Okla. Admin. Code § 317:35-21-12 - Changes after certification/continued need for treatment
(a) A woman found
to be in need of treatment as the result of an abnormal BCC screen has sixty
(60) days from the date of the application to complete the initial appointment
for a diagnostic procedure and an additional sixty (60) days to complete any
additional diagnostic testing required or to initiate compensable treatment for
a cancerous or pre-cancerous condition. The exception to the time limit is
evidence of a lack of appointment availability. Upon completion of the
diagnostic testing, OHCA is provided a medical report of the findings.
(1) If the woman is found not to have breast
or cervical cancer including pre-cancerous conditions and early stage,
recurrent or metastatic cancer for which she is in need of treatment or fails
to have diagnostic testing or begin treatment within the time frames described
in OAC 317:35-21-12(a), the case is closed by OHCA and appropriate notification
is computer generated.
(2) If a
medical report necessary to determine continued treatment is not received from
a provider within ten (10) working days after a request is made by OHCA, the
report is considered negative and the case is closed by OHCA and appropriate
notification is computer generated.
(b) If the woman in need of treatment refuses
SoonerCare compensable treatment or diagnostic services and does not plan to
pursue the care in the time frames described in OAC 317:35-21-12(a), the case
is closed by OHCA and appropriate notification is computer generated.
(c) In the event a woman is unable to
initiate or complete diagnostic services due to a catastrophic illness or
injury occurring after certification, SoonerCare will remain open with the
approval of a Chief Medical Officer or his/her designee.
(d) If it is determined at any time during
the certification period by either the woman's treating physician or by a Chief
Medical Officer or his or her designee that the woman is no longer in need of
treatment for breast or cervical cancer or a precancerous condition, the
eligibility coordinator closes the case and appropriate notification is
computer generated.
(e) If it is
determined at any time during the certification period that the woman has
creditable health insurance coverage, the eligibility coordinator closes the
case and appropriate notification is computer generated.
(f) If the eligibility coordinator later
determines that the woman is otherwise eligible for SoonerCare, the worker
takes necessary actions to certify her for the appropriate category of
SoonerCare coverage.
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.
(a) A woman found to be in need of treatment as the result of an abnormal BCC screen has sixty (60) days from the date of the application to complete the initial appointment for a diagnostic procedure and an additional sixty (60) days to complete any additional diagnostic testing required or to initiate compensable treatment for a cancerous or pre-cancerous condition. The exception to the time limit is evidence of a lack of appointment availability. Upon completion of the diagnostic testing, OHCA is provided a medical report of the findings.
(1) If the woman is found not to have breast or cervical cancer including pre-cancerous conditions and early stage, recurrent or metastatic cancer for which she is in need of treatment or fails to have diagnostic testing or begin treatment within the time frames described in OAC 317:35-21-12(a), the case is closed by OHCA and appropriate notification is computer generated.
(2) If a medical report necessary to determine continued treatment is not received from a provider within ten (10) working days after a request is made by OHCA , the report is considered negative and the case is closed by OHCA and appropriate notification is computer generated.
(b) If the woman in need of treatment refuses SoonerCare compensable treatment or diagnostic services and does not plan to pursue the care in the time frames described in OAC 317:35-21-12(a), the case is closed by OHCA and appropriate notification is computer generated.
(c) In the event a woman is unable to initiate or complete diagnostic services due to a catastrophic illness or injury occurring after certification, SoonerCare will remain open with the approval of a Chief Medical Officer or his/her designee.
(d) If it is determined at any time during the certification period by either the woman's treating physician or by a Chief Medical Officer or his or her designee that the woman is no longer in need of treatment for breast or cervical cancer or a precancerous condition, the eligibility coordinator closes the case and appropriate notification is computer generated.
(e) If it is determined at any time during the certification period that the woman has creditable health insurance coverage, the eligibility coordinator closes the case and appropriate notification is computer generated.
(f) If the eligibility coordinator later determines that the woman is otherwise eligible for SoonerCare, the worker takes necessary actions to certify her for the appropriate category of SoonerCare coverage.