (ITFC)
					 agency"
means an agency that provides foster care as defined in Section
					 1355.20 of Title 45 of the Code of Federal Regulation, as twenty-four (24) hour
					 substitute care for children placed away from their parents or guardians and
					 for whom the title IV-E agency has placement and care responsibility. ITFC
					 settings are foster family homes.
"Intensive treatment family care (ITFC) home"
means an agency-supervised, private family home in which foster parents [at
					 least one (1) parent must be a stay-at home parent] have been trained to
					 provide individualized, structured services in a safe, nurturing family-living
					 environment. These services are provided to children with severe behavioral and
					 emotional health needs. They may also present a secondary physical,
					 developmental, intellectual, and/or social disorder that is supported alongside
					 the mental health needs of the member. These members require a higher level of
					 care that cannot be provided in the traditional foster care or TFC home. ITFC
					 homes provide the higher level of care needed for these children and help
					 prevent placement in a more restrictive setting, including an inpatient
					 setting.
"Intensivetreatment family care (ITFC) model"
means a model in which children in the ITFC environment receive intensive
					 individualized behavioral health and other support services from qualified
					 staff. Because ITFC members require exceptional levels of skill, time, and
					 supervision, the number of unrelated children placed per home is limited; no
					 more than one (1) ITFC member may be placed in a home at any one (1) time
					 unless additional cases are specifically authorized by Child Welfare Services
					 (CWS) of the Oklahoma Department of Human Services (OKDHS), or Oklahoma Office
					 of Juvenile Affairs (OJA).
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 84 - INTENSIVE TREATMENT FAMILY CARE › Section 317:30-5-750.1 - Eligible providers and requirements

Current through Vol. 41, No. 20, July 1, 2024
(a)
ITFC agency.
Eligible ITFC
				  agencies must have:
(1) Current certification
				  from the Oklahoma Department of Human Services (OKDHS) as a child placing
				  agency;
(2) A contract with the
				  Child Welfare Division of OKDHS, or Oklahoma Office of Juvenile Affairs (OJA);
(3) A contract with the Oklahoma
				  Health Care Authority (OHCA); and
(4) A current accreditation status
				  appropriate to provide behavioral health services in a foster care setting
				  from:
(A) The Joint Commission; or
(B) The Commission on Accreditation of
				  Rehabilitative Facilities (CARF); or
(C) The Council on Accreditation (COA).
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 84 - INTENSIVE TREATMENT FAMILY CARE › Section 317:30-5-750.2 - Provider selection

Current through Vol. 41, No. 20, July 1, 2024
Parents who retain legal custody of an ITFC member may
					 select any eligible ITFC agency as the provider of services. In the case of
					 members in the custody of the State of Oklahoma, the State, acting in its
					 custodial role, selects the ITFC agency.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 84 - INTENSIVE TREATMENT FAMILY CARE › Section 317:30-5-752 - Description of services

Current through Vol. 41, No. 20, July 1, 2024
(a) Treatment
				  services must be provided in the least restrictive, non-institutional
				  therapeutic environment. The ITFC setting is restorative in nature, allowing
				  members with severe behavioral and emotional health needs, who may also present
				  a secondary physical, developmental, intellectual, and/or social disorder that
				  is supported alongside the mental health needs, to develop the necessary
				  control to function in a less restrictive setting.
(b) Behavioral health services must include
				  an individual plan of care (IPC) for each member served. The IPC requirements
				  are set out in Oklahoma Administrative Code (OAC)
				  317:30-5-753.
(c) Treatment services in an ITFC
				  must include at least two (2) hours of individual, family, and/or group therapy
				  per week, as set forth in OAC
				  317:30-5-753(3).
				  Treatment may also include, but is not limited to, an array of the following
				  services:
(1) Substance abuse/chemical
				  dependency education, prevention, and therapy;
(2) Psychosocial rehabilitation and support
				  services;
(3) Behavior management;
(4) Crisis intervention; and
(5) Case management.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 84 - INTENSIVE TREATMENT FAMILY CARE › Section 317:30-5-754 - Service quality review (SQR)

Current through Vol. 41, No. 20, July 1, 2024
(a)
				  Providers must maintain an appropriate records system. Current individual plans
				  of care, case files, and progress notes are maintained in the provider's files
				  during the time the member is receiving services. All services must be
				  reflected by documentation in the records. Documentation of services must
				  include all of the following:
(1) The date
				  the service was provided;
(2) The
				  beginning and ending time the service was provided;
(3) A description of the member's response to
				  the service;
(4) The type of
				  service provided (individual, group, or family session; group rehabilitative
				  treatment; social skills (re)development; basic living skills (re)development;
				  crisis behavior management and redirection; or discharge planning); and
(5) The dated signature with
				  credentials of the person providing the service.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 84 - INTENSIVE TREATMENT FAMILY CARE › Section 317:30-5-755 - Billing

Current through Vol. 41, No. 20, July 1, 2024
(a) Claims must be
				  submitted in accordance with guidelines found at Oklahoma Administrative Code
				  (OAC)
				  317:30-3-11,
				  317:30-3-11.1
				  and
				  317:30-3-20.
(b) Claims for dually eligible
				  individuals (Medicare/Medicaid) should be filed directly with the Oklahoma
				  Health Care Authority (OHCA).
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 84 - INTENSIVE TREATMENT FAMILY CARE › Section 317:30-5-756 - Reimbursement

Current through Vol. 41, No. 20, July 1, 2024
(a) ITFC services
				  will be paid at the current fee-for-service (FFS) rate. Services provided to a
				  member without a written individual plan of care (IPC) as described in Oklahoma
				  Administrative Code (OAC)
				  317:30-5-753
				  will not be reimbursed.
(b)
				  Additional services may require prior authorization by the OHCA, or its
				  designated agent. Refer to OAC
				  317:30-3-31.
				  Documentation must be provided to ensure that services are not duplicative. If
				  additional services are approved for a member in state custody, the Oklahoma
				  Department of Human Services (OKDHS), or Oklahoma Office of Juvenile Affairs
				  (OJA) will collaborate with the provider of such services as directed by the
				  OHCA.
(c) Reimbursement for ITFC
				  services is not available for the following:
(1) Room and board;
(2) Educational costs;
(3) Supported employment;
(4) Inpatient psychiatric services;
(5) Respite care;
(6) Day treatment services;
(7) Partial hospitalization services; and
(8) Intensive outpatient services.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 84 - INTENSIVE TREATMENT FAMILY CARE › Section 317:30-5-757 - Prior authorization and appeal of prior authorization decision

Current through Vol. 41, No. 20, July 1, 2024
(a) All behavioral
				  health services must be prior authorized by the Oklahoma Health Care Authority
				  (OHCA) or its designated agent before the service is rendered by an eligible
				  provider. Without prior authorization, payment is not authorized.
(b) If a denial decision is made, an appeal
				  may be initiated by the member or the member's legal guardian. The denial can
				  be appealed to the OHCA within thirty (30) calendar days of the receipt of the
				  notification of the denial by the OHCA or its designated agent.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 85 - ADVANTAGE PROGRAM WAIVER SERVICES › Section 317:30-5-760 - ADvantage program

Current through Vol. 41, No. 20, July 1, 2024
The ADvantage Program is a Medicaid Home and Community
					 Based Services (HCBS) Waiver used to finance noninstitutional long-term care
					 services through Oklahoma's Medicaid program for elderly and disabled
					 individuals. To receive ADvantage Program services, individuals must meet the
					 nursing facility (NF) level of care (LOC) criteria, be age 65 years or older,
					 or age 21 or older if physically disabled and not developmentally disabled, or
					 if developmentally disabled and between the ages of 21 and 65, not have an
					 intellectual disability or a cognitive impairment related to the developmental
					 disability. ADvantage Program members must be Medicaid eligible. The number of
					 members of ADvantage services is limited.
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 14 Ok Reg 3529, eff 7-23-97 (emergency); Amended at 15 Ok
					 Reg 1528, eff 5-11-98; Amended at 18 Ok Reg 265, eff 11-21-00 (emergency);
					 Amended at 18 Ok Reg 1130, eff 5-11-01; Amended at 25 Ok Reg 660, eff 2-1-08
					 through 7-14-08 (emergency)1; Amended at 25 Ok Reg
					 2685, eff 7-25-08; Amended at 29 Ok Reg 1076, eff
					 6-25-12
1This emergency action expired
					 on 7-14-08 before being superseded by a permanent action. Upon expiration of an
					 emergency amendatory action, the last effective permanent text is reinstated.
					 Therefore, on 7-15-08 (after the 7-14-08 expiration of the emergency action),
					 the text of 317:30-5-760 reverted back to the permanent text that became
					 effective 5-11-01, as was last published in the 2006 Edition of the OAC, and
					 remained as such until amended again by permanent action on
					 7-25-08.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 85 - ADVANTAGE PROGRAM WAIVER SERVICES › Section 317:30-5-761 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
ADvantage ProgramADvantage Administration (AA) certifies
					 ADvantage Program service providers, except pharmacy providers, and they have a
					 current signed SoonerCare (Medicaid) contract on file with the Oklahoma Health
					 Care Authority (OHCA), the State Medicaid agency.
(1) The provider programmatic-certification
				  process verifies the provider meets licensure, certification, and training
				  standards as specified in the waiver document. All providers, except nursing
				  facility (NF) respite; medical equipment and supplies; and environmental
				  modification providers, must obtain programmatic-certification to be ADvantage
				  program certified.
(2) The provider
				  financial-certification verifies the provider uses sound business management
				  practices and has a financially-stable business. All providers, except for NF
				  respite; medical equipment and supplies; and environmental modification
				  providers, will obtain financial certification to be ADvantage program
				  certified.
(3) At minimum, provider
				  financial certification is re-evaluated annually.
(4) Providers may fail to gain or may lose
				  ADvantage program certification due to failure to meet programmatic or
				  financial standards.
(5) All
				  provider service types must agree to the Conditions of Provider Participation
				  and Service Standards.
(6) The
				  Oklahoma Human Services (OKDHS) Community Living, Aging and Protective Services
				  (CAP) does not authorizethe member's CD-PASS services provider to also have an
				  active power of attorney for the member.
(7) OKDHS CAP may authorize a member's
				  legally-responsible spouse or legal guardian to be SoonerCare (Medicaid)
				  reimbursed, per 1915(c) ADvantage Program as a personal care, service provider.
				  Authorization for a spouse or legal guardian as a provider requires the
				  criteria in (A) through (D)of this paragraph and monitoring provisions to be
				  met.
(A) Authorization for a spouse or legal
				  guardian to be a member's care provider may occur only when the member is
				  offered provider choice and documentation demonstrates:
(i) No provider included on the Certified
				  Agency Report (CAR)or in the member's service area, has available staffing.
				  Documentation also affirms all area providers attempt to employ staff to serve;
				  or
(ii) The member's needs are so
				  complex that unless the spouse or legal guardian provides the care, the
				  member's risk level would increase; and
(iii) It is mentally or physically
				  detrimental for someone other than the spouse or legal guardian to provide
				  care. This is evidenced by documentation from a qualified clinician or medical
				  provider, such as a physician or licensed psychologist.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 85 - ADVANTAGE PROGRAM WAIVER SERVICES › Section 317:30-5-762 - Coverage

Current through Vol. 41, No. 20, July 1, 2024
Individuals receiving ADvantage Program services must be
					 determined eligible for the program and must have an approved person-centered
					 service plan. Any ADvantage Program service provided must be listed on the
					 approved person-centered service plan to prevent institutionalization of the
					 member. Waiver services that are expansions of Oklahoma Medicaid State Plan
					 services may only be provided after the member has exhausted services available
					 under the State Plan.
(1)
				  Consumer-Directed Personal Assistance Services and Supports (CD-PASS), services
				  are available to ADvantage Program members in every county.
(2) ADvantage case managers provide
				  information and materials that explain the CD-PASS service option to members.
				  The ADvantage Administration (AA) provides information and material on CD-PASS
				  to case managers for distribution to members.
(3) The member may request CD-PASS services
				  from his or her case manager or call an AA-maintained toll-free number to
				  request CD-PASS services.
(4) The
				  AA uses the following criteria to determine an ADvantage member's service
				  eligibility to participate in CD-PASS , the:
(A) member's health and safety with CD-PASS
				  services can reasonably be assured based on a review of service history records
				  and review of a member's capacity and readiness to assume employer
				  responsibilities under CD-PASS with any one of the following findings as basis
				  to deny a request for CD-PASS due to inability to assure member health and
				  safety , when the member:
(i) does not have
				  the ability to make decisions about his/her care or service planning and the
				  member's authorized representative is unwilling to assume CD-PASS
				  responsibilities ; or
(ii) is
				  unwilling to assume responsibility, or to enlist an authorized representative
				  to assume responsibility, in one or more areas of CD-PASS , such as in service
				  planning assuming the role of employer of the personal services assistant (PSA)
				  or advanced personal services assistant (APSA) provider, in monitoring and
				  managing health or in preparation for emergency backup ; or
(iii) member has a recent history of
				  self-neglect or self-abuse as evidenced by Adult Protective Services
				  intervention within the past 12 months and does not have an authorized
				  representative with capacity to assist with CD-PASS responsibilities;
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 85 - ADVANTAGE PROGRAM WAIVER SERVICES › Section 317:30-5-763 - Description of services

Current through Vol. 41, No. 20, July 1, 2024
Services included in the ADvantage program are:
(1)
Case management.
(A) Case management services, regardless of
				  payment source, assist a member to gain access to medical, social, educational,
				  or other services that may benefit him or her to maintain health and safety.
				  Case managers:
(i) Initiate and oversee
				  necessary assessments and reassessments to establish or reestablish waiver
				  program eligibility;
(ii) Develop
				  the member's comprehensive person-centered service plan, listing only the
				  services necessary to prevent institutionalization of the member, as determined
				  through the assessments;
(iii)
				  Initiate the addition of necessary services or deletion of unnecessary
				  services, as dictated by the member's condition and available support;
				  and
(iv) Monitor the member's
				  condition to ensure delivery and appropriateness of services and initiate
				  person-centered service plan reviews. Case managers submit an individualized
				  Services Backup Plan, on all initial service plans, annually at reassessment,
				  and on updates as appropriate throughout the year, reflecting risk factors and
				  measures in place to minimize risks. When a member requires hospital or nursing
				  facility (NF) services, the case manager:
(I)
				  Assists the member in accessing institutional care and, as appropriate,
				  periodically monitors the member's progress during the institutional
				  stay;
(II) Helps the member
				  transition from institution to home by updating the person-centered service
				  plan;
(III) Prepares services to
				  start on the date the member is discharged from the institution; and
(IV) Must meet ADvantage program minimum
				  requirements for qualification and training prior to providing services to
				  ADvantage members.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 85 - ADVANTAGE PROGRAM WAIVER SERVICES › Section 317:30-5-763.1 - Medicaid agency monitoring of the ADvantage program

Current through Vol. 41, No. 20, July 1, 2024
(a) The OHCA's monitoring of the ADvantage
				  Program is a quality assurance activity. The agency evaluates the ADvantage
				  program on a continual basis to ensure quality, through the review of various
				  performance measures set forth in the waiver document. The areas evaluated
				  include:
(1) Member eligibility
				  determination;
(2) Member "freedom
				  of choice";
(3) Member health and
				  welfare;
(4) ADvantage certified
				  and SoonerCare contracted providers on the plan;
(5) Member acceptance of the plan;
(6) Qualified case managers;
(7) Plan services are goal-oriented services;
				  and,
(8) Plan of care costs are
				  within cost cap guidelines.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 87 - BIRTHING CENTERS [Revoked] › Section 317:30-5-890 - Eligible providers [Revoked]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg 751, eff 1-5-95 through 7-14-95
						(emergency) ; Added at 12 Ok Reg 3131, eff 7-27-95 ; Amended at 30 Ok Reg 1143,
						eff 7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 87 - BIRTHING CENTERS [Revoked] › Section 317:30-5-890.1 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
The following words or terms, when used in this Part, shall
					 have the following meaning, unless the context clearly indicates
					 otherwise:
"Birthing center"
means a freestanding
					 facility, place or institution, which is maintained or established primarily
					 for the purpose of providing services of a certified midwife or licensed
					 medical doctor to assist or attend a woman in delivery and birth, and where a
					 woman is scheduled in advance to give birth following a normal, uncomplicated,
					 low-risk pregnancy.
"Certified Nurse Midwife"
means a person
					 educated in the discipline of nursing and midwifery, certified by the American
					 College of Nurse-Midwives (ACNM) and licensed by the state to engage in the
					 practice of midwifery and as a registered nurse.
"Low-risk"
means a normal, uncomplicated
					 prenatal course as determined by adequate prenatal care and prospects for a
					 normal, uncomplicated birth as defined by generally accepted criteria of
					 maternal and fetal health.
"Newborn"
means an infant during the first 28
					 days following birth.
Added at 30 Ok Reg 1143, eff
						7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 87 - BIRTHING CENTERS [Revoked] › Section 317:30-5-891 - Coverage by category [Revoked]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg 751, eff 1-5-95 through 7-14-95
						(emergency) ; Added at 12 Ok Reg 3131, eff 7-27-95 ; Amended at 30 Ok Reg 1143,
						eff 7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 87 - BIRTHING CENTERS [Revoked] › Section 317:30-5-892 - Reimbursement [Revoked]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 17 Ok Reg 3361, eff 8-1-00 (emergency); Amended at 18 Ok
					 Reg 1130, eff 5-11-01; Amended at 19 Ok Reg 2134, eff
					 6-27-02
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 87 - BIRTHING CENTERS [Revoked] › Section 317:30-5-893 - Billing [Revoked]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 89 - RADIOLOGICAL MAMMOGRAPHER › Section 317:30-5-900 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
The mammographer must be Medicare certified and have
					 accreditation by the American College of Radiology for Mammography. Providers
					 must have a current contract on file with the Oklahoma Health Care
					 Authority.
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 89 - RADIOLOGICAL MAMMOGRAPHER › Section 317:30-5-901 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
(a)
Adults.
Medically necessary screening mammography is a covered
				  benefit. Additional follow-up mammograms are covered when medically
				  necessary.
(b)
Children.
Coverage for children is the same as for
				  adults.
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 14 Ok Reg 3077, eff 7-1-97 (emergency); Amended at 15 Ok
					 Reg 1528, eff 5-11-98; Amended at 23 Ok Reg 2571, eff 6-25-06; Amended at 24 Ok
					 Reg 303, eff 12-1-06 (emergency); Amended at 24 Ok Reg 895, eff
					 5-11-07
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 89 - RADIOLOGICAL MAMMOGRAPHER › Section 317:30-5-902 - Vocational rehabilitation [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Revoked at 19 Ok Reg 2134, eff 6-27-02
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 89 - RADIOLOGICAL MAMMOGRAPHER › Section 317:30-5-903 - Individuals eligible for Part B of Medicare

Current through Vol. 41, No. 20, July 1, 2024
Payment is made utilizing the Medicaid allowable for
					 comparable services.
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 19 Ok Reg 2922, eff 7-1-02 (emergency); Amended at 20 Ok
					 Reg 1193, eff 5-27-03
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 89 - RADIOLOGICAL MAMMOGRAPHER › Section 317:30-5-904 - Covered procedures [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 14 Ok Reg 3077, eff 7-1-97 (emergency); Amended at 15 Ok
					 Reg 1528, eff 5-11-98; Revoked at 23 Ok Reg 2571, eff
					 6-25-06
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 89 - RADIOLOGICAL MAMMOGRAPHER › Section 317:30-5-905 - Reimbursement

Current through Vol. 41, No. 20, July 1, 2024
Reimbursement to mammographers will be based on the current
					 allowed charge for radiologic procedures.
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 90 - DIAGNOSTIC TESTING ENTITIES › Section 317:30-5-907 - Provider requirements

Current through Vol. 41, No. 20, July 1, 2024
(a) An
				  Independent Diagnostic Testing Facility (IDTF) is either a fixed location or
				  mobile entity independent of a hospital or physician's office where diagnostic
				  services are performed by licensed certified non-physician personnel under
				  appropriate physician supervision. Diagnostic testing entities must be Medicare
				  certified as Mobile X-ray or an IDTF and have a current contract on file with
				  the Oklahoma Health Care Authority.
(b) An IDTF must have one or more supervising
				  physicians who are responsible for the direct and ongoing oversight of the
				  quality of the testing performed, the proper operation and calibration of the
				  equipment used to perform tests and the qualifications of non-physician
				  personnel who use the equipment.
(c) An IDTF enrolled in the SoonerCare
				  program must comply with all applicable federal regulations, including
				  applicable provisions of
				  42
				  CFR 410.32 and
				  42 CFR
				  410.33.
Added at 22 Ok Reg
					 168, eff 10-6-04 (emergency); Added at 21 Ok Reg 2494, eff
					 7-11-05
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 90 - DIAGNOSTIC TESTING ENTITIES › Section 317:30-5-907.1 - Coverage and limitations

Current through Vol. 41, No. 20, July 1, 2024
(a)
Adults.
For IDTF services to be covered:
(1) Services must be medically
				  necessary;
(2) The treating
				  physician's order must specify the procedures to be performed and the reason
				  for the service; and
(3) The IDTF
				  may not add any procedures based on internal protocols without a written order
				  by the treating physician.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 90 - DIAGNOSTIC TESTING ENTITIES › Section 317:30-5-907.2 - Individuals eligible for Part B of Medicare

Current through Vol. 41, No. 20, July 1, 2024
Payment is made utilizing the Medicaid allowable for
					 comparable services.
Added at 22 Ok Reg
					 168, eff 10-6-04 (emergency); Added at 21 Ok Reg 2494, eff
					 7-11-05
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 90 - DIAGNOSTIC TESTING ENTITIES › Section 317:30-5-907.3 - Reimbursement

Current through Vol. 41, No. 20, July 1, 2024
(a) Diagnostic
				  procedure are reimbursable if the services were rendered to a non-hospital
				  patient and the IDTF provided all services (professional and technical)
				  associated with the total procedure as defined in the CPT. When separate CPT
				  codes itemize a service by its professional and technical components, the IDTF
				  may bill and be reimbursed for the components of the procedure it actually
				  performed.
(b) Payment is made for
				  the technical component on outpatient diagnostic procedures in accordance with
				  the guidelines set forth in OAC
				  317:30-5-24.
Added at 22 Ok Reg
					 168, eff 10-6-04 (emergency); Added at 21 Ok Reg 2494, eff
					 7-11-05
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 91 - TUBERCULOSIS CLINIC SERVICES [Revoked] › Section 317:30-5-910 - Eligible providers [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Revoked at 24 Ok Reg 2070, eff 6-25-07
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 91 - TUBERCULOSIS CLINIC SERVICES [Revoked] › Section 317:30-5-911 - Coverage by category [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Revoked at 24 Ok Reg 2070, eff 6-25-07
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 91 - TUBERCULOSIS CLINIC SERVICES [Revoked] › Section 317:30-5-912 - Covered services [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Revoked at 19 Ok Reg 2134, eff 6-27-02
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 91 - TUBERCULOSIS CLINIC SERVICES [Revoked] › Section 317:30-5-913 - Billing [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Revoked at 24 Ok Reg 2070, eff 6-25-07
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 93 - CASE MAAGEMENT SERVICES FOR PERSONS INFECTED WITH TUBERCULOSIS [Revoked] › Section 317:30-5-920 - Eligible providers [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Revoked at 24 Ok Reg 2070, eff 6-25-07
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 93 - CASE MAAGEMENT SERVICES FOR PERSONS INFECTED WITH TUBERCULOSIS [Revoked] › Section 317:30-5-921 - Coverage by category [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Revoked at 24 Ok Reg 2070, eff 6-25-07
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 93 - CASE MAAGEMENT SERVICES FOR PERSONS INFECTED WITH TUBERCULOSIS [Revoked] › Section 317:30-5-922 - Billing [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Revoked at 19 Ok Reg 2134, eff 6-27-02
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 93 - CASE MAAGEMENT SERVICES FOR PERSONS INFECTED WITH TUBERCULOSIS [Revoked] › Section 317:30-5-923 - Reimbursement [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 19 Ok Reg 2134, eff 6-27-02; Revoked at 24 Ok Reg 2070, eff
					 6-25-07
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 93 - CASE MAAGEMENT SERVICES FOR PERSONS INFECTED WITH TUBERCULOSIS [Revoked] › Section 317:30-5-924 - Documentation of records [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Revoked at 24 Ok Reg 2070, eff 6-25-07
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 95 - AGENCY PERSONAL CARE SERVICES › Section 317:30-5-950 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
Reimbursement for personal care is made only to agencies
					 that are certified as home care agency providers by the Oklahoma State
					 Department of Health and are certified by the ADvantage Administration as
					 meeting applicable federal, state and local laws, rules and regulations. In
					 order to be eligible for reimbursement, the home care agency must have an
					 approved provider agreement on file with the Oklahoma Health Care Authority,
					 per Oklahoma Administrative Code (OAC)
					 317:30-3-2.
					 Service time of personal care is documented through thedesignated statewide
					 Electronic Visit Verification (EVV) system when services are provided in the
					 member's home. The home care agency is required to use the EVV system. Refer to
					 OAC 317:30-3-34(7) for additional procedures for EVV system failure or EVV
					 system unavailability. Refer to OAC
					 317:35-17-22
					 for additional instructions.
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 18 Ok Reg 2962, eff 5-17-01 (emergency); Amended at 19 Ok
					 Reg 1067, eff 5-13-02; Amended at 26 Ok Reg 994, eff 5-1-09 (emergency);
					 Amended at 27 Ok Reg 621, eff 1-14-10 (emergency); Amended at 27 Ok Reg 1466,
					 eff 6-11-10
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 95 - AGENCY PERSONAL CARE SERVICES › Section 317:30-5-951 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
SoonerCare payment is made to agencies, on behalf of
					 SoonerCare members, for personal care services (PC services) provided in the
					 member's home. Personal Care services may be provided in an educational or
					 employment setting to assist the member in achieving vocational goals
					 identified on an approved care plan. Personal care services preventor minimize
					 a member's physical health regression and deterioration. Tasks performed during
					 the provision of PC services include, but are not limited to, assisting an
					 individual in performing tasks of personal hygiene, dressing and medication.
					 Tasks may also include meal preparation, light housekeeping, errands, and
					 laundry directly related to the recipient's personal care needs. Personal care
					 does not include the provision of care of a technical nature. For example,
					 tracheal suctioning, bladder catheterization, colostomy irrigation and
					 operation/maintenance of technical machinery is not performed as part of PC
					 services. PC skilled nursing service is an assessment of the member's needs to
					 determine the frequency of PC services and tasks performed, development of a PC
					 service care plan to meet identified personal care needs, service delivery
					 oversight and annual re-assessment and updating of care plan. It may also
					 include more frequent re-assessment and updating of the care plan if changes in
					 the member's needs require.
(1)
Adults.
Payment for services provided by a PC services agency is
				  made on behalf of eligible individuals who have needs requiring the service in
				  accordance with OAC
				  317:35-15-4
				  as determined through an assessment utilizing the Uniform Comprehensive
				  Assessment Tool (UCAT). Before PC services can begin the individual must:
(A) require a care plan involving the
				  planning and administration of services delivered under the supervision of
				  professional personnel;
(B) have a
				  physical impairment or combination of physical and mental
				  impairments;
(C) lack the ability
				  to meet personal care needs without additional supervision or assistance, or to
				  communicate needs to others; and
(D) require assistance, not of a technical
				  nature, to prevent or minimize physical health regression and
				  deterioration.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 95 - AGENCY PERSONAL CARE SERVICES › Section 317:30-5-952 - Prior authorization

Current through Vol. 41, No. 20, July 1, 2024
Eligible members receiving personal care services must have
					 an approved care plan developed by a PC services skilled nurse. For persons
					 receiving ADvantage Program services, the nurse works with the member's
					 ADvantage Program Case Manager to develop the care plan. The amount and
					 frequency of the service, to be provided to the member, is listed on the care
					 plan. The amount and frequency of PC services is approved by the OKDHS nurse or
					 authorized in the ADvantage Program Service Plan. At the time of a member's
					 initial referral to a PC services agency, OKDHS/ASD authorizes PC services,
					 skilled nursing for PC services, needs assessment and care plan development.
					 The number of units of PC services or PC skilled nursing the member is eligible
					 to receive is limited to the amounts approved on the care plan as authorized by
					 OKDHS/ASD. Care plans are authorized for no more than one year from the date of
					 care plan authorization. Services provided without prior authorization are not
					 compensable.
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 18 Ok Reg 2962, eff 5-17-01 (emergency); Amended at 19 Ok
					 Reg 1067, eff 5-13-02; Amended at 20 Ok Reg 1942, eff 6-26-03; Amended at 20 Ok
					 Reg 2892, eff 7-1-03 (emergency); Amended at 21 Ok Reg 2210, eff 6-25-04;
					 Amended at 24 Ok Reg 83, eff 8-2-06 (emergency); Amended at 24 Ok Reg 932, eff
					 5-11-07; Amended at 26 Ok Reg 756, eff 4-1-09 (emergency); Amended at 27 Ok Reg
					 963, eff 5-13-10
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 95 - AGENCY PERSONAL CARE SERVICES › Section 317:30-5-953 - Billing

Current through Vol. 41, No. 20, July 1, 2024
A billing unit for personal care services provided by a
					 home care agency is fifteen (15) minutes of service delivery and equals a
					 visit. Billing procedures for personal care services are contained in the
					 Oklahoma Medicaid Management Information Systems (OKMMIS) Billing and Procedure
					 Manual. Service time for personal care and nursing is documentedthrough the
					 designated statewide Electronic Visit Verification (EVV) system.Refer to OAC
					 317:30-3-34(7) for additional procedures for EVV system failure or EVV system
					 unavailability.
Added at 12 Ok Reg
					 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
					 7-27-95; Amended at 19 Ok Reg 2134, eff 6-27-02; Amended at 20 Ok Reg 1942, eff
					 6-26-03; Amended at 24 Ok Reg 83, eff 8-2-06 (emergency); Amended at 24 Ok Reg
					 932, eff 5-11-07; Amended at 26 Ok Reg 543, eff 2-1-09 (emergency); Amended at
					 26 Ok Reg 2127, eff 6-25-09