Okla. Admin. Code § 317:30-5-42.20 - High-investment drugs - outpatient hospitals
(a) The Oklahoma Health Care Authority (OHCA)
designates certain high-investment drugs to be reimbursed separately pursuant
to the Oklahoma Medicaid State Plan for members receiving services at an
outpatient hospital.
(b) The list
of OHCA-designated high-investment drugs is set forth on the Pharmacy page of
the OHCA website, which is available at https://okhca.org. This list may be updated as
deemed necessary.
(c) All
high-investment drugs require prior authorization [refer to Oklahoma
Administrative Code (OAC)
317:30-3-31]
, and the outpatient hospital stay continues to be subject to applicable
medical necessity criteria requirements [refer to OAC
317:30-3-1(f)]
.
(d) OHCA-designated
high-investment drugs provided to eligible members, when treated in
out-of-state outpatient hospitals, may be reimbursed in the same manner as
in-state hospitals. Out-of-state outpatient hospitals must meet applicable
out-of-state conditions of payment set forth in OAC
317:30-3-89 through
317:30-3-92,
and in the Oklahoma Medicaid State Plan.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.