Current through Vol. 42, No. 1, September 16, 2024
Health Center services are covered for SoonerCare adults
and children as set forth in this Part, unless otherwise specified.
(1) Services furnished by a physician, PA,
APRN, CNM, CP, or CSW.
(2) Services
and supplies incident to services provided by a physician, PA, APRN, CNM, CP,
or CSW are covered in accordance with
42 C.F.R
§§
405.2413 and
405.2415,
if the service or supply is:
(A) Furnished in
accordance with State law;
(B) A
type commonly furnished in physicians' offices;
(C) A type commonly rendered either without
charge or included in the FQHC's bill;
(D) Furnished as an incidental, although
integral, part of a physician, PA, APRN, CNM, CP or CSW services; or
(E) Furnished under the direct supervision of
a physician PA, APRN, or CNM; and
(F) Drugs and biologicals which cannot be
self-administered or are specifically covered by Medicare law, are included
within the scope of FQHC services. Drugs and biologicals commonly used in life
saving procedures, such as analgesics, anesthetics (local), antibiotics,
anticonvulsants, antidotes and emetics, serums and toxoids are not billed
separately.
(G) "Services and
supplies incident to" include but are not limited to services such as minor
surgery, reading x-rays, setting casts or simple fractures and other activities
that involve evaluation or treatment of a patient's condition. They also
include laboratory services performed by the Health Center, specimen collection
for laboratory services furnished by an off-site CLIA certified laboratory and
injectable drugs.
(3)
Visiting nurse services to the homebound are covered if:
(A) The FQHC is located in an area in which
the Secretary of Health and Human Services has determined there is a shortage
of home health agencies;
(B) The
services are rendered to members who are homebound;
(C) The member is furnished nursing care on a
part-time or intermittent basis by a registered nurse, licensed practical
nurse, or licensed vocational nurse who is employed by or receives compensation
for the services from the FQHC; and
(D) The services are furnished under a
written plan of treatment as required by
42 C.F.R §
405.2416.
(4) Preventive primary services in accordance
with
42 C.F.R §
405.2448;
(5) Medical nutrition services in accordance
with OAC
317:30-5-1075
through
317:30-5-1076;
and
(6) Preventive primary dental
services.
Added at 23 Ok Reg
3183, eff 6-7-06 (emergency); Added at 24 Ok Reg 2105, eff 6-25-07; Amended at
28 Ok Reg 123, eff 10-14-10 (emergency); Amended at 28 Ok Reg 1443, eff
6-25-11
