SECTION 317:30-5-321. Coverage by category

  Payment is made to Room and Board Providers as set forth in this Section.

(1)   Adults. Payment is made to Room and Board Providers for room and board of an eligible adult and an escort, if necessary, when authorized by OHCA. Room and Board is authorized by, Room and Board Order form, for Adults and Children. A copy of the authorization must be attached to each claim along with the dates of stay and signature of authorized escort.

(2)   Children. Coverage for children is the same as for adults.

(A)   Services, deemed medically necessary and allowable under Federal Medicaid regulations, may be covered by the EPSDT/OHCA Child Health program even though the services may not be part of the OHCA SoonerCare program. Such services must be prior authorized.

(B)   Federal Medicaid regulations also require the State to make the determination as to whether the service is medically necessary and do not require the provision of any items or services that the State determines are not safe and effective or which are considered experimental.

[Source: Added at 12 Ok Reg 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff 7-27-95; Amended at 19 Ok Reg 2134, eff 6-27-02; Amended at 24 Ok Reg 2086, eff 6-25-07]