SECTION 340:75-13-64. Sources of funding for medical services

  Medical services for children in Oklahoma Department of Human Services (DHS) custody are paid through a variety of funds.

(1)   Title XIX Medicaid and Children's Special Health Care Needs program. Title XIX Medicaid, a combination of state and federal money, is administered through Oklahoma Health Care Authority (OHCA). Medicaid claims are paid from the OHCA budget through a designated fiscal agent. The Medicaid program:

(A)   has specific eligibility requirements;

(B)   covers specific services as determined by Oklahoma's State Plan; and

(C)   does not pay for experimental procedures.

(2)   Child Welfare Services (CWS) medical - special approval. CWS has limited funds, state monies that are utilized when the needed service, excluding experimental procedures, is not covered by other medical programs. Utilization of these funds is considered for approval by CWS Finance and Business Operations (FBO) after Title XIX and OHCA denial. Only services for children in DHS custody and out-of-home placement are eligible for payment from these funds. All expenditures paid from state funds are paid at the Oklahoma Medicaid compensable amount.

(3)   Child abuse examinations. When a child abuse examination is warranted, the reimbursement process is dependent upon the child's medical assistance case status on the date of the examination. When the child is:

(A)   not a Medicaid recipient and the parent(s) is unable or unwilling to pay for the examination, state funds pay for the examination at established Medicaid rates. The provider completes claims, per Oklahoma Administrative Code 317:30-3-1. The claim is routed to CWS FBO with an explanation for using state funds; or

(B)   a Medicaid recipient and is designated eligible for:

(i)   fee-for-service, OHCA reimburses for these services at the established rates; or

(ii)   SoonerCare, OHCA reimburses for these services at the established rates.

[Source: Amended at 10 Ok Reg 3987, eff 7-13-93 (emergency); Amended at 11 Ok Reg 505, eff 11-15-93 (emergency); Amended at 11 Ok Reg 1733, eff 5-12-94; Amended at 16 Ok Reg 102, eff 10-13-98 (preemptive); Amended at 19 Ok Reg 2265, eff 6-27-02; Amended at 22 Ok Reg 854, eff 5-12-05; Amended at 23 Ok Reg 1024, eff 5-11-06; Amended at 28 Ok Reg 894, eff 7-1-11; Amended at 37 Ok Reg 1850, eff 9-15-20]