Oklahoma Administrative Code
Title 317 - Oklahoma Health Care Authority
Chapter 30 - Medical Providers-Fee for Service
Subchapter 5 - Individual Providers and Specialties
Part 83 - THERAPEUTIC FOSTER CARE
Section 317:30-5-743.1 - Service quality review (SQR)

Universal Citation: OK Admin Code 317:30-5-743.1
Current through Vol. 42, No. 1, September 16, 2024

There will be an SQR performed by the Oklahoma Health Care Authority (OHCA) or its designated agent of each TFC agency that provides care to members. The OHCA will designate the members of the SQR team . This team will consist of at least two(2) team members and will be comprised of licensed behavioral health professionals (LBHPs) and/or registered nurses (RNs) . The SQR will consist of a survey of current members receiving services, as well as members for which claims have been filed with OHCA for TFC services. Observation and contact with members may be incorporated. The review includes validation of certain factors, all of which must be met for the services to be compensable. Following the review, the SQR team will report its findings to the TFC agency. The TFC agency will be provided with written notification if the findings of the SQR have resulted in any deficiencies. A copy of the final report will be sent to the TFC agency's accrediting body. Deficiencies found during the SQR may result in a recoupment of the compensation received for that service. The individual plan of care(IPC) is considered to be critical to the integrity of care and treatment and must be completed within the timelines designated at Oklahoma Administrative Code (OAC) 317:30-5-742.2. If the IPC is missing, or it is found that the member did not meet medical necessity criteria at any time, all paid services will be recouped for each day the IPC was missing from the date the plan of care was due for completion or the date from which medical necessity criteria was no longer met.

Added at 23 Ok Reg 2566, eff 6-25-06; Amended at 24 Ok Reg 2857, eff 7-1-07 (emergency); Amended at 25 Ok Reg 1200, eff 5-25-08; Amended at 27 Ok Reg 1360, eff 4-21-10 (emergency); Amended at 28 Ok Reg 1419, 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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