Last updated 07/03/2023
Consent Requirements
There will be no dissemination of any member images or information to other entities without written consent from the member or member’s parent or legal guardian, if the member is a minor.
In order for OHCA to reimburse medically necessary telehealth services provided to SoonerCare members in a primary or secondary school setting, all of the telehealth requirements must be met, with the exception of the requirement that a parent or legal guardian being there to present the child, as well as all of the requirements shown below, as applicable.
Advance parent or legal guardian consent for telehealth services must be obtained for minors, in accordance with 25 O.S. §§ 2004 through 2005. Additional consent requirements shall apply to school-based services.
Even though physical therapy, occupational therapy, and/or speech and hearing services are not subject to the notification requirements of OAC 317:30-3-27(d)(2), said services must still comply with all other State and Federal Medicaid requirements, in order to be reimbursable by Medicaid. Accordingly, for those physical therapy, occupational therapy, and/or speech and hearing services that are provided in a primary or secondary school setting, but that are not school-based services (i.e., not provided pursuant to an IEP), providers must adhere to all State and Federal requirements relating to prior authorization and prescription or referral.
If the member is a minor, the provider must obtain the prior written consent of the member’s parent or legal guardian to provide services via telehealth, that includes, at a minimum, the name of the provider; the provider’s permanent business office address and telephone number; an explanation of the services to be provided, including the type, frequency, and duration of services. Written consent must be obtained annually, or whenever there is a change in the information in the written consent form, as set forth above. The parent or legal guardian need not attend the telehealth session unless attendance is therapeutically appropriate. The requirements of subsection OAC 317:30-3-27(c)(5), however, do not apply to telehealth services provided in a primary or secondary school setting. If the member is a minor, the telehealth provider shall notify the parent or legal guardian that a telehealth service was performed on the minor through electronic communication whether a text message or email.
For telehealth medical services provided in a primary or secondary school setting, the telehealth practitioner must provide a summary of the service, including, but not limited to, information regarding the exam findings, prescribed or administered medications, and patient instructions, to:
- The SoonerCare member, if he or she is an adult, or the member’s parent or legal guardian, if the member is a minor; or
- The SoonerCare member’s primary care provider, if requested by the member or the member’s parent or legal guardian.
SOURCE: OK Admin. Code Sec. 317:30-3-27. (Accessed Jul. 2023).
Last updated 07/03/2023
Definitions
Telehealth is the use of interactive audio, video or other electronic media for the purpose of diagnosis, consultation or treatment that occurs in real time and when the member is actively participating during the transmission. Telehealth service is not an expansion of SoonerCare but a different way to offer quality health care access to SoonerCare members.
SOURCE: Health Care Authority, Providers, Telehealth, Modified Jun. 2, 2023. (Accessed Jul. 2023).
“Telehealth” means the practice of health care delivery, diagnosis, consultation, evaluation and treatment, transfer of medical data or exchange of medical education information by means of a two-way, real-time interactive communication, not to exclude store and forward technologies, between a patient and a health care provider with access to and reviewing the patient’s relevant clinical information prior to the telemedicine visit. Telehealth shall not include consultations provided by telephone audio-only communication, electronic mail, text message, instant messaging conversation, website questionnaire, nonsecure video conference, or facsimile transmission.
“Telehealth medical service” means, for the purpose of the notification requirements of OAC 317:30-3-27(d)(2), telehealth services that expressly do not include physical therapy, occupational therapy, and/or speech and hearing services.
SOURCE: OK Admin. Code Sec. 317:30-3-27. (Accessed Jul. 2023).
“Telehealth” means the practice of health care delivery, diagnosis, consultation, evaluation and treatment, transfer of medical data or exchange of medical education information by means of a two-way, real-time interactive communication, not to exclude store and forward technologies, between a patient and a health care provider with access to and reviewing the patient’s relevant clinical information prior to the telemedicine visit. In accordance with Oklahoma law, including OAC 317:30-3-27 and 59 O.S. § 478, telehealth shall not include consultations provided by telephone audio-only communication, electronic mail, text message, instant messaging conversation, website questionnaire, nonsecure videoconference, or facsimile transmission.
SOURCE: OK Admin Code Emergency Reg. Recently Amended, Sec. 317:55-1-3, (Accessed Jul. 2023).
Last updated 07/03/2023
Email, Phone & Fax
Audio- only modifiers listed as allowable including FQ and 93.
SOURCE: Health Care Authority, Providers, Telehealth, Modified Jun. 2, 2023. (Accessed Jul. 2023).
See medical audio-only codes allowed after 5/11/23.
SOURCE: OK Health Care Authority, Audio-only Codes Allowed after 5/11/23, (Accessed Jul. 2023).
See behavioral health services audio only codes as of 5/12/23.
SOURCE: OK Health Care Authority, Audio-only Codes, 5/12/23, Accessed Jul. 2023).
Telehealth shall not include consultations provided by telephone audio-only communication, electronic mail, text message, instant messaging conversation, website questionnaire, nonsecure video conference, or facsimile transmission.
SOURCE: OK Admin. Code Sec. 317:30-3-27(a). (Accessed Jul. 2023).
Last updated 07/03/2023
Live Video
POLICY
SoonerCare (Oklahoma’s Medicaid program) reimburses providers for live video. Providers must:
- Be contracted with SoonerCare and appropriately licensed,
- Bill for services using the appropriate modfier (GT, FQ, or 93), and
- Maintain documentation of services, to include: service rendered, location at which service was rendered, and that service was provided via telehealth. (Documentation of services must follow all other SoonerCare documentation guidelines as well.)
SOURCE: Health Care Authority, Providers, Telehealth, Modified Jun. 2, 2023. (Accessed Jul. 2023).
Oklahoma Health Care Authority issued letter regarding HIPAA Compliancy for Telehealth and Audio-Only Services.
ELIGIBLE SERVICES/SPECIALTIES
To participate, a member:
- May receive telehealth services outside of Oklahoma when medically necessary;
- Retains right to withdraw from telehealth services at any time; and
- Should be aware that all telehealth activities must comply with the Health Insurance Portability and Accountability Act (HIPAA) Security Rule, OHCA policy and all other applicable state and federal laws and regulations.
Also, if member is a minor child, a parent or legal guardian must present the child for services unless exempted by state or federal law. The parent or guardian need not attend the session unless attendance is therapeutically appropriate.
SOURCE: Health Care Authority, Providers, Telehealth, Modified Jun. 2, 2023. (Accessed Jul. 2023).
See Medical Codes allowed for telehealth post-PHE.
SOURCE: OK Health Care Authority, Medical Codes Allowed via telehealth after 5/11/23, Updated 6/2/23, (Accessed Jul. 2023).
See behavioral health codes allowed for telehealth post-PHE.
SOURCE: OK Health Care Authority, Behavioral Health Codes Allowed via telehealth after 5/11/23, Updated 6/2/23, (Accessed Jul. 2023).
OHCA has discretion and final authority to approve or deny telehealth services based on agency and/or SoonerCare members’ needs.
SOURCE: OK Admin. Code Sec. 317:30-3-27(g) (Accessed Jul. 2023).
A telehealth service is subject to the same SoonerCare program restrictions, limitations, and coverage which exist for the service when not provided through telehealth; provided, however, that only certain telehealth codes are reimbursable by SoonerCare. For a list of the SoonerCare-reimbursable telehealth codes, refer to the OHCA’s Behavioral Health Telehealth Services and Medical Telehealth Services, available on OHCA’s website, www.okhca.org.
Where there are established service limitations, the use of telehealth to deliver those services will count towards meeting those noted limitations. Service limitations may be set forth by Medicaid and/or other third-party payers.
SOURCE: OK Admin. Code Sec. 317:30-3-27(c)(11) &(12). (Accessed Jul. 2023).
Physical, Occupational and Speech and Hearing Services
For physical therapy, occupational therapy, and/or speech and hearing services that are provided in a primary or secondary school setting, but that are not school-based services (i.e., not provided pursuant to an IEP), providers must adhere to all State and Federal requirements relating to prior authorization and prescription or referral.
SOURCE: OK Admin. Code Sec. 317:30-3-27(d). (Accessed Jul. 2023).
Psychiatric Services
Payment is made for procedure codes listed in the psychiatry section of the most recent edition of the American Medical Association Current Procedural Terminology (CPT) codebook. Check administrative rules for certain exceptions. Psychiatric services performed via telemedicine are subject to the requirements found in Oklahoma Administrative Code (OAC) 317:30-3-27.
SOURCE: OK Admin. Code Sec. 317:30-5-11(a) & (d) (Accessed Jul. 2023).
Certified Community Behavioral Health Clinics – Care coordination
Transitional care will be provided by the facility for consumers who have been hospitalized or placed in other non-community settings, such as psychiatric residential treatment facilities. The CCBHC will provide care coordination while the consumer is hospitalized as soon as it becomes known. A team member will go to the hospital setting to engage the consumer in person and/or will connect through telehealth as a face to face meeting. Reasonable attempts to fulfill this important contact shall be documented. In addition, the facility will make and document reasonable attempts to contact all consumers who are discharged from these settings within 24 hours of discharge.
SOURCE: OK Admin. Code Sec. 450:17-5-183. (Accessed Jul. 2023).
Crisis services
Facilities shall make crisis services available, through clearly defined arrangements, for behavioral health emergencies during hours when the facility is closed. The Facility will also provide crisis services that are available and accessible twenty-four (24) hours a day and delivered within one (1) hour from the time services are requested. The facility will make available, either directly or through a qualified DCO, the following co-occurring capable services:
- Twenty-four (24) hour mobile crisis teams that are available via telehealth/secure tablet, or if an in-person response is required, arrival within one (1) hour from the time requested.
SOURCE: OK Admin. Code Sec. 450:17-5-184. (Accessed Jul. 2023).
Outpatient therapy services
The facility will directly provide outpatient mental health and substance use disorder services in accordance with 450:17-3 Part 7. In the event specialized services outside the expertise of the facility are required to meet the needs of the consumer, the facility will make them available through referral or other formal arrangement with other providers or, where necessary and appropriate, through the use of telemedicine services.
SOURCE: OK Admin. Code Sec. 450:17-5-185. (Accessed Jul. 2023).
Certified Community Behavioral Health Clinics
To the extent allowed by state law, facility will make services available via telemedicine in order to ensure consumers have access to all required services.
SOURCE: OK Admin. Code Sec. 450:17-5-176. (Accessed Jul. 2023).
Developmental Disabilities Services
Telehealth services do not expand services covered through Developmental Disabilities Services (DDS) Home and Community-Based Services (HCBS) waivers. Telehealth services are a delivery option for certain covered services. Telehealth services are a delivery option for certain covered services. Telehealth services apply to contract professional services, including speech therapy, physical therapy, occupational therapy, audiology, psychology, nutrition, family training, family counseling, nursing, and dental care. Telehealth services are billed with the appropriate modifier. See administration code for additional requirements.
SOURCE: OK Admin Code 340:100-3-41. (Accessed Jul. 2023).
ELIGIBLE PROVIDERS
To participate, a provider must:
- Be contracted with SoonerCare and appropriately licensed
- Bill for services using the appropriate modfier (GT, FQ, or 93), and
- Maintain documentation of services, to include: service rendered, location at which service was rendered, and that service was provided via telemedicine. (Documentation of services must follow all other SoonerCare documentation guidelines as well.)
Additionally, out-of-state providers must comply with all laws and regulations of the provider’s location, including health care and telehealth requirements.
SOURCE: Health Care Authority, Providers, Telehealth, Modified Jun. 2, 2023. (Accessed Jul. 2023).
The provider must be contracted with SoonerCare and appropriately licensed or certified, in good standing. Services that are provided must be within the scope of the practitioner’s license or certification. If the provider is outside of Oklahoma, the provider must comply with all laws and regulations of the provider’s location, including health care and telehealth requirements.
SOURCE: OK Admin. Code Sec. 317:30-3-27. (Accessed Jul. 2023).
Indian Health Service/Tribal 638
An I/T/U encounter means a face to face or telehealth contact between a health care professional and an IHS eligible SoonerCare member for the provision of medically necessary Title XIX or Title XXI covered services through an IHS or Tribal 638 facility or an urban Indian clinic within a 24-hour period ending at midnight, as documented in the patient’s record.
SOURCE: OK Admin. Code Sec. 317:30-5-1098. I/T/U outpatient encounters. (Accessed Jul. 2023).
ELIGIBLE SITES
The medical or behavioral health related service must be provided at an appropriate site for the delivery of telehealth services. An appropriate telehealth site is one that has the proper security measures in place; the appropriate administrative, physical, and technical safeguards should be in place that ensures the confidentiality, integrity, and security of electronic protected health information. The location of the room for the encounter at both ends should ensure comfort, privacy, and confidentiality. Both visual and audio privacy are important, and the placement and selection of the rooms should consider this. Appropriate telehealth equipment and networks must be used considering factors such as appropriate screen size, resolution, and security. Providers and/or members may provide or receive telehealth services outside of Oklahoma when medically necessary; however, prior authorization may be required.
SOURCE: OK Admin. Code Sec. 317:30-3-27(c)(3). (Accessed Jul. 2023).
School Setting
In order for OHCA to reimburse medically necessary telehealth services provided to SoonerCare members in a primary or secondary school setting, all of the requirements in (c) above must be met, with the exception of (c)(5), as well as all of the requirements shown below, as applicable. There are special consent and notification requirements for school-based sites. See Oklahoma Code.
Physical therapy, occupational therapy, and/or speech and hearing services that are provided in a primary or secondary school setting, but that are not school-based services (i.e., not provided pursuant to an IEP), providers must adhere to all State and Federal requirements relating to prior authorization and prescription or referral.
SOURCE: OK Admin. Code Sec. 317:30-3-27. (Accessed Jul. 2023).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
The cost of telehealth equipment and transmission is not reimbursable by SoonerCare.
SOURCE: OK Admin. Code Sec. 317:30-3-27(e)(4). (Accessed Jul. 2023).
Last updated 07/03/2023
Miscellaneous
All telehealth activities must comply with Oklahoma Health Care Authority (OHCA) policy, and all other applicable State and Federal laws and regulations.
See administrative code for specific documentation requirements.
SOURCE: OK Admin. Code Sec. 317:30-3-27(c)(8) & (f). (Accessed Jul. 2023).
Health Access Networks (HANs) must Facilitate members’ access to all levels of care, including primary, outpatient, specialty, certain ancillary services, and acute inpatient care, within a community or across a broad spectrum of providers across a service region or the state through improved access to specialty care, telehealth, and expended quality improvement strategies.
SOURCE: OK Admin. Code Sec. 317:25-9-2. (Accessed Jul. 2023).
“Emergency detention” means the detention of a person who appears to be a person requiring treatment in a facility approved by the Commissioner of Mental Health and Substance Abuse Services as appropriate for such detention after the completion of an emergency examination, either in person or via telemedicine, and a determination that emergency detention is warranted for a period not to exceed one hundred twenty (120) hours or five (5) days, excluding weekends and holidays, except upon a court order authorizing detention beyond a one hundred twenty (120) hour period or pending the hearing on a petition requesting involuntary commitment or treatment as provided by 43A of the Oklahoma Statutes.
“Face-To-Face” for the purposes of the delivery of behavioral health care, means a face-to-face physical contact and in-person encounter between the health care provider and the consumer, including the initial visit. The use of telemedicine shall be considered a face-to-face encounter.
SOURCE: OK Admin. Code Sec. 450:17-1-2. (Accessed Jul. 2023).
On April 11, 2023, OCR announced that it is providing a 90-calendar day transition period for covered health care providers to come into compliance with the HIPAA Rules with respect to their provision of telehealth. The transition period will be in effect beginning on May 12, 2023 and will expire at 11:59 p.m. on August 9, 2023. OCR will continue to exercise its enforcement discretion and will not impose penalties on covered healthcare providers for noncompliance with the HIPAA Rules that occurs in connection with the good faith provision of telehealth during the 90-calendar day transition period.
In June 2022, OCR issued FAQs on healthcare services delivered via telehealth (audio/video) and audio-only telecommunication to provide additional clarification, including how you can continue to use audio-only modalities after the PHE. HIPAA-covered entities can use remote communication technologies to provide telehealth services, including audio-only services, in compliance with the HIPAA Privacy Rule. See letter for additional details.
SOURCE: OK Health Care Authority, Letter 2023-10 RE: Post-PHE HIPAA Compliancy for Telehealth & Audio-only Services, May 19, 2023, (Accessed Jul. 2023).
Last updated 07/03/2023
Out of State Providers
Out-of-state providers must comply with all laws and regulations of the provider’s location, including health care and telehealth requirements.
SOURCE: Health Care Authority, Providers, Telehealth, Modified Jun. 2, 2023. (Accessed Jul. 2023).
The provider must be contracted with SoonerCare and appropriately licensed or certified, in good standing. Services that are provided must be within the scope of the practitioner’s license or certification. If the provider is outside of Oklahoma, the provider must comply with all laws and regulations of the provider’s location, including health care and telehealth requirements.
Providers and/or patients may provide or receive telehealth services outside of Oklahoma when medically necessary, however prior authorization may be required.
SOURCE: OK Admin. Code Sec. 317:30-3-27. (Accessed Jul. 2023).
Last updated 07/03/2023
Overview
SoonerCare reimburses for live video telehealth. Store-and-Forward and Remote Patient Monitoring must be compensable by the Oklahoma Health Care Authority (OHCA) in order to be reimbursed. Continuous Glucose Monitoring (CGM) is covered under certain circumstances. OK Medicaid also added a list of codes reimbursable through audio-only after 5/11/23 and allows for reporting of audio-only modifiers FQ and 93.
Last updated 07/03/2023
Remote Patient Monitoring
POLICY
“Remote patient monitoring” means the use of digital technologies to collect medical and other forms of health data (e.g. vital signs, weight, blood pressure, blood sugar) from individuals in one (1) location and electronically transmit that information securely to health care providers in a different location for assessment and recommendations.
Health care services delivered by telehealth such as remote patient monitoring, store-and-forward, or any other telehealth technology must be compensable by OHCA in order to be reimbursed.
Services provided by telehealth must be billed with the appropriate modifier.
The cost of telehealth equipment and transmission is not reimbursable by SoonerCare.
SOURCE: OK Admin. Code Sec. 317:30-3-27(a) & (e). (Accessed Jul. 2023).
Continuous glucose monitoring (CGM)
CGM means a minimally invasive system that measures glucose levels in subcutaneous or interstitial fluid. CGM provides blood glucose levels and can help members make more informed management decisions throughout the day.
CGM must be determined by a provider to be medically necessary and documented in the member’s plan of care as medically necessary and used for medical purposes. A request by a qualified provider for CGM in and of itself shall not constitute medical necessity. The Oklahoma Health Care Authority (OHCA) shall serve as the final authority pertaining to all determinations of medical necessity. Refer to Oklahoma Administrative Code (OAC) 317:30-5-211.2 and 317:30-3-1(f) for policy on medical necessity. CGM devices must be approved by the U.S. Food and Drug Administration (FDA) as non-adjunctive and must be used for therapeutic purposes. Devices may only be used for members within the age range for which the devices have been FDA approved.
In-person or telehealth visit [within the last six (6) months] between the treating provider, member and/or family to evaluate their diabetes control.
SOURCE: OK Admin. Code Sec. 317:30-5-211.25. (Accessed Jul. 2023).
CONDITIONS
Continuous glucose monitoring (CGM)
Member must have a diagnosis that correlates to the use of CGM.
SOURCE: OK Admin. Code Sec. 317:30-5-211.25. (Accessed Jul. 2023).
PROVIDER LIMITATIONS
Continuous glucose monitoring (CGM)
Prescription must be made by a qualified provider.
SOURCE: OK Admin. Code Sec. 317:30-5-211.25. (Accessed Jul. 2023).
OTHER RESTRICTIONS
No Reference Found
Last updated 07/03/2023
Store and Forward
POLICY
Health care services delivered by telehealth such as remote patient monitoring, store-and-forward, or any other telehealth technology must be compensable by OHCA in order to be reimbursed.
Services provided by telehealth must be billed with the appropriate modifier.
If the technical component of an X-ray, ultrasound or electrocardiogram is performed during a telehealth transmission, the technical component can be billed by the provider that provided that service. The professional component of the procedure and the appropriate visit code should be billed by the provider that rendered that service.
“Store and forward technologies” means the transmission of a patient’s medical information from an originating site to the health care provider at the distant site; provided, photographs visualized by a telecommunications system shall be specific to the patient’s medical condition and adequate for furnishing or confirming a diagnosis or treatment plan. Store and forward technologies shall not include consultations provided by telephone audio-only communication, electronic mail, text message, instant messaging conversation, website questionnaire, nonsecure video conference, or facsimile transmission.
SOURCE: OK Admin. Code Sec. 317:30-3-27. (Accessed Jul. 2023).
ELIGIBLE SERVICES/SPECIALTIES
No Reference Found
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
The cost of telehealth equipment and transmission is not reimbursable by SoonerCare.
SOURCE: OK Admin. Code Sec. 317:30-3-27. (Accessed Jul. 2023).
