Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 103 - QUALIFIED SCHOOLS AS PROVIDERS OF HEALTH-RELATED SERVICES › Section 317:30-5-1023 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
(a)
Adults.
There is no coverage for services rendered to adults
				  twenty-one (21) years of age and older.
(b)
Children.
For
				  non-Individualized Education Program (IEP) medical services that can be
				  provided in a school setting, refer to Part 4, Early And Periodic Screening,
				  Diagnostic and Treatment
(EPSDT)
Program/Child-Health Services, of
				  Oklahoma Administrative Code(OAC) at
				  317:30-3-65
				  through
				  317:30-3-65.12.
				  Payment is made for the following compensable services rendered by qualified
				  school providers:
(1)
Diagnostic
				  encounters.
Diagnostic encounters are defined as those services
				  necessary to fully evaluate defects, physical or behavioral health illnesses,
				  or conditions discovered by the screening. Approved diagnostic encounters may
				  include the following:
(A)
Hearing and
				  hearing aid evaluation.
Hearing evaluation includes pure tone air, bone,
				  and speech audiometry. Hearing evaluations must be provided by a state-licensed
				  audiologist as listed in OAC
				  317:30-5-675(d)
				  (1) and (2).
(B)
Audiometry
				  test.
Audiometric test (Immittance [Impedance] audiometry or
				  tympanometry) includes bilateral assessment of middle ear status and reflex
				  studies (when appropriate) provided by a state-licensed audiologist as listed
				  in OAC
				  317:30-5-675(d)
				  (1) and (2).
(C)
Ear
				  impression (for earmold).
Ear impression (for earmold) includes taking
				  an impression of a member's ear and providing a finished earmold, to be used
				  with the member's hearing aid as provided by a state-licensed audiologist as
				  listed in OAC
				  317:30-5-675(d)
				  (1) and (2).
(D)
Vision
				  screening.
Vision screening in schools includes application of tests and
				  examinations to identify visual defects or vision disorders. The vision
				  screening may be performed by a registered nurse (RN) or licensed practical
				  nurse (LPN) under the supervision of an RN. The service can be billed when a
				  SoonerCare member has an individualized documented concern that warrants a
				  screening. A vision examination must be provided by a state-licensed doctor of
				  optometry (O.D.) or licensed physician specializing in ophthalmology (M.D. or
				  D.O.). This vision examination, at a minimum, includes diagnosis and treatment
				  for defects in vision.
(E)
Speech-language evaluation.
Speech-language evaluation is for the
				  purpose of identification of children or adolescents with speech or language
				  disorders and the diagnosis and appraisal of specific speech and language
				  services. Speech-language evaluations must be provided by a fully licensed
				  speech-language pathologist as listed in OAC
				  317:30-5-675(a)
				  (1) through (3).
(F)
Physical
				  therapy evaluation.
Physical therapy evaluation includes evaluating the
				  student's ability to move throughout the school and to participate in classroom
				  activities and the identification of movement dysfunction and related
				  functional problems. It must be provided by a fully licensed physical therapist
				  as listed in OAC
				  317:30-5-290.1(a)
				  (1) and (2). Physical therapy evaluations must adhere to guidelines found at
				  OAC
				  317:30-5-291.
(G)
Occupational therapy
				  evaluation.
Occupational therapy evaluation services include determining
				  what therapeutic services, assistive technology, and environmental
				  modifications a student requires for participation in the special education
				  program and must be provided by a fully licensed occupational therapist as
				  listed in OAC
				  317:30-5-295(a)
				  (1) and (2). Occupational therapy evaluations must adhere to guidelines found
				  at OAC
				  317:30-5-296.
(H)
Evaluation and testing.
Evaluation and testing by psychologists and certified school psychologists are
				  for the purpose of assessing emotional, behavioral, cognitive, or developmental
				  issues that are affecting academic performance and for determining recommended
				  treatment protocol. Evaluation or testing for the sole purpose of academic
				  placement (e.g., diagnosis of learning disorders) is not a compensable service.
				  These evaluations and tests must be provided by a state-licensed,
				  board-certified psychologist or a certified school psychologist certified by
				  the State Department of Education (SDE).