Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 9 - Icf/Iid, Hcbw/Iid, and Individuals Age 65 or Older in Mental Health Hospitals › Part 11 - PAYMENT, BILLING, AND OTHER ADMINISTRATIVE PROCEDURES › Section 317:35-9-103 - Special procedures for release of adults in mental health hospitals to long-term care facilities

Current through Vol. 41, No. 20, July 1, 2024
(a)
Procedures.
Adult patients in state mental health hospitals being
				  considered for release to long-term care facilities due to their physical
				  conditions may be predetermined eligible for Medicaid.
(b)
Responsibility of mental
				  hospitals.
The mental health hospital social and reimbursement staff
				  works with the Social Security Administration to secure the approval for
				  Supplemental Security Income (SSI) for individuals not currently eligible who
				  may qualify for SSI. They will also assist the patient with the application for
				  Medicaid medical services. By forwarding the completed Medical Assistance
				  Application form and the Capital Resources Information form to the county
				  office, the determination of financial eligibility by the DHS county worker can
				  proceed at the same time that SSA is determining SSI eligibility. If the
				  individual has other income (Social Security, VA, etc.) and does not qualify
				  for SSI, the mental health hospital social and reimbursement staff evaluates
				  the known resources. If the resources do not exceed the maximum as shown on the
				  DHS Appendix C-1, Schedule VIII. D., individuals may be referred for a decision
				  of eligibility for care in an intermediate care facility for the mentally
				  retarded and, if necessary, categorical relationship. If the individual appears
				  to meet the requirements as set out in this Subchapter, the mental health
				  hospital social and reimbursement staff will submit a copy of the admitting
				  history and physical progress notes, psychiatric examination and a physician's
				  recommendation for a specific level of care, based on the individual's physical
				  condition, to the Department of Mental Health and Substance Abuse Services,
				  Central Office, Long-Term Care Division for review. If release to a long-term
				  care facility appears appropriate, the medical information is submitted to
				  LOCEU at the same time that the application forms are submitted to the
				  county.
(c)
Responsibility of
				  LOCEU.
The LOCEU reviews the hospital records, the social summary, the
				  physician's recommendation for level of care as well as categorical
				  relationship, if necessary. A Level II PASRR assessment is initiated by LOCEU
				  at this point, if indicated. The MEDATS file is updated advising the DHS county
				  office of LOCEU's decision.
(d)
Responsibility of the DHS county office.
The county office (in the
				  county where the hospital is located) has the responsibility for the case
				  number assignment, placing the case in application status and the subsequent
				  determination of financial eligibility. The case is not certified until the
				  patient enters an approved long-term care facility.
(1) Once the patient is determined
				  financially and medically eligible a letter (including the assigned case
				  number) is sent to the Department of Mental Health and Substance Abuse
				  Services, Central Office, Long-Term Care Division.
(2) If the patient is determined to be
				  ineligible, the denial is teleprocessed and a computer generated notice sent to
				  the client or responsible person.