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OHCA Policies and Rules

317:30-5-620. Eligible providers

[Revised 6-11-99]

Services are provided statewide by case management providers established for the purpose of providing early intervention case management services. Services must be made available to all eligible recipients on a statewide basis, in a manner that ensures continuity of services, without duplication and in compliance with federal and state mandates and regulations related to servicing the targeted population in a uniform and consistent manner.

(1) Department of Education criteria. OHCA will reimburse case managers who meet program criteria set by the Oklahoma State Department of Education (OSDE), the certification agency. Case manager qualifications are:

(A) Knowledge or community-based, facility and institutional resources available to the target group and the experience to link to said resources;

(B) Experience in working in education, health or human service field;

(C) Administrative experience to meet state and federal requirements as well as requirements set out by the certifying agency;

(D) Ability to maintain programmatic and financial records required by the certifying agency including the capacity to document case records consistent with program standards and state and federal requirements;

(E) Graduation from an accredited college or university with a bachelor's degree in education, social work, health-related field and one year of experience in one of more of these fields;

(F) Receipt of approved State Department of Education Training; and

(2) Provider agreement.

(A) A memorandum of agreement between the Oklahoma Health Care Authority (OHCA) and the Oklahoma State Department of Education (OSDE) for Medicaid reimbursement of early intervention case management services must be in effect before reimbursement can be made for compensable services. The agreement outlines the contractual requirements for reimbursement.

(B) Provision of case management services will not restrict an individual's free choice of medical providers. Eligible case management providers must be certified by the OSDE in keeping with certification standards referenced in State Law Title 70, Section 3-104, Part 9 to ensure that the case managers for the targeted group of recipients are capable of assisting the recipients in receiving the full range of services they need. Recipients will have free choice of providers of other medical care under the plan.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.