reglab/statecodes huggingface dataset:
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 113 - LIVING CHOICE PROGRAM › Section 317:30-5-1202 - Benefits for members with physical disabilities

Current through Vol. 41, No. 20, July 1, 2024
(a) Living Choice program participants with
				  physical disabilities may receive a range of necessary medical and home and
				  community based services for one year after moving from the institution. The
				  one year period begins the day the member occupies a qualified residence in the
				  community. Once this transition period is complete, the member receives
				  services through one of the Opportunities for Living Life home and community
				  based services waivers.
(b)
				  Services must be billed using the appropriate HCPCS or CPT codes and must be
				  medically necessary.
(c) All
				  services must be necessary for the individual to live in the community, require
				  prior authorization, and must be documented in the individual transition plan.
				  The number of units of services the member is eligible to receive is limited to
				  the amounts approved in the transition plan.
(d) Services that may be provided to members
				  with physical disabilities are listed in paragraphs (1) through (32) of this
				  subsection:
(1) case management;
(2) personal care services as described in
				  Part 95 of this Chapter;
(3)
				  respite care;
(4) adult day health
				  care with personal care and therapy enhancements;
(5) architectural modifications;
(6) specialized medical equipment and
				  supplies;
(7) advanced
				  supportive/restorative assistance;
(8) skilled nursing;
(9) home delivered meals;
(10) therapy services including physical,
				  occupational, speech and respiratory;
(11) hospice care;
(12) Personal Emergency Response System
				  (PERS);
(13)
				  Self-Direction;
(14) agency
				  companion services;
(15) extended
				  duty nursing;
(16) psychological
				  services;
(17) audiology treatment
				  and evaluation;
(18) non-emergency
				  transportation;
(19) assistive
				  technology;
(20) dental services
				  (up to $1,000 per person annually);
(21) vision services including eye
				  examinations and eyeglasses;
(22)
				  pharmacotherapy management;
(23)
				  independent living skills training;
(24) nutrition services;
(25) family counseling;
(26) family training;
(27) transition coordination;
(28) psychiatry services;
(29) community transition services as
				  described in OAC
				  317:30-5-1205;
(30) pharmacological evaluations;
(31) assisted living services; and
(32) SoonerCare compensable medical
				  services.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 113 - LIVING CHOICE PROGRAM › Section 317:30-5-1203 - Billing procedures for Living Choice services

Current through Vol. 41, No. 20, July 1, 2024
(a) The approved individual transition plan
				  is the medical basis for services and includes the prior authorizations,
				  specifying:
(1) the service;
(2) the service provider;
(3) the number of units authorized;
				  and
(4) the authorized begin and
				  end dates of the service.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 113 - LIVING CHOICE PROGRAM › Section 317:30-5-1204 - Disclosure of information on health care providers and contractors

Current through Vol. 41, No. 20, July 1, 2024
In accordance with the requirements of the Social Security
					 Act and the regulations issued by the Secretary of Health and Human Services,
					 the OHCA is responsible for disclosure of pertinent findings resulting from
					 surveys made to determine eligibility of certain providers for home health care
					 and contractors under SoonerCare. The Oklahoma State Department of Health
					 (OSDH) is responsible for surveying home health care providers and contractors
					 to obtain information for use by the Federal Government in determining whether
					 these entities meet the standards required for participation as Medicare and
					 SoonerCare providers.
Added at 26 Ok Reg
					 258, eff 12-1-08 (emergency); Added at 26 Ok Reg 1069, eff
					 5-11-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 113 - LIVING CHOICE PROGRAM › Section 317:30-5-1205 - Community transition services

Current through Vol. 41, No. 20, July 1, 2024
(a)
				  Community transition services are one-time set-up expenses for members who
				  transition from a nursing facility or public ICF/MR to a home in the
				  community.
(b) Each member who
				  transitions into the community is eligible for up to $2,400 per person for the
				  purchase of essential goods and/or services authorized by a transition
				  coordinator on the member's behalf.
(c) Community transition services must be
				  reasonable and necessary as determined through the transition plan development
				  process and must be clearly identified in the plan.
(d) Allowable expenses for community
				  transition services include, but are not limited to:
(1) security deposits that are required to
				  obtain a lease on a qualified residence;
(2) essential household items required for
				  occupation and use in a community residence such as furniture, window
				  coverings, food preparation and bed/bath linens;
(3) connection, set-up fees or deposits for
				  utility service or access including telephone, electricity, heating and
				  water;
(4) services necessary for
				  the member's health, safety and welfare such as pest eradication and one-time
				  cleaning prior to occupancy;
(5)
				  moving expenses;
(6) fees to obtain
				  a copy of birth certificate, identification card or driver's license;
				  and
(7) delivery, set-up costs and
				  removal fees for appliances, furniture, etc.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 113 - LIVING CHOICE PROGRAM › Section 317:30-5-1206 - Transition coordinator services

Current through Vol. 41, No. 20, July 1, 2024
Transition coordinators must meet the requirements in
					 paragraphs (1) and (2) of this subsection.
(1) Transition coordinators must:
(A) complete case management training with
				  the ADvantage waiver; or
(B)
				  complete the curriculum requirements for a bachelor's degree and one year paid
				  professional experience in aging or disability populations; or
(C) complete a degree program as a registered
				  nurse or licensed practice nurse and one year paid professional experience;
				  or
(D) have at least two years paid
				  work experience as an independent living specialist or transition specialist at
				  one of the five federally recognized Centers for Independent Living
				  organizations in Oklahoma.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 113 - LIVING CHOICE PROGRAM › Section 317:30-5-1207 - Benefits for members ages sixteen (16) through eighteen (18) in a psychiatric residential treatment facility

Current through Vol. 41, No. 20, July 1, 2024
(a) Living Choice program participants, ages
				  sixteen (16) through eighteen (18), may receive a range of necessary home and
				  community based services for one(1) year after transitioning to the community
				  from a psychiatric residential treatment facility (PRTF) setting. In order to
				  be eligible for the Living Choice program, the member must:
(1) Have been in a PRTF facility for ninety
				  (90) or more days during an episode of care; and
(2) Meet Level 3 criteria on the Individual
				  Client Assessment Record; or
(3)
				  Meet the criteria for Serious Emotional Disturbance as defined in OAC
				  317:30-5-240.1; or
(4) Show critical impairment on a
				  caregiver rated Ohio Scales (score of 25 and above on the Problems Subscale or
				  a score of 44 and below on the Functioning Subscales).
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 114 - DOULA SERVICES › Section 317:30-5-1215 - General

Current through Vol. 41, No. 20, July 1, 2024
(a) A doula or
				  birth worker is a trained professional who provides emotional, physical, and
				  informational support services during the prenatal, labor and delivery, and
				  postpartum periods. Doulas are non-clinical and do not provide medical care.
				  Services should not replace the services of other licensed and trained medical
				  professionals including, but not limited to, physicians, physicians assistants,
				  advanced practice registered nurses, and certified nurse midwives.
(b) All Title XIX, CHIP, expansion adult, and
				  Soon-to-be-Sooners (STBS) members who are pregnant or within the postpartum
				  period are eligible for doula services.
(c) Doula services are available for twelve
				  (12) months postpartum, depending on the members continued SoonerCare
				  eligibility.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 114 - DOULA SERVICES › Section 317:30-5-1216 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
(a)
Provider
				  requirements.
At minimum, providers must:
(1) Be eighteen (18) years of age;
(2) Obtain and maintain a National Provider
				  Identifier (NPI); and
(3) Use the
				  taxonomy number required by the State.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 114 - DOULA SERVICES › Section 317:30-5-1217 - General coverage

Current through Vol. 41, No. 20, July 1, 2024
(a)
Covered
				  benefits.
The following benefits are covered:
(1)
Prenatal/postpartum visits.
There is a total of eight (8) prenatal/postpartum visits allowed for the
				  member. The doula must work with the member to determine how best to utilize
				  the benefit to meet the needs of the member.
(2)
Labor and delivery.
There is
				  one (1) labor and delivery visit allowed, regardless of the duration.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 7 - Billing and Inquiries [Revoked] › Section 317:30-7-1 - Preparation of claims forms [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
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;
				  Revoked at 13 Ok Reg 4055, eff 9-17-96 (emergency); Revoked at 14 Ok Reg 1780,
				  eff 5-27-97
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 7 - Billing and Inquiries [Revoked] › Section 317:30-7-2 - Remittance statement [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
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;
				  Revoked at 13 Ok Reg 4055, eff 9-17-96 (emergency); Revoked at 14 Ok Reg 1780,
				  eff 5-27-97
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 7 - Billing and Inquiries [Revoked] › Section 317:30-7-3 - Electronic billing [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
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;
				  Revoked at 13 Ok Reg 4055, eff 9-17-96 (emergency); Revoked at 14 Ok Reg 1780,
				  eff 5-27-97
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 7 - Billing and Inquiries [Revoked] › Section 317:30-7-4 - Medicare crossover claims [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
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;
				  Revoked at 13 Ok Reg 4055, eff 9-17-96 (emergency); Revoked at 14 Ok Reg 1780,
				  eff 5-27-97
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 7 - Billing and Inquiries [Revoked] › Section 317:30-7-5 - Claim status inquiries [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
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;
				  Revoked at 13 Ok Reg 4055, eff 9-17-96 (emergency); Revoked at 14 Ok Reg 1780,
				  eff 5-27-97
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 7 - Billing and Inquiries [Revoked] › Section 317:30-7-6 - Policy questions [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
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;
				  Revoked at 13 Ok Reg 4055, eff 9-17-96 (emergency); Revoked at 14 Ok Reg 1780,
				  eff 5-27-97
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 7 - Billing and Inquiries [Revoked] › Section 317:30-7-7 - Medicaid provider file changes [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
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;
				  Revoked at 13 Ok Reg 4055, eff 9-17-96 (emergency); Revoked at 14 Ok Reg 1780,
				  eff 5-27-97
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 7 - Billing and Inquiries [Revoked] › Section 317:30-7-8 - Claim adjustments [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
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;
				  Revoked at 13 Ok Reg 4055, eff 9-17-96 (emergency); Revoked at 14 Ok Reg 1780,
				  eff 5-27-97
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 7 - Billing and Inquiries [Revoked] › Section 317:30-7-9 - Inquiry instructions/addresses for filing claims [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
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;
				  Revoked at 13 Ok Reg 4055, eff 9-17-96 (emergency); Revoked at 14 Ok Reg 1780,
				  eff 5-27-97
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 1 - General Provisions › Section 317:35-1-1 - Purpose

Current through Vol. 41, No. 20, July 1, 2024
The purpose of this Chapter is to provide the rules for the
				  Oklahoma Health Care Authority's (OHCA) Title XIX (Medicaid) and Title XXI
				  (CHIP) programs for adults and children. The Authority provides payment for
				  medical services to adults and children, within the scope of the program, on
				  behalf of individuals who meet the eligibility requirements for Title XIX
				  (Medicaid) or Title XXI (CHIP).
Added at 12 Ok Reg 753, eff 1-6-95 through 7-14-95
					 (emergency) ; Added at 12 Ok Reg 3133, eff 7-27-95 ; Amended at 30 Ok Reg 1209,
					 eff 7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 1 - General Provisions › Section 317:35-1-3 - Legal bases

Current through Vol. 41, No. 20, July 1, 2024
The Federal legal base of the Medical Assistance program is
				  vested in Titles XIX and XXI of the Federal Social Security Act. The State
				  Legal base is vested in 56 O.S. 1981, Sec. 328 et seq.
Added at 12 Ok Reg 753, eff 1-6-95 through 7-14-95
					 (emergency) ; Added at 12 Ok Reg 3133, eff 7-27-95 ; Amended at 30 Ok Reg 1209,
					 eff 7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 3 - Coverage and Exclusions › Section 317:35-3-1 - Reimbursement

Current through Vol. 41, No. 20, July 1, 2024
(a)
Payment
				eligibility.
In order for the Authority to make payment for SoonerCare
				services, the individual must be determined eligible to have such payment made
				by:
(1) having eligibility previously
				determined, or
(2) making
				application for SoonerCare at the time the medical services is requested, and
				having eligibility determined at that time.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 3 - Coverage and Exclusions › Section 317:35-3-2

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg 753, eff 1-6-95 through 7-14-95
					 (emergency) ; Added at 12 Ok Reg 3133, eff 7-27-95 ; Amended at 13 Ok Reg 911,
					 eff 8-1-95 (emergency) ; Amended at 13 Ok Reg 2537, eff 6-27-96 ; Amended at 14
					 Ok Reg 779, eff 11-25-96 (emergency) ; Amended at 14 Ok Reg 538, eff 12-24-96
					 (emergency) ; Amended at 14 Ok Reg 787, eff 1-24-97 (emergency) ; Amended at 14
					 Ok Reg 1805, eff 5-27-97 ; Amended at 15 Ok Reg 1117, eff 1-6-98 (emergency) ;
					 Amended at 15 Ok Reg 1559, eff 5-11-98 ; Amended at 15 Ok Reg 3679, eff 5-18-98
					 (emergency) ; Amended at 16 Ok Reg 60, eff 9-11-98 (emergency) ; Amended at 16
					 Ok Reg 162, eff 10-14-98 (emergency) ; Amended at 16 Ok Reg 1438, eff 5-27-99 ;
					 Amended at 16 Ok Reg 3363, eff 6-1-99 (emergency) ; Amended at 16 Ok Reg 3502,
					 eff 7-16-99 (emergency) ; Amended at 17 Ok Reg 231, eff 9-7-99 (emergency) ;
					 Amended at 17 Ok Reg 1212, eff 5-11-00 ; Amended at 17 Ok Reg 3517, eff 8-1-00
					 (emergency) ; Amended at 18 Ok Reg 114, eff 11-1-00 (emergency) ; Amended at 18
					 Ok Reg 269, eff 10-7-00 (emergency) ; Amended at 18 Ok Reg 506, eff 1-1-01
					 (emergency) ; Amended at 18 Ok Reg 784, eff 1-23-01 (emergency) ; Amended at 18
					 Ok Reg 1139, eff 5-11-01 ; Amended at 20 Ok Reg 2775, eff 7-1-03 (emergency) ;
					 Amended at 20 Ok Reg 2901, eff 7-1-03 (emergency) ; Amended at 21 Ok Reg 2234,
					 eff 6-25-04 ; Amended at 23 Ok Reg 817, eff 3-9-06 (emergency) ; Amended at 23
					 Ok Reg 2580, eff 6-25-06 ; Amended at 24 Ok Reg 93, eff 8-2-06 (emergency) ;
					 Amended at 24 Ok Reg 943, eff 5-11-07 ; Amended at 24 Ok Reg 2115, eff 6-25-07
					 ; Amended at 29 Ok Reg 1147, eff 6-25-12 ; Amended at 30 Ok Reg 1244, eff
					 7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 3 - Coverage and Exclusions › Section 317:35-3-3 - Prior authorization requirements [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 12 Ok Reg 753,
				  eff 1-6-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3133, eff 7-27-95;
				  Amended at 14 Ok Reg 779, eff 11-25-96 (emergency); Amended at 14 Ok Reg 1802,
				  eff 5-27-97; Amended at 18 Ok Reg 506, eff 1-1-01 (emergency); Amended at 18 Ok
				  Reg 1139, eff 5-11-01
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 1 - DETERMINATION OF QUALIFYING CATEGORICAL RELATIONSHIP › Section 317:35-5-1 - Scope and applicability

Current through Vol. 41, No. 20, July 1, 2024
The provisions in this Part apply to all individuals
					 requesting medical services within the scope of the SoonerCare Program.
Added at 12 Ok Reg 753, eff 1-6-95 through 7-14-95
						(emergency) ; Added at 12 Ok Reg 3133, eff 7-27-95 ; Amended at 18 Ok Reg 114,
						eff 11-1-00 (emergency) ; Amended at 18 Ok Reg 1139, eff 5-11-01 ; Amended at
						20 Ok Reg 2775, eff 7-1-03 (emergency) ; Amended at 21 Ok Reg 2234, eff 6-25-04
						; Amended at 30 Ok Reg 1209, eff 7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 1 - DETERMINATION OF QUALIFYING CATEGORICAL RELATIONSHIP › Section 317:35-5-3 - Determining categorical relationship to the aged

Current through Vol. 41, No. 20, July 1, 2024
An individual is categorically related to the aged when
					 his/her age is established as 65 years or older. The individual meets the
					 condition of categorical relationship for the entire month in which his/her
					 65th birthday occurs. Age as determined by SSA is sufficient to establish
					 categorical relationship.
Added at 12 Ok Reg
					 753, eff 1-6-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3133, eff
					 7-27-95
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 1 - DETERMINATION OF QUALIFYING CATEGORICAL RELATIONSHIP › Section 317:35-5-4.1 - Special level of care and cost effectiveness application procedures for Tax Equity and Fiscal Responsibility Act (TEFRA)

Current through Vol. 41, No. 20, July 1, 2024
(a) In order for a child to be eligible for
				  TEFRA, he/she must require a level of care provided in an acute care hospital
				  for a minimum of sixty (60) days, or a nursing facility(NF) or intermediate
				  care facility for individuals with intellectual disabilities(ICF/IID) for a
				  minimum of thirty (30) days. It must also be appropriate to provide care to the
				  child at home. The level of care determination is made by LOCEU. The level of
				  care certification period may be for any number of months that the LOCEU
				  determines appropriate. At the time of application, an assessment form is
				  provided to the applicant for completion by the child's physician. Once
				  completed by the physician and returned to the Oklahoma Health Care Authority,
				  the assessment form is forwarded to the LOCEU along with the request for a
				  disability determination (if needed).
(b) The estimated cost of caring for the
				  child at home must not exceed the estimated cost of treating the child within
				  an institution at the appropriate level of care, i.e., hospital, NF, or
				  ICF/IID. The initial cost analysis is established by LOCEU based on the
				  information provided by the TEFRA-1 Assessment form and medical information
				  used in the relationship to disability determination.
(c) The level of care determination and cost
				  effectiveness analysis are reported by LOCEU annually.
Added at 22 Ok Reg
					 2494, eff 7-11-05
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 1 - DETERMINATION OF QUALIFYING CATEGORICAL RELATIONSHIP › Section 317:35-5-4.2 - Determining nursing facility level of care for TEFRA children

Current through Vol. 41, No. 20, July 1, 2024
In order to determine nursing facility level of care for
					 TEFRA children:
(1) The child must be
				  age 18 years or younger and expected to meet the following criteria for a
				  minimum of 30 days.
(A) The child must:
(i) have a long-term medical or physical
				  condition which significantly diminishes his/her functional capacity;
(ii) require health-related services that are
				  so inherently complex that it can only be safely and effectively provided by
				  technical or professional medical personnel, such as a registered nurse,
				  licensed practical nurse, etc., and are ordinarily provided in a nursing
				  facility. Without these services, the child is at risk of being
				  institutionalized within a nursing facility; and
(iii) the services needed are above general
				  supervision but can be provided safely in the child's home. The services are
				  usually required 24 hours per day and are ordinarily provided in a nursing
				  facility inpatient basis (see
				  42 CFR
				  409.31 -
				  409.34
				  for the types of services and service frequencies that would be normally
				  considered as nursing facility level of care).
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 1 - DETERMINATION OF QUALIFYING CATEGORICAL RELATIONSHIP › Section 317:35-5-4.3 - Determining acute hospital level of care for TEFRA children

Current through Vol. 41, No. 20, July 1, 2024
In order to determine acute hospital level of care for
					 TEFRA children:
(1) The child must be
				  age 18 years or younger and expected to meet the following criteria for at
				  least 60 days.
(A) The child must need
				  services that:
(i) are ordinarily provided in
				  a hospital setting for the care and treatment of inpatients; and
(ii) are provided in a hospital that is
				  maintained primarily for the care and treatment of patients with disorders
				  other than mental health diagnosis.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 1 - DETERMINATION OF QUALIFYING CATEGORICAL RELATIONSHIP › Section 317:35-5-5 - Determining categorical relationship to the blind

Current through Vol. 41, No. 20, July 1, 2024
An individual is related to the blind if he/she has central
					 visual acuity of 20/200 or less in the better eye with the use of a correcting
					 lens. When the limitation in the fields of vision is such that the widest
					 diameter of the visual field subtends an angle no greater than 20 degrees,
					 central visual acuity is 20/200 or less. If the individual is to be related to
					 the blind, the exact procedures are followed as are outlined for the disabled.
					 Exception: If a decision on blindness is to be made and current medical
					 information regarding degree of vision is not available to the local office,
					 the individual is referred to an ophthalmologist or optometrist, with payment
					 authorized by the local office, for an examination or existing current medical
					 information. Upon receipt, the local office routes the medical information and
					 the Medical Social Summary to the LOCEU where the decision on blindness is
					 made.
Added at 12 Ok Reg
					 753, eff 1-6-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3133, eff
					 7-27-95; Amended at 18 Ok Reg 2587, eff 6-25-01
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 1 - DETERMINATION OF QUALIFYING CATEGORICAL RELATIONSHIP › Section 317:35-5-6 - Determining categorical relationship to pregnancy-related services

Current through Vol. 41, No. 20, July 1, 2024
(a) For
				  applications made prior to January 1, 2014, categorical relationship to
				  pregnancy-related services can be established by determining through medical
				  evidence that the individual is currently or has been pregnant. Pregnancy must
				  be verified by providing medical proof of pregnancy within thirty (30) days of
				  application submission. OKDHS form 08MA005E, Notification of Needed Medical
				  Services, is not required but will be accepted as medical verification. If
				  proof of pregnancy is not provided within thirty (30) days of application
				  submission, SoonerCare benefits will be closed for the pregnant woman at the
				  end of the thirty (30) day period. The expected date of delivery must be
				  established either by information from the applicant's physician or certified
				  nurse midwife or the member's statement.
(b) Effective January 1, 2014, women who are
				  pregnant, including twelve (12) months postpartum, are related to the pregnant
				  women group. Pregnancy does not have to be verified unless the declaration that
				  an applicant or member is pregnant is not reasonably compatible with other
				  information available to the agency. The individual must also provide the
				  expected date of delivery.
Added at 12 Ok Reg 753, eff 1-6-95 through 7-14-95
						(emergency) ; Added at 12 Ok Reg 3133, eff 7-27-95 ; Amended at 27 Ok Reg 711,
						eff 2-4-10 (emergency) ; Amended at 27 Ok Reg 1471, eff 6-11-10 ; Amended at 28
						Ok Reg 1532, eff 6-25-11 ; Amended at 30 Ok Reg 1209, eff
						7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 1 - DETERMINATION OF QUALIFYING CATEGORICAL RELATIONSHIP › Section 317:35-5-6.1 - Determining categorical relationship for pregnancy related services covered under Title XXI

Current through Vol. 41, No. 20, July 1, 2024
(a) For
				  applications made prior to January 1, 2014, categorical relationship for
				  pregnancy related benefits covered under Title XXI is determined in accordance
				  with OAC
				  317:35-22-1
				  and through medical evidence that the individual is currently or has recently
				  been pregnant and may qualify for pregnancy related services. Pregnancy must be
				  verified by providing medical proof of pregnancy within 30 days of application
				  submission. OKDHS form 08MA005E, Notification of Needed Medical Services, is
				  not required but will be accepted as medical verification. If proof of
				  pregnancy is not provided within 30 days of application submission, SoonerCare
				  benefits will be closed for the pregnant woman at the end of the thirty day
				  period. The applicant must be residing in the State of Oklahoma with the intent
				  to remain at the time the medical service is received. The expected date of
				  delivery must be established either by information from the applicant's
				  physician or other qualified practitioner.
(b) Effective January 1, 2014, relationship
				  to the pregnancy-related services group under Title XXI is determined in
				  accordance with OAC
				  317:35-22-1.
				  Pregnancy does not have to be verified unless the declaration that an applicant
				  or member is pregnant is not reasonably compatible with other information
				  available to the agency. The individual must also provide the expected date of
				  delivery.
Added at 25 Ok Reg 430, eff 1-1-08 (emergency) ; Added
						at 25 Ok Reg 1227, eff 5-25-08 ; Amended at 27 Ok Reg 711, eff 2-4-10
						(emergency) ; Amended at 27 Ok Reg 1471, eff 6-11-10 ; Amended at 28 Ok Reg
						1532, eff 6-25-11 ; Amended at 30 Ok Reg 1209, eff
						7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 1 - DETERMINATION OF QUALIFYING CATEGORICAL RELATIONSHIP › Section 317:35-5-7 - Determining categorical relationship to the children and parent and caretaker relative groups

Current through Vol. 41, No. 20, July 1, 2024
(a)
Categorical relationship.
All individuals under age nineteen (19)
				  are automatically related to the children's group and further determination is
				  not required. Adults age nineteen (19) or older are related to the parent and
				  caretaker relative group when there is a minor dependent child(ren) in the home
				  and the individual is the parent, or is the caretaker relative other than the
				  parent who meets the proper degree of relationship. A minor dependent child is
				  any child who meets the AFDC eligibility requirements of age and relationship.
(b)
Requirement for referral
				  to the Oklahoma Child Support Services Division (OCSS).
As a condition
				  of eligibility, when both the parent or caretaker and minor child(ren) are
				  receiving SoonerCare and a parent is absent from the home, the parent or
				  caretaker relative must agree to cooperate with OCSS.However, cooperation with
				  OCSS is not required in the following instances:
(1) OCSS made a good cause determination that
				  cooperation is not in the best interest of the child;
(2) The child is eligible for health care
				  services through the Indian Health Service and the child support case was or
				  would have been opened because of a Medicaid referral based solely on health
				  care services provided through an Indian Health Program, in accordance with
				  Section 533.152 of Title of the Code of Federal Regulations; or
(3) The SoonerCare application is only for
				  child(ren) and/or pregnant women.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 1 - DETERMINATION OF QUALIFYING CATEGORICAL RELATIONSHIP › Section 317:35-5-8 - Determining categorical relationship for the SoonerPlan Family Planning Program

Current through Vol. 41, No. 20, July 1, 2024
All non-pregnant women and men ages 19 and older,
					 regardless of pregnancy or paternity history, who are otherwise ineligible for
					 SoonerCare are categorically related to the SoonerPlan Family Planning Program.
					 If eligible for SoonerCare benefits, the individual can choose to enroll only
					 in SoonerPlan with the option of applying for SoonerCare at any time.
Added at 22 Ok Reg 1012, eff 4-1-05 (emergency) ; Added
						at 22 Ok Reg 2518, eff 7-11-05 ; Amended at 25 Ok Reg 128, eff 10-1-07
						(emergency) ; Amended at 25 Ok Reg 1227, eff 5-25-08 ; Amended at 29 Ok Reg
						1149, eff 6-25-12 ; Amended at 30 Ok Reg 1209, eff
						7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 1 - DETERMINATION OF QUALIFYING CATEGORICAL RELATIONSHIP › Section 317:35-5-9 - Determining the categorical relationship to expansion adults

Current through Vol. 41, No. 20, July 1, 2024
(a) To be eligible
				  for SoonerCare under expansion adults, individuals shall meet the following
				  requirements:
(1) Are age nineteen (19) years
				  or older, and under age sixty-five (65);
(2) Are not pregnant;
(3) Are not entitled to or enrolled for
				  Medicare benefits under part A or B;
(4) Are not eligible for SoonerCare in
				  another mandatory eligibility group under Oklahoma's Medicaid State
				  Plan;
(5) Have household income
				  that is at or below 133 percent of the federal poverty level (FPL) for their
				  household size; and
(6) Meet
				  general SoonerCare program eligibility requirements described in Oklahoma
				  Administrative Code (OAC) 317:35, including but not limited to citizenship and
				  residence requirements.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 3 - NON-MEDICAL ELIGIBILITY REQUIREMENTS › Section 317:35-5-25 - Citizenship/noncitizen status and identity verification requirements

Current through Vol. 41, No. 20, July 1, 2024
(a)
Citizenship/noncitizen status and identity verification
				  requirements.
Verification of citizenship/noncitizen status and identity
				  is required for all adults and children approved for SoonerCare. An exception
				  is individuals who are initially eligible for SoonerCare as deemed newborns;
				  according to Section 1903(x) of the Social Security Act, they will not be
				  required to further document citizenship or identity at any subsequent
				  SoonerCare eligibility redetermination. They are considered to have provided
				  satisfactory documentation of citizenship and identity by virtue of being born
				  in the United States.
(1) The types of
				  acceptable evidence that verify identity and citizenship include:
(A) United States (U.S.) passport;
(B) Certificate of Naturalization issued by
				  U.S. Citizenship & Immigration Services (USCIS)(Form N-550 or
				  N-570);
(C) Certificate of
				  Citizenship issued by USCIS (Form N-560 or N-561);
(D) Copy of the Medicare card or printout of
				  a Beneficiary Earnings and Data Exchange (BENDEX) or State Data Exchange (SDX)
				  screen showing receipt of Medicare benefits, Supplemental Security Income or
				  disability benefits from the Social Security Administration; or
(E) Tribal membership card or Certificate of
				  Degree of Indian Blood (CDIB) card, with a photograph of the
				  individual.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 3 - NON-MEDICAL ELIGIBILITY REQUIREMENTS › Section 317:35-5-26 - Residence requirements; residents of public institutions; homeless persons; and residents of IHS, BIA or Tribal controlled dormitories

Current through Vol. 41, No. 20, July 1, 2024
(a)
Residence.
To be eligible
				  for SoonerCare services, the applicant must be residing in the State of
				  Oklahoma with intent to remain at the time the medical service is received. A
				  durational residence requirement is not imposed.
(1) Temporary absence from the State, with
				  subsequent returns to the State, or intent to return when the purposes of the
				  absence have been accomplished, does not interrupt continuity of Oklahoma
				  residence.
(2) Oklahoma residence
				  does not include transients or visitors passing through the state but does not
				  preclude persons who do not have a fixed address if intent is established.
(3) Intent to remain or return is
				  defined as a clear statement of plans to remain or return in addition to other
				  evidence and/or corroborative statements of others.
(4) When a non-resident makes application for
				  SoonerCare benefits, the local office provides services necessary to make
				  available to the applicant any SoonerCare services for which he/she might be
				  eligible from his/her state of residence. The local office contacts the state
				  or county of the applicant's residence to explore possible eligibility for
				  medical benefits from the state and to obtain information needed for the
				  determination of medical eligibility for the services received while in
				  Oklahoma.
(5) If a member's where
				  abouts are unknown, as indicated by the return of unforwardable agency mail,
				  refer to OAC
				  317:35-5-67.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 3 - NON-MEDICAL ELIGIBILITY REQUIREMENTS › Section 317:35-5-27 - Social Security number

Current through Vol. 41, No. 20, July 1, 2024
Federal regulations require that an individual must
					 furnish, or show documentation of application for, a Social Security number at
					 the time of application for Title XIX services. Documentation of application
					 for a SSN number may include, but is not limited to, Form SSA-2853 or DHS Form
					 Adm-101 (Social Security Number Enumeration Referral).
Added at 12 Ok Reg
					 753, eff 1-6-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3133, eff
					 7-27-95; Amended at 14 Ok Reg 3533, eff 7-23-97 (emergency); Amended at 15 Ok
					 Reg 1554, eff 5-11-98
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 5 - COUNTABLE INCOME AND RESOURCES › Section 317:35-5-40 - Scope and applicability

Current through Vol. 41, No. 20, July 1, 2024
The rules in this Part are used to determine financial
					 eligibility once categorical relationship and other factors of eligibility have
					 been determined.
Added at 12 Ok Reg
					 753, eff 1-6-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3133, eff
					 7-27-95
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 5 - COUNTABLE INCOME AND RESOURCES › Section 317:35-5-41.3 - Automobiles, pickups, and trucks

Current through Vol. 41, No. 20, July 1, 2024
In accordance with Section 416.1218 of Title 20 of the Code
					 of Federal Regulations (C.F.R.), "automobile" includes cars, pickups, trucks,
					 and other vehicles used to provide necessary transportation.
(1)
Exempt automobiles.
One
				  automobile is totally excluded from counting as a resource, regardless of its
				  value, if it is used for transportation of the individual or a member of the
				  individual's household.
(2)
Other automobiles.
Any other automobiles are considered to be
				  nonliquid resources. The equity in other automobiles is considered as a
				  countable resource. The current market value, less encumbrances on the vehicle,
				  is the equity, per
				  20 C.F.R. §
											416.1201(c). Only
				  encumbrances that can be verified are considered in computing equity.
(A) The market value of each year's make and
				  model is established on the basis of the "Avg. Trade In" value as shown in the
				  current publication of the National Automobile Dealers Association (NADA) on
				  "Cars, Trucks, and Imports".
(B) If
				  a vehicle's listing has been discontinued in the NADA book, the household's
				  estimate of the value of the vehicle is accepted unless the worker has reason
				  to believe the estimate is incorrect.
(C) The market value of a vehicle that is no
				  longer operable is its verified salvage value.
(D) In the event the member and worker cannot
				  agree on the value of the vehicle, the member secures written appraisal by two
				  (2) persons who are familiar with current values. If there is substantial
				  unexplained divergence between these appraisals or between the book value and
				  one (1) or more of these appraisals, the worker and the member jointly arrange
				  for the market value to be established by an appraisal made by a third (3rd)
				  person who is familiar with current values and who is acceptable to both the
				  member and the worker.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 5 - COUNTABLE INCOME AND RESOURCES › Section 317:35-5-41.4 - Stocks and bonds

Current through Vol. 41, No. 20, July 1, 2024
(a) The member's
				  equity in stocks and bonds (including U.S. Savings Bonds series A thru EE) is
				  considered in relation to the maximum resource limit. The current market value
				  less encumbrances is the equity. In general, determination of current market
				  value can be obtained from daily newspaper quotations, brokerage houses, banks,
				  etc.
(b) The current value of U.S.
				  Savings bonds which have been held beyond the maturity date is the redemption
				  value listed in the table on the back of the bond for the anniversary date most
				  recently reached. If the bond has been held beyond maturity date, it has
				  continued to draw interest. An acceptable determination of the value may be
				  made by checking against a chart at the bank.
Added at 25 Ok Reg
					 130, eff 8-1-07 (emergency); Added at 25 Ok Reg 1257, eff
					 5-25-08
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 5 - COUNTABLE INCOME AND RESOURCES › Section 317:35-5-41.5 - Purchase of promissory notes, loans, or mortgages

Current through Vol. 41, No. 20, July 1, 2024
(a) The amount which can be realized from
				  promissory notes, loans, mortgages, and similar instruments, if offered for
				  immediate sale, constitutes a countable resource. Promissory notes, loans,
				  mortgages, and similar instruments have value regardless of whether there is an
				  actual offer. Appraisals obtained from bankers, realtors, loan companies and
				  others qualified to make such estimates are obtained in determining current
				  market value. When a total resource approaches the maximum, it is desirable to
				  get two or more estimates.
(b)
				  Promissory Notes, loans, and mortgages (including contracts for deed) which are
				  income producing are liquid countable resources.
(c) For an individual who has purchased a
				  promissory note, loan, or mortgage on or after February 8, 2006, and is
				  applying for long-term care services, see OAC
				  317:35-5-41.8(b).
Added at 25 Ok Reg
					 130, eff 8-1-07 (emergency); Added at 25 Ok Reg 1257, eff
					 5-25-08
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 5 - Eligibility and Countable Income › Part 5 - COUNTABLE INCOME AND RESOURCES › Section 317:35-5-41.8 - Eligibility regarding long-term care services

Current through Vol. 41, No. 20, July 1, 2024
(a)
Home Property.
In
				  determining eligibility for long-term care services for applications filed on
				  or after January 1, 2006, home property is excluded from resources unless the
				  individual's equity interest in his or her home exceeds the amount at Oklahoma
				  Department of Human Services (DHS) Appendix C-1, Schedule VIII(D)(2).
(1) Long-term care services include nursing
				  facility (NF) services and other long-term care services. For purposes of this
				  Section, other long-term care services include:
(A) A level of care in any institution
				  equivalent to nursing facility services; and
(B) Home and community-based services
				  furnished under a waiver.