Okla. Admin. Code § 317:30-5-557

Current through Vol. 42, No. 4, November 1, 2024

Section 317:30-5-557 - Coverage by category

(a)Adults. SoonerCare does not cover adults [twenty-one (21) years of age and over] for private duty nursing(PDN) with the exception of subsection (c).

(b)Children. SoonerCare does cover children [under twenty-one (21) years of age] if:

(1) The member is eligible for SoonerCare; and

(2) The Oklahoma Health Care Authority(OHCA), in its discretion, deems the services medically necessary. Medical necessity is determined in accordance with Oklahoma Administrative Code (OAC) 317:30-5-560.1.

(c)Individuals eligible for Part B of Medicare. Payment is made utilizing the SoonerCare allowable for comparable services.

(d)1915(c) home and community-based services (HCBS) waivers. If private duty nursing services are provided, they will be defined within each waiver and must be prior authorized.

Okla. Admin. Code § 317:30-5-557

Added at 23 Ok Reg 33, eff 8-1-05 (emergency); Added at 23 Ok Reg 1364, eff 5-25-06; Amended at 28 Ok Reg 14, eff 8-13-10 (emergency); Amended at 28 Ok Reg 1429, eff 6-25-11

Amended by Oklahoma Register, Volume 39, Issue 24, September 1, 2022, eff. 9/12/2022