Okla. Admin. Code § 317:30-5-742.1

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

Section 317:30-5-742.1 - Reimbursement

(a) TFC services will be paid at the current fee-for-service (FFS) rate. Services provided to a member without a written individual plan of care (IPC) as described in Oklahoma Administrative Code (OAC) 317:30-5-742.2 will not be reimbursed.

(b) Additional services may require prior authorization by the OHCA, or its designated agent. Refer to OAC 317:30-3-31. Documentation must be provided to ensure that services are not duplicative. If additional services are approved for a member in state custody, the Oklahoma Department of Human Services (OKDHS), or Oklahoma Office of Juvenile Affairs (OJA) will collaborate with the provider of such services as directed by the OHCA.

(c) Reimbursement for TFC services is not available for the following:

(1) Room and board;

(2) Educational costs;

(3) Supported employment;

(4) Inpatient psychiatric services;

(5) Respite care;

(6) Day treatment services;

(7) Partial hospitalization services; and

(8) Intensive outpatient services.

(d) Case management services are reimbursed to government providers as per the methodology in the approved Oklahoma Medicaid State Plan.

Okla. Admin. Code § 317:30-5-742.1

Added at 17 Ok Reg 2402, eff 6-26-00; Amended at 20 Ok Reg 523, eff 12-1-02 (emergency); Amended at 20 Ok Reg 1216, eff 5-27-03; Amended at 24 Ok Reg 2857, eff 7-1-07 (emergency); Amended at 25 Ok Reg 1200, eff 5-25-08; Amended at 27 Ok Reg 1360, eff 4-21-10 (emergency); Amended at 28 Ok Reg 1419, eff 6-25-11

Amended by Oklahoma Register, Volume 37, Issue 24, September 1, 2020, eff. 9/14/2020