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                                                                                 Center for Connected Health Policy

           Oklahoma


             Medicaid Program:  SoonerCare

           Medicaid Program Administrator:  Oklahoma Health Care Authority

           Regional Telehealth Resource Center:
           Heartland Telehealth Resource Center
           3901 Rainbow Blvd MS 1048
           Kansas City, KS 66160
           (877) 643-4872
           heartlandtrc.org


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM
            Definition of telemedicine/telehealth
            "Telemedicine means the practice of health care    "Telehealth means the use of telecommunication
            delivery, diagnosis, consultation, treatment, including but  technologies for clinical care (telemedicine), patient
            not limited to, the treatment and prevention of strokes,   teaching and home health, health professional education
            transfer of medical data, or exchange of medical   (distance learning), administrative and program
            education information by means of audio, video, or data  planning, and other diverse aspects of a health care
            communications. Telemedicine is not a consultation   delivery system.”
            provided by telephone or facsimile machine.”
                                                               Source: OK Admin. Code Sec. 317:30-3-27.
            Source: OK Statutes, Title 36, Sec. 6802.
                                                               "Telemedicine means the practice of health care
            "Telemedicine means the practice of health care    delivery, diagnosis, consultation and treatment and the
            delivery, diagnosis, consultation, treatment, including but   transfer of medical data through interactive audio, video
            not limited to, the treatment and prevention of strokes,   or data communications that occur in the real-time or
            transfer of medical data, or exchange of medical   near real-time and in the physical presence of the
            education information by means of audio, video, or data   member.”
            communications. Telemedicine is not a consultation
            provided by telephone, facsimile machine nor does it   Source: OK Admin. Code Sec. 317:30-3-27 (b)(8).
            include administrative applications such as billing,
            contracted services, security systems, etc.”       Telemedicine is the communication between an
                                                               approved specialist and a SoonerCare member either by
            Source: OK Admin Code Title 165: 59-1-4 & 435:10-1-4.   audio, video, or data interaction.

            This definition excludes phone or Internet contact or   Source: Health Care Authority, Providers, Telemedicine
            prescribing and other forms of communication, such as   http://okhca.org/providers.aspx?id=10014 (accessed Jan. 15,
                                                               2015).
            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.

            Source: OK Admin Code Title 435:10-1-4.

            (also see Medicaid column)
            Live Video Reimbursement

            Oklahoma statute requires coverage of telemedicine   SoonerCare (Oklahoma’s Medicaid program)
            services, which includes live video, by health care   reimburses for live video if the health care provider
            service plans, disability insurer programs, workers’   determines the service to be appropriately provided via
            compensation programs, and state Medicaid managed   telemedicine.  This applies to health care service plans,
            care program contracts, subject to contract terms and   disability insurer programs, workers’ compensation


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            conditions.                                        programs or state Medicaid managed care program
                                                               contracts.
            Source: OK Statute, Title 36 Sec. 6803.
                                                               Eligible services:
            (see Medicaid column & “Private Payers” section)
                                                                   •   Consultations;

                                                                   •   Office visits;
                                                                   •   Individual psychotherapy;
                                                                   •   Psychiatric diagnostic interview examinations
                                                                       and testing;
                                                                   •   Mental health assessments;
                                                                   •   Pharmacologic management.

                                                               Eligible distant-site providers:

                                                                   •   Physicians;
                                                                   •   Advanced registered nurse practitioners;
                                                                   •   Physician assistants;
                                                                   •   Genetic counselors;
                                                                   •   Licensed behavioral health professionals;
                                                                   •   Dieticians;
                                                                   •   An Indian Health Service facility, a Tribal health
                                                                       facility or an Urban Indian (I/T/U) clinic with
                                                                       specialty service providers as listed here.


                                                                Coverage of all telemedicine services is at the discretion
                                                                of the Oklahoma Health Care Authority.

                                                               Source: OK Admin. Code Sec. 317:30-3-27 & Health Care
                                                               Authority, Providers, Telemedicine
                                                               http://okhca.org/providers.aspx?id=10014 (accessed Jan. 15,
                                                               2015).

                                                               Office and outpatient visits count toward benefit limits.

                                                               Source: OK Statute, Title 36 Sec. 6803.

            Store and Forward Reimbursement
            (see Medicaid column)                              SoonerCare will reimburse for “conventional health care
                                                               delivery”, the service does not require face-to-face
                                                               contact between the patient and the provider.

                                                               Examples include:

                                                                   •   Tele-radiology;
                                                                   •   Tele-pathology;
                                                                   •   Fetal monitor strips;
                                                                   •   Physician interpretation of electrocardiogram
                                                                       and electroencephalogram readings.

                                                                SoonerCare does not consider these services
                                                                telemedicine as defined by OHCA.

                                                               Source: OK Admin. Code Sec. 317:30-3-27(e).


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Remote Patient Monitoring Reimbursement
            No reference found.                                No reference found.

            Email/Phone/FAX
            No reference found for email.                      No reimbursement for email.
            No reimbursement for telephone.                    No reimbursement for telephone.
            No reimbursement for FAX.                          No reimbursement for FAX.

            Source: OK Statute, Title 36 St. Sec. 6802.        Source: OK Admin. Code Sec. 317:30-3-27(d).

            (also see Medicaid column)

            Online Prescribing
             Telemedicine physicians who meet certain criteria are   No reference found.
             not subject to the face-to-face requirement to establish
             a physician-patient relationship.

             Source: OK Admin. Code Sec. 435:10-7-12.

             Prescribing or administering a drug or treatment without
             sufficient examination and the establishment of a valid
             physician-patient relationship is prohibited.

             Source: OK Statute, Title 59, Sec. 509.

             A physician-patient relationship includes an in-person
             patient exam.

             Source: OK Admin. Code Sec. 435:10-1-4.
            Consent
            Written patient consent is required prior to the delivery of  Written consent required.
            any telemedicine services.  The provider who is in
            physical contact with the patient shall obtain this   Source: OK Admin. Code Sec. 317:30-3-27(f)(6).
            consent.

            Source: OK Statute, Title 36 Sec. 6804.

            (also see Medicaid column)
            Location

            No reference found.                                Coverage is limited to rural or geographic areas where
                                                               there is a lack of local medical/psychiatric/mental health
                                                               expertise.

                                                               Source: OK Admin. Code Sec. 317:30-3-27(c)(2).  Health Care
                                                               Authority, Providers, Telemedicine
                                                               http://okhca.org/providers.aspx?id=10014 (accessed Jan. 15,
                                                               2015).

                                                               Rural areas are defined as counties with fewer than
                                                               50,000 people.

                                                               Source: OK Admin. Code Sec. 317:30-3-27(b)(5).  Jan. 15, 2015

                                                               Eligible originating sites:


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                                   •   Practitioner offices;
                                                                   •   Hospitals;
                                                                   •   Schools;
                                                                   •   Outpatient behavioral health clinics;
                                                                   •   Critical Access Hospitals;
                                                                   •   Rural Health Clinics;
                                                                   •   Federally Qualified Health Centers;
                                                                   •   Indian Health Service, tribal health, or Urban
                                                                       Indian facility (I/T/U).

                                                               Source: OK Admin. Code Sec. 317:30-3-27(c)(5) & Oklahoma
                                                               Health Care Authority, Providers, Telemedicine
                                                               http://okhca.org/providers.aspx?id=10014 (accessed Jan. 15,
                                                               2015).
            Cross-State Licensing

            Physician treating patients in OK through telemedicine   No reference found.
            must be fully licensed in OK.

            Source: OK Admin Code Title 435:10-1-4.

            The State Board of Osteopathic Examiners has the
            authority to issue a telemedicine license.

            Source: OK Statute, Title 59, Sec. 633
            Private Payers
            Requires coverage of telemedicine services by health   No reference found.
            care service plans, disability insurer programs, workers’
            compensation programs, and state Medicaid managed
            care program contracts, subject to contract terms and
            conditions.

            Source: OK Statute, Title 36 Sec. 6803.
            Site/Transmission Fee

            (see Medicaid column)                              Facility fee paid to originating site.

                                                               Source: OK Admin. Code Sec. 317:30-3-27.

                                                               No originating site fee for store and forward.

                                                               Source: OK Admin. Code Sec. 317:30-3-27(e).
            Miscellaneous
            OK provides, at no cost, one telecommunications line or
            wireless connection for telemedicine services to the
            following:

               •   Not-for-profit hospitals;
               •   County health departments;
               •   City-county health departments;
               •   Federally Qualified Health Centers.

            Source: OK Statutes, Title 17 Sec. 139.109.


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                                                                                 Center for Connected Health Policy

           Comments:     The OK Dept. of Health has begun to develop a statewide telemedicine network.
                         Oklahoma Statutes, Title 63 Sec. 1-2702.

                         OK New Regulations Passed:
                           •   State Board of Medical Licensure and Supervision













































































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