Access and Service Delivery. 20. Defendants will provide the following Medicaid covered mental health services to Class members: (1) Intensive Care Coordination, (2) Intensive Home and Community Based Services, and (3) Mobile Crisis Intervention and Stabilization Services. In Washington, these services are referred to collectively as WISe, and are defined in Appendix A.
Access and Service Delivery. With the exception of individuals receiving benefits through Insure Oklahoma, all SoonerCare Choice beneficiaries select or are assigned a PCP/CM responsible for furnishing primary and preventive services and making medically necessary referrals. For purposes of determining the member’s choice of PCP, the most recent selection received by the OHCA determines the PCP with which the member is enrolled, as long as capacity is available. If capacity is not available or the member does not choose, the member is assigned to a PCP according to the assignment mechanism as defined by the OHCA. A member, who is eligible for SoonerCare Choice but is not assigned, may request enrollment with a PCP by contacting the SoonerCare Helpline. Members may also request a change to their PCP by contacting the SoonerCare Helpline. PCP/CMs must belong to one of the provider types listed below. Provider Required Qualifications Primary Care Physician Engaged in Family Medicine, General Internal Medicine, General Pediatrics or General Practice; may be board certified or board eligible; or meet all Federal employment requirements, be employed by the Federal Government and practice primary care in an Indian Health Services (IHS) facility. Specialist Physician At discretion of OHCA CEO, based on consideration of percentage of primary care services delivered in physician’s practice, the availability of primary care physicians in the geographic area, the extent to which the physician has historically served Medicaid and his/her medical education and training. Advanced Practice Nurse Must be licensed by the state in which s/he practices and have prescriptive authority; or meet all Federal employment requirements, be employed by the Federal Government and practice in an IHS facility. Physician’s Assistant Must be licensed by the state in which s/he practices; or meet all Federal employment requirements, be employed by the Federal government and practice primary care in an IHS facility. Medical Resident Must be at least at the Post Graduate 2 level and may serve as a PCP/CM only within his/her continuity clinic setting. Must work under the supervision of a licensed attending physician. Health Department Clinics Beneficiaries would be served by one of 68 county health departments or the two city-county health departments in Oklahoma City and Tulsa.
Access and Service Delivery. With the exception of Insure Oklahoma members enrolled in Qualified Health Plans, all SoonerCare beneficiaries select or are aligned with a PCP/CM responsible for furnishing primary and preventive services and making medically necessary referrals. PCP/CMs must belong to one of the provider types listed below. Provider Required Qualifications Primary Care Physician Engaged in Family Medicine, General Internal Medicine, General Pediatrics or General Practice; may be board certified or board eligible; or meet all Federal employment requirements, be employed by the Federal Government and practice primary care in an Indian Health Services (IHS) facility. Specialist Physician At discretion of OHCA CEO, based on consideration of percentage of primary care services delivered in physician’s practice, the availability of primary care physicians in the geographic area, the extent to which the physician has historically served Medicaid and his/her medical education and training. Advanced Practice Nurse Must be licensed by the State in which s/he practices and have prescriptive authority; or meet all Federal employment requirements, be employed by the Federal Government and practice in an IHS facility. Physician’s Assistant Must be licensed by the State in which s/he practices; or meet all Federal employment requirements, be employed by the Federal government and practice primary care in an IHS facility. Medical Resident Must be at least at the Post Graduate 2 level and may serve as a PCP/CM only within his/her continuity clinic setting. Must work under the supervision of a licensed attending physician. Health Department Clinics Beneficiaries would be served by one of 68 county health departments or the two city-county health departments in Oklahoma City and Tulsa.
