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 317:35-9-95 - Payment to ICF/IID (public and private)

Current through Vol. 41, No. 20, July 1, 2024
The Oklahoma Health Care Authority may execute agreements
					 to provide care only with facilities which are properly licensed by the state
					 licensing agency. The agreement is initiated by application from the facility
					 and expires on a specified date, or with termination of the facility license,
					 or shall be automatically terminated on notice to OHCA that the facility is not
					 in compliance with Medicaid (or other federal long-term care)
					 requirements.
(1) In the event that a
				  facility changes ownership, the agreement with the previous owner may be
				  extended to the new owner, pending certification of the new owner to provide
				  care to individuals during the change of ownership. In the event that the new
				  owner is not showing good faith in pursuit of certification, the OHCA will
				  begin planning for alternate placement of Medicaid patients. The county office
				  is immediately notified of any relevant change in facility status.
(2) Payment for long-term care is made only
				  for those individuals who have been approved by the DHS for such care. The
				  amount of payment is based on the actual time the individual received care
				  (including therapeutic/hospital leave) from a nursing facility during any given
				  month. Payment for nursing care cannot be made for any period during which the
				  care has been temporarily interrupted for reasons other than therapeutic leave.
				  Therapeutic leave is any planned leave other than hospitalization that is for
				  the benefit of the patient. Therapeutic leave must be clearly documented in the
				  patient's plan of care before payment for a reserved bed can be made by the
				  OHCA. Hospital leave is planned or unplanned leave when the patient is admitted
				  to a licensed hospital.
(3) A
				  nursing facility may receive payment for up to 7 days per calendar year for
				  each eligible individual in order to reserve a bed when the patient is on
				  therapeutic leave.
(4) The ICF/
				  IID may receive payment for a maximum of 60 days of therapeutic leave per
				  calendar year for each recipient to reserve a bed. No more than 14 consecutive
				  days of therapeutic leave may be claimed per absence. Recipients approved for
				  ICF/ IID on or after July 1 of the year will only be eligible for 30 days of
				  therapeutic leave during the remainder of that year.
(5) The Statement of Compensable Therapeutic
				  Leave Only form is used by the facility to record use of therapeutic leave.
				  This form is to be made available by the local office to the nursing facility
				  upon request.
(6) No payment shall
				  be made for hospital leave.
Added at 12 Ok Reg
					 753, eff 1-6-95 through 7-145-95 (emergency); Added at 12 Ok Reg 3133, eff
					 7-27-95; Amended at 13 Ok Reg 927, eff 8-1-95 (emergency); Amended at 13 Ok Reg
					 415, eff 1-1-96 (emergency); Amended at 13 Ok Reg 1677, eff 5-27-96; Amended at
					 17 Ok Reg 2410, eff 6-26-00