Title 56, Title 56 — Poor Persons
0 chapters · 401 sections in this title.
56 O.S. § 1001 Short title
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This act shall be known and may be cited as the "Oklahoma Medicaid Program Integrity Act". Added by Laws 1989, c. 220, § 1, operative July 1, 1989.
56 O.S. § 1002 Definitions
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As used in the Oklahoma Medicaid Program Integrity Act: 1. "Authority" means the Oklahoma Health Care Authority; 2. "Attorney General" means the Attorney General of this state, his employees or his authorized representatives; 3. "Claim" means a communication, including written, e…
56 O.S. § 1003 Medicaid fraud control unit - Creation - Status - Power
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and authority - Attorney General's Medicaid Fraud Revolving Fund. A. There is hereby created within the Office of the Attorney General, a Medicaid fraud control unit. B. The Medicaid fraud control unit shall be the state entity to which all cases of suspected Medicaid fraud shall…
56 O.S. § 1004 Potential recipient's authorization to examine records -
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Provider's signed statement as to accuracy of reports, etc. - Maintenance of records - Access to records - Confidentiality of records and information - Disclosure - Liability. A. No potential Medicaid recipient shall be eligible for medical assistance unless such recipient has, i…
56 O.S. § 1005 Unlawful acts
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A. It shall be unlawful and deemed a Class D1 felony offense for any person to willfully and knowingly: 1. Make or cause to be made a claim, knowing the claim to be false, in whole or in part, by commission or omission; 2. Make or cause to be made a statement or representation fo…
56 O.S. § 1005.1 Definitions – Fraudulent receipt of assistance
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A. As used in this section: 1. “Administrative sanction” means the court may enter an order making an individual who violates a provision of this section ineligible for assistance for a specified period of time. Such order shall be communicated to the Oklahoma Health Care Authori…
56 O.S. § 1005.2 Short title - Defunding Fetal-Body-Parts Trafficking
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Act. This act shall be known and may be cited as the "Defunding Fetal-Body-Parts Trafficking Act". Added by Laws 2018, c. 202, § 1, eff. Nov. 1, 2018.
56 O.S. § 1005.3 Definitions
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For purposes of this act: 1. "Provider" means a provider of services for compensation; 2. "Affiliate" means an entity which licenses the use of a trademark or other recognized name to the provider, and which exercises control over the use of part or all of the provider's name, or…
56 O.S. § 1005.4 Violations – Penalties – Investigation
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A. No provider shall be eligible for reimbursement through Medicaid or any other federal or state program or any other funding from any political subdivision of this state including but not limited to cities, towns, municipalities or counties, directly or by subcontract with any …
56 O.S. § 1006 Medicaid fraud - Penalties
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A. Any person found to have committed any violation of paragraphs 1 through 6 of subsection A of Section 1005 of this title shall be deemed guilty of Medicaid fraud. B. 1. Any person committing Medicaid fraud where the aggregate amount of payments illegally claimed or received is…
56 O.S. § 1007 Additional penalties
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A. Any person who receives payment for furnishing goods or services under the Oklahoma Medicaid Program, which the person is not entitled to receive by reason of offenses under paragraphs 1 through 6 of subsection A of Section 1005 of this title, shall, in addition to any other p…
56 O.S. § 1007.1 Short title - Defunding Statutory Rape Cover-up Act
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This act shall be known and may be cited as the "Defunding Statutory Rape Cover-up Act". Added by Laws 2019, c. 239, § 1, eff. Nov. 1, 2019.
56 O.S. § 1007.2 Definitions
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As used in the Defunding Statutory Rape Cover-up Act: 1. "Provider" shall mean a provider of services for compensation; and 2. "Affiliate" shall mean an entity which licenses the use of a trademark or other recognized name to the provider, and which exercises control over the use…
56 O.S. § 1007.3 Eligibility for Medicaid reimbursement – Failure to
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report statutory rape. A. No provider shall be eligible for reimbursement through Medicaid or any other federal or state program, directly or by subcontract with any other party, if: 1. That provider, or any affiliate of that provider, has been found by a court of law, either civ…
56 O.S. § 1007.4 Promulgation of rules to investigate complaints
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The Oklahoma Health Care Authority shall promulgate rules to investigate complaints pursuant to the Defunding Statutory Rape Cover-up Act. Nothing in the Defunding Statutory Rape Cover-up Act shall preclude the Oklahoma Attorney General or any district attorney with jurisdiction …
56 O.S. § 1008 Annual report on Medicaid fraud
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The Attorney General shall submit an annual report, due by July 1 of each year, to the Speaker of the House of Representatives, the President Pro Tempore of the Senate, the Governor and the Secretary of State detailing the number of Medicaid fraud cases investigated and litigated…
56 O.S. § 1009.1 Short title - Legislative findings
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A. Sections 1 and 2 of this act shall be known and may be cited as the “All Kids Act”. B. The Legislature finds that, for the economic and social benefit of all residents of the State of Oklahoma, it is important to enable all children of this state to access affordable health in…
56 O.S. § 1009.2 Medical coverage for children 18 and under -
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Eligibility - Privately sponsored insurance - Partial coverage - Cost-sharing - Rules - Waivers - Funding. A. On or before January 1, 2011, the Oklahoma Health Care Authority shall establish and maintain a program with a voucher and/or other subsidy to provide medical coverage as…
56 O.S. § 1010.1 Short title - Oklahoma Medicaid Program Reform Act of
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2003 – Purpose - Coverage – Waivers - Health Employee and Economy Improvement Act (HEEIA) Revolving Fund. A. Section 1010.1 et seq. of this title shall be known and may be cited as the “Oklahoma Medicaid Program Reform Act of 2003”. B. Recognizing that many Oklahomans do not have…
56 O.S. § 1010.12 Prescriptions for non-sedating antihistamines -
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Exemption from prior authorization procedures. Subject to the provisions of subsection B of Section 204 of Title 56 of the Oklahoma Statutes, effective September 1, 1998, children age eighteen (18) or younger may be prescribed non-sedating antihistamines under the state Medicaid …
56 O.S. § 1010.13 Representatives of incompetent Medicaid beneficiaries
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A Medicaid beneficiary, including, but not limited to, a beneficiary currently enrolled in a fully or partially capitated managed care delivery model pursuant to the provisions of the Oklahoma Medicaid Healthcare Options System, who is not medically or legally competent may have …
56 O.S. § 1010.21 Short title – Purpose - Definition
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A. This act shall be known and may be cited as the “Oklahoma Pharmacy Connection Program”. B. Initial implementation of the program shall target senior citizens and shall utilize the existing toll-free Senior Info-Line telephone number for senior citizen services. C. The purpose …
56 O.S. § 1010.22 Establishment of program – Services to be offered –
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Target population. A. The Department of Human Services shall establish a program through which health care providers and members of the public can obtain information about manufacturer-sponsored prescription drug assistance programs and shall provide such information to pharmacie…
56 O.S. § 1010.8A Medicaid Health Improvement Revolving Fund
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There is hereby created in the State Treasury a revolving fund for the Oklahoma Health Care Authority to be designated the "Medicaid Health Improvement Revolving Fund". The fund shall be a continuing fund, not subject to fiscal year limitations, and shall consist of all monies re…
56 O.S. § 1011.1 Short title
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Sections 1 through 10 of this act shall be known and cited as the “Oklahoma Medicaid Reform Act of 2006”. Added by Laws 2006, c. 315, § 1, emerg. eff. June 9, 2006.
56 O.S. § 1011.10 Health care benefit waiver for full-time state
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university or college students. The Oklahoma Health Care Authority shall apply for any necessary waiver to extend health care benefits to persons up to the age of twenty-three (23) years if the person is enrolled as a full-time student in an accredited university or college in th…
56 O.S. § 1011.11 Durable medical equipment retrieval program – Rules -
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Definition. A. The Oklahoma Health Care Authority shall develop and implement, as funds become available, a durable medical equipment retrieval program that will allow the Authority to: 1. Retrieve durable medical equipment, purchased with Medicaid funds, from the Medicaid consum…
56 O.S. § 1011.12 Feasibility study for state plan amendment for applied
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behavior analysis treatment of autism spectrum disorder. A. The Oklahoma Health Care Authority, in conjunction with the Department of Mental Health and Substance Abuse Services, the State Department of Health and the State Department of Education shall examine the feasibility of …
56 O.S. § 1011.13 Nursing Facility Supplemental Payment Program
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Revolving Fund. A. There is hereby created in the State Treasury a revolving fund for the Oklahoma Health Care Authority to be designated the "Nursing Facility Supplemental Payment Program Revolving Fund". The fund shall be a continuing fund, not subject to fiscal year limitation…
56 O.S. § 1011.14 Penalties and interest for failing to timely pay
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The Oklahoma Health Care Authority shall promulgate administrative rules that govern the assessment of penalties and interest against any nonstate governmental organization that fails to timely pay the full amount of a quarterly intergovernmental transfer; provided, however, that…
56 O.S. § 1011.15 SoonerCare eligibility modifications
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A. The Oklahoma Health Care Authority (OHCA) shall seek Medicaid waiver authority to pursue modifications to Medicaid eligibility criteria so that receipt of SoonerCare coverage for certain Medicaid populations is conditional upon documentation of certain education, skills, train…
56 O.S. § 1011.2 Program to improve service delivery system - Waivers of
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federal laws - Implementation of phase one of act - Independent evaluation - Purpose. A. The Oklahoma Health Care Authority is authorized to seek waivers and/or other federal authorizations to create a statewide program to provide for a more efficient and effective service delive…
56 O.S. § 1011.25 Coverage for hospice services
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A. As used in this act, "hospice care" means a comprehensive, holistic program of palliative and/or comfort care and support provided to the member and his or her family when a physician certifies that the member has a terminal illness and has a life expectancy of six (6) months …
56 O.S. § 1011.3 Powers, duties and responsibilities of Health Care
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Authority – Program opt-out option. A. The Oklahoma Health Care Authority shall have the following powers, duties, and responsibilities with respect to the development of the program established in Section 1011.2 of this title: 1. The consumer education component shall include th…
56 O.S. § 1011.4 Database of clinical utilization information - Needs
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analysis - Electronic prescribing pilot program. A. The Oklahoma Health Care Authority shall conduct a needs analysis to design a database of clinical utilization information or electronic medical records for Medicaid providers. This system shall be web-based and allow providers …
56 O.S. § 1011.5 Nursing facility incentive reimbursement rate plan
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A. 1. The Oklahoma Health Care Authority shall develop an incentive reimbursement rate plan for nursing facilities focused on improving resident outcomes and resident quality of life. 2. Under the current rate methodology, the Authority shall reserve Five Dollars ($5.00) per pati…
56 O.S. § 1011.6 Disease management program
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A. The Oklahoma Health Care Authority shall develop a formal program for disease management to improve the quality of care and reduce the cost of care. The Authority is authorized to contract for the development of the program if contracting is more cost effective to the state th…
56 O.S. § 1011.7 Plan to implement alternatives for long-term care
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The Oklahoma Health Care Authority shall develop and administer a plan for the implementation of alternatives for long-term care. The plan shall include, but not be limited to: 1. The continued development and funding of community-based options throughout the State of Oklahoma; 2…
56 O.S. § 1011.8 Program to encourage use of primary care services in
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lieu of emergency room services. A. The Oklahoma Health Care Authority and the State Department of Health, subject to the availability of funds, may develop and administer a program to encourage the timely and appropriate use of primary care services in lieu of emergency room uti…
56 O.S. § 1011.9 Establishment of method to reduce payment error rate -
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Reporting of errors. A. 1. The Oklahoma Health Care Authority shall establish a method to deter abuse and reduce errors in Medicaid billing, payment, and eligibility through the use of technology and accountability measures for the Authority, providers, and consumers. The Authori…
56 O.S. § 1011.9A Claims payable to providers of Medicaid home and
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community-based services — OHCA prohibited from utilizing certain audit methods — Development and refinement with DOH of audit methodology. A. As used in this section: 1. "Error rate" means the percentage of dollars of audited claims found to be billed in error; 2. "Extrapolation…
56 O.S. § 1012.1 Short title - Commitment to Care for People with
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Complex Physical Disabilities Act. This act shall be known and may be cited as the "Commitment to Care for People with Complex Physical Disabilities Act". Added by Laws 2015, c. 324, § 2, eff. Nov. 1, 2015.
56 O.S. § 1012.2 Definitions
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As used in the Commitment to Care for People with Complex Physical Disabilities Act: 1. "Complex physical disability" means a diagnosis or medical condition that results in significant physical impairment and/or functional limitation. Such term shall include, but not be limited t…
56 O.S. § 1012.3 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 se…
56 O.S. § 1012.4 Regulations and policies for CRT products and services
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The Oklahoma Health Care Authority shall establish focused regulations and policies for CRT products and services. These focused regulations and policies shall take into consideration the customized nature of CRT and the broad range of services necessary to meet the unique medica…
56 O.S. § 1015.1 Short title
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This act shall be known and may be cited as the “Consumer Protection for Wheeled Mobility Act”. Added by Laws 2008, c. 410, § 1, eff. July 1, 2008.
56 O.S. § 1015.2 Definitions
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As used in the Consumer Protection for Wheeled Mobility Act: 1. “Assistive technology practitioner” or “ATP” means a for- service provider who is involved in analysis of the needs and training of a consumer in the use of a particular assistive technology device; 2. “Assistive tec…
56 O.S. § 1015.3 Requirements for Medicaid claims on wheeled mobility
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purchases. A. Contingent upon the availability of funding, for Medicaid claims with dates of service on or after April 1, 2009, on all purchased wheeled mobility, the patient shall either have: 1. A specialty evaluation that was performed by a licensed or certified medical profes…
56 O.S. § 1016 Study of coverage for prosthetic and orthotic devices for
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Medicaid-eligible individuals. A. The Oklahoma Health Care Authority shall study and recommend coverage for prosthetic devices and orthotic devices for Medicaid- eligible individuals. The study shall include the review of payment rates necessary to provide the benefit. The study …
56 O.S. § 1017.1 Oklahoma Choices for Long-Term Care Act - Purpose
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A. Sections 1 through 5 of this act shall be known and may be cited as the “Oklahoma Choices for Long-Term Care Act”. B. The purpose of the Oklahoma Choices for Long-Term Care Act is to make long-term services and supports for citizens easily accessible, cost-effective and of hig…