SECTION 317:30-5-559. How services are authorized

Latest version.

  An eligible provider may have private duty nursing services authorized by following all the following steps:
(1)   create a treatment plan for the patient as expressed in OAC 317:30-5-560;
(2)   submit the prior authorization request with the appropriate OHCA required forms, the treatment plan, and request the telephonic interview and/or personal visit by an OHCA Care Management Nurse; and
(3)   have an OHCA physician determine medical necessity of the service including scoring the member's needs on the Private Duty Nursing Acuity Grid.

[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; Amended at 32 Ok Reg 1081, eff 8-27-15]

                    
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