Oklahoma Administrative Code
Title 317 - Oklahoma Health Care Authority
Chapter 30 - Medical Providers-Fee for Service
Subchapter 5 - Individual Providers and Specialties
Part 62 - PRIVATE DUTY NURSING
Section 317:30-5-557 - Coverage by category

Universal Citation: OK Admin Code 317:30-5-557

Current through Vol. 42, No. 1, September 16, 2024

(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.

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

Disclaimer: These regulations may not be the most recent version. Oklahoma may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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