Current through Vol. 42, No. 1, September 16, 2024
(a)
General provisions.
(1) Payment is made to eligible providers
certified by the Oklahoma State Department of Education (OSDE) or the Oklahoma
State Department of Health (OSDH) for the delivery of Early Periodic Screening,
Diagnosis and Treatment (EPSDT) services to infants and toddlers from birth up
to their third birthday with developmental disabilities, pursuant to the
requirements of the Individuals with Disabilities Education Improvement Act
(IDEIA) of 2004, Public
Law 108-446 Part C, and subsequent
amendments.
(2) EPSDT services are
comprehensive child-health services, designed to ensure the availability of,
and access to, required health care resources and to help parents and guardians
of SoonerCare eligible children use these resources. Effective EPSDT services
assure that health problems are diagnosed and treated early before they become
more complex and their treatment more costly. The OSDE and the OSDH play a
significant role in educating parents about EPSDT services.
(3) An Individualized Family Services Plan
(IFSP) entitles the SoonerCare eligible child to medically necessary and
appropriate health related EPSDT treatment services. Such services must be
allowable under federal Medicaid regulations and must be necessary to
ameliorate or correct defects of physical or mental illnesses or
conditions.
(4) Federal regulations
require that the State set standards and protocols for each component of EPSDT
services. The standards must provide for services at intervals that meet
reasonable standards of medical and dental practice. The standards must also
provide for EPSDT services at other intervals as medically necessary to
determine the existence of certain physical and mental illnesses or conditions.
SoonerCare providers who offer EPSDT screenings must assure that the screenings
they provide meet the minimum standards for those services in order to be
reimbursed at the level established for EPSDT services.
(b)
Eligible providers. Eligible
providers are state education and health departments and their contract
agencies as designated in the State's Plan for Early Intervention Services,
developed in response to the requirements of Part C of the IDEIA and who are
enrolled as eligible SoonerCare providers. A completed contract to provide
EPSDT health related services must be submitted to the Oklahoma Health Care
Authority (OHCA). Providers must have a SoonerCare provider agreement in order
to receive reimbursement.
Added at 12 Ok Reg
751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
7-27-95; Amended at 16 Ok Reg 1927, eff 6-11-99; Amended at 23 Ok Reg 2562, eff
6-25-06
