SECTION 317:30-5-376. Coverage by category

  Payment is made to advanced practice registered nurses (APRNs) as set forth in this Section.

(1)   Adults. Payment for adults is made for primary care health services, within the scope of practice of an APRN and within the scope of the Oklahoma Health Care Authority (OHCA) medical programs.

(2)   Children. Payment for children is made for primary care health services, within the scope of practice of an APRN, to members under twenty-one (21) years of age, including Early and Periodic Screening, Diagnostic and Treatment (EPSDT) screening services.

(A)   Payment is made to eligible providers for EPSDT services to members under twenty-one (21) years of age. Specific guidelines for the EPSDT program including the periodicity schedule are found in Oklahoma Administrative Code (OAC) 317:30-3-65 through 317:30-3-65.12.

(B)   Comprehensive screening examinations are to be performed by a provider qualified under State law to furnish primary health care services.

(3)   Individuals eligible for Part B of Medicare. Payment is made utilizing the Medicaid allowable for comparable services.

[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 16 Ok Reg 141, eff 10-14-98 (emergency); Amended at 16 Ok Reg 1429, eff 5-27-99; Amended at 19 Ok Reg 2922, eff 7-1-02 (emergency); Amended at 20 Ok Reg 1193, eff 5-27-03; Amended at 23 Ok Reg 2463, eff 6-25-06; Amended at 36 Ok Reg 1099, eff 7-1-19 (emergency); Amended at 37 Ok Reg 514, eff 1-6-20 (emergency); Amended at 37 Ok Reg 1492, eff 9-14-20]