Library: Policy

317:35-18-3. Definitions

Revised 9-14-20

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

(1) "American Indian/Alaska Native (AI/AN)" means an individual of Native American descent who has or is eligible for a Certificate of Degree of Indian Blood (CDIB) card;

(2) "Capitation" means the per member per month (pmpm) amount that the Oklahoma Health Care Authority pays PACE providers for PACE compensable services.

(3) "Interdisciplinary Team (IDT)" means the team of persons who interact and collaborate to assess PACE participants and plan for their care as set forth in 42 CFR 460.102.The IDT may also include the PACE participant's personal representative or advocate.

(4) "Participant" means an individual enrolled in a PACE program.

(5) "Program agreement" means the three-party agreement between the PACE provider, Centers for Medicare & Medicaid Services (CMS), and OHCA.

(6) "Provider" means the non-profit or for-profit entity that delivers required PACE services under an agreement with OHCA and CMS.

(7) "Service area" means the geographic area served by the provider agency, according to the program agreement.

(8) "State Administering Agency (SAA)" means the Oklahoma Health Care Authority.