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 77 - SPEECH-LANGUAGE PATHOLOGISTS, SPEECH-LANGUAGE PATHOLOGY ASSISTANTS, CLINICAL FELLOWS AND AUDIOLOGISTS › Section 317:30-5-677 - Payment rates [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 3516, eff 9-1-00 (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 77 - SPEECH-LANGUAGE PATHOLOGISTS, SPEECH-LANGUAGE PATHOLOGY ASSISTANTS, CLINICAL FELLOWS AND AUDIOLOGISTS › Section 317:30-5-678 - 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 3516, eff 9-1-00 (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 77 - SPEECH-LANGUAGE PATHOLOGISTS, SPEECH-LANGUAGE PATHOLOGY ASSISTANTS, CLINICAL FELLOWS AND AUDIOLOGISTS › Section 317:30-5-679 - 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 77 - SPEECH-LANGUAGE PATHOLOGISTS, SPEECH-LANGUAGE PATHOLOGY ASSISTANTS, CLINICAL FELLOWS AND AUDIOLOGISTS › Section 317:30-5-680 - Team therapy (Co-treatment)

Current through Vol. 41, No. 20, July 1, 2024
Therapists, or therapy assistants, working together as a
					 team to treat one(1) or more members cannot bill separately for the same or
					 different service provided at the same time to the same member.
(1) Current Procedural Terminology (CPT)
				  codes are used for billing the services of one (1) therapist or therapy
				  assistant. The therapist cannot bill for his/her services and those of another
				  therapist or a therapy assistant, when both provide the same or different
				  services, at the same time, to the same member.
(2) If multiple therapies (physical therapy,
				  occupational therapy, and/or speech therapy) are provided to one(1) member at
				  the same time, only one(1) therapist can bill for the entire service, or each
				  therapist can divide the service units.
(3) Providers must report the CPT code for
				  the time actually spent in the delivery of the modality requiring constant
				  attendance and therapy services. Pre- and post-delivery services are not to be
				  counted in determining the treatment service time. The time counted must begin
				  when the therapist is directly working with the member to deliver treatment
				  services.
(4) The time counted is
				  the time the member is being treated. If the member requires both a therapist
				  and an assistant, or even two(2) therapists, each service unit of time the
				  member is being treated can count as only one(1) unit of each code. The service
				  units billed must equal the total time the member was receiving actual therapy
				  services. It is not allowable for each therapist or therapy assistant to bill
				  for the entire therapy session. The time the member spends not being treated,
				  for any reason, must not be billed.
Added at 28 Ok Reg 12,
					 eff 8-13-10 (emergency); Added at 28 Ok Reg 1475, 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 79 - DENTISTS › Section 317:30-5-695 - Eligible dental providers and definitions

Current through Vol. 41, No. 20, July 1, 2024
(a) Eligible dental providers in Oklahoma's
				  SoonerCare program are:
(1) Individuals
				  licensed as dentists under Title 59 of Oklahoma Statutes (O.S.), Sections
				  (§§) 328.21, 328.22, and 328.23 (licensed dentists, specialty
				  dentists and out of state dentists);
(2) Individuals issued permits as dental
				  interns under 59 O.S. §
											328.26;
(3) Individuals who are third and
				  fourth year dental students at an accredited Oklahoma dental college; and
(4) Any individual issued a
				  license in another state as a dentist.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 79 - DENTISTS › Section 317:30-5-695.1 - Payment for eligible providers

Current through Vol. 41, No. 20, July 1, 2024
To receive payment from the Oklahoma Health Care Authority,
					 an eligible provider must:
(1) hold an
				  active Medicaid contract with the OHCA;
(2) submit a claim form in the format
				  required by the OHCA; and
(3)
				  submit the claim timely to the OHCA.
Added at 17 Ok Reg
					 3201, eff 6-21-00 (emergency); Added at 18 Ok Reg 1130, eff 5-11-01; Amended at
					 23 Ok Reg 2489, eff 6-25-06
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 79 - DENTISTS › Section 317:30-5-695.2 - Payment for dental interns and students

Current through Vol. 41, No. 20, July 1, 2024
(a) For those eligible providers under OAC
				  317:30-5-695(a)(2)
				  and (3) (dental interns who hold permits or
				  third and fourth year students), in addition to the requirements of OAC
				  317:30-5-695.1,
				  the following requirements must be met for OHCA to pay a claim:
(1) the patient must be examined by an
				  attending dentist in the dental training program;
(2) the care delivered to the Medicaid client
				  by the student or intern must be supervised by the attending dentist;
				  and
(3) the supervision by the
				  attending dentist must be documented in the patient's medical record.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 79 - DENTISTS › Section 317:30-5-696.1 - Anesthesia

Current through Vol. 41, No. 20, July 1, 2024
Payment is made for medical and surgical services
					 performed by a dentist to the extent such services may be performed under State
					 law either by a doctor of dental surgery or dental medicine, when those
					 services would be covered if performed by a physician. Payment is made to
					 Dentists who have received appropriate formal education in conscious sedation
					 and general anesthesia.
(1) Training
				  to competency in conscious sedation techniques may be acquired at the
				  predoctoral, postgraduate, graduate, or continuing education level. Dentists
				  who wish to utilize conscious sedation are expected to successfully complete
				  formal training which is structured in accordance with the American Dental
				  Association's educational guidelines as well as the board of Dentistry for the
				  State in which they practice.
(2)
				  The knowledge and skills required for the administration of deep sedation and
				  general anesthesia are beyond the scope of pre-doctoral and continuing
				  education. Only dentists who have successfully completed an accredited/approved
				  residency program in anesthesiology, for the administration of anesthetic
				  agents will be permitted to provide and bill for this service.
(3) All anesthesia services must be provided
				  in accordance with OAC
				  317:30-5-7.
(A) Dentists who provide or supervise deep
				  sedation or general anesthesia are required to have training in anesthesiology,
				  oral surgery or pediatric dentistry, such as in a residency
				  curriculum.
(B) To be considered
				  qualified to supervise the administration of general anesthesia or deep
				  sedation, OHCA requires a minimum of eighteen (18) hours of courses related to
				  the administration of anesthesia, deep sedation or medical emergencies in the
				  dental office every three (3) years.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 79 - DENTISTS › Section 317:30-5-697 - Oral surgery procedures

Current through Vol. 41, No. 20, July 1, 2024
Some elective oral surgery procedures require a written
					 report or treatment plan be reviewed by the OHCA Dental Consultant prior to
					 surgery to determine if the service is within the scope of the Dental Program.
					 All oral surgeons may bill on the HCFA-1500 using CPT codes or the ADA dental
					 claim form using the HCPCS, Level II, Dental codes.
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 20 Ok Reg 2891, eff 7-1-03 (emergency); Amended at 21 Ok
					 Reg 2210, eff 6-25-04
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 79 - DENTISTS › Section 317:30-5-698 - Services requiring prior authorization

Current through Vol. 41, No. 20, July 1, 2024
(a)
Prior authorizations.
Providers must have prior authorization for certain specified services before
				  delivery of that service, unless the service is provided on an emergency basis
				  [See Oklahoma Administrative Code (OAC)
				  317:30-5-695(d)(2)]
				  . Requests for dental services requiring prior authorization must be
				  accompanied by sufficient documentation.
(b)
Requests for prior
				  authorization.
Requests for prior authorization, and any related
				  documents, must be submitted electronically through the OHCA secure provider
				  portal. Prior authorized services must be billed exactly as they appear on the
				  prior authorization. Payment is not made for any services provided prior to
				  receiving authorization except for the relief of pain.
(c)
Prosthodontic services.
Prosthodontic services provided to members who have become ineligible
				  mid-treatment are covered if the member was eligible for SoonerCare on the date
				  the final impressions were made.
(d)
Adults.
Listed below are
				  examples of services requiring prior authorization for members twenty-one (21)
				  years of age and over/older. Minimum required records to be submitted with each
				  request are right and left mounted bitewings and periapical films or images of
				  tooth/teeth involved or the edentulous areas if not visible in the bitewings.
				  Images must be of diagnostic quality. Images must be identified by the tooth
				  number and include date of exposure, member name, member ID, provider name, and
				  provider ID. All images, regardless of the media, must be submitted together
				  with a completed and signed comprehensive treatment plan that details all
				  needed treatment at the time of examination, with the prior authorization
				  requesting all needed treatment. The images, digital media, and photographs
				  must be of sufficient type and quality to clearly demonstrate for the reviewer,
				  the pathology which is the basis for the authorization request. Documentation
				  of a periodontal evaluation with six (6) point measurements for teeth to remain
				  must be included with requests.
(1)
Removable prosthetics.
(A) This
				  includes full and partial dentures.
(i) One
				  (1) per every five (5) years is available for adults under twenty-five (25)
				  years of age.
(ii) One (1) per
				  every seven (7) years is available for adults twenty-five (25) years of age and
				  over.
(iii) Provider is responsible
				  for any needed follow up for a period of two (2) years post
				  insertion.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 79 - DENTISTS › Section 317:30-5-699 - Restorations

Current through Vol. 41, No. 20, July 1, 2024
(a)
Utilization parameters.
(1) The
				  Oklahoma Health Care Authority utilization parameters allow only one (1)
				  permanent restorative service to be provided per tooth per twenty-four (24)
				  months.
(2) Additional restorations
				  may be authorized upon approval of OHCA in cases of trauma.
(3) The provider is responsible for follow-up
				  or any required replacement of a failed restoration, if the member is currently
				  SoonerCare eligible.
(4) Providers
				  must document type of isolation used in treatment progress notes.
(5) For members who are under twenty-one (21)
				  years of age and who are receiving a restoration are eligible within three (3)
				  months for consideration of a single crown if endodontically treated.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 79 - DENTISTS › Section 317:30-5-700 - Orthodontic services

Current through Vol. 41, No. 20, July 1, 2024
(a) Orthodontic
				  services are available for members who are SoonerCare-eligible and under
				  eighteen (18) years of age at the time the request for prior authorization for
				  treatment is received. In order to be eligible for SoonerCare orthodontic
				  services, members must be referred through an OHCA contracted primary care
				  dentist using the DEN-2 form found on the Oklahoma Health Care Authority (OHCA)
				  website; a member can receive a referral from a primary care dentist to the
				  orthodontist only after meeting the following:
(1) The member has had a caries free initial
				  visit; or
(2) Has all decayed areas
				  restored and has remained caries free for twelve 12 months; and
(3) Has demonstrated competency in
				  maintaining an appropriate level of oral hygiene.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 79 - DENTISTS › Section 317:30-5-700.1 - Orthodontic prior authorization

Current through Vol. 41, No. 20, July 1, 2024
(a) Orthodontic services are available for members who are SoonerCare-eligible and under eighteen (18) years of age, at the time the request for prior authorization for treatment is received, per Oklahoma Administrative Code 317:30-5-700. The following records and documentation, plainly labeled with the member's full name, recipient identification number (RID), and the orthodontist's name are required for prior authorization of orthodontic services and must be electronically submitted to the Dental Unit of the Oklahoma Health Care Authority (OHCA) Dental Program when the member has a total score of not less than thirty (30) points or meets other eligibility criteria in paragraph (d).
(1) Completed prior authorization requesting all needed treatments;
(2) Complete and scored Handicapping Labio-Lingual Deviation (HLD) Index with Diagnosis of Angle's classification;
(3) Detailed description of any oral maxillofacial anomaly;
(4) Estimated length of treatment;
(5) Intraoral photographs showing teeth in centric occlusion and/or photographs of trimmed anatomically occluded diagnostic casts. A lingual view of casts may be included to verify impinging overbites;
(6) Cephalometric images with tracing, and panoramic film, with a request for prior authorization of comprehensive orthodontic treatment;
(7) Completed OHCA caries risk assessment form;
(8) If diagnosed as a surgical case, submit an oral surgeon's written opinion that orthognathic surgery is indicated and the surgeon is willing to provide this service; and
(9) Additional pertinent information as determined necessary by the orthodontist or as requested by the OHCA.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 79 - DENTISTS › Section 317:30-5-700.1 - Orthodontic prior authorization

Current through Vol. 41, No. 20, July 1, 2024
(a)
				  Orthodontic services are available for members who are SoonerCare-eligible and
				  under eighteen (18) years of age, at the time the request for prior
				  authorization for treatment is received, per Oklahoma Administrative Code
				  317:30-5-700.
				  The following records and documentation, plainly labeled with the member's full
				  name, recipient identification number (RID), and the orthodontist's name are
				  required for prior authorization of orthodontic services and must be submitted
				  to the Dental Unit of the Oklahoma Health Care Authority (OHCA) Dental Program
				  when the member has a total score of not less than thirty (30) points or meets
				  other eligibility criteria in paragraph (d).
(1) Completed prior authorization requesting
				  all needed treatments;
(2) Complete
				  and scored Handicapping Labio-Lingual Deviation (HDL) Index with Diagnosis of
				  Angle's classification;
(3)
				  Detailed description of any oral maxillofacial anomaly;
(4) Estimated length of treatment;
(5) Intraoral photographs showing teeth in
				  centric occlusion and/or photographs of trimmed anatomically occluded
				  diagnostic casts. A lingual view of casts may be included to verify impinging
				  overbites;
(6) Cephalometric images
				  with tracing, and panoramic film, with a request for prior authorization of
				  comprehensive orthodontic treatment;
(7) Completed OHCA caries risk assessment
				  form;
(8) If diagnosed as a
				  surgical case, submit an oral surgeon's written opinion that orthognathic
				  surgery is indicated and the surgeon is willing to provide this service;
				  and
(9) Additional pertinent
				  information as determined necessary by the orthodontist or as requested by the
				  OHCA.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 79 - DENTISTS › Section 317:30-5-701 - Surface identification

Current through Vol. 41, No. 20, July 1, 2024
Surfaces requiring dental treatment must be indicated using
					 standard Latin abbreviations. The following capital letters are used on
					 claims:
(1) M - Mesial
(2) D - Distal
(3) O - Occlusal
(4) L - Lingual
(5) F - Facial
(6) I - Incisal
(7) B - Buccal.
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 2489, eff 6-25-06
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 79 - DENTISTS › Section 317:30-5-702 - Dental 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 16 Ok Reg 692, eff 12-31-98 (emergency); Revoked at 16 Ok
					 Reg 1429, eff 5-27-99
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 79 - DENTISTS › Section 317:30-5-703 - Tooth numbering system

Current through Vol. 41, No. 20, July 1, 2024
(a)
				  For adult teeth, the universal tooth numbering system (1 through 32) is used.
				  For primary teeth, tooth letters A through T are used.
(b) No other tooth letter or number system is
				  accepted. All procedures performed on a specific tooth require the appropriate
				  tooth number.
(c) Supernumerary
				  teeth are identified as follows:
(1)
Permanent dentition.
Supernumerary teeth are identified by the
				  numbers 51 through 82, beginning with the area of the upper right third molar,
				  following around the upper arch and continuing on the lower arch to the area of
				  the lower right third molar. For example, supernumerary number 51 is adjacent
				  to the upper right molar number 1, and supernumerary number 82 is adjacent to
				  the lower right third molar number 32.
(2)
Primary dentition.
Supernumerary teeth are identified by the placement of the letter "S" following
				  the letter identifying the adjacent primary tooth. For example, supernumerary
				  "AS" is adjacent to "A" and supernumerary "TS" is adjacent to "T".
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 79 - DENTISTS › Section 317:30-5-704 - Billing instructions

Current through Vol. 41, No. 20, July 1, 2024
(a)
HCPCS Codes.
The Oklahoma Health Care Authority (OHCA) utilizes the Medicare Level II Healthcare Common Procedure Coding System (HCPCS) codes. All claim submissions must be in compliance with this coding system.
(b)
Prior authorization.
Where applicable, the appropriate arch, quadrant, or tooth surface and tooth number must be included on the claim. Diagnosis codes are requested to be listed in the appropriate field when submitting prior authorizations on the provider portal.
(c)
Images.
Any type of film or prints submitted will not be returned. All images must be dated, mounted and have patient's name, recipient identification number (RID), provider name and provider number.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 79 - DENTISTS › Section 317:30-5-704 - Billing instructions

Current through Vol. 41, No. 20, July 1, 2024
(a)
HCPCS Codes.
The Oklahoma Health Care Authority(OHCA) utilizes the
				  Medicare Level II Healthcare Common Procedure Coding System (HCPCS) codes. All
				  claim submissions must be in compliance with this coding system.
(b)
Prior authorization.
Where
				  applicable, the appropriate arch, quadrant, or tooth surface and tooth number
				  must be included on the claim. Diagnosis codes are requested to be listed in
				  box 34 of the current American Dental Association (ADA) dental claim form. For
				  mailed prior authorizations, a completed HCA-13D form is required.
(c)
Images.
Any type of film or
				  prints submitted will not be returned. All images must be dated, mounted and
				  have patient's name, recipient identification number (RID), provider name and
				  provider number.
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 3822, eff 7-1-98 (emergency); Amended at 16 Ok
					 Reg 692, eff 12-31-98 (emergency); Amended at 16 Ok Reg 1429, eff 5-27-99;
					 Amended at 23 Ok Reg 2489, eff 6-25-06
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 79 - DENTISTS › Section 317:30-5-705 - Billing and reimbursement

Current through Vol. 41, No. 20, July 1, 2024
(a)
				  Dental claims, and any related documents, must be submitted electronically or
				  through the OHCA secure provider portal. Electronic submission must be made on
				  the HIPAA compliant Form 837D.
(b)
				  Billing and reimbursement methodology, including copayments, are outlined in
				  the Oklahoma Medicaid State Plan.
Added at 16 Ok Reg
					 692, eff 12-31-98 (emergency); Added at 16 Ok Reg 1429, eff 5-27-99; Amended at
					 23 Ok Reg 2489, eff 6-25-06
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 80 - MOBILE AND PORTABLE DENTAL SERVICES › Section 317:30-5-706 - Mobile dental units

Current through Vol. 41, No. 20, July 1, 2024
(a)
Definition.
"Mobile dental unit"
means a motor
				  vehicle or trailer that contains dental equipment and is used to provide dental
				  services to eligible SoonerCare members on-site in accordance with Title 59 of
				  Oklahoma Statutes (O.S.), Section
				  328.3 (59 O.S.
				  §328.3).
(b)
Eligible
				  providers.
For dental services provided at a mobile dental unit to be
				  eligible for SoonerCare reimbursement, a dental group shall meet all applicable
				  requirements set forth in the Oklahoma Board of Dentistry rules, the Oklahoma
				  State Dental Act (59 O.S., Ch. 7), and the requirements in this Section,
				  including but not limited to, all licensing and permitting requirements.
(1) All dentists working at a mobile dental
				  unit shall be currently licensed in good standing with the Oklahoma Board of
				  Dentistry. All other contracted providers of the dental group, working at a
				  mobile dental unit, shall meet all credentialing/certification requirements, as
				  per their specialty. In addition, all members of the dental group working at a
				  mobile dental unit shall comply with the requirements at Oklahoma
				  Administrative Code (OAC)
				  317:30-5-695.
(2) The license, certification,
				  accreditation, and/or permit (or a photocopy of these documents) of every
				  individual provider in the dental group shall be prominently displayed at the
				  mobile dental unit, pursuant to 59 O.S., Section (§) 328.21.
(3) For services provided in a mobile dental
				  unit, the permit to operate the mobile dental unit shall be prominently
				  displayed in the mobile dental unit vehicle, pursuant to 59 O.S.
				  §328.40a.
(4) In accordance
				  with OAC 317:30-5-695.1, every dental
				  group providing services at a mobile dental unit must be fully contracted with
				  the Oklahoma Health Care Authority (OHCA) as a dental group provider and must
				  also be fully contracted with OHCA as a mobile dental unit.
(5) Every individual dentist practicing at a
				  mobile dental unit must be fully contracted with the OHCA as a
				  dentist.
(6) Dental groups and
				  individual providers providing dental services at a mobile dental unit shall
				  comply with all applicable state and federal Medicaid laws, including, but not
				  limited to, OHCA administrative rules, the Code of Federal Regulations, and the
				  Oklahoma State Medicaid Plan.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 80 - MOBILE AND PORTABLE DENTAL SERVICES › Section 317:30-5-707 - Portable dental units

Current through Vol. 41, No. 20, July 1, 2024
(a)
Definition.
Portable dental unit means a non-facility in which
				  dental equipment used in the practice of dentistry is transported to and used
				  on a temporary basis at an out-of-office location at either group homes for
				  juveniles or public and private schools.
(b)
Eligible providers.
For
				  dental services provided at a portable dental unit to be eligible for
				  SoonerCare reimbursement, a dental group shall meet all applicable requirements
				  set forth in the Oklahoma Board of Dentistry rules, the Oklahoma State Dental
				  Act (59 O.S., Ch. 7), and the requirements in this Section, including but not
				  limited to, all licensing and permitting requirements.
(1) All dentists working at a portable dental
				  unit shall be currently licensed in good standing with the Oklahoma Board of
				  Dentistry. All other contracted providers of the dental group, working at a
				  portable dental unit, shall meet all credentialing/certification requirements,
				  as per their specialty. In addition, all members of the dental group working at
				  a portable dental unit shall comply with the requirements at Oklahoma
				  Administrative Code (OAC)
				  317:30-5-695.
(2) The license or permit (or a photocopy of
				  the license or permit) of every individual provider shall be prominently
				  displayed at the portable dental unit site, pursuant to Title of 59 O.S. §
				  328.21.
(3) In accordance with OAC
				  317:30-5-695.1, every dental
				  group providing services at a portable dental unit must be fully contracted
				  with the OHCA as a dental group provider.
(4) Every individual dentist practicing at a
				  portable dental unit must be fully contracted with the OHCA as a
				  dentist.
(5) Dental groups and
				  individual providers providing dental services at a portable dental unit shall
				  comply with all state and federal Medicaid laws, including, but not limited to,
				  OHCA administrative rules, the Code of Federal Regulations, and the Oklahoma
				  State Medicaid Plan.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 80 - MOBILE AND PORTABLE DENTAL SERVICES › Section 317:30-5-708 - Parental consent requirements

Current through Vol. 41, No. 20, July 1, 2024
Individual providers at a mobile or portable dental unit
					 shall not perform any service on a minor without having obtained, prior to the
					 provision of services, a signed, written consent from the minor's parent or
					 legal guardian, that includes, at a minimum, the:
(1) Name of the dental group and/or dentist
				  providing the dental services at the mobile and/or portable dental
				  unit;
(2) Permanent business
				  mailing address of the dental group and/or dentist providing the dental
				  services at the mobile and/or portable dental unit;
(3) Business telephone number of the dental
				  group and/or dentist providing the dental services at the mobile and/or
				  portable dental unit. This telephone number must be available for emergency
				  calls;
(4) Full printed name of the
				  child to receive services;
(5)
				  Child's SoonerCare Member ID number; and
(6) An inquiry of whether the child has had
				  dental care in the past twelve (12) months and if the child has a dental
				  appointment scheduled with his/her regular dentist. If applicable, parent
				  should list the name and address of the dentist and/or dental office where the
				  care is provided.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 81 - CHIROPRACTORS › Section 317:30-5-720 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
(a) Must be
				  appropriately licensed, in good standing in the state in which they practice,
				  and working in accordance with the Oklahoma Chiropractic Practice Act or other
				  applicable statute(s); and
(b)
				  Entered into a provider agreement with the Oklahoma Health Care Authority
				  (OHCA) to provide chiropractic 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 81 - CHIROPRACTORS › Section 317:30-5-721 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
Payment is made to chiropractors as set forth in this
					 Section.
(1)
Children.
There is no coverage for children.
(2)
Adults.
There is no coverage
				  for adults.
(3)
Individuals
				  eligible for Part B of Medicare.
Payment is made utilizing the Medicaid
				  allowable for comparable services.
(4)
Manual spinal manipulation services
				  for pain management.
Refer to Oklahoma Administrative Code 317:30-5-727.
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
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 82 - ALTERNATIVE TREATMENTS FOR PAIN MANAGEMENT › Section 317:30-5-725 - General

Current through Vol. 41, No. 20, July 1, 2024
Alternative treatments for pain management are
					 non-pharmacological treatments recommended by a physician or other licensed
					 practitioner of the healing arts for adults age twenty-one (21) or older with
					 acute, subacute, and chronic spinal/back pain or injury. Treatments are
					 intended to reduce pain, increase mobility, optimize function, and decrease use
					 and misuse of opioid medications and may include the services listed in Part
					 82, of this Chapter.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 82 - ALTERNATIVE TREATMENTS FOR PAIN MANAGEMENT › Section 317:30-5-726 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
(a)
Manual
				  spinal manipulation.
Providers must meet the requirements outlined at
				  Oklahoma Administrative Code (OAC)
				  317:30-5-720.
(b)
Physical therapy (PT) for
				  alternative treatments for pain management.
Providers must meet the
				  requirements outlined at OAC
				  317:30-5-290.1.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 82 - ALTERNATIVE TREATMENTS FOR PAIN MANAGEMENT › Section 317:30-5-727 - Manual spinal manipulation

Current through Vol. 41, No. 20, July 1, 2024
Chiropractic services are limited to manual spinal
					 manipulation. This includes the manipulation of the five (5) regions of the
					 spinal column for the treatment of back pain in a member with a primary
					 diagnosis of acute or chronic pain and is performed by a licensed
					 chiropractor.
(1)
Medical
				  necessity.
All manual spinal manipulation services should be determined
				  to be medically necessary for the affected member. Documentation in the
				  member's plan of care should support the medical necessity of the need for
				  manual spinal manipulation services. The Oklahoma Health Care Authority (OHCA)
				  will serve as the final authority pertaining to all determinations of medical
				  necessity. Refer to Oklahoma Administrative Code (OAC)
				  317:30-3-1(f)
				  for policy on medical necessity.
(2)
Documentation/requirements.
All documentation submitted to request manual spinal manipulation services
				  should demonstrate, through adequate objective medical records, evidence
				  sufficient to justify the member's need for the service, in accordance with OAC
				  317:30-3-1(f)(2).
(A)
Evaluations.
One (1) initial
				  evaluation and one (1) re-evaluation, for chiropractic manual spinal
				  manipulation, are allowed per calendar year and do not require a PA.
(B)
Prior authorization (PA).
Documentation, for a PA request, will include the following:
(i) The member is over twenty-one (21) years
				  of age;
(ii) Attestation stating
				  that manual spinal manipulation services are being used in place of opioid
				  treatment for pain or used to decrease the use of opioids;
(iii) Primary diagnosis of acute or chronic
				  spinal pain or neuromusculoskeletal disorder related to the spinal
				  column;
(iv) Plan of care that is
				  designed for the treatment of spinal pain;
(v) Signed informed consent for
				  care;
(vi) For full guidelines,
				  please refer to
www.okhca.org/mau
.
(C)
Subsequent PA requests.
Requests for a subsequent PA will include the following:
(i) All documentation found at (2)(B)(i)
				  through (v) of this Section;
(ii)
				  Medical records that document that the treatments meet the functional needs of
				  the member;
(iii) Treatment goals
				  for acute pain/injury, chronic pain management, or chronic back pain;
(iv) Treatment evaluations that should
				  demonstrate improvement, including but not limited to, improved function,
				  decreased use of pain medications, increased activity level;
(v) Records showing persistent or recurrent
				  conditions;
(vi) For full
				  guidelines, please refer to
www.okhca.org/mau
.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 83 - THERAPEUTIC FOSTER CARE › Section 317:30-5-740 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
The following words or terms used in this Part shall have
					 the following meaning, unless the context clearly indicates otherwise:
"Therapeutic foster" care (TFC) agency"
means
					 a foster care agency that provides foster care as defined in Section 1355.20 of
					 Title 45 of the Code of Federal Regulation as twenty-four (24) hour substitute
					 care for children placed away from their parents or guardians and for whom the
					 title IV-E agency has placement and care responsibility. TFC settings are
					 foster family homes.
"TFC home"
means an agency-supervised, private
					 family home in which foster parents have been trained to provide
					 individualized, structured services in a safe, nurturing family-living
					 environment. The children receiving services in this setting have moderate
					 behavioral and emotional health needs, and may also present secondary physical,
					 developmental, intellectual, and/or social disorder that is supported alongside
					 the mental health needs. TFC homes are considered the least restrictive
					 out-of-home placement for these children.
"Therapeutic foster care (TFC) model"
means a
					 model in which children in the TFC environment receive increased individualized
					 behavioral health and other support services from qualified staff. Because TFC
					 members require exceptional levels of skill, time, and supervision, the number
					 of unrelated children placed per home is limited; no more than two (2) TFC
					 members may be placed in a home at any one (1) time unless additional cases are
					 specifically authorized by Child Welfare Services (CWS) of the Oklahoma
					 Department of Human Services (OKDHS), or Oklahoma Office of Juvenile Affairs
					 (OJA).
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 4049, eff 9-17-96 (emergency); Amended at 14 Ok
					 Reg 1780, eff 5-27-97; Amended at 17 Ok Reg 2402, eff 6-26-00; Amended at 20 Ok
					 Reg 523, eff 12-1-02 (emergency); Amended at 20 Ok Reg 1216, eff 5-27-03;
					 Amended at 23 Ok Reg 2566, eff 6-25-06; Amended at 24 Ok Reg 2857, eff 7-1-07
					 through 7-14-08 (emergency)1; Amended at 25 Ok Reg
					 2683, eff 7-25-08; Amended at 27 Ok Reg 1360, eff 4-21-10 (emergency); Amended
					 at 28 Ok Reg 1419, eff 6-25-11
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 317:30-5-740 reverted back to the permanent text that became
					 effective 6-25-06, 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 83 - THERAPEUTIC FOSTER CARE › Section 317:30-5-740.1 - Eligible providers and requirements

Current through Vol. 41, No. 20, July 1, 2024
(a)
TFC Agency.
Eligible TFC
				  agencies must have:
(1) Current certification
				  from the Oklahoma Department of Human Services (OKDHS) as a child placing
				  agency;
(2) A contract with the
				  Child Welfare Division of OKDHS, or Oklahoma Office of Juvenile Affairs (OJA);
(3) A contract with the Oklahoma
				  Health Care Authority (OHCA); and
(4) A current accreditation status
				  appropriate to provide behavioral health services in a foster care setting
				  from:
(A) The Joint Commission; or
(B) The Commission on Accreditation of
				  Rehabilitative Facilities (CARF); or
(C) The Council on Accreditation (COA).
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 83 - THERAPEUTIC FOSTER CARE › Section 317:30-5-740.2 - Provider selection

Current through Vol. 41, No. 20, July 1, 2024
Parents who retain legal custody of a TFC child may select
					 any eligible TFC agency as the provider of services. In the case of members in
					 the custody of the State of Oklahoma, the State, acting in its custodial role,
					 selects the TFC agency.
Added at 17 Ok Reg
					 2402, eff 6-26-00
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 83 - THERAPEUTIC FOSTER CARE › Section 317:30-5-742 - Description of services

Current through Vol. 41, No. 20, July 1, 2024
(a) Treatment
				  services must be provided in the least restrictive, non-institutional
				  therapeutic environment. The TFC setting is restorative in nature, allowing
				  members with moderate behavioral and emotional health needs who may also have a
				  secondary physical, developmental, intellectual, and/or social disorder that is
				  supported alongside the mental health needs to develop the necessary control to
				  function in a less restrictive setting.
(b) Behavioral health services must include
				  an individual plan of care (IPC) for each member served. The IPC requirements
				  are set out in Oklahoma Administrative Code (OAC)
				  317:30-5-742.2.
(c) Treatment services in a TFC
				  setting must include at least one (1) hour of individual, family, and/or group
				  therapy per week, as set forth in OAC
				  317:30-5-742.2(3).
				  Treatment may also include, but is not limited to, an array of the following
				  services:
(1) Substance abuse/chemical
				  dependency education, prevention, and therapy;
(2) Psychosocial rehabilitation and support
				  services;
(3) Behavior management;
(4) Crisis intervention; and
(5) Case management.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 83 - THERAPEUTIC FOSTER CARE › Section 317:30-5-742.1 - Reimbursement

Current through Vol. 41, No. 20, July 1, 2024
(a) TFC services
				  will be paid at the current fee-for-service (FFS) rate. Services provided to a
				  member without a written individual plan of care (IPC) as described in Oklahoma
				  Administrative Code (OAC)
				  317:30-5-742.2
				  will not be reimbursed.
(b)
				  Additional services may require prior authorization by the OHCA, or its
				  designated agent. Refer to OAC
				  317:30-3-31.
				  Documentation must be provided to ensure that services are not duplicative. If
				  additional services are approved for a member in state custody, the Oklahoma
				  Department of Human Services (OKDHS), or Oklahoma Office of Juvenile Affairs
				  (OJA) will collaborate with the provider of such services as directed by the
				  OHCA.
(c) Reimbursement for TFC
				  services is not available for the following:
(1) Room and board;
(2) Educational costs;
(3) Supported employment;
(4) Inpatient psychiatric services;
(5) Respite care;
(6) Day treatment services;
(7) Partial hospitalization services; and
(8) Intensive outpatient services.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 83 - THERAPEUTIC FOSTER CARE › Section 317:30-5-743 - Payment rates and recoupment [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 3646, eff 10-1-95 (emergency); Amended at 13 Ok
					 Reg 1645, eff 5-27-96; Amended at 13 Ok Reg 4049, eff 9-17-96 (emergency);
					 Amended at 14 Ok Reg 1780, eff 5-27-97; Amended at 17 Ok Reg 2402, eff 6-26-00;
					 Revoked at 27 Ok Reg 1360, eff 4-21-10 (emergency); Revoked at 28 Ok Reg 1419,
					 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 83 - THERAPEUTIC FOSTER CARE › Section 317:30-5-743.1 - Service quality review (SQR)

Current through Vol. 41, No. 20, July 1, 2024
There will be an SQR performed by the Oklahoma Health Care
					 Authority (OHCA) or its designated agent of each TFC agency that provides care
					 to members. The OHCA will designate the members of the SQR team . This team
					 will consist of at least two(2) team members and will be comprised of licensed
					 behavioral health professionals (LBHPs) and/or registered nurses (RNs) . The
					 SQR will consist of a survey of current members receiving services, as well as
					 members for which claims have been filed with OHCA for TFC services.
					 Observation and contact with members may be incorporated. The review includes
					 validation of certain factors, all of which must be met for the services to be
					 compensable. Following the review, the SQR team will report its findings to the
					 TFC agency. The TFC agency will be provided with written notification if the
					 findings of the SQR have resulted in any deficiencies. A copy of the final
					 report will be sent to the TFC agency's accrediting body. Deficiencies found
					 during the SQR may result in a recoupment of the compensation received for that
					 service. The individual plan of care(IPC) is considered to be critical to the
					 integrity of care and treatment and must be completed within the timelines
					 designated at Oklahoma Administrative Code (OAC)
					 317:30-5-742.2.
					 If the IPC is missing, or it is found that the member did not meet medical
					 necessity criteria at any time, all paid services will be recouped for each day
					 the IPC was missing from the date the plan of care was due for completion or
					 the date from which medical necessity criteria was no longer met.
Added at 23 Ok Reg
					 2566, eff 6-25-06; Amended at 24 Ok Reg 2857, eff 7-1-07 (emergency); Amended
					 at 25 Ok Reg 1200, eff 5-25-08; Amended at 27 Ok Reg 1360, eff 4-21-10
					 (emergency); Amended at 28 Ok Reg 1419, 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 83 - THERAPEUTIC FOSTER CARE › Section 317:30-5-744 - Billing

Current through Vol. 41, No. 20, July 1, 2024
(a) Claims must be
				  submitted in accordance with guidelines found at Oklahoma Administrative Code
				  (OAC)
				  317:30-3-11,
				  317:30-3-11.1,
				  and
				  317:30-3-20.
(b) Claims for dually eligible
				  individuals (Medicare/Medicaid) should be filed directly with the Oklahoma
				  Health Care Authority (OHCA) .
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 4049, eff 9-17-96 (emergency); Amended at 14 Ok
					 Reg 1780, eff 5-27-97; Amended at 17 Ok Reg 2402, eff 6-26-00; Amended at 19 Ok
					 Reg 2134, eff 6-27-02; Amended at 27 Ok Reg 1360, eff 4-21-10 (emergency);
					 Amended at 28 Ok Reg 1419, eff 6-25-11