§ 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

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.