SECTION 317:30-5-327.6. Denial of SoonerRide NET services by the SoonerRide broker

(a)   In addition to the exclusions listed in 317:30-5-327.5 of this Part, the SoonerRide broker may deny NET services if:

(1)   the nursing facility/member refuses to cooperate in determining the member's eligibility;

(2)   the nursing facility/member refuses to provide the documentation required to determine the medical necessity for NET services;

(3)   the member or attendant exhibits uncooperative behavior or misuses/abuses NET services;

(4)   the member is not ready to board NET transport at the scheduled time or within 10 minutes after the scheduled pick up time; and

(5)   the nursing facility/member fails to request a reservation at least three days in advance of a health care appointment without good cause. Good cause is created by factors such as, but not limit to any of the following:

(A)   urgent care;

(B)   post-surgical and/or medical follow up care specified by a health care provider to occur in fewer than three days;

(C)   imminent availability of an appointment with a specialist when the next available appointment would require a delay of two weeks or more; and

(D)   the result of administrative or technical delay caused by SoonerRide and requiring that an appointment be rescheduled.

(b)   Pursuant to Federal law, SoonerRide will provide notification in writing to nursing facilities/member when members have been denied services. This notification must include the specific reason for the denial and the member's right to appeal.

[Source: Added at 24 Ok Reg 2095, eff 6-25-07]