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OHCA Policies and Rules

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317:35-18-3. Definitions

[Revised 09-14-2020]

The words and terms used in this Subchapter have the following meanings, unless the context clearly indicates otherwise:

(1) "American Indian/Alaska Native (AI/AN)" means an individual of Native American descent who has or is eligible for a Certificate of Degree of Indian Blood (CDIB) card;

(2) "Capitation" means the per member per month (pmpm) amount that the Oklahoma Health Care Authority pays PACE providers for PACE compensable services.

(3) "Interdisciplinary Team (IDT)" means the team of persons who interact and collaborate to assess PACE participants and plan for their care as set forth in 42 CFR 460.102.  The IDT may also include the PACE participant's personal representative or advocate.

(4) "Participant" means an individual enrolled in a PACE program.

(5) "Program agreement" means the three-party agreement between the PACE provider, Centers for Medicare & Medicaid Services (CMS), and OHCA.

(6) "Provider" means the non-profit or for-profit entity that delivers required PACE services under an agreement with OHCA and CMS.

(7) "Service area" means the geographic area served by the provider agency, according to the program agreement.

(8) "State Administering Agency (SAA)" means the Oklahoma Health Care Authority.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.

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The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law.