Library: Policy

317:30-3-29. Revisions of provider fee schedules

Issued 6-25-11

(a) The Oklahoma Health Care Authority (OHCA) reserves the right to review and/or update and adjust provider fee schedules.  Provider fee schedules will be reviewed annually and adjustments to the fee schedules may be made at any time based on efficiency, budget considerations, economy, and quality of care.  The OHCA assures that all payments will be sufficient to enlist enough providers so that care and services are available under the State Plan at least to the extent that such care and services are available to the general population in the geographic area.  The OHCA may issue revisions to provider fee schedules during the year that they are effective.  Providers will be notified of any revisions to the fee schedule and the revision effective dates.  Provider fee schedules, when reviewed and changed, are posted to the OHCA's website in relation to the current State Fiscal Year.  The OHCA will adjust provider fee schedules to:

• (1) comply with changes in state or federal requirements;

• (2) comply with changes in nationally recognized coding systems, such as Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT);

• (3) establish an initial allowable amount for a new procedure based on information that was not available when the fee schedule was established for the current year; and

• (4) adjust the allowable amount when the OHCA determines that the current allowable amount is:

  • (A) not appropriate for the service provided; or

  • (B) based on errors in data or calculation.

(b) The OHCA will provide public notice, unless specified below, of any significant proposed change in its methods and standards for setting provider payment rates for services.  The OHCA will not provide notice if:

• (1) the change is being made to conform to Medicare methods or levels of reimbursement;

• (2) the change is required by a court order; or

• (3) the change is based on changes in wholesalers' or manufacturers' prices of drugs or materials.