SECTION 317:30-5-664.10. Health Center reimbursement

(a)   In accordance with Section 702 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000, reimbursement is provided for core services and other health services at a Health Center facility-specific Prospective Payment System (PPS) rate per visit (encounter) determined according to the methodology described in OAC 317:30-5-664.12.

(b)   As claims/encounters are filed, reimbursement for SoonerCare Choice members is made for all medically necessary covered primary care and other approved health services at the PPS rate.

(c)   Primary and preventive behavioral health services rendered by health care professionals authorized in the FQHC approved state plan pages will be reimbursed at the PPS encounter rate.

(d)   Vision services provided by Optometrists within the scope of their licensure for non-dual eligible members and allowed under the Medicaid State Plan are reimbursed pursuant to the SoonerCare fee-for-service fee schedule.

[Source: Added at 23 Ok Reg 3183, eff 6-7-06 (emergency); Added at 24 Ok Reg 2105, eff 6-25-07; Amended at 26 Ok Reg 249, eff 1-1-09 (emergency); Amended at 26 Ok Reg 1053, eff 5-11-09; Amended at 28 Ok Reg 123, eff 10-14-10 (emergency); Amended at 28 Ok Reg 1443, eff 6-25-11; Amended at 34 Ok Reg 641, eff 9-1-17]