Oklahoma Administrative Code
Title 317 - Oklahoma Health Care Authority
Chapter 30 - Medical Providers-Fee for Service
Subchapter 5 - Individual Providers and Specialties
Part 114 - DOULA SERVICES
Section 317:30-5-1217 - General coverage
Current through Vol. 41, No. 13, March 15, 2024
(a) Covered benefits. The following benefits are covered:
(b) Visit requirements. Each covered visit is subject to the following requirements:
(c) Service locations. Service location requirements for each covered visit are as follows:
(d) Referral requirements. Doula services must be recommended by a physician or other licensed practitioner of the healing arts who is operating within the scope of their practice under State law.
(e) Prior authorization (PA) requirements. A prior authorization (PA) is not required to access the standard doula benefit package. A PA may be submitted, for members with extenuating medical circumstances, if there is need for additional visits beyond the eight (8) prenatal/postpartum visits.
(f) Medical records requirements. The medical record must include, but is not limited to, the following:
(g) Auditing review. All doula services are subject to post-payment reviews and audits by the OHCA.
(h) Reimbursement. All doula services, that are outlined in Part 114 of this Chapter, are reimbursed per the methodology established in the Oklahoma Medicaid State Plan. There are no allotted incentive payments.