SECTION 317:30-5-557. Coverage by category

Latest version.

(a)   Adults. SoonerCare does not cover adults (Age 21 or over) for private duty nursing with the exception of subsection (c).
(b)   Children. SoonerCare does cover children (Under the age of 21) if:
(1)   the child is eligible for SoonerCare; and
(2)   the Oklahoma Health Care Authority, in its discretion, deems the services medically necessary. Medical necessity is determined in accordance with OAC 317:30-5-560.1.
(c)   Individuals eligible for Part B of Medicare. Payment is made utilizing the SoonerCare allowable for comparable services.

[Source: Added at 23 Ok Reg 33, eff 8-1-05 (emergency); Added at 23 Ok Reg 1364, eff 5-25-06; Amended at 28 Ok Reg 14, eff 8-13-10 (emergency); Amended at 28 Ok Reg 1429, eff 6-25-11]

                    
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