Title 63, Title 63 — Public Health and Safety

A. The Oklahoma Health Care Authority shall examine the feasibility of a state plan amendment to the Oklahoma Medicaid Program for diabetes self-management training (DSMT). B. By December 1, 2018, the Authority shall submit a report to the President Pro Tempore of the Senate, the…

services. A. The Oklahoma Health Care Authority shall seek any necessary federal approval to provide coverage for nutrition supports under the state Medicaid program for the purpose of implementing Food is Medicine programs as provided by this section. B. Food is Medicine program…

cost containment and delivery alternatives. A. The Oklahoma Health Care Authority shall analyze the state- purchased and state-subsidized health care programs and explore options for cost containment and delivery alternatives for those programs that are consistent with the purpos…

be permitted to provide vision care or medical diagnosis and treatment of the eye. A. All state-purchased and state-subsidized health care benefit plans, including but not limited to Medicaid, which offer services for vision care or medical diagnosis and treatment for the eye sha…

Legislature - Contents. On or before January 1, 1996, the Authority shall submit plans, recommendations and proposals to the Governor and the Legislature regarding state-purchased and state subsidized health care. Said plans, proposals and recommendations shall include, but not b…

care access, cost containment and related health issues. A. The Authority shall serve as a resource for information on state-purchased and state-subsidized health care access, cost containment and related health issues, and shall: 1. Provide data and information required by the G…

personal care services pursuant to contract with Authority. A. An individual who only provides Medicaid home- and community-based personal care services, pursuant to a contract with the Oklahoma Health Care Authority, shall be exempt from the provisions of the Home Care Act, Sect…

services to Medicaid members through a licensed home care agency — Requirements. A. As used in this section: 1. “Family member” means a child, parent, parent-in-law, sibling, grandparent, grandchild, spouse, or any other individual related by blood, and any other individual with …

care programs and regulatory agencies - Report to Legislature. The Oklahoma Health Care Authority shall review state-purchased and state-subsidized health care programs and health care regulatory agencies, including, but not limited to, medical services within the Department of M…

A. The Oklahoma Health Care Authority Board shall establish a legal division or unit in the Oklahoma Health Care Authority. The Administrator of the Oklahoma Health Care Authority may employ attorneys as needed, which may be on full-time and part-time basis. Provided the Oklahoma…

There is hereby created in the State Treasury a revolving fund for the Oklahoma Health Care Authority to be designated the "Oklahoma Health Care Authority Revolving Fund". The fund shall be a continuing fund, not subject to fiscal year limitations, and shall consist of all monies…

There is hereby created in the State Treasury a fund for the Oklahoma Health Care Authority to be designated the "Oklahoma Health Care Authority Federal Disallowance Fund". The fund shall be a continuing fund, not subject to fiscal year limitations. It shall consist of monies rec…

Disclosure to authorized representative. All applications and records concerning any applicant or recipient under the Medicaid Program shall be confidential and shall be open to inspection only to persons duly authorized by the Oklahoma Health Care Authority, this state, or the U…

members. If a person who is on active duty with the United States Armed Forces makes an application to the Oklahoma Health Care Authority to receive any type of benefits, either for himself or herself or for an immediate family member, and the person has previously made the same …

There is hereby created in the State Treasury a fund for the Oklahoma Health Care Authority to be designated the "Oklahoma Health Care Authority Medicaid Program Fund". The fund shall be a continuing fund, not subject to fiscal year limitations. All monies accruing to the credit …

A. There is hereby created in the State Treasury a fund for the Oklahoma Health Care Authority to be designated the "Rate Preservation Fund". The fund shall be a continuing fund, not subject to fiscal year limitations, and shall consist of monies designated to the fund by law. Al…

reimbursement. The Oklahoma Health Care Authority shall promulgate rules which shall provide that the liability insurance costs of nursing facilities shall be allowable costs for purposes of Medicaid reimbursement. Added by Laws 2000, c. 340, § 6, eff. July 1, 2000.

Effective January 1, 2000, and every January thereafter, the Oklahoma Health Care Authority will adjust the nursing facility per diem rate in an amount equal to the total amount of the savings to the Medicaid program as a result of the automatic cost-of-living adjustment on Socia…

programs. A. 1. Effective July 1, 2001, the Oklahoma Health Care Authority is authorized to offer to eligible contracted incorporated physician providers, elective income deferral programs which can result in federal income tax advantages and other advantages to such providers an…

The Oklahoma Health Care Authority may establish, with available funds, a reimbursement methodology that will enhance the reimbursement for services provided to Medicaid beneficiaries in emergency hospitals in rural areas of the state. Added by Laws 2001, c. 317, § 2, eff. Nov. 1…

phenylketonuria. A. The Oklahoma Health Care Authority Board shall, in administering the Medicaid prescription drug program, utilize the following definition for "phenylketonuria" to mean: An inborn error of metabolism attributable to a deficiency of or a defect in phenylalanine …

for sickle cell disease. A. The Oklahoma Health Care Authority shall conduct an annual review of all medications and forms of treatment for sickle cell disease and services for enrollees with a diagnosis of sickle cell disease. The purpose of the annual review is to determine if …

A. As used in this section “health care district” means a subordinate health care entity that better promotes efficient administration of health care service delivery for counties with a population of one hundred thousand (100,000) or less to eligible persons in this state. B. A …

for newborns through children 18 years of age. A. The Oklahoma Health Care Authority, with assistance from the Department of Human Services and the Department of Mental Health and Substance Abuse Services, shall initiate a request for information for care coordination models for …

A. The Oklahoma Health Care Authority shall coordinate with domestic violence sexual assault programs certified by the Office of the Attorney General who provide counseling services for victims of domestic violence to ensure that any information relating to billing or explanation…

A. As used in this section, “birthing center” has the same meaning as provided by Section 1-701 of Title 63 of the Oklahoma Statutes. B. The Oklahoma Health Care Authority shall seek federal approval to allow a birthing center that is not licensed by the state but has been accred…

A. There is hereby created within the Oklahoma Health Care Authority the Medicaid Drug Utilization Review Board, which shall be responsible for the development, implementation and assessment of retrospective and prospective drug utilization programs under the direction of the Aut…

As used in Sections 1 through 5 of this act: 1. “Compendia” means the “American Hospital Formulary Services Drug Information”, “U.S. Pharmacopoeia Drug Information”, peer- reviewed medical literature, other information provided by individuals involved in health care, and informat…

A. The Medicaid Drug Utilization Review Board shall have the power and duty to: 1. Advise and make recommendations regarding rules promulgated by the Oklahoma Health Care Authority Board to implement the provisions of this act; 2. Oversee the development, implementation and asses…

1. The Medicaid Drug Utilization Review Board shall develop and recommend to the Oklahoma Health Care Authority Board a retrospective and prospective drug utilization review program for medical outpatient drugs to ensure that prescriptions are appropriate, medically necessary, an…

A. The Oklahoma Health Care Authority shall study the feasibility of implementing one or more disease state management programs. B. The components of the study shall include, but not be limited to: 1. A description and assessment of the findings, costs of the program, savings inc…

A. Except as provided in subsection F of this section, any drug prior authorization program approved or implemented by the Medicaid Drug Utilization Review Board shall meet the following conditions: 1. The Medicaid Drug Utilization Review Board shall make note of and consider inf…

A. As used in this section, “contracted entity” has the same meaning as provided by Section 4002.2 of Title 56 of the Oklahoma Statutes. B. In establishing and maintaining the formulary for the state Medicaid program, the Oklahoma Health Care Authority shall ensure that no nonopi…

expenses of injured and diseased persons - Liens or other legal action. A. 1. The payment of medical expenses by the Oklahoma Health Care Authority for or on behalf of or the receipt of medical assistance by a person who has been injured, passed away, or who has suffered a diseas…

Assignment to Oklahoma Health Care Authority. A. Whenever the Oklahoma Health Care Authority pays for medical services or renders medical services, for or on behalf of a person who has been injured or suffered an illness or disease, the right of the provider of the services to re…

A. Pursuant to the provisions of this section, the Oklahoma Health Care Authority is authorized to file and enforce a lien against the homestead of a recipient for payments of medical assistance made by the Authority to the recipient who is an inpatient of a nursing facility or a…

Enrollment fee and/or premium. The Oklahoma Health Care Authority is hereby authorized to charge an enrollment fee and/or premium for the provision of health care coverage under the Oklahoma Medicaid Program Reform Act of 2003. Such charges, if unpaid, create a debt to the state …

insurers - Exchange of information with Authority. A. 1. On or after November 1, 2003, any entity that provides health insurance in this state including, but not limited to, a licensed insurance company, not-for-profit hospital service, medical indemnity corporation, managed care…

Review by Administrator - Judicial review. A. Any applicant or recipient, adversely affected by a decision of the Oklahoma Health Care Authority on benefits or services provided pursuant to the provisions of this title, shall be afforded an opportunity for a hearing pursuant to t…

This act shall be known and may be cited as the "Oklahoma Medicaid False Claims Act". Added by Laws 2007, c. 137, § 1, eff. Nov. 1, 2007.

claims. A. For purposes of this section: 1. "Claim": a. means any request or demand for money or property, whether under a contract or otherwise and whether or not the state has title to the money or property, that: (1) is presented to an officer, employee or agent of the state, …

authorized - Complaint procedure. A. The Attorney General shall diligently investigate a violation under the Oklahoma Medicaid False Claims Act. If the Attorney General finds that a person has violated or is violating the Oklahoma Medicaid False Claims Act, the Attorney General m…

- Procedure. A. If the state proceeds with the action pursuant to Section 5053.2 of this title, it shall have the primary responsibility for prosecuting the action, and shall not be bound by an act of the person bringing the action. Such person shall have the right to continue as…

actions or settlement - Award of expenses, fees, and costs. A. 1. If the state proceeds with an action brought by a person under subsection B of Section 5053.2 of this title, the person shall, subject to paragraph 2 of this subsection, receive at least fifteen percent (15%) but n…

Liability for expenses or fees - Relief following adverse acts - Statute of limitations. A. In no event may a person bring an action under subsection B of Section 5053.2 of this title which is based upon allegations or transactions which are the subject of a civil suit or an admi…

proof - Res judicata. A. A subpoena requiring the attendance of a witness at a trial or hearing conducted under the Oklahoma Medicaid False Claims Act may be served at any place in Oklahoma. B. A civil action under Section 5053.2 of this title may not be brought: 1. More than six…

A. Any action under Section 5053.2 of this title may be brought in any judicial district in which the defendant or, in the case of multiple defendants, any one defendant can be found, resides, transacts business, or in which any act proscribed by the Oklahoma Medicaid False Claim…

A. The Oklahoma Health Care Authority may administer administrative sanctions to Medicaid recipients who abuse the state Medicaid program. B. Administrative sanctions shall not be administered by the Oklahoma Health Care Authority until notice and hearing have been provided to th…

providers. A. Where practicable and in accordance with state and federal law, the state Medicaid program shall not contract with an out-of- state medical provider for treatment that is available from one or more providers licensed and practicing in the State of Oklahoma. B. The O…

A. The purpose of this act is to maximize and direct the reinvestment of any savings to the Oklahoma Health Care Authority generated by enhanced federal matching authorized under Section 1905(b) of the Social Security Act at a rate of one hundred percent (100%) for covered servic…