OHCA Policies and Rules
317:30-5-659. Definitions
[Issued 09-01-21]
The following words and terms, when used in this Chapter, shall have the following meaning, unless the context clearly indicates otherwise:
"APRN" means advanced practice registered nurse.
"C.F.R" means the U.S. Code of Federal Regulations.
"CLIA" means the Clinical Laboratory Improvement Amendments.
"CMS" means the Centers for Medicare and Medicaid Services.
"CNM" means certified nurse midwife.
"Core services" means outpatient services that may be covered when furnished to a patient at the Center or other location, including the patient's place of residence.
"CPT" means current procedural terminology.
"CSW" means clinical social worker.
"Encounter" or "visit" means a face-to-face contact between an approved health care professional as authorized in the FQHC pages of the Oklahoma Medicaid State Plan and an eligible SoonerCare member for the provision of defined services through a Health Center within a twenty-four (24) hour period ending at midnight, as documented in the patient's medical record.
"FFS" means the current OHCA's fee-for-service reimbursement rate.
"FQHC" means Federally Qualified Health Center.
"HHS" means the U.S. Department of Health and Human Services.
"HRSA" means the Health Resources and Services Administration.
"Licensed behavioral health professional (LBHP) means any of the following practitioners:
(A) An allopathic or osteopathic physician with a current license and board certification in psychiatry or board eligible in the state in which services are provided, or a current resident in psychiatry practicing as described in OAC 317:30-5-2.
(B) A practitioner with a current license to practice in the state in which services are provided, within one (1) of the areas of practice listed in (i) through (vi).
(i) Psychology;
(ii) Social work (clinical specialty only);
(iii) Professional counselor;
(iv) Marriage and family therapist;
(v) Behavioral practitioner; or
(vi) Alcohol and drug counselor.
(C) An advanced practice registered nurse certified in a psychiatric mental health specialty, and licensed as a registered nurse (RN) with a current certification of recognition from the board of nursing in the state in which services are provided.
(D) A physician assistant who is licensed and in good standing in the state and has received specific training for and is experienced in performing mental health therapeutic, diagnostic, or counseling functions.
"OAC" means the Oklahoma Administrative Code.
"OHCA" means the Oklahoma Health Care Authority.
"Other ambulatory services" means other health services covered under the Oklahoma Medicaid State Plan other than core services.
"PA" means physician assistant.
"Physician" means:
(A) A doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which the function is performed or who is a licensed physician employed by the Public Health Service;
(B) Within limitations as to the specific services furnished, a doctor of dentistry or dental, a doctor of optometry, or a doctor of podiatry.
"Physicians' services" means professional services that are performed by a physician at the Health Center (or are performed away from the Center, excluding inpatient hospital services) whose agreement with the Center provides that he or she will be paid by the Health Center for such services.
"PPS" means prospective payment system all-inclusive per visit rate method specified in the Oklahoma Medicaid State Plan.
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.
