Library: Policy

317:30-5-1088. I/T/U provider participation requirements

Revised 7-25-08

(a) I/T/Us must either directly employ or contract the services of legally credentialed professional staff that are authorized within their scope of practice under state law to provide the services for which claims are submitted to SoonerCare; or I/T/U Physicians may meet all requirements for employment by the Federal Government as a physician and be employed by the Federal Government in an IHS facility or affiliated with a 638 Tribal Facility.

(b) The facility is required to report professional staff contracted or employed by the I/T/U to the OHCA.  Participating I/T/Us are required to submit a list of names of all practitioners working within the facility and a list of all individual OHCA provider and National Provider Identifier (NPI) numbers.  The reimbursement for the services rendered at or on behalf of the I/T/U will be made to the facility.

(c) The following professional staff are recognized by OHCA:

• (1) Physicians;

• (2) Licensed Physician Assistants;

• (3) Dentists;

• (4) Pharmacists;

• (5) Advanced Practice Nurses (APNs) which include:

  • (A) Advanced Registered Nurse Practitioners (ARNPs);

  • (B) Certified Nurse Midwives (CNMs);

  • (C) Certified Registered Nurse Anesthetists (CRNAs); and

  • (D) Clinical Nurse Specialists (CNSs);

• (6) Registered nurses under the supervision of a licensed physician; and

• (7) Practitioners who are actively and regularly receiving board approved supervision, or those receiving extended supervision by a fully licensed clinician if board's supervision requirement is met but the individual is not yet fully licensed for the services that are within the practitioner's scope of practice.  This includes but is not limited to:

• (A) licensed clinical social workers (LSW-C);

• (B) marital and family therapists (LMFT);

• (C) licensed professional counselors (LPC);

• (D) licensed behavioral practitioners (LBP); and

• (E) licensed alcohol and drug counselors (LADC).