For provision of health care services, the OHCA contracts
with qualified PCPs. All providers serving as PCPs must have a valid SoonerCare
Fee-for-Service contract as well as an exercised SoonerCare Choice addendum.
Additionally, all PCPs, excluding provider or physician groups must agree to
accept a minimum capacity of fifty (50) patients; provided, however, this does
not guarantee PCPs a minimum patient volume. PCPs are limited to:
(1)
Physicians. Any physician
licensed to practice medicine in the state in which he or she practices who is
engaged in a general practice or in family medicine, general internal medicine
or general pediatrics may serve as a PCP. Out-of-state PCPs are required to
comply with all access standards imposed on Oklahoma physicians, as well as
Oklahoma Administrative Code (OAC)
317:30-3-89 through
317:30-3-92.
(2)
Advanced Practice Registered Nurses
(APRNs). APRNs who have prescriptive authority may serve as PCPs for the
Primary Care Case Management delivery system if licensed to practice in the
state in which he or she practices.
(3)
Physician Assistants (PAs).
PAs may serve as PCPs if licensed to practice in the state in which he or she
practices.
(4)
Indian Health
Service (IHS) Facilities and Federally Qualified Health Center (FQHC) provider
groups and Rural Health Clinics (RHC).
(A) IHS facilities whose professional staff
meet the general requirements in paragraphs (1) through (3) of this Section and
the provider participation requirements at OAC
317:30-5-1088 may serve as
PCPs.
(B) FQHCs whose professional
staff meet the general requirements in paragraphs (1) through (3) of this
Section and the provider participation requirements in OAC
317:30-
5-
660.2 may
serve as PCPs.
(C) RHCs whose
professional staff meet the general requirements in paragraphs (1) through (3)
of this Section and the provider participation requirements in OAC
317:30-
5-
355 may serve as PCPs.
(5)
Provider or physician group
capacity and enrollment.
(A) Provider
or physician groups must agree to accept a minimum enrollment capacity of fifty
(50) members.
(B) Provider or
physician groups must designate a medical director to serve as the primary
contact with OHCA.
Notes
Okla. Admin.
Code §
317:25-7-5
Added at 14 Ok Reg
3061, eff 7-1-97 (emergency); Added at 15 Ok Reg 1511, eff 5-11-98; Amended at
15 Ok Reg 3778, eff 7-1-98 (emergency); Amended at 16 Ok Reg 138, eff 10-14-98
(emergency); Amended at 16 Ok Reg 1422, eff 5-27-99; Amended at 17 Ok Reg 425,
eff 11-2-99 (emergency); Amended at 17 Ok Reg 2366, eff 6-26-00; Amended at 21
Ok Reg 2149, eff 6-25-04; Amended at 24 Ok Reg 2057, eff 6-25-07; Amended at 26
Ok Reg 401, eff 1-1-09 (emergency); Amended at 26 Ok Reg 2074, eff
6-25-09
Amended
by
Oklahome
Register, Volume 33, Issue 23, August 15, 2016, eff.
9/1/2016
Amended by
Oklahoma
Register, Volume 37, Issue 24, September 1, 2020, eff.
9/14/2020
Amended by
Oklahoma
Register, Volume 40, Issue 6, December 1, 2022, eff.
11/4/2022
Amended by
Oklahoma
Register, Volume 40, Issue 24, September 1, 2023, eff.
9/11/2023
