Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 108 - NUTRITION SERVICES › Section 317:30-5-1076 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
Payment is made for nutritional services as set forth in
					 this Section .
(1)
Adults.
Payment is made for six(6) hours of medically necessary
				  nutritional counseling per year by a licensed registered dietician. All
				  services must be prescribed by a physician, physician assistant(PA), advanced
				  practice registered nurse(APRN), or certified nurse midwife(CNW), and be
				  face-to-face encounters between a licensed registered dietitian and the member.
				  Services must be expressly for diagnosing, treating or preventing, or
				  minimizing the effects of illness. Nutritional services for the treatment of
				  obesity is not covered unless there is documentation that the obesity is a
				  contributing factor in another illness.
(2)
Children.
Payment is made
				  for medically necessary nutritional counseling as described above for adults.
				  Nutritional services for the treatment of obesity may be covered for children
				  as part of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
				  benefit. Additional services which are deemed medically necessary and allowable
				  under federal regulations may be covered by the EPSDT benefit found at OAC
				  317:30-3-65
				  through
				  317:30-3-65.12.
(3)
Home and community-based
				  services (HCBS) waiver for the intellectually disabled .
All providers
				  participating in the HCBS waiver for the intellectually disabled program must
				  have a separate contract with the Oklahoma Health Care Authority (OHCA) to
				  provide nutrition services under this program. All services are specified in
				  the individual's plan of care.
(4)
Individuals eligible for Part B of Medicare.
Payment is made
				  utilizing the Medicaid allowable for comparable services. Services which are
				  not covered under Medicare should be billed directly to OHCA.
(5)
Obstetrical patients.
Payment is made for a maximum of six(6) hours of medically necessary
				  nutritional counseling per year by a licensed registered dietitian for members
				  at risk for or those who have been recently diagnosed with gestational
				  diabetes. The initial consultation may be in a group setting for a maximum of
				  two(2) hours of class time. Thereafter, four(4) hours of nutritional counseling
				  by a licensed registered dietitian may be provided to the individual if deemed
				  medically necessary, which may include a post-partum visit, typically done at
				  six (6) weeks after delivery. All services must be prescribed by a physician,
				  PA, APRN, or CNM and be face to face between a licensed registered dietitian
				  and the member(s). Services must be solely for the prevention, diagnosis, or
				  treatment of gestational diabetes.
Added at 17 Ok Reg
					 2401, eff 6-26-00; Amended at 19 Ok Reg 2922, eff 7-1-02 (emergency); Amended
					 at 20 Ok Reg 1193, eff 5-27-03; Amended at 24 Ok Reg 678, eff 2-1-07
					 (emergency); Amended at 24 Ok Reg 2094, eff 6-25-07; Amended at 26 Ok Reg 254,
					 eff 12-1-08 (emergency); Amended at 26 Ok Reg 1059, eff 5-11-09; Amended at 28
					 Ok Reg 1477, eff 6-25-11; Amended at 29 Ok Reg 1076, eff
					 6-25-12