OKDHS - OAC 340:75-13-64. Sources of funding forr medical services

340:75-13-64. Sources of funding for medical services

Back

|

Next

Revised 7-1-11

Medical services for children in Oklahoma Department of Human Services (OKDHS) custody are paid through a variety of funds.

(1) Title XIX Medicaid and Children's Special Health Care Needs program. Title XIX Medicaid, a combination of state and federal money, is administered through Oklahoma Health Care Authority (OHCA). Medicaid claims are paid from the OHCA budget through a designated fiscal agent. The Medicaid program:
- (A) has specific eligibility requirements;
- (B) covers specific services as determined by Oklahoma's State Plan; and
- (C) does not pay for experimental procedures.
(2) Child Welfare medical - special approval. Children and Family Services Division (CFSD) has limited funds, state monies, that are utilized when the needed service, excluding experimental procedures, is not covered by other medical programs. Utilization of these funds is considered for approval by CFSD Administrative Services Unit after denial by Title XIX and OHCA. Only services for children in OKDHS custody and out-of-home placement are eligible for payment from these funds. All expenditures paid from state funds are paid at the Oklahoma Medicaid compensable amount.
(3) Child abuse examinations. When a child abuse examination is warranted, the reimbursement process is dependent upon the child's medical assistance case status on the date of the examination. When the child is:
- (A) not a Medicaid recipient and the parent(s) is unable or unwilling to pay for the examination, state funds pay for the examination at established Medicaid rates. The provider completes claims per OAC 317:30-7-1. The claim is routed to the county director with an explanation for using state funds; or • 1
- (B) a Medicaid recipient and is designated eligible for:
  - (i) fee-for-service, OHCA reimburses for these services at the established rates; or
  - (ii) SoonerCare, OHCA reimburses for these services at the established rates.

INSTRUCTIONS TO STAFF

Revised 6-1-07

1. Review of funding claim. The county director reviews the claim information to ensure the funding source is appropriate. After county director approval, the claim is attached to Form 10CL017E, Claim Code Slip, and forwarded to Oklahoma Department of Human Services Finance Division. When requesting payment of a child abuse and neglect examination, staff ensures that Form 10CL017E, includes:

(1) Fund: 32X;

(2) County number: 99;

(3) Building number: 999;

(4) Vendor federal employer identification (FEI) number or Social Security number: provider's federal tax identification number or Social Security number;

(5) Purchase authorization (PA) number: XX909040;

(6) Invoice number: child's account number listed on claim;

(7) Invoice date: date claim was signed;

(8) Date received: date service was received;

(9) HJR 1010 date: date claim and form are sent to Finance Division;

(10) Account number: 2112;

(11) Location code: 95060;

(12) Object code: 511100; and

(13) Case number: child's KK number.

Back

|

Next