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 30 - APPLIED BEHAVIOR ANALYSIS (ABA) SERVICES › Section 317:30-5-316 - Reimbursement methodology

Current through Vol. 41, No. 20, July 1, 2024
SoonerCare shall provide reimbursement for ABA services in
					 accordance with the Medicaid State Plan.
(1) Payment shall only be made to
				  SoonerCare-contracted groups or qualified individual providers who are
				  currently licensed and in good standing. Payment is not made to under
				  supervision ABA practitioners/paraprofessionals, including but not limited to,
				  BCaBAs and RBTs.
(2) Reimbursement
				  for ABA services is only made on a fee-for-services basis. The maximum
				  allowable fee for a unit of service has been determined by OHCA to be a
				  reasonable fee, consistent with efficiency, economy, and quality of care.
				  Payment for covered services is the lower of the provider's actual billed
				  charges, consistent with the provider's usual and customary charge to the
				  general public for the service, or the maximum allowable per unit of
				  service.
(3) Reimbursement shall
				  only be made for services that have been prior authorized by OHCA or its
				  designee; and performed on an individualized basis and not in a group setting
				  except for family adaptive behavior treatment guidance by a qualified ABA
				  provider (OAC 317:30-5-311) .
(4)
				  Providers may only concurrently bill current Procedural Terminology (CPT) codes
				  when they outline in the prior authorization the following criteria:
(A) The BCBA or licensed psychologist met
				  with the member and/or parent or guardian and directed the RBT through one (1)
				  or more of the following:
(i) Monitoring
				  treatment integrity to ensure satisfactory implementation of treatment
				  protocols;
(ii) Directing RBT staff
				  and/or caregivers in the implementation of new or revised treatment
				  protocols;
(iii) Selection and
				  development of treatment goals, protocols, and data collection
				  systems;
(iv) Collaboration with
				  family members and other stakeholders;
(v) Creating materials, gathering
				  materials;
(vi) Reviewing data to
				  make adjustments to treatment protocols; and/or
(vii) Development and oversight of transition
				  and discharge planning.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 31 - ROOM AND BOARD PROVIDERS › Section 317:30-5-320 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
All providers of accommodations for overnight lodging,
					 which may include meals, for clients to obtain medical services must have
					 entered into a contract to provide services to eligible individuals. Each
					 provider must agree to accept the payment made by this Authority as full and
					 complete reimbursement for such 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
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 31 - ROOM AND BOARD PROVIDERS › Section 317:30-5-321 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
Payment is made to Room and Board Providers as set forth
					 in this Section.
(1)
Adults.
Payment is made to Room and Board Providers for room and
				  board of an eligible adult and an escort, if necessary, when authorized by the
				  Oklahoma Health Care Authority (OHCA). Room and Board is authorized by, Room
				  and Board Order form, for Adults and Children. A copy of the authorization must
				  be attached to each claim along with the dates of stay and signature of
				  authorized escort.
(2)
Children.
Coverage for children is the same as for adults.
(A) Services, deemed medically necessary and
				  allowable under Federal Medicaid regulations, may be covered by the EPSDT/OHCA
				  Child Health program even though the services may not be part of the OHCA
				  SoonerCare program. Such services must be prior authorized.
(B) Federal Medicaid regulations also require
				  the State to make the determination as to whether the service is medically
				  necessary and do not require the provision of any items or services that the
				  State determines are not safe and effective or which are considered
				  experimental.For more information regarding experimental or investigational
				  including clinical trials see, Oklahoma Administrative Code 317:30-3-57.1.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 31 - ROOM AND BOARD PROVIDERS › Section 317:30-5-322 - Procedure codes and allowable amounts [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 2086, 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 31 - ROOM AND BOARD PROVIDERS › Section 317:30-5-323 - Claim form [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 32 - SOONERRIDE NON-EMERGENCY TRANSPORTATION (NEMT) › Section 317:30-5-325 - RESERVED

Current through Vol. 41, No. 20, July 1, 2024
Reserved at 18 Ok Reg
					 258, eff 11-21-00 (emergency); Reserved 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 32 - SOONERRIDE NON-EMERGENCY TRANSPORTATION (NEMT) › Section 317:30-5-326 - Provider eligibility

Current through Vol. 41, No. 20, July 1, 2024
The Oklahoma Health Care Authority (OHCA) is responsible
					 for assuring that necessary transportation is available to all eligible
					 SoonerCare members who are in need of SoonerCare medical services in accordance
					 with Section
					 431.53 of Title 42 of the Code of
					 Federal Regulations.
(1) The agency
				  contracts with a broker to provide the most appropriate, and least costly mode
				  of transportation necessary to meet the individual needs of SoonerCare members
				  statewide.
(2) All SoonerRide
				  contracted providers must meet the standards and requirements outlined in the
				  Oklahoma Medicaid State Plan, the SoonerRide provider manual and contract, as
				  well as all applicable federal and state laws/regulations.
(3) Payment for covered services to the
				  broker is made pursuant to the methodology described in the Oklahoma Medicaid
				  State Plan.
Reserved at 18 Ok Reg
					 258, eff 11-21-00 (emergency); Reserved at 18 Ok Reg 1130, eff 5-11-01; Added
					 at 24 Ok Reg 2095, eff 6-25-07; Amended at 25 Ok Reg 526, eff 1-2-09
					 (emergency); Amended at 26 Ok Reg 1066, eff 5-11-09; Amended at 26 Ok Reg 526,
					 eff 1-2-09 (emergency); Amended at 26 Ok Reg 2113, eff
					 6-25-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 32 - SOONERRIDE NON-EMERGENCY TRANSPORTATION (NEMT) › Section 317:30-5-327 - Eligibility for SoonerRide NET

Current through Vol. 41, No. 20, July 1, 2024
Transportation is provided when medically necessary in
					 connection with examination and treatment to the nearest appropriate facility
					 in accordance with
					 42
					 CFR 440.170. As the Medicaid Agency, the
					 Oklahoma Health Care Authority (OHCA) is the payer of last resort, with few
					 exceptions. When other resources are available, those resources must first be
					 utilized. Exceptions to this policy are those receiving medical treatment
					 through Indian Health Services and those eligible for the Crime Victims
					 Compensation Act. Individuals considered fully dual eligible qualify for
					 SoonerRide. However, SoonerRide excludes those individuals who are categorized
					 as:
(1) Qualified Medicare
				  Beneficiaries(QMB);
(2) Specified
				  Low Income Medicare Beneficiaries (SLMB) only;
(3) Qualifying Individuals-1 and individuals
				  who are in an institution for mental disease (IMD);
(4) inpatient;
(5) institutionalized ;
(6) Home and Community Based Waiver members,
				  with the exception of the In-home Supports Waiver for Children, the Advantage
				  Waiver, the Living Choice demonstration, and the Medically Fragile
				  Waiver.
Added at 18 Ok Reg 258, eff 11-21-00 (emergency) ; Added
						at 18 Ok Reg 1130, eff 5-11-01 ; 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
						2095, eff 6-25-07 ; Amended at 29 Ok Reg 1104, eff 6-25-12 ; Amended at 30 Ok
						Reg 1129, 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 32 - SOONERRIDE NON-EMERGENCY TRANSPORTATION (NEMT) › Section 317:30-5-327.1 - SoonerRide NEMT coverage and exclusions

Current through Vol. 41, No. 20, July 1, 2024
(a)
SoonerRide NEMT coverage.
SoonerRide NEMT is available for SoonerCare compensable services under the
				  following conditions:
(1)
Nearest
				  appropriate facility.
(A)
				  Transportation is to the nearest appropriate facility or medical provider that
				  is capable of providing the necessary services.
(B) SoonerRide NEMT services to a more
				  distant hospital, clinic, practitioner or physicians' office solely to avail a
				  member of the service of a specific physician or physician assistant does not
				  make the institution in which the physician has staff privileges the nearest
				  institution with appropriate facilities.
(C) The nearest facility is not considered
				  appropriate if:
(i) The member's condition
				  requires a higher level of care or specialized services available at a more
				  distant facility; or
(ii) There
				  are no beds or providers available. Medical records must be properly documented
				  in this circumstance.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 32 - SOONERRIDE NON-EMERGENCY TRANSPORTATION (NEMT) › Section 317:30-5-327.2 - Service availability [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 24 Ok Reg
					 2095, eff 6-25-07; Revoked at 29 Ok Reg 1104, 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 32 - SOONERRIDE NON-EMERGENCY TRANSPORTATION (NEMT) › Section 317:30-5-327.4 - Coverage for children

Current through Vol. 41, No. 20, July 1, 2024
(a)
				  Services, deemed medically necessary and allowable under federal Medicaid
				  regulations, may be covered by the EPSDT/OHCA Child Health program even though
				  the services may not be part of the OHCA SoonerCare program. Such services must
				  be prior authorized.
(b) Federal
				  Medicaid regulations also require the State to make the determination as to
				  whether the service is medically necessary and do not require the provision of
				  any items or services that the State determines are not safe and effective or
				  which are considered experimental.For more information regarding experimental
				  or investigational including clinical trials, see Oklahoma Administrative Code
				  317:30-3-57.1.
Added at 24 Ok Reg
					 2095, 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 32 - SOONERRIDE NON-EMERGENCY TRANSPORTATION (NEMT) › Section 317:30-5-327.5

Current through Vol. 41, No. 20, July 1, 2024
Added at 24 Ok Reg
					 2095, eff 6-25-07; Amended at 25 Ok Reg 659, eff 1-18-08 through 7-14-08
					 (emergency)1; Amended at 25 Ok Reg 2674, 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 317:30-5-327.5 reverted back to the permanent text that became
					 effective 6-25-07, as was last published in the 2007 OAC Supplement, 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 32 - SOONERRIDE NON-EMERGENCY TRANSPORTATION (NEMT) › Section 317:30-5-327.6 - Denial of SoonerRide NEMT services by the SoonerRide broker

Current through Vol. 41, No. 20, July 1, 2024
(a) In addition to
				  the exclusions listed in Oklahoma Administrative Code (OAC)
				  317:30-5-327.1(f)
				  (1) - (4) of this Part, the SoonerRideNEMT broker may deny NEMT services if:
(1) The long-term care facility/member
				  refuses to cooperate in determining the member's eligibility;
(2) The long-term care facility/member
				  refuses to provide the documentation required to determine the medical
				  necessity for NEMT services;
(3)
				  The member, medical escort, attendant, or service animal exhibits uncooperative
				  behavior or misuses/abuses NEMT services;
(4) The member is not ready to board the NEMT
				  transport at the scheduled time or within fifteen (15) minutes after the
				  scheduled pick up time;
(5) The
				  member has not shown or cancelled previous appointments less than twenty-four
				  (24) hours prior to the appointment, or has cancelled three (3) times within a
				  ninety (90) day period, upon the SoonerRide NEMT transport's arrival at the
				  member's residence; or
(6) The
				  long-term care facility/member fails to request a reservation at least three(3)
				  days in advance of a health care appointment without good cause. Good cause is
				  created by factors such as, but not limited to, any of the following:
(A) Urgent care;
(B) Post-surgical and/or medical follow up
				  care specified by a health care provider to occur in fewer than three(3) days;
(C) Imminent availability of an
				  appointment with a specialist when the next available appointment would require
				  a delay of two(2) weeks or more; and
(D) The result of administrative or technical
				  delay caused by SoonerRide and requiring that an appointment be rescheduled.
(7) All requests,
				  provided with or without good cause, are subject to availability and resources.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 32 - SOONERRIDE NON-EMERGENCY TRANSPORTATION (NEMT) › Section 317:30-5-327.7 - SoonerRide provider network

Current through Vol. 41, No. 20, July 1, 2024
(a)
				  The SoonerRide broker will maintain an adequate number of appropriate network
				  providers to provide non-emergency, non-ambulance transportation services for
				  eligible members.
(b) If a nursing
				  facility has the capability to provide non-emergency, non-ambulance
				  transportation, the SoonerRide broker may contract with the nursing facility as
				  a NET network provider. The nursing facility must meet the same standards as
				  any other SoonerRide contracted provider for vehicle and driver licensing,
				  safety, training, liability, and ADA regulations. Additionally, when a nursing
				  facility is contracted as a NET provider, the nursing facility cannot limit
				  transportation services to members of a specific nursing facility, but must
				  have the same availability as any other contracted network provider except for
				  the transportation of members for dialysis services.
(c) SoonerRide may contract with other
				  transportation providers solely for the non-emergency, non-ambulance
				  transportation of members for dialysis services.
Added at 24 Ok Reg
					 2095, 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 32 - SOONERRIDE NON-EMERGENCY TRANSPORTATION (NEMT) › Section 317:30-5-327.8 - Type of services provided and duties of the SoonerRide NEMT driver

Current through Vol. 41, No. 20, July 1, 2024
(a) The SoonerRide
				  NEMT program shall not exceed curb-to-curb services. This service will be
				  determined by the SoonerRide NEMT broker.
(1)
				  Curb-to-curb services are defined as services for which the vehicle picks up
				  and discharges the passengers at the curb or driveway in front of their place
				  of residence or destination.
(A) The
				  SoonerRide NEMT driver will open and close the vehicle doors, load or provide
				  assistance with loading adaptive equipment.
(B) The SoonerRide NEMT driver may fasten and
				  unfasten safety restraints when that service is requested by the rider or on
				  behalf of the rider.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 32 - SOONERRIDE NON-EMERGENCY TRANSPORTATION (NEMT) › Section 317:30-5-327.9 - Scheduling NEMT services through SoonerRide

Current through Vol. 41, No. 20, July 1, 2024
(a) The long-term care facility/member will
				  schedule SoonerRide NEMT services for transportation to covered services.
				  SoonerRide NEMT services may be scheduled by calling the toll free SoonerRide
				  number or by faxing a request to SoonerRide.
(b) All SoonerRide NEMT routine services must
				  be scheduled by advance appointment. Appointments must be made at least
				  three(3) business days in advance of the health care appointment, but may be
				  scheduled up to fourteen(14) business days in advance. Scheduling for members
				  with standing appointments may be scheduled for those appointments beyond the
				  fourteen (14) days.
(c) NEMT
				  services for eligible members will be scheduled and obtained through the
				  SoonerRide NEMT program. The long-term care facility/member will be financially
				  responsible for NEMT services which are not scheduled for eligible members
				  through the SoonerRide program. The long-term care facility may not charge the
				  member or member's family for NEMT services which were not paid for by
				  SoonerRide because they were not scheduled through SoonerRide in the
				  appropriate manner.
(d) The
				  long-term care facility/member must provide wheelchairs or car seats when
				  needed. These items will not be provided by the SoonerRide NEMT transport.
(e) Whenever possible SoonerRide
				  will give consideration for members who request NEMT for routine care and the
				  request is made less than three(3) business days in advance of the appointment.
				  However, such requests for service are not guaranteed and will depend on the
				  availability of space and resources, as well as, the distance to the medical
				  appointment .
(f) If SoonerRide
				  cannot provide NEMT for urgent care, the long-term care facility/member may
				  provide the NEMT transportation and submit proper documentation to SoonerRide
				  for reimbursement. In such cases the long-term care facility/member must
				  attempt to schedule the service through SoonerRide first, and obtain a
				  reference number or the service must have become necessary during a time that
				  SoonerRide scheduling was unavailable, such as after hours or weekends. For
				  NEMT for urgent services provided after hours or on weekends, the long-term
				  care facility/member must notify SoonerRide within two(2) business days of the
				  date of service.
Added at 24 Ok Reg
					 2095, 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 32 - SOONERRIDE NON-EMERGENCY TRANSPORTATION (NEMT) › Section 317:30-5-328 - Subsistence (sleeping accommodations and meals) [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Revoked at 29 Ok Reg 1129, 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 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-335 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
To be eligible for reimbursement, all ambulance service
					 suppliers that operate air, water or ground services (including stretcher
					 service) must be licensed by the State Department of Health (OSDH) consistent
					 with the level of care they provide, in accordance with the Oklahoma Emergency
					 Response System Development Act of 2005, 63 OS 1-2503. Ambulance suppliers that
					 do not provide services in Oklahoma must be licensed by the appropriate agency
					 in the state in which they provide services. Ambulance companies and all other
					 transportation providers must have a current contract on file with the Oklahoma
					 Health Care Authority (OHCA). Air Ambulance providers must indicate on the
					 application for enrollment that they are requesting fixed wing or rotary wing
					 ambulance status and provide a copy of their license with their enrollment
					 application.
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 23 Ok Reg 265, eff 10-3-05 (emergency); Added at 23 Ok Reg
					 1360, eff 5-25-06; Amended at 24 Ok Reg 601, eff 12-21-06 (emergency); Amended
					 at 24 Ok Reg 920, 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 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-336 - General coverage

Current through Vol. 41, No. 20, July 1, 2024
(a) OHCA covers
				  ground and air ambulance transportation services, within certain limitations.
(1) Ambulance and stretcher transportation is
				  covered only when medically necessary and when due to the member's condition
				  any other method of transportation is contraindicated.
(2) As a general rule ambulance
				  transportation to the nearest appropriate facility in the locality is covered.
				  OHCA utilizes the locality areas as defined by Medicare.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-336.1 - Medical necessity

Current through Vol. 41, No. 20, July 1, 2024
(a) The member's
				  condition must require the ambulance/stretcher transportation itself and the
				  level of service provided, in order for the billed service to be considered
				  medically necessary. Medical necessity is established when the member's
				  condition is such that the use of any other method of transportation is
				  contraindicated.
(b) The medical
				  personnel in attendance, including the Emergency Medical Technician (EMT) at
				  the scene of an emergency, determine medical necessity and appropriateness of
				  service within the scope of accepted medical practice and SoonerCare
				  guidelines.
(c) Non-emergency
				  transports are not covered unless the member is bed confined or has a medical
				  condition that requires medical expertise not available with a less specialized
				  method of transportation. Medical necessity for non-emergency transports must
				  be substantiated with a physician's written order.
Added at 24 Ok Reg
					 601, eff 12-21-06 (emergency); Added at 24 Ok Reg 920, 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 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-336.2 - Nearest appropriate facility

Current through Vol. 41, No. 20, July 1, 2024
(a)
				  OHCA covers transportation to the nearest facility that can appropriately treat
				  the member.
(b) An institution is
				  not considered an appropriate facility if the member's condition requires a
				  higher level of care or specialized services available at the more distant
				  hospital. However, a legal impediment barring a member's admission would mean
				  that the institution did not have "appropriate facilities". For example, the
				  nearest transplant center may be in another state and that state's law
				  precludes admission of nonresidents.
(c) An institution is not considered an
				  appropriate facility if no bed is available. However, the medical records must
				  be properly documented.
Added at 24 Ok Reg
					 601, eff 12-21-06 (emergency); Added at 24 Ok Reg 920, 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 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-336.3 - Destination and transport outside of locality

Current through Vol. 41, No. 20, July 1, 2024
(a) Transportation
				  is covered from the point of origin to the Hospital, Critical Access Hospital
				  or Nursing Facility that is capable of providing the required level and type of
				  care for the member.
(b) Ambulance
				  transportation from a hospital with a higher level of care to a hospital with a
				  lower level of care in the locality is covered, provided all other criteria are
				  met and approved by the OHCA.
(c)
				  Non-emergency transportation to the outpatient facilities of a Hospital,
				  free-standing Ambulatory Surgery Center (ASC), Independent Diagnostic Testing
				  Facility (IDTF), Physician's office or other outpatient facility is compensable
				  if the member's condition necessitates ambulance or stretcher transportation
				  and all other conditions are met.
(d) Ambulance Transportation to a Veteran's
				  Administration (VA) Hospital is covered when the trip has not been authorized
				  by the VA.
(e) If ambulance
				  transportation is provided out of the transport locality, the claim must be
				  documented with the reason for the transport outside of the service
				  area.
(f) If it is determined the
				  member was transported out of locality and the closest facility could have
				  cared for the member, payment will be made only for the distance to the nearest
				  medical institution with the appropriate facilities.
(g) Any transportation which begins or ends
				  outside of the Oklahoma geographic border requires prior authorization. The
				  exception to this rule is if transportation begins or ends within one hundred
				  (100) miles of Oklahoma's geographic border, no prior authorization is
				  required.
Added at 24 Ok Reg
					 601, eff 12-21-06 (emergency); Added at 24 Ok Reg 920, 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 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-336.4

Current through Vol. 41, No. 20, July 1, 2024
Added at 24 Ok Reg 601, eff 12-21-06 (emergency) ; Added
						at 24 Ok Reg 920, eff 5-11-07 ; Amended at 30 Ok Reg 1164, 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 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-336.5 - Levels of ambulance service, ambulance fee schedule and base rate

Current through Vol. 41, No. 20, July 1, 2024
(a) In accordance
				  with the Oklahoma Emergency Response System Development Act of 2005, §63
				  OS 1-2503, a license may be issued for basic life support, intermediate life
				  support, paramedic life support, specialized mobile intensive care units, or
				  stretcher aid vans.
(b) Payment is
				  made at the lower of the provider's usual and customary charge or the OHCA fee
				  schedule for SoonerCare compensable services.
(1) The ambulance provider bills one base
				  rate procedure. Levels of service base rates are defined at
				  42
				  CFR 414.605.
(2) The base rate must reflect the level of
				  service rendered, not the type of vehicle in which the member was
				  transported.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-336.6 - Mileage

Current through Vol. 41, No. 20, July 1, 2024
(a) Charges for
				  mileage must be based on loaded mileage only, i.e., from the pickup of a member
				  to his/her arrival at the destination.
(b) Coverage is allowed only to the nearest
				  appropriate facility.
Added at 24 Ok Reg
					 601, eff 12-21-06 (emergency); Added at 24 Ok Reg 920, 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 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-336.7 - Waiting time

Current through Vol. 41, No. 20, July 1, 2024
(a) Waiting time is
				  reimbursable after the first 30 minutes when a physician deems it medically
				  necessary for the ambulance provider to wait at a hospital while the member is
				  being stabilized, with the intent of continuing the member's transport to an
				  appropriate hospital for care or back to the point of origin.
(b) The maximum number of hours allowed for
				  waiting time is four hours.
Added at 24 Ok Reg
					 601, eff 12-21-06 (emergency); Added at 24 Ok Reg 920, 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 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-336.8 - Special situations

Current through Vol. 41, No. 20, July 1, 2024
(a)
Continuous or round trip transport.
(1) If a member is transported to a
				  destination and returned to their original point of pickup, coverage includes
				  payment for the primary transport and the return transport.
(2) If the provider is required to remain and
				  attend the member between transports, the provider may claim waiting
				  time.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-336.9 - Air ambulance

Current through Vol. 41, No. 20, July 1, 2024
(a) Air
				  Ambulance service, which includes fixed and rotary wing transportation, are
				  covered only when:
(1) The point of pickup is
				  inaccessible by land vehicle; or,
(2) Great distances or other obstacles are
				  involved in getting the member to the nearest hospital with appropriate
				  facilities and timely admission is essential; i.e., in cases where
				  transportation by land ambulance is contraindicated; or
(3) The member's medical condition and other
				  circumstances of the case necessitated the use of this type of transportation.
				  However, where land ambulance service would have sufficed, payment is based on
				  the amount payable for land ambulance, if this is less costly.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-336.10 - Fixed wing air ambulance services

Current through Vol. 41, No. 20, July 1, 2024
(a) Fixed wing air ambulance transports must
				  be approved by OHCA. This approval is contingent upon medical
				  necessity.
(b) Ambulance transport
				  in a fixed wing aircraft is a covered service if the following requirements are
				  met:
(1) The transport, including ancillary
				  services (e.g. flight nurse), is ordered by a physician.
(2) The written physician order is maintained
				  in the member's file.
(3) Transport
				  by ground vehicle would endanger the member's life due to time and distance
				  from the hospital.
(4) Medically
				  necessary care or services for the member's medical condition cannot be
				  provided by a local facility.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-336.11 - Rotary wing air ambulance

Current through Vol. 41, No. 20, July 1, 2024
Rotary wing air ambulance services are covered by the OHCA
					 only under the following circumstances:
(1) Time and distance in a ground ambulance
				  would be a hazard to the life of the member;
(2) The medically necessary care and services
				  for the member's need are not available at the local hospital, and;
(3) The transfer is for medical or surgical
				  procedures, not solely for diagnostic services only.
Added at 24 Ok Reg
					 601, eff 12-21-06 (emergency); Added at 24 Ok Reg 920, 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 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-336.12 - Non-emergency ambulance and stretcher service transportation

Current through Vol. 41, No. 20, July 1, 2024
(a) OHCA covers non-emergency ground,
				  stretcher and air transportation to and from a medically necessary service. To
				  be covered, the member must be either:
(1)
				  bed confined and unable to use another means of transportation, or
(2) the member's condition must warrant
				  ambulance transportation.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-336.13 - Non-covered services

Current through Vol. 41, No. 20, July 1, 2024
(a) Ambulance
				  transportation from residence to residence is not covered except for transfers
				  from nursing home to nursing home when the transferring facility is not
				  certified.
(b) Payment will not be
				  made for ambulance transportation determined not to be medically
				  necessary.
(c) Transportation to a
				  funeral home, mortuary, or morgue is not covered.
Added at 24 Ok Reg 601, eff 12-21-06 (emergency) ; Added
						at 24 Ok Reg 920, eff 5-11-07 ; Amended at 30 Ok Reg 1164, 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 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-337 - Coverage for children

Current through Vol. 41, No. 20, July 1, 2024
(a)
				  Services, deemed medically necessary and allowable under federal Medicaid
				  regulations, may be covered by the EPSDT/OHCA Child Health program even though
				  those services may not be part of the OHCA SoonerCare program. Such services
				  must be prior authorized.
(b)
				  Federal Medicaid regulations also require the State to make the determination
				  as to whether the service is medically necessary and do not require the
				  provision of any items or services that the State determines are not safe and
				  effective or which are considered experimental.For more information regarding
				  experimental or investigational including clinical trials, see Oklahoma
				  Administrative Code 317:30-3-57.1.
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 601, eff 12-21-06 (emergency); Amended at 24 Ok
					 Reg 920, 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 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-338 - Vocational rehabilitation coverage [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 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-339 - Individuals eligible for Part B of Medicare

Current through Vol. 41, No. 20, July 1, 2024
Payment for ambulance transportation is made using current
					 Medicare methodology.
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; Amended at 24 Ok Reg 601, eff 12-21-06 (emergency);
					 Amended at 24 Ok Reg 920, 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 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-340 - 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; 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 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-341 - Claim form [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 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-342 - Public transportation [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 23 Ok Reg 265, eff 10-3-05 (emergency); Revoked at 23 Ok
					 Reg 1360, 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 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-343 - Reimbursement

Current through Vol. 41, No. 20, July 1, 2024
Payment is made at the lower of the provider's usual and
					 customary charge or the OHCA's fee schedule.
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 23 Ok Reg 265, eff 10-3-05 (emergency); Added at 23 Ok Reg
					 1360, 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 34 - SECURE BEHAVIORAL HEALTH TRANSPORTATION › Section 317:30-5-347 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
The following words and terms, when used in this Part shall
					 have the following meaning, unless context clearly indicates otherwise:
"Member/eligible member"
means any person
					 eligible for SoonerCare and individuals considered to be Medicare/SoonerCare
					 dual eligible.
"Nearest appropriate facility"
means a medical
					 facility that is generally equipped and legally permitted to provide the needed
					 care for the illness or injury involved that is the closest in geographical
					 proximity to the member's pickup location.
"OAC"
means Oklahoma Administrative
					 Code.
"ODMHSAS"
means the Oklahoma Department of
					 Mental Health and Substance Abuse Services.
"O.S."
means Oklahoma Statutes.
"Qualified Transportation Service Provider"
or
"QTSP"
means an ODMHSAS-contracted transportation provider for
					 members requiring transportation to a treatment facility for the purpose of
					 examination, emergency detention, protective custody, or inpatient services in
					 accordance with 43A O.S. § 1-110.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 34 - SECURE BEHAVIORAL HEALTH TRANSPORTATION › Section 317:30-5-348 - Program overview

Current through Vol. 41, No. 20, July 1, 2024
(a)
				  ODMHSAS-contracted Qualified Transportation Service Providers (QTSPs) are
				  required to transport SoonerCare members reasonably believed to be experiencing
				  a behavioral health crisis to and from designated sites/facilities for the
				  purpose of examination, emergency detention, protective custody, or inpatient
				  services in accordance with 43A O.S. § 1- 110.
(b) SoonerCare members being transported
				  shall be afforded all rights and privileges guaranteed by the laws and
				  Constitution of the State of Oklahoma and the United States of America.
				  SoonerCare members have the right to be transported in a way that protects
				  their dignity and safety.
(c)
				  Mechanical restraints may only be used in the transportation of members when
				  needed in accordance with 43A O.S. § 1-110 and as defined in the QTSP's
				  contract with ODMHSAS.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 34 - SECURE BEHAVIORAL HEALTH TRANSPORTATION › Section 317:30-5-349 - Program eligibility and covered services

Current through Vol. 41, No. 20, July 1, 2024
(a)
				  SoonerCare members, both children and adults, are eligible for services when
				  medically necessary.
(b) A member
				  must be reasonably believed to be experiencing a behavioral health crisis as
				  evidenced by extreme emotional distress that includes, but is not limited to,
				  an acute episode of mental illness and/or suicidal thoughts and/or behavior
				  that may occur with substance use and other disorders.
(c) Secure behavioral health transportation
				  may be provided when medically necessary for the following:
(1) Transportation to a facility arranged by
				  individuals authorized by ODMHSAS, including but not limited to, hospitals and
				  other mental health facilities;
(2)
				  Facility-to-facility transports; and
(3) Transport of a member seeking voluntary
				  admission to a facility.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 34 - SECURE BEHAVIORAL HEALTH TRANSPORTATION › Section 317:30-5-350 - Service requirements

Current through Vol. 41, No. 20, July 1, 2024
(a)
Eligible
				  providers.
Service providers must be ODMHSAS-contracted Qualified
				  Transportation Service Providers (QTSPs) and meet the Uniform Transportation
				  Standards for QTSPs described in this Section.
(b)
Driver requirements.
Drivers
				  must:
(1) Be twenty-one (21) years of age or
				  older;
(2) Hold a valid driver's
				  license issued by the State of Oklahoma;
(3) Undergo a criminal background check and
				  not have been convicted of or received a deferred or probated sentence related
				  to any felony crime, a crime involving moral turpitude or a crime of domestic
				  violence; and not have any criminal charges pending in ay court in the State of
				  Oklahoma, another state, in tribal court or pursuant to the United States
				  Code;
(4) Be able to ensure that
				  SoonerCare members who are transported are protected by harm and injuries due
				  to abuse, self-abuse, neglect, sexual incidents, serious injuries and other
				  sources of immediate danger;
(5) Be
				  able to provide emergency care or have an established plan to access emergency
				  care;
(6) Be trained in effective
				  communication skills with persons with mental illness, consumer rights,
				  CPR/First Aid, and confidentiality as prescribed by ODMHSAS prior to completing
				  transports;
(7) Be able to
				  recognize and plan for problematic behaviors in a therapeutic and safe manner
				  and complete a 16-hour Therapeutic Options Course or similar curriculum
				  approved by ODMHSAS prior to completing transports; and
(8) Be familiar with the statutes and
				  standards related to transporting members.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 34 - SECURE BEHAVIORAL HEALTH TRANSPORTATION › Section 317:30-5-351 - Authorization and reimbursement

Current through Vol. 41, No. 20, July 1, 2024
(a) Secure
				  behavioral health transportation does not require a prior authorization, with
				  the exception of out-of-state transports, which may require prior approval or
				  authorization by ODMHSAS.
(b)
				  Secure behavioral health transportation is reimbursed per the methodology
				  described in the Oklahoma Medicaid State Plan.