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Part 75      FEDERALLY QUALIFIED HEALTH CENTERS

317:30-5-660.Eligible providers
[Revised 06-25-07]
(a) Federally Qualified Health Centers (FQHC) are entities or programs more commonly known as Community Health Centers, Migrant Health Centers, and Health Care for the Homeless Programs. The facilities in this Part are hereafter referred to as "Health Centers" or "Centers".
(b) For purposes of providing covered services under Medicaid, Health Centers may qualify by one of the following methods:
(1) The entity receives a grant under Section 330 of the Public Health Service (PHS) Act (Public Law 104-229), receives funding from such grants under a contract with the recipient of such a grant and includes an outpatient health program or entity operated by a tribe or tribal organization under the Indian Self-Determination Act (Public Law 93-638);
(2) The Health Resources and Services Administration (HRSA) within the PHS recommends, and the Secretary determines that, the entity meets the requirements for receiving such a grant; or
(3) The Secretary of Health and Human Services determines that an entity may, for good cause, qualify through waiver of requirements. Such a waiver cannot exceed a period of two years.
(c) Any entity seeking to qualify as a FQHC should contact the U.S. Public Health Service.

317:30-5-660.1.Health Center multiple sites contracting
[Revised 09-01-15]

(a) Health Centers may contract as SoonerCare Traditional providers and as a PCP/CM under SoonerCare Choice (Refer to OAC 317:25-7-5).

(b) Health Centers are required to submit a list of all entities affiliated or owned by the Center including any programs that do not have Health Center status, along with all OHCA provider numbers.

(c)  Payment for FQHC services is based on a Prospective Payment System (PPS). (Refer to OAC 317:30-5-664.10) In order to be eligible for reimbursement under this method for covered services, in traditional primary care settings, each site must submit an approval copy of the Health Resource and Service Administration (HRSA) Notice of Grant Award Authorization for Public Health Services Funds under Section 330, (or a copy of the letter from CMS designating the facility as a "Look Alike" FQHC) at the time of enrollment.
317:30-5-660.2.Health Center professional staff
[Revised 06-25-07]
(a) Health Centers must either directly employ or contract the services of legally credentialed professional staff that are authorized within their scope of practice under state law to provide the services for which claims are submitted to OHCA or its designated agent.
(b) Professional staff contracted or employed by the Health Center recognized by the OHCA for direct reimbursement are required to individually enroll with the OHCA and will be affiliated with the organization which contracts or employs them. Participating Health Centers are required to submit a list of names upon request of all practitioners working within the Center and a list of all individual OHCA provider numbers. Reimbursement for services rendered at or on behalf of the Health Center is made to the organization. Practitioners eligible for direct reimbursement for providing services to a clinic patient outside of the clinic may bill with their individual assigned number if they are not compensated under agreement by the Health Center.
(c) Other providers who are not eligible for direct reimbursement may be recognized by OHCA for the provision and payment of FQHC services to a health center as long as they are legally credentialed under state law and OHCA enrollment requirements.

317:30-5-660.3.Health Center enrollment requirements for other behavioral health services
[Revised 09-01-17]

(a) For the provision of behavioral health related case management services and psychosocial rehabilitation services, Health Centers must contract as an outpatient behavioral health agency and meet the requirements found at OAC 317:30-5-241.3 and 317:30-5-241.6.

(b) Health Centers which provide substance use treatment services must also be certified by the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS).

 



317:30-5-660.4.Health Center enrollment requirements for health services in a school setting
[Revised 06-25-11]
 (a)   Physical and behavioral health services provided in accordance with the Individuals with Disabilities Education Act (IDEA) and pursuant to an Individual Education Plan (IEP) or Individual Family Service Plan (IFSP) are the responsibility of the school district. Health Centers must contract with the school district and invoice the school district for services rendered. (Refer to OAC 317:30-5-1020 through 30-5-1027). Reimbursement is made directly to the school. 
(b)   Payment may be made for FQHC services to Health Centers that have a school-based health center that meets the definition of Section 2110(c)(9) of the Social Security Act.
317:30-5-660.5.Health Center service definitions
[Revised 09-01-16]

The following words and terms, when used in this Subchapter, shall have the following meaning, unless the context clearly indicates otherwise:

"Core Services" means outpatient services that may be covered when furnished to a patient at the Center or other location, including the patient's place of residence.

"Encounter or Visit" means a face-to-face contact between an approved health care professional as authorized in the FQHC state plan pages and an eligible SoonerCare member for the provision of defined services through a Health Center within a 24-hour period ending at midnight, as documented in the patient's medical record.

"Licensed Behavioral Health Professional (LBHP)" means licensed psychologists, licensed clinical social workers (LCSWs), licensed marital and family therapists (LMFTs), licensed professional counselors (LPCs), licensed behavioral practitioners (LBPs), and licensed alcohol and drug counselors (LADCs).

"Other ambulatory services" means other health services covered under the State plan other than core services.

"Physician" means:

(A) a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which the function is performed or who is a licensed physician employed by the Public Health Service;

(B) within limitations as to the specific services furnished, a doctor of dentistry or dental or oral surgery, a doctor of optometry, or a doctor of podiatry;

"Physicians' services" means professional services that are performed by a physician at the Health Center (or are performed away from the Center, excluding inpatient hospital services) whose agreement with the Center provides that he or she will be paid by the Health Center for such services.

   "PPS" means prospective payment system all-inclusive per visit rate method specified in the State plan.
317:30-5-661.Coverage by category
[Revised 06-07-06]
Health Center services are covered for SoonerCare adults and children as set forth in this Part, unless otherwise specified.

317:30-5-661.1.Health Center core services
[Revised 09-01-17]

Health Center "core" services include:

(1) Physicians' services and services and supplies incident to a physician's services;

(2) Services of advanced practice nurse (APNs), physician assistants (PAs), certified nurse midwives (CNMs), or specialized advanced practice nurse practitioners;

(3) Services and supplies incident to the services of APNs, certified nurse midwives, and PAs;

(4) Visiting nurse services to the homebound;

(5) Behavior health professional services as authorized under the FQHC State Plan pages and services and supplies incident thereto;

(6) Preventive primary care services;

(7) Preventive primary dental services.


317:30-5-661.2.Services and supplies "incident to" Health Center encounters
[Revised 06-25-07]
(a) Services and supplies incident to the service of covered health center providers may be covered if the service or supply is:
(1) of a type commonly furnished in physician offices;
(2) of a type commonly rendered either without charge or included in the Health Center's bill;
(3) furnished as an incidental, although integral, part of professional services furnished by a physician, advanced practice nurse, physician assistant, certified nurse midwife, or specialized advanced practice nurse;
(4) furnished under the direct, personal supervision of an advanced practice nurse, physician assistant, certified nurse midwife, specialized advanced practice nurse or a physician; and
(5) in the case of a service, furnished by a member of the Health Center's health care staff who is an employee or contractor of the organization.
(b) "Services and supplies incident to" include 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.

317:30-5-661.3.Visiting Nurse services
[Revised 06-25-07]
Visiting Nurse services may be covered if the Health Center is located in an area in which the Secretary of Health and Human Services has determined that there is a shortage of home health agencies.

317:30-5-661.4.Behavioral health professional services provided at Health Centers and other settings
[Revised 09-01-17]

(a) Medically necessary behavioral health services that are primary, preventive, and therapeutic and that would be covered if provided in another setting may be provided by Health Centers. Services provided by a Health Center (refer to OAC 317:30-5-241 for a description of services) must meet the same requirements as services provided by other behavioral health providers. Rendering providers must be eligible to individually enroll or meet the requirements as an agency/organization provider specified in OAC 317:30-5-240.2 and 317:30-5-280. Behavioral Health Services include:

(1) Assessment/Evaluation;

(2) Crisis Intervention Services;

(3) Individual/Interactive Psychotherapy;

(4) Group Psychotherapy;

(5) Family Psychotherapy;

(6) Psychological Testing; and

(7) Case Management (as an integral component of services 1-6 above).

(b) Medically necessary behavioral health professional therapy services are covered when provided in accordance with a documented individualized treatment plan, developed to treat the identified behavioral health disorder(s). A one-on-one standard clinical session must be completed by a health care professional authorized in the approved FQHC State Plan pages in order to bill the PPS encounter rate for the session. Services rendered by providers not authorized under the approved FQHC state plan pages to bill the PPS encounter rate will be reimbursed pursuant to the SoonerCare fee-for-service fee schedule and must comply with rules found at OAC 317:30-5-280 through 317:30-5-283. Behavioral health services must be billed on an appropriate claim form using appropriate Current Procedural Terminology (CPT) procedure code and guidelines. The time indicated on the claim form must be the time actually spent with the member.

(c) Centers are reimbursed the PPS rate for services when rendered by approved health care professionals, as authorized under FQHC state plan pages, if the Health Center receives funding pursuant to Section 330 or is otherwise funded under Public Law to provide primary health care services at locations off-site (not including satellite or mobile locations) to Health Center patients on a temporary or intermittent basis, unless otherwise limited by Federal law.

(d) Health Centers that operate day treatment programs in school settings must meet the requirements found at OAC 317:30-5-240.2(b)(7).

(e) In order to support the member's access to behavioral health services, these services may take place in settings away from the Health Center. Off-site behavioral health services must take place in a confidential setting.

 

317:30-5-661.5.Health Center preventive primary care services
[Revised 06-25-11]
(a) Preventive primary care services are those health services that:
(1) a HealthCenter is required to provide as preventive primary health services under section 330 of the Public Health Service Act;
(2) are furnished by or under the direct supervision of an APN, PA, CNMW, specialized advanced practice nurse practitioner, licensed psychologist, LCSW ,a physician, or other approved health care professional as authorized in the FQHC state plan pages;
(3) are furnished by a member of the Health Center's health care staff who is an employee of the Center or provides services under arrangements with the Center; and
(4) includes only drugs and biologicals that cannot be self-administered.
(b) Preventive primary care services which may be paid for when provided by Health Centers include:
(1) medical social services;
(2) nutritional assessment and referral;
(3) preventive health education;
(4) children's eye and ear examinations;
(5) prenatal and post-partum care;
(6) perinatal services;
(7) well child care, including periodic screening (refer to    OAC 317:30-3-65);
(8) immunizations, including tetanus-diphtheria booster and influenza vaccine;
(9) voluntary family planning services;
(10) taking patient history;
(11) blood pressure measurement;
(12) weight;
(13) physical examination targeted to risk;
(14) visual acuity screening;
(15) hearing screening;
(16) cholesterol screening;
(17) stool testing for occult blood;
(18) dipstick urinalysis;
(19) risk assessment and initial counseling regarding risks;
(20) tuberculosis testing for high risk patients;
(21) clinical breast exam;
(22) referral for mammography;
(23) thyroid function test; and
(24) dental services (specified procedure codes).
317:30-5-661.6.Health Center preventive and primary care exclusions
[Revised 06-25-07]
Preventive primary care Health Center services do not include:
(1) health education classes, or group education activities, including media productions and publications, group or mass information programs;
(2) eyeglasses or hearing aids (except under EPSDT);
(3) screening mammography provided at a Health Center unless the Center meets the requirements as specified in OAC 317:30-5-900; and
(4) vaccines covered by the Vaccines For Children program (refer to OAC 317:30-5-14).

317:30-5-661.7.Off-site services
[Revised 06-25-07]
(a) Off-site Services means services provided at a location other than the Center. Off-site services are considered Health Center services if the physician's or other practitioner's agreement requires that he or she seek reimbursement from the Health Center. Off-site services include services provided at mobile health clinics operated by the Center. Services provided by Centers in school settings (i.e., the school has no responsibility/no contract with OHCA and a parental authorization must be on file) are considered off-site services.
(b) Medically necessary Health Center services provided off-site or outside of the Health Center setting are compensable when billed by the Center. The Health Center must have a written contract with the physician and other Center core practitioners that specify that Center services provided off-site will be billed to Medicaid and, how such providers will be compensated. It is expected that services provided in off-site settings should be, in most cases, temporary and intermittent, i.e., when the member cannot come to the clinic due to health reasons.
(c) In order to support the member's access to behavioral health services, these services may take place in settings away from the Center. Off-site behavioral health services must take place in a confidential setting.

317:30-5-662.Reimbursement [REVOKED]
[Revoked 06-07-06]

317:30-5-663.Billing [REVOKED]
[Revoked 06-07-06]

317:30-5-664.Timely filing [REVOKED]
[Revoked 06-07-06]

317:30-5-664.1.Provision of other health services outside of the Health Center core services
[Revised 01-06-2020]

(a) If the Center chooses to provide other Oklahoma Medicaid State Plan covered health services which are not included in the Health Center core service definition in Oklahoma Administrative Code (OAC) 317:30-5-661.1, the practitioners of those services are subject to the same program coverage limitations, enrollment, and billing procedures described by the OHCA, and these services (e.g., home health services) are not included in the PPS settlement methodology in OAC 317:30-5-664.12.

(b) Other medically necessary health services that will be reimbursed at the fee-for-service (FFS) rate include, but are not limited to:

(1) Dental services (refer to OAC 317:30-5-696) except for primary preventive dental services;

(2) Eyeglasses (refer to OAC 317:30-5-431, 317:30-5-432.1 and 317:30-5-451);

(3) Clinical lab tests performed in the Center lab (other than the specific laboratory tests set out for Health Centers' certification and covered as Health Center services);

(4) Technical component of diagnostic tests such as x-rays and EKGs (interpretation of the test provided by the Center physician is included as physician professional services);

(5) Durable medical equipment (refer to OAC 317:30-5-210);

(6) Transportation by ambulance (refer to OAC 317:30-5-335);

(7) Prescribed drugs (refer to OAC 317:30-5-70);

(8) Prosthetic devices (other than dental) which replace all or part of an internal body organ (including colostomy bags) and supplies directly related to colostomy care and the replacement of such devices;

(9) Specialized laboratory services furnished away from the clinic;

(10) Psychosocial rehabilitation services (refer to OAC 317:30-5-241.3);

(11) Behavioral health related case management services (refer to OAC 317:30-5-241.6); and

(12) Applied behavior analysis (ABA) (refer to OAC 317:30-3-65.12).

(13) Diabetes self-management training (DSMT) (refer to OAC 317:30-5-1080 through 317:30-5-1084).

 

 

317:30-5-664.2.Prior authorization and referrals
[Issued 06-07-06]
(a) Health Center encounters for core services, whether medical or behavioral health, are not subject to prior authorization. However, some Health Center services may require a referral from a PCP/CM.
(b) Other SoonerCare State Plan covered health services that the Center chooses to provide are subject to all applicable Medicaid regulations which govern the provision and coverage for that service.

317:30-5-664.3.Federally Qualified Health Center (FQHC) encounters
[Revised 09-01-19]

(a) FQHC encounters that are billed to the Oklahoma Health Care Authority (OHCA) must meet the definition in this Section and are limited to services covered by OHCA.  Only encounters provided by the authorized health care professional on the approved FQHC state plan pages within the scope of their licensure trigger a prospective payment system encounter rate.
(b) An encounter is defined as a face-to-face contact between a health care professional and a member for the provision of defined services through a FQHC within a 24-hour period ending at midnight, as documented in the member's medical record.

(c) An FQHC may bill for one medically necessary encounter per 24 hour period when the appropriate modifier is applied. Medical review will be required for additional visits for children. For information about multiple encounters, refer to Oklahoma Administrative Code (OAC) 317:30-5-664.4. Payment is limited to four (4) visits per member per month for adults.

(d) Services considered reimbursable encounters (including any related medical supplies provided during the course of the encounter) include:

(1) medical;

(2) diagnostic;

(3) dental, medical and behavioral health screenings;

(4) vision;

(5) physical therapy;

(6) occupational therapy;

(7) podiatry;

(8) behavioral health;

(9) speech;

(10) hearing;

(11) medically necessary FQHC encounters with a registered nurse or  licensed practical nurse and related medical supplies (other than drugs and biologicals) furnished on a part-time or intermittent basis to home-bound members (refer to OAC 317:30-5-661.3); and

(12) any other medically necessary health services (i.e. optometry and podiatry) are also reimbursable as permitted within the FQHCs scope of services when medically reasonable and necessary for the diagnosis or treatment of illness or injury, and must meet all applicable coverage requirements.

(e) Services and supplies incident to a physician's professional service are reimbursable within the encounter if the service or supply is:

(1) of a type commonly furnished in physicians' offices;

(2) of a type commonly rendered either without a charge or included in the health clinic's bill;

(3) furnished as an incidental, although integral, part of a physician's professional services;

(4) furnished under the direct, personal supervision of a physician; and

(5) in the case of a service, furnished by a member of the clinic's health care staff who is an employee of the clinic.

(f) Only drugs and biologicals which cannot be self-administered are included within the scope of this benefit.

 
317:30-5-664.4.Multiple encounters at Federally Qualified Health Centers (FQHC)

[Revised 09-01-19]
   An FQHC may bill for more than one (1) medically necessary encounter per 24-hour period under certain conditions when the appropriate modifier is applied.

(1) It is intended that multiple medically necessary encounters will occur on an infrequent basis.

(2) An FQHC may not develop FQHC procedures that routinely involve multiple encounters for a single date of service, unless medical necessity warrants multiple encounters.

(3) Each service must have distinctly different diagnoses in order to meet the criteria for multiple encounters.  For example, a medical visit and a dental visit on the same day are considered different services with distinctly different diagnoses.

(4) Similar services, even when provided by two (2) different health care practitioners, are not considered multiple encounters.

(5) Encounters with more than one (1) FQHC practitioner on the same day, regardless of the length or complexity of the visit, would constitute a single visit. An exception is when the patient has either or both of these:

(A) An illness or injury requiring additional diagnosis or treatment subsequent to the first encounter; and/or

(B) A qualified medical visit, a qualified mental health and/or dental visit on the same day.

317:30-5-664.5.Health Center encounter exclusions and limitations
[Revised 09-01-16]

(a) Service limitations governing the provision of all services apply pursuant to OAC 317:30. Excluded from the definition of reimbursable encounter core services are:

(1) Services provided by an independently CLIA certified and enrolled laboratory.

(2) Radiology services including nuclear medicine and diagnostic ultrasound services.

(3) Venipuncture for lab tests is considered part of the encounter and cannot be billed separately. When a member is seen at the clinic for a lab test only, use the appropriate CPT code. A visit for "lab test only" is not considered a Center encounter.

(4) Durable medical equipment or medical supplies not generally provided during the course of a Center visit such as diabetic supplies. However, gauze, band-aids, or other disposable products used during an office visit are considered as part of the cost of an encounter and cannot be billed separately under SoonerCare.

(5) Supplies and materials that are administered to the member are considered a part of the physician's or other health care practitioner's service.

(6) Drugs or medication treatments provided during a clinic visit are included in the encounter rate. For example, a member has come into the Center with high blood pressure and is treated at the Center with a hypertensive drug or drug samples provided to the Center free of charge are not reimbursable services and are included in the cost of an encounter. Prescriptions are not included in the encounter rate and must be billed through the pharmacy program by a qualified enrolled pharmacy.

(7) Administrative medical examinations and report services;

(8) Emergency services including delivery for pregnant members that are eligible under the Non-Qualified (ineligible) provisions of OAC 317:35-5-25;

(9) SoonerPlan family planning services;

(10) Optometry and podiatric services other than for dual eligible for Part B of Medicare; and

(11) Other services that are not defined in this rule or the State Plan.

(b) In addition, the following limitations and requirements apply to services provided by Health Centers:

(1) Physician services are not covered in a hospital.

(2) Behavioral health case management and psychosocial rehabilitation services are limited to Health Centers enrolled under the provider requirements in OAC 317:30-5-240 and contracted with OHCA as an outpatient behavioral health agency.

317:30-5-664.6.Prescription drugs purchased under the 340B Drug Discount Program provided by Health Centers
[Revised 09-12-14]
   For 340B Drug Discount Program guidelines, refer to section 317:30-5-87.
317:30-5-664.7.Dental services provided by Health Centers
[Revised 06-25-11]
(a) Adults. The Health Center core service benefit to adults is intended to provide services requiring immediate treatment, relief of pain and/or extraction and is not intended to restore teeth. For scope of services for individuals eligible under other program categories, refer to OAC 317:30-5-696. Core services are limited to treatment for conditions such as:
(1) Acute infection;
(2) Acute abscesses;
(3) Severe tooth pain; and
(4) Tooth re-implantation, when clinically appropriate.
(b) Children. Medically necessary dental services for children are covered.
(c) Exclusions and Limitations. Other medically necessary dental services which are not considered core services may be billed by the HealthCenter utilizing the current SoonerCare fee schedule.
(1) Smoking and tobacco use cessation is a covered service for adults and children and is separately reimbursable. Refer to OAC 317:30-5-2.
(2) Refer to OAC 317:30-5-695 for other specific coverage, exclusions and prior authorization requirements.(d) Health Centers must submit all claims for SoonerCare reimbursement for dental services on the American Dental Association (ADA) form.
317:30-5-664.8.Obstetrical care provided by Health Centers
[Revised 09-01-19]

(a) Billing written agreement.  In order to avoid duplicative billing situations, a Health Center must have a written agreement with its physician, certified nurse midwife, advanced practice nurse, or physician assistant that specifically identifies how obstetrical care will be billed. The agreement must specifically identify the service provider's compensation for Health Center core services and other health services that may be provided by the Health Center.

(b) Prenatal or postpartum services.

(1) If the Health Center compensates the physician, certified nurse midwife or advanced practice nurse for the provision of obstetrical care, then the Health Center bills the Oklahoma Health Care Authority (OHCA) for each prenatal and postpartum visit separately using the appropriate Current Procedural Terminology (CPT) evaluation and management code(s) as provided in the Health Center billing manual.

(2) If the clinic does not compensate the provider for the provision of obstetrical care, then the provider must bill the OHCA for prenatal care according to the global method described in the SoonerCare Traditional provider specific rules for physicians, certified nurse midwives, physician assistants, and advanced practice nurses [refer to Oklahoma Administrative Code (OAC) 317:30-5-22].

(3) Under both billing methods, payment for prenatal care includes all routine or minor medical problems. No additional payment is made to the prenatal provider except in the case of a major illness distinctly unrelated to pregnancy.

(c) Delivery services.  Delivery services are billed using the appropriate CPT codes for delivery. If the clinic does not compensate the provider for the provision of obstetrical care, then the provider must be individually enrolled and bill for those services using his or her assigned provider number. The costs associated with the delivery must be excluded from the cost settlement/encounter rate setting process.

317:30-5-664.9.Family planning services provided by Health Centers
[Revised 06-25-07]
Family planning services provided to SoonerCare Traditional and Choice members are considered Health Center core services.

317:30-5-664.10.Health Center reimbursement
[Revised 09-01-17]

(a) In accordance with Section 702 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000, reimbursement is provided for core services and other health services at a Health Center facility-specific Prospective Payment System (PPS) rate per visit (encounter) determined according to the methodology described in OAC 317:30-5-664.12.

(b) As claims/encounters are filed, reimbursement for SoonerCare Choice members is made for all medically necessary covered primary care and other approved health services at the PPS rate.

(c) Primary and preventive behavioral health services rendered by health care professionals authorized in the FQHC approved state plan pages will be reimbursed at the PPS encounter rate.

(d) Vision services provided by Optometrists within the scope of their licensure for non-dual eligible members and allowed under the Medicaid State Plan are reimbursed pursuant to the SoonerCare fee-for-service fee schedule.

317:30-5-664.11.PPS rate reconciliation to Health Centers
[Revised 06-25-07]
(a) PPS reconciliation/wrap-around adjustments will be made for the difference in the facility-specific PPS rate and the fee schedule payments.
(b) OHCA compares the total payments due under the PPS rate per visit method and the payments made under the methods described in OAC 317:30-5-664.10 (b) and (c).
(c) OHCA will make an adjustment for the difference in the payments allowed and the facility-specific PPS rate. The difference in payments will be reconciled not less often than quarterly.

317:30-5-664.12.Determination of Health Center PPS rate
[Revised 09-01-15]

(a) Methodology.  The methodology for establishing each facility's PPS rate is found in Attachment 4.19 B of the OHCA's State Plan, as amended effective January 1, 2001, and incorporated herein by reference.

(b) Scope of service adjustment.  If a Center significantly changes its scope of services, the Center may request in writing that new baseline encounter rates be determined. Adjustments to encounter rates are made if it is determined that a significant change in the scope-of-service has occurred which impacts the base rate, as indicated within the State Plan. If there is a change in scope-of-service, it is the responsibility of the FQHC to request OHCA to review services that have had a change to the scope-of-service.  The OHCA may initiate a rate adjustment in accordance with procedures in the State Plan, based on audited financial statements or cost reports, if the scope of services has been modified or would otherwise result in a change to the Center's current rate.  If a new rate is set, the rate will be effective on the date the change in scope-of-service was implemented.

317:30-5-664.13.Individuals eligible for Part B of Medicare
[Issued 06-07-06]
For individuals eligible for Part B of Medicare, payment is made utilizing the SoonerCare allowable for comparable services.

317:30-5-664.14.Health Center record keeping
[Issued 06-07-06]
(a) Adequate records must be maintained to show what services were provided in the encounter claimed.
(b) All outpatient behavioral health services must be reflected by documentation in the patient records in accordance with OAC 317:30-5-248.

317:30-5-664.15.Health Center cost reporting
[Issued 06-07-06]
(a) All Health Centers requesting SoonerCare reimbursement must complete an annual report, in a format prescribed by the OHCA, covering a 12-month period of operations based upon the Center's reporting period, to accommodate all allowable costs.
(b) Health Centers that have several sites must file the required cost report.
(c) The cost report may be used to adjust payments based on increases or decreases in change in scope of services provided.
(d) Health Centers select the annual period for reporting purposes, subject to approval by the OHCA.
(e) Once the Health Center has selected a reporting period and obtained the approval of the OHCA, the Center must adhere to the period initially selected unless a change has been authorized in writing by the OHCA. Such a change is made only after the OHCA has established that the reason for such a change is valid.
(f) Periodically, the OHCA may contract for an independent audit of the Health Center's cost report.

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.