OHCA Policies and Rules

Search Entire Policy
OHCA Policies and Rules Main Page


Chapter 25SOONERCARE
SubChapter 1HEALTH PLAN COMPETITIVE BID REQUIREMENTS [REVOKED]
317:25-1-1.Purpose [REVOKED]
317:25-1-2.Definitions [REVOKED]
317:25-1-3.General purchasing provisions [REVOKED]
317:25-1-4.Health Plan registration [REVOKED]
317:25-1-5.Health Plan retention and removal from bidder list [REVOKED]
317:25-1-6.Submission of bids [REVOKED]
317:25-1-7.Bid openings [REVOKED]
317:25-1-8.Award of bid [REVOKED]
317:25-1-9.Best and final offer (BFO) or additional negotiation processes [REVOKED]
317:25-1-10.Terms and conditions for acceptable bids [REVOKED]
317:25-1-11.Challenge of award [REVOKED]
317:25-1-12.Administrative review [REVOKED]
317:25-1-13.Confidentiality [REVOKED]
SubChapter 3HEALTH MAINTENANCE ORGANIZATIONS [REVOKED]
317:25-3-1.Health Maintenance Organizations [REVOKED]
317:25-3-2.Public managed care plans [REVOKED]
317:25-3-2.1.Reinsurance [REVOKED]
317:25-3-2.2.Health Care Authority Risk Control Program [REVOKED]
317:25-3-3.Quality Assurance credentialing and recredentialing requirements [REVOKED]
SubChapter 5SOONERCARE PLUS [REVOKED]
Part 1GENERAL PROVISIONS
317:25-5-1.Purpose [REVOKED]
317:25-5-2.SoonerCare Plus overview [REVOKED]
317:25-5-3.Definitions [REVOKED]
317:25-5-4.Health Plan proposals to the Oklahoma Health Care Authority and the DUR for modifying medication coverage [REVOKED]
317:25-5-5. Contractor payments to providers [REVOKED]
Part 3ENROLLMENT CRITERIA
317:25-5-10.Enrollment in SoonerCare Plus [REVOKED]
317:25-5-11.Geographic Coverage Areas [REVOKED]
317:25-5-12.Enrollment requirements [REVOKED]
317:25-5-13.Enrollment ineligibility [REVOKED]
317:25-5-14.Availability of plan choices [REVOKED]
Part 5ENROLLMENT PROCESS
317:25-5-25.Recipient enrollment process [REVOKED]
317:25-5-26.Automatic re-enrollment [REVOKED]
317:25-5-27.Primary care provider selection or assignment [REVOKED]
317:25-5-28.Disenrollment from a Health Plan by the client [REVOKED]
317:25-5-29.Termination of a client's enrollment by the Health Plan [REVOKED]
317:25-5-30.Plan benefit package [REVOKED]
317:25-5-31.Obtaining Medicaid services not covered under the plan [REVOKED]
317:25-5-32.Emergency and family planning services [REVOKED]
Part 7PLAN REQUIREMENTS
317:25-5-40.Health Plan Qualifications for Participation [REVOKED]
317:25-5-41.Primary Care Provider (PCP) [REVOKED]
317:25-5-41.1.Medical residents serving as primary care providers [REVOKED]
Part 9 SPECIAL PROVISIONS
317:25-5-50.Supplemental payments to medical schools [REVOKED]
SubChapter 7SOONERCARE
Part 1GENERAL PROVISIONS
317:25-7-1.Purpose
317:25-7-2.SoonerCare Choice: overview
317:25-7-2.1.Medical residents [REVOKED]
317:25-7-3.Definitions
317:25-7-4.Credentialling and e-credentialling [REVOKED]
317:25-7-5.Primary care providers
317:25-7-6.Primary Care Provider responsibilities
317:25-7-7.Referrals for specialty services
Part 3ENROLLMENT CRITERIA
317:25-7-10.Enrollment with a Primary Care Provider
317:25-7-11.Geographic coverage areas
317:25-7-12.Enrollment/eligibility requirements
317:25-7-13.Enrollment ineligibility
Part 5ENROLLMENT PROCESS
317:25-7-25.Member enrollment process
317:25-7-26.Automatic re-enrollment
317:25-7-27.Changing PCPs
317:25-7-28.Disenrolling a member from SoonerCare
Part 7COORDINATION AND CONTINUITY OF CARE
317:25-7-29.Screening, diagnosis and preventive benefits
317:25-7-30.Obtaining SoonerCare services
Part 9REIMBURSEMENT
317:25-7-40.SoonerCare Choice reimbursement
SubChapter 9HEALTH ACCESS NETWORKS
317:25-9-1.Purpose
317:25-9-2.Requirements
317:25-9-3.Reimbursement

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.