SECTION 317:30-5-546. Coverage by category

  Payment is made for home health services as set forth in this section when a face to face encounter has occurred in accordance with provisions of 42 CFR 440.70.

(1)   Adults. Payment is made for home health services provided in the member's residence to all categorically needy individuals. Coverage for adults is as follows.

(A)   Covered items.

(i)   Part-time or intermittent nursing services;

(ii)   Home health aide services;

(iii)   Standard medical supplies;

(iv)   Durable medical equipment (DME) and appliances; and

(v)   Items classified as prosthetic devices.

(B)   Non-covered items. The following are not covered:

(i)   Sales tax;

(ii)   Enteral therapy and nutritional supplies;

(iii)   Electro-spinal orthosis system (ESO); and

(iv)   Physical therapy, occupational therapy, speech pathology, or audiological services.

(2)   Children. Home Health Services are covered for persons under age 21.

(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 15 Ok Reg 4182, eff 8-5-98 (emergency); Amended at 16 Ok Reg 1429, eff 5-27-99; Amended at 16 Ok Reg 3451, eff 7-1-99 (emergency); Amended at 17 Ok Reg 1204, eff 5-11-00; Amended at 18 Ok Reg 477, eff 1-1-01 (emergency); Amended at 18 Ok Reg 1130, eff 5-11-01; Amended at 19 Ok Reg 2922, eff 7-1-02 (emergency); Amended at 20 Ok Reg 1193, eff 5-27-03; Amended at 34 Ok Reg 672, eff 9-1-17]