Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 110 - INDIAN HEALTH SERVICES, TRIBAL PROGRAMS, AND URBAN INDIAN CLINICS (I/T/Us) › Section 317:30-5-1087 - Terms and definitions

Current through Vol. 41, No. 20, July 1, 2024
The following words and terms, when used in this Part,
					 have the following meaning, unless the context clearly indicates otherwise:
(1)
"American Indian/Alaska
				  Native (AI/AN)"
means an individual of Native American descent who has
				  or is eligible for a Certificate of Degree of Indian Blood (CDIB)
				  card.
(2)
"Audio-only health
				  service delivery"
means the delivery of healthcare services through the
				  use of audio-only telecommunications, permitting real-time communication
				  between a patient and the provider, for the purpose of diagnosis, consultation,
				  or treatment, and does not include the use of facsimile or email nor the
				  delivery of health care services that are customarily delivered by audio-only
				  telecommunications and customarily not billed as separate services by the
				  provider, such as the sharing of laboratory results. This definition includes
				  health services delivered via audio-only when audio-visual is unavailable or
				  when a member chooses audio-only.
(3)
"Behavioral Health services"
means professional medical services for the treatment of a mental health and/or
				  substance use disorder.
(4)
"CFR"
means the Code of Federal Regulations.
(5)
"CMS"
means the Centers for
				  Medicare and Medicaid Services.
(6)
"Encounter"
means a contact between a health care professional and
				  an IHS eligible SoonerCare member for the provision of medically necessary
				  Title XIX or Title XXI covered services through an IHS or Tribal 638 facility
				  or an urban Indian clinic within a twenty-four (24) hour period ending at
				  midnight, as documented in the patient's record.
(7)
"Licensed Behavioral Health
				  Professional (LBHP)"
means a licensed psychologist, licensed clinical
				  social worker (LCSW), licensed marital and family therapist (LMFT), licensed
				  professional counselor (LPC), licensed behavioral practitioner (LBP) or
				  licensed alcohol and drug counselor (LADC).
(8)
"OHCA"
means the Oklahoma
				  Health Care Authority.
(9)
"OMB rate"
means the Medicaid reimbursement rate negotiated
				  between CMS and IHS. Inpatient and outpatient Medicaid reimbursement rates for
				  I/T/Us are published annually in the Federal Register or Federal Register
				  Notices. The outpatient rate is also known as the I/T/U encounter rate. The
				  encounter rate is available only to I/T/U facilities that appear on the IHS
				  maintained listing of IHS-operated and Indian health care facilities operating
				  under a 638 agreement. It is the sole responsibility of the facility to
				  petition IHS for placement on this list.
(10)
"Physician"
means a doctor
				  of medicine or osteopathy legally authorized to practice medicine and surgery
				  or who is a licensed physician employed by the Federal Government in an IHS
				  facility or who provides services in a 638 Tribal Facility.
(11)
"State Administering Agency
				  (SAA)"
is the Oklahoma Health Care Authority.
(12)
"Telehealth"
means the
				  practice of health care delivery, diagnosis, consultation, evaluation and
				  treatment, transfer of medical data or exchange of medical education
				  information by means of a two-way, real-time interactive communication, not to
				  exclude store and forward technologies, between a patient and a healthcare
				  provider with access to and reviewing the patient's relevant clinical
				  information prior to the telemedicine visit. Telehealth shall not include
				  consultations provided by telephone audio-only communication, electronic mail,
				  text message, instant messaging conversation, website questionnaire, nonsecure
				  video conference, or facsimile transmission.
(13)
"638 Tribal Facility"
is a
				  facility that is operated by a tribe or tribal organization and funded by Title
				  I or Title III of the Indian Self Determination and Education Assistance Act
				  (Public Law
				  93-638).