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317:30-5-756.Reimbursement

[Issued 10-02-19]
(a) ITFC services will be paid at the current fee-for-service (FFS) rate. Services provided to a member without a written individual plan of care (IPC) as described in Oklahoma Administrative Code (OAC) 317:30-5-753 will not be reimbursed.

(b) In the case of a member who needs additional specialized behavioral health services, prior authorization by the Oklahoma Health Care Authority (OHCA) is required. See OAC 317:30-3-31. Only specialized rehabilitation or psychological treatment services to address unique, unusual, or severe symptoms or disorders will be authorized. Documentation must be provided to ensure that services are not duplicative.

(c) If additional services are approved for a member in state custody, the Oklahoma Department of Human Services (DHS), or Oklahoma Office of Juvenile Affairs (OJA) will collaborate with the provider of such services as directed by the OHCA. Any additional specialized behavioral health services provided to members in state custody are funded in the normal manner.

(d) Reimbursement for ITFC services is not available for the following:

(1) Room and board;

(2) Educational costs;

(3) Supported employment;

(4) Inpatient psychiatric services; and

(5) Respite care.

(e) Case management services are reimbursed to government providers as per the methodology in the approved Medicaid State Plan.

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.