Okla. Admin. Code § 317:25-7-25 - Member enrollment process
(a)
SoonerCare eligible individuals whose eligibility is based on one(1) of the aid
categories defined in Oklahoma Administrative Code (OAC)
317:25-7-12
are eligible to enroll with a primary care physician (PCP). Parents or
guardians will choose on behalf of minor members in the household. Families
with more than one(1) enrollee may choose a different PCP for each family
member.
(b) Until the effective
date of enrollment with a PCP, services for a newborn are reimbursed at a
fee-for-service rate. Upon eligibility determination, newborns may enroll with
a PCP who is in general practice, family practice, or general pediatrics.
Enrollment materials will advise the parent or guardian of the right to change
a PCP after the effective date of enrollment.
(c) A description of the PCCM program and the
PCP directory are available on the Oklahoma Health Care Authority's (OHCA)
website.
(d) For purposes of
determining the member's choice of PCP, the most recent PCP selection received
by the OHCA determines the PCP with which the member is enrolled, as long as
capacity is available. If capacity is not available or the member does not
choose, the member is assigned according to the assignment mechanism as defined
by the OHCA. A member who is eligible for SoonerCare Choice but is not
assigned, may request enrollment with a PCP by contacting the SoonerCare Help
line or through the member's my SoonerCare. org account, if applicable.
(e) PCPs may not refuse an
assignment, seek to disenroll a member, or otherwise discriminate against a
member on the basis of age, sex, race, physical or mental disability, national
origin, or type of illness or condition, unless that condition can be better
treated by another provider type, except that Indian Health Service, tribal or
urban Indian programs may provide services to members consistent with federal
law.
Notes
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