OHCA Policies and Rules
317:30-5-354. Definitions
[Revised 07-06-23]
The following words and terms, when used in this Chapter, shall have the following meaning, unless the context clearly indicates otherwise:
"APRN" means advanced practice registered nurse.
"C.F.R." means the U.S. Code of Federal Regulations.
"CLIA" means the Clinical Laboratory Improvement Amendments.
"CMS" means the Centers for Medicare and Medicaid Services.
"CNM" means certified nurse midwife.
"Core services" means outpatient services that may be covered when furnished to a patient at the rural health clinic (RHC) or other location, including the patient's place of residence.
"CP" means clinical psychologist.
"CPT" means current procedural terminology.
"CSW" means clinical social worker.
"EPSDT" means the Early and Periodic Screening, Diagnostic and Treatment program for members under twenty-one (21).
"FFS" means the current OHCA's fee-for-service reimbursement rate.
"HCPCS" means Healthcare Common Procedure Coding System.
"OAC" means the Oklahoma Administrative Code.
"OHCA" means the Oklahoma Health Care Authority.
"Other ambulatory services" means other outpatient health services covered under the Oklahoma Medicaid State Plan other than core services.
"PA" means physician assistant.
"Physician" means:
(A) A doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which the function is performed or who is a licensed physician employed by the Public Health Service;
(B) Within limitations as to the specific services furnished, a doctor of dentistry or dental, a doctor of optometry, or a doctor of podiatry.
"Physicians' services" means professional services that are performed by a physician at the RHC (or are performed away from the Center, excluding inpatient hospital services) whose agreement with the RHC provides that he or she will be paid by the RHC for such services.
"PPS" means prospective payment system all-inclusive per visit rate method specified in the Oklahoma Medicaid State Plan.
"RHC" means rural health clinic.
"Visit" means a face-to-face encounter between a clinic patient and a physician, Physician Assistant (PA), Advanced Practice Registered Nurse (APRN), Certified Nurse Midwife (CMN), Clinical Psychologist (CP), or Clinical Social Worker whose services are reimbursed under the RHC PPS payment method. Encounters with more than one (1) health care professional and multiple encounters with the same health care professional that take place on the same day and at a single location constitute a single visit, except when the patient, after the first encounter, suffers illness or injury requiring additional diagnosis or treatment. Services delivered via audio-only telecommunications and reimbursed pursuant to the fee-for-service (FFS) fee schedule do not constitute a visit and/or an encounter.
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.
