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

311 words·~1 min read·/ok/title-56-poor-persons/56-1012-4

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

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.