- 317:2-1-1. Purpose
- 317:2-1-2. Appeals
- 317:2-1-2.5. Expedited appeals
- 317:2-1-2.6. Continuation of benefits or services pending appeal
- 317:2-1-5. Hearing procedures
- 317:2-1-7. Program Integrity Audit Appeals
- 317:2-1-8. Nursing home provider contract appeals
- 317:2-1-9. OHCA's Designated Agent's appeal process for QIO Decisions
- 317:2-1-10. Drug Rebate appeal process
- 317:2-1-11. Medicaid Drug Utilization Review Board (DUR) appeal process
- 317:2-1-12. For cause and immediate provider contract termination appeals process
- 317:2-1-13. Appeal to the chief executive officer
- 317:2-1-14. Contract award protest process
- 317:2-1-15. Supplemental Hospital Offset Payment Program (SHOPP) Appeals
- 317:2-1-17. Long-term care facility cost report appeals
- 317:2-1-18. Step therapy protocol exception appeals
- 317:2-3-1. Definitions
- 317:2-3-2. Timeframes
- 317:2-3-3. Grievance and appeals system
- 317:2-3-4. Member grievances
- 317:2-3-5. Member appeals
- 317:2-3-5.1 Continuation of benefits pending appeal and state fair hearing
- 317:2-3-6. External medical review and clinical expertise
- 317:2-3-7. Obligation to pay costs of services
- 317:2-3-8. Grievances and appeals notice
- 317:2-3-9. Exhaustion of CE or DBM appeals
- 317:2-3-10. Provider complaint system and appeal requests
- 317:2-3-11. Recordkeeping
- 317:2-3-12. State fair hearing for members
- 317:2-3-13. State fair hearing for providers
- 317:2-3-14. Administrative Law Judge (ALJ) jurisdiction
- 317:25-7-2. SoonerCare Choice: overview
- 317:25-7-3. Definitions
- 317:25-7-5. Primary care providers (PCPs)
- 317:25-7-6. Primary Care Provider/Case Manager Payment to Subcontractors
- 317:25-7-7. Referrals for specialty services
- 317:25-7-12 Enrollment/eligibility requirements
- 317:25-7-40. SoonerCare Choice reimbursement
- 317:30-3-19.6. Complaints related to the Defunding Statutory Rape Cover-up Act
- 317:30-3-25 Crossovers (deductibles, coinsurance, and copays)
- 317:30-3-31. Prior authorization for health care-related goods and services
- 317:30-3-32. Retrospective review for payment for services to certain aliens
- 317:30-3-34 Electronic visit verification (EVV) system
- 317:30-3-35. Oklahoma State Health Information Network and Exchange (OKSHINE)
- 317:30-3-57.1. Clinical trials
- 317:30-3-60. General program exclusions - children
- 317:30-3-65.5. Diagnosis and treatment
- 317:30-3-65.12. Applied Behavior Analysis (ABA) services
- 317:30-3-89. Definitions
- 317:30-3-90. Out-of-state services
- 317:30-3-91. Reimbursement of services rendered by out-of-state providers
- 317:30-3-92. Payment for lodging and meals
- 317:30-3-19.5. Termination of provider agreements
- 317:30-3-1. Creation and implementation of rules; applicability
- 317:30-3-2. Provider agreements
- 317:30-3-2.1. Program Integrity Audits/Reviews
- 317:30-3-3. Group billings
- 317:30-3-3.1. Medicaid Income Deferral Program [REVOKED 9-11-23]
- 317:30-3-4. Electronic fund transfer or direct deposit
- 317:30-3-4.1. Uniform Electronic Transaction Act
- 317:30-3-5. Assignment and cost sharing
- 317:30-3-5.1. Usual and Customary fees
- 317:30-3-6. Utilization review for physician/hospital services
- 317:30-3-8. Pre-billing
- 317:30-3-10. Sales tax
- 317:30-3-11. Timely filing limitation
- 317:30-3-11.1. Resolution of claim payment
- 317:30-3-12. Credits and adjustments
- 317:30-3-13. Advance directives
- 317:30-3-14. Freedom of choice
- 317:30-3-15. Record retention
- 317:30-3-16. Release of medical records
- 317:30-3-17. Discrimination laws
- 317:30-3-18. Criminal penalties
- 317:30-3-19.3. Denial of application for new or renewed provider enrollment
- 317:30-3-19.4. Application fee, provider screening, and applicants subject to a fingerprint-based criminal background check
- 317:30-3-20. Claim inquiry procedures (excluding nursing homes and hospitals)
- 317:30-3-21. Appeals procedures for nursing facilities
- 317:30-3-23. Reconsideration request
- 317:30-3-24. Third party liability
- 317:30-3-25. Crossovers (deductibles, coinsurance, and copays)
- 317:30-3-27. Telehealth
- 317:30-3-27.1. Audio-only health service delivery
- 317:30-3-28. Oklahoma Electronic Health Records Incentive Program
- 317:30-3-29. Revisions of provider fee schedules
- 317:30-3-30. Signature requirements
- 317:30-3-39. Home and Community Based Services Waivers
- 317:30-3-40. Home and Community-Based Services Waivers (HCBS) for persons with intellectual disabilities or certain persons with related conditions
- 317:30-3-41. Home and Community Based Services Waivers for persons with physical disabilities
- 317:30-3-42. Services in a Nursing Facility (NF)
- 317:30-3-43. Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IDD)
- 317:30-3-44. Personal care
- 317:30-3-45. Services for persons age 65 or older in mental health hospitals
- 317:30-3-46. Services for persons infected with tuberculosis
- 317:30-3-57. General SoonerCare coverage - categorically needy
- 317:30-3-59. General program exclusions - adults
- 317:30-3-60. General program exclusions - children
- 317:30-3-61. Self-Directed Services
- 317:30-3-62. Provider Preventable Conditions
- 317:30-3-63. Hospital acquired conditions [REVOKED 3-1-24]
- 317:30-3-64. Payment for lodging and meals [AMENDED AND RENUMBERED TO 317:30-3-92]
- 317:30-3-65. Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program/Child-health Services
- 317:30-3-65.2. Periodicity schedule
- 317:30-3-65.3. Initial screening examination
- 317:30-3-65.4. Screening components
- 317:30-3-65.5. Diagnosis and treatment
- 317:30-3-65.6. Documentation of Services
- 317:30-3-65.7. Vision services
- 317:30-3-65.8. Dental services
- 317:30-3-65.9. Hearing services
- 317:30-3-65.10. Periodic and interperiodic screening examinations
- 317:30-3-65.11. Partial screening examination
- 317:30-5-1 Eligible providers
- 317:30-5-2 General coverage by category
- 317:30-5-3 Documentation of services
- 317:30-5-4 Procedure and diagnosis coding
- 317:30-5-6 Abortions
- 317:30-5-7 Anesthesia
- 317:30-5-8 Surgery
- 317:30-5-9 Medical services
- 317:30-5-10 Ophthalmology services
- 317:30-5-11 Psychiatric services
- 317:30-5-12 Family planning
- 317:30-5-13 Rape and abuse exams
- 317:30-5-14 Injections
- 317:30-5-14.1 Allergy services
- 317:30-5-15 Chemotherapy injections
- 317:30-5-17 Authorized examinations - eligibility determinations
- 317:30-5-18 Elective sterilizations
- 317:30-5-19 Hysterectomies
- 317:30-5-20 Laboratory services
- 317:30-5-20.1 Drug screening and testing
- 317:30-5-20.2. Molecular diagnostic testing utilizing polymerase chain reaction for infectious diseases
- 317:30-5-21 Unusual procedures
- 317:30-5-22 Obstetrical care
- 317:30-5-22.1 Enhanced services for medically high risk pregnancies
- 317:30-5-23 Newborn care
- 317:30-5-24 Radiology
- 317:30-5-25 Oklahoma Health Care Authority's Quality Improvement Organization (QIO)
- 317:30-5-30 Eligible providers
- 317:30-5-31 General coverage by category
- 317:30-5-32 Utilization
- 317:30-5-33 Post payment utilization review [REVOKED 9-11-23]
- 317:30-5-40 Eligible providers
- 317:30-5-40.1 General information
- 317:30-5-40.2 Definitions [REVOKED 9-12-22]
- 317:30-5-41 Inpatient hospital coverage/limitations
- 317:30-5-41.1 Acute inpatient psychiatric services
- 317:30-5-41.2 Organ transplants
- 317:30-5-42.1 Outpatient hospital services
- 317:30-5-42.2 Blood and blood fractions
- 317:30-5-42.3 Chemotherapy and radiation therapy
- 317:30-5-42.4 Clinic/treatment room services; urgent care
- 317:30-5-42.5 Diagnostic testing therapeutic services
- 317:30-5-42.6 Dialysis
- 317:30-5-42.7 Emergency department (ED) care/services
- 317:30-5-42.8 Hearing and speech therapy
- 317:30-5-42.9 Infusions/injections
- 317:30-5-42.10 Laboratory
- 317:30-5-42.11 Observation/treatment
- 317:30-5-42.12 Physical therapy
- 317:30-5-42.13 Radiology
- 317:30-5-42.14 Surgery and diagnostic services
- 317:30-5-42.15 Outpatient hospital services for members infected with tuberculosis
- 317:30-5-42.16 Related services
- 317:30-5-42.17 Non-covered services
- 317:30-5-42.18 Coverage for children
- 317:30-5-42.19 340B Drug Discount Program
- 317:30-5-42.20. High-investment drugs B outpatient hospitals
- 317:30-5-44 Medicare eligible individuals
- 317:30-5-47 Reimbursement for inpatient hospital services
- 317:30-5-47.1 Reimbursement for newborn screening services provided by the OSDH
- 317:30-5-47.2 Disproportionate share hospitals (DSH)
- 317:30-5-47.3 Indirect medical education (IME) adjustment
- 317:30-5-47.4 Direct medical education payment adjustment
- 317:30-5-47.5 Critical Access Hospitals
- 317:30-5-47.6 High-investment drugs - inpatient hospitals
- 317:30-5-49 Reporting suspected abuse
- 317:30-5-50 Abortions
- 317:30-5-51 Elective sterilizations
- 317:30-5-52 Hysterectomies
- 317:30-5-53 Newborn care
- 317:30-5-56 Utilization review
- 317:30-5-57 Notice of denial
- 317:30-5-58 Supplemental Hospital Offset Payment Program.
- 317:30-5-60 Subacute level of care
- 317:30-5-61 Eligible providers
- 317:30-5-62 Coverage by category
- 317:30-5-63 Trust funds
- 317:30-5-64 Inpatient and routine services
- 317:30-5-65 Ancillary services
- 317:30-5-66 Reimbursement for inpatient hospital subacute services
- 317:30-5-67 Cost reports
- 317:30-5-70 Eligible providers
- 317:30-5-70.1 Pharmacist responsibility
- 317:30-5-70.2 Record retention/post payment review
- 317:30-5-70.3 Prescriber identification numbers
- 317:30-5-70.4 Federal/State cost share-optional program
- 317:30-5-72 Categories of service eligibility
- 317:30-5-72.1 Drug benefit
- 317:30-5-76 Generic drugs
- 317:30-5-77 Brand necessary certification
- 317:30-5-77.1 Dispensing quantity
- 317:30-5-77.2 Prior authorization
- 317:30-5-77.3 Product-based prior authorization (PBPA)
- 317:30-5-77.4. Step therapy exception process
- 317:30-5-78 Reimbursement
- 317:30-5-78.1 Special billing procedures
- 317:30-5-78.2 Falsification of claims
- 317:30-5-80 National drug code
- 317:30-5-86 Drug Utilization Review (DUR) program
- 317:30-5-86.2 Case management
- 317:30-5-87 340B Drug Discount Program
- 317:30-5-94. Definitions
- 317:30-5-95 General provisions and eligible providers
- 317:30-5-95.1 Medical necessity criteria and coverage for adults aged twenty-one (21) to sixty-four (64)
- 317:30-5-95.4 Individual plan of care for adults aged twenty-one (21) to sixty-four (64)
- 317:30-5-95.5 Physician review of prescribed medications for adults age 21 to 64
- 317:30-5-95.6 Medical, psychiatric, and social evaluations for adults aged twenty-one (21) to sixty-four (64)
- 317:30-5-95.7 Active treatment for adults age 21 to 64
- 317:30-5-95.8 Nursing services for adults age 21 to 64
- 317:30-5-95.9 Therapeutic services for adults aged 21 to 64
- 317:30-5-95.10 Discharge plan for adults aged twenty-one (21) to sixty-four (64)
- 317:30-5-95.11 Inpatient acute psychiatric services for persons sixty-five (65) years of age or older
- 317:30-5-95.12 Utilization control requirements for inpatient acute psychiatric services for persons sixty-five (65) years of age or older
- 317:30-5-95.13 Certification and recertification of need for inpatient care for inpatient acute psychiatric services for persons sixty-five (65) years of age or older
- 317:30-5-95.14 Individual plan of care for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services
- 317:30-5-95.15 Physician review of prescribed medications for persons over 65 years of age receiving inpatient acute psychiatric services
- 317:30-5-95.16 Medical psychiatric and social evaluations for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services
- 317:30-5-95.17 Active treatment for persons over 65 years of age receiving inpatient acute psychiatric services
- 317:30-5-95.18 Nursing services for persons over 65 years of age receiving inpatient acute psychiatric services
- 317:30-5-95.19 Therapeutic services for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services
- 317:30-5-95.20 Discharge plan for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services
- 317:30-5-95.21 Continued stay review for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services
- 317:30-5-95.22 Coverage for children
- 317:30-5-95.23 Individuals age 21
- 317:30-5-95.24 Prior authorization of inpatient psychiatric services for individuals under twenty-one (21)
- 317:30-5-95.25 Medical necessity criteria for acute psychiatric admissions for children
- 317:30-5-95.26 Medical necessity criteria for continued stay - acute psychiatric admission for children
- 317:30-5-95.27 Medical necessity criteria for admission - inpatient chemical dependency detoxification for children
- 317:30-5-95.28 Medical necessity criteria for continued stay - inpatient chemical dependency detoxification program for children
- 317:30-5-95.29 Medical necessity criteria Acute II and PRTF admissions for children
- 317:30-5-95.30 Medical necessity criteria for Acute II and PRTF continued stay for children
- 317:30-5-95.31 Prior authorization and extension procedures for children
- 317:30-5-95.32 Quality of care requirements for children
- 317:30-5-95.33 Individual plan of care for children
- 317:30-5-95.34 Active treatment for children
- 317:30-5-95.35 Certificate of need requirements for children in psychiatric hospitals and PRTFs
- 317:30-5-95.36 Treatment team for inpatient children's services
- 317:30-5-95.37 Medical, psychiatric and social evaluations for inpatient services for children
- 317:30-5-95.38 Nursing services for children
- 317:30-5-95.39 Restraint, seclusion, and serious occurrence reporting requirements for members under the age of twenty-one (21)
- 317:30-5-95.40 Other required standards
- 317:30-5-95.41 Documentation of records for children receiving inpatient services
- 317:30-5-95.42 Service quality review (SQR) of psychiatric facilities and residential substance use disorder (SUD) facilities
- 317:30-5-95.43 Residential substance use disorder (SUD) treatment
- 317:30-5-95.44 Residential substance use disorder (SUD) - Eligible providers and requirements
- 317:30-5-95.45 Residential substance use disorder (SUD) - Coverage by category
- 317:30-5-95.46 Residential substance use disorder (SUD) - Covered services and medical necessity criteria
- 317:30-5-95.47. Residential substance use disorder (SUD) - Individualized service plan requirements
- 317:30-5-95.48. Staff training
- 317:30-5-95.49. Medication policies and records
- 317:30-5-95.50 Residential substance use disorder (SUD) - Reimbursement
- 317:30-5-96.2. Payment definitions
- 317:30-5-96.3 Methods of payment
- 317:30-5-96.4 Outlier intensity adjustment
- 317:30-5-96.5 Disproportionate share hospitals (DSH)
- 317:30-5-96.6 Payment for Medicare/Medicaid dual eligible individuals
- 317:30-5-96.7 Cost reports
- 317:30-5-96.8 Psychiatric Residential Treatment Facility payments to subcontractors
- 317:30-5-97 Reporting abuse and/or neglect
- 317:30-5-100 Eligible providers
- 317:30-5-101 Coverage for adults
- 317:30-5-102 Coverage for children
- 317:30-5-103 Vocational rehabilitation
- 317:30-5-104 Individuals eligible for Part B of Medicare
- 317:30-5-105 Non-covered procedures
- 317:30-5-106 Payment rates
- 317:30-5-110 Eligible providers
- 317:30-5-111 Coverage for adults
- 317:30-5-112 Coverage for children
- 317:30-5-113 Medicare eligible individuals
- 317:30-5-114 Reimbursement
- 317:30-5-120 Eligible providers
- 317:30-5-121 Coverage by category
- 317:30-5-122 Levels of care
- 317:30-5-123 Member certification for long-term care
- 317:30-5-124 Facility licensure
- 317:30-5-125 Trust funds
- 317:30-5-126 Therapeutic leave and Hospital leave
- 317:30-5-127 Notification of nursing facility changes
- 317:30-5-129 Required monthly notifications
- 317:30-5-130 Inspections of care in Intermediate Care Facilities for the Mentally Retarded (ICF/MR)
- 317:30-5-131 Rates of payments
- 317:30-5-131.2 Quality of care fund requirements and report
- 317:30-5-132 Cost reports
- 317:30-5-132.1. Reconsideration of cost report adjustments
- 317:30-5-132.2. Allowable costs
- 317:30-5-133 Payment methodologies
- 317:30-5-133.1 Routine services
- 317:30-5-133.2 Ancillary services [REVOKED 07-01-21]
- 317:30-5-133.3 Nursing home ventilator-dependent and tracheostomy care services
- 317:30-5-134 Nurse Aide Training Reimbursement
- 317:30-5-136.1 Pay-for-Performance (PFP) program
- 317:30-5-137 Bariatric surgery
- 317:30-5-137.1 Member candidacy [REVOKED 9-1-21]
- 317:30-5-137.2 General coverage [REVOKED 9-1-21]
- 317:30-5-140 Coverage for children
- 317:30-5-141 Reimbursement [REVOKED 9-1-21]
- 317:30-5-180 Purpose and general provisions
- 317:30-5-180.1 Definitions
- 317:30-5-180.2 Eligibility
- 317:30-5-180.3 Services
- 317:30-5-180.4 Fraud
- 317:30-5-180.5 Pharmacy Benefit Manager
- 317:30-5-204 General information
- 317:30-5-205 Eligible providers
- 317:30-5-206 Coverage
- 317:30-5-207 Limitations
- 317:30-5-208 Reimbursement
- 317:30-5-209 Documentation
- 317:30-5-210 Eligible providers
- 317:30-5-210.1 Coverage for adults
- 317:30-5-210.2 Coverage for children
- 317:30-5-211.1 Definitions
- 317:30-5-211.2 Medical necessity
- 317:30-5-211.3 Prior authorization (PA)
- 317:30-5-211.4 Rental and/or purchase
- 317:30-5-211.5 Repairs, maintenance, replacement, and delivery
- 317:30-5-211.6 General documentation requirements
- 317:30-5-211.7 Free choice
- 317:30-5-211.9 Adaptive equipment [REVOKED 7-1-21]
- 317:30-5-211.10 Medical supplies, equipment, and appliances
- 317:30-5-211.11 Oxygen and oxygen equipment
- 317:30-5-211.12 Oxygen rental
- 317:30-5-211.13 Orthotics and prosthetics
- 317:30-5-211.14 Nutritional support
- 317:30-5-211.15 Medical Supplies
- 317:30-5-211.16 Coverage for nursing facility residents
- 317:30-5-211.17 Wheelchairs
- 317:30-5-211.18 Ownership of durable medical equipment
- 317:30-5-211.19 Quality assurances and safeguards
- 317:30-5-211.20. Enteral nutrition
- 317:30-5-211.21. Incontinence supplies
- 317:30-5-211.22. Pulse oximeter
- 317:30-5-211.23. Continuous passive motion device for the knee
- 317:30-5-211.24. Parenteral nutrition
- 317:30-5-211.25. Continuous glucose monitoring
- 317:30-5-211.26. Bathroom equipment
- 317:30-5-211.27. Positive airway pressure (PAP) devices
- 317:30-5-211.28. Sleep studies
- 317:30-5-211.29 Donor human breast milk
- 317:30-5-214 Coverage for individuals eligible for Part B of Medicare
- 317:30-5-216 Prior authorization requests [REVOKED 8-1-20]
- 317:30-5-217 Billing
- 317:30-5-218 Reimbursement
- 317:30-5-219 General information
- 317:30-5-220 Eligible providers
- 317:30-5-221 Coverage
- 317:30-5-222 Reimbursement
- 317:30-5-223 Documentation
- 317:30-5-225 Eligible providers
- 317:30-5-226 Coverage by category
- 317:30-5-229 Reimbursement
- 317:30-5-230 General information
- 317:30-5-231 Eligible providers
- 317:30-5-232 Coverage
- 317:30-5-233 Limitations
- 317:30-5-234 Reimbursement
- 317:30-5-235 Documentation
- 317:30-5-240 Eligible providers
- 317:30-5-240.1 Definitions
- 317:30-5-240.2 Provider participation standards
- 317:30-5-240.3 Staff credentials
- 317:30-5-241 Covered Services
- 317:30-5-241.1 Screening, assessment and service plan
- 317:30-5-241.2 Psychotherapy
- 317:30-5-241.3 Behavioral Health Rehabilitation (BHR) services
- 317:30-5-241.4 Crisis Intervention
- 317:30-5-241.5 Support services
- 317:30-5-241.6 Behavioral health targeted case management
- 317:30-5-241.7 Medication-assisted treatment (MAT) services for eligible individuals with opioid use disorder (OUD)
- 317:30-5-241.8 Multi-systemic therapy (MST)
- 317:30-5-241.9 Partial hospitalization program (PHP) - Children/Adolescent
- 317:30-5-241.10 Partial hospitalization program (PHP) - Adults
- 317:30-5-241.11 Day treatment program
- 317:30-5-244 Individuals eligible for Part B of Medicare
- 317:30-5-245 Reimbursement
- 317:30-5-248 Documentation of records
- 317:30-5-249 Non-covered services
- 317:30-5-250 Purpose [REVOKED 10-1-21]
- 317:30-5-251 Eligible providers [REVOKED 10-1-21]
- 317:30-5-252 Covered Services [REVOKED 10-1-21]
- 317:30-5-253 Reimbursement [REVOKED 10-1-21]
- 317:30-5-254 Limitations [REVOKED 10-1-21]
- 317:30-5-260 Eligible providers
- 317:30-5-261 Coverage by category
- 317:30-5-263. Definitions
- 317:30-5-264. Purpose
- 317:30-5-265. Eligible providers
- 317:30-5-266. Covered services
- 317:30-5-267. Reimbursement
- 317:30-5-268. Limitations
- 317:30-5-275 Eligible providers
- 317:30-5-276 Coverage by category
- 317:30-5-278 Non-covered procedures
- 317:30-5-278.1 Documentation of records
- 317:30-5-280 Eligible Providers
- 317:30-5-281 Coverage by Category
- 317:30-5-282. Non-covered procedures
- 317:30-5-283. Documentation of records
- 317:30-5-290.1 Eligible providers
- 317:30-5-291 Coverage by category
- 317:30-5-291.1 Payment rates [REVOKED 9-12-22]
- 317:30-5-291.2 Procedure codes [REVOKED 9-12-22]
- 317:30-5-293 Team therapy (Co-treatment)
- 317:30-5-295 Eligible providers
- 317:30-5-296 Coverage by category
- 317:30-5-297 Payment rates [REVOKED 9-12-22]
- 317:30-5-298 Procedure codes
- 317:30-5-299 Team therapy (Co-treatment)
- 317:30-5-305 Eligible providers
- 317:30-5-306 Coverage by category
- 317:30-5-307 Payment methodology
- 317:30-5-310 Purpose
- 317:30-5-311 Eligible providers and requirements
- 317:30-5-312 Treatment plan components and documentation requirements
- 317:30-5-313 Medical necessity criteria for members under twenty-one (21) years of age
- 317:30-5-314 Prior authorization
- 317:30-5-315 ABA extension requests
- 317:30-5-316 Reimbursement methodology
- 317:30-5-320 Eligible providers
- 317:30-5-321 Coverage by category
- 317:30-5-325 [Reserved]
- 317:30-5-326 Provider eligibility
- 317:30-5-326.1 Definitions
- 317:30-5-327 Eligibility for SoonerRide NET
- 317:30-5-327.1 SoonerRide NMET coverage and exclusions
- 317:30-5-327.3 Coverage for residents of long-term care facilities
- 317:30-5-327.4 Coverage for children
- 317:30-5-327.5 Exclusions from SoonerRide NET [REVOKED 9-1-21]
- 317:30-5-327.6 Denial of SoonerRide NMET services by the SoonerRide broker
- 317:30-5-327.7 SoonerRide provider network
- 317:30-5-327.8 Type of services provided and duties of the SoonerRide NEMT driver
- 317:30-5-327.9 Scheduling NMET services through SoonerRide
- 317:30-5-335 Eligible providers
- 317:30-5-335.1 Definitions
- 317:30-5-336.1 Medical necessity
- 317:30-5-336.2 Nearest appropriate facility
- 317:30-5-336.3 Destination
- 317:30-5-336.4 Transport outside of locality
- 317:30-5-336.5 Levels of ambulance service, ambulance fee schedule and base rate
- 317:30-5-336.6 Mileage
- 317:30-5-336.7 Waiting time
- 317:30-5-336.8 Special situations
- 317:30-5-336.9 Air ambulance
- 317:30-5-336.10 Fixed wing air ambulance services
- 317:30-5-336.11 Rotary wing air ambulance
- 317:30-5-336.12 Non-emergency ambulance and stretcher service transportation
- 317:30-5-336.13 Non-covered services
- 317:30-5-339 Individuals eligible for Part B of Medicare
- 317:30-5-343 Reimbursement
- 317:30-5-344. Ground Emergency Medical Transportation (GEMT) supplemental payment program
- 317:30-5-345. Ambulance Service Provider Access Payment Program (ASPAPP)
- 317:30-5-347. Definitions
- 317:30-5-348. Program overview
- 317:30-5-349. Program eligibility and covered services
- 317:30-5-350. Service requirements
- 317:30-5-351. Authorization and reimbursement
- 317:30-5-354 Definitions
- 317:30-5-355 Eligible providers and staffing requirements
- 317:30-5-355.1 RHC professional staff
- 317:30-5-355.2 Covered services
- 317:30-5-356 Coverage for adults
- 317:30-5-357 Coverage for children
- 317:30-5-359 Claims for Medicare eligible recipients
- 317:30-5-359.1 Cost reports
- 317:30-5-359.2 Reimbursement
- 317:30-5-361 Billing
- 317:30-5-362 Documentation of records
- 317:30-5-363 340B Drug Discount Program
- 317:30-5-375 Eligible providers
- 317:30-5-376 Coverage by category
- 317:30-5-390 Home and Community-Based Services waivers for adults with an intellectual disability or certain adults with related conditions
- 317:30-5-391 Coverage for skilled nursing services
- 317:30-5-392 Description of Skilled Nursing services
- 317:30-5-393 Coverage limitations for Skilled Nursing Services
- 317:30-5-410 Home and Community-Based Services Waivers for persons with an intellectual disability or certain persons with related conditions
- 317:30-5-411 Coverage
- 317:30-5-412 Description of services
- 317:30-5-420 Home and Community-Based Services Waivers for persons with an intellectual disability or certain persons with related conditions
- 317:30-5-421 Coverage
- 317:30-5-422 Description of services
- 317:30-5-423 Coverage limitations
- 317:30-5-430 Eligible providers
- 317:30-5-431 Coverage by category
- 317:30-5-432 Procedure Codes
- 317:30-5-432.1 Corrective lenses and optical supplies
- 317:30-5-450 Eligible providers
- 317:30-5-451 Coverage by category
- 317:30-5-480 Home and Community-Based Services for persons with an intellectual disability or certain persons with related conditions
- 317:30-5-481 Coverage
- 317:30-5-482 Description of services
- 317:30-5-495 Home and Community-Based Services Waivers for persons with an intellectual disability or certain persons with related conditions
- 317:30-5-496 Coverage
- 317:30-5-497 Description of services
- 317:30-5-498 Coverage limitations
- 317:30-5-515 Home and Community-Based Services Waivers for persons with an intellectual disability or certain persons with related conditions
- 317:30-5-530 Eligible providers
- 317:30-5-531 Coverage for adults
- 317:30-5-532 Coverage for children
- 317:30-5-535 Home and Community-Based Services Waiver for persons with an intellectual disability or certain persons with related conditions
- 317:30-5-536 Coverage [REVOKED 9-11-23]
- 317:30-5-537 Description of services [REVOKED 9-11-23]
- 317:30-5-545 Eligible providers
- 317:30-5-546 Coverage by category
- 317:30-5-547 Reimbursement
- 317:30-5-548 Procedure codes
- 317:30-5-549 Prosthetic devices [REVOKED 7-1-21, 9-12-22]
- 317:30-5-555 Private Duty Nursing (PDN)
- 317:30-5-556 Eligible providers
- 317:30-5-557 Coverage by category
- 317:30-5-558 Private duty nursing (PDN) coverage limitations
- 317:30-5-559 How Private Duty Nursing (PDN) services are authorized
- 317:30-5-560 Treatment Plan
- 317:30-5-560.1 Prior authorization requirements
- 317:30-5-560.2 Record documentation
- 317:30-5-561. Private duty nursing (PDN) payment rates
- 317:30-5-565 Eligible providers
- 317:30-5-566 Ambulatory Surgery Center services
- 317:30-5-567 Coverage by category
- 317:30-5-568 Elective sterilizations
- 317:30-5-575 General information
- 317:30-5-576 Eligible providers
- 317:30-5-577 Coordination of care
- 317:30-5-578 Limitation on services
- 317:30-5-579 Prescription drugs purchased under the 340B Drug Discount Program provided by Clinics
- 317:30-5-605 Eligible providers
- 317:30-5-606 Coverage by category
- 317:30-5-607 Billing instructions
- 317:30-5-611 Payment methodology
- 317:30-5-612 Eligible providers
- 317:30-5-613 Coverage by category
- 317:30-5-614 Billing instructions
- 317:30-5-615 Payment methodology
- 317:30-5-620 Eligible providers
- 317:30-5-621 Coverage by category
- 317:30-5-622 Reimbursement
- 317:30-5-624 Documentation of records
- 317:30-5-640 General provisions and eligible providers
- 317:30-5-640.1 Periodicity schedule
- 317:30-5-641 Coverage by category
- 317:30-5-641.1 Periodic and interperiodic screening examination [REVOKED 9-12-22]
- 317:30-5-641.3 Reporting of suspected child abuse/neglect
- 317:30-5-644 Documentation of records
- 317:30-5-659 Definitions
- 317:30-5-660 Eligible providers
- 317:30-5-660.1 Health Center multiple sites contracting
- 317:30-5-660.2 Health Center professional staff
- 317:30-5-660.3 Health Center enrollment requirements for specialty behavioral health services
- 317:30-5-660.4 Health Center enrollment requirements for health services in a school setting
- 317:30-5-660.5 Health Center service definitions [REVOKED 9-1-21]
- 317:30-5-661 Coverage by category [REVOKED 9-1-21]
- 317:30-5-661.1 Coverage of core services
- 317:30-5-661.2 Services and supplies "incident to" Health Center encounters [REVOKED 9-1-21]
- 317:30-5-661.3 Visiting Nurse services [REVOKED 9-1-21]
- 317:30-5-661.4 Behavioral health professional services provided at Health Centers and other settings
- 317:30-5-661.5 Health Center preventive primary care services
- 317:30-5-661.6 Health Center preventive and primary care exclusions [REVOKED 9-1-21]
- 317:30-5-661.7 Allowable Places of services
- 317:30-5-664.1 Provision of other health services outside of the Health Center core services
- 317:30-5-664.2 Prior authorization and referrals
- 317:30-5-664.3 FQHC encounters
- 317:30-5-664.4 Multiple encounters at Federally Qualified Health Centers (FQHC)
- 317:30-5-664.5 Health Center encounter exclusions and limitations
- 317:30-5-664.6 Prescription drugs purchased under the 340B Drug Discount Program provided by Health Centers
- 317:30-5-664.7 Dental services provided by Health Centers
- 317:30-5-664.8 Obstetrical care provided by Health Centers
- 317:30-5-664.9 Family planning services provided by Health Centers
- 317:30-5-664.10 Health Center reimbursement
- 317:30-5-664.12 Determination of Health Center PPS rate
- 317:30-5-664.13 Individuals eligible for Part B of Medicare
- 317:30-5-664.14 Health Center record keeping
- 317:30-5-664.15 Health Center cost reporting
- 317:30-5-675 Eligible providers
- 317:30-5-676 Coverage by category
- 317:30-5-677 Payment rates [REVOKED 9-12-22]
- 317:30-5-678 Procedure codes [REVOKED 9-12-22]
- 317:30-5-680 Team therapy (Co-treatment)
- 317:30-5-695 Eligible dental providers and definitions
- 317:30-5-695.1 Payment for eligible providers
- 317:30-5-695.2 Payment for dental interns and students
- 317:30-5-696 Coverage by category
- 317:30-5-696.1 Anesthesia
- 317:30-5-697 Oral surgery procedures
- 317:30-5-698 Services requiring prior authorization
- 317:30-5-699 Restorations
- 317:30-5-700 Orthodontic services
- 317:30-5-700.1 Orthodontic prior authorization
- 317:30-5-701 Surface identification
- 317:30-5-703 Tooth numbering system
- 317:30-5-704 Billing instructions
- 317:30-5-705 Billing
- 317:30-5-706. Definitions
- 317:30-5-707. Eligible providers
- 317:30-5-708. Parental consent requirements
- 317:30-5-709. Coverage [REVOKED 11-4-22]
- 317:30-5-710. Post-care [REVOKED 11-4-22]
- 317:30-5-711. Billing [REVOKED 11-4-22]
- 317:30-5-720. Eligible providers
- 317:30-5-721. Coverage by category
- 317:30-5-722. General
- 317:30-5-723. Eligible providers
- 317:30-5-724. Manual spinal manipulation
- 317:30-5-725. Physical therapy (PT) for treatment of spinal pain
- 317:30-5-740 Definitions
- 317:30-5-740.1 Eligible providers and requirements
- 317:30-5-740.2 Provider selection
- 317:30-5-741 Coverage by category
- 317:30-5-742 Description of services
- 317:30-5-742.1 Reimbursement
- 317:30-5-742.2 Individual plan of care (IPC)
- 317:30-5-743.1 Service quality review (SQR)
- 317:30-5-744 Billing
- 317:30-5-745 Documentation of records
- 317:30-5-746 Prior authorization and appeal of prior authorization decision
- 317:30-5-750. Definitions
- 317:30-5-750.1. Eligible providers and requirements
- 317:30-5-750.2. Provider selection
- 317:30-5-751. Coverage by category
- 317:30-5-752. Description of services
- 317:30-5-753. Individual plan of care (IPC) requirements
- 317:30-5-754. Service quality review (SQR)
- 317:30-5-755. Billing
- 317:30-5-756. Reimbursement
- 317:30-5-757. Prior authorization and appeal of prior authorization decision
- 317:30-5-760 ADvantage program
- 317:30-5-761 Eligible providers
- 317:30-5-762 Coverage
- 317:30-5-763 Description of services
- 317:30-5-763.1 Medicaid agency monitoring of the ADvantage program
- 317:30-5-764 Reimbursement
- 317:30-5-900 Eligible providers
- 317:30-5-901 Coverage by category
- 317:30-5-903 Individuals eligible for Part B of Medicare
- 317:30-5-905 Reimbursement
- 317:30-5-907 Provider requirements
- 317:30-5-907.1 Coverage and limitations
- 317:30-5-907.2 Individuals eligible for Part B of Medicare
- 317:30-5-907.3 Reimbursement
- 317:30-5-950 Eligible providers
- 317:30-5-951 Coverage by category
- 317:30-5-952 Prior authorization
- 317:30-5-953 Billing
- 317:30-5-970 Eligible providers
- 317:30-5-971 Coverage by category
- 317:30-5-971.1. Description of targeted case management (TCM) services
- 317:30-5-972 Reimbursement
- 317:30-5-973 Billing
- 317:30-5-974 Documentation of records
- 317:30-5-990 Eligible providers
- 317:30-5-991 Coverage by category
- 317:30-5-992 Reimbursement
- 317:30-5-993 Billing
- 317:30-5-994 Documentation of records
- 317:30-5-1010 Eligible providers
- 317:30-5-1010.1 Scope of service
- 317:30-5-1011 Coverage by category
- 317:30-5-1012 Reimbursement
- 317:30-5-1013 Billing
- 317:30-5-1014 Documentation of records
- 317:30-5-1020 General provisions
- 317:30-5-1021 Eligible providers
- 317:30-5-1023 Coverage by category
- 317:30-5-1026 Reporting of suspected abuse/neglect
- 317:30-5-1027 Billing
- 317:30-5-1030 Eligible providers
- 317:30-5-1031 Coverage by category
- 317:30-5-1032 Reimbursement
- 317:30-5-1033 Billing
- 317:30-5-1034 Documentation of records
- 317:30-5-1040 Organized health care delivery system
- 317:30-5-1041 Eligible providers
- 317:30-5-1042 Memorandum of agreement
- 317:30-5-1043 Coverage by category
- 317:30-5-1044 Payment rates
- 317:30-5-1045 Billing
- 317:30-5-1046 Documentation of records and records review
- 317:30-5-1047 Confidentiality of information
- 317:30-5-1075 Eligible providers
- 317:30-5-1076 Coverage by category
- 317:30-5-1080. Definitions
- 317:30-5-1081. Eligible providers and requirements
- 317:30-5-1082. Scope of services
- 317:30-5-1083. Coverage by category
- 317:30-5-1084. Reimbursement methodology
- 317:30-5-1085 General provisions
- 317:30-5-1086 Eligible I/T/U providers
- 317:30-5-1087 Terms and definitions
- 317:30-5-1088 I/T/U provider participation requirements
- 317:30-5-1089 I/T/U multiple sites
- 317:30-5-1090 Provision of other health services outside of the I/T/U encounter
- 317:30-5-1091 Definition of I/T/U services
- 317:30-5-1092 Services and supplies incidental to I/T/U outpatient encounters
- 317:30-5-1093 I/T/U visiting nurses services
- 317:30-5-1094 Behavioral health services provided at I/T/US
- 317:30-5-1095 I/T/U services not compensable under outpatient encounters
- 317:30-5-1096 Off-site services
- 317:30-5-1097 Billable I/T/U encounters
- 317:30-5-1098 I/T/U outpatient encounters
- 317:30-5-1099 I/T/U service limitations and requirements
- 317:30-5-1100 Inpatient care provided by IHS facilities
- 317:30-5-1101. I/T/U Shared Savings Program
- 317:30-5-1150 General
- 317:30-5-1151 Eligible providers
- 317:30-5-1152 Provider participation requirements
- 317:30-5-1153 Physician
- 317:30-5-1154 County health department (CHD)and city-county health department (CCHD) services/limitations
- 317:30-5-1155 Immunizations
- 317:30-5-1156 Environmental lead investigations
- 317:30-5-1157 Newborn screening
- 317:30-5-1158 Public health nursing services
- 317:30-5-1159 Tuberculosis
- 317:30-5-1160 Public health nursing services for first time mothers and their infants/children (Children's First program)
- 317:30-5-1161 Targeted case management
- 317:30-5-1200 Benefits for members age 65 or older with disabilities or long-term illnesses
- 317:30-5-1201 Benefits for members with intellectual disabilities
- 317:30-5-1202 Benefits for members with physical disabilities
- 317:30-5-1203 Billing procedures for Living Choice services
- 317:30-5-1204 Disclosure of information on health care providers and contractors
- 317:30-5-1205 Community transition services
- 317:30-5-1206 Transition coordinator services
- 317:30-5-1207. Benefits for members ages sixteen (16) through eighteen (18) in a psychiatric residential treatment facility
- 317:30-5-1215. General
- 317:30-5-1216. Eligible providers
- 317:30-5-1217. General coverage
- 317:30-5-1. Eligible providers
- 317:30-5-2. General coverage by category
- 317:30-5-3. Documentation of services
- 317:30-5-4. Procedure and diagnosis coding
- 317:30-5-6. Abortions
- 317:30-5-7. Anesthesia
- 317:30-5-8. Surgery
- 317:30-5-9. Medical services
- 317:30-5-10. Ophthalmology services
- 317:30-5-11. Psychiatric services
- 317:30-5-12. Family planning
- 317:30-5-13. Rape and abuse exams
- 317:30-5-14. Injections
- 317:30-5-14.1. Allergy services
- 317:30-5-15. Chemotherapy injections
- 317:30-5-17. Authorized examinations - eligibility determinations
- 317:30-5-18. Elective sterilizations
- 317:30-5-19. Hysterectomies
- 317:30-5-20. Laboratory services
- 317:30-5-20.1. Urine drug screening and testing
- 317:30-5-21. Unusual procedures
- 317:30-5-22. Obstetrical care
- 317:30-5-22.1. Enhanced services for medically high risk pregnancies
- 317:30-5-23. Newborn care
- 317:30-5-24. Radiology
- 317:30-5-25. Oklahoma Health Care Authority's Quality Improvement Organization (QIO)
- 317:30-5-40. Eligible providers
- 317:30-5-40.1. General information
- 317:30-5-40.2. Definitions
- 317:30-5-41. Inpatient hospital coverage/limitations
- 317:30-5-41.1. Acute inpatient psychiatric services
- 317:30-5-41.2. Organ transplants
- 317:30-5-42.1. Outpatient hospital services
- 317:30-5-42.2. Blood and blood fractions
- 317:30-5-42.3. Chemotherapy and radiation therapy
- 317:30-5-42.4. Clinic/treatment room services; urgent care
- 317:30-5-42.5. Diagnostic testing therapeutic services
- 317:30-5-42.6. Dialysis
- 317:30-5-42.7. Emergency department (ED) care/services
- 317:30-5-42.8. Hearing and speech therapy
- 317:30-5-42.9. Infusions/injections
- 317:30-5-42.10. Laboratory
- 317:30-5-42.11. Observation/treatment
- 317:30-5-42.12. Physical therapy
- 317:30-5-42.13. Radiology
- 317:30-5-42.14. Surgery and diagnostic services
- 317:30-5-42.15. Outpatient hospital services for members infected with tuberculosis
- 317:30-5-42.16. Related services
- 317:30-5-42.17. Non-covered services
- 317:30-5-42.18. Coverage for children
- 317:30-5-42.19. 340B Drug Discount Program
- 317:30-5-44. Medicare eligible individuals
- 317:30-5-47. Reimbursement for inpatient hospital services
- 317:30-5-47.1. Reimbursement for newborn screening services provided by the OSDH
- 317:30-5-47.2. Disproportionate share hospitals (DSH)
- 317:30-5-47.3. Indirect medical education (IME) adjustment
- 317:30-5-47.4. Direct medical education payment adjustment
- 317:30-5-47.5. Critical Access Hospital
- 317:30-5-49. Reporting suspected abuse
- 317:30-5-50. Abortions
- 317:30-5-51. Elective sterilizations
- 317:30-5-52. Hysterectomies
- 317:30-5-53. Newborn care
- 317:30-5-56. Utilization review
- 317:30-5-57. Notice of denial
- 317:30-5-58. Supplemental Hospital Offset Payment Program
- 317:30-5-70. Eligible providers
- 317:30-5-70.1. Pharmacist responsibility
- 317:30-5-70.2. Record retention/Post Payment Review
- 317:30-5-70.3. Prescriber identification numbers
- 317:30-5-70.4. Federal/State cost share-optional program
- 317:30-5-72. Categories of service eligibility
- 317:30-5-72.1. Drug benefit
- 317:30-5-76. Generic drugs
- 317:30-5-77. Brand necessary certification
- 317:30-5-77.1. Dispensing Quantity
- 317:30-5-77.2. Prior authorization
- 317:30-5-77.3. Product-Based Prior Authorization (PBPA)
- 317:30-5-78. Reimbursement
- 317:30-5-78.1. Special billing procedures
- 317:30-5-78.2. Falsification of claims
- 317:30-5-80. National drug code
- 317:30-5-86. Drug Utilization Review (DUR) Program
- 317:30-5-86.2. Case management
- 317:30-5-87. 340B Drug Discount Program
- 317:30-5-95. General provisions and eligible providers
- 317:30-5-95.1. Medical necessity criteria and coverage for adults aged twenty-one (21) to sixty-four (64)
- 317:30-5-95.4. Individual plan of care for adults aged twenty-one (21) to sixty-four (64)
- 317:30-5-95.5. Physician review of prescribed medications for adults age 21 to 64
- 317:30-5-95.6. Medical, psychiatric, and social evaluations for adults aged twenty-one (21) to sixty-four (64)
- 317:30-5-95.7. Active treatment for adults age 21 to 64
- 317:30-5-95.8. Nursing services for adults age 21 to 64
- 317:30-5-95.9. Therapeutic services for adults age 21 to 64
- 317:30-5-95.10. Discharge plan for adults aged twenty-one (21) to sixty-four (64)
- 317:30-5-95.11. Inpatient acute psychiatric services for persons sixty-five (65) years of age or older
- 317:30-5-95.12. Utilization control requirements for inpatient acute psychiatric services for persons sixty-five (65) years of age or older
- 317:30-5-95.13. Certification and recertification of need for inpatient care for inpatient acute psychiatric services for persons sixty-five (65) years of age or older
- 317:30-5-95.14. Individual plan of care for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services
- 317:30-5-95.15. Physician review of prescribed medications for persons over 65 years of age receiving inpatient acute psychiatric services
- 317:30-5-95.16. Medical psychiatric and social evaluations for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services
- 317:30-5-95.17. Active treatment for persons over 65 years of age receiving inpatient acute psychiatric services
- 317:30-5-95.18. Nursing services for persons over 65 years of age receiving inpatient acute psychiatric services
- 317:30-5-95.19. Therapeutic services for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services
- 317:30-5-95.20. Discharge plan for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services
- 317:30-5-95.21. Continued stay review for persons sixty-five (65) years of age or older receiving inpatient acute psychiatric services
- 317:30-5-95.22. Coverage for children
- 317:30-5-95.23. Individuals age 21
- 317:30-5-95.24. Prior-authorization of inpatient psychiatric services for children
- 317:30-5-95.25. Medical necessity criteria for acute psychiatric admissions for children
- 317:30-5-95.26. Medical necessity criteria for continued stay - acute psychiatric admission for children
- 317:30-5-95.27. Medical necessity criteria for admission - inpatient chemical dependency detoxification for children
- 317:30-5-95.28. Medical necessity criteria for continued stay - inpatient chemical dependency detoxification program for children
- 317:30-5-95.29. Medical necessity criteria for admission - psychiatric residential treatment for children
- 317:30-5-95.30. Medical necessity criteria for continued stay - psychiatric residential teatment center for children
- 317:30-5-95.31. Prior authorization and extension procedures for children
- 317:30-5-95.32. Quality of care requirements for children
- 317:30-5-95.33. Individual plan of care for children
- 317:30-5-95.34. Active treatment for children
- 317:30-5-95.35. Certificate of need requirements for members under the age of twenty-one (21) in psychiatric hospital and PRTFs
- 317:30-5-95.36. Treatment team for inpatient children's services
- 317:30-5-95.37. Medical, psychiatric and social evaluations for inpatient services for children
- 317:30-5-95.38. Nursing services for children
- 317:30-5-95.39. Restraint, seclusion, and serious occurrence reporting requirements for members under the age of twenty-one (21)
- 317:30-5-95.40. Other required standards
- 317:30-5-95.41. Documentation of records for children receiving inpatient services
- 317:30-5-95.42. Service quality review (SQR) of psychiatric facilities
- 317:30-5-96.3. Methods of payment
- 317:30-5-96.4. Outlier intensity adjustment
- 317:30-5-96.5. Disproportionate share hospitals (DSH)
- 317:30-5-96.6. Payment for Medicare/Medicaid dual eligible individuals
- 317:30-5-96.7. Cost reports
- 317:30-5-96.8. Psychiatric Residential Treatment Facility payments to subcontractors
- 317:30-5-97. Reporting abuse and/or neglect
- 317:30-5-120. Eligible providers
- 317:30-5-121. Coverage by category
- 317:30-5-122. Levels of care
- 317:30-5-123. Member certification for long term care
- 317:30-5-124. Facility licensure
- 317:30-5-125. Trust funds
- 317:30-5-126. Therapeutic leave and Hospital leave
- 317:30-5-127. Notification of nursing facility changes
- 317:30-5-129. Required monthly notifications
- 317:30-5-130. Inspections of care in Intermediate Care Facilities for the Mentally Retarded (ICF/MR)
- 317:30-5-131. Rates of payments
- 317:30-5-131.2. Quality of care fund requirements and report
- 317:30-5-132. Cost reports
- 317:30-5-133. Payment methodologies
- 317:30-5-133.1. Routine services
- 317:30-5-133.3. Nursing home ventilator-dependent and tracheostomy care services
- 317:30-5-134. Nurse Aide Training Reimbursement
- 317:30-5-210. Eligible providers
- 317:30-5-210.1. Coverage for adults
- 317:30-5-210.2. Coverage for children
- 317:30-5-211.1. Definitions
- 317:30-5-211.2. Medical necessity
- 317:30-5-211.3. Prior authorization (PA)
- 317:30-5-211.4. Rental and/or purchase
- 317:30-5-211.5. Repairs, maintenance, replacement, and delivery
- 317:30-5-211.6. General documentation requirements
- 317:30-5-211.7. Free choice
- 317:30-5-211.10. Medical supplies, equipment, and appliances
- 317:30-5-211.11. Oxygen and oxygen equipment
- 317:30-5-211.12. Oxygen rental
- 317:30-5-211.13. Orthotics and prosthetics
- 317:30-5-211.14. Nutritional support
- 317:30-5-211.15. Medical Supplies
- 317:30-5-211.16. Coverage for long-term care facility residents
- 317:30-5-211.17. Wheelchairs
- 317:30-5-211.18. Ownership of durable medical equipment
- 317:30-5-211.19. Quality assurances and safeguards
- 317:30-5-214. Coverage for individuals eligible for Part B of Medicare
- 317:30-5-217. Billing
- 317:30-5-218. Reimbursement
- 317:30-5-240. Eligible providers
- 317:30-5-240.1. Definitions
- 317:30-5-240.2. Provider participation standards
- 317:30-5-240.3. Staff Credentials
- 317:30-5-241. Covered Services
- 317:30-5-241.1. Screening, assessment and service plan
- 317:30-5-241.2. Psychotherapy
- 317:30-5-241.3. Behavioral Health Rehabilitation (BHR) services
- 317:30-5-241.4. Crisis Intervention
- 317:30-5-241.5. Support services
- 317:30-5-241.6. Behavioral Health Case Management
- 317:30-5-244. Individuals eligible for Part B of Medicare
- 317:30-5-245. Reimbursement
- 317:30-5-248. Documentation of records
- 317:30-5-249. Non-covered services
- 317:30-5-325. [Reserved]
- 317:30-5-326. Provider eligibility
- 317:30-5-326.1. Definitions
- 317:30-5-327. Eligibility for SoonerRide NET
- 317:30-5-327.1. SoonerRide NET Coverage
- 317:30-5-327.3. Coverage for residents of nursing facilities
- 317:30-5-327.4. Coverage for children
- 317:30-5-327.5. Exclusions from SoonerRide NET
- 317:30-5-327.6. Denial of SoonerRide NET services by the SoonerRide broker
- 317:30-5-327.7. SoonerRide provider network
- 317:30-5-327.8. Type of services provided and duties of the SoonerRide driver
- 317:30-5-327.9. Scheduling NET services through SoonerRide
- 317:30-5-335. Eligible providers
- 317:30-5-335.1. Definitions
- 317:30-5-336. General coverage
- 317:30-5-336.1. Medical necessity
- 317:30-5-336.2. Nearest appropriate facility
- 317:30-5-336.3. Destination
- 317:30-5-336.4. Transport outside of locality
- 317:30-5-336.5. Levels of ambulance service, ambulance fee schedules and base rate
- 317:30-5-336.6. Mileage
- 317:30-5-336.7. Waiting time
- 317:30-5-336.8. Special situations
- 317:30-5-336.9. Air ambulance
- 317:30-5-336.10. Fixed wing air ambulance services
- 317:30-5-336.11. Rotary wing air ambulance
- 317:30-5-336.12. Non-emergency ambulance and stretcher service transportation
- 317:30-5-336.13. Non covered services
- 317:30-5-337. Coverage for children
- 317:30-5-339. Individuals eligible for Part B of Medicare
- 317:30-5-343. Reimbursement
- 317:30-5-355. Eligible providers
- 317:30-5-355.1. Definition of services
- 317:30-5-356. Coverage for adults
- 317:30-5-357. Coverage for children
- 317:30-5-359. Claims for Medicare eligible recipients
- 317:30-5-359.1. Cost reports
- 317:30-5-359.2. Reimbursement
- 317:30-5-361. Billing
- 317:30-5-362. Documentation of records
- 317:30-5-363. 340B Drug Discount Program
- 317:30-5-390. Home and Community-Based Services Waivers for adults with an intellectual disability or certain adults with related conditions
- 317:30-5-391. Coverage for Skilled Nursing Services
- 317:30-5-392. Description of Skilled Nursing services
- 317:30-5-393. Coverage limitations for Skilled Nursing Services
- 317:30-5-660. Eligible providers
- 317:30-5-660.1. Health Center multiple sites contracting
- 317:30-5-660.2. Health Center professional staff
- 317:30-5-660.3. Health Center enrollment requirements for other behavioral health services
- 317:30-5-660.4. Health Center enrollment requirements for health services in a school setting
- 317:30-5-660.5. Health Center service definitions
- 317:30-5-661. Coverage by category
- 317:30-5-661.1. Health Center core services
- 317:30-5-661.2. Services and supplies "incident to" Health Center encounters
- 317:30-5-661.3. Visiting Nurse services
- 317:30-5-661.4. Behavioral health professional services provided at Health Centers and other settings
- 317:30-5-661.5. Health Center preventive primary care services
- 317:30-5-661.6. Health Center preventive and primary care exclusions
- 317:30-5-661.7. Off-site services
- 317:30-5-664.1. Provision of other health services outside of the Health Center core services
- 317:30-5-664.2. Prior authorization and referrals
- 317:30-5-664.3. Federally Qualified Health Center (FQHC) encounters
- 317:30-5-664.4. Multiple encounters at Federally Qualified Health Centers (FQHC)
- 317:30-5-664.5. Health Center encounter exclusions and limitaitons
- 317:30-5-664.6. Prescription drugs purchased under the 340B Drug Discount program provided by Health Centers
- 317:30-5-664.7. Dental services provided by Health Centers
- 317:30-5-664.8. Obstetrical care provided by Health Centers
- 317:30-5-664.9. Family planning services provided by Health Centers
- 317:30-5-664.10. Health Center reimbursement
- 317:30-5-664.11. PPS rate reconciliation to Health Centers
- 317:30-5-664.12. Determination of Health Center PPS rate
- 317:30-5-664.13. Individual eligible for Part B of Medicare
- 317:30-5-664.14. Health Center record keeping
- 317:30-5-664.15. Health Center cost reporting
- 317:30-5-695. Eligible dental providers and definitions
- 317:30-5-695.1. Payment of eligible providers
- 317:30-5-695.2. Payment for dental interns and students
- 317:30-5-696. Coverage by category
- 317:30-5-696.1. Conscious Sedation
- 317:30-5-697. Oral surgery procedures
- 317:30-5-698. Services requiring prior authorization
- 317:30-5-699. Restorations
- 317:30-5-700. Orthodontic services
- 317:30-5-700.1. Orthodontic prior authorization
- 317:30-5-701. Surface identification
- 317:30-5-703. Tooth numbering system
- 317:30-5-704. Billing instructions
- 317:30-5-705. Billing
- 317:30-5-740. Definitions
- 317:30-5-740.1. Eligible providers and requirements
- 317:30-5-740.2. Provider selection
- 317:30-5-741. Coverage by category
- 317:30-5-742. Description of services
- 317:30-5-742.1. Reimbursement
- 317:30-5-742.2. Individual plan of care (IPC)
- 317:30-5-743.1. Service quality review (SQR)
- 317:30-5-744. Billing
- 317:30-5-745. Documentation of records
- 317:30-5-746. Prior authorization and appeal of prior authorization decision
- 317:30-5-1020. General provisions
- 317:30-5-1021. Eligible providers
- 317:30-5-1022. Periodicity schedule
- 317:30-5-1023. Coverage by category
- 317:30-5-1024. Periodic screening examination
- 317:30-5-1025. Interperiodic screening examination
- 317:30-5-1026. Reporting of suspected child abuse/neglect
- 317:30-5-1027. Billing
- 317:30-5-1085. General provisions
- 317:30-5-1086. Eligible I/T/U providers
- 317:30-5-1087. Terms and definitions
- 317:30-5-1088. I/T/U provider participation requirements
- 317:30-5-1089. I/T/U multiple sites
- 317:30-5-1090. Provision of other health services outside of the I/T/U encounter
- 317:30-5-1091. Definition of I/T/U services
- 317:30-5-1092. Services and supplies incidental to I/T/U outpatient encounters
- 317:30-5-1093. I/T/U visiting nurses services
- 317:30-5-1094. Behavioral health services provided at I/T/Us
- 317:30-5-1095. I/T/U services not compensable under outpatient encounters
- 317:30-5-1096. Off-site services
- 317:30-5-1097. Billable I/T/U encounters
- 317:30-5-1098. I/T/U outpatient encounters
- 317:30-5-1099. I/T/U service limitations and requirements
- 317:30-5-1100. Inpatient care provided by IHS facilities
- 317:30-5-1150. General
- 317:30-5-1151. Eligible providers
- 317:30-5-1152. Provider participation requirements
- 317:30-5-1153. Physician
- 317:30-5-1154. County health department (CHD) and city-county health department (CCHD) services/limitations
- 317:30-5-1155. Immunizations
- 317:30-5-1156. Environmental lead investigations
- 317:30-5-1157. Newborn screening
- 317:30-5-1158. Public health nursing services
- 317:30-5-1159. Tuberculosis
- 317:30-5-1160. Public health nursing services for first time mothers and their infants/children (Children's First program)
- 317:30-5-1161. Targeted case management
- 317:30-5-1200. Benefits for members age 65 or older with disabilities or long-term illnesses
- 317:30-5-1201. Benefits for members with intellectual disabilities
- 317:30-5-1202. Benefits for members with physical disabilities
- 317:30-5-1203. Billing procedures for Living Choice services
- 317:30-5-1204. Disclosure of information on health care providers and contractors
- 317:30-5-1205. Community transition services
- 317:30-5-1206. Transition coordinator services
- 317:35-5-1. Scope and applicability
- 317:35-5-2. Categorically related programs
- 317:35-5-3. Determining categorical relationship to the aged
- 317:35-5-4. Determining categorical relationship to the disabled
- 317:35-5-4.1. Special level of care and cost effectiveness application procedures for Tax Equity and Fiscal Responsibility Act (TEFRA)
- 317:35-5-5. Determining categorical relationship to the blind
- 317:35-5-6. Determining categorical relationship to pregnancy-related services
- 317:35-5-6.1. Determining categorical relationship for pregnancy related services covered under Title XXI
- 317:35-5-7. Determining categorical relationship to the children and parent and caretaker relative groups
- 317:35-5-8. Determining categorical relationship for the SoonerPlan Family Planning Program
- 317:35-5-9. Determining categorical relationship to expansion adults
- 317:35-5-40. Scope and applicability
- 317:35-5-41. Determination of capital resources for individuals categorically related to aged, blind and disabled
- 317:35-5-41.1. Home/real property
- 317:35-5-41.2. Miscellaneous Personal property
- 317:35-5-41.3. Automobiles, pickups, and trucks
- 317:35-5-41.4. Stocks and bonds
- 317:35-5-41.5. Purchase of promissory notes, loans, or mortgages
- 317:35-5-41.6. Trust accounts
- 317:35-5-41.7. Retirement funds
- 317:35-5-41.8. Eligibility regarding long-term care services
- 317:35-5-41.9. Exclusion from resources
- 317:35-5-41.10. Changes in capital resources
- 317:35-5-41.11. Maximum resources
- 317:35-5-42. Determination of countable income for individuals categorically related to aged, blind and disabled
- 317:35-5-43. Third party resources; insurance, workers' compensation and Medicare
- 317:35-5-44. Child/spousal support
- 317:35-5-45. Determination of income and resources for children and parents and caretaker relatives
- 317:35-5-46. Determination of income and resources for categorical relationship to pregnancy-related services
- 317:35-5-47. Determination of income and resources for categorical relationship to Disability for TB infected individuals
- 317:35-5-48. Determination of income and resources for categorical relationship to expansion adults
- 317:35-5-49. Determination of income and resources for categorical relationship to Tax Equity and Fiscal Responsibility Act (TEFRA)
- 317:35-6-35. General eligibility consideration
- 317:35-6-36. Financial eligibility of individuals categorically related to aid to families with dependent children (AFDC), pregnancy-related services or expansion adults
- 317:35-6-37. Financial eligibility of categorically needy individuals related to aid to families with dependent children (AFDC), pregnancy-related services, parent/caretaker relatives, families with children, and expansion adults
- 317:35-6-38. Hospital presumptive eligibility (HPE)
- 317:35-6-39. General calculation of countable income for MAGI eligibility groups
- 317:35-6-40. MAGI household composition; taxpayers and tax dependents
- 317:35-6-41. MAGI household composition; tax filers
- 317:35-6-42. MAGI household composition; exceptions to tax filer rules
- 317:35-6-43. MAGI household composition; non-filers
- 317:35-6-44. Determination of whether a household member's income is counted
- 317:35-6-50. Countable sources of income
- 317:35-6-51. Exceptions to Internal Revenue Code rules
- 317:35-6-52. Adjustments to income
- 317:35-6-53. Determination of current monthly income
- 317:35-6-54. Determination of current monthly amount of adjustments to income
- 317:35-6-60. Certification for Soonercare for pregnant women and families with children
- 317:35-6-60.1. Changes in circumstances
- 317:35-6-60.2 Retroactive eligibility
- 317:35-6-61. Redetermination of eligibility for persons receiving SoonerCare
- 317:35-6-63. Denials
- 317:35-6-64. Closures
- 317:35-6-64.1. Transitional Medical Assistance (TMA)
- 317:35-6-65. Transfer of case records between counties
- 317:35-7-36. Financial eligibility of individuals categorically related to ABD
- 317:35-7-38. Financial eligibility of categorically needy individuals related to ABD
- 317:35-7-40. Eligibility as Qualified Medicare Beneficiary Plus
- 317:35-7-41. Eligibility as Qualified Disabled and Working Individual
- 317:35-7-43. Eligibility as Specified Low-Income Medicare Beneficiaries
- 317:35-7-44. Eligibility for TB related services
- 317:35-7-46. Eligibility as Qualifying Individuals
- 317:35-7-48. Eligibility for the SoonerPlan Family Planning Program
- 317:35-7-60. Certification for SoonerCare
- 317:35-7-60.1. Certification for the SoonerPlan Family Planning Program
- 317:35-7-61. Redetermination of eligibility for persons receiving ABD or TANF
- 317:35-7-61.1. Special redetermination procedures for Tax Equity and Fiscal Responsibility Act (TEFRA)
- 317:35-7-62. Special redetermination procedures for children in custody or subsidized adoptions
- 317:35-9-1. Overview of long-term medical care services; relationship to QMB, SLMB, and other Medicaid services eligibility, and spenddown calculation
- 317:35-9-4. Services in Intermediate Care Facility for Individuals with Intellectual Disabilities (public and private)
- 317:35-9-5. Home and Community - Based Services (HCBS) Waivers for persons with intellectual disabilities or certain persons with related conditions
- 317:35-9-7. Services for persons age 65 or older in mental health hospitals
- 317:35-9-25. Application for ICF/MR, HCBW/ID, and persons aged 65 or over in mental health hospitals
- 317:35-9-26. Application procedures for private ICF/MR
- 317:35-9-27. Application procedures for public ICF/MR
- 317:35-9-28. Application procedures for services provided by Developmental Disability Services Division (DDSD)
- 317:35-9-29. Application procedures for persons age 65 or older in mental health hospitals
- 317:35-9-45. Determination of medical eligibility for care in a private Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)
- 317:35-9-48. Determination of medical eligibility for care in public ICF/MR
- 317:35-9-48.1. Determining ICF/IID institutional level of care for TEFRA children
- 317:35-9-49. Determination of medical eligibility for Home and Community Based Waiver Services for the Intellectually Disabled
- 317:35-9-50. Determination of medical eligibility for persons age 65 or older in mental health hospitals
- 317:35-9-65. General financial eligibility requirements for ICF/MR, HCBW/MR and individuals age 65 or older in mental health hospitals
- 317:35-9-67. Determining financial eligibility of categorically needy individuals
- 317:35-9-68. Determining financial eligibility for care in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) (public and private), for HCBW/IID services, and for persons age sixty-five (65) or older in mental health ho
- 317:35-9-95. Payment to ICF/MR (public and private)
- 317:35-9-97. Payment for Home and Community Based Waiver services for the Intellectually Disabled (HCBW/ID)
- 317:35-9-98. Payment to mental health hospitals
- 317:35-9-99. Billing procedures for ICF/MR, HCBW/MR services and services for individuals 65 older in a mental health hospital
- 317:35-9-100. Management of client's funds while receiving care in NF, ICF/MR (public and private) or for persons age 65 or older in mental health hospitals
- 317:35-9-101. Disclosure of information on health care providers and contractors
- 317:35-9-102. Referral for social services
- 317:35-9-103. Special procedures for release of adults in mental health hospitals to long-term care facilities
- 317:35-10-10. Capital resources
- 317:35-10-12. Real property other than home property [TERMINATED]
- 317:35-10-13. Personal property [TERMINATED]
- 317:35-10-14. Trust accounts [TERMINATED]
- 317:35-10-15. Transfer or disposal of capital resources [TERMINATED]
- 317:35-10-16. Resources acquired while receiving assistance [TERMINATED]
- 317:35-10-17. Family relations as a resource [TERMINATED]
- 317:35-10-18. Maximum reserve [TERMINATED]
- 317:35-10-105. Requirements [TERMINATED]
- 317:35-10-106. Citizenship [TERMINATED]
- 317:35-10-107. Alienage [TERMINATED]
- 317:35-10-108. Immigrants [TERMINATED]
- 317:35-10-109. Permanent residence under color or law (PRUCOL) [TERMINATED]
- 317:35-10-110. Parolees [TERMINATED]
- 317:35-10-111. Refugees [TERMINATED]
- 317:35-10-112. Conditioned entries of aliens made available by the Attorney General of the United States for emergent reasons or for reasons deemed strictly in the public interest [TERMINATED]
- 317:35-10-113. Special provisions relating to Kickapoo Indians [TERMINATED]
- 317:35-15-1. Overview of long-term medical care services; relationship to QMBP, SLMB and other SoonerCare services and eligibility
- 317:35-15-2. State Plan Personal care services
- 317:35-15-3. Application for State Plan Personal Care
- 317:35-15-4. Determination of medical eligibility for State Plan Personal Care
- 317:35-15-5. General financial eligibility requirements for State Plan Personal Care
- 317:35-15-6. Determining financial eligibility of categorically needy individuals
- 317:35-15-7. Certification for State Plan Personal Care
- 317:35-15-8. Agency personal care service authorization and monitoring
- 317:35-15-8.1. Agency State Plan Personal Care services; billing, and issue resolution
- 317:35-15-8.2. State Plan Personal Care Eligible Provider Exception
- 317:35-15-9. Redetermination of financial eligibility for State Plan Personal Care
- 317:35-15-10. Redetermination of medical eligibility for State Plan personal care services
- 317:35-15-12. Case changes
- 317:35-15-13.1. Individual personal care assistant (IPCA) service management
- 317:35-15-13.2. Individual personal care assistants (IPCA) provider contractor; billing, training, and problem resolution
- 317:35-15-14. Billing procedures for State Plan personal care
- 317:35-15-15. Referral for social services
- 317:35-16-1. State Plan Personal Care Services (SPPC)
- 317:35-16-2. Determination of medical eligibility for State Plan Personal Care (SPPC) services for Expansion Adults, TEFRA, and certain MAGI populations
- 317:35-16-3. General financial eligibility requirements for State Plan Personal Care
- 317:35-16-4. Determining financial eligibility of categorically needy individuals
- 317:35-16-5. Certification for State Plan Personal Care
- 317:35-16-6. Agency State Plan Personal Care (SPPC) service authorization and monitoring
- 317:35-16-7. Agency State Plan Personal Care services; billing, and problem resolution
- 317:35-16-8. Financial eligibility redetermination for State Plan Personal Care
- 317:35-16-9. Medical eligibility redetermination for State Plan Personal Care (SPPC) services
- 317:35-16-10. Case changes
- 317:35-16-11. Billing procedures for State Plan Personal Care
- 317:35-16-12. Social services referral
- 317:35-17-1. Overview of long-term medical care services; relationship to Qualified Medicare Beneficiary Plus (QMBP), Specified Low-Income Medicare Beneficiary (SLMB), and other Medicaid (SoonerCare) services eligibility
- 317:35-17-2. Level of care medical eligibility determination
- 317:35-17-3. ADvantage program services
- 317:35-17-4. Application for ADvantage services
- 317:35-17-5. ADvantage program medical eligibility determination
- 317:35-17-9. General financial eligibility requirements for the ADvantage program
- 317:35-17-10. Determining financial eligibility/categorical relationship for the ADvantage program
- 317:35-17-11. Determining financial eligibility for ADvantage program services
- 317:35-17-12. Certification for ADvantage program services
- 317:35-17-14. Case management services
- 317:35-17-15. Redetermination of eligibility for ADvantage services
- 317:35-17-16. Member annual level of care re-evaluation and annual service plan reauthorization
- 317:35-17-18. ADvantage services during hospitalization or NF placement
- 317:35-17-19. Closure or termination of ADvantage services
- 317:35-17-21. Case changes
- 317:35-17-21.1. ADvantage and agency Personal Care provider certification
- 317:35-17-22. Billing procedures for ADvantage services
- 317:35-17-23. Disclosure of information on health care providers and contractors
- 317:35-17-24. Referral for social services
- 317:35-17-25. Address Confidentiality Program
- 317:35-17-26. Ethics of Care Committee
- 317:35-17-27. Incident reporting
- 317:35-18-1. Programs of All-Inclusive Care for the Elderly (PACE)
- 317:35-18-2. Introduction
- 317:35-18-3. Definitions
- 317:35-18-4. Provider regulations
- 317:35-18-5. Eligibility criteria
- 317:35-18-6. Program benefits
- 317:35-18-7. Appeals process
- 317:35-18-8. Enrollment
- 317:35-18-9. Continuation of enrollment
- 317:35-18-10. Disenrollment (voluntary and involuntary)
- 317:35-18-11. Data collection and reporting
- 317:35-18-12. Medicaid Payments
- 317:35-19-2. Nursing Facility (NF) program medical eligibility determination
- 317:35-19-3. Services in a Nursing Facility (NF)
- 317:35-19-4. Medicaid recovery
- 317:35-19-5. Application for nursing facility care; forms
- 317:35-19-6. Application procedures for NF
- 317:35-19-7.1. Level of care medical eligibility determination
- 317:35-19-8. Pre-admission screening and resident review
- 317:35-19-9. PASRR screening process
- 317:35-19-14. New admissions, readmissions, interfacility transfers, and same level of care program transfers
- 317:35-19-16. PASRR appeals process
- 317:35-19-18. Change in level of long-term medical care
- 317:35-19-19. General financial eligibility requirements for NF and skilled nursing care
- 317:35-19-20. Determining financial eligibility of categorically needy individuals
- 317:35-19-21. Determining financial eligibility for care in nursing facility
- 317:35-19-22. Certification for nursing facility (NF)
- 317:35-19-22.1. Discharge planning
- 317:35-19-23. Redetermination of eligibility for NF care
- 317:35-19-24. Case transfer between categories
- 317:35-19-25. Case changes
- 317:35-19-26. Payment to NF
- 317:35-19-27. Billing procedures for NF
- 317:35-19-28. Management of client's funds while receiving care in NF
- 317:35-19-29. Disclosure of information on health care providers and contractors
- 317:35-19-30. Referral for social services
- 317:35-19-31. Special procedures for release of adults in mental health hospitals to Nursing Facilities
- 317:35-21-1. Oklahoma Cares Breast and Cervical Cancer Treatment (BCC) program
- 317:35-21-2. Scope of coverage
- 317:35-21-3. CDC screening
- 317:35-21-4. Creditable coverage
- 317:35-21-5. In need of treatment
- 317:35-21-6. Age requirements
- 317:35-21-7. Citizenship and Residence
- 317:35-21-8. Social security number
- 317:35-21-9. Income
- 317:35-21-10. Resources
- 317:35-21-11. Certification for BCC
- 317:35-21-12. Changes after certification/continued need for treatment
- 317:35-21-13. Redetermination
- 317:35-21-14. Appeals and reconsiderations
- 317:35-22-1. Pregnancy related benefits covered under Title XXI
- 317:35-22-2. Scope of coverage for Titile XXI Pregnancy
- 317:35-22-2.1. Non-covered services
- 317:35-22-3. Need for pregnancy related services for the unborn child
- 317:35-22-4. Citizenship
- 317:35-22-5. Social Security number
- 317:35-22-6. Income
- 317:35-22-7. Resources
- 317:35-22-8. Period of eligibility
- 317:35-22-9. Notification of eligibility
- 317:35-22-10. Denials
- 317:35-22-11. Closures
- 317:40-1-1. Home and Community-Based Services (HCBS) Waivers for persons with intellectual disabilities or certain persons with related conditions
- 317:40-1-2. Authorization for Residential Supports in the Community Waiver
- 317:40-1-3. Requirements for Home and Community-Based settings
- 317:40-1-4. Remote support (RS)
- 317:40-5-3. Agency companion services (ACS)
- 317:40-5-5. Agency Companion Services (ACS) provider requirements and responsibilities
- 317:40-5-6. Agency Companion Services provider requirements
- 317:40-5-11. Termination of Agency Companion placement
- 317:40-5-13. Agency Companion Services provider agency responsibilities
- 317:40-5-50. Purpose of Specialized Foster Care
- 317:40-5-51. Scope of Specialized Foster Care
- 317:40-5-52. Visitation and reunification in Specialized Foster Care
- 317:40-5-54. Selection of Specialized Foster Care provider
- 317:40-5-55. Specialized Foster Care provider responsibilities
- 317:40-5-56. Responsibilities of the parents of individuals in voluntary specialized foster care
- 317:40-5-57. Developmental Disabilities Services Division case manager roles and responsibilities regarding Specialized Foster Care
- 317:40-5-58. Developmental Disabilities Services Division Specialized Foster Care (SFC) staff roles and responsibilities
- 317:40-5-59. Back-up Plan for persons receiving Specialized Foster Care
- 317:40-5-62. Evaluation of policy violation or program concern in a specialized foster care home
- 317:40-5-63. Plan of action in Specialized Foster Care
- 317:40-5-64. Termination of a Specialized Foster Care Provider
- 317:40-5-66. Dispute and grievance procedures for Specialized Foster Care providers
- 317:40-5-67. Specialized Foster Care provider rights
- 317:40-5-100. Assistive technology (AT) devices and services
- 317:40-5-101. Architectural modifications
- 317:40-5-102. Nutrition Services
- 317:40-5-103. Transportation
- 317:40-5-104. Medical supplies, equipment, and appliances
- 317:40-5-110. Authorization for Habilitation Training Specialist Services
- 317:40-5-111. Authorization for Habilitation Training Specialist Services in the Homeward Bound Waiver
- 317:40-5-112. Dental services
- 317:40-5-150. Daily Living Supports for the Community Waiver
- 317:40-5-151. Intensive Personal Supports
- 317:40-5-152. Group home services for persons with an intellectual disability or certain persons with related conditions
- 317:40-5-153. Daily Living Supports for the Homeward Bound Waiver
- 317:40-5-154. Intensive Personal Supports in the Homeward Bound Waiver
- 317:40-7-1. Overview of Waiver Employment Services
- 317:40-7-2. Definitions
- 317:40-7-3. Eligibility for Waiver Employment Services
- 317:40-7-4. Services provided through Waiver Employment Services
- 317:40-7-5. Community-Based Services
- 317:40-7-6. Center-based services
- 317:40-7-7. Job coaching services
- 317:40-7-8. Employment training specialist services
- 317:40-7-11. Stabilization Services
- 317:40-7-12. Enhanced rates
- 317:40-7-13. Supplemental supports for center-based services
- 317:40-7-15. Service requirements for employment services through Home and Community-Based Services (HCBS) Waivers
- 317:40-7-18. Contracts with industry
- 317:40-7-20. Waiver Employment Services provider staff qualifications and training
- 317:40-7-21. Exception process for employment services through Home and Community-Based Services Waivers
- 317:40-7-22. Value-Based Payments (VBP)
- 317:45-11-1. Insure Oklahoma Individual Plan providers [REVOKED 7-1-21, 9-12-22]
- 317:45-11-2. Insure Oklahoma IP provider payments [REVOKED 7-1-21, 9-12-22]
- 317:45-11-10. Insure Oklahoma IP adult benefits [REVOKED 7-1-21, 9-12-22]
- 317:45-11-11. Insure Oklahoma IP adult non-covered services [REVOKED 7-1-21, 9-12-22]
- 317:45-11-12. Insure Oklahoma IP children benefits [REVOKED 10-15-13]
- 317:45-11-13. Insure Oklahoma IP children non-covered services [REVOKED 10-15-13]
- 317:45-11-20. Insure Oklahoma IP eligibility requirements [REVOKED 7-1-21, 9-12-22]
- 317:45-11-21. Dependent eligibility [REVOKED 7-1-21, 9-12-22]
- 317:45-11-21.1. Certification of newborn child deemed eligible [REVOKED 9-12-22]
- 317:45-11-22. PCP choices [REVOKED 7-1-21, 9-12-22]
- 317:45-11-23. Member eligibility period [REVOKED 7-1-21, 9-12-22]
- 317:45-11-24. Member cost sharing [REVOKED 7-1-21, 9-12-22]
- 317:45-11-26. Audits [REVOKED 7-1-21, 9-12-22]
- 317:45-11-27. Closure [REVOKED 7-1-21, 9-12-22]
- 317:45-11-28. Appeals [REVOKED 7-1-21, 9-12-22]
- 317:50-1-1. Purpose
- 317:50-1-2. Definitions
- 317:50-1-3. Medically Fragile Program overview
- 317:50-1-4. Application for Medically Fragile Waiver services
- 317:50-1-5. Medically Fragile Waiver program medical eligibility determination
- 317:50-1-6. Determining financial eligibility for the Medically Fragile Waiver program
- 317:50-1-7. Certification for Medically Fragile Waiver program services
- 317:50-1-8. Redetermination of eligibility for Medically Fragile Waiver services
- 317:50-1-9. Member annual level of care re-evaluation and annual re-authorization of service plan
- 317:50-1-10. Medically Fragile Waiver services during hospitalization or NF placement
- 317:50-1-11. Closure or termination of Medically Fragile Waiver services
- 317:50-1-12. Eligible providers
- 317:50-1-13. Coverage
- 317:50-1-14. Description of services
- 317:50-1-15. Reimbursement
- 317:50-1-16. Billing procedures for Medically Fragile Waiver services
- 317:55-3-1. Mandatory populations
- 317:55-3-2. Enrollment and disenrollment process
- 317:55-3-3. Enrollee rights
- 317:55-3-10. Grievances and appeals
- 317:55-3-11. Cost sharing
- 317:55-3-12. Provider contracting and networking requirements
- 317:55-3-13. Time, distance, and access standards
- 317:55-3-14. Primary care requirements
- 317:55-3-15. Provider agreement/contract termination
- 317:55-3-16. Non-licensed providers
- 317:55-3-20. SoonerSelect enrollee grievance and appeal system
- 317:55-3-21. Provider complaint system
- 317:55-5-1. Monitoring system for all SoonerSelect programs
- 317:55-5-2. Program integrity, data and reporting
- 317:55-5-3. Critical incident reporting system
- 317:55-5-10. Non-compliance of contracted entities
- 317:55-5-11. Non-compliance of dental benefit managers
- 317:55-5-12. Termination of contract
- 317:55-5-13. Notification of material change
- 317:55-5-14. Patient data
- 317:55-5-20. Financial standards and third-party liability
- 317:55-5-21. Payment to CEs and DMBs
- 317:55-5-22. Payment to providers
- 317:55-5-23. Timely claims filing and processing
- 317:55-5-24. Hospital readmission damages
- 317:55-5-25. Claims processing and methodology; post payment audits
- 317:55-5-26. Prohibited payments
- 317:55-5-30. SoonerSelect quality advisory committee
- 317:55-5-31. Quality scorecard
- 317:55-5-40. Accountable care organization, no prohibition
- 317:55-5-41. Accountable care organization, duties
