Coverage for specialty provider services.

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A. The Oklahoma Health Care Authority shall take into consideration the unique medical and functional needs of members with complex physical disabilities when preparing or adjusting its budget.

B. The Oklahoma Health Care Authority shall provide coverage for specialty provider services, specialized equipment, and supplies for people with complex physical disabilities. Such coverage shall take into consideration the unique medical and functional needs of people with complex physical disabilities by:

1. Identifying a means by which to recognize people with complex physical disabilities through ID codes and/or billing modifiers;

2. Determining current procedure terminology billing codes that recognize specialized provider care and preserve a specialized rate which will ensure access to care;

3. Identifying criteria required to establish qualifications as a specialty provider; and

4. Classifying specialty products and goods into a separate category and establishing a reasonable access protocol for certain items.

Added by Laws 2015, c. 324, § 4, eff. Nov. 1, 2015.


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