Okla. Admin. Code § 317:30-5-575

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

Section 317:30-5-575 - General information

(a)Clinic services. Clinic services means preventive, diagnostic, therapeutic, rehabilitative, or palliative services that are furnished by a facility that is not part of a hospital but is organized and operated to provide medical care to outpatients. The term includes the following services furnished to outpatients:

(1) Services furnished at the clinic by or under the direction of a physician or a dentist.

(2) Services furnished outside the clinic, by clinic personnel under the direction of a physician, to an eligible individual who does not reside in a permanent dwelling or does not have a fixed home or mailing address.

(3) Teleheath and audio-only health service delivery requires either the provider or the member to be located at the freestanding clinic that is providing services pursuant to 42 Code of Federal Regulations (CFR) § 440.90. Refer to section Oklahoma Administrative Code (OAC) 317:30-3-27 for telehealth policy and OAC 317:30-327.1 for audio-only telecommunication policy.

(b)Prior authorization. OHCA requires prior authorization for certain procedures to validate the medical need for the service.

(c)Medical necessity. Medical necessity requirements are listed at OAC 317:30-3-1(f).

Okla. Admin. Code § 317:30-5-575

Added at 28 Ok Reg 1394, eff 6-25-11

Amended by Oklahoma Register, Volume 40, Issue 23, August 15, 2023, eff. 7/6/2023 (emergency)

Amended by Oklahoma Register, Volume 41, Issue 23, August 15, 2024, eff. 9/1/2024