317:30-5-557. Coverage by category
(a) Adults. SoonerCare does not cover adults [twenty-one (21) years of age and over] for private duty nursing (PDN) with the exception of subsection (c).
(b) Children. SoonerCare does cover children [under twenty-one (21) years of age] if:
(1) The member is eligible for SoonerCare; and
(2) The Oklahoma Health Care Authority (OHCA), in its discretion, deems the services medically necessary. Medical necessity is determined in accordance with Oklahoma Administrative Code (OAC) 317:30-5-560.1.
(c) Individuals eligible for Part B of Medicare. Payment is made utilizing the SoonerCare allowable for comparable services.
(d) 1915(c) home and community-based services (HCBS) waivers. If private duty nursing services are provided, they will be defined within each waiver and must be prior authorized.