Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 17 - Advantage Waiver Services › Section 317:35-17-18 - ADvantage services during hospitalization or NF placement

Current through Vol. 41, No. 20, July 1, 2024
When the member's DHS social worker, ADvantage case manager,
				  or the AA is informed by the member, family, or service provider of a member's
				  hospitalization or placement in a nursing facility (NF), that party determines
				  the date of the member's institutionalization and communicates the date, name
				  of the institution, reason for placement , and expected duration for placement
				  to the other ADvantage Program Administrative partners. When a member requires
				  hospital or NF services, the case manager assists the member access
				  institutional care, periodically monitors the member's progress during the
				  institutional stay and, as appropriate, updates the person-centered service
				  plan and prepares services to start on the date the member is discharged from
				  the institution and returns home. All case management units for institution
				  transition services to plan for and coordinate service delivery and to assist
				  the member to safely return home, even when provided while the person is in an
				  institution, are considered delivered on and billed for the date the member
				  returns home from institutional care.
(1)
Hospital discharge.
When the
				member returns home from a hospital or when notified of the member's
				anticipated discharge date, the case manager notifies relevant providers and
				the ADvantage Administration (AA), and coordinates the resumption of services.
(2)
Nursing Facility
placement of less than 30-calendar days.
When the member returns
				home from a NF stay of 30-calendar or less or when notified of the member's
				anticipated discharge date , the case manager notifies relevant providers, the
				member's DHS worker and the AA of the discharge and coordinates the resumption
				of ADvantage services in the home.
(3)
Nursing Facility
placement longer
than 30-calendar days. When the member is
				scheduled to be discharged and return home from a NF stay that is longer than
				30-calendar the member's DHS worker, ADvantage case manager, or the AA, whoever
				first receives notification of the discharge, notifies other ADvantage Program
				Administrative partners to expedite the restart of ADvantage services for the
				member. The member's case manager provides institution transition case
				management services to assist the member to re-establish him or herself safely
				in the home.
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 56, eff 4-30-96 (emergency); Amended at 14 Ok Reg 1802,
				  eff 5-27-97; Amended at 15 Ok Reg 3715, eff 5-18-98 (emergency); Amended at 16
				  Ok Reg 1438, eff 5-27-99; Amended at 19 Ok Reg 338, eff 11-14-01; Amended at 19
				  Ok Reg 1071, eff 5-13-02; Amended at 20 Ok Reg 1958, eff 6-26-03; Amended at 26
				  Ok Reg 758, eff 4-1-09 (emergency); Amended at 27 Ok Reg 1507, eff 6-11-10;
				  Amended at 29 Ok Reg 1172, eff 6-25-12