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Library: Policy

317:25-7-3. Definitions

Revised 9-14-20

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

"Aged, Blind and Disabled (ABD)" means the Medicaid covered populations under 42 United States Code (U.S.C.) Section 1396a (a)(10)(A)(i) and (F).

"Board" means the board designated by the Oklahoma legislature to establish policies and adopt and promulgate rules for the Oklahoma Health Care Authority.

"Custody" means the custodial status, as reported by the Oklahoma Department of Human Services.

"Medicaid" means the medical assistance program authorized by 42 U.S.C., Section 1396a et seq. The program provides medical benefits for certain low-income persons. It is jointly administered by the federal and state governments.

"Medicare" means the program defined at 42 U.S.C. ' 1395 et seq.

"OHCA" means the Oklahoma Health Care Authority.

"OKDHS" means the Oklahoma Department of Human Services.

"PCCM" means Primary Care Case Management.

"Primary Care Case Management" means a managed care health service delivery system in which health services are delivered and coordinated by Primary Care Providers.

"Primary care provider (PCP)" means a Primary Care Provider, including a provider or physician group, under contract with the OHCA to provide primary care services and case management, including securing all medically-necessary referrals for specialty services and prior authorizations.

"Provider" or "physician group" means a partnership, limited partnership, limited liability company, corporation or professional corporation, composed of doctors of medicine and/or doctors of osteopathy and/or advanced practice registered nurses, and/or physician assistants who provide health care of the nature provided by independent practitioners and are permitted by state and federal law and regulations to receive SoonerCare provider payments.

"SoonerCare" means the Medicaid program administered by the OHCA.

"SoonerCare Choice" means a comprehensive medical benefit plan featuring a medical home including a PCP for each member.

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