(a) Pregnant women may be eligible for certification under the Authority's presumptive eligibility program. The presumptive eligibility program provides for immediate certification of pregnant women while a formal application is being processed. Therefore, enabling the client to receive needed ambulatory services. Providers who will be able to make presumptive eligibility determinations will be required to meet all of the following criteria.
- (1) Qualified presumptive eligibility providers must be eligible for payment under the Authority's Medicaid Program.
- (2) They must provide services of the type provided by outpatient hospitals, rural clinics or those clinics furnished by, or under the direction of a physician, without regard to whether the clinic itself is administered by a physician.
- (3) They have been specifically designated in writing by the Authority as a qualified Presumptive Eligibility provider which the Authority has determined they are capable of making presumptive eligibility determinations.
- (4) They must meet one of the following:
- (A) Receive funds under one of the following
- (i) The Migrant Health Centers, Community Health Centers or Public Health Service primary care research and demonstration projects,
- (ii) The Maternal and Child Health Services Block Grant Programs, or
- (iii) Title V of the Indian Health Care Improvement Act; or
- (B) They must be participants in a program established under the Special Supplemental Food Program for Women, Infants and Children (WIC) or the Commodity Supplemental Food Program; or
- (C) They must be participants in a State perinatal program; or
- (D) They are an Indian Health Service program or facility operated by a tribe or tribal organization under the Indian Self Determination Act.
(b) Providers interested in being certified as a Presumptive Eligibility Provider should submit evidence of meeting the above requirements to the Oklahoma Health Care Authority, 4545 N. Lincoln Blvd., Suite 124, Oklahoma City, Oklahoma 73105.