OHCA Policies and Rules

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317:30-5-321. Coverage by category

[Revised 09-01-21]

Payment is made to Room and Board Providers as set forth in this Section.

(1) Adults.  Payment is made to Room and Board Providers for room and board of an eligible adult and an escort, if necessary, when authorized by the Oklahoma Health Care Authority (OHCA).  Room and Board is authorized by, Room and Board Order form, for Adults and Children.  A copy of the authorization must be attached to each claim along with the dates of stay and signature of authorized escort.

(2) Children.  Coverage for children is the same as for adults.

(A) Services, deemed medically necessary and allowable under Federal Medicaid regulations, may be covered by the EPSDT/OHCA Child Health program even though the services may not be part of the OHCA SoonerCare program.  Such services must be prior authorized.

(B) Federal Medicaid regulations also require the State to make the determination as to whether the service is medically necessary and do not require the provision of any items or services that the State determines are not safe and effective or which are considered experimental. For more information regarding experimental or investigational including clinical trials see, Oklahoma Administrative Code 317:30-3-57.1.

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.