Okla. Admin. Code § 317:30-5-559 - [Effective until 9/14/2025] How Private Duty Nursing (PDN) services are authorized

PDN services may be initiated after completion of the following steps:

(1) A treatment plan for the patient has been created by an eligible PDN provider per Oklahoma Administrative Code (OAC) 317:30-5-560;

(2) A prior authorization request is submitted with the appropriate Oklahoma Health Care Authority (OHCA) required data elements and the treatment plan;

(3) An assessment (telephonic, virtual, or face-to-face) has been conducted by an OHCA care management nurse, per OAC 317:30-5-558 (3); and

(4) An OHCA physician, or his or her designee, has determined the medical necessity of the service, including but not limited to, scoring the member's needs on the OHCA PDN assessment.

Notes

Okla. Admin. Code § 317:30-5-559

Amended by Oklahoma Register, Volume 32, Issue 23, August 17, 2015, eff. 8/27/2015 Amended by Oklahoma Register, Volume 39, Issue 24, September 1, 2022, eff. 9/12/2022 Amended by Oklahoma Register, Volume 41, Issue 17, May 15, 2024, eff. 3/27/2024, exp. 9/14/2025 (Emergency)