OHCA Policies and Rules
317:30-5-326.1. Definitions
[Revised 09-01-21]
The following words and terms, when used in this Part shall have the following meaning, unless context clearly indicates otherwise.
"Attendant" means one (1) of the following:
(1) An employee of a long-term care facility who is provided by and trained by the long-term care facility at the long-term care facility's expense; or
(2) A provider of private duty nursing (PDN) services.
"Emergency/Emergent" means a serious situation or occurrence that happens unexpectedly and demands immediate action such as a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected, by a reasonable and prudent layperson, to result in placing the members' health in serious jeopardy, serious impairment to bodily function, or serious dysfunction of any bodily organ or part.
"Medical escort" means a family member, legal guardian, or volunteer whose presence is required and medically necessary to assist a member during transport and while at the place of treatment. A medical escort voluntarily accompanies the member during transport and leaves the vehicle at its destination and remains with the member. A medical escort must be of an age of legal majority recognized under Oklahoma State law, an emancipated minor, or a minor who is escorting his or her child to treatment.
"Medically necessary" means services that meet the criteria described in Oklahoma Administrative Code 317:30-3-1 (f) (1) - (6) and are not primarily for the convenience of the member.
"Member/eligible member" means any person eligible for SoonerCare and individuals considered to be Medicare/SoonerCare dual eligible.
"Nearest appropriate facility" means a medical facility that is generally equipped and legally permitted to provide the needed care for the illness or injury involved that is the closest in geographical proximity to the members' residence with exceptions. In the case of approved hospital services, it also means that a physician or physician specialist is available to provide the necessary care required to treat the member's condition. The fact that a particular physician does or does not have staff privileges in a hospital is not a consideration in determining whether the hospital has appropriate facilities.
"Non-ambulance" means a carrier that is not an ambulance.
"Non-emergency" means all reasons for transportation that are not an emergency as defined above.
"Service animal" means an animal individually trained to work or perform tasks for an individual with a disability. The work or task an animal has been trained to provide must be directly related to the individual's disability.
"SoonerRide Non-Emergency Transportation (NEMT)" means non-emergency non-ambulance transportation provided statewide within the geographical boundaries of the State of Oklahoma.
"Standing appointments" means recurring appointments that are scheduled over a significant period of time. Examples include, but are not limited to, dialysis and chemotherapy.
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.
