Oklahoma § 63-2550.1 - Definitions

§ 63-2550.1. Definitions

As used in Sections 2550.1 through 2550.4 of this title:

1. “Covered person” means an individual who receives medical

care and treatment through a managed care plan. In the case of a

minor child, the term includes the parent or legal guardian of the

child and, in the case of an incapacitated or partially

incapacitated person, the legal guardian of that person;

2. “Degenerative and disabling condition or disease” means a

condition or disease caused by a congenital or acquired injury or

illness that requires a specialized rehabilitation program or a high

level of care, service, resources or continued coordination of care

in the community;

3. “Designee of the covered person” means an individual

designated by the covered person to represent the interests of the

covered person, including the covered person’s provider;

4. “Managed care plan” means a plan operated by a managed care

entity, including the Oklahoma State and Education Employees Group

Insurance Board, that provides for the financing and delivery of

health care services to persons enrolled in such plan through:

a.

arrangements with selected providers to furnish health

care services,

b.

standards for the selection of participating

providers,

c.

organizational arrangements for ongoing quality

assurance, utilization review programs, and dispute

resolution, and

Oklahoma Statutes - Title 63. Public Health and Safety

d.

financial incentives for persons enrolled in the

managed care plan to use the participating providers

and procedures provided for by the managed care plan;

provided, however, the term “managed care plan” shall not include a

preferred provider organization (PPO) as defined in Section 6054 of

Title 36 of the Oklahoma Statutes, or a certified workplace medical

plan as defined in Section 14.2 of Title 85 of the Oklahoma

Statutes;

5. “Provider” shall have the same meaning as such term is

defined by a health maintenance organization, an indemnity plan or a

preferred provider organization; and

6. “Treatment plan” means a proposal developed for a covered

person that is specifically tailored to the individual’s treatment

needs for a specific illness or condition, and that includes, but is

not limited to:

a.

a statement of treatment goals or objectives, based

upon and related to a medical evaluation,

b.

treatment methods and procedures to be used to obtain

these goals, and

c.

identification of the types of professional personnel

who will carry out the treatment procedures.

Added by Laws 1999, c. 361, § 1, eff. Nov. 1, 1999. Amended by Laws

2000, c. 292, § 4, eff. Nov. 1, 2000.