Okla. Admin. Code § 310:530-1-4

Current through Vol. 42, No. 7, December 16, 2024

Section 310:530-1-4 - Methods and Procedures

(a)General. Fees will be charged for services based upon client's ability to pay, and upon the potential for payments or contribution from the client's third party health insurance provider. Clients will not be denied family planning services, or be subjected to any variation in quality or delivery of family planning services, because of inability to pay. The Commissioner of Health must approve the schedule of fees for family planning services annually and prior to implementation. The calculation of the maximum recommended fee assessment will be completed before July 1 implementation each year.

(b)Determining the base unit cost.

(1)Examination services component. The base unit cost for the examination service component is derived by dividing the total dollar amount attributable to the medical cost center by the sum of the collective weighted values of each examination service. The collective weighted value of each examination service is derived by multiplying the relative value for the examination service by the frequency of encounters for that service during the attributable analysis period.

(2)Laboratory service component. The base unit cost for the laboratory service component is derived by dividing the total dollar amount attributable to the laboratory cost center by the sum of the collective weighted values of each laboratory service. The collective weighted value of each laboratory service is derived by multiplying the relative value for the laboratory service by the frequency of encounters for that service during the attributable analysis period.

(c)Deriving the applicable ancillary unit cost.

(1)Allocated unit indirect costs. Allocated unit indirect costs are those indirect unit costs attributable to the family planning program and are prorated and added as an ancillary cost to each examination service provided by family planning centers. The allocated unit indirect cost is derived by dividing the sum of all indirect costs approved by the Commissioner for allocation to family planning during the attributable analysis period by the relative proportion of the collective weighted value of a given examination service to the total collective weighted value of the examination service component.

(2)Unit clinical supply costs. Unit clinical supply costs are prorated and added as an ancillary cost to each examination service provided by family planning centers. The unit clinical supply cost is derived by dividing the sum of all non-laboratory supplies consumed by family planning during the attributable analysis period by the relative proportion of the collective weighted value of a given examination service to the total collective weighted value of the examination service component.

(3)Unit laboratory supply costs. Unit laboratory supply costs are prorated and added as an ancillary cost to each laboratory service provided by family planning centers. The unit laboratory supply cost is derived by dividing the sum of all laboratory supplies consumed by family planning during the attributable analysis period by the relative proportion of the collective weighted value of a given laboratory service to the total collective weighted value of the laboratory service component.

(d)Deriving the inflationary adjustment modifier. The inflationary adjustment modifier is derived by first consulting the annual percentage change in the Medical Care expenditure category reported for the South Region in the latest Consumer Price Index Detailed Report published by the United States Department of Labor prior to the time the maximum RFA is due to be calculated by the Department for the upcoming fiscal year. The annual percentage change reported is multiplied by the subtotal of the sum of ancillary unit costs and the product of the base unit cost and the weighted value attributed to the service.

(e)Deriving the sliding fee scale adjustment. The sliding fee scale adjustment is used to convert the maximum RFA into the adjusted RFA. The scale is divided into seven (7) increments that correspond to incremental levels of poverty ranging from 100% to 250% of poverty based upon the annual Federal Poverty Guidelines. The base increment of the sliding fee scale shall correspond to 100% of poverty and cause the maximum RFA to be reduced to zero. The next increment of the sliding fee scale shall correspond to approximately 118.75% of poverty and cause the assessment to be reduced to a sum that is 10% of the maximum RFA. The next increment of the sliding fee scale shall correspond to approximately 137.5% of poverty and cause the assessment to be reduced to a sum that is 20% of the maximum RFA. Successive increments of the sliding fee scale shall correspond to successive incremental increases of approximately 37.5 percentage points of poverty and cause incremental 20 percentage point increases of the percentage of the maximum RFA to be assessed to the client.

(f)Deriving the maximum recommended fee assessment for utilization of services (RFA).

(1)Examination services. The maximum RFA for a given examination service is derived by multiplying the base unit cost determined for the examination service by the weighted value attributed to the service. This product is then added to the sum of the ancillary unit costs derived for the service. The subtotal derived is then added to the inflationary adjustment modifier to derive the maximum RFA. The maximum RFA is then applied to the sliding fee scale adjustment applicable to the client and adjusted as indicatedto derive the adjusted RFA for a given examination service.

(2)Laboratory services. The maximum RFA for a given laboratory service is derived by multiplying the base unit cost determined for the laboratory service by the weighted value attributed to the service. This product is then added to the sum of the ancillary unit costs derived for the service. The subtotal derived is then added to the inflationary adjustment modifier to derive the maximum RFA. The maximum RFA is then applied to the sliding fee scale adjustment applicable to the client and adjusted as indicatedto derive the adjusted RFA for a given laboratory service.

(3)Delivered products. The maximum RFA for a delivered product is the average unit cost incurred by the Department for the product during the most recently completed purchasing cycle. This amount is then applied to the sliding fee scale adjustment applicable to the client and adjusted as indicated.

(g)Waiver. The family planning center may waive in whole or in part an adjusted RFA for any client who is unable, for good cause, to pay for the family planning service or product provided.

Okla. Admin. Code § 310:530-1-4

Added at 19 Ok Reg 2077, eff 6-27-02; Amended at 21 Ok Reg 2751, eff 7-12-04; Amended at 26 Ok Reg 1497, eff 6-11-09