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 317:30-5-560.1 - Prior authorization requirements
Universal Citation: OK Admin Code 317:30-5-560.1
Current through Vol. 42, No. 1, September 16, 2024
(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, or his or her
designee, 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.
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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