SECTION 317:30-5-1087. Terms and definitions

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

(1)   "American Indian/Alaska Native (AI/AN)" means an individual of Native American descent who has or is eligible for a Certificate of Degree of Indian Blood (CDIB) card.

(2)   "Behavioral Health services" means professional medical services for the treatment of a mental health and/or substance use disorder.

(3)   "CFR" means the Code of Federal Regulations.

(4)   "CMS" means the Centers for Medicare and Medicaid Services.

(5)   "Encounter" means a face to face contact between a health care professional and an IHS eligible SoonerCare member for the provision of medically necessary Title XIX or Title XXI covered services through an IHS or Tribal 638 facility or an urban Indian clinic within a 24-hour period ending at midnight, as documented in the patient's record.

(6)   "Licensed Behavioral Health Professional (LBHP)" means a licensed psychologist, licensed clinical social worker(LCSW), licensed marital and family therapist (LMFT), licensed professional counselor (LPC), licensed behavioral practitioner (LBP) or licensed alcohol and drug counselor (LADC).

(7)   "OHCA" means the Oklahoma Health Care Authority.

(8)   "OMB rate" means the Medicaid reimbursement rate negotiated between CMS and IHS. Inpatient and outpatient Medicaid reimbursement rates for I/T/Us are published annually in the Federal Register or Federal Register Notices. The outpatient rate is also known as the I/T/U encounter rate. The encounter rate is available only to I/T/U facilities that appear on the IHS maintained listing of IHS-operated and Indian health care facilities operating under a 638 agreement. It is the sole responsibility of the facility to petition IHS for placement on this list.

(9)   "Physician" means a doctor of medicine or osteopathy legally authorized to practice medicine and surgery or who is a licensed physician employed by the Federal Government in an IHS facility or who provides services in a 638 Tribal Facility.

(10)   "State Administering Agency (SAA)" is the Oklahoma Health Care Authority.

(11)   "638 Tribal Facility" is a facility that is operated by a tribe or tribal organization and funded by Title I or Title III of the Indian Self Determination and Education Assistance Act (Public Law 93-638).

[Source: Added at 23 Ok Reg 2575, eff 6-25-06; Amended at 25 Ok Reg 2698, eff 7-25-08; Amended at 33 Ok Reg 837, eff 9-1-16; Amended at 34 Ok Reg 674, eff 9-1-17]