Oklahoma

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

SoonerCare

Administrator

Oklahoma Health Care Authority

Regional Telehealth Resource Center

Heartland Telehealth Resource Center

Medicaid Reimbursement

Live Video: Yes
Store-and-Forward: No
Remote Patient Monitoring: Yes

Private Payer Law

Law Exists: Yes
Payment Parity: No

Professional Requirements

Licensure Compacts: IMLC, PTC, eNLC, PSY, ASLP-IC
Consent Requirements: Yes

Last updated 02/28/2021

Audio-Only Delivery

Medicaid: Provider Updates (many telehealth related)

STATUS: Active, until end of national/state emergency

Medicaid: WebAlerts SoonerCare Members

STATUS: Active

Medicaid: Expanded telehealth and telephonic services

STATUS: Active, extended until April 30, 2021 (see below)

Medicaid 1915(c) Waiver: Appendix K – ADvantage Waiver

STATUS: Expired January 26, 2021

Medicaid 1915(c) Waiver: Appendix K Addendum – Community Waiver; Homeward Bound Waiver; In Home Supports Waiver for Adults; In Home Supports Waiver for Children; Medically Fragile Waiver Combined

STATUS: Active, expires six months after Public Health Emergency expiration

Last updated 02/28/2021

Cross State Licensing

No Reference Found

Last updated 02/28/2021

Easing Prescribing Requirements

Executive Order: Occupational Licenses and Patient-Provider Relationship (Fifth Amended 2020-20)

STATUS: Expired February 12, 2021

Last updated 02/28/2021

Miscellaneous

Medicaid: Telehealth Expansion Extended

STATUS: Active, expires April 30, 2021

Medicaid 1915(c) Waiver: Appendix K – Medically Fragile Waiver

STATUS: Expired January 26, 2021; extended through Addendum (see below)

Medicaid 1915(c) Waiver: Appendix K Addendum – ADvantage Waiver; Medically Fragile Waiver Combined (miscellaneous)

STATUS: Varies

Medicaid 1915(c) Waiver: Appendix K Addendum – Community Waiver; Homeward Bound Waiver; In Home Supports Waiver for Adults; In Home Supports Waiver for Children; Medically Fragile Waiver Combined

STATUS: Active, expires six months after Public Health Emergency expiration

Last updated 02/28/2021

Originating Site

Medicaid 1915(c) Waiver: Appendix K – ADvantage Waiver

STATUS: Expired January 26, 2021

Medicaid 1915(c) Waiver: Appendix K Addendum – Community Waiver; Homeward Bound Waiver; In Home Supports Waiver for Adults; In Home Supports Waiver for Children; Medically Fragile Waiver Combined

STATUS: Active, expires six months after Public Health Emergency expiration

Last updated 02/28/2021

Private Payer

Insurance Department:  Bulletin on Coronavirus (includes telemedicine)

STATUS: Active, until Executive Order 2020-02 is rescinded

Last updated 02/28/2021

Provider Type

Medicaid: Provider Updates (many telehealth related)

STATUS: Active, until end of national/state emergency.

Last updated 02/28/2021

Service Expansion

Medicaid: Provider Updates (many telehealth related)

STATUS: Active, until end of national/state emergency

Medicaid: Expanded telehealth and telephonic services

STATUS: Active, extended until April 30, 2021 (see below)

Medicaid: Telehealth at an FQHC or RHC

STATUS: Active

Executive Order: Telemedicine Flexibilities

STATUS: Expired February 12, 2021

Last updated 02/28/2021

Definitions

For purposes of SoonerCare reimbursement, telehealth is the use of interactive audio, video or other electronic media for the purpose of diagnosis, consultation or treatment that occur in real-time and when the member is actively participating during the transmission.

SOURCE: Health Care Authority, Providers, Telehealth. (Accessed Feb. 2021).

“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 (a(4)). (Accessed Feb. 2021).

Last updated 02/28/2021

Email, Phone & Fax

No reimbursement for email.

No reimbursement for telephone.

No reimbursement for FAX.

SOURCE: OK Admin. Code Sec. 317:30-3-27(a). (Accessed Feb. 2021).

Last updated 02/28/2021

Live Video

POLICY

SoonerCare (Oklahoma’s Medicaid program) reimburses for live video when:

  • Provider is contracted with SoonerCare and appropriately licensed
  • The GT modifier is billed

Proper documentation of services rendered 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: OK Health Care Authority, Telehealth. (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

OHCA has discretion and final authority to approve or deny telehealth services based on agency and/or SoonerCare members’ needs.  See Medicaid Telehealth webpage for a link to a full list of eligible CPT Codes for Medical and Behavioral Health Services.  Services provided by telehealth must be billed with the appropriate modifier.

SOURCE: OK Admin. Code Sec. 317:30-3-27 & Health Care Authority, Providers, Telehealth. (Accessed Feb. 2021).

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. (Accessed Feb. 2021).

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 Feb. 2021).

Behavioral Health

See SoonerCare behavioral health fee schedule for reimbursable telemedicine services.

SOURCE:  Oklahoma Health Care Authority, Behavioral Health Services Reimbursable via telemedicine. Updated July 18, 2018. (Accessed Feb. 2021).

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 – Psychiatric services. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

To participate, a provider must:

  • Be contracted with SoonerCare and appropriately licensed
  • Bill for services using the appropriate modifier (GT)
  • 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.)

SOURCE: Oklahoma Health Care Authority, Telehealth. (12/03/20).  (Accessed Feb. 2021).

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(c)(3). (Accessed Feb. 2021).

Certain outpatient behavioral health services are only reimbursed when provided by a licensed psychiatrist, certified mobile crisis team or an inpatient psychiatric facility.

SOURCE:  Oklahoma Health Care Authority, Behavioral Health Services Reimbursable via telemedicine. Updated July 18, 2018. (Accessed Feb. 2021).

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 Feb. 2021).


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 Feb. 2021).

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(d). (Accessed Feb. 2021).


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 Feb. 2021).

Last updated 02/28/2021

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 Feb. 2021).

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 Feb. 2021).

Last updated 02/28/2021

Out of State Providers

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(c)(3 & 4). (Accessed Feb. 2021).

Last updated 02/28/2021

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.

Last updated 02/28/2021

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 Feb. 2021).

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 medical 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.

CGM patients must have an in-person or telehealth visit within 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 Feb. 2021).


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 Feb. 2021).


PROVIDER LIMITATIONS

Continuous glucose monitoring (CGM)

Prescription must be made by a physician, physician assistant, or an advanced practice registered nurse.

SOURCE: OK Admin. Code Sec. 317:30-5-211.25. (Accessed Feb. 2021).


OTHER RESTRICTIONS

No Reference Found

Last updated 02/28/2021

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.

SOURCE: OK Admin. Code Sec. 317:30-3-27(e). (Accessed Feb. 2021).

“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 (a). (Accessed Feb. 2021).


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(e)(4). (Accessed Feb. 2021).

Last updated 02/28/2021

Definitions

“Telemedicine means the practice of health care delivery, diagnosis, consultation, treatment, including but not limited to, the treatment and prevention of strokes, transfer of medical data, or exchange of medical education information by means of audio, video, or data communications. Telemedicine is not a consultation provided by telephone or facsimile machine.”

SOURCE: OK Statute, Title 36, Sec. 6802. (Accessed Feb. 2021).

Last updated 02/28/2021

Parity

SERVICE PARITY

If a provider determines that telemedicine is an appropriate way to deliver care, an insurer cannot require person-to-person contact.

SOURCE: OK Statute, Title 36 Sec. 6803. (Accessed Feb. 2021).


PAYMENT PARITY

No explicit payment parity.

Last updated 02/28/2021

Requirements

For services determined to be appropriately provided by means of telemedicine, health care service plans, disability insurer programs, workers’ compensation programs, or state Medicaid managed care program contracts issued, amended, or renewed on or after January 1, 1998, shall not require person-to-person contact between a health care practitioner and a patient.

SOURCE: OK Statute, Title 36 Sec. 6803. (Accessed Feb. 2021).

Last updated 02/28/2021

Cross State Licensing

Physician treating patients in OK through telemedicine must be fully licensed in OK.

SOURCE: OK Admin Code Sec. 435:10-7-13(a).  (Accessed Feb. 2021).

Last updated 02/28/2021

Definitions

Telemedicine 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 physician with access to and reviewing the patient’s relevant clinical information prior to the telemedicine visit. “Telemedicine” and “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 machine.

SOURCE: OK Statute, Title 59, Sec. 478. (Accessed Feb. 2021).

“Telemedicine means the practice of health care delivery, diagnosis, consultation, treatment, including but not limited to, the treatment and prevention of conditions appropriate to treatment by telemedicine management, transfer of medical data, or exchange of medical education information by means of audio, video, or data communications. Telemedicine is not a consultation provided by telephone or facsimile machine.

This definition excludes phone or Internet contact or prescribing and other forms of communication, such as web-based video, that might occur between parties that does not meet the equipment requirements as specified in OAC 435:10-7-13 and therefore requires an actual face-to-face encounter. Telemedicine physicians who meet the requirements of OAC 435:10-7-13 do not require a face-to-face encounter.

SOURCE: OK Admin Code Sec. 435: 10-1-4. (Accessed Feb. 2021).

“Telemedicine” means the practice of health care delivery, diagnosis, consultation, evaluation, treatment, transfer of medical data, or exchange of medical education information by means of audio, video, or data communications. Telemedicine uses audio and video multimedia telecommunication equipment which permits two-way real time communication between a health care practitioner and a patient who are not in the same physical location. Telemedicine shall not include consultation provided by telephone or facsimile machine.

SOURCE: OK Statute Title 43A-1-103. (18). (Accessed Feb. 2021).

Occupational Therapy

“Telehealth” means, and shall have, the same meaning as it does under 59 O.S. § 888.3(8).

“Telemedicine” means, and includes, the practice of healthcare delivery, diagnosis, consultation, treatment, including but not limited to, the treatment and prevention of conditions appropriate to treatment by telehealth management, transfer of medical data, or exchange of medical education information by means of audio, video, or data communications. Telemedicine is not a consultation provided by telephone or facsimile machine.

SOURCE: OK Admin Code Sec. 435:30-1-2 (Accessed Feb. 2021).

Speech Language Pathology and Audiology

Telepractice means the use of audio, video or data communication to provide speech-language pathology and audiology services to clients who are not present at the same site as the licensee when the service is provided.

SOURCE: OK Admin Code Sec. 690: 10-3-9(a). (Accessed Feb. 2021).

Physician Assistants

“Telecommunication” means the use of electronic technologies to transmit words, sounds or images for interpersonal communication, clinical care (telemedicine) and review of electronic health records.

SOURCE: OK Statutes §59-519.2. (Accessed Feb. 2021).

Diagnostic X-Ray Systems

“Telemedicine” means the use of electronic communication processes for the transmission of information and data related to the diagnosis and/or treatment of medical conditions.

SOURCE: OK Admin Code Sec. 310:281-1-2 (Accessed Feb. 2021).

 

Last updated 02/28/2021

Licensure Compacts

Oklahoma is part of the Interstate Medical Licensing Compact.

SOURCE:  Interstate Medical Licensure Compact, The IMLC. (Accessed Feb. 2021).

The State Board of Osteopathic Examiners has the authority to issue a telemedicine license.

SOURCE: OK Statute, Title 59, Sec. 633, (Accessed Feb. 2021).

Member of enhanced Nurse Licensure Compact.

SOURCE:  Nurse Licensure Compact.  Current NLC States and Status.  (Accessed Feb. 2021).

Member of Physical Therapy Compact.

SOURCE:  Compact Map. PT Compact.  (Accessed Feb. 2021).

Member of Audiology and Speech Language Pathology Interstate Compact.

SOURCE:  Senate Bill 1837 (2020 Session).  (Accessed Feb. 2021).

Member of Psychology Interjurisdictional Compact.

SOURCE:  Association of State and Provincial Psychology Boards, PSYPACT, Legislative Updates.  (Accessed Feb. 2021).

Last updated 02/28/2021

Miscellaneous

OK provides, to each eligible healthcare entity, Special Universal Services for telemedicine providers. This includes the provision of bandwidth per standards as recommended by the Federal Communications Commission sufficient for providing telemedicine services including the telemedicine line, reasonable installation and network termination equipment owned and operated by the eligible provider. See statute for additional eligibility requirements.

SOURCE: OK Statutes, Title 17 Sec. 139.109.1 & OK Admin Code Title 165:59-7-6. (Accessed Feb. 2021).

The OK Dept. of Health established a statewide telemedicine network: Oklahoma Center for Telemedicine (Office of Telehealth)

SOURCE: Oklahoma Statutes, Title 63 Sec. 1-2702. & Office of Telehealth. (Accessed Feb. 2021).

Last updated 02/28/2021

Online Prescribing

A valid physician-patient relationship may be established by an allopathic or osteopathic physician with a patient located in this state through telemedicine, provided that the physician:

  • Holds a license to practice medicine in this state;
  • Confirms the patient’s identity and physical location; and
  • Provides the patient with the treating physician’s identity and professional credentials.

Telemedicine and store and forward technology encounters shall comply with the Health Insurance Portability and Accountability Act of 1996 and ensure that all patient communications and records are secure and confidential.  Telemedicine encounters and encounters involving store-and-forward technology shall not be used to establish a valid physician-patient relationship for purpose of prescribing opiates, synthetic opiates, semisynthetic opiates, benzodiazepine or carisprodol, but may be used to prescribe opioid antagonists or partial agonists.

The relationship shall not be based solely on the receipt of patient health information by a physician.  The duties and obligations created by a physician-patient relationship shall not apply until the physician affirmatively:

  • Undertakes to diagnose and treat the patient; or
  • Participates in the diagnosis and treatment of the patient.

SOURCE: OK Statutes, Title 59, Ch. 11 Sec. 478.1. (Accessed Feb. 2021).

Unprofessional Conduct includes prescribing or administering a drug or treatment without sufficient examination and the establishment of a valid physician-patient relationship and not prescribing in a safe, medically accepted manner.

SOURCE: OK Statute, Title 59, Sec. 509.(12), (Accessed Feb. 2021).

A physician/patient relationship is established when a physician agrees by direct or indirect contact with a patient to diagnose or treat any condition, illness or disability presented by a patient to that physician, whether or not such a presenting complaint is considered a disease by the general medical community. The physician/patient relationship shall include a medically appropriate, timely-scheduled, face-to-face encounter with the patient, subject to any supervisory responsibilities established elsewhere in these rules.  Telemedicine physicians who meet certain criteria are not subject to the face-to-face requirement to establish a physician-patient relationship.

A physician-patient relationship includes a medically appropriate, timely-scheduled, actual face-to-face encounter with the patient.

SOURCE: OK Admin. Code Sec. 435:10-7-12. (Accessed Feb. 2021).

 

Last updated 02/28/2021

Professional Board Standards

State Board of Medical Licensure and Supervision

SOURCE: OK Admin. Code Sec. 435:10-7-13. (Accessed Feb. 2021).

State Board of Examiners for Speech-Language Pathology and Audiology

SOURCE: OK Admin. Code Sec. 690:10-3-9. (Accessed Feb. 2021).

State Board of Occupational Therapy

SOURCE: OK Admin. Code Sec. 435:30-1-18. (Accessed Feb. 2021).