OHCA Policies and Rules

Search Entire Policy
OHCA Policies and Rules Main Page

317:25-7-25.Member enrollment process
[Revised 01-01-09]
(a) SoonerCare eligible individuals whose eligibility is based on one of the aid categories included in the program as defined in OAC 317:25-7-12 must enroll with a PCP. Parents or guardians will choose on behalf of minor members in the household. Families with more than one enrollee may choose a different PCP for each family member.
(b) Until the effective date of enrollment with a PCP, services for a newborn are reimbursed at a fee-for-service rate. Upon eligibility determination, newborns may enroll with a PCP who is in general practice, family practice or general pediatrics. Enrollment materials will advise the parent or guardian of the right to change the PCP after the effective date of enrollment.
(c) A description of the PCCM program and the PCP directory is provided by the OHCA to OKDHS for distribution to OKDHS county offices.
(d) For purposes of determining the member's choice of PCP, the most recent PCP selection received by the OHCA determines the PCP which the member is enrolled with as long as capacity is available. If capacity is not available or the member does not choose, the member is assigned according to the assignment mechanism as defined by the OHCA. A member who is eligible for SoonerCare Choice but is not assigned, may request enrollment with a PCP by contacting the SoonerCare Helpline.
(e) PCPs may not refuse an assignment, seek to disenroll a member, or otherwise discriminate against a member on the basis of age, sex, race, physical or mental disability, national origin or type of illness or condition, unless that condition can be better treated by another provider type, except that IHS, tribal or urban Indian programs may provide services to Native American IHS members consistent with federal law.


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.