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Chapter 30MEDICAL PROVIDERS-FEE FOR SERVICE
SubChapter 1GENERAL PROVISIONS
317:30-1-1.Purpose; use of manuals
317:30-1-2.Authority responsibility; fiscal agent
317:30-1-3.Description of rules
SubChapter 3GENERAL PROVIDER POLICIES
Part 1GENERAL SCOPE AND ADMINISTRATION
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
317:30-3-4.Electronic fund transfer/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
317:30-3-7.Care assurance validation support review for long term care [REVOKED]
317:30-3-8.Pre-billing
317:30-3-9.Medical services provided to relatives [REVOKED]
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.Administrative sanctions [REVOKED]
317:30-3-19.1.Revocation of enrollment and billing privileges in the Medicaid Program [REVOKED]
317:30-3-19.2.Denial of application for new or renewed provider enrollment contract based on criminal history [EXPIRED]
317:30-3-19.3.Denial of application for new or renewed provider enrollment contract
317:30-3-19.4.Applicants subject to a fingerprint-based criminal background check
317:30-3-19.5.Termination of provider agreements
317:30-3-20.Claim inquiry procedures (excluding nursing homes and hospitals)
317:30-3-20.1.Pharmacy grievance procedures and processes [REVOKED]
317:30-3-21.Appeals procedures for nursing facilities
317:30-3-22.Hospital reimbursement rate appeals [REVOKED]
317:30-3-23.Reconsideration request
317:30-3-24.Third party resources
317:30-3-25.Crossovers (coinsurance and deductible)
317:30-3-26.Medicare Physician Payment Reform methodology [REVOKED]
317:30-3-27.Telehealth
317:30-3-28.Electronic Health Records Incentive Program
317:30-3-29.Revisions of provider fee schedules
317:30-3-30.Signature requirements
Part 3GENERAL MEDICAL PROGRAM INFORMATION
317:30-3-39.Home and Community Based Services Waivers
317:30-3-40.Home and Community-Based Services Waivers 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/IID)
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
317:30-3-46.1.Poison control services [REVOKED]
317:30-3-47.Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program [REVOKED]
317:30-3-48.Periodicity schedule [REVOKED]
317:30-3-49.Initial screening examination [REVOKED]
317:30-3-50.Screening components [REVOKED]
317:30-3-51.Diagnosis and treatment [REVOKED]
317:30-3-52.Vision services [REVOKED]
317:30-3-53.Dental services [REVOKED]
317:30-3-54.Hearing services [REVOKED]
317:30-3-55.Periodic and interperiodic screening examinations [REVOKED]
317:30-3-56.Partial screening examination [REVOKED]
317:30-3-57.General SoonerCare coverage - categorically needy
317:30-3-58.General Medicaid coverages - medically needy [REVOKED]
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.Serious reportable events - never events
317:30-3-63.Hospital acquired conditions
317:30-3-64.Payment for lodging and meals
Part 4EARLY AND PERIODIC SCREENING, DIAGNOSIS AND TREATMENT (EPSDT) PROGRAM/CHILD HEALTH SERVICES
317:30-3-65.Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program/Child Health Services
317:30-3-65.1.Minimum required screenings
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
Part 5ELIGIBILITY
317:30-3-70.Categorical relationship [REVOKED]
317:30-3-71.Financial need [REVOKED]
317:30-3-72.Spenddown [REVOKED]
317:30-3-73.Persons eligible for medical assistance [REVOKED]
317:30-3-74.Persons not eligible for medical assistance [REVOKED]
317:30-3-75.Person codes [REVOKED]
317:30-3-76.Retroactive eligibility [REVOKED]
317:30-3-77.Notification of needed medical services [REVOKED]
317:30-3-78.Request for prior authorization for dental services
317:30-3-79.Hearing appliance prescription and supplier request for prior authorization
317:30-3-80.Physician's prescription for appliances, prostheses, and/or medical equipment and medical suppliers request for prior authorization [REVOKED]
317:30-3-81.Notification of eligibility status for assistance (adults) [REVOKED]
317:30-3-82.Prior authorization for services to individuals under 21 years of age
317:30-3-83.Prior authorization for services to adults
317:30-3-84.Catastrophic illness [REVOKED]
317:30-3-85.Citizenship and alienage [REVOKED]
317:30-3-86.Residency [REVOKED]
317:30-3-87.Presumptive eligibility [REVOKED]
317:30-3-88.Medical identification card [REVOKED]
SubChapter 5INDIVIDUAL PROVIDERS AND SPECIALTIES
Part 1PHYSICIANS
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
317:30-5-5.Diagnosis Codes [REVOKED]
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
317:30-5-16.Miscellaneous injections [REVOKED]
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)
Part 2PHYSICIAN ASSISTANTS
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
317:30-5-34.Payment rates [REVOKED]
Part 3HOSPITALS
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.Coverage for children [REVOKED]
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
317:30-5-43.Vocational Rehabilitation coverage [REVOKED]
317:30-5-44.Medicare eligible individuals
317:30-5-45.Psychiatric hospitals - inpatient services for persons age 65 and over [REVOKED]
317:30-5-46.Psychiatric hospitals and residential psychiatric treatment facilities - inpatient services for persons under age 21 [REVOKED]
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
317:30-5-48.Cost reports [REVOKED]
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
317:30-5-54.Hospital rate appeals [REVOKED]
317:30-5-55.Residential psychiatric treatment facility rate appeals [REVOKED]
317:30-5-56.Utilization review
317:30-5-57.Notice of denial
317:30-5-58.Supplemental Hospital Offset Payment Program
Part 4LONG TERM CARE HOSPITALS
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
317:30-5-68.Rate Appeals [REVOKED]
Part 5PHARMACIES
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
317:30-5-71.Drug Utilization Review [REVOKED]
317:30-5-72.Categories of service eligibility
317:30-5-72.1.Drug benefit
317:30-5-73.Coverage for children (categorically and medically needy) [REVOKED]
317:30-5-74.Vocational rehabilitation [REVOKED]
317:30-5-75.Individuals eligible for Part B of Medicare [REVOKED]
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
317:30-5-78.Reimbursement
317:30-5-78.1.Special billing procedures
317:30-5-78.2.Falsification of claims
317:30-5-79.Quantity dispensed [REVOKED]
317:30-5-80.National drug code
317:30-5-81.Medical identification card [REVOKED]
317:30-5-82.Prescriber numbers [REVOKED]
317:30-5-83.Pharmacist's responsibility [REVOKED]
317:30-5-84.Record retention [REVOKED]
317:30-5-85.Special billing procedures [REVOKED]
317:30-5-86.Drug Utilization Review Program
317:30-5-86.1.Disease state management [REVOKED]
317:30-5-86.2.Case management
317:30-5-87.340B Drug Discount Program
Part 6INPATIENT PSYCHIATRIC HOSPITALS
317:30-5-95.General provisions and eligible providers
317:30-5-95.1.Coverage for adults ages 21 to 64
317:30-5-95.2.Coverage for children [REVOKED]
317:30-5-95.3.Medicare eligible individuals [REVOKED]
317:30-5-95.4.Individual plan of care for adults ages 21 to 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 age 21 to 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 age 21 to 64
317:30-5-95.11.Inpatient acute psychiatric services for persons over 65 years of age
317:30-5-95.12.Utilization control requirements for inpatient acute psychiatric services for persons over 65 years of age
317:30-5-95.13.Certification and recertification of need for inpatient care for inpatient acute psychiatric services for persons over 65 years of age
317:30-5-95.14.Individual plan of care for persons over 65 years of age 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 over 65 years of age 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 over 65 years of age receiving inpatient acute psychiatric services
317:30-5-95.20.Discharge plan for persons over 65 years of age receiving inpatient acute psychiatric services
317:30-5-95.21.Continued stay review for persons over 65 years of age 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 treatment 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.Credentialing requirements for treatment team members for children
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 (inpatient psychiatric acute only)
317:30-5-95.39.Seclusion, restraint, and serious incident reporting requirements for children
317:30-5-95.40.Other required standards
317:30-5-95.41.Documentation of records for children's inpatient services
317:30-5-95.42.Service quality review of psychiatric facilities providing services to children
317:30-5-96.Reimbursement for inpatient services [REVOKED]
317:30-5-96.1.Cost reports [REVOKED]
317:30-5-96.2.Payments 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 eligibles
317:30-5-96.7.Cost reports
317:30-5-96.8.Psychiatric Residential Treatment Facility payments to subcontractors
317:30-5-97.Child abuse
317:30-5-98.Claim Form [REVOKED]
Part 7CERTIFIED LABORATORIES
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
317:30-5-107.Claim form [REVOKED]
Part 8REHABILITATION HOSPITALS
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
Part 9LONG TERM CARE FACILITIES
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
317:30-5-128.Private rooms [REVOKED]
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
317:30-5-131.1.Wage enhancement
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
317:30-5-133.2.Ancillary services
317:30-5-133.3.Nursing home ventilator-dependent and tracheostomy care services
317:30-5-134.Nurse Aide Training Reimbursement
317:30-5-135.Intermediate care facility for the mentally retarded (ICF/MR) service fee [REVOKED]
317:30-5-136.Nursing Facility Supplemental Payment Program
Part 10BARIATRIC SURGERY
317:30-5-137.Eligible providers to perform bariatric surgery
317:30-5-137.1.Member candidacy
317:30-5-137.2.General coverage
317:30-5-138.General coverage [REVOKED]
317:30-5-139.Member requirements [REVOKED]
317:30-5-140.Coverage for children
317:30-5-141.Reimbursement
Part 11MATERNITY CLINIC SERVICES
317:30-5-175.Eligible providers [REVOKED]
317:30-5-176.Coverage by category [REVOKED
317:30-5-177.Payment rates [REVOKED]
317:30-5-178.Covered services [REVOKED]
317:30-5-179.Billing [REVOKED]
Part 12THE OKLAHOMA PRESCRIPTION DRUG DISCOUNT PROGRAM
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
Part 13HIGH RISK PREGNANT WOMEN CASE MANAGEMENT SERVICES
317:30-5-185.Eligible providers and services [REVOKED]
317:30-5-186.Coverage [REVOKED]
317:30-5-187.Payment rates [REVOKED]
317:30-5-188.Documentation of records [REVOKED]
Part 14TARGETED CASE MANAGEMENT SERVICES FOR FIRST TIME MOTHERS AND THIER INFANTS/CHILDREN
317:30-5-190.Eligible providers and services [REVOKED]
317:30-5-191.Coverage [REVOKED]
317:30-5-192.Payment rates [REVOKED]
317:30-5-193.Documentation of records [REVOKED]
Part 15CHILD HEALTH CENTERS
317:30-5-195.General provisions [REVOKED]
317:30-5-196.Eligible providers [REVOKED]
317:30-5-197.Periodicity schedule [REVOKED]
317:30-5-198.Coverage by category [REVOKED]
317:30-5-199.Periodic screening examination [REVOKED]
317:30-5-200.Interperiodic screening examination [REVOKED]
317:30-5-201.Reporting of suspected child abuse/neglect [REVOKED]
317:30-5-202.Payment rates and billing [REVOKED]
317:30-5-203.Billing [REVOKED]
Part 16MATERNAL AND INFANT HEALTH LICENSED CLINICAL SOCIAL WORKERS
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
Part 17MEDICAL SUPPLIERS
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.Coverage for adults
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
317:30-5-211.8.Coverage [REVOKED]
317:30-5-211.9.Adaptive equipment
317:30-5-211.10.Durable medical equipment (DME)
317:30-5-211.11.Oxygen and oxygen equipment
317:30-5-211.12.Oxygen rental
317:30-5-211.13.Prosthetic devices
317:30-5-211.14.Nutritional support
317:30-5-211.15.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
317:30-5-212.Coverage for children [REVOKED]
317:30-5-213.Coverage for vocational rehabilitation [REVOKED]
317:30-5-214.Coverage for individuals eligible for Part B of Medicare
317:30-5-215.Billing requirements
317:30-5-216.Prior authorization requests
317:30-5-217.Billing
317:30-5-218.Reimbursement
Part 18GENETIC COUNSELORS
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
Part 19NURSE MIDWIVES
317:30-5-225.Eligible providers
317:30-5-226.Coverage by category
317:30-5-227.Procedure codes [REVOKED]
317:30-5-228.Billing [REVOKED]
317:30-5-229.Reimbursement
Part 20LACTATION CONSULTANTS
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
Part 21OUTPATIENT BEHAVIORAL HEALTH SERVICES
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
317:30-5-242.Coverage for children [REVOKED]
317:30-5-243.Vocational rehabilitation coverage [REVOKED]
317:30-5-244.Individuals eligible for Part B of Medicare
317:30-5-245.Reimbursement
317:30-5-246.Covered services [REVOKED]
317:30-5-247.Billing [REVOKED]
317:30-5-248.Documentation of records
317:30-5-249.Non-covered services
Part 22HEALTH HOMES
317:30-5-250.Purpose
317:30-5-251.Eligible providers
317:30-5-252.Covered Services
317:30-5-253.Reimbursement
317:30-5-254.Limitations
Part 23PODIATRISTS
317:30-5-260.Eligible providers
317:30-5-261.Coverage by category
317:30-5-262.Claim form [REVOKED]
Part 25PSYCHOLOGISTS
317:30-5-275.Eligible providers
317:30-5-276.Coverage by category
317:30-5-277.Procedure codes [REVOKED]
317:30-5-278.Non-covered procedures
317:30-5-278.1.Documentation of records
317:30-5-279.Claim form [REVOKED]
Part 26LICENSED BEHAVIORAL HEALTH PROVIDERS
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
Part 27INDEPENDENT LICENSED PHYSICAL THERAPISTS
317:30-5-290.Payment for outpatient services [REVOKED]
317:30-5-290.1.Eligible providers
317:30-5-291.Coverage by category
317:30-5-291.1.Payment rates
317:30-5-291.2.Procedure codes
317:30-5-292.Claim form [REVOKED]
317:30-5-293.Team therapy (Co-treatment)
Part 28OCCUPATIONAL THERAPY SERVICES
317:30-5-295.Eligible Providers
317:30-5-296.Coverage by category
317:30-5-297.Payment rates
317:30-5-298.Procedure codes
317:30-5-299.Team therapy (Co-treatment)
Part 29RENAL DIALYSIS FACILITIES
317:30-5-305.Eligible providers
317:30-5-306.Coverage by category
317:30-5-307.Payment methodology
Part 31ROOM AND BOARD PROVIDERS
317:30-5-320.Eligible providers
317:30-5-321.Coverage by category
317:30-5-322.Procedure codes and allowable amounts [REVOKED]
317:30-5-323.Claim Form [REVOKED]
Part 32SOONERRIDE NON-EMERGENCY TRANSPORTATION
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
317:30-5-327.2.Service availability
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
317:30-5-328.Subsistence (sleeping accommodations and meals) [REVOKED]
Part 33TRANSPORTATION BY AMBULANCE
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 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
317:30-5-337.Coverage for children
317:30-5-338.Vocational rehabilitation coverage [REVOKED]
317:30-5-339.Individuals eligible for Part B of Medicare
317:30-5-340.Procedure codes [REVOKED]
317:30-5-341.Claim form [REVOKED]
317:30-5-342.Public transportation [REVOKED]
317:30-5-343.Reimbursement
Part 35RURAL HEALTH CLINICS
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
317:30-5-358.Vocational rehabilitation [REVOKED]
317:30-5-359.Claims for Medicare eligible recipients
317:30-5-359.1.Cost reports
317:30-5-359.2.Reimbursement
317:30-5-360.Payment rates [REVOKED]
317:30-5-361.Billing
317:30-5-362.Documentation of records
317:30-5-363.340B Drug Discount Program
Part 37ADVANCED PRACTICE NURSE
317:30-5-375.Eligible providers
317:30-5-376.Coverage by category
317:30-5-377.Billing instructions [REVOKED]
Part 39SKILLED NURSING SERVICES
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
317:30-5-394.Diagnosis codes [REVOKED]
Part 41FAMILY SUPPORT 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
317:30-5-413.Diagnosis codes [REVOKED]
Part 43AGENCY COMPANION, SPECIALIZED FOSTER CARE, DAILY LIVING SUPPORTS, GROUP HOMES, AND COMMUNITY TRANSITION 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
317:30-5-424.Diagnosis code [REVOKED]
Part 45OPTOMETRISTS
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
317:30-5-433.Diagnosis codes [REVOKED]
Part 47OPTICAL SUPPLIERS
317:30-5-450.Eligible providers
317:30-5-451.Coverage by category
317:30-5-452.Procedure codes
Part 49FAMILY PLANNING CENTERS
317:30-5-465.Eligible providers
317:30-5-466.Coverage by category
317:30-5-467.Coverage limitations
Part 51HABILITATION SERVICES
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
317:30-5-483.Diagnosis codes [REVOKED]
Part 53SPECIALIZED FOSTER CARE
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
317:30-5-499.Diagnosis code [REVOKED]
Part 55RESPITE CARE
317:30-5-515.Home and Community-Based Services Waivers for persons with an intellectual disability or certain persons with related conditions
317:30-5-516.Coverage
317:30-5-517.Description of services
317:30-5-518.Coverage limitations
317:30-5-519.Diagnosis codes [REVOKED]
Part 57HOSPICE CARE
317:30-5-525.Eligible providers [REVOKED]
317:30-5-526.Coverage by category [REVOKED]
317:30-5-527.Hospice reimbursement [REVOKED]
317:30-5-528.Billing [REVOKED]
Part 58NON-HOSPITAL BASED HOSPICE
317:30-5-530.Eligible providers
317:30-5-531.Coverage for adults
317:30-5-532.Coverage for children
Part 59HOMEMAKER SERVICES
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
317:30-5-537.Description of services
317:30-5-538.Diagnosis codes [REVOKED]
Part 61HOME HEALTH AGENCIES
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
Part 62PRIVATE DUTY NURSING
317:30-5-555.Eligible providers
317:30-5-556.Definitions
317:30-5-557.Coverage by category
317:30-5-558.Private duty coverage limitations
317:30-5-559.How services are authorized
317:30-5-560.Treatment Plan
317:30-5-560.1.Prior authorization requirements
317:30-5-560.2.Record documentation
Part 63AMBULATORY SURGICAL CENTERS (ASC)
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
Part 64CLINIC SERVICES
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
Part 65CASE MANAGEMENT SERVICES FOR OVER 21
317:30-5-585.Eligible providers[REVOKED]
317:30-5-586.Coverage by category [REVOKED]
317:30-5-586.1.Prior authorization [REVOKED]
317:30-5-587.Reimbursement [REVOKED]
317:30-5-588.Billing [REVOKED]
317:30-5-589.Documentation of records [REVOKED]
Part 67BEHAVIORAL HEALTH CASE MANAGEMENT SERVICES [REVOKED]
317:30-5-595.Eligible providers [REVOKED]
317:30-5-596.Coverage by category [REVOKED]
317:30-5-596.1.Prior authorization [REVOKED]
317:30-5-596.2.Direct and Indirect Case Management services [REVOKED]
317:30-5-597.Reimbursement [REVOKED]
317:30-5-598.Billing [REVOKED]
317:30-5-599.Documentation of records [REVOKED]
Part 69CERTIFIED REGISTERED NURSE ANESTHETISTS
317:30-5-605.Eligible providers
317:30-5-606.Coverage by category
317:30-5-607.Billing instructions
317:30-5-608.Elective sterilizations[REVOKED]
317:30-5-609.Hysterectomies [REVOKED]
317:30-5-610.Abortions [REVOKED]
317:30-5-611.Payment methodology
Part 70ANESTHESIOLOGIST ASSISTANTS
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
Part 71EARLY INTERVENTION CASE MANAGEMENT SERVICES
317:30-5-620.Eligible providers
317:30-5-621.Coverage by category
317:30-5-622.Reimbursement
317:30-5-623.Billing [REVOKED]
317:30-5-624.Documentation of records
Part 73EARLY INTERVENTION SERVICES
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
317:30-5-641.2.Interperiodic screening examination [REVOKED]
317:30-5-641.3.Reporting of suspected child abuse/neglect
317:30-5-642.Services [REVOKED]
317:30-5-643.Billing [REVOKED]
317:30-5-644.Documentation of records
Part 75FEDERALLY QUALIFIED HEALTH CENTERS
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
317:30-5-662.Reimbursement [REVOKED]
317:30-5-663.Billing [REVOKED]
317:30-5-664.Timely filing [REVOKED]
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.Health Center encounters
317:30-5-664.4.Multiple encounters at Health Centers
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
317:30-5-664.11.PPS rate reconciliation to Health Centers
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
Part 77SPEECH AND HEARING SERVICES
317:30-5-675.Eligible providers
317:30-5-676.Coverage by category
317:30-5-677.Payment rates
317:30-5-678.Procedure codes
317:30-5-679.Claim form [REVOKED]
317:30-5-680.Team therapy (Co-treatment)
Part 79DENTISTS
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
317:30-5-702.Dental diagnosis codes [REVOKED]
317:30-5-703.Tooth numbering system
317:30-5-704.Billing instructions
317:30-5-705.Billing
Part 81CHIROPRACTORS
317:30-5-720.Eligible providers
317:30-5-721.Coverage by category
Part 83RESIDENTIAL BEHAVIOR MANAGEMENT SERVICES
317:30-5-740.Eligible providers
317:30-5-740.1.Provider qualifications 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.Residential behavior management reimbursement
317:30-5-742.2.Individual plan of care and prior authorization of services
317:30-5-743.Payment rates and recoupment [Revoked]
317:30-5-743.1.Service Quality Review
317:30-5-744.Billing
317:30-5-745.Documentation of records
317:30-5-746.Appeal of Prior Authorization Decision
Part 85ADVANTAGE PROGRAM WAIVER SERVICES
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
Part 87BIRTHING CENTERS
317:30-5-890.Eligible providers
317:30-5-890.1.Definitions
317:30-5-891.Coverage by category
317:30-5-892.Reimbursement
317:30-5-893.Billing
Part 89RADIOLOGICAL MAMMOGRAPHER
317:30-5-900.Eligible providers
317:30-5-901.Coverage by category
317:30-5-902.Vocational rehabilitation [REVOKED]
317:30-5-903.Individuals eligible for Part B of Medicare
317:30-5-904.Covered procedures [REVOKED]
317:30-5-905.Reimbursement
Part 90DIAGNOSTIC TESTING ENTITIES
317:30-5-907.Eligible providers
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
Part 91TUBERCULOSIS CLINIC SERVICES
317:30-5-910.Eligible providers [REVOKED]
317:30-5-911.Coverage by category [REVOKED]
317:30-5-912.Covered services [REVOKED]
317:30-5-913.Billing [REVOKED]
Part 93CASE MANAGEMENT SERVICES FOR PERSONS INFECTED WITH TUBERCULOSIS
317:30-5-920.Eligible providers [REVOKED]
317:30-5-921.Coverage by category [REVOKED]
317:30-5-922.Billing [REVOKED]
317:30-5-923.Reimbursement [REVOKED]
317:30-5-924.Documentation of records [REVOKED]
Part 95AGENCY PERSONAL CARE SERVICES
317:30-5-950.Eligible providers
317:30-5-951.Coverage by category
317:30-5-952.Prior authorization
317:30-5-953.Billing
Part 97CASE MANAGEMENT SERVICES FOR UNDER AGE 18 AT RISK OF OR IN THE TEMPORARY CUSTODY OR SUPERVISION OF OFFICE OF JUVENILE AFFAIRS
317:30-5-970.Eligible providers
317:30-5-971.Coverage by category
317:30-5-972.Reimbursement
317:30-5-973.Billing
317:30-5-974.Documentation of records
Part 99CASE MANAGEMENT SERVICES FOR UNDER AGE 18 IN EMERGENCY, TEMPORARY OR PERMANENT CUSTODY OR SUPERVISION OF THE DEPARTMENT OF HUMAN SERVICES
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
Part 101TARGETED CASE MANAGEMENT SERVICES FOR PERSONS WITH MENTAL RETARDATION AND/OR RELATED CONDITIONS
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
Part 103QUALIFIED SCHOOLS AS PROVIDERS OF HEALTH RELATED SERVICES
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
317:30-5-1028.Billing [REVOKED]
Part 104SCHOOL-BASED CASE MANAGEMENT SERVICES
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
Part 105RESIDENTIAL BEHAVIORAL MANAGEMENT SERVICES IN GROUP SETTINGS AND NON-SECURE DIAGNOSTIC AND EVALUATION CENTERS
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
Part 108NUTRITION SERVICES
317:30-5-1075.Eligible providers
317:30-5-1076.Coverage by category
317:30-5-1077.Procedure codes and claim form [REVOKED]
Part 110INDIAN HEALTH SERVICES, TRIBAL PROGRAMS, AND URBAN INDIAN CLINICS (I/T/US)
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.I/T/U 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
317:30-5-1100.Inpatient care provided by IHS facilities
Part 112PUBLIC HEALTH CLINIC SERVICES
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.CHD/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
Part 113LIVING CHOICE PROGRAM
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 mental retardation
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

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.