OHCA Policies and Rules

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Part       PUBLIC HEALTH CLINIC SERVICES

317:30⊂chapter=5∂=112--1150.General
[Issued 06-25-07]
Public Health Clinic services consist of primary and preventive health care, related diagnostic services, and/or dental services. County health departments (CHDs) and City-County Health Departments (CCHDs) may participate as providers in the SoonerCare program as Public Health Clinics. The Statutory basis for their participation is pursuant to 42 CFR 431.615 (Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees), thereby implementing Sec. 1902(a)(11) and (22)(C) of the Social Security Act. The CHD Clinics are administered by the Oklahoma State Department of Health (OSDH) for the purpose of providing public health services.

317:30⊂chapter=5∂=112--1151.Eligible providers
[Issued 06-25-07]
To be eligible for reimbursement, a CHD or the OSDH (on behalf of the CHDs) or CCHD, must complete a provider contract with the Oklahoma Health Care Authority (OHCA). The CHD or CCHD clinic must have a licensed physician on staff or physician supervising the services. The supervising physician must be available at all times in person or by direct telecommunication for advice and assistance on patient referrals or emergencies. Clinic services must be provided in accordance with 42 CFR 440.90.

317:30⊂chapter=5∂=112--1152.Provider participation requirements
[Issued 06-25-07]
(a) OSDH and or/ CHD or CCHD must employ or contract the services of professional staff that are authorized within their scope of practice under state law to provide the services for which claims are submitted to the OHCA.
(b) The OSDH and CCHDs are required to submit a list of names of all practitioners who are working within the CHD and not individually enrolled with the OHCA when requested by the OHCA or it's designated agent.

317:30⊂chapter=5∂=112--1153.Physician
[Issued 06-25-07]
Physicians who perform services in Oklahoma, but who are not licensed in Oklahoma may provide services for the CHD/CCHD if they are commissioned medical officers of the Public Health Service or Armed Services of the United States, on active duty, and acting within the scope of their Public Health Service or military responsibilities.

317:30⊂chapter=5∂=112--1154.County health department (CHD)and city-county health department (CCHD) services/limitations

[Revised 07-01-19]
   CHD/CCHD service limitations are:

(1) Child-guidance services (refer to Oklahoma Administrative Code (OAC)317:30-5-1023).

(2) Dental services (refer to OAC 317:30-3-65.4(7) for specific coverage).

(3) Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services, including blood lead testing and follow-up services (refer to OAC 317:30-3-65 through 317:30-3-65.12 for specific coverage).

(4) Environmental investigations.

(5) Family planning and SoonerPlan family planning services (refer to OAC 317:30-5-12 for specific coverage guidelines).

(6) Immunizations (adult and child).

(7) Blood lead testing (refer to OAC 317:30-3-65.4 for specific coverage).

(8) Newborn hearing screening.

(9) Newborn metabolic screening.

(10) Maternity services (refer to OAC 317:30-5-22 for specific coverage).

(11) Public health nursing services.

(12) Tuberculosis case management and directly observed therapy.

(13) Laboratory services.

(14) Targeted case management.

317:30⊂chapter=5∂=112--1155.Immunizations
[Issued 06-25-07]
(a) Immunizations are administered in accordance with Centers for Disease Control, Advisory Committee on Immunization Practices.
(b) The Vaccines for Children (VFC) program offers free vaccines to qualified health care providers for children 18 years of age and under who are Soonercare members, American Indian or Alaska Native, uninsured, or under insured. The Oklahoma State Department of Health administers this program.

317:30⊂chapter=5∂=112--1156.Environmental lead investigations
[Issued 06-25-07]
Environmental inspections are provided through the Oklahoma State Department of Health (OSDH) upon notification from laboratories or providers and reimbursed through the Oklahoma SoonerCare program. The OCLPPP schedules an environmental inspection to identify the source of the lead for children who have a persistent blood lead level 15 ug/dL or greater. After the results of the environmental inspection have been received, the OHCA and OCLPPP continue case management activities until two consecutive blood lead measurements equal to or below 10 ug/dL have been achieved. A qualified investigator must be certified, accredited or granted approval by the Oklahoma Department of Environmental Quality to perform environmental lead testing.

317:30⊂chapter=5∂=112--1157.Newborn screening
[Issued 06-25-07]
(a) The newborn hearing screening is for the purpose of testing all newborns for hearing impairments to alleviate the adverse effects of hearing loss or speech and language development. The screening is a test or battery of tests administered to determine the need for an in-depth hearing diagnostic evaluation. Payment for the initial screening is included in the inpatient facility payment. Follow-up screening is covered if the child has not been seen by his/her PCP/CM.
(b) The newborn metabolic screening is for the purpose of testing all newborns born in Oklahoma for disorders as determined by the OSDH Board of Health. Short-term and long-term follow-up services are provided in conjunction with the laboratory testing.

317:30⊂chapter=5∂=112--1158.Public health nursing services
[Issued 06-25-07]
(a) Public health nursing services must be performed at a main clinic site, satellite clinic or mobile clinic site that is open to the public, or a member's home.
(b) Clinic visits may include but are not limited to services in the following areas:
(1) health promotion and counseling;
(2) medication management;
(3) nursing assessment, treatment and diagnostic testing;
(4) home visits;
(5) nursing treatments;
(6) immunizations;
(7) administration of injectable medications;
(8) medication management and the direct observation of the intake of prescribed drugs to treat tuberculosis (TB); and
(9) case management for TB, first time mothers and their infant children, and high risk pregnant women.

317:30⊂chapter=5∂=112--1159.Tuberculosis
[Issued 06-25-07]
The purpose of the Tuberculosis program is to identify and treat clients with tuberculosis, insure appropriate measures are taken to prevent the occurrence and transmission of tuberculosis, analyze tuberculosis related data for program planning and evaluation, and ultimately eliminate tuberculosis in Oklahoma. Payment is made for tuberculosis clinic services pursuant to (1) - (7) of this Section.
(1) Nursing visit - regular with disease. Nursing visit - regular with disease requires an initial intensive interview by Health Department personnel for gathering clinical and epidemiologic data and administration of a tuberculosis skin test.
(A) The nursing visit in this paragraph includes:
(i) one x-ray every two months;
(ii) a monthly blood test;
(iii) one series (3 samples) of sputum tests every two months;
(iv) monitoring of side effects; and
(v) provision of medication.
(B) Notification and consultation with the Tuberculosis Control Officer must be established and maintained during the treatment regimen as required by State law.
(C) The nursing visit in this paragraph is appropriate for a patient with the disease of tuberculosis that is drug susceptible and a treatment regimen of six to 12 months is prescribed.
(2) Nursing visit - multi-drug resistant with disease. A nursing visit - multi-drug resistant with disease requires an initial intensive interview by Health Department personnel for gathering clinical and epidemiologic data and administration of a tuberculosis skin test.
(A) This nursing visit in this paragraph includes:
(i) one x-ray every two months;
(ii) a monthly blood test;
(iii) one series (3 samples) of sputum tests each month;
(iv) monitoring of side effects; and
(v) provision of medication.
(B) Notification and consultation with the Tuberculosis Control Officer must be established and maintained during the treatment regimen as required by State law.
(C) The nursing visit in this paragraph is appropriate for a patient with the disease of tuberculosis that is multi-drug resistant and a treatment regimen of 18 to 24 months has been prescribed.
(3) Nursing visit - regular preventive therapy with infection. A nursing visit - regular preventive therapy with infection requires an initial intensive interview by Health Department personnel for gathering clinical and epidemiologic data and administration of a tuberculin skin test.
(A) The nursing encounter in this paragraph includes:
(i) one x-ray every three months;
(ii) four blood tests in six months;
(iii) one series (3 samples) of sputum tests;
(iv) monitoring of side effects; and
(v) provision of medication.
(B) Notification and consultation with the Tuberculosis Control Officer must be established and maintained during the treatment regimen as required by State law.
(C) The nursing visit in this paragraph is appropriate for a patient with an infection of drug susceptible tuberculosis and a treatment regimen of 12 months has been prescribed.
(4) Nursing visit - multi-drug resistant preventive therapy with infection. A nursing visit - multi-drug resistant preventive therapy with infection requires an initial intensive interview by Health Department personnel for gathering clinical and epidemiologic data and administration of a tuberculin skin test.
(A) The nursing visit in this paragraph includes:
(i) one x-ray every two months;
(ii) eight blood tests in 12 months;
(iii) two series (6 samples) of sputum tests each 12 months;
(iv) monitoring of side effects; and
(v) provision of medication.
(B) Notification and consultation with Tuberculosis Control Officer must be established and maintained during the treatment regimen as required by State law.
(C) The nursing visit in this paragraph is appropriate for a patient with a multi-drug resistant tuberculosis infection and a treatment regimen of 12 months has been prescribed.
(5) Nursing visit - other. A nursing visit - other - requires an interview by Health Department personnel for gathering clinical data. This nursing visit may include an x-ray, blood test, sputum sample and monitoring of side effects. It does not include medication. Consultation with the Tuberculosis Control Officer may be required. This visit may be appropriate for either a patient with a tuberculosis infection or disease if the patient is continuing to experience symptoms or on orders of a physician.
(6) Screening. In a TB screening, Health Department personnel perform tuberculin skin testing of contacts to all TB cases and suspects, high risk population groups and nursing home residents. Tuberculin skin testing is always done at least one time. For negative skin tests, a two-step boosted skin test one to two weeks later will be performed and repeated three months later for contact individuals with a negative boosted skin test.
(7) Direct Observed Therapy (DOT). The DOT provider delivers medication to the patient and observes and records the patient's ingestion of medication. Visits may be as frequent as three times a day, seven days a week. The DOT provider is responsible for monitoring side effects of medication and the collection of sputum samples.

317:30⊂chapter=5∂=112--1160.Public health nursing services for first time mothers and their infants/children (Children's First program)
[Issued 06-25-07]
(a) The purpose of the Children's First program is to make home visits to low income, first time parents teaching them about pregnancy, nutrition, fetal development and how to care for themselves and their baby after delivery. A first time mother is:
(1) a woman who is expecting her first live birth, has never parented and plans on parenting this child;
(2) a woman who is expecting her first live birth, has never parented and is contemplating placing the child for adoption;
(3) a woman who has been pregnant, but has not delivered a child due to abortion or miscarriage;
(4) a woman who is expecting her first live birth, but has parented stepchildren or younger siblings;
(5) a woman who has delivered a child, but her parental rights were legally terminated within the first few months of that child's life; or
(6) a woman who has delivered a child, but the child died within the first few months of life.
(b) The pregnant woman must enter the program prior to the 28th week of gestation. Services may be provided until the infant's/child's second birthday.
(c) Reimbursement is limited to one nursing service per day provided during the pre and postnatal period of the first time mother and for the first two years of the infant's/child's life. Public health nurse clinic services are limited to five services per month per eligible member/child.

317:30⊂chapter=5∂=112--1161.Targeted case management
[Issued 06-25-07]
(a) Case management is a set of interrelated activities under which responsibility for locating, coordinating and monitoring appropriate services for an individual rests with a specific person within the case management agency. Services under case management are not comparable in amount duration and scope.
(b) Case management is designed to assist a individual in gaining access to needed medical, social, educational and other services essential to meeting basic human needs, and is not restrictive in nature.
(c) Major components of the services include working with the individual in the use of basic community resources, referral, linkage and advocacy.
(d) In order to ensure that case management services are not duplicated by other staff, case management activities will be provided in accordance with a comprehensive individualized treatment/service plan. The development of this plan includes clinical staff participation, thus ensuring that staff knows a client has a case manager.
(e) Case management services for first time mothers must provide necessary coordination with providers of non-medical services, such as nutrition, psycho social or health education programs, when services provided by these entities are needed. The case manager coordinates these services with needed medical services. The purpose of case management services for first time mothers and their infants/children is to:
(1) assist first time mothers and their infants/children in gaining access to needed medical, social, educational and other services;
(2) encourage the use of appropriate medical providers; and
(3) discourage over utilization or duplication of services.
(f) Targeted case management does not include:
(1) SoonerCare eligibility determinations and re-determinations;
(2) SoonerCare intake processing;
(3) SoonerCare preadmission screening for inpatient care;
(4) Prior Authorization for SoonerCare services and utilization review;
(5) SoonerCare outreach;
(6) physically escorting or transporting a member to scheduled appointments or staying with a member during an appointment;
(7) monitoring financial goals;
(8) providing specific services such as shopping or payment of bills; or
(9) delivering bus tickets, food stamps, money, etc.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.