Okla. Admin. Code § 317:25-7-27 - Changing Primary care providers (PCPs)
(a) The Oklahoma Health Care Authority (OHCA)
is responsible for changing a member's enrollment from one(1) PCP to another:
(1) Without cause upon the member's request;
or
(2) Upon demonstration of good
cause. For purposes of this paragraph, good cause means:
(A) Those members who are habitually
non-compliant with the documented medical directions of the provider; or
(B) Those members who pose a
threat to employees, or other patients of the PCP; or
(C) As a result of a grievance determination
by the OHCA; or
(D) In those cases
where reliable documentation demonstrates that the physician-patient
relationship has so deteriorated that continued service would be detrimental to
the member, the provider or both; or
(E) The member's illness or condition would
be better treated by another type of provider; or
(3) when the state imposes an intermediate
sanction.
(b) A written
request by the PCP to change the enrollment of a member is acted upon by the
OHCA within thirty (30) days of its receipt. The decision to change PCPs for
cause is made at the discretion of the OHCA, subject to appeals policies
delineated at Oklahoma Administrative Code 317:2-1. The effective date of
change is set so as to avoid the issue of abandonment.
(c) In the event a SoonerCare PCP contract is
terminated by OHCA for any reason, or the PCP terminates participation in the
SoonerCare Choice program the panel members formerly aligned with the
terminating PCP shall be enrolled with a different PCP.
Notes
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