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 47 - OPTICAL SUPPLIERS › Section 317:30-5-451 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
Payment is made to optical suppliers as set forth in this
					 Section.
(1)
Adults.
There is no provision for the coverage of glasses for adults, or for the
				  purchase of visual aids.
(2)
Children.
Payment is made for medically necessary lenses and
				  frames. Refer to OAC
				  317:30-5-432.1.
				  for specific guidelines.
(3)
Individuals eligible for Part B of Medicare.
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 17 Ok Reg 3354, eff 8-1-00 (emergency); Amended at 18 Ok
					 Reg 1130, eff 5-11-01; Amended at 19 Ok Reg 2922, eff 7-1-02 (emergency);
					 Amended at 20 Ok Reg 1193, eff 5-27-03; Amended at 25 Ok Reg 653, eff 2-1-08
					 through 7-14-08 (emergency)1; Amended at 25 Ok Reg
					 2634, eff 7-25-08
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					 on 7-14-08 before being superseded by a permanent action.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 317:30-5-451 reverted back to the permanent text that became
					 effective 5-27-03, 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 47 - OPTICAL SUPPLIERS › Section 317:30-5-452 - Procedure codes [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 3354, 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; Revoked at 25 Ok
					 Reg 653, eff 2-1-08 through 7-14-08 (emergency)1;
					 Revoked at 25 Ok Reg 2634, eff 7-25-08
1This emergency action expired
					 on 7-14-08 before being superseded by a permanent action. Upon expiration of an
					 emergency action revoking a section, 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 317:30-5-452 reverted back to the permanent text
					 that became effective 6-27-02, as was last published in the 2006 Edition of the
					 OAC, and remained as such until revoked 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 49 - FAMILY PLANNING CENTERS [Revoked] › Section 317:30-5-465 - 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 29 Ok Reg 1085, eff 6-25-12
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 49 - FAMILY PLANNING CENTERS [Revoked] › Section 317:30-5-466 - 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 13 Ok Reg 4045, eff 9-17-96 (emergency); Amended at 14 Ok
					 Reg 1780, eff 5-27-97; 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 303, eff 12-1-06
					 (emergency); Amended at 24 Ok Reg 895, eff 5-11-07; Revoked at 29 Ok Reg 1085,
					 eff 6-25-12
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 49 - FAMILY PLANNING CENTERS [Revoked] › Section 317:30-5-467 - Coverage limitations [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; Amended at 24 Ok Reg 303, eff
					 12-1-06 (emergency); Amended at 24 Ok Reg 895, eff 5-11-07; Revoked at 29 Ok
					 Reg 1085, eff 6-25-12
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 51 - HABILITATION SERVICES › Section 317:30-5-480 - Home and Community-Based Services for persons with an intellectual disability or certain persons with related conditions

Current through Vol. 41, No. 20, July 1, 2024
The Oklahoma Health Care Authority (OHCA) administers Home
					 and Community-Based Services (HCBS) Waivers for persons with intellectual
					 disabilities or certain persons with related conditions that are operated by
					 the Oklahoma Department of Human Services Developmental Disabilities Services
					 Division (DDSD). Each waiver allows Medicaid compensable services provided to
					 persons who are:
(1) medically and
				  financially eligible; and
(2) not
				  covered through the OHCA's SoonerCare program.
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 769, eff 1-24-97 (emergency); Amended at 14 Ok
					 Reg 1792, eff 5-27-97; Amended at 24 Ok Reg 879, eff 5-11-07; Amended at 25 Ok
					 Reg 2675, eff 7-25-08; Amended at 29 Ok Reg 1076, eff
					 6-25-12
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 51 - HABILITATION SERVICES › Section 317:30-5-481 - Coverage

Current through Vol. 41, No. 20, July 1, 2024
All habilitation services will be included in the member's
					 Individual Plan (IP). Arrangements for care under this program must be made
					 with the member's case manager.
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 24 Ok Reg 879, 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 51 - HABILITATION SERVICES › Section 317:30-5-482 - Description of services

Current through Vol. 41, No. 20, July 1, 2024
Habilitation services include the services identified in (1) through (15) of this Section. Habilitation services providers must have an applicable agreement with the Oklahoma Health Care Authority (OHCA) to provide Developmental Disabilities Services (DDS) through Home and Community-Based Services (HCBS).
(1)
Dental services.
Dental services are provided per Oklahoma Administrative Code (OAC) 317:40-5-112.
(A)
Minimum qualifications.
Dental services providers must have non-restrictive licensure by the Oklahoma State Board of Dentistry to practice dentistry in Oklahoma.
(B)
Description of services.
Dental services include services for maintenance or improvement of dental health as well as relief of pain and infection. These services may include:
(i) Oral examinations;
(ii) Medically necessary images;
(iii) Prophylaxis;
(iv) Fluoride application;
(v) Development of a sequenced treatment plan that prioritizes:
(I) Pain elimination;
(II) Adequate oral hygiene; and
(III) Restoring or improving ability to chew;
(vi) Routine training of member or primary caregiver regarding oral hygiene; and
(vii) Preventive, restorative, replacement, and repair services to achieve or restore functionality provided after appropriate review when applicable, per OAC 317:40-5-112.
(C)
Coverage limitations.
Dental service coverage is specified in the member's Individual Plan (IP) in accordance with applicable Waiver limits. Cosmetic dental services are not authorized.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 51 - HABILITATION SERVICES › Section 317:30-5-482 - Description of services

Current through Vol. 41, No. 20, July 1, 2024
Habilitation services include the services identified in
					 (1) through (15) of this Section. Habilitation services providers must have an
					 applicable agreement with the Oklahoma Health Care Authority (OHCA) to provide
					 Developmental Disabilities Services (DDS)through Home and Community-Based
					 Services (HCBS).
(1)
Dental
				  services.
Dental services are provided per Oklahoma Administrative Code
				  (OAC)
				  317:40-5-112.
(A)
Minimum qualifications.
Dental services providers must have non-restrictive licensure by the Oklahoma
				  State Board of Dentistry to practice dentistry in Oklahoma.
(B)
Description of services.
Dental services include services for maintenance or improvement of dental
				  health as well as relief of pain and infection. These services may include:
(i) Oral examinations;
(ii) Medically necessary images;
(iii) Prophylaxis;
(iv) Flouride application;
(v) Development of a sequenced treatment plan
				  that prioritizes:
(I) Pain
				  elimination;
(II) Adequate oral
				  hygiene; and
(III) Restoring or
				  improving ability to chew;
(vi) Routine training of member or primary
				  caregiver regarding oral hygiene; and
(vii) Preventive, restorative, replacement,
				  and repair services to achieve or restore functionality provided after
				  appropriate review when applicable, per OAC
				  317:40-5-112.
(C)
Coverage limitations.
Dental
				  service coverage is specified in the member's Individual Plan (IP) in
				  accordance with applicable Waiver limits. Cosmetic dental services are not
				  authorized.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 51 - HABILITATION SERVICES › Section 317:30-5-483 - Diagnosis codes [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 30 Ok Reg 1169,
						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 53 - SPECIALIZED FOSTER CARE › Section 317:30-5-495 - Home and Community-Based Services Waivers for persons with an intellectual disability or certain persons with related conditions

Current through Vol. 41, No. 20, July 1, 2024
(a)
Introduction to waiver
				  services.
The Oklahoma Health Care Authority (OHCA) administers Home and
				  Community-Based Services (HCBS) Waivers for persons with an intellectual
				  disability or certain persons with related conditions that are operated by
				  Oklahoma Department of Human Services (OKDHS) Developmental Disabilities
				  Services Division (DDSD). The Community Waiver and Homeward Bound Waiver allow
				  payment for specialized foster care (SFC), also known as specialized family
				  care, as defined in the waiver approved by Centers for Medicare and Medicaid
				  Services.
(b)
Eligible
				  providers.
All SFC providers must:
(1)
				  enter into contractual agreements with the OHCA to provide HCBS for persons
				  with an intellectual disability or certain persons with related
				  conditions;
(2) have an approved
				  home profile per OAC
				  317:40-5-40;
(3) complete training per OAC
				  340:100-3-38;
(4) have the ability to implement the
				  member's Individual Plan (IP); and
(5) be emotionally and financially stable, in
				  good health, and of reputable character.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 53 - SPECIALIZED FOSTER CARE › Section 317:30-5-496 - Coverage

Current through Vol. 41, No. 20, July 1, 2024
All specialized foster care must be included in the
					 member's Individual Plan (IP). Arrangements for care under this program must be
					 made through the member's case manager.
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 25 Ok Reg 2675, eff 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 53 - SPECIALIZED FOSTER CARE › Section 317:30-5-497 - Description of services

Current through Vol. 41, No. 20, July 1, 2024
Specialized foster care (SFC) is an individualized living
					 arrangement offering 24-hour per day supervision, supportive assistance, and
					 training in daily living skills. Services are intended to allow the member to
					 reside with a surrogate family. Services are provided to one to three members
					 in the home in which the SFC provider resides. Four levels of SFC, based upon
					 the member's age and level of need as determined by the Personal Support Team,
					 are:
(1) maximum supervision - for
				  members 18 years of age or younger with extensive needs;
(2) close supervision - for members 18 years
				  of age or younger with moderate needs ;
(3) maximum supervision - for members 19
				  years of age or older with extensive needs; and
(4) close supervision - for members 19 years
				  of age or older with moderate needs.
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 15 Ok Reg 3820, eff 7-1-98 (emergency); Amended at 16 Ok
					 Reg 1429, eff 5-27-99; Amended at 25 Ok Reg 2675, eff
					 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 53 - SPECIALIZED FOSTER CARE › Section 317:30-5-498 - Coverage limitations

Current through Vol. 41, No. 20, July 1, 2024
(a) Coverage
				  limitations for specialized foster care (SFC) are:
(1) Description: close supervision; Unit: one
				  day; 366 units each 12 months.
(2)
				  Description: maximum supervision; Unit: one day; 366 units each 12
				  months.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 53 - SPECIALIZED FOSTER CARE › Section 317:30-5-499 - Diagnosis code [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 25 Ok Reg 2675,
						eff 7-25-08 ; Revoked at 30 Ok Reg 1169, 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 55 - RESPITE CARE › Section 317:30-5-515 - Home and Community-Based Services Waivers for persons with an intellectual disability or certain persons with related conditions

Current through Vol. 41, No. 20, July 1, 2024
The Oklahoma Health Care Authority administers Home and
					 Community-Based Services (HCBS) Waivers for persons with an intellectual
					 disability or certain persons with related conditions that are operated by the
					 Oklahoma Department of Human Services Developmental Disabilities Services
					 Division. Each waiver allows payment for respite care as defined in the waiver
					 approved by the Centers for Medicare and Medicaid 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 25 Ok Reg 2756, eff 6-1-08 (emergency); Amended at 26 Ok
					 Reg 1067, eff 5-11-09; Amended at 29 Ok Reg 1076, eff
					 6-25-12
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 55 - RESPITE CARE › Section 317:30-5-516 - Coverage

Current through Vol. 41, No. 20, July 1, 2024
All respite care must be included in the member's
					 Individual Plan (IP). Arrangements for this service must be made through the
					 member's case manager.
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 25 Ok Reg 2756, eff 6-1-08 (emergency); Amended at 26 Ok
					 Reg 1067, eff 5-11-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 55 - RESPITE CARE › Section 317:30-5-517 - Description of services

Current through Vol. 41, No. 20, July 1, 2024
Respite care is:
(1) available to eligible members not
				  receiving daily living supports or group home services and who are unable to
				  care for themselves; and
(2)
				  furnished on a short-term basis due to the absence or need for relief of those
				  persons normally providing the care, and includes:
(A) homemaker respite per OAC
				  317:30-5-535
				  through
				  317:30-5-538;
(B) daily respite provided in a group home.
(i) Group homes providing respite must be
				  licensed per OAC 340:100-6.
(ii)
				  Respite care provided in a group home is authorized as respite at the
				  applicable group home rate as identified in the member's Plan of
				  Care;
(C) daily respite
				  provided in an agency companion services (ACS) home.
(i) Respite must be approved in accordance
				  with the home profile process, per OAC
				  317:40-5-40,
				  and required training, per OAC
				  340:100-3-38.
(ii) Respite provided in an ACS home is
				  authorized as respite at the applicable level of support per OAC
				  317:40-5-3.
(iii) Respite providers are limited to
				  providing 52 days of respite per year when they concurrently provide ACS;
				  and
(D) daily respite
				  provided in any other approved home. Respite:
(i) must be approved in accordance with the
				  home profile process, per OAC
				  317:40-5-40,
				  and required training, per OAC 340-100-3-38;
(ii) is based on the member's needs and
				  includes:
(I) maximum supervision - for
				  members with extensive needs;
(II)
				  close supervision - for members with moderate needs; and
(III) intermittent supervision - for members
				  with minimum needs; and
(iii) providers must:
(I) pass a background investigation per OAC
				  317:40-5-40
				  and OAC
				  340:100-3-39;
				  and
(II) be at least 18 years of
				  age.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 55 - RESPITE CARE › Section 317:30-5-518 - Coverage limitations

Current through Vol. 41, No. 20, July 1, 2024
(a) Payment is
				  not made for daily respite care and specialized foster care or agency companion
				  services (ACS) for the same member on the same date of service.
(b) Respite care:
(1) is not available to members in Oklahoma
				  Department of Human Services (DHS) custody or in out-of-home placement funded
				  by DHS Child Welfare Services; and
(2) for members not receiving ACS, is limited
				  to 30 days or 720 hours annually per member, except as approved by the DHS
				  Developmental Disabilities Services director and authorized in the member's
				  Plan of Care; or
(3) for members
				  receiving ACS, is limited per Oklahoma Administrative Code
				  317:40-5-3.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 55 - RESPITE CARE › Section 317:30-5-519 - Diagnosis code [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 25 Ok Reg 2756,
						eff 6-1-08 (emergency) ; Amended at 26 Ok Reg 1067, eff 5-11-09 ; Revoked at 30
						Ok Reg 1169, 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 57 - HOSPICE CARE › Section 317:30-5-525 - 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 21 Ok Reg 2460, 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 57 - HOSPICE CARE › Section 317:30-5-526 - 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
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 57 - HOSPICE CARE › Section 317:30-5-527 - Hospice 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
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 57 - HOSPICE CARE › Section 317:30-5-528 - 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 58 - HOSPICE › Section 317:30-5-530 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
(a) Providers of
				  hospice services will meet applicable state and federal licensing requirements
				  and meet Medicare certification requirements to provide hospice
				  services.
(b) Providers of hospice
				  services will enter into a contractual agreement with the State Medicaid
				  Agency, Oklahoma Health Care Authority (OHCA).
Added at 23 Ok Reg 29,
					 eff 8-1-05 (emergency); Added at 23 Ok Reg 1354, eff
					 5-25-06
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 58 - HOSPICE › Section 317:30-5-531 - Coverage for adults

Current through Vol. 41, No. 20, July 1, 2024
There is no coverage for hospice services provided
					 Medicaid eligible adults except for the hospice provision provided through the
					 ADvantage Waiver.
(a)
Definition.
"Hospice care"
means a comprehensive,
				  holistic program of palliative and/or comfort care and support provided to the
				  member and his/her family when a physician certifies that the member has a
				  terminal illness and has a life expectancy of six (6) months or less.
(b)
Requirements.
(1) Hospice services must be related to the
				  palliation and management of the member's illness, symptom control, or to
				  enable the individual to maintain activities of daily living and basic
				  functional skills.
(2) Hospice care
				  is performed under the direction of a physician as per the member's plan of
				  care in an approved hospital hospice facility, in-home hospice program, or
				  nursing facility.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 59 - HOMEMAKER SERVICES › Section 317:30-5-535 - Homemaker Service in Home and Community-Based Services (HCBS) Waiver for persons with an intellectual disability or certain persons with related conditions

Current through Vol. 41, No. 20, July 1, 2024
(a)
Introduction to waiver services.
The Oklahoma Health Care
				  Authority (OHCA) administers HCBS Waivers for persons with an intellectual
				  disability or certain persons with related conditions that are operated by
				  Oklahoma Human Services (OKDHS) Developmental Disabilities Services (DDS). Each
				  waiver allows payment for homemaker service as defined in the waiver approved
				  by the Centers for Medicare and Medicaid Services.
(b)
Eligible providers.
Homemaker services providers enter into contractual agreements with the OHCA to
				  provide HCBS for persons with an intellectual disability or related conditions.
(1) Providers must complete the OKDHS DDS
				  sanctioned training per Oklahoma Administrative Code
				  340:100-3-38.
(2) Homemaker service is included in the
				  member's Individual Plan (Plan). Arrangements for this service must be made
				  through the member's DDS case manager.
(3) Homemaker service includes general
				  household activities, such as meal preparation and routine household care when
				  the regular caregiver responsible for these activities is temporarily absent or
				  unable to manage the home and care for others in the home.
(4) Limits are specified in the member's
				  Plan.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 59 - HOMEMAKER SERVICES › Section 317:30-5-536

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 25 Ok Reg 2675, eff
					 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 59 - HOMEMAKER SERVICES › Section 317:30-5-537

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; Amended at 25 Ok Reg 2675, eff
					 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 59 - HOMEMAKER SERVICES › Section 317:30-5-538 - Diagnosis codes [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 25 Ok Reg 2675,
						eff 7-25-08 ; Revoked at 30 Ok Reg 1169, 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 61 - HOME HEALTH AGENCIES › Section 317:30-5-545 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
All eligible home health service providers must be
					 Medicare certified, or have deemed status with Medicare, and have a current
					 contract with the Oklahoma Health Care Authority(OHCA). Home health agencies
					 billing for medical supplies, equipment, and appliances must have a supplier
					 contract and bill equipment on claim form CMS-1500. Additionally, home health
					 services providers that did not participate in Medicaid prior to January 1,
					 1998, must meet the "Capitalization Requirements" set forth in
					 42 Code of Federal
					 Regulations (C.F.R.) §
											489.28. Home
					 health services providers that do not meet these requirements will not be
					 permitted to participate in the Medicaid program.
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 16 Ok Reg 59, eff 9-11-98 (emergency); Amended at 16 Ok Reg
					 1429, eff 5-27-99; Amended at 24 Ok Reg 332, eff 12-1-06 (emergency); Amended
					 at 24 Ok Reg 929, 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 61 - HOME HEALTH AGENCIES › Section 317:30-5-546 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
Payment is made for home health services as set forth in
					 this section when a face-to-face encounter has occurred in accordance with
					 provisions of
					 42 Code of Federal Regulations (C.F.R.) §
											440.70. Payment is made for home health
					 services provided by a home health agency in the member's residence and in any
					 setting in which normal life activities take place except for a hospital,
					 long-term care facility, or intermediate care facility for individuals with
					 intellectual disabilities. For individuals eligible for Part B of Medicare,
					 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 15 Ok Reg 4182, eff 8-5-98 (emergency); Amended at 16 Ok
					 Reg 1429, eff 5-27-99; Amended at 16 Ok Reg 3451, eff 7-1-99 (emergency);
					 Amended at 17 Ok Reg 1204, eff 5-11-00; Amended at 18 Ok Reg 477, eff 1-1-01
					 (emergency); Amended at 18 Ok Reg 1130, eff 5-11-01; 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 61 - HOME HEALTH AGENCIES › Section 317:30-5-547 - Reimbursement and procedure codes

Current through Vol. 41, No. 20, July 1, 2024
(a) Nursing
				  services and home health aide services are covered services on a per visit
				  basis. Thirty-six (36) visits per calendar year of nursing and/or home health
				  aide services for any member do not require prior authorization; however, any
				  visit surpassing the thirty-sixth (36) visit will require prior authorization
				  and medical review.
(b)
				  Reimbursement for durable medical equipment and supplies will be made using the
				  amount derived from the lesser of the Oklahoma Health Care Authority (OHCA) fee
				  schedule or the provider's usual and customary charge. When a procedure code is
				  not assigned a maximum allowable fee for a unit of service, a fee will be
				  established. Once the service has been provided, the supplier is required to
				  include a copy of the invoice documenting the supplier's cost of the item with
				  the claim.
(c) Reimbursement for
				  oxygen and oxygen supplies is as follows:
(1)
				  Payment for oxygen systems (stationary, liquid and oxygen concentrators) is
				  based on continuous rental, i.e., a continuous monthly payment is made as long
				  as it is medically necessary. The rental payment includes all contents and
				  supplies, i.e., regulators, tubing, masks, etc. Portable oxygen systems are
				  also considered continuous rental. Ownership of the equipment remains with the
				  supplier.
(2) Separate payment will
				  not be made for maintenance, servicing, delivery, or for the supplier to pick
				  up the equipment when it is no longer medically necessary.
(3) Payment for oxygen and oxygen equipment
				  and supplies will not exceed the Medicare fee for the same procedure code. The
				  fee schedule will be reviewed annually and adjustments to the fee schedule may
				  be made at any time based on efficiency, budget considerations, and quality of
				  care as determined by the OHCA.
(4)
				  Physical therapy, occupational therapy, and/or speech pathology and audiology
				  services, are not covered when provided by a home health
				  agency.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 61 - HOME HEALTH AGENCIES › Section 317:30-5-548

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 16 Ok Reg 3451, eff 7-1-99 (emergency); Amended at 17 Ok
					 Reg 1204, eff 5-11-00; 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 61 - HOME HEALTH AGENCIES › Section 317:30-5-549 - Prosthetic devices [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 764, eff 11-25-96 (emergency); Amended at 14 Ok
					 Reg 1780, eff 5-27-97; Amended at 16 Ok Reg 3451, eff 7-1-99 (emergency);
					 Amended at 17 Ok Reg 1204, eff 5-11-00; Amended at 18 Ok Reg 477, eff 1-1-01
					 (emergency); Amended at 18 Ok Reg 1130, eff
					 5-11-01
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 62 - PRIVATE DUTY NURSING › Section 317:30-5-555 - Private Duty Nursing (PDN)

Current through Vol. 41, No. 20, July 1, 2024
PDN is medically necessary care provided on a regular
					 basis by a licensed practical nurse or registered nurse. PDN is the level of
					 care that would routinely be provided by the nursing staff of a hospital or
					 skilled nursing facility. PDN services are provided:
(1) In the member's primary residence, unless
				  it is medically necessary for a nurse to accompany the individual in the
				  community.
(A) The individual's place of
				  residence is wherever the individual lives, whether the residence is the
				  individual's own dwelling, a relative's home, or other type of living
				  arrangement. The place of residence cannot include a hospital, nursing
				  facility, or intermediate care facility for individuals with intellectual
				  disabilities (ICF/IID).
(B) The
				  place of service in the community cannot include the residence or business
				  location of the provider of PDN services unless the provider of PDN is a
				  live-in caregiver.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 62 - PRIVATE DUTY NURSING › Section 317:30-5-556 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
(a) A home health
				  agency that desires to be reimbursed by SoonerCare for private duty nursing
				  (PDN) must meet the following requirements prior to providing services to
				  eligible SoonerCare members:
(1) The agency
				  must be fully contracted with OHCA as a provider; and,
(2) The agency must meet the requirements of
				  Oklahoma Administrative Code (OAC)
				  317:30-5-545,
				  and it must be licensed by the Oklahoma State Health Department (OSDH) as a
				  home care agency.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 62 - PRIVATE DUTY NURSING › Section 317:30-5-557 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
(a)
Adults.
SoonerCare does not cover adults [twenty-one (21) years of
				  age and over] for private duty nursing(PDN) with the exception of subsection
				  (c).
(b)
Children.
SoonerCare does cover children [under twenty-one (21) years of age] if:
(1) The member is eligible for SoonerCare;
				  and
(2) The Oklahoma Health Care
				  Authority(OHCA), in its discretion, deems the services medically necessary.
				  Medical necessity is determined in accordance with Oklahoma Administrative Code
				  (OAC)
				  317:30-5-560.1.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 62 - PRIVATE DUTY NURSING › Section 317:30-5-558 - Private duty nursing (PDN) coverage limitations

Current through Vol. 41, No. 20, July 1, 2024
The following provisions apply to all PDN services and provide coverage limitations:
(1) All services must be prior authorized to receive payment from the Oklahoma Health Care Authority (OHCA). Prior authorization means authorization in advance of services provided in accordance with Oklahoma Administrative Code (OAC) 317:30-3-31 and 317:30-5-560.1;
(2) A treatment plan must be completed by an eligible PDN provider before requesting prior authorization and must be updated at least annually and signed by the physician [medical doctor (MD), or doctor of osteopathy, (DO)], a physician assistant (PA), or advanced practice registered nurse (APRN)];
(3) An assessment by an OHCA care management nurse is required prior to the authorization for services. The assessment will be conducted by the OHCA through one (1) of the following:
(A)
Telephone.
Audio-only telephonic communication;
(B)
Virtually.
Virtual visits are the standard method of assessment. This is a means to use virtual technology to collect medical and other forms of health data for the purposes of assessment and recommendation; or
(C)
Face-to-face.
In person face-to-face assessments are completed when determined by OHCA to be the most appropriate assessment method. A face-to-face assessment is not completed at the parent or caregiver's request.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 62 - PRIVATE DUTY NURSING › Section 317:30-5-558 - Private duty nursing (PDN) coverage limitations

Current through Vol. 41, No. 20, July 1, 2024
The following provisions apply to all PDN services and
					 provide coverage limitations:
(1) All
				  services must be prior authorized to receive payment from the Oklahoma Health
				  Care Authority (OHCA). Prior authorization means authorization in advance of
				  services provided in accordance with Oklahoma Administrative Code (OAC)
				  317:30-3-31
				  and
				  317:30-5-560.1;
(2) A treatment plan must be completed by an
				  eligible PDN provider before requesting prior authorization and must be updated
				  at least annually and signed by the physician [medical doctor (MD), or doctor
				  of osteopathy, (DO)], a physician assistant (PA), or advanced practice
				  registered nurse (APRN)];
(3) An
				  assessment by an OHCA care management nurse is required prior to the
				  authorization for services. The assessment will be conducted by the OHCA
				  through one (1) of the following:
(A)
				  Telephone;
(B) Virtually;
				  or
(C)
				  Face-to-face;
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 62 - PRIVATE DUTY NURSING › Section 317:30-5-559 - How Private Duty Nursing (PDN) services are authorized

Current through Vol. 41, No. 20, July 1, 2024
PDN services may be initiated after completion of the following steps:
(1) A treatment plan for the patient has been created by an eligible PDN provider per Oklahoma Administrative Code (OAC) 317:30-5-560;
(2) A prior authorization request is submitted with the appropriate Oklahoma Health Care Authority (OHCA) required data elements and the treatment plan;
(3) An assessment (telephonic, virtual, or face-to-face) has been conducted by an OHCA care management nurse, per OAC 317:30-5-558 (3); and
(4) An OHCA physician, or his or her designee, has determined the medical necessity of the service, including but not limited to, scoring the member's needs on the OHCA PDN assessment.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 62 - PRIVATE DUTY NURSING › Section 317:30-5-559 - How Private Duty Nursing (PDN) services are authorized

Current through Vol. 41, No. 20, July 1, 2024
PDN services may be initiated after completion of the
					 following steps:
(1) A treatment plan
				  for the patient has been created by an eligible PDN provider per Oklahoma
				  Administrative Code (OAC)
				  317:30-5-560;
(2) A prior authorization request is
				  submitted with the appropriate Oklahoma Health Care Authority (OHCA) required
				  data elements and the treatment plan;
(3) An assessment (telephonic, virtual, or
				  face-to-face) has been conducted by an OHCA care management nurse, per OAC
				  317:30-5-558(3);
				  and
(4) An OHCA physician has
				  determined the medical necessity of the service, including but not limited to,
				  scoring the member's needs on the OHCA PDN assessment.
Added at 23 Ok Reg 33,
					 eff 8-1-05 (emergency); Added at 23 Ok Reg 1364, eff 5-25-06; Amended at 28 Ok
					 Reg 14, eff 8-13-10 (emergency); Amended at 28 Ok Reg 1429, 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 62 - PRIVATE DUTY NURSING › Section 317:30-5-560 - Treatment plan

Current through Vol. 41, No. 20, July 1, 2024
(a) An eligible organization must create a treatment plan for the member as part of the authorization process for private duty nursing (PDN) services. The initial treatment plan must be signed by the member's attending physician [medical doctor (MD), or doctor of osteopathy, (DO)], a physician assistant (PA), or advanced practice registered nurse (APRN).
(b) The treatment plan must include all of the following:
(1) Diagnosis;
(2) Prognosis;
(3) Anticipated length of treatment;
(4) Number of PDN requested hours per week;
(5) Assessment needs and frequency (e.g., vital signs, glucose checks, neuro checks, respiratory);
(6) Medication method of administration and frequency;
(7) Age-appropriate feeding requirements (diet, method and frequency);
(8) Respiratory needs;
(9) Mobility requirements including need for turning and positioning, and the potential for skin breakdown;
(10) Developmental deficits;
(11) Casting, orthotics, therapies;
(12) Age-appropriate elimination needs;
(13) Seizure activity and precautions;
(14) Age-appropriate sleep patterns;
(15) Disorientation and/or combative issues;
(16) Age-appropriate wound care and/or personal care;
(17) Communication issues;
(18) Social support needs;
(19) Name, skill level, and availability of all caregivers; and
(20) Other pertinent nursing needs such as dialysis, isolation.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 62 - PRIVATE DUTY NURSING › Section 317:30-5-560 - Treatment plan

Current through Vol. 41, No. 20, July 1, 2024
(a) An eligible
				  organization must create a treatment plan for the member as part of the
				  authorization process for private duty nursing (PDN) services. The initial
				  treatment plan must be signed by the member's attending physician [medical
				  doctor (MD), or doctor of osteopathy, (DO)], a physician assistant (PA), or
				  advanced practice registered nurse (APRN).
(b) The treatment plan must include all of
				  the following:
(1) Diagnosis;
(2) Prognosis;
(3) Anticipated length of
				  treatment;
(4) Number of PDN
				  requested hours per day;
(5)
				  Assessment needs and frequency (e.g., vital signs, glucose checks, neuro
				  checks, respiratory);
(6)
				  Medication method of administration and frequency;
(7) Age-appropriate feeding requirements
				  (diet, method and frequency);
(8)
				  Respiratory needs;
(9) Mobility
				  requirements including need for turning and positioning, and the potential for
				  skin breakdown;
(10) Developmental
				  deficits;
(11) Casting, orthotics,
				  therapies;
(12) Age-appropriate
				  elimination needs;
(13) Seizure
				  activity and precautions;
(14)
				  Age-appropriate sleep patterns;
(15) Disorientation and/or combative
				  issues;
(16) Age-appropriate wound
				  care and/or personal care;
(17)
				  Communication issues;
(18) Social
				  support needs;
(19) Name, skill
				  level, and availability of all caregivers; and
(20) Other pertinent nursing needs such as
				  dialysis, isolation.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 62 - PRIVATE DUTY NURSING › Section 317:30-5-560.1 - Prior authorization requirements

Current through Vol. 41, No. 20, July 1, 2024
(a) Authorizations are provided for a maximum period of six (6) months.
(b) Authorizations require:
(1) A treatment plan for the member;
(2) An assessment (telephonic, virtual, or face-to-face) has been conducted by an Oklahoma Health Care Authority (OHCA) care management nurse, per Oklahoma Administrative Code (OAC) 317:30-5-558 (2); and
(3) An OHCA physician, or his or her designee, to determine medical necessity including use of the OHCA Private Duty Nursing (PDN) assessment.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 62 - PRIVATE DUTY NURSING › Section 317:30-5-560.1 - Prior authorization requirements

Current through Vol. 41, No. 20, July 1, 2024
(a) Authorizations are provided for a maximum
				  period of six(6) months.
(b)
				  Authorizations require:
(1) A treatment plan
				  for the member;
(2) An assessment
				  (telephonic, virtual, or face-to-face) has been conducted by an Oklahoma Health
				  Care Authority (OHCA) care management nurse, per Oklahoma Administrative Code
				  (OAC)
				  317:30-5-558(2);
				  and
(3) An OHCA physician to
				  determine medical necessity including use of the OHCA Private Duty Nursing
				  (PDN) assessment.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 62 - PRIVATE DUTY NURSING › Section 317:30-5-560.2 - Record documentation

Current through Vol. 41, No. 20, July 1, 2024
(a)
				  The treatment plan must be updated and signed by the attending physician
				  [medical doctor (MD), or doctor of osteopathy, (DO)], a physician assistant
				  (PA), or advanced practice registered nurse (APRN) at least annually.
(b) Copies of the attending physician's
				  orders and, at a minimum, the last thirty (30) days of medical records for the
				  actual care provided must be maintained and include the following:
(1) The beginning and ending time of the care
				  and must be signed by the person providing care;
(2) The nurse's credentials;
(3) All provisions of the treatment plan,
				  such as vital signs, medication administration, glucose/neuro checks, vital
				  signs, respiratory assessments, and all applicable treatments must be
				  documented; and
(4) Meet the record
				  retention requirements set forth in Oklahoma Administrative Code (OAC)
				  317:30-3-15.