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 5 - DETERMINATION OF MEDICAL ELIGIBILITY FOR ICF/IID, HCBW/IID, AND INDIVIDUALS AGE 65 OR OLDER IN MENTAL HEALTH HOSPITALS › Section 317:35-9-48 - Determination of medical eligibility for care in public ICF/MR

Current through Vol. 41, No. 20, July 1, 2024
(a) DHS,
				  Developmental Disability Services Division (DDSD) evaluation reports provide
				  case material for referral to the LOCEU for determination of the need for
				  ICF/MR level of care/medical eligibility.
(b) The following procedure is used in
				  handling referrals from a public ICF/MR for determination of eligibility for
				  public assistance and/or long-term care in the community or private ICF/MR. The
				  superintendent of the public ICF/MR refers to DHS DDSD those persons who in the
				  judgement of the facility staff can adequately be cared for in the community.
				  The referral includes (in addition to the social and financial information)
				  current medical information on the Report of Physician's Examination form; the
				  Long Term Care Assessment form; psychological information and, if applicable,
				  Form SMR-103-A, Itemized Statement of Charges for Care and Treatment.
(1) The DDSD upon receiving the referral from
				  the facility forwards the information to the Level of Care Evaluation Unit
				  (LOCEU) to determine the medical eligibility for long-term care in the
				  community. LOCEU enters the medical determination on MEDATS.
(2) In instances where referral is from a
				  public ICF/MR for an individual returning to the home and/or Community Based
				  Waiver Services, the DDSD case manager forwards to the worker the medical
				  eligibility determination for HCBW/MR services along with the latest
				  application and redetermination forms used to determine eligibility for
				  long-term care. A new application will not be required. A case number is
				  assigned retaining the application date, certification date and redetermination
				  of eligibility date.
(3) The
				  superintendent of the facility makes a referral to the county where the
				  guardian or responsible relative resides. If there is no guardian or parent,
				  the superintendent of the facility makes the referral to the county where the
				  public ICF/MR is located. The county is responsible for taking the application,
				  determining eligibility, certifying the case and for locating an ICF/MR for the
				  applicant in the appropriate county (this may be within the county or in
				  another county in the State). The date of application on these referrals from
				  the public ICF/MR is the date the superintendent made the referral.
(4) If a facility is located in another
				  county, the complete active case is transferred in the usual manner to the
				  county in which the ICF/MR is located. The transferring county is responsible
				  for notifying the superintendent of the public ICF/MR when an active case is
				  transferred to another county.
(5)
				  When an individual is discharged from a public ICF/MR to return home and/or
				  Community Based Waiver Services, the MRP or MRE case is updated with a
				  discharge date, placed in closed status and retained in the county where the
				  facility is located.