Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 17 - MEDICAL SUPPLIERS › Section 317:30-5-210 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
All eligible medical suppliers must have a current
					 contract with the Oklahoma Health Care Authority (OHCA). The supplier must
					 comply with all applicable state and federal laws. All suppliers of medical
					 supplies, equipment, and appliances must be accredited by a Medicare deemed
					 accreditation organization for quality standards for durable medical equipment
					 (DME) suppliers in order to bill the SoonerCare program. OHCA may make
					 exceptions to this standard based on the exemptions provided by the Centers for
					 Medicare and Medicaid Services (CMS) for Medicare accreditation, if the
					 provider is a government-owned entity, or at a provider's request and at the
					 discretion of OHCA based on access issues and/or agency needs for SoonerCare
					 members. Additionally, unless an exception is granted from the OHCA, all DME
					 providers must meet the following criteria:
(1) DME providers are required to have a
				  physical location in the State of Oklahoma, or within a designated range of the
				  Oklahoma State border, as determined by the OHCA. The OHCA may make exceptions
				  to this requirement if a DME provider provides a specialty item, product, or
				  service, which is not otherwise available to SoonerCare members within the
				  State of Oklahoma. Provider contracts for out-of-state DME providers will be
				  reviewed on a case-by-case basis for specialty items only. The OHCA has
				  discretion and the final authority to approve or deny any provider
				  contract.
(2) DME providers are
				  required to comply with Medicare DME Supplier Standards for medical supplies,
				  equipment, and appliances provided to SoonerCare members, except the
				  requirement to meet surety bond requirements, as specified in
				  42 Code of Federal
				  Regulations (C.F.R.)
				  424.57(c).
(3) Complex rehabilitation technology (CRT)
				  suppliers are considered DME providers. Only CRT suppliers may bill CRT
				  procedure codes. A CRT supplier means a company or entity that:
(A) Is accredited by a recognized accrediting
				  organization as a supplier of CRT;
(B) Is an enrolled Medicare supplier and
				  meets the supplier and quality standards established for DME suppliers,
				  including those for CRT, under the Medicare program;
(C) Employs as a W-2 employee at least one
				  (1) qualified CRT professional, also known as assistive technology
				  professional, for each location to:
(i)
				  Analyze the needs and capacities of complex-needs patients in consultation with
				  qualified health care professionals;
(ii) Participate in selecting appropriate CRT
				  items for such needs and capacities; and
(iii) Provide the complex-needs patient
				  technology related training in the proper use and maintenance of the CRT items.
(D) Requires a qualified
				  CRT professional be physically present for the evaluation and determination of
				  the appropriate CRT;
(E) Has the
				  capability to provide service and repair by qualified technicians for all CRT
				  items it sells; and
(F) Provides
				  written information to the complex-needs patient prior to ordering CRT as to
				  how to access service and repair.