Oklahoma § 56-1012.4 - Regulations and policies for CRT products and services

§ 56-1012.4. Regulations and policies for CRT products and services

The Oklahoma Health Care Authority shall establish focused

regulations and policies for CRT products and services. These

focused regulations and policies shall take into consideration the

customized nature of CRT and the broad range of services necessary

to meet the unique medical and functional needs of people with

complex physical disabilities by:

1. Designating specific HCPCS billing codes as CRT and, as

needed, creating new billing codes or modifiers for services and

products covered for people with complex physical disabilities;

2. Establishing specific supplier standards for companies or

entities that provide CRT and restricting the provision of CRT to

only qualified CRT suppliers that meet such standards as defined in

Section 3 of this act;

3. Requiring complex-needs patients receiving a complex

rehabilitation manual wheelchair, power wheelchair, or seating

component to be evaluated by:

a.

a qualified health care professional as defined in

Section 3 of this act, and

b.

a qualified complex rehabilitation technology

professional as defined in Section 3 of this act;

4. Maintaining payment policies and rates for complex

rehabilitation technology to ensure payment amounts are adequate to

provide people with complex physical disabilities with access to

such items. Such policies and rates shall take into account the

significant resources, infrastructure, and staff needed to

appropriately provide CRT to meet the unique needs of complex-needs

patients;

5. Exempting the HCPCS billing codes defined in Section 3 of

this act from inclusion in any bidding, selective contracting, or

similar such initiative, if the specialty provider service,

specialized equipment or supply can only be obtained from a sole

source;

6. Requiring that Managed Care Medicaid plans adopt the

regulations and policies outlined in this act and contract with any

willing, qualified CRT supplier; and

7. Making other changes as needed to protect access to CRT for

complex-needs patients.

Added by Laws 2015, c. 324, § 5, eff. Nov. 1, 2015.