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Oklahoma Department of
Human Services
Stronger Families Grow
Brighter Futures
Oklahoma Department of Human Services
Sequoyah Memorial Office Building, 2400 N. Lincoln Blvd. • Oklahoma City, OK 73105
(405) 521-3646 • Fax (405) 521-6684 • Internet: www.okdhs.org
 
 
 
Library: Policy 
OAC 317:  Chapter 30. Medical Providers-Fee for Service

Subchapter 5. Individual Providers and Specialties
    
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PART 1. PHYSICIANS
317:30-5-1.Eligible providers  Revised 7-1-09
317:30-5-2.General coverage by category  Revised 6-25-11
317:30-5-3.Documentation of services  Issued 7-27-95
317:30-5-4.Procedure and diagnosis coding  Revised 6-27-02
317:30-5-6.Abortions  Revised 5-27-99
317:30-5-7.Anesthesia  Revised 6-26-03
317:30-5-8.Surgery  Revised 7-25-08
317:30-5-9.Medical services  Revised 6-25-11
317:30-5-10.Ophthalmology services  Revised 2-1-08
317:30-5-11.Psychiatric services  Revised 7-25-08
317:30-5-12.Family planning  Revised 12-1-06
317:30-5-13.Rape and abuse exams  Revised 8-2-06
317:30-5-14.Injections  Revised 1-14-10
317:30-5-15.Chemotherapy injections  Revised 1-18-08
317:30-5-17.Authorized examinations - eligibility determinations  Revised 6-27-02
317:30-5-18.Elective sterilizations  Revised 9-1-07
317:30-5-19.Hysterectomies  Issued 7-27-95
317:30-5-20.Laboratory services  Revised 2-4-10
317:30-5-21.Unusual procedures  Issued 7-27-95
317:30-5-22.Obstetrical care  Revised 10-1-09
317:30-5-22.1.Enhanced services for medically high risk pregnancies  Revised 8-1-08
317:30-5-23.Newborn care  Revised 6-25-07
317:30-5-24.Radiology  Revised 6-25-11
317:30-5-25.Oklahoma Health Care Authority's Quality Improvement Organization (QIO)  Revised 8-2-06
PART 2. PHYSICIAN ASSISTANTS
317:30-5-30.Eligible providers  Revised 7-1-04
317:30-5-31.General coverage by category  Revised 7-1-04
317:30-5-32.Utilization  Issued 5-27-97
317:30-5-33.Post payment utilization review  Issued 5-27-97
PART 3. HOSPITALS
317:30-5-40.Eligible providers  Revised 12-1-06
317:30-5-40.1.General information  Issued 12-1-06
317:30-5-40.2.Definitions  Issued 12-1-06
317:30-5-41.Inpatient hospital coverage/limitations  Revised 12-1-06
317:30-5-41.1.Acute inpatient psychiatric services  Issued 12-1-06
317:30-5-41.2.Organ transplants  Issued 6-25-07
317:30-5-42.1.Outpatient hospital services  Revised 1-14-10
317:30-5-42.2.Blood and blood fractions  Issued 12-1-06
317:30-5-42.3.Chemotherapy and radiation therapy  Issued 12-1-06
317:30-5-42.4.Clinic/treatment room services; urgent care  Issued 12-1-06
317:30-5-42.5.Diagnostic testing therapeutic services  Issued 12-1-06
317:30-5-42.6.Dialysis  Issued 12-1-06
317:30-5-42.7.Emergency department (ED) care/services  Issued 12-1-06
317:30-5-42.8.Hearing and speech therapy  Issued 12-1-06
317:30-5-42.9.Infusions/injections  Issued 12-1-06
317:30-5-42.10.Laboratory  Issued 12-1-06
317:30-5-42.11.Observation/treatment  Revised 10-2-09
317:30-5-42.12.Physical therapy  Issued 12-1-06
317:30-5-42.13.Radiology  Issued 12-1-06
317:30-5-42.14.Surgery and diagnostic services  Revised 1-2-09
317:30-5-42.15.Outpatient hospital services for members infected with tuberculosis  Issued 12-1-06
317:30-5-42.16.Related services  Revised 1-6-11
317:30-5-42.17.Non-covered services  Revised 11-3-09
317:30-5-42.18.Coverage for children  Issued 12-1-06
317:30-5-44.Medicare eligible individuals  Revised 1-1-08
317:30-5-47.Reimbursement for inpatient hospital services  Revised 12-1-06
317:30-5-47.1.Reimbursement for newborn screening services provided by the OSDH  Revised 12-1-06
317:30-5-47.2.Disproportionate share hospitals (DSH)  Revised 12-1-06
317:30-5-47.3.Indirect medical education (IME) adjustment  Revised 12-1-06
317:30-5-47.4.Direct medical education payment adjustment  Revised 12-1-06
317:30-5-47.5.Critical Access Hospital  Issued 10-03-05
317:30-5-49.Child abuse  Revised 6-25-09
317:30-5-50.Abortions  Revised 12-1-06
317:30-5-51.Elective sterilizations  Issued 7-27-95
317:30-5-52.Hysterectomies  Issued 7-27-95
317:30-5-53.Newborn care  Issued 7-27-95
317:30-5-56.Utilization review  Issued 12-1-06
317:30-5-57.Notice of denial  Issued 12-1-06
317:30-5-58.Supplemental Hospital Offset Program  Issued 11-22-11
PART 4. LONG TERM CARE HOSPITALS
317:30-5-60.Subacute level of care  Issued 5-11-98
317:30-5-61.Eligible providers  Issued 5-11-98
317:30-5-62.Coverage by category  Revised 7-1-06
317:30-5-63.Trust funds  Issued 5-11-98
317:30-5-64.Inpatient and routine services  Issued 5-11-98
317:30-5-65.Ancillary Services  Revised 1-1-10
317:30-5-66.Reimbursement for inpatient hospital subacute services  Issued 5-11-98
317:30-5-67.Cost reports  Issued 5-11-98
PART 5. PHARMACIES
317:30-5-70.Eligible providers  Revised 7-25-08
317:30-5-70.1.Pharmacist responsibility  Revised 7-25-08
317:30-5-70.2.Record retention/Post Payment Review  Revised 10-1-07
317:30-5-70.3.Prescriber identification numbers  Revised 7-25-08
317:30-5-70.4.Federal/State cost share-optional program  Issued 6-26-00
317:30-5-72.Categories of service eligibility  Revised 6-25-11
317:30-5-72.1.Drug benefit  Revised 6-25-11
317:30-5-76.Generic drugs  Revised 6-26-00
317:30-5-77.Brand necessary certification  Revised 11-15-10
317:30-5-77.1.Dispensing Quantity  Revised 7-25-08
317:30-5-77.2.Prior authorization  Revised 7-25-08
317:30-5-77.3.Product  Revised 6-25-11
317:30-5-78.Reimbursement  Revised 6-25-11
317:30-5-78.1.Special billing procedures  Revised 11-15-10
317:30-5-78.2.Falsification of claims  Revised 7-25-08
317:30-5-80.National drug code  Revised 4-24-02
317:30-5-86.Drug Utilization Review Program  Revised 7-25-08
317:30-5-86.2.Case management  Issued 6-26-00
PART 6. INPATIENT PSYCHIATRIC HOSPITALS
317:30-5-95.General provisions and eligible providers  Revised 7-1-10
317:30-5-95.1.Coverage for adults ages 21 to 64  Revised 7-1-06
317:30-5-95.4.Individual plan of care for adults ages 21 to 64  Revised 7-1-10
317:30-5-95.5.Physician review of prescribed medications for adults age 21 to 64  Revised 7-1-10
317:30-5-95.6.Medical, psychiatric and social evaluations for adults age 21 to 64  Revised 7-1-10
317:30-5-95.7.Active treatment for adults age 21 to 64  Revised 7-1-07
317:30-5-95.8.Nursing services for adults age 21 to 64  Revised 7-1-10
317:30-5-95.9.Therapeutic services for adults age 21 to 64  Revised 7-1-10
317:30-5-95.10.Discharge plan for adults age 21 to 64  Revised 7-1-10
317:30-5-95.11.Inpatient acute psychiatric services for persons over 65 years of age  Issued 7-1-06
317:30-5-95.12.Utilization control requirements for inpatient acute psychiatric services for persons over 65 years of age  Issued 7-1-06
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  Revised 7-1-10
317:30-5-95.14.Individual plan of care for persons over 65 years of age receiving inpatient acute psychiatric services  Revised 7-1-10
317:30-5-95.15.Physician review of prescribed medications for persons over 65 years of age receiving inpatient acute psychiatric services  Revised 7-1-10
317:30-5-95.16.Medical psychiatric and social evaluations for persons over 65 years of age receiving inpatient acute psychiatric services  Revised 7-1-10
317:30-5-95.17.Active treatment for persons over 65 years of age receiving inpatient acute psychiatric services  Revised 7-1-07
317:30-5-95.18.Nursing services for persons over 65 years of age receiving inpatient acute psychiatric services  Revised 7-1-10
317:30-5-95.19.Therapeutic services for persons over 65 years of age receiving inpatient acute psychiatric services  Revised 7-1-10
317:30-5-95.20.Discharge plan for persons over 65 years of age receiving inpatient acute psychiatric services  Revised 7-1-10
317:30-5-95.21.Continued stay review for persons over 65 years of age receiving inpatient acute psychiatric services  Issued 7-1-06
317:30-5-95.22.Coverage for children  Revised 7-1-10
317:30-5-95.23.Individuals age 21  Revised 7-1-10
317:30-5-95.24.Pre-authorization of inpatient psychiatric services for children  Revised 7-1-10
317:30-5-95.25.Medical necessity criteria for acute psychiatric admissions for children  Revised 7-1-10
317:30-5-95.26.Medical necessity criteria for continued stay - acute psychiatric admission for children  Revised 7-1-10
317:30-5-95.27.Medical necessity criteria for admission - inpatient chemical dependency detoxification for children  Revised 7-1-10
317:30-5-95.28.Medical necessity criteria for continued stay - inpatient chemical dependency detoxification program for children  Revised 7-1-10
317:30-5-95.29.Medical necessity criteria for admission - psychiatric residential treatment for children  Revised 7-1-10
317:30-5-95.30.Medical necessity criteria for continued stay - psychiatric residential teatment center for children  Revised 7-1-10
317:30-5-95.31.Pre-authorization and extension procedures for children  Revised 7-1-10
317:30-5-95.32.Quality of care requirements for children  Revised 7-1-10
317:30-5-95.33.Individual plan of care for children  Revised 7-1-10
317:30-5-95.34.Active treatment for children  Revised 7-1-10
317:30-5-95.35.Credentialing requirements for treatment team members for children  Revised 7-1-10
317:30-5-95.36.Treatment team for inpatient children's services  Revised 7-1-10
317:30-5-95.37.Medical, psychiatric and social evaluations for inpatient services for children  Revised 7-1-10
317:30-5-95.38.Nursing services for children  Revised 7-1-10
317:30-5-95.39.Seclusion, restraint, and serious incident reporting requirements for children  Revised 7-1-10
317:30-5-95.40.Other required standards  Revised 7-1-10
317:30-5-95.41.Documentation of records for children's inpatient services  Revised 7-1-07
317:30-5-95.42.Inspection of care of psychiatric facilities providing services to children  Revised 7-1-10
317:30-5-96.2.Payment definitions  Revised 7-1-10
317:30-5-96.3.Methods of payment  Revised 7-1-10
317:30-5-96.4.Outlier intensity adjustment  Revised 7-1-10
317:30-5-96.5.Disproportionate share hospitals (DSH)  Issued 7-1-06
317:30-5-96.6.Payment for Medicare/Medicaid dual eligibles  Issued 7-1-06
317:30-5-96.7.Cost reports  Revised 7-1-10
317:30-5-96.8.Psychiatric Residential Treatment Facility payments to subcontractors  Revised 2-1-08
317:30-5-97.Child abuse  Revised 6-25-09
PART 7. CERTIFIED LABORATORIES
317:30-5-100.Eligible providers  Revises 2-4-10
317:30-5-101.Coverage for adults  Revised 5-11-00
317:30-5-102.Coverage for children  Issued 7-27-95
317:30-5-103.Vocational rehabilitation  Issued 7-27-95
317:30-5-104.Individuals eligible for Part B of Medicare  Revised 7-1-02
317:30-5-105.Non-covered procedures  Issued 7-27-95
317:30-5-106.Payment rates  Revised 5-11-01
PART 8. REHABILITATION HOSPITALS
317:30-5-110.Eligible providers  Issued 10-03-05
317:30-5-111.Coverage for adults  Revised 10-1-07
317:30-5-112.Coverage for children  Issued 10-03-05
317:30-5-113.Medicare eligible individuals  Issued 10-03-05
317:30-5-114.Reimbursement  Issued 10-03-05
PART 9. LONG TERM CARE FACILITIES
317:30-5-120.Eligible providers  Revised 5-27-97
317:30-5-121.Coverage by category  Revised 6-25-01
317:30-5-122.Levels of care  Revised 6-25-11
317:30-5-123.Patient certification for long term care  Revised 6-1-07
317:30-5-124.Facility licensure  Revised 3-1-06
317:30-5-125.Trust funds  Revised 5-27-97
317:30-5-126.Therapeutic leave and Hospital leave  Revised 7-25-08
317:30-5-127.Notification of nursing facility changes  Revised 6-25-01
317:30-5-128.Private rooms  Revised 5-27-97
317:30-5-129.Required monthly notifications  Revised 7-11-05
317:30-5-130.Inspections of care in Intermediate Care Facilities for the Mentally Retarded (ICF/MR)  Revised 5-27-97
317:30-5-131.Rates of payments  Revised 7-1-07
317:30-5-131.1.Wage enhancement  Revised 3-1-06
317:30-5-131.2.Quality of care fund requirements and report  Revised 7-25-08
317:30-5-132.Cost reports  Revised 7-25-08
317:30-5-133.Payment methodologies  Revised 7-1-07
317:30-5-133.1.Routine services  Revised 6-25-07
317:30-5-133.2.Ancillary services  Revised 7-25-08
317:30-5-134.Nurse Aide Training Reimbursement  Revised 7-25-08
PART 10. BARIATRIC SURGERY
317:30-5-137.Eligible providers to perform bariatric surgery  Revised 12-3-09
317:30-5-137.1.Member candidacy  Issued 12-3-09
317:30-5-137.2.General coverage  Issued 12-3-09
317:30-5-140.Coverage for children  Issued 10-8-06
317:30-5-141.Reimbursement  Issued 10-8-06
PART 12. THE OKLAHOMA PRESCRIPTION DRUG DISCOUNT PROGRAM
317:30-5-180.Purpose and general provisions  Issued 2-1-07
317:30-5-180.1.Definitions  Issued 2-1-07
317:30-5-180.2.Eligibility  Issued 2-1-07
317:30-5-180.3.Services  Issued 2-1-07
317:30-5-180.4.Fraud  Issued 2-1-07
317:30-5-180.5.Pharmacy Benefit Manager  Issued 2-1-07
PART 16. MATERNAL AND INFANT HEALTH LICENSED CLINICAL SOCIAL WORKERS
317:30-5-204.General Information  Issued 11-1-07
317:30-5-205.Eligible Providers  Issued 11-1-07
317:30-5-206.Coverage  Issued 11-1-07
317:30-5-207.Limitations  Issued 11-1-07
317:30-5-208.Reimbursement  Issued 11-1-07
317:30-5-209.Documentation  Issued 11-1-07
PART 17. MEDICAL SUPPLIERS
317:30-5-210.Eligible providers  Revised 6-25-11
317:30-5-210.1.Coverage for adults  Issued 12-3-09
317:30-5-210.2.Coverage for children  Issued 12-3-09
317:30-5-211.1.Definitions  Revised 12-3-09
317:30-5-211.2.Medical necessity  Issued 7-1-07
317:30-5-211.3.Prior authorization (PA)  Revised 5-25-08
317:30-5-211.4.Rental and/or purchase  Issued 7-1-07
317:30-5-211.5.Repairs, maintenance, replacement, and delivery  Revised 8-13-10
317:30-5-211.6.General documentation requirements  Issued 7-1-07
317:30-5-211.7.Free choice  Issued 7-1-07
317:30-5-211.9.Adaptive equipment  Revised 5-25-08
317:30-5-211.10.Durable medical equipment (DME)  Revised 1-14-10
317:30-5-211.11.Oxygen and oxygen equipment  Revised 5-25-08
317:30-5-211.12.Oxygen rental  Revised 1-14-10
317:30-5-211.13.Prosthetics and orthotics  Revised 12-3-09
317:30-5-211.14.Nutritional support  Revised 12-3-09
317:30-5-211.15.Supplies  Revised 1-14-10
317:30-5-211.16.Coverage for nursing facility residents  Issued 7-1-07
317:30-5-211.17.Wheelchairs  Revised 1-1-10
317:30-5-211.18.Ownership of durable medical equipment  Issued 12-3-09
317:30-5-211.19.Quality assurances and safeguards  Issued 6-25-11
317:30-5-214.Coverage for individuals eligible for Part B of Medicare  Revised 7-1-02
317:30-5-216.Prior authorization requests  Revised 12-3-09
317:30-5-217.Billing  Revised 5-25-08
317:30-5-218.Reimbursement  Revised 1-14-10
PART 18. GENETIC COUNSELORS
317:30-5-219.General Information  Issued 11-1-07
317:30-5-220.Eligible Providers  Issued 11-1-07
317:30-5-221.Coverage  Issued 11-1-07
317:30-5-222.Reimbursement  Issued 11-1-07
317:30-5-223.Documentation  Issued 11-1-07
PART 19. NURSE MIDWIVES
317:30-5-225.Eligible providers  Revised 10-03-05
317:30-5-226.Coverage by category  Revised 12-1-06
PART 20. LACTATION CONSULTANTS
317:30-5-230.General information  Issued 12-1-07
317:30-5-231.Eligible Providers  Revised 7-25-08
317:30-5-232.Coverage  Issued 12-1-07
317:30-5-233.Limitations  Revised 7-25-08
317:30-5-234.Reimbursement  Revised 7-25-08
317:30-5-235.Documentation  Issued 12-1-07
PART 21. OUTPATIENT BEHAVIORAL HEALTH SERVICES
317:30-5-240.Eligible providers  Revised 7-1-10
317:30-5-240.1.Definitions  Revised 7-1-10
317:30-5-240.2.Provider participation standards  Revised 7-1-10
317:30-5-240.3.Staff Credentials  Revised 7-1-10
317:30-5-241.Covered Services  Revised 6-25-11
317:30-5-241.1.Screening, assessment and service plan  Revised 6-25-11
317:30-5-241.2.Psychotherapy  Revised 6-25-11
317:30-5-241.3.Behavioral Health Rehabilitation (BHR) services  Revised 7-1-10
317:30-5-241.4.Crisis Intervention  Issued 4-1-09
317:30-5-241.5.Support services  Revised 7-1-10
317:30-5-244.Individuals eligible for Part B of Medicare  Revised 4-1-09
317:30-5-245.Reimbursement  Revised 7-25-08
317:30-5-248.Documentation of records  Revised 7-1-10
317:30-5-249.Non-covered services  Issued 4-1-09
PART 23. PODIATRISTS
317:30-5-260.Eligible providers  Revised 5-11-00
317:30-5-261.Coverage by category  Revised 7-1-02
PART 25. PSYCHOLOGISTS
317:30-5-275.Eligible providers  Revised 7-1-10
317:30-5-276.Coverage by category  Revised 6-25-11
317:30-5-278.Non-covered procedures  Revised 7-1-10
317:30-5-278.1.Documentation of records  Revised 6-25-09
PART 26. LICENSED BEHAVIORAL HEALTH PROVIDERS
317:30-5-280.Eligible Providers  Issued 7-1-10
317:30-5-281.Coverage by Category  Revised 6-25-11
317:30-5-282.Non-covered procedures  Issued 7-1-10
317:30-5-283.Documentation of records  Issued 7-1-10
PART 27. REGISTERED PHYSICAL THERAPISTS
317:30-5-290.1.Eligible providers  Issued 8-1-07
317:30-5-291.Coverage by category  Revised 8-1-07
317:30-5-291.1.Payment rates  Issued 8-1-07
317:30-5-291.2.Procedure codes  Issued 8-1-07
317:30-5-293.Team therapy (Co-treatment)  Issued 8-13-10
PART 28. OCCUPATIONAL THERAPY SERVICES
317:30-5-295.Eligible Providers  Issued 8-1-07
317:30-5-296.Coverage by category  Issued 8-1-07
317:30-5-297.Payment rates  Issued 8-1-07
317:30-5-298.Procedure codes  Issued 8-1-07
317:30-5-299.Team therapy (Co-treatment)  Issued 8-13-10
PART 29. RENAL DIALYSIS FACILITIES
317:30-5-305.Eligible providers  Issued 7-27-95
317:30-5-306.Coverage by category  Revised 7-1-02
317:30-5-307.Payment methodology  Issued 7-27-95
PART 31. ROOM AND BOARD PROVIDERS
317:30-5-320.Eligible providers  Issued 7-27-95
317:30-5-321.Coverage by category  Revised 6-25-07
PART 32. SOONERRIDE NON-EMERGENCY TRANSPORTATION
317:30-5-325.[Reserved]
317:30-5-326.Provider eligibility  Revised 1-2-09
317:30-5-326.1.Definitions  Issued 6-25-07
317:30-5-327.SoonerRide non-emergency non-ambulance transportation eligibility  Revised 6-25-07
317:30-5-327.1.Access to non-emergency non-ambulance transportation through SoonerRide  Issued 6-25-07
317:30-5-327.2.Service availability  Issued 6-25-07
317:30-5-327.3.Coverage for residents of nursing facilities  Issued 6-25-07
317:30-5-327.4.Coverage for children  Issued 6-25-07
317:30-5-327.5.Exclusions from SoonerRide NET  Revised 1-18-08
317:30-5-327.6.Denial of SoonerRide NET services by the SoonerRide broker  Issued 6-25-07
317:30-5-327.7.SoonerRide provider network  Issued 6-25-07
317:30-5-327.8.Type of services provided and duties of the SoonerRide driver  Issued 6-25-07
317:30-5-327.9.Scheduling NET services through SoonerRide  Issued 6-25-07
PART 33. TRANSPORTATION BY AMBULANCE
317:30-5-335.Eligible providers  Revised 12-21-06
317:30-5-335.1.Definitions  Issued 12-21-06
317:30-5-336.General coverage  Revised 12-21-06
317:30-5-336.1.Medical necessity  Issued 12-21-06
317:30-5-336.2.Nearest appropriate facility  Issued 12-21-06
317:30-5-336.3.Destination  Issued 12-21-06
317:30-5-336.4.Transport outside of locality  Issued 12-21-06
317:30-5-336.5.Levels of ambulance service, ambulance fee schedules and base rate  Issued 12-21-06
317:30-5-336.6.Mileage  Issued 12-21-06
317:30-5-336.7.Waiting time  Issued 12-21-06
317:30-5-336.8.Special situations  Issued 12-21-06
317:30-5-336.9.Air ambulance  Issued 12-21-06
317:30-5-336.10.Fixed wing air ambulance services  Revised 6-25-11
317:30-5-336.11.Rotary wing air ambulance  Issued 12-21-06
317:30-5-336.12.Non-emergency ambulance and stretcher service transportation  Issued 12-21-06
317:30-5-336.13.Non covered services  Issued 12-21-06
317:30-5-337.Coverage for children  Revised 12-21-06
317:30-5-339.Individuals eligible for Part B of Medicare  Revised 12-21-06
317:30-5-343.Reimbursement  Revised 10-03-05
PART 35. RURAL HEALTH CLINICS
317:30-5-355.Eligible providers  Revised 5-27-96
317:30-5-355.1.Definition of services  Revised 12-1-06
317:30-5-356.Coverage for adults  Revised 8-1-08
317:30-5-357.Coverage for children  Revised 6-27-02
317:30-5-359.Claims for Medicare eligible recipients  Revised 7-1-02
317:30-5-359.1.Cost reports  Issued 5-27-96
317:30-5-359.2.Reimbursement  Revised 5-27-99
317:30-5-361.Billing  Revised 12-1-06
317:30-5-362.Documentation of records  Revised 5-27-96
PART 37. ADVANCED PRACTICE NURSE
317:30-5-375.Eligible providers  Revised 6-25-07
317:30-5-376.Coverage by category  Revised 7-01-06
PART 39. SKILLED AND REGISTERED NURSING SERVICES
317:30-5-390.Home and Community-Based Services Waivers for adults with mental retardation or certain adults with related conditions  Revised 7-25-08
317:30-5-391.Coverage for Skilled Nursing Services  Revised 8-2-06
317:30-5-392.Description of Skilled Nursing services  Revised 8-2-06
317:30-5-393.Coverage limitations for Skilled Nursing Services  Revised 8-2-06
317:30-5-394.Diagnosis codes  Revised 5-11-00
PART 41. FAMILY SUPPORT SERVICES
317:30-5-410.Home and Community-Based Services Waivers for persons with mental retardation or certain persons with related conditions  Revised 6-25-09
317:30-5-411.Coverage  Revised 5-11-07
317:30-5-412.Description of services  Revised 6-25-11
317:30-5-413.Diagnosis codes  Issued 7-27-95
PART 43. AGENCY 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 mental retardation or certain persons with related conditions  Revised 10-1-07
317:30-5-421.Coverage  Revised 10-1-07
317:30-5-422.Description of services  Revised 6-25-09
317:30-5-423.Coverage limitations  Revised 10-1-07
317:30-5-424.Diagnosis code  Revised 10-1-07
PART 45. OPTOMETRISTS
317:30-5-430.Eligible providers  Revised 5-11-01
317:30-5-431.Coverage by category  Revised 2-1-08
317:30-5-432.Procedure codes  Revised 2-1-08
317:30-5-432.1.Corrective lenses and optical supplies  Issued 2-1-08
PART 47. OPTICAL COMPANIES
317:30-5-450.Eligible providers  Issued 7-27-95
317:30-5-451.Coverage by category  Revised 2-1-08
PART 49. FAMILY PLANNING CENTERS
317:30-5-465.Eligible providers  Issued 7-27-95
317:30-5-466.Coverage by category  Revised 12-1-06
317:30-5-467.Coverage limitations  Revised 12-1-06
PART 51. HABILITATION SERVICES
317:30-5-480.Home and Community-Based Services for persons with mental retardation or certain persons with related conditions  Revised 7-25-08
317:30-5-481.Coverage  Revised 5-11-07
317:30-5-482.Description of services  Revised 6-11-10
317:30-5-483.Diagnosis codes  Issued 7-27-95
PART 53. SPECIALIZED FOSTER CARE
317:30-5-495.Home and Community-Based Services Waivers for persons with mental retardation or certain persons with related conditions  Revised 7-25-08
317:30-5-496.Coverage  Revised 7-25-08
317:30-5-497.Description of services  Revised 7-25-08
317:30-5-498.Coverage limitations  Revised 7-25-08
317:30-5-499.Diagnosis code  Revised 7-25-08
PART 55. RESPITE CARE
317:30-5-515.Home and Community-Based Services Waivers for persons with mental retardation or certain persons with related conditions  Revised 6-1-08
317:30-5-516.Coverage  Revised 6-1-08
317:30-5-517.Description of services  Revised 6-1-08
317:30-5-518.Coverage limitations  Revised 6-1-08
317:30-5-519.Diagnosis code  Revised 6-1-08
PART 58. NON-HOSPITAL BASED HOSPICE
317:30-5-530.Eligible providers  Issued 8-1-05
317:30-5-531.Coverage for adults  Issued 8-1-05
317:30-5-532.Coverage for children  Revised 1-6-11
PART 59. HOMEMAKER SERVICES
317:30-5-535.Home and Community-Based Services Waiver for persons with mental retardation or certain persons with related conditions  Revised 7-25-08
317:30-5-536.Coverage  Revised 7-25-08
317:30-5-537.Description of services  Revised 7-25-08
317:30-5-538.Diagnosis codes  Revised 7-25-08
PART 61. HOME HEALTH AGENCIES
317:30-5-545.Eligible providers  Revised 12-21-06
317:30-5-546.Coverage by category  Revised 7-1-02
317:30-5-547.Reimbursement  Revised 1-14-10
317:30-5-548.Procedure codes  Revised 6-27-02
317:30-5-549.Prosthetic devices  Revised 5-11-01
PART 62. PRIVATE DUTY NURSING
317:30-5-555.Eligible providers  Revised 8-13-10
317:30-5-556.Definitions  Revised 6-25-11
317:30-5-557.Coverage by category  Revised 8-13-10
317:30-5-558.Private duty nursing coverage limitations  Revised 8-13-10
317:30-5-559.How services are authorized  Revised 8-13-10
317:30-5-560.Treatment Plan  Revised 6-25-11
317:30-5-560.1.Prior authorization requirements  Revised 8-13-10
317:30-5-560.2.Record documentation  Revised 12-1-06
PART 63. AMBULATORY SURGICAL CENTERS
317:30-5-565.Eligible providers  Revised 1-2-09
317:30-5-566.Ambulatory Surgery Center services  Revised 2-4-10
317:30-5-567.Coverage by category  Revised 2-4-10
317:30-5-568.Elective sterilizations  Revised 9-1-07
PART 64. CLINIC SERVICES
317:30-5-575.General information  Issued 6-25-11
317:30-5-576.Eligible providers  Issued 6-25-11
317:30-5-577.Coordination of care  Issued 6-25-11
317:30-5-578.Limitation on services  Issued 6-25-11
PART 65. CASE MANAGEMENT SERVICES FOR OVER 21
317:30-5-586.1.Prior authorization  Revised 7-1-07
317:30-5-589.Documentation of records  Revised 7-1-07
PART 67. BEHAVIORAL HEALTH CASE MANAGEMENT SERVICES FOR INDIVIDUALS UNDER 21 YEARS OF AGE
317:30-5-595.Eligible providers  Revised 3-3-10
317:30-5-596.Coverage by category  Revised 3-3-10
317:30-5-596.1.Prior authorization  Revised 3-3-10
317:30-5-599.Documentation of records  Revised 7-01-07
PART 69. CERTIFIED REGISTERED NURSE ANESTHETISTS
317:30-5-605.Eligible providers  Revised 7-1-09
317:30-5-606.Coverage by category  Revised 7-1-02
317:30-5-607.Billing instructions  Revised 7-1-09
317:30-5-611.Payment methodology  Revised 7-1-09
317:30-5-612.Eligible providers  Issued 7-1-09
317:30-5-613.Coverage by category  Issued 7-1-09
317:30-5-614.Billing instructions  Issued 7-1-09
317:30-5-615.Payment methodology  Issued 7-1-09
PART 71. EARLY INTERVENTION CASE MANAGEMENT SERVICES
317:30-5-620.Eligible providers  Revised 6-11-99
317:30-5-621.Coverage by category  Revised 6-11-99
317:30-5-622.Reimbursement  Revised 6-27-02
317:30-5-624.Documentation of records  Issued 7-27-95
PART 73. EARLY INTERVENTION SERVICES
317:30-5-640.General provisions and eligible providers  Revised 7-01-06
317:30-5-640.1.Periodicity schedule  Revised 7-01-06
317:30-5-641.Coverage by category  Revised 7-01-06
317:30-5-641.1.Periodic and interperiodic screening examinations  Revised 7-01-06
317:30-5-641.3.Reporting of suspected child abuse/neglect  Revised 7-1-06
317:30-5-644.Documentation of records  Revised 7-01-06
PART 75. FEDERALLY QUALIFIED HEALTH CENTERS
317:30-5-660.Eligible providers  Revised 6-25-07
317:30-5-660.1.Health Center multiple sites contracting  Revised 6-25-11
317:30-5-660.2.Health Center professional staff  Revised 6-25-07
317:30-5-660.3.Health Center enrollment requirements for other behavioral health services  Revised 6-25-07
317:30-5-660.4.Health Center enrollment requirements for health services in a school setting  Revised 6-25-11
317:30-5-660.5.Health Center service definitions  Revised 6-25-11
317:30-5-661.Coverage by category  Issued 6-07-06
317:30-5-661.1.Health Center core services  Revised 6-25-11
317:30-5-661.2.Services and supplies "incident to" Health Center encounters  Revised 6-25-07
317:30-5-661.3.Visiting Nurse services  Revised 6-25-07
317:30-5-661.4.Behavioral health professional services provided at Health Centers  Revised 6-25-07
317:30-5-661.5.Health Center preventive primary care services  Revised 6-25-11
317:30-5-661.6.Health Center preventive and primary care exclusions  Revised 6-25-07
317:30-5-661.7.Off-site services  Revised 6-25-07
317:30-5-664.1.Provision of other health services outside of the Health Center core services  Revised 6-25-07
317:30-5-664.2.Prior authorization and referrals  Issued 6-07-06
317:30-5-664.3.Health Center encounters  Revised 6-25-11
317:30-5-664.4.Multiple encounters at Health Centers  Revised 6-25-07
317:30-5-664.5.Health Center encounter exclusions and limitaitons  Revised 6-25-11
317:30-5-664.6.Prescription drugs provided by Health Centers  Revised 6-25-07
317:30-5-664.7.Dental services provided by Health Centers  Revised 6-25-11
317:30-5-664.8.Obstetrical care provided by Health Centers  Revised 6-25-07
317:30-5-664.9.Family planning services provided by Health Centers  Revised 6-25-07
317:30-5-664.10.Health Center reimbursement  Revised 6-25-11
317:30-5-664.11.PPS rate reconciliation to Health Centers  Revised 6-25-07
317:30-5-664.12.Determination of Health Center PPS rate  Revised 6-25-07
317:30-5-664.13.Individual eligible for Part B of Medicare  Issued 6-07-06
317:30-5-664.14.Health Center record keeping  Issued 6-07-06
317:30-5-664.15.Health Center cost reporting  Issued 6-07-06
PART 77. SPEECH AND HEARING SERVICES
317:30-5-675.Eligible providers  Revised 5-11-01
317:30-5-676.Coverage by category  Revised 8-2-06
317:30-5-677.Payment rates  Revised 5-11-01
317:30-5-678.Procedure codes  Revised 5-11-01
317:30-5-680.Team therapy (Co-treatment)  Issued 8-13-10
PART 79. DENTISTS
317:30-5-695.Eligible dental providers and definitions  Revised 6-25-11
317:30-5-695.1.Payment of eligible providers  Revised 7-1-06
317:30-5-695.2.Payment for dental interns and students  Revised 7-01-06
317:30-5-696.Coverage by category  Revised 6-11-11
317:30-5-696.1.Conscious Sedation  Issued 2-1-07
317:30-5-697.Oral surgery procedures  Revised 7-1-03
317:30-5-698.Services requiring prior authorization  Revised 6-25-11
317:30-5-699.Restorations  Revised 6-25-11
317:30-5-700.Orthodontic services  Revised 6-25-11
317:30-5-700.1.Orthodontic prior authorization  Revised 6-25-11
317:30-5-701.Surface identification  Revised 7-01-06
317:30-5-703.Tooth numbering system  Revised 7-01-06
317:30-5-704.Billing instructions  Revised 7-01-06
317:30-5-705.Billing  Revised 7-01-06
PART 81. CHIROPRACTORS
317:30-5-720.Eligible providers  Issued 7-27-95
317:30-5-721.Coverage by category  Revised 7-1-02
PART 83. RESIDENTIAL BEHAVIOR MANAGEMENT SERVICES
317:30-5-740.Eligible providers  Revised 4-21-10
317:30-5-740.1.Provider qualifications and requirements  Revised 4-21-10
317:30-5-740.2.Provider selection  Issued 6-26-00
317:30-5-741.Coverage by category  Revised 4-21-10
317:30-5-742.Description of services  Revised 4-21-10
317:30-5-742.1.Reimbursement  Revised 4-21-10
317:30-5-742.2.Required Residential Behavior Management Services  Revised 4-21-10
317:30-5-743.1.Inspection of Care  Revised 4-21-10
317:30-5-744.Billing  Revised 4-21-10
317:30-5-745.Documentation of records  Revised 4-21-10
317:30-5-746.Appeal of Prior Authorization Decision  Revised 7-1-07
PART 85. ADVANTAGE PROGRAM WAIVER SERVICES
317:30-5-760.ADvantage program  Revised 2-1-08
317:30-5-761.Eligible providers  Revised 5-1-09
317:30-5-762.Coverage  Revised 2-1-08
317:30-5-763.Description of services  Revised 11-22-11
317:30-5-763.1.Medicaid agency monitoring of the ADvantage program  Revised 4-1-09
317:30-5-764.Reimbursement  Revised 2-1-10
PART 87. BIRTHING CENTERS
317:30-5-890.Birthing Center Services  Issued 7-27-95
317:30-5-891.Coverage by category  Issued 7-27-95
317:30-5-892.Reimbursement  Revised 6-27-02
317:30-5-893.Billing  Issued 7-27-95
PART 89. RADIOLOGICAL MAMMOGRAPHER
317:30-5-900.Eligible providers  Issued 7-27-95
317:30-5-901.Coverage by category  Revised 12-1-06
317:30-5-903.Individuals eligible for Part B of Medicare  Revised 7-1-02
317:30-5-905.Reimbursement  Issued 7-27-95
PART 90. DIAGNOSTIC TESTING ENTITIES
317:30-5-907.Eligible providers  Issued 10-6-04
317:30-5-907.1.Coverage by category  Issued 10-6-04
317:30-5-907.2.Individuals eligible for Part B of Medicare  Issued 10-6-04
317:30-5-907.3.Reimbursement  Issued 10-6-04
PART 95. AGENCY PERSONAL CARE SERVICES
317:30-5-950.Eligible providers  Revised 2-1-10
317:30-5-951.Coverage by category  Revised 8-2-06
317:30-5-952.Prior authorization  Revised 4-1-09
317:30-5-953.Billing  Revised 1-2-09
PART 97. CASE 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  Issued 5-11-98
317:30-5-971.Coverage by category  Issued 5-11-98
317:30-5-972.Reimbursement  Revised 3-3-10
317:30-5-973.Billing  Issued 5-11-98
317:30-5-974.Documentation of records  Issued 5-11-98
PART 99. CASE 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  Issued 5-11-98
317:30-5-991.Coverage by category  Issued 5-11-98
317:30-5-992.Reimbursement  Revised 3-3-10
317:30-5-993.Billing  Issued 5-11-98
317:30-5-994.Documentation of records  Issued 5-11-98
PART 101. TARGETED CASE MANAGEMENT SERVICES FOR PERSONS WITH MENTAL RETARDATION AND/OR RELATED CONDITIONS
317:30-5-1010.Eligible providers  Revised 6-25-09
317:30-5-1010.1.Scope of service  Revised 6-25-09
317:30-5-1011.Coverage by category  Revised 5-13-02
317:30-5-1012.Reimbursement  Revised 5-13-02
317:30-5-1013.Billing  Issued 5-11-98
317:30-5-1014.Documentation of records  Issued 5-11-98
PART 103. QUALIFIED SCHOOLS AS PROVIDERS OF HEALTH RELATED SERVICES
317:30-5-1020.General provisions  Revised 6-27-02
317:30-5-1021.Eligible providers  Revised 6-26-00
317:30-5-1022.Periodicity schedule  Issued 5-11-98
317:30-5-1023.Coverage by category  Revised 7-15-10
317:30-5-1024.Periodic screening examination  Issued 5-11-98
317:30-5-1025.Interperiodic screening examination  Issued 5-11-98
317:30-5-1026.Reporting of suspected child abuse/neglect  Revised 6-25-09
317:30-5-1027.Billing  Revised 7-15-10
PART 104. SCHOOL-BASED CASE MANAGEMENT SERVICES
317:30-5-1030.Eligible providers  Revised 1-14-10
317:30-5-1031.Coverage by category  Revised 6-27-02
317:30-5-1032.Reimbursement  Issued 6-11-99
317:30-5-1033.Billing  Revised 6-27-02
317:30-5-1034.Documentation of records  Issued 6-11-99
PART 105. RESIDENTIAL BEHAVIORAL MANAGEMENT SERVICES IN GROUP SETTINGS AND NON-SECURE DIAGNOSTIC AND EVALUATION CENTERS
317:30-5-1040.Foster Care Agency  Revised 1-14-10
317:30-5-1041.Eligible providers  Revised 1-14-10
317:30-5-1042.Memorandum of agreement  Revised 1-14-10
317:30-5-1043.Coverage by category  Revised 1-14-10
317:30-5-1044.Payment rates  Revised 1-14-10
317:30-5-1045.Billing  Issued 5-11-98
317:30-5-1046.Documentation of records and records review  Revised 1-14-10
317:30-5-1047.Confidentiality of information  Revised 1-14-10
PART 108. NUTRITION SERVICES
317:30-5-1075.Eligible providers  Issued 6-26-00
317:30-5-1076.Coverage by category  Revised 6-25-11
PART 110. INDIAN HEALTH SERVICES, TRIBAL PROGRAMS, AND URBAN INDIAN CLINICS (I/T/US)
317:30-5-1085.General provisions  Revised 7-25-08
317:30-5-1086.Eligible I/T/U providers  Revised 7-25-08
317:30-5-1087.Terms and definitions  Revised 7-25-08
317:30-5-1088.I/T/U provider participation requirements  Revised 7-25-08
317:30-5-1089.I/T/U multiple sites  Issued 7-1-06
317:30-5-1090.Provision of other health services outside of the I/T/U encounter  Revised 7-25-08
317:30-5-1091.Definition of I/T/U services  Revised 8-13-10
317:30-5-1092.Services and supplies incidental to I/T/U outpatient encounters  Issued 7-1-06
317:30-5-1093.I/T/U visiting nurses services  Revised 7-25-08
317:30-5-1094.Mental health services provided at I/T/Us  Revised 7-25-08
317:30-5-1095.I/T/U services not compensable under outpatient encounters  Revised 7-25-08
317:30-5-1096.I/T/U off-site services  Revised 7-25-08
317:30-5-1097.Billable I/T/U encounters  Issued 7-1-06
317:30-5-1098.I/T/U outpatient encounters  Revised 8-13-10
317:30-5-1099.I/T/U service limitations  Revised 7-25-08
317:30-5-1100.Inpatient care provided by IHS facilities  Issued 7-25-08
PART 112. PUBLIC HEALTH CLINIC SERVICES
317:30-5-1150.General  Issued 6-25-07
317:30-5-1151.Eligible providers  Issued 6-25-07
317:30-5-1152.Provider participation requirements  Issued 6-25-07
317:30-5-1153.Physician  Issued 6-25-07
317:30-5-1154.CHD/CCHD services/limitations  Issued 6-25-07
317:30-5-1155.Immunizations  Issued 6-25-07
317:30-5-1156.Environmental lead investigations  Issued 6-25-07
317:30-5-1157.Newborn screening  Issued 6-25-07
317:30-5-1158.Public health nursing services  Issued 6-25-07
317:30-5-1159.Tuberculosis  Issued 6-25-07
317:30-5-1160.Public health nursing services for first time mothers and their infants/children (Children's First program)  Issued 6-25-07
317:30-5-1161.Targeted case management  Issued 6-25-07
PART 113. LIVING CHOICE PROGRAM
317:30-5-1200.Benefits for members age 65 or older with disabilities or long-term illnesses  Issued 12-1-08
317:30-5-1201.Benefits for members with mental retardation  Issued 12-1-08
317:30-5-1202.Benefits for members with physical disabilities  Issued 12-1-08
317:30-5-1203.Billing procedures for Living Choice services  Issued 12-1-08
317:30-5-1204.Disclosure of information on health care providers and contractors  Issued 12-1-08
317:30-5-1205.Community transition services  Issued 12-1-08
317:30-5-1206.Transition coordinator services  Issued 12-1-08


Last Updated:  1/12/2012
Oklahoma Department of Human Services
Street address: Sequoyah Memorial Office Building, 2400 N. Lincoln Blvd., Oklahoma City, OK 73105
Mailing address: P.O. Box 25352, Oklahoma City, OK 73125
(405) 521-3646
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