Okla. Admin. Code § 317:30-5-560.1

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

Section 317:30-5-560.1 - [Effective 9/14/2025] Prior authorization requirements

(a) Authorizations are provided for a maximum period of six(6) months.

(b) Authorizations require:

(1) A treatment plan for the member;

(2) An assessment (telephonic, virtual, or face-to-face) has been conducted by an Oklahoma Health Care Authority (OHCA) care management nurse, per Oklahoma Administrative Code (OAC) 317:30-5-558(2); and

(3) An OHCA physician to determine medical necessity including use of the OHCA Private Duty Nursing (PDN) assessment.

(c) The number of hours authorized may differ from the hours requested on the treatment plan based on the review by an OHCA physician.

(d) If the member's condition necessitates a change in the treatment plan, the provider must request a new prior authorization.

(e) Changes in the treatment plan may necessitate another assessment (telephonic, virtual, or face-to-face) by an OHCA care management nurse.

Okla. Admin. Code § 317:30-5-560.1

Added at 23 Ok Reg 33, eff 8-1-05 (emergency); Added at 23 Ok Reg 1364, eff 5-25-06; Amended at 24 Ok Reg 333, eff 12-1-06 (emergency); Amended at 24 Ok Reg 930, eff 5-11-07; 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 32, Issue 23, August 17, 2015, eff. 8/27/2015

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

Amended by Oklahoma Register, Volume 41, Issue 17, May 15, 2024, eff. 3/27/2024, exp. 9/14/2025 (Emergency)