OHCA Policies and Rules
(a) For residents in a nursing facility, most DMEPOS are considered part of the facility's per diem rate. The following are not included in the per diem rate and may be billed by the appropriate medical supplier:
(1) Services requiring prior authorization:
(A) ventilators and supplies;
(B) total parenteral nutrition (TPN), and supplies;
(C) custom seating for wheelchairs; and
(D) external breast prosthesis and support accessories.
(2) Services not requiring prior authorization:
(A) permanent indwelling or male external catheters and catheter accessories;
(B) colostomy and urostomy supplies;
(C) tracheostomy supplies;
(D) catheters and catheter accessories;
(E) oxygen and oxygen concentrators.
(i) PRN oxygen. Members in nursing facilities requiring oxygen PRN will be serviced by oxygen kept on hand as part of the per diem rate.
(ii) Billing for Medicare eligible nursing home members. Oxygen supplied to Medicare eligible nursing home members may be billed directly to OHCA. It is not necessary to obtain a denial from Medicare prior to filing the claim with OHCA.
(b) Items not covered include but are not limited to:
(3) medicine cups;
(4) eating utensils; and
(5) personal comfort items.
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.