OHCA Policies and Rules

Search Entire Policy
OHCA Policies and Rules Main Page


317:30-5-545.Eligible providers

[Revised 08-01-20]
   All eligible home health service providers must be Medicare certified, or have deemed status with Medicare, and have a current contract with the Oklahoma Health Care Authority (OHCA).  Home health agencies billing for medical supplies, equipment, and appliances must have a supplier contract and bill equipment on claim form CMS-1500.  Additionally, home health services providers that did not participate in Medicaid prior to January 1, 1998, must meet the "Capitalization Requirements" set forth in 42 Code of Federal Regulations (C.F.R.)
' 489.28.  Home health services providers that do not meet these requirements will not be permitted to participate in the Medicaid program.

317:30-5-546.Coverage by category

[Revised 08-01-20]
   Payment is made for home health services as set forth in this section when a face-to-face encounter has occurred in accordance with provisions of 42 Code of Federal Regulations (C.F.R.) ' 440.70. Payment is made for home health services provided in the member's residence and in any setting in which normal life activities take place except for a hospital, long-term care facility, or intermediate care facility for individuals with intellectual disabilities. For individuals eligible for Part B of Medicare, payment is made utilizing the Medicaid allowable for comparable services.


[Revised 08-01-20]
(a) Nursing services and home health aide services are covered services on a per visit basis.  Thirty-six (36) visits per calendar year of nursing and/or home health aide services for any member do not require prior authorization; however, any visit surpassing thirty-six (36) would require prior authorization and medical review.

(b) Reimbursement for durable medical equipment and supplies will be made using the amount derived from the lesser of the Oklahoma Health Care Authority (OHCA) fee schedule or the provider's usual and customary charge.   When a procedure code is not assigned a maximum allowable fee for a unit of service, a fee will be established.  Once the service has been provided, the supplier is required to include a copy of the invoice documenting the supplier's cost of the item with the claim.

(c) Reimbursement for oxygen and oxygen supplies is as follows:

(1) Payment for oxygen systems (stationary, liquid and oxygen concentrators) is based on continuous rental, i.e., a continuous monthly payment is made as long as it is medically necessary. The rental payment includes all contents and supplies, i.e., regulators, tubing, masks, etc. Portable oxygen systems are also considered continuous rental.  Ownership of the equipment remains with the supplier.

(2) Separate payment will not be made for maintenance, servicing, delivery, or for the supplier to pickup the equipment when it is no longer medically necessary.

(3) Payment for oxygen and oxygen equipment and supplies will not exceed the Medicare fee for the same procedure code. The fee schedule will be reviewed annually and adjustments to the fee schedule may be made at any time based on efficiency, budget considerations, and quality of care as determined by the OHCA.

(4) Physical therapy, occupational therapy, and/or speech pathology and audiology services, are not covered when provided by a home health agency.




317:30-5-548.Procedure codes

[Revised 08-01-20]
   All home health services are billed using Healthcare Common Procedure Coding System (HCPCS) codes.

317:30-5-549.Prosthetic devices [REVOKED]

[Revoked 08-01-20]

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.