Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 104 - SCHOOL-BASED CASE MANAGEMENT SERVICES › Section 317:30-5-1030 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
(a)
Case
				  management providers.
Services are provided by case managers certified
				  by the State Department of Education as meeting the requirements for providing
				  case management. SoonerCare School-Based Targeted Case Management (SBTCM)
				  services must be made available to all eligible members and must be delivered
				  on a statewide basis with procedures that ensure continuity of service without
				  duplication and in compliance with federal and state mandates and regulations
				  related to servicing the targeted population in a uniform and consistent
				  manner. The case managers must be certified by the single state Medicaid agency
				  as meeting the following:
(1) a minimum of
				  five (5) years experience in meeting the case management and service needs of
				  the target population.
(2) a
				  minimum of five (5) years experience in providing all core elements of case
				  management services, including:
(A)
				  individualized strengths and needs assessment;
(B) needs-based service planning;
(C) service coordination, monitoring and
				  advocacy;
(D) service plan review;
				  and
(E) crisis assistance
				  planning.
(3) a minimum
				  of five (5) years experience in developing and implementing Individualized
				  Education Programs (IEP) and/or Individualized Family Service Plans (IFSP) and
				  in meeting the requirements of the IDEA, in accordance with State and Federal
				  law. Each IEP and/or IFSP is dependent upon the needs of the individual student
				  as determined by consultation that may include any or all of the professions in
				  (A) through (F) of this paragraph. Those providing input must meet state or
				  national licensure, registration or certification requirements of the
				  profession in which they practice and include:
(A) special education,
(B) school psychologist,
(C) occupational therapist,
(D) physical therapist,
(E) speech language specialist, or
(F) school counselor and other specialists as
				  identified.
(4) a
				  demonstrated ability to collaborate with public and private services
				  providers.
(5) experience in
				  providing and coordinating education support services, including but not
				  limited to Student Assistance, Special Education, Psychology and Counseling
				  Services.
(6) adequate
				  administrative capacity to fulfill state and federal requirements.
(7) a financial management capacity and
				  system that provides documentation of services and costs.
(8) a capacity to document and maintain
				  individual case records in accordance with state and federal
				  requirements.
(9) a demonstrated
				  ability to meet all state and federal laws governing participation of providers
				  in the SoonerCare program including, but not limited to, the ability to meet
				  federal and state requirements for documentation, billing and audits.