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 97 - TARGETED CASE MANAGEMENT SERVICES FOR MEMBERS UNDER TWENTY-ONE YEARS OF AGE AT RISK OF INVOLVEMENT WITH OR IN THE TEMPORARY CUSTODY OR SUPERVISION OF THE OKLAHOMA OFFICE OF JUVENILE AFFAIRS (OJA) › Section 317:30-5-970 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
(a)
Case
				  management agency qualifications.
As the provider agency, the Oklahoma
				  Office of Juvenile Affairs (OJA) must meet applicable state and federal laws
				  governing the participation of providers in the Medicaid program. The Office of
				  Juvenile Affairs Targeted Case Management (OJATCM) program must:
(1) Be available to all eligible members;
(2) Be delivered on a statewide
				  basis with procedures that assure twenty-four (24) hour availability, the
				  protection and safety of recipients, and continuity of services without
				  duplication;
(3) Ensure compliance
				  with federal and state mandates and regulations related to serving the targeted
				  population are met in a consistent and uniform manner;
(4) Meet applicable state and federal laws
				  governing the participation of providers in the Medicaid program, including,
				  but not limited to, the ability to meet federal and state requirements for
				  documentation billing and audits;
(5) Demonstrate that its staff has experience
				  working with the target population and a minimum of five (5) years' experience
				  in providing all core elements of case management including:
(A) Individual strengths and needs
				  assessment;
(B) Needs-based
				  service planning;
(C) Service
				  coordination and monitoring; and
(D) Ongoing assessment and treatment plan
				  revision.
(6) Have
				  adequate administrative capacity to fulfill state and federal requirements;
(7) Have financial management
				  capacity and systems that provide documentation of services and costs in
				  accordance with Generally Accepted Government Auditing Standards (GAGAS);
(8) Have the capacity to document
				  and maintain individual case records in accordance with state and federal
				  requirements;
(9) Have a minimum
				  of five (5) years' experience in providing and meeting the case management and
				  service needs of the target population;
(10) Have responsibility for planning and
				  coordinating statewide juvenile justice and delinquency prevention services in
				  accordance with Title 10A of the Oklahoma Statutes (O.S.), Section (§)
				  2-2-102; and
(11) Have the ability
				  to evaluate the effectiveness, accessibility, and quality of targeted case
				  management (TCM) services on a community-wide basis.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 97 - TARGETED CASE MANAGEMENT SERVICES FOR MEMBERS UNDER TWENTY-ONE YEARS OF AGE AT RISK OF INVOLVEMENT WITH OR IN THE TEMPORARY CUSTODY OR SUPERVISION OF THE OKLAHOMA OFFICE OF JUVENILE AFFAIRS (OJA) › Section 317:30-5-971 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
The target group includes individuals under twenty-one (21)
					 years of age involved in, or at serious risk of involvement with, the juvenile
					 justice system, as provided in Article II of the Oklahoma Juvenile Code. The
					 target group includes individuals, under twenty-one (21) years of age, who have
					 been temporarily placed in OJA custody or supervision or who are voluntarily
					 supervised by OJA to prevent further involvement with the juvenile justice
					 system. The target group may include individuals, under twenty-one (21) years
					 of age, who are assessed as at risk of abuse or neglect as defined in Title 10A
					 of the Oklahoma Statutes (O.S.), Section (§) 1-1-105. The target group
					 does not include those who are involuntarily in secure custody of law
					 enforcement or judicial systems, except individuals who meet Medicaid criteria
					 for inpatient care as defined in § 435.1010 of Title 42 of the Code of
					 Federal Regulations.
(1)
Adults.
There is no coverage for adults age twenty-one (21) and
				  older.
(2)
Children.
Payment is made for services to members under the age twenty-one (21).
Added at 14 Ok Reg
					 3686, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff
					 5-11-98
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 97 - TARGETED CASE MANAGEMENT SERVICES FOR MEMBERS UNDER TWENTY-ONE YEARS OF AGE AT RISK OF INVOLVEMENT WITH OR IN THE TEMPORARY CUSTODY OR SUPERVISION OF THE OKLAHOMA OFFICE OF JUVENILE AFFAIRS (OJA) › Section 317:30-5-971.1 - Description of targeted case management (TCM) services

Current through Vol. 41, No. 20, July 1, 2024
(a)
Definition.
In accordance
				  with Section (§) 440.169(b) of Title 42 of the Code of Federal Regulations
				  (C.F.R.), TCM services are defined as services furnished to assist individuals,
				  eligible under the Oklahoma Medicaid State Plan, in gaining access to needed
				  medical, social, educational, and other services. TCM includes providing
				  services that are directly related to identifying the individual's needs and
				  care, for the purposes of helping the individual access services; identifying
				  needs and supports to assist the individual in obtaining services; providing
				  case managers with useful feedback, and alerting case managers to changes in
				  the individual's needs [
				  42 C.F.R.
				  440.169(e) ]. TCM includes
				  the following assistance:
(1) Comprehensive
				  assessment and periodic reassessment of an individual's needs, to determine the
				  need for any medical, educational, social, or other services.
(A) All members are assessed using
				  comprehensive, evidence-based, risk/needs assessment tools at the beginning of
				  case assignment.
(B)
				  Comprehensive, evidence-based, risk/needs assessment tools are used to measure
				  multiple areas or domains in the lives of the members and then linking that
				  information to case planning.
(C)
				  Any area showing a moderate to high-risk/need/strength score could result in
				  additional goals and action steps documented within the individualized
				  treatment plan.
(D) In addition to
				  the initial assessment, each member is assessed, at least once every six (6)
				  months. Assessment activities include:
(i)
				  Taking member history;
(ii)
				  Identifying and documenting the member's needs; and
(iii) Gathering information from family
				  members, medical providers, social workers, educators (if necessary), and other
				  applicable sources to form a complete assessment of the member.
(E) Should behavior shifts or
				  life-changing events occur prior to six (6) months, the member is reassessed
				  and the individualized treatment service plan is adjusted to reflect identified
				  needs. Any needed changes in services, service providers, treatment type,
				  frequency, or duration may be adjusted at this time.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 97 - TARGETED CASE MANAGEMENT SERVICES FOR MEMBERS UNDER TWENTY-ONE YEARS OF AGE AT RISK OF INVOLVEMENT WITH OR IN THE TEMPORARY CUSTODY OR SUPERVISION OF THE OKLAHOMA OFFICE OF JUVENILE AFFAIRS (OJA) › Section 317:30-5-972 - Reimbursement

Current through Vol. 41, No. 20, July 1, 2024
(a) Targeted case
				  management (TCM) services will be reimbursed pursuant to the methodology
				  described in the Oklahoma Medicaid State Plan.
(b) The reimbursement methodology is based
				  upon qualifying costs for the eligible population from the Cost Allocation
				  Plan. The TCM unit rate is a prospective flat rate based on a qualifying TCM
				  contact with the member in the target population or with some other person on
				  behalf of the member during the claim period.
Added at 14 Ok Reg
					 3686, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff 5-11-98; Amended at
					 19 Ok Reg 2134, eff 6-27-02; Amended at 27 Ok Reg 808, eff 3-3-10 (emergency);
					 Amended at 27 Ok Reg 1458, eff 6-11-10
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 97 - TARGETED CASE MANAGEMENT SERVICES FOR MEMBERS UNDER TWENTY-ONE YEARS OF AGE AT RISK OF INVOLVEMENT WITH OR IN THE TEMPORARY CUSTODY OR SUPERVISION OF THE OKLAHOMA OFFICE OF JUVENILE AFFAIRS (OJA) › Section 317:30-5-973 - Billing

Current through Vol. 41, No. 20, July 1, 2024
Billing for case management services must be submitted,
					 ensuring no duplication of services, and in accordance with state and federal
					 requirements, reflective of guidelines found at Oklahoma Administrative Code
					 (OAC)
					 317:30-3-11,
					 317:30-3-11.1,
					 and
					 317:30-3-20.
Added at 14 Ok Reg
					 3686, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff
					 5-11-98
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 97 - TARGETED CASE MANAGEMENT SERVICES FOR MEMBERS UNDER TWENTY-ONE YEARS OF AGE AT RISK OF INVOLVEMENT WITH OR IN THE TEMPORARY CUSTODY OR SUPERVISION OF THE OKLAHOMA OFFICE OF JUVENILE AFFAIRS (OJA) › Section 317:30-5-974 - Documentation of records

Current through Vol. 41, No. 20, July 1, 2024
(a) The Oklahoma
				  Office of Juvenile Affairs (OJA) must maintain case records that document for
				  all members receiving targeted case management (TCM) as follows:
(1) The name of the member;
(2) The dates of the case management
				  services;
(3) The name of the OJA
				  as the provider agency (if applicable) and the person providing the case
				  management service;
(4) The
				  nature, content, units of the case management services received, and whether
				  goals specified in the treatment service plan have been achieved;
(5) Whether the member has declined services
				  in the treatment service plan;
(6)
				  The need for, and occurrences of, coordination with other case managers;
(7) A timeline for obtaining
				  needed services; and
(8) A
				  timeline for reevaluation of the plan.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 99 - CASE MANAGEMENT SERVICES FOR UNDER AGE 18 IN EMERGENCY, TEMPORARY OR PERMANENT CUSTODY OR SUPERVISION OF THE DEMENT OF HUMAN SERVICES › Section 317:30-5-990 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
(a)
Case
				  management agencies.
Services are provided by case management agencies
				  established for the purpose of providing case management services. Medicaid
				  Child Welfare Targeted Case Management (CWTCM) services must be made available
				  to all eligible recipients and must be delivered by provider agencies on a
				  statewide basis with procedures that assure 24 hour availability, the
				  protection and safety of recipients, continuity of services without
				  duplication, and compliance with federal and State mandates and regulations
				  related to servicing the targeted population are met in a uniform and
				  consistent manner. The agency must demonstrate that their staff has:
(1) a minimum of five 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
				  and monitoring; and
(D) on-going
				  assessment and treatment plan revision.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 99 - CASE MANAGEMENT SERVICES FOR UNDER AGE 18 IN EMERGENCY, TEMPORARY OR PERMANENT CUSTODY OR SUPERVISION OF THE DEMENT OF HUMAN SERVICES › Section 317:30-5-991 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
Payment is made for case management service as set forth in
					 this Section.
(1)
Adults.
There is no coverage for adults.
(2)
Children.
Payment is made
				  for services to persons under age 18 as follows:
(A)
Description of case management
				  services.
The target group for CWTCM services are persons under age 18
				  who are in emergency, temporary or permanent custody of the Department of Human
				  Services (DHS) or in voluntary status who are placed in out-of home care or
				  trial adoption.
(i) Case management services
				  are activities that assist the target population in gaining access to needed
				  medical, social, educational and other services. These services include
				  services covered under the Oklahoma Medicaid State Plan as well as those
				  services not covered under the State Plan.
(ii) Case management is designed to assist
				  individuals in accessing services. The client has the right to refuse case
				  management and cannot be restricted from services because of a refusal for Case
				  Management Services.
(iii) Case
				  management does not include:
(I) Physically
				  escorting or transporting a client to scheduled appointments or staying with
				  the client during an appointment;
(II) Monitoring financial goals;
(III) Providing specific services such as
				  shopping or paying bills; or
(IV)
				  Delivering bus tickets, food stamps, money, etc.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 99 - CASE MANAGEMENT SERVICES FOR UNDER AGE 18 IN EMERGENCY, TEMPORARY OR PERMANENT CUSTODY OR SUPERVISION OF THE DEMENT OF HUMAN SERVICES › Section 317:30-5-992 - Reimbursement

Current through Vol. 41, No. 20, July 1, 2024
Child Welfare Targeted Case Management (CWTCM) services
					 will be reimbursed pursuant to the methodology described in the Oklahoma Title
					 XIX State Plan.
Added at 14 Ok Reg
					 3711, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff 5-11-98; Amended at
					 19 Ok Reg 2134, eff 6-27-02; Amended at 27 Ok Reg 808, eff 3-3-10 (emergency);
					 Amended at 27 Ok Reg 1458, eff 6-11-10
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 99 - CASE MANAGEMENT SERVICES FOR UNDER AGE 18 IN EMERGENCY, TEMPORARY OR PERMANENT CUSTODY OR SUPERVISION OF THE DEMENT OF HUMAN SERVICES › Section 317:30-5-993 - Billing

Current through Vol. 41, No. 20, July 1, 2024
Billing for case management services is on Form HCFA-1500.
					 Claims must be submitted in accordance with guidelines found at OAC
					 317:30-3-11
					 and
					 317:30-3-11.1.
Added at 14 Ok Reg
					 3711, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff
					 5-11-98
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 99 - CASE MANAGEMENT SERVICES FOR UNDER AGE 18 IN EMERGENCY, TEMPORARY OR PERMANENT CUSTODY OR SUPERVISION OF THE DEMENT OF HUMAN SERVICES › Section 317:30-5-994 - Documentation of records

Current through Vol. 41, No. 20, July 1, 2024
All case management services rendered must be reflected by
					 documentation in the records. All units of Medicaid CWTCM services provided are
					 documented by the case manager on the monthly Record of Contact
					 form.
Added at 14 Ok Reg
					 3711, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff
					 5-11-98
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 101 - TARGETED CASE MANAGEMENT SERVICES FOR PERSONS WITH INTELLECTUAL DISABILITY AND/OR RELATED CONDITIONS › Section 317:30-5-1010 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
(a)
Eligible providers.
Services are provided by Oklahoma Department
				  of Human Services (OKDHS) Developmental Disabilities Services Division (DDSD)
				  case managers.
(1)
Certification
				  requirements.
SoonerCare Developmental Disabilities Services Division
				  Targeted Case Management (DDSDTCM) services must be made available to all
				  eligible members and must be delivered on a statewide basis with procedures
				  that assure 24 hour availability, the protection and safety of members,
				  continuity of services without duplication, and compliance with federal and
				  State mandates and regulations related to servicing the targeted population are
				  met in a uniform and consistent manner. A DDSDTCM case manager must:
(A) be employed by the OKDHS, DDSD.
(B) possess knowledge of:
(i) case management methods, principles and
				  techniques;
(ii) types of
				  developmental disabilities represented within the caseload;
(iii) types of providers and services
				  available for members;
(iv) the
				  behavioral sciences and allied disciplines involved in the evaluation, care and
				  training of persons with developmental disabilities;
(v) interviewing principles and
				  techniques;
(vi) counseling
				  principles and techniques; and
(vii) adaptive communication techniques and
				  non-verbal communication.
(C) possess skill in:
(i) managing a caseload;
(ii) effectively intervening in crisis
				  situations;
(iii) working
				  cooperatively and effectively with other professionals in a team
				  situation;
(iv) collecting and
				  analyzing information;
(v) making
				  decisions relating to services provided to members;
(vi) developing a logical and practical plan
				  of treatment for members with developmental disabilities;
(vii) evaluating the progress of members and
				  the quality of their habilitation programs;
(viii) communicating effectively;
				  and
(ix) mediating with providers
				  and agencies to resolve problems.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 101 - TARGETED CASE MANAGEMENT SERVICES FOR PERSONS WITH INTELLECTUAL DISABILITY AND/OR RELATED CONDITIONS › Section 317:30-5-1010.1 - Scope of service

Current through Vol. 41, No. 20, July 1, 2024
(a)
Description of targeted case management services.
(1) Case management services are services
				  furnished to assist members, eligible under the Medicaid State Plan, in gaining
				  access to needed medical, social, educational and other services. Case
				  management includes the following assistance:
(A) assessment of a member to determine the
				  need for medical, educational, social, or other services. Assessment activities
				  include:
(i) taking member history;
(ii) identifying the member's needs and
				  completing related documentation; and
(iii) gathering information from other
				  sources such as family members, medical providers, social workers, and
				  educators to form a complete assessment of the member.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 101 - TARGETED CASE MANAGEMENT SERVICES FOR PERSONS WITH INTELLECTUAL DISABILITY AND/OR RELATED CONDITIONS › Section 317:30-5-1011 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
Payment is made for targeted case management service as set
					 forth in this Section.
(1)
Adults.
Payment is made for services to persons with an
				  intellectual disability and/or related conditions as follows:
(A) The target group for Developmental
				  Disabilities Services Division Targeted Case Management (DDSDTCM) services are
				  Medicaid eligible individuals:
(i) served by
				  the Home and Community Based Waivers operated by the Department of Human
				  Services/Developmental Disabilities Services Division (DHS/DDSD); or
(ii) residing in institutions who:
(I) have requested Home and Community Based
				  Waiver services operated by DHS/DDSD, and
(II) receive targeted case management
				  services during a transition period not to exceed 180 consecutive days
				  immediately prior to entering the Waiver; or
(iii) who are being assessed for admission to
				  the Home and Community Based Waiver operated by DHS/DDSD.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 101 - TARGETED CASE MANAGEMENT SERVICES FOR PERSONS WITH INTELLECTUAL DISABILITY AND/OR RELATED CONDITIONS › Section 317:30-5-1012 - Reimbursement

Current through Vol. 41, No. 20, July 1, 2024
(a) Reimbursement
				  for DDSDTCM services is a unit rate based on the weekly cost per case for
				  documented DDSDTCM services. The cost base consists of the annualized cost of
				  case management staff including all applicable overhead and indirect service
				  cost in accordance with the approved DHS cost allocation plan. A first year
				  interim rate is computed by dividing the annual cost base by the projected
				  number of units. Subsequent annual rates will include an adjustment based on
				  previous years cost versus total billable amount. A unit of service is defined
				  as one calendar week of targeted case management, provided that a minimum of
				  one contact which meets the description of a targeted case management activity
				  with or on behalf of the member has been documented during the week claimed.
				  Payment is made on the basis of claims submitted for payment. The provider
				  bills at the weekly unit rate for a documented unit of SoonerCare DDSDTCM
				  services provided to each SoonerCare eligible member during the calendar
				  week.
(b) Only one unit of DDSDTCM
				  services may be billed for each SoonerCare eligible member per week while the
				  member is receiving services under a DHS/DDSD HCBS Waiver or is in the
				  transition process to receive those services. No more than twenty-six units of
				  DDSDTCM may be provided and billed for each eligible SoonerCare member during
				  their transition period from the institution. DHS/DDSD must provide
				  documentation of all such transitional DDSDTCM services provided, indicating
				  the date performed for each unit billed. In no case may DHS/DDSD bill for
				  transitional and regular DDSDTCM services provided during the same week (i.e.,
				  if DDSD bills transitional DDSDTCM for the third week in June and the member is
				  deinstitutionalized into the particular Waiver during the third week in June,
				  DDSD cannot also bill for regular DDSDTCM for the third week in June). If
				  DDSDTCM has been provided to an individual during such a transitional period
				  but that individual dies before the placement into the community is made,
				  decides to refuse the placement or the placement falls through, reimbursement
				  is available.
(c) the billing week
				  for DDSDTCM is Monday through Sunday.
Added at 14 Ok Reg
					 3704, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff 5-11-98; Amended at
					 18 Ok Reg 968, eff 3-21-01 (emergency); Amended at 19 Ok Reg 1067, eff 5-13-02;
					 Amended at 29 Ok Reg 1088, eff 6-25-12
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 101 - TARGETED CASE MANAGEMENT SERVICES FOR PERSONS WITH INTELLECTUAL DISABILITY AND/OR RELATED CONDITIONS › Section 317:30-5-1013 - Billing

Current through Vol. 41, No. 20, July 1, 2024
Billing for case management services is on Form HCFA-1500.
					 Claims should not be submitted until Medicaid eligibility of the individual has
					 been determined. However, a claim must be received by OHCA within 12 months of
					 the date of service. If the eligibility of the individual has not been
					 determined after ten months from the date of service, a claim must be submitted
					 in order to assure that the claim is timely filed and reimbursement from Title
					 XIX funds can be made should the individual be determined eligible at a later
					 date.
Added at 14 Ok Reg
					 3704, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff
					 5-11-98
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 101 - TARGETED CASE MANAGEMENT SERVICES FOR PERSONS WITH INTELLECTUAL DISABILITY AND/OR RELATED CONDITIONS › Section 317:30-5-1014 - Documentation of records

Current through Vol. 41, No. 20, July 1, 2024
All case management services rendered must be reflected by
					 documentation in the records. All units of SoonerCare DDSDTCM services provided
					 are documented by the case manager weekly in Client Contact Manager. The
					 following conditions must be met in order for case management services to
					 reimbursed under SoonerCare.
(1) The
				  case manager must conduct a face-to-face interview with the member in order to
				  determine member needs and develop approaches to meet these needs.
(2) The case manager with a team including
				  the member or member's representative, must develop a plan of care which is
				  documented in the case record.
(3)
				  The case manager must reassess the plan of care when necessary but at a minimum
				  annually.
(4) The case manager must
				  provide documentation to supplement the plan of care which includes:
(A) information supporting the selection of
				  outcomes;
(B) information
				  supporting the approaches selected;
(C) information supporting case management
				  decisions and actions;
(D)
				  documentation of communication with the member and, as appropriate, his/her
				  representative;
(E) documentation
				  of linkages with resources;
(F)
				  documentation of follow-up and monitoring of the plan; and
(G) other factual information relevant to the
				  case.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 103 - QUALIFIED SCHOOLS AS PROVIDERS OF HEALTH-RELATED SERVICES › Section 317:30-5-1021 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
(a) Eligible
				  providers are local, regional, and state educational services agencies as
				  defined by state law and the Individuals with Disabilities Education Act
				  (IDEA), as most recently amended (hereinafter, "school providers"). School
				  providers must submit a completed contract to the Oklahoma Health Care
				  Authority (OHCA), including a Special Provisions for Schools, and must receive
				  approval thereof prior to receiving reimbursement for school-based
				  services.
(b) Qualified school
				  providers must notify OHCA of all subcontractors performing Individualized
				  Education Program (IEP) related evaluations and services in the school setting
				  prior to services being rendered. The notification must include a copy of the
				  agreement between the school and subcontractor and must reflect the start and
				  ending dates of the agreement for services. All subcontractors must be
				  individually contracted with SoonerCare and, if rendering services, must be
				  identified on any claim for payment as the rendering provider.
Added at 14 Ok Reg
					 3707, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff 5-11-98; Amended at
					 17 Ok Reg 2394, eff 6-26-00
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 103 - QUALIFIED SCHOOLS AS PROVIDERS OF HEALTH-RELATED SERVICES › Section 317:30-5-1022 - Periodicity schedule [Revoked]

Current through Vol. 41, No. 20, July 1, 2024
Added at 14 Ok Reg
					 3707, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff
					 5-11-98
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 103 - QUALIFIED SCHOOLS AS PROVIDERS OF HEALTH-RELATED SERVICES › Section 317:30-5-1024 - Periodic screening examination [Revoked]

Current through Vol. 41, No. 20, July 1, 2024
Added at 14 Ok Reg
					 3707, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff
					 5-11-98
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 103 - QUALIFIED SCHOOLS AS PROVIDERS OF HEALTH-RELATED SERVICES › Section 317:30-5-1025 - Interperiodic screening examination [Revoked]

Current through Vol. 41, No. 20, July 1, 2024
Added at 14 Ok Reg
					 3707, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff
					 5-11-98
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 103 - QUALIFIED SCHOOLS AS PROVIDERS OF HEALTH-RELATED SERVICES › Section 317:30-5-1026 - Reporting of suspected abuse/neglect

Current through Vol. 41, No. 20, July 1, 2024
Instances of child abuse and/or neglect are to be reported
					 in accordance with state law, including, but not limited to, Section (§)
					 1-2-101 of Title 10A of the Oklahoma Statutes and 43A O.S. § 10-104. Any
					 person suspecting child abuse or neglect shall immediately report it to the
					 Oklahoma Department of Human Services (OKDHS) hotline, at 1-800-522-3511; any
					 person suspecting abuse, neglect, or exploitation of a vulnerable adult shall
					 immediately report it to the local DHS County Office, municipal or county law
					 enforcement authorities, or, if the report occurs after normal business hours,
					 the OKDHS hotline. Health care professionals who are requested to report
					 incidents of domestic abuse by adult victims with legal capacity shall promptly
					 make a report to the nearest law enforcement agency, per 22 O.S. § 58.
Added at 14 Ok Reg
					 3707, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff 5-11-98; Amended at
					 26 Ok Reg 2081, eff 6-25-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 103 - QUALIFIED SCHOOLS AS PROVIDERS OF HEALTH-RELATED SERVICES › Section 317:30-5-1027 - Billing

Current through Vol. 41, No. 20, July 1, 2024
Each service has a specified unit of service (unit) for
					 billing purposes which represents the actual time spent providing a direct
					 service. Direct service must be face-to face with the child. There is no
					 reimbursement for time reviewing/completing paperwork and/or documentation
					 related to the service or for staff travel to/from the site of service, unless
					 otherwise specified.
(1) Most units of
				  service are time-based, meaning that the service must be of a minimum duration
				  in order to be billed. A unit of service that is time-based is continuous
				  minutes; the time cannot be aggregated throughout the day.
(2) There are no minimum time requirements
				  for evaluation services, for which the unit of service is generally a completed
				  evaluation. The only exception is the evaluation and testing (OAC
				  317:30-5-1023(b)(1)(H),
				  which is billed in hourly increments.
Added at 14 Ok Reg
					 3707, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff 5-11-98; Amended at
					 16 Ok Reg 1927, eff 6-11-99; Amended at 17 Ok Reg 2394, eff 6-26-00; Amended at
					 18 Ok Reg 3633, eff 5-22-01 (emergency); Amended at 18 Ok Reg 2579, eff
					 6-25-01; Amended at 19 Ok Reg 1067, eff 5-13-02; Amended at 19 Ok Reg 2134, eff
					 6-27-02; Amended at 27 Ok Reg 706, eff 2-4-10 through 7-14-10 (emergency);
					 Amended at 27 Ok Reg 2387, eff 7-15-10 (emergency); Amended at 28 Ok Reg 1431,
					 eff 6-25-11; Amended at 29 Ok Reg 1098, eff
					 6-25-12
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 103 - QUALIFIED SCHOOLS AS PROVIDERS OF HEALTH-RELATED SERVICES › Section 317:30-5-1028 - Billing [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 14 Ok Reg
					 3707, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff 5-11-98; Amended at
					 17 Ok Reg 2394, eff 6-26-00; Revoked at 19 Ok Reg 2134, eff
					 6-27-02
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 317:30-5-1031 - Coverage by category

Current through Vol. 41, No. 20, July 1, 2024
(a) Payment is
				  made for case management services to children as set forth in this Section.
(1)
Description of case management
				  services.
The target group for case management services is individuals
				  0-21 who are receiving services pursuant to an Individualized Education Program
				  (IEP), an Individualized Family Service Plan (IFSP), a Section 504
				  Accommodation Plan, or an Individualized Health Service Plan (IHSP), and who
				  have a disability or are medically at risk. A disability is defined as a
				  physical or mental impairment that substantially limits one or more major life
				  activities. Medically at risk refers to individuals who have a diagnosable
				  physical or mental condition that has a high probability of impairing
				  cognitive, emotional, neurological, social or physical development.
(A) Services are provided to assist the
				  target population in gaining access to needed medical, social, educational, and
				  other services. Major components of the service include:
(i) Individualized needs assessment
(ii) Needs-based service planning;
(iii) Service coordination, monitoring and
				  advocacy;
(iv) Services plan
				  review; and
(v) Crisis assistance
				  planning.
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 317:30-5-1032 - Reimbursement

Current through Vol. 41, No. 20, July 1, 2024
(a) Reimbursement
				  for SBTCM services is a unit rate based on the analysis of the average annual
				  costs of providing case management services by participating providers. A unit
				  of service is defined as each completed 10 minute increment that meets the
				  description of case management activity with, or on behalf of the individual,
				  his or her parent(s) or legal guardian.
(b) Payment will be made on the basis of
				  claims submitted for payment. The provider will bill for the unit rate for each
				  documented unit of SoonerCare SBTCM service provided to each SoonerCare
				  eligible individual.
Added at 16 Ok Reg
					 1927, eff 6-11-99
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 317:30-5-1033 - Billing

Current through Vol. 41, No. 20, July 1, 2024
Claims should not be submitted until SoonerCare eligibility
					 of the individual has been determined. However, a claim must be received by
					 OHCA within six (6) months of the date of service. If the eligibility of the
					 individual has not been determined after four (4) months from the date of
					 service, a claim should be submitted in order to assure that the claim is filed
					 and reimbursement can be made should the individual be determined eligible at a
					 later date.
Added at 16 Ok Reg
					 1927, eff 6-11-99; Amended at 19 Ok Reg 2134, eff
					 6-27-02
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 317:30-5-1034 - Documentation of records

Current through Vol. 41, No. 20, July 1, 2024
All case management services rendered must be reflected by
					 documentation in the records. The case manager documents all units of
					 SoonerCare SBTCM services provided on the service record
					 form.
Added at 16 Ok Reg
					 1927, eff 6-11-99
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 105 - RESIDENTIAL BEHAVIORAL MANAGEMENT SERVICES IN GROUP SETTINGS › Section 317:30-5-1040 - Organized health care delivery system

Current through Vol. 41, No. 20, July 1, 2024
The OHCA recognizes an Organized Health Care Delivery
					 System (OHCDS) as an entity with an identifiable component within its mission
					 which is organized for the purpose of delivering health care. The entity must
					 furnish at least one service covered by the Oklahoma Medicaid State Plan itself
					 (i.e. through its own employees). Those employees who furnish each service must
					 meet the State's minimum qualifications for its provision. So long as the
					 entity continues to furnish at least one service itself, it may contract with
					 other qualified providers to furnish Medicaid covered
					 services.
Added at 15 Ok Reg
					 538, eff 11-5-97 (emergency); Added at 15 Ok Reg 1528, eff 5-11-98; Amended at
					 27 Ok Reg 623, eff 1-14-10 through 7-14-10
					 (emergency)1
1This emergency action expired
					 without being superseded by a permanent action. Upon expiration of an emergency
					 amendatory action, the last effective permanent text is reinstated. Therefore,
					 on 7-15-10 (after the 7-14-10 expiration of this emergency action), the text of
					 317:30-5-1040 reverted back to the permanent text that became effective
					 5-11-98, as was last published in the 2006 Edition of the
					 OAC.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 105 - RESIDENTIAL BEHAVIORAL MANAGEMENT SERVICES IN GROUP SETTINGS › Section 317:30-5-1041 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
Payment is made for Residential Behavior Management
					 Services (RBMS) in group settings to any Organized Heath Care Delivery System
					 (OHCDS) that is a child placing agency, that has a statutory authority for the
					 care of children in the custody of the State of Oklahoma and which enters into
					 a contract with the State Medicaid program. The OHCDS must certify to the
					 Oklahoma Health Care Authority (OHCA) that all direct providers of services
					 (whether furnished through its own employees or under contract) meet the
					 minimum program qualifications. RBMS are covered only for those beds contracted
					 by the OHCDS.
Added at 15 Ok Reg
					 538, eff 11-5-97 (emergency); Added at 15 Ok Reg 1528, eff 5-11-98; Amended at
					 27 Ok Reg 623, eff 1-14-10 through 7-14-10
					 (emergency)1
1This emergency action expired
					 without being superseded by a permanent action. Upon expiration of an emergency
					 amendatory action, the last effective permanent text is reinstated. Therefore,
					 on 7-15-10 (after the 7-14-10 expiration of this emergency action), the text of
					 317:30-5-1041 reverted back to the permanent text that became effective
					 5-11-98, as was last published in the 2006 Edition of the
					 OAC.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 105 - RESIDENTIAL BEHAVIORAL MANAGEMENT SERVICES IN GROUP SETTINGS › Section 317:30-5-1042 - Memorandum of agreement

Current through Vol. 41, No. 20, July 1, 2024
A Memorandum of Agreement between the Oklahoma Health Care
					 Authority (OHCA) and the Organized Heath Care Delivery System (OHCDS) must be
					 in effect before reimbursement can be made for compensable services. The
					 agreement outlines the contractual and subcontractual requirements for
					 reimbursement. This agreement provides that the OHCDS is responsible for the
					 Medicaid state share required for federal financial participation for all
					 Residential Behavior Management Services (RBMS) provided to custody children in
					 residential group homes.
Added at 15 Ok Reg
					 538, eff 11-5-97 (emergency); Added at 15 Ok Reg 1528, eff 5-11-98; Amended at
					 27 Ok Reg 623, eff 1-14-10 through 7-14-10
					 (emergency)1
1This emergency action expired
					 without being superseded by a permanent action. Upon expiration of an emergency
					 amendatory action, the last effective permanent text is reinstated. Therefore,
					 on 7-15-10 (after the 7-14-10 expiration of this emergency action), the text of
					 317:30-5-1042 reverted back to the permanent text that became effective
					 5-11-98, as was last published in the 2006 Edition of the
					 OAC.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 105 - RESIDENTIAL BEHAVIORAL MANAGEMENT SERVICES IN GROUP SETTINGS › Section 317:30-5-1044 - Payment rates

Current through Vol. 41, No. 20, July 1, 2024
A per diem rate is established for each residential level
					 of care in which behavior management services are provided. The payment is an
					 all-inclusive daily rate for all behavior management services provided under
					 the auspices of the Organized Health Care Delivery System (OHCDS). Room and
					 board costs, educational costs and related administrative costs are not
					 reimbursable and are excluded from the calculation of the daily rate.
					 Residential Behavioral Management Services (RBMS) are limited to a maximum of
					 one (1) service per day per eligible recipient.
Added at 15 Ok Reg
					 538, eff 11-5-97 (emergency); Added at 15 Ok Reg 1528, eff 5-11-98; Amended at
					 18 Ok Reg 492, eff 1-1-01 (emergency); Amended at 18 Ok Reg 1130, eff 5-11-01;
					 Amended at 19 Ok Reg 2134, eff 6-27-02; Amended at 27 Ok Reg 623, eff 1-14-10
					 through 7-14-10
					 (emergency)1
1This emergency action expired
					 without being superseded by a permanent action. Upon expiration of an emergency
					 amendatory action, the last effective permanent text is reinstated. Therefore,
					 on 7-15-10 (after the 7-14-10 expiration of this emergency action), the text of
					 317:30-5-1044 reverted back to the permanent text that became effective
					 6-27-02, as was last published in the 2006 Edition of the
					 OAC.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 105 - RESIDENTIAL BEHAVIORAL MANAGEMENT SERVICES IN GROUP SETTINGS › Section 317:30-5-1045 - Billing

Current through Vol. 41, No. 20, July 1, 2024
(a) Billing is on
				  the HCFA-1500.
(b) Claims must be
				  submitted in accordance with guidelines found at OAC
				  317:30-3-11
				  and
				  317:30-3-11.1.
Added at 15 Ok Reg
					 538, eff 11-5-97 (emergency); Added at 15 Ok Reg 1528, eff 5-11-98; Amended at
					 27 Ok Reg 623, eff 1-14-10 through 7-14-10
					 (emergency)1
1This emergency action expired
					 without being superseded by a permanent action. Upon expiration of an emergency
					 amendatory action, the last effective permanent text is reinstated. Therefore,
					 on 7-15-10 (after the 7-14-10 expiration of this emergency action), the text of
					 317:30-5-1045 reverted back to the permanent text that became effective
					 5-11-98, as was last published in the 2006 Edition of the
					 OAC.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 105 - RESIDENTIAL BEHAVIORAL MANAGEMENT SERVICES IN GROUP SETTINGS › Section 317:30-5-1046 - Documentation of records and records review

Current through Vol. 41, No. 20, July 1, 2024
(a) The Organized Health Care Delivery System
				  (OHCDS) and the facilities with whom it contracts must maintain appropriate
				  records system. Current individual plans of care, case files, and progress
				  notes are maintained in the facilities' files during the time the child or
				  youth is receiving services. All services rendered must be reflected by
				  documentation in the case records.
(b) The Oklahoma Health Care Authority (OHCA)
				  and the Centers for Medicare and Medicaid Services (CMS) may evaluate through
				  inspection or other means, the quality, appropriateness and timeliness of
				  services provided by the OHCDS or facilities with whom it contracts.
(c) All Residential Behavioral Management
				  Services (RBMS) in group settings must be reflected by documentation in the
				  patients' records. Individual, group, family, and alcohol and other drug
				  counseling and social and basic living skills development services must include
				  all of the following:
(1) Date;
(2) Start and stop time for each session;
(3) Signature of the
				  therapist/staff providing service;
(4) Credentials of therapist/staff providing
				  service;
(5) Specific problem(s)
				  addressed (problem must be identified on individualized plan of care);
(6) Methods used to address
				  problem(s);
(7) Progress made
				  toward goals;
(8) Patient response
				  to the session or intervention; and
(9) Any new problem(s) identified during the
				  session.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 105 - RESIDENTIAL BEHAVIORAL MANAGEMENT SERVICES IN GROUP SETTINGS › Section 317:30-5-1047 - Confidentiality of information

Current through Vol. 41, No. 20, July 1, 2024
In accordance with the provisions of 42 CFR 431, Subpart F,
					 the OHCDS and the facilities with whom it contracts must safeguard information
					 about the client.
Added at 15 Ok Reg
					 538, eff 11-5-97 (emergency); Added at 15 Ok Reg 1528, eff 5-11-98; Amended at
					 27 Ok Reg 623, eff 1-14-10 through 7-14-10
					 (emergency)1
1This emergency action expired
					 without being superseded by a permanent action. Upon expiration of an emergency
					 amendatory action, the last effective permanent text is reinstated. Therefore,
					 on 7-15-10 (after the 7-14-10 expiration of this emergency action), the text of
					 317:30-5-1047 reverted back to the permanent text that became effective
					 5-11-98, as was last published in the 2006 Edition of the
					 OAC.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 108 - NUTRITION SERVICES › Section 317:30-5-1075 - Eligible providers

Current through Vol. 41, No. 20, July 1, 2024
Payment is made for compensable services to dietitians
					 licensed in the state where they practice. Each dietitian must have a current
					 contract with the Oklahoma Health Care Authority (OHCA).
Added at 17 Ok Reg
					 2401, eff 6-26-00
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 108 - NUTRITION SERVICES › Section 317:30-5-1077 - Procedure codes and claim form [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 17 Ok Reg
					 2401, eff 6-26-00; Revoked at 19 Ok Reg 2134, eff
					 6-27-02