1. (a) Payment of abortion related services is made only in those instances where there is no detectable heartbeat of the fetus, or if, in reasonable medical judgment, the SoonerCare member has a complicating condition that necessitates termination of the pregnancy to avert death or serious risk of substantial and irreversible physical impairment of a major bodily function, not including psychological or emotional conditions.
2. (b) For abortions necessary to avert death or irreversible physical impairment of a major bodily function, the physician, must complete the Certification for Medicaid Funded Abortion and certify in writing that the abortion is being performed to avert death or irreversible physical impairment of a major bodily function. The patient's name and address must be included in the certification and the certification must be signed and dated by the physician. The certification must be attached to the claim.
3. (c) Prior to, or post payment, OHCA may perform a review of abortion related services. These reviews will require that the Agency obtain the applicable medical records.
4. (d) Claims for services related to fetal demise, including dilation and curettage, do not require the Certification for Medicaid Funded Abortion.
5. (e) The appropriate diagnosis codes should be used; otherwise, the procedure(s) will be denied.

Added at 12 Ok Reg 751, eff 1-5-95 through 7-14-95 (emergency)

Added at 12 Ok Reg 3131, eff 7-27-95

Amended at 13 Ok Reg 2521, eff 6-27-96

Amended at 15 Ok Reg 4194, eff 7-20-98 (emergency)

Amended at 16 Ok Reg 1429, eff 5-27-99

Amended at 24 Ok Reg 317, eff 12-1-06 (emergency)

Amended at 24 Ok Reg 905, eff 5-11-07

Amended at 38 Ok Reg 1000, eff 9-1-21

<div>Amended at 42 Ok Reg, Number 13, effective 1-31-25 (emergency)</div>

Amended at 42 Ok Reg, Number 21, effective 9-1-25