Oklahoma

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

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

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: ASLP-IC, CC, EMS, IMLC, NLC, PSY, PTC
  • Consent Requirements: Yes

FQHCs

  • Originating sites explicitly allowed for Live Video: Yes
  • Distant sites explicitly allowed for Live Video: Yes
  • Store and forward explicitly reimbursed: No
  • Audio-only explicitly reimbursed: Yes
  • Allowed to collect PPS rate for telehealth: No

STATE RESOURCES

  1. Medicaid Program: SoonerCare
  2. Administrator: Oklahoma Health Care Authority
  3. Oklahoma Health Care Authority: Heartland Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Last updated 12/04/2023

Definitions

“Telemedicine” or “telehealth” means technology-enabled health and care management and delivery systems that extend capacity and access, which includes:

  • Synchronous mechanisms, which may include live audiovisual interaction between a patient and a health care professional or real-time provider-to-provider consultation through live interactive audiovisual means,
  • Asynchronous mechanisms, which include store and forward transfers, online exchange of health information between a patient and a health care professional and online exchange of health information between health care professionals, but shall not include the use of automated text messages or automated mobile applications that serve as the sole interaction between a patient and a health care professional,
  • Remote patient monitoring, and
  • Other electronic means that support clinical health care, professional consultation, patient and professional health-related education, public health and health administration.

SOURCE: OK Statute, Title 36, Sec. 6802 (Accessed Dec. 2023).

Last updated 12/04/2023

Parity

SERVICE PARITY

For services that a health care professional determines 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 professional and a patient.

An insurer shall not exclude a service for coverage solely because the service is provided through telemedicine and is not provided through in-person consultation or contact between a health care professional and a patient when such services are appropriately provided through telemedicine. An insurer may limit coverage of services provided by telehealth consistent with coding and clinical standards recognized by the American Medical Association or the Centers for Medicare and Medicaid Services as covered if delivered by telehealth or telemedicine, except as agreed to by the insurer and provider.

SOURCE: OK Statute, Title 36, Sec. 6803, (Accessed Dec. 2023).


PAYMENT PARITY

An insurer shall reimburse the treating health care professional or the consulting health care professional for the diagnosis, consultation or treatment of the patient delivered through telemedicine services on the same basis and at least at the rate of reimbursement that the insurer is responsible for coverage for the provision of the same, or substantially similar, services through in-person consultation or contact.

Any copayment or coinsurance applied to telemedicine benefits by an insurer shall not exceed the copayment or coinsurance applied to such benefits when provided through in-person consultation or contact.

SOURCE: OK Statute, Title 36, Sec. 6803, (Accessed Dec. 2023).

If the beneficiary of a health benefit plan is unable to obtain covered behavioral health services from an in-network provider in a timely manner as defined in subsection A of this section, including medically appropriate telehealth services, such plan shall ensure coverage of the behavioral health services from an out-of-network provider by arranging a network exception with a negotiated rate from an out-of-network provider. Such an agreement between the health benefit plan and the out-of-network provider shall hold the beneficiary harmless for any amount greater than the in-network cost-sharing amount, including copayment, coinsurance, and deductible, that the beneficiary would have paid had the same services been rendered by an in-network provider. The negotiated rate in the network exception, in addition to the beneficiary’s in-network cost-sharing amount, shall be accepted as payment in full for the provided behavioral health services. In no instance shall the beneficiary pay more than the in-network cost-sharing amount for such services.

SOURCE: OK Statute Title 36, Ch. 2, Sec. 6060.11a, (Accessed Dec. 2023).

Last updated 12/04/2023

Requirements

For services that a health care professional determines 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 professional and a patient.

An insurer shall not exclude a service for coverage solely because the service is provided through telemedicine and is not provided through in-person consultation or contact between a health care professional and a patient when such services are appropriately provided through telemedicine.

An insurer shall not impose any type of utilization review on benefits provided through telemedicine unless such type of utilization review is imposed when such benefits are provided through in-person consultation or contact. Any type of utilization review that is imposed on benefits provided through telemedicine shall not occur with greater frequency or more stringent application than such form of utilization review is imposed on such benefits provided through in-person consultation or contact.

An insurer shall not restrict coverage of telemedicine benefits or services to benefits or services provided by a particular vendor, or other third party, or benefits or services provided through a particular electronic communications technology platform; provided, that nothing shall require an insurer to cover any electronic communications technology platform that does not comply with applicable state and federal privacy laws.

An insurer shall not place any restrictions on prescribing medications through telemedicine that are more restrictive than what is required under applicable state and federal law.

SOURCE: OK Statute, Title 36, Sec. 6803  (Accessed Dec. 2023).

If the beneficiary of a health benefit plan is unable to obtain covered behavioral health services from an in-network provider in a timely manner as defined in subsection A of this section, including medically appropriate telehealth services, such plan shall ensure coverage of the behavioral health services from an out-of-network provider by arranging a network exception with a negotiated rate from an out-of-network provider. Such an agreement between the health benefit plan and the out-of-network provider shall hold the beneficiary harmless for any amount greater than the in-network cost-sharing amount, including copayment, coinsurance, and deductible, that the beneficiary would have paid had the same services been rendered by an in-network provider. The negotiated rate in the network exception, in addition to the beneficiary’s in-network cost-sharing amount, shall be accepted as payment in full for the provided behavioral health services. In no instance shall the beneficiary pay more than the in-network cost-sharing amount for such services.

SOURCE: OK Statute Title 36, Ch. 2, Sec. 6060.11a, (Accessed Dec. 2023).

Last updated 12/04/2023

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 Jul. 18, 2023. (Accessed Dec. 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” 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 healthcare 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. For audio-only health service delivery, see OAC 317:30-3-27.1.

“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 Dec. 2023).

Indian Health Services

“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 healthcare 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.

SOURCE: OK Admin Code Sec. 317.30-5-1087, (Accessed Dec. 2023).

 

Last updated 12/04/2023

Email, Phone & Fax

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.  For audio-only health service delivery, see OAC 317:30-3-27.1.

For reimbursement of audio-only health service delivery, see OAC 317:30-3-27.1.

SOURCE: OK Admin. Code Sec. 317:30-3-27(a). (Accessed Dec. 2023).

“Audio-only health service delivery” means the delivery of healthcare services through the use of audio-only telecommunications, permitting real-time communication between a patient and the provider, for the purpose of diagnosis, consultation, and/or treatment.  Audio-only health service delivery does not include the use of facsimile, email, or health care services that are customarily delivered by audio-only telecommunications and not billed as separate services by the provider, such as the sharing of laboratory results. This definition includes health services delivered via audio-only when audio-visual is unavailable or when a member chooses audio-only.

Audio-only telecommunications is an option for the delivery of certain covered services and is not an expansion of SoonerCare-covered services.

The applicability and scope of this section of policy is outlined below:

  • Health service delivery via audio-only telecommunications is applicable to medically necessary covered primary care and other approved health services. Refer to the Oklahoma Health Care Authority (OHCA) website, www.okhca.org, for a complete list of the SoonerCare-reimbursable audio-only health services codes.
  • If there are technological difficulties in performing medical assessment through audio-only telecommunications, then hands-on-assessment and/or in-person care must be provided for the member. Any service delivered using audio-only telecommunications must be appropriate for audio-only delivery and be of the same quality and otherwise on par with the same service delivered in person.
  • Confidentiality and security of protected health information in accordance with applicable state and federal law, including, but not limited to, 42 Code of Federal Regulations (CFR) Part 2, 45 CFR Parts 160 and 164, and 43A Oklahoma Statutes (O.S.) § 1-109, must be maintained in the delivery of health services by audio-only telecommunications.
  • For purposes of SoonerCare reimbursement, audio-only health service delivery is the use of interactive audio technology for the purpose of diagnosis, consultation, and/or treatment that occurs in real-time and when the member is actively participating during the transmission.

The following requirements apply to all services rendered via audio-only health service delivery:

  • Interactive audio telecommunications must be used, permitting real-time communication between the physician or practitioner and the SoonerCare member. As a condition of payment, the member must actively participate in the audio-only telecommunications health service visit.
  • The audio telecommunications technology used to deliver the services must meet the standards required by state and federal laws governing the privacy and security of protected health information (PHI).
  • The provider must be contracted with SoonerCare and appropriately licensed and/or certified, and in good standing. Services that are provided must be within the scope of the practitioner’s license and/or certification.
  • Either the provider or the member must be located at the freestanding clinic that is providing services pursuant to 42 CFR § 440.90 and Oklahoma Administrative Code (OAC) 317:30-5-575.
  • 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 audio-only telecommunications, that includes, at a minimum, the name of the provider; the provider’s permanent business office address and telephone number; and 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 audio-only telecommunications session unless attendance is therapeutically appropriate.
  • The member retains the right to withdraw at any time.
  • All audio-only health service delivery activities must comply with Oklahoma Health Care Authority (OHCA) policy, and all other applicable State and Federal laws and regulations.
  • A health service delivered via audio-only telecommunications is subject to the same SoonerCare program restrictions, limitations, and coverage which exist for the service when not delivered via audio-only telecommunications.
  • A health service delivered by audio-only telecommunications must be designated for reimbursement by SoonerCare.
  • Where there are established service limitations, the use of audio-only telecommunications 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.

Reimbursement.

  • Health care services delivered via audio-only telecommunications must be compensable by OHCA in order to be reimbursed.
  • Services delivered via audio-only telecommunications must be billed with the appropriate modifier.
  • Health care services delivered via audio-only telecommunications are reimbursed pursuant to the fee-for-service fee schedule approved under the Oklahoma Medicaid State Plan.
  • An RHC and an FQHC shall be reimbursed for services delivered via audio-only telecommunications at the fee-for-service rate per the fee-for-service fee schedule.
  • An I/T/U shall be reimbursed for services delivered via audio-only telecommunications at the Office of Management and Budget (OMB) all-inclusive rate.
  • The cost of audio-only telecommunication equipment and other service related costs are not reimbursable by SoonerCare.

See rule for documentation requirements

The OHCA has discretion and final authority to approve or deny any services delivered via audio-only telecommunications based on agency and/or SoonerCare members’ needs.

SOURCE: OK Admin. Code Sec. 317:30-3-27.1. (Accessed Dec. 2023).

Audio- only modifiers listed as allowable including FQ and 93.

SOURCE: Health Care Authority, Providers, Telehealth, Modified Jul. 18, 2023. (Accessed Dec. 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 Dec. 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 Dec. 2023).

Videoconferencing for Mental Illness (MI) PASRR Level II after PHE expires 5/11/2023

Telephonic evaluations should be used as a last resort if this is the only means of communication and, if due to a geographic or resource limitation, it would prevent the evaluation from being completed within 7 to 9 business days. The evaluation should only be completed with approval by OHCA and the Oklahoma Department of Mental Health and Substance Abuse Services.

SOURCE: OK Healthcare Authority, 2023 Global Messages, Videoconferencing for Mental Illness (MI) PASRR Level II after PHE expires 5/11/2023, 5/9/23, (Accessed Dec. 2023).

Case Management Services

Case management services shall be provided in accordance with Chapter 50 of this Title and shall include planned referral, linkage, monitoring and support, and advocacy assistance provided in partnership with a person served to support that individual in self-sufficiency and community tenure. Activities include: …

  • Crisis diversion (unanticipated, unscheduled situation requiring supportive assistance, face-to-face or telephone, to resolve immediate problems before they become overwhelming and severely impair the individual’s ability to function or maintain in the community) to prevent progression to a higher level of care.

SOURCE: OK Admin. Code Sec. 450:70-6-1. (Accessed Dec. 2023).

Clinic Services

Telehealth and audio-only health service delivery requires either the provider or the member to be located at the freestanding clinic that is providing services pursuant to the Code of Federal Regulations. Refer to section Oklahoma Administrative Code (OAC) 317:30-3-27 for telehealth policy and OAC 317:30-3-27.1 for audio-only telecommunication policy.

SOURCE: OK Admin Code Sec. 317.30-5-575, (Accessed Dec. 2023).

Rural Health Center Services

RHC services are covered when medically necessary and furnished at the clinic or other outpatient setting, including the member’s place of residence, delivered via telehealth, or via audio-only telecommunications pursuant to Oklahoma Administrative Code (OAC) 317:30-3-27 and OAC 317:30-3-27.1.

SOURCE: OK Admin Code Sec. 317.30-5-355.2, (Accessed Dec. 2023).

Indian Health Services

“Audio-only health service delivery” means the delivery of healthcare services through the use of audio-only telecommunications, permitting real-time communication between a patient and the provider, for the purpose of diagnosis, consultation, or treatment, and does not include the use of facsimile or email nor the delivery of health care services that are customarily delivered by audio-only telecommunications and customarily not billed as separate services by the provider, such as the sharing of laboratory results. This definition includes health services delivered via audio-only when audio-visual is unavailable or when a member chooses audio-only.

SOURCE: OK Admin Code Sec. 317.30-5-1087, (Accessed Dec. 2023).

An I/T/U encounter means a face to face, a telehealth contact, or an audio-only telecommunications contact between a health care professional and an Indian Health Services (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 twenty-four (24) period ending at midnight, as documented in the patient’s record.

SOURCE: OK Admin Code Sec. 317.30-5-1098, (Accessed Dec. 2023).

Last updated 12/04/2023

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 Jul. 18, 2023. (Accessed Dec. 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 Jul. 18, 2023. (Accessed Dec. 2023).

See Medical Codes allowed for telehealth post-PHE.

SOURCE: OK Health Care Authority, Medical Codes Allowed via telehealth after 5/11/23, Updated 7/18/23, (Accessed Dec. 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 5/24/23, (Accessed Dec. 2023).

The OHCA has discretion and the final authority to approve or deny any telehealth services based on agency and/or SoonerCare members’ needs.

SOURCE: OK Admin. Code Sec. 317:30-3-27(g) (Accessed Dec. 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 Dec. 2023).

Physical, Occupational and Speech and Hearing 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, including, but not limited to, 42 C.F.R. § 440.110, OAC 317:30-5-291, 317:30-5-296, and 317:30-5-676.

SOURCE: OK Admin. Code Sec. 317:30-3-27(d). (Accessed Dec. 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 Dec. 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 Dec. 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 Dec. 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 Dec. 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 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 Dec. 2023).

Doula Services

Prenatal and postpartum visits can also be conducted via telehealth.

SOURCE: OK Health Care Authority, Provider Letter OHCA 2023-14, RE: Doula Services, July 1, 2023, (Accessed Dec. 2023).

Prenatal and postpartum visits may be conducted via telehealth.

Labor and delivery services may not be conducted via telehealth.

SOURCE: OK Admin Code 317:30-5-1215. (Accessed Dec. 2023).

Mobile Medication Units

Mobile medication units that provide appropriate privacy and adequate space may additionally provide the following services: …

  • Clinical services, such as therapy, provided in-person or when permissible through use of telehealth services.

SOURCE: OK Admin Code 350:70-6-10.1. (Accessed Dec. 2023).

Crisis Intervention

Onsite CIS is the provision of CIS to the member at the treatment facility, either in-person or via telehealth.

SOURCE: OK Admin Code 317:30-5-241.4. (Accessed Dec. 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 Jul. 18, 2023. (Accessed Dec. 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).

OHCA is expanding the use of telehealth to include certain occupational and physical therapy services. Effective May 12, 2023, OHCA began reimbursing for therapy services utilizing the following service codes delivered via telehealth: 97110, 97112, 97116, 97150, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97530, 97535, and 97755.

OHCA asks that providers use modifier GT to denote services were performed utilizing telehealth. For providers unable to submit a claim with the GT modifier for an OHCA approved telehealth-rendered service, please utilize Place of Service (POS) code 02 to denote when telehealth is used.

SOURCE: Oklahoma Healthcare Authority, 2023 Global Messages, Telehealth expanded for OT/PT providers, 7/20/23, (Accessed Dec. 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 Dec. 2023).

Clinic Services

Telehealth and audio-only health service delivery requires either the provider or the member to be located at the freestanding clinic that is providing services pursuant to the Code of Federal Regulations. Refer to section Oklahoma Administrative Code (OAC) 317:30-3-27 for telehealth policy and OAC 317:30-3-27.1 for audio-only telecommunication policy.

SOURCE: OK Admin Code Sec. 317.30-5-575, (Accessed Dec. 2023).

Rural Health Center Services

RHC services are covered when medically necessary and furnished at the clinic or other outpatient setting, including the member’s place of residence, delivered via telehealth, or via audio-only telecommunications pursuant to Oklahoma Administrative Code (OAC) 317:30-3-27 and OAC 317:30-3-27.1.

SOURCE: OK Admin Code Sec. 317.30-5-355.2, (Accessed Dec. 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 Dec. 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 Dec. 2023).

Clinic Services

Telehealth and audio-only health service delivery requires either the provider or the member to be located at the freestanding clinic that is providing services pursuant to the Code of Federal Regulations. Refer to section Oklahoma Administrative Code (OAC) 317:30-3-27 for telehealth policy and OAC 317:30-3-27.1 for audio-only telecommunication policy.

SOURCE: OK Admin Code Sec. 317.30-5-575, (Accessed Dec. 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 Dec. 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 Dec. 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 Dec. 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”means, for the purpose of the delivery of behavioral health care, an in-person encounter between the health care provider and the consumer, or a telehealth encounter with two-way video functionality.

SOURCE: OK Admin. Code Sec. 450:17-1-2. (Accessed Dec. 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 12/04/2023

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 Jul. 2, 2023. (Accessed Dec. 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 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. (Accessed Dec. 2023).

Last updated 12/04/2023

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) and Extended Ambulatory Cardiac Monitoring 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.  Newly passed regulations also clarify audio-only requirements and allow FQHCs to bill for audio-only through the FFS rate.

Last updated 12/04/2023

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 Dec. 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 Dec. 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 Dec. 2023).

Extended Ambulatory Cardiac Monitoring

Effective Nov. 1, 2023, OHCA has added coverage for extended ambulatory cardiac monitoring codes 93241-93244 and 93245-93248. Coverage is intended to evaluate syncope and lightheadedness, to document arrhythmia in members with a non-diagnostic Holter monitor or 48-hour telemetry, or in persons whose symptoms occur infrequently such that the arrhythmia is unlikely to be diagnosed by Holter monitoring.

SOURCE:  OK Health Care Authority, 2023 Global Messages, Extended Ambulatory Cardiac Monitoring, 11/9/23, (Accessed Dec. 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 Dec. 2023).

Extended Ambulatory Cardiac Monitoring

Providers: 08, 09, 10, 31, and 52

SOURCE:  OK Health Care Authority, 2023 Global Messages, Extended Ambulatory Cardiac Monitoring, 11/9/23, (Accessed Dec. 2023).


OTHER RESTRICTIONS

No Reference Found

Last updated 12/04/2023

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 Dec. 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 Dec. 2023).

Last updated 12/04/2023

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 Dec. 2023).

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

SOURCE: OK Statute, Title 59, Sec. 633, (Accessed Dec. 2023).

 The Oklahoma Board of Nursing may issue temporary licenses to nurses from other states upon proper application stating the purpose of such licenses; provided, no temporary license may be issued for more than ninety (90) days. Temporary licenses may be renewed at the discretion of the Board but shall not extend over a period longer than one (1) year.

The Board may issue temporary critical need licenses for registered nurses, licensed practical nurses, and Advanced Practice Registered Nurses under Section 1 of this act.

SOURCE: OK Statute, Title 59, Ch. 12, Sec. 567.15. (Accessed Dec. 2023).

Except as provided in 59 O.S.§ 1604, no practitioner licensed in another state may deliver speech-language pathology and audiology services via telepractice to clients located in Oklahoma, unless licensed in Oklahoma.

SOURCE: OK Admin Code Sec. 690:10-3-9.  (Accessed Dec. 2023).

The Board may issue a license for a speech-language pathology assistant to a person who holds a current speech-language pathology assistant license in another state or country according to the following conditions:

  • Payment of the Board’s current fee for licensure; AND one of the following:
  • The applicant submits evidence of licensure in good standing from another other state or country which maintains a system and standard of qualifications and examinations for speech-language pathology assistants which meets or exceeds the current requirements for licensure in Oklahoma; OR
  • The applicant is currently certified as an American Speech-Language-Hearing Association (ASHA) speech-language pathology assistant.

SOURCE: OK Admin Code Sec. 690:10-7-9.  (Accessed Dec. 2023).

In order to provide physical therapy via telehealth defined in 435:20-1-1.1 of the Code, a physical therapist or physical therapist assistant providing services to a patient or client, physically located in Oklahoma, must have a valid and current Oklahoma Physical Therapist or Physical Therapist Assistant license, issued by State of Oklahoma.

SOURCE: OK Admin Code Sec. 435:20-5-11 (Accessed Dec. 2023).

Last updated 12/04/2023

Definitions

“Telemedicine” means technology-enabled health and care management and delivery systems that extend capacity and access, which includes:

  • Synchronous mechanisms, which may include live audiovisual interaction between a patient and a health care professional or real-time provider to provider consultation through live interactive audiovisual means,
  • Asynchronous mechanisms, which include store and forward transfers, online exchange of health information between a patient and a health care professional and online exchange of health information between health care professionals, but shall not include the use of automated text messages or automated mobile applications that serve as the sole interaction between a patient and a health care professional,
  • Remote patient monitoring, and
  • other electronic means that support clinical health care, professional consultation, patient and professional health-related education, public health and health administration.

SOURCE: OK Statute Title 43A-1-103 & OK Statute, Title 59, Sec. 478. (Accessed Dec. 2023).

“Telemedicine” means the practice of healthcare 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 (Oklahoma Statutes, Title 36, Sec. 6802). 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 Dec. 2023).

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 Dec. 2023).

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 Dec. 2023).

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 Dec. 2023).

Diagnostic X-Ray Systems

“Teleradiology” means the electronic transmission of radiological images from one location to another for the purposes of interpretation and/or consultation.

SOURCE: OK Admin Code Sec. 310:281-1-2 (Accessed Dec. 2023).

Veterinary Medicine

“Telemedicine” or “telehealth” means the practice of veterinary medicine including diagnosis, consultation, evaluation, treatment, transfer of medical data or exchange of information by means of a two-way, real-time interactive communication between a client or patient and a veterinarian with access to and reviewing the patient’s relevant information prior to the telemedicine visit.  Telemedicine or telehealth shall not include consultations provided by telephone audio-only communication. A veterinarian using telehealth technologies shall take appropriate steps to establish the veterinarian-client-patient relationship and conduct all appropriate evaluations and history of the patient consistent with traditional standards of care for the particular patient presentation. A veterinarian shall be licensed, or under the jurisdiction of, the veterinary board of the jurisdiction where the patient is located. The practice of medicine occurs where the patient is located at the time telehealth technologies are used.

SOURCE: OK Statute 59-698.2, (Accessed Dec. 2023).

Teledentistry

“Teledentistry” means the remote delivery of dental patient care via telecommunications and other technology for the exchange of clinical information and images for dental consultation, preliminary treatment planning and patient monitoring.

SOURCE: OK Statute 59-328.3, (Accessed Dec. 2023).

Physical Therapy

“Telehealth” means the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.

SOURCE: OK Statute Title 59, Sec. 887.2. (Accessed Dec. 2023).

“Telehealth” means, and shall have, the same meaning as it does under 59 O.S. § 887.2(7).

“Telecommunication” means, and shall have, the same meaning as it does under 59 O.S. § 887.2(8).

SOURCE: OK Admin Code Sec. 435:20-1-1.1 (Accessed Dec. 2023).

Last updated 12/04/2023

Licensure Compacts

Member of Interstate Medical Licensing Compact.

SOURCE:  Interstate Medical Licensure Compact, The IMLC. (Accessed Dec. 2023).

Member of Nurse Licensure Compact.

SOURCE:  Nurse Licensure Compact.  Current NLC States and Status.  (Accessed Dec. 2023).

Member of Emergency Medical Services Compact.

SOURCE: The EMS Compact, EMS States and Commissioners, (Accessed Dec. 2023).

Member of Physical Therapy Compact.

SOURCE:  Compact Map. PT Compact.  (Accessed Dec. 2023).

Member of Audiology and Speech Language Pathology Interstate Compact.

SOURCE:  ASLP-IC Compact. Compact Map. (Accessed Dec. 2023).

Member of Psychology Interjurisdictional Compact.

SOURCE: PSYPACT Compact. (Accessed Dec. 2023).

Member of Counseling Compact.

SOURCE: Counseling Compact, Compact Map, (Accessed Dec. 2023).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 12/04/2023

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 Dec. 2023).

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 Dec 2023).

A licensed dentist may allow a dental hygienist with an elder care advanced procedure permit to treat patients under general supervision by utilizing teledentistry on a patient in:

  • A nursing facility, specialized facility, or nursing care component of a continuum of care facility licensed under or otherwise subject to the Nursing Home Care Act, Section 1-1901 et seq. of Title 63 of the Oklahoma Statutes;
  • An assisted living center or continuum of care facility licensed under the Continuum of Care and Assisted Living Act, Section 1-890.1 et seq. of Title 63 of the Oklahoma Statutes;
  • A residential care home licensed under the Residential Care Act, Section 1-819 et seq. of Title 63 of the Oklahoma Statutes;
  • An adult day care center or adult day care component of a continuum of care facility licensed under or otherwise subject to the Adult Day Care Act, Section 1-870 et seq. of Title 63 of the Oklahoma Statutes; or
  • Another healthcare facility or long-term care facility as specifically approved by the Board of Dentistry.

Upon receipt of the advanced procedure permit, the dental hygienist may provide hygiene treatments to a new or existing patient in a facility listed in subsection A of this section, utilizing mobile or other applicable dental equipment. In addition to a written record and patient file, the hygienist shall complete a visual recording of the patient’s mouth through video or live teledentistry to aid the dentist in completing an evaluation and diagnosis of the patient. The video recording shall be maintained as part of the patient record.

A dentist shall complete an in-person, live, or recorded teledentistry assessment, diagnosis, and treatment plan for the patient taking into consideration the needs, health, and physical abilities of the patient a minimum of every thirteen (13) months.

The supervising dentist shall maintain all patient records including teledentistry recordings for a period of seven (7) years.

A dental assistant having a minimum of two (2) years of active dental assisting practice may apply to the Board for an expanded duty permit for elder care and public health. Upon receipt of the expanded duty permit, the dental assistant may assist a hygienist while providing treatment in a facility listed in subsection A of this section under the general supervision of the supervising dentist. The patient records shall list the dental assistant providing treatment while assisting the dental hygienist.

SOURCE: OK Statute Title 59, Ch. 7, 328.58 (Accessed Dec. 2023).

Last updated 12/04/2023

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 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 in this state shall not be used to establish a valid physician-patient relationship for the purpose of prescribing opiates, synthetic opiates, semisynthetic opiates, benzodiazepine or carisprodol, unless the encounter is used to prescribe:

  • Opioid antagonists or partial agonists pursuant to Sections 1-2506.1 and 1-2506.2 of Title 63 of the Oklahoma Statutes; or
  • A Schedule III, IV, or V controlled dangerous substance approved by the United States Food and Drug Administration for medication assisted treatment or detoxification treatment for substance use disorder.

A physician-patient relationship shall not be created solely based 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 Dec. 2023).

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 Dec. 2023).

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 except the following providers are not subject to the face-to-face encounter:

  • Providers covering the practice of another provider may approve refills of previously ordered medications if they have access to the medical file of the patient.
  • Hospice medical directors may initiate prescriptions based on requests from licensed health care providers and on information from Hospice records.
  • Providers ordering appropriate medications for persons with laboratory-proven, sexually transmitted diseases and persons who have been in contact with certain infectious diseases.
  • Telemedicine physicians who meet the criteria set out in OAC 435:10-7-13 of this Subchapter.
  • Licensed healthcare providers providing medical immunizations, which may be implemented by means of standing order(s) and/or policies.
  • Licensed providers ordering opioid antagonists pursuant to 63 O.S. §1-2506.2.

SOURCE: OK Admin. Code Sec. 435:10-7-12. (Accessed Dec. 2023).

Abortion-inducing drugs shall not be provided directly to the patient through the mail, telemedicine or otherwise outside of the parameters of the Oklahoma Abortion-Inducing Drug Certification Program.

SOURCE: OK Statute, Title 63, Ch. 1, Sec.1-757.4, (Accessed Dec. 2023).

The Board has the right to refuse to issue, renew or reinstate a license and may revoke a license or impose other appropriate sanctions for unprofessional conduct. In addition to those acts of unprofessional conduct listed in Title 59 O.S., Section 637 the following acts shall be included without limiting, in any way the Board’s ability to interpret other acts as unprofessional conduct.

It shall not be considered unprofessional conduct for a physician to renew a prescription for controlled drugs over telemedicine provided an initial script was issued in person.

SOURCE: OK Admin. Code Sec. 510:5-7-1. (Accessed Dec. 2023).

Last updated 12/04/2023

Professional Board Standards

State Board of Medical Licensure and Supervision

SOURCE: OK Admin. Code Sec. 435:10-7-13. (Accessed Dec. 2023).

State Board of Examiners for Speech-Language Pathology and Audiology

SOURCE: OK Admin. Code Sec. 690:10-3-9. (Accessed Dec. 2023).

State Board of Occupational Therapy

SOURCE: OK Admin. Code Sec. 435:30-1-18. (Accessed Dec. 2023).

State Board of Physical Therapists and Assistants

SOURCE: OK Admin Code Sec. 435:20-5-11 (Accessed Dec. 2023).

Teledentistry

A dentist holding a valid dental license in Oklahoma may consult, diagnose and treat a patient of record via synchronous or asynchronous telecommunication between the patient and dentist. The dentist must record all activities relating to teledentistry in the patient record and must have an office location in Oklahoma available for follow-up treatment and maintenance of records.

SOURCE: OK Statute Sec. 328.54, (Accessed Dec. 2023).

Physical Therapy 

Physical therapy services may be provided in person or remotely, via telehealth, to individuals or groups.

SOURCE: OK Statute Title 59, Sec. 887.2, (Accessed Dec. 2023).

Veterinary Medicine

The practice of veterinary medicine shall include, but not be limited to: … Diagnosing, surgery, treating, correcting, changing, relieving, or preventing animal disease, deformity, defect, injury or other physical or mental conditions including the prescribing or administering of any drug, medicine, biologic, apparatus, application, anesthetic, telemedicine, animal chiropractic diagnosis and treatment, or other therapeutic diagnostic substance or technique; dentistry; complementary and alternative therapies to be defined by rule pursuant to Section 698.7 of Title 59 of the Oklahoma Statutes; testing for pregnancy or correcting sterility or enhancing fertility; or rendering advice or recommendation with regard to any of the above.

SOURCE: OK Statute Title 59, Chapter 15, Sec 698.11 (Accessed Dec. 2023).

Last updated 12/04/2023

Definition of Visit

“Encounter” or “visit” means a face-to-face contact between an approved health care professional as authorized in the FQHC pages of the Oklahoma Medicaid State Plan and an eligible SoonerCare member for the provision of defined services through a Health Center within a twenty-four (24) hour period ending at midnight, as documented in the patient’s medical record.

SOURCE: OK Admin. Rule 317:30-5-659. (Accessed Dec. 2023).

An encounter is defined as a face-to-face contact between a health care professional and a member for the provision of defined services through a FQHC within a twenty-four (24) hour period ending at midnight, as documented in the member’s medical record. Services delivered via audio-only telecommunications do not constitute an encounter.

SOURCE: OK Admin. Rule 317:30-5-664.3. (Accessed Dec. 2023).

Last updated 12/04/2023

Eligible Distant Site

Clinic Services

Telehealth and audio-only health service delivery requires either the provider or the member to be located at the freestanding clinic that is providing services pursuant to the Code of Federal Regulations. Refer to section Oklahoma Administrative Code (OAC) 317:30-3-27 for telehealth policy and OAC 317:30-3-27.1 for audio-only telecommunication policy.

SOURCE: OK Admin Code Sec. 317.30-5-575, (Accessed Dec. 2023).

See: OK Medicaid Live Video Distant Site

Last updated 12/04/2023

Eligible Originating Site

Clinic Services

Telehealth and audio-only health service delivery requires either the provider or the member to be located at the freestanding clinic that is providing services pursuant to the Code of Federal Regulations. Refer to section Oklahoma Administrative Code (OAC) 317:30-3-27 for telehealth policy and OAC 317:30-3-27.1 for audio-only telecommunication policy.

SOURCE: OK Admin Code Sec. 317.30-5-575, (Accessed Dec. 2023).

See: OK Medicaid Live Video Eligible Sites.

Last updated 12/04/2023

Facility Fee

No reference found

See: OK Medicaid Live Video Facility/Transmission Fee

Last updated 12/04/2023

Home Eligible

Health Center services are covered for SoonerCare adults and children as set forth in this Part, unless otherwise specified.

Visiting nurse services to the homebound are covered if:

  • The FQHC is located in an area in which the Secretary of Health and Human Services has determined there is a shortage of home health agencies;
  • The services are rendered to members who are homebound;
  • The member is furnished nursing care on a part-time or intermittent basis by a registered nurse, licensed practical nurse, or licensed vocational nurse who is employed by or receives compensation for the services from the FQHC; and
  • The services are furnished under a written plan of treatment as required by 42 C.F.R § 405.2416.

SOURCE: OK Admin. Rule 317:30-5-661.1. (Accessed Dec. 2023).

Services provided to members within the four walls of the Health Center and approved Health Center satellites including mobile health clinics operated by the Center are allowable for reimbursement under the PPS.

Off-site services provided by employed practitioners of the Health Center to patients temporarily homebound or in any skilled nursing facility because of a medical condition that prevents the patient from going to the Health Center for health care are also allowable for reimbursement under the PPS encounter rate if the service would be reimbursed the PPS at the Center. It is expected that services provided in off-site settings should be, in most cases, temporary and intermittent, i.e., when the member cannot come to the clinic due to health reasons.

SOURCE: OK Admin. Rule 317:30-5-661.7. (Accessed Dec. 2023).

Clinic Services

Telehealth and audio-only health service delivery requires either the provider or the member to be located at the freestanding clinic that is providing services pursuant to the Code of Federal Regulations. Refer to section Oklahoma Administrative Code (OAC) 317:30-3-27 for telehealth policy and OAC 317:30-3-27.1 for audio-only telecommunication policy.

SOURCE: OK Admin Code Sec. 317.30-5-575, (Accessed Dec. 2023).

Last updated 07/03/2023

Modalities Allowed

Live Video

Clinic Services

Telehealth and audio-only health service delivery requires either the provider or the member to be located at the freestanding clinic that is providing services pursuant to the Code of Federal Regulations. Refer to section Oklahoma Administrative Code (OAC) 317:30-3-27 for telehealth policy and OAC 317:30-3-27.1 for audio-only telecommunication policy.

SOURCE: OK Admin Code Sec. 317.30-5-575, (Accessed Dec. 2023).

See: OK Medicaid Live Video.


 Store and Forward

According to OK Admin Code, health care delivered by telehealth such as store-and-forward must be compensable by OHCA in order to be reimbursed.  There is no explicit reference to whether or not FQHCs can be reimbursed for store-and-forward.

See: OK Medicaid Store and Forward.


Remote Patient Monitoring 

According to OK Admin Code, health care delivered by telehealth such as remote patient monitoring must be compensable by OHCA in order to be reimbursed.  Reimbursement is provided for continuous glucose monitoring in some circumstances.  There is no explicit reference to whether or not FQHCs can be reimbursed for remote patient monitoring.

See: OK Medicaid Remote Patient Monitoring.


 Audio-Only 

An RHC and an FQHC shall be reimbursed for services delivered via audio-only telecommunications at the fee-for-service rate per the fee-for-service fee schedule.

SOURCE: OK Admin. Rule 317:30-3-27.1. (Accessed Dec. 2023).

See: OK Medicaid Email, Phone and Fax.

Last updated 12/04/2023

Patient-Provider Relationship

No reference found

Last updated 12/04/2023

PPS Rate

An RHC and an FQHC shall be reimbursed for services delivered via audio-only telecommunications at the fee-for-service rate per the fee-for-service fee schedule.

SOURCE: OK Admin. Rule 317:30-3-27.1. (Accessed Dec. 2023).

As claims/encounters are filed, reimbursement for SoonerCare Choice members is made for all medically necessary covered primary care and other approved health services at the PPS rate, except for services delivered via audio-only telecommunications which are reimbursed at the fee-for-service (FFS) rate pursuant to the FFS fee schedule.

Primary and preventive behavioral health services rendered by health care professionals authorized in the Federally Qualified Health Center (FQHC) approved state plan pages will be reimbursed at the PPS encounter rate, except for services delivered via audio-only telecommunications which are reimbursed at the FFS rate pursuant to the FFS fee schedule.

SOURCE: OK Admin. Rule 317:30-3-664.10. (Accessed Dec. 2023).

Last updated 12/04/2023

Same Day Encounters

An FQHC may bill for one (1) medically necessary encounter per twenty-four (24) hour period when the appropriate modifier is applied. Medical review will be required for additional visits for children. For information about multiple encounters, refer to OAC 317:30-5-664.4. Payment is limited to four (4) visits per member per month for adults. This limit may be exceeded if the SoonerCare Choice member has elected the FQHC as his/her/their Patient Centered Medical Home/Primary Care Provider.

SOURCE: OK Admin. Rule 317:30-5-664.3. (Accessed Dec. 2023).

An FQHC may bill for more than one (1) medically necessary encounter per 24-hour period under certain conditions when the appropriate modifier is applied.

  • It is intended that multiple medically necessary encounters will occur on an infrequent basis.
  • An FQHC may not develop FQHC procedures that routinely involve multiple encounters for a single date of service, unless medical necessity warrants multiple encounters.
  • Each service must have distinctly different diagnoses in order to meet the criteria for multiple encounters. For example, a medical visit and a dental visit on the same day are considered different services with distinctly different diagnoses.
  • Similar services, even when provided by two (2) different health care practitioners, are not considered multiple encounters.
  • Encounters with more than one (1) FQHC practitioner on the same day, regardless of the length or complexity of the visit, would constitute a single visit. An exception is when the patient has either or both of these:
    • An illness or injury requiring additional diagnosis or treatment subsequent to the first encounter; and/or
    • A qualified medical visit, a qualified mental health and/or dental visit on the same day.

SOURCE: OK Admin. Rule 317:30-5-664.4. (Accessed Dec. 2023).