reglab/statecodes huggingface dataset:
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 19 - Nursing Facility Services › Section 317:35-19-28 - Management of client's funds while receiving care in NF

Current through Vol. 41, No. 20, July 1, 2024
When an individual has been approved for long-term care in a
				  facility, the administrator of the facility where he/she is receiving care
				  completes the Management of Recipient's Funds form and when applicable, the
				  form is signed according to instructions on the form.
(1) If the recipient requests the
				administrator to hold the recipient's funds, the administrator of the facility
				completes the Management of Recipient's Funds form to acknowledge receipt of
				money and other items of value. As long as the recipient remains in the
				facility, the administrator is responsible for completing this form each time
				funds or other items of value, other than monthly income, are received. The
				form also serves to acknowledge the agreement to an accounting of funds
				expended in behalf of the recipient and as a source document for posting
				credits and debits to Form ABCDM-99, Ledger Sheet for Recipient's
				Account.
(2) The administrator of
				the facility prepares Form ABCDM-99 for each recipient for whom he/she is
				holding funds or other items of value. He/she is obligated to keep an accurate
				accounting of all receipts and expenditures and the amount of money on hand at
				all times. Form ABCDM-99 is to be available for inspection at all
				times.
(3) As a part of each
				redetermination of eligibility for a recipient for whom the administrator is
				holding funds or other items, the worker secures from the administrator a
				current Accounting Recipient's Personal Funds and Property form. This form is
				also prepared by the administrator of the facility when the recipient dies or
				leaves the facility for some other reason and is routed to the county office
				within five days from the last day the recipient was in residence.
(4) If the facility operator does not handle
				the recipient's funds, the worker is responsible for determining who does
				handle the funds, the amount of the funds and for recording this in the case
				narrative.
(5) If there is
				indication that, prior to the next regular determination of eligibility, the
				amount of the recipient's resources is likely to increase or decrease, the
				worker is responsible for taking the necessary action to assure continued
				eligibility on the part of the recipient.
(6) A copy of the Management of Recipient's
				Funds form must be on file in the local office for each recipient for whom
				Title XIX funds are being used for payment of care.
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
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 19 - Nursing Facility Services › Section 317:35-19-29 - Disclosure of information on health care providers and contractors

Current through Vol. 41, No. 20, July 1, 2024
In accordance with the requirements of the Social Security
				  Act and the regulations issued by the Secretary of Health and Human Services,
				  the OHCA is responsible for disclosure of pertinent findings resulting from
				  surveys made to determine eligibility of certain providers for NF under
				  Medicaid. In Oklahoma, the State Department of Health is the agency responsible
				  for surveying NF to obtain information for use by the Federal Government in
				  determining whether these facilities meet the standards required for
				  participation as Medicare and Medicaid providers.
(1) Following its survey of each facility,
				the State Department of Health sends a copy of pertinent materials, showing its
				findings, to the Oklahoma Health Care Authority, Contract Services/Service
				Contract Operations, who forwards pertinent materials to the DHS county office
				in the county where such facility is located.
(2) Each county office is responsible for
				permitting anyone, who requests permission to do so, to inspect and/or copy
				such findings, if this is done within the county office. Such request to see
				these materials may be specifically related to one provider or may be a request
				to see the available survey materials on all providers. The requests need not
				be made in writing and the person making the request need sign no document in
				order to obtain access to the materials. No one can be given permission to take
				any of these materials from the county office.
(3) These materials are to be filed in an
				administrative file. Only the material requested by the individual is made
				available to him/her. The county director is responsible for devising a plan
				for assuring that all such survey material made available to an individual is
				returned by him/her before he/she leaves the office.
(4) When a new survey report is received on a
				facility, the former survey report on that facility is to be destroyed. A
				permanent file of survey reports is maintained in the OHCA.
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 17 Ok Reg 2410, eff 6-26-00
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 19 - Nursing Facility Services › Section 317:35-19-30 - Referral for social services

Current through Vol. 41, No. 20, July 1, 2024
In many situations, social services are needed by adults who
				  are receiving medical services through Medicaid. The LTC nurse may make
				  referrals for social services to the social worker in the local office by use
				  of Form K-13, Information/Referral Social Services. In addition to these
				  referrals, a request for social services may be initiated by a client or by
				  another individual acting upon behalf of a client.
(1) The social worker is responsible for
				providing the indicated services or for referral to the appropriate resource
				outside the DHS if the services are not available within the DHS.
(2) Among the services provided by the social
				worker are:
(A) Services which will enable
				individuals to attain and/or maintain as good physical and mental health as
				possible;
(B) Services to assist
				patients who are receiving care outside their own homes in planning for and
				returning to their own homes or to other alternate care;
(C) Services to encourage the development and
				maintenance of family and community interest and ties;
(D) Services to promote maximum independence
				in the management of their own affairs;
(E) Protective services, including evaluation
				of need for and arranging for guardianship; and
(F) Appropriate family planning services
				which include assisting the family in acquiring means to responsible
				parenthood. Services are offered in making the necessary referral and
				follow-up.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 21 - Oklahoma Cares Breast and Cervical Cancer Treatment Program › Section 317:35-21-1 - Oklahoma Cares Breast and Cervical Cancer Treatment (BCC) program

Current through Vol. 41, No. 20, July 1, 2024
(a) The Breast and
				Cervical Cancer Prevention and Treatment Act of 2000 (BCCPTA) allows states to
				provide Medicaid to uninsured women under age sixty-five (65) who are in need
				of treatment for breast and/or cervical cancer. A medical eligibility
				evaluation is performed through the Centers for Disease Control(CDC) and
				Prevention's National Breast and Cervical Cancer Early Detection Program
				(NBCCEDP). If the evaluation determines the woman is in need of treatment for
				breast and/or cervical cancer, including pre-cancerous conditions and early
				stage, recurrent or metastatic cancer the case is forwarded to Oklahoma Health
				Care Authority (OHCA) for final medical eligibility determination.
(b) To receive Breast and Cervical Cancer
				(BCC) Treatment services, the woman must meet all of the following conditions.
(1) The woman must have been screened for BCC
				under the CDC Breast and Cervical Cancer Early Detection Program [see Oklahoma
				Administrative Code (OAC)
				317:35-21-3 ] established under
				Title XV of the Public Health Service Act, and upon screening examination found
				to be in need of treatment, including an abnormal finding that is potentially
				indicative of a cancerous or precancerous condition or found to have an early
				stage, recurrent or metastatic cancer of the breast or cervix. (see OAC
				317:35-21-5 ).
(2) The woman must:
(A) not have creditable insurance coverage
				that covers the treatment of breast or cervical cancer (see OAC
				317:35-21-4 ),
(B) not be eligible for any other
				categorically needy SoonerCare eligibility group,
(C) be under sixty-five (65) years of age,
(D) be a US citizen or qualified
				alien (see OAC
				317:35-5-25 for citizenship/alien
				status and identity verification requirements),
(E) be a resident of Oklahoma,
(F) declare her Social Security
				number,
(G) assign her rights to
				Third Party Liability if she has insurance that is not creditable,
				and
(H) declare her household
				income for the purpose of determining eligibility for services under the
				SoonerCare program.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 21 - Oklahoma Cares Breast and Cervical Cancer Treatment Program › Section 317:35-21-2 - Scope of coverage

Current through Vol. 41, No. 20, July 1, 2024
The Oklahoma Cares Breast and Cervical Treatment program
				  provides the full scope of SoonerCare coverage. Coverage is not limited to
				  treatment of breast and/or cervical cancer.
Added at 22 Ok Reg 409,
				  eff 1-1-05 (emergency); Added at 22 Ok Reg 2528, eff 7-11-05; Amended at 28 Ok
				  Reg 1546, eff 6-25-11
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 21 - Oklahoma Cares Breast and Cervical Cancer Treatment Program › Section 317:35-21-3 - CDC screening

Current through Vol. 41, No. 20, July 1, 2024
(a) To be
				eligible for the BCC program, a woman must be screened under the CDC Breast and
				Cervical Cancer Early Detection Program. A woman is considered screened under
				the CDC program if her screening was provided all or in part by CDC Title XV
				funds, or the service was rendered by a provider funded at least in part by CDC
				Title XV funds, and/or if she is screened by another provider whose screening
				activities are pursuant to CDC Title XV of the Public Health Service
				Act.
(b) Prior to certification of
				the BCC application an OHCA Care Management nurse must review the application
				and clinical data to verify the BCC applicant meets medical eligibility
				criteria for the BCC program.
(c)
				Upon verification by OHCA Care Management, the application is forwarded to the
				eligibility coordinator to verify the BCC applicant was screened by a CDC
				provider and meets criteria for the program as outlined in OAC
				317:35-21-1.
Added at 22 Ok Reg 409,
				  eff 1-1-05 (emergency); Added at 22 Ok Reg 2528, eff 7-11-05; Amended at 28 Ok
				  Reg 1546, eff 6-25-11
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 21 - Oklahoma Cares Breast and Cervical Cancer Treatment Program › Section 317:35-21-4 - Creditable coverage

Current through Vol. 41, No. 20, July 1, 2024
(a) Creditable
				coverage when used in this subchapter means any insurance that pays for medical
				bills incurred for the diagnosis and/or treatment of breast or cervical cancer.
				A woman having any one of the following types of coverage is considered to have
				creditable coverage and would normally be ineligible for the BCC program:
(1) Coverage under a group health plan;
(2) Health insurance coverage,
				i.e., benefits consisting of medical care under any hospital or medical service
				policy or certificate, hospital or medical service plan contract, or health
				maintenance organization contract offered by a health insurance issuer;
(3) Medicare Part A and/or
				B;
(4) SoonerCare;
(5) Armed Forces insurance; and/or
(6) A state health risk pool.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 21 - Oklahoma Cares Breast and Cervical Cancer Treatment Program › Section 317:35-21-5 - In need of treatment

Current through Vol. 41, No. 20, July 1, 2024
In need of treatment, when used in this subchapter, means an
				  abnormal screen determined as a result of a screening for BCC under the CDC BCC
				  Early Detection Program established under Title XV of the Public Health Service
				  Act, indicating pre-cancerous conditions and early stage, recurrent or
				  metastatic cancer. Services include diagnostic services for an abnormal finding
				  that may be necessary to determine the extent and proper course of treatment,
				  as well as definitive cancer treatment itself. Women who are determined to
				  require only routine monitoring services for precancerous breast or cervical
				  condition (e.g., breast examinations, mammograms, pelvic exams and pap smears)
				  are not considered to be "in need of treatment". The American Society for
				  Colposcopy and Cervical Pathology Consensus and National Comprehensive Cancer
				  Network guidelines are used to make the "in need of treatment" determination.
Added at 22 Ok Reg 409,
				  eff 1-1-05 (emergency); Added at 22 Ok Reg 2528, eff 7-11-05; Amended at 28 Ok
				  Reg 1546, eff 6-25-11
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 21 - Oklahoma Cares Breast and Cervical Cancer Treatment Program › Section 317:35-21-6 - Age requirements

Current through Vol. 41, No. 20, July 1, 2024
To be eligible for the BCC program, a woman must be under
				  sixty-five (65) years of age. If a woman turns sixty-five (65) during the
				  certification period, eligibility ends effective the last day of her birth
				  month. The eligibility coordinator assists the woman in determining if
				  eligibility may continue in another SoonerCare category.
Added at 22 Ok Reg 409,
				  eff 1-1-05 (emergency); Added at 22 Ok Reg 2528, eff 7-11-05; Amended at 28 Ok
				  Reg 1546, eff 6-25-11
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 21 - Oklahoma Cares Breast and Cervical Cancer Treatment Program › Section 317:35-21-7 - Citizenship and Residence

Current through Vol. 41, No. 20, July 1, 2024
The requirements for citizenship/alien status and identity
				  verification and residence found at OAC
				  317:35-5-25
				  and
				  317:35-5-26
				  apply to the BCC treatment program.
Added at 22 Ok Reg 409,
				  eff 1-1-05 (emergency); Added at 22 Ok Reg 2528, eff 7-11-05; Amended at 24 Ok
				  Reg 2116, eff 6-25-07
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 21 - Oklahoma Cares Breast and Cervical Cancer Treatment Program › Section 317:35-21-8 - Social security number

Current through Vol. 41, No. 20, July 1, 2024
Federal regulations require a woman furnish her Social
				  Security number at the time of application for the Oklahoma Cares Breast and
				  Cervical Cancer Treatment program.
Added at 22 Ok Reg 409,
				  eff 1-1-05 (emergency); Added at 22 Ok Reg 2528, eff 7-11-05; Amended at 28 Ok
				  Reg 1546, eff 6-25-11
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 21 - Oklahoma Cares Breast and Cervical Cancer Treatment Program › Section 317:35-21-9 - Income

Current through Vol. 41, No. 20, July 1, 2024
(a) There is no
				income limit imposed by State or Federal law for the BCC program. However, the
				CDC Breast and Cervical Cancer Early Detection Program established under Title
				XV of the Public Health Service Act does allow CDC program grantees to set
				maximum income limits.
(b) Income
				limits are established for women receiving BCC program services through
				SoonerCare. The woman is required to declare her household income so that the
				eligibility coordinator may determine if she qualifies for the program or is
				otherwise SoonerCare eligible.
Added at 22 Ok Reg 409,
				  eff 1-1-05 (emergency); Added at 22 Ok Reg 2528, eff 7-11-05; Amended at 28 Ok
				  Reg 1546, eff 6-25-11
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 21 - Oklahoma Cares Breast and Cervical Cancer Treatment Program › Section 317:35-21-10 - Resources

Current through Vol. 41, No. 20, July 1, 2024
There is no resource test for the Breast and Cervical Cancer
				  Treatment program.
Added at 22 Ok Reg 409,
				  eff 1-1-05 (emergency); Added at 22 Ok Reg 2528, eff
				  7-11-05
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 21 - Oklahoma Cares Breast and Cervical Cancer Treatment Program › Section 317:35-21-11 - Certification for BCC

Current through Vol. 41, No. 20, July 1, 2024
(a) In order for a
				woman to receive BCC treatment services, she must first be screened for BCC
				under the CDC Breast and Cervical Cancer Early Detection Program established
				under Title XV of the Public Health Service Act and found to be in need of
				treatment. Once determined to be in need of treatment, the CDC screener
				determines that the woman:
(1) does not have
				creditable health insurance coverage,
(2) is under age sixty-five (65),
(3) is a US citizen or qualified alien (see
				OAC 317:35-5-25 ),
(4) is a self-declared Oklahoma resident,
(5) has provided her social
				security number,
(6) is willing to
				assign medical rights to Third Party Liability, and
(7) has declared all household income.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 21 - Oklahoma Cares Breast and Cervical Cancer Treatment Program › Section 317:35-21-12 - Changes after certification/continued need for treatment

Current through Vol. 41, No. 20, July 1, 2024
(a) A woman found
				to be in need of treatment as the result of an abnormal BCC screen has sixty
				(60) days from the date of the application to complete the initial appointment
				for a diagnostic procedure and an additional sixty (60) days to complete any
				additional diagnostic testing required or to initiate compensable treatment for
				a cancerous or pre-cancerous condition. The exception to the time limit is
				evidence of a lack of appointment availability. Upon completion of the
				diagnostic testing, OHCA is provided a medical report of the findings.
(1) If the woman is found not to have breast
				or cervical cancer including pre-cancerous conditions and early stage,
				recurrent or metastatic cancer for which she is in need of treatment or fails
				to have diagnostic testing or begin treatment within the time frames described
				in OAC 317:35-21-12(a), the case is closed by OHCA and appropriate notification
				is computer generated.
(2) If a
				medical report necessary to determine continued treatment is not received from
				a provider within ten (10) working days after a request is made by OHCA, the
				report is considered negative and the case is closed by OHCA and appropriate
				notification is computer generated.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 21 - Oklahoma Cares Breast and Cervical Cancer Treatment Program › Section 317:35-21-13 - Redetermination

Current through Vol. 41, No. 20, July 1, 2024
A periodic redetermination of eligibility is required every
				  12 months. The computer generated redetermination form is mailed to the woman
				  during her 11th month of eligibility. The woman is responsible for having her
				  SoonerCare provider complete the statement certifying that she continues to be
				  in need of treatment and for providing any other information necessary to
				  redetermine eligibility.
(1) If the
				completed forms are not returned, the case is closed and appropriate notice is
				computer generated.
(2) When the
				completed forms are returned timely and the woman remains eligible for the BCC
				program, the computer is updated to show her continued eligibility.
Added at 22 Ok Reg 409, eff 1-1-05 (emergency) ; Added at
					 22 Ok Reg 2528, eff 7-11-05 ; Amended at 28 Ok Reg 1546, eff 6-25-11 ; Amended
					 at 30 Ok Reg 1209, eff 7-1-13
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 21 - Oklahoma Cares Breast and Cervical Cancer Treatment Program › Section 317:35-21-14 - Appeals and reconsiderations

Current through Vol. 41, No. 20, July 1, 2024
(a)
				Applicants who wish to appeal a denial decision made by the OHCA may submit
				form LD-1 to the OHCA within thirty (30) days of receipt of the decision
				notification. If the form is not received at the OHCA within the required time
				frame, the appeal will not be heard. More information on the appeals process is
				provided at OAC
				317:2-1-2(a).
(b) Reconsiderations to the OHCA may be
				requested by a CDC screener if missing documentation, which could potentially
				result in a determination of eligibility, has been obtained. The missing
				documentation must be presented within thirty (30) days of the date of the
				notice of denial.
Added at 28 Ok Reg 1546,
				  eff 6-25-11
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 22 - Pregnancy Related Benefits Covered Under Title XXI › Section 317:35-22-1 - Pregnancy related benefits covered under Title XXI

Current through Vol. 41, No. 20, July 1, 2024
(a) The revision of the definition of child
				at
				42 CFR
				457.10, allows states to cover pregnancy
				related services under Title XXI, individuals who would not otherwise qualify
				for services under SoonerCare. This coverage is intended to benefit newborn
				children who are Oklahoma residents at birth.
(b) To receive pregnancy related services
				under Title XXI, the pregnant woman must:
(1)
				be otherwise ineligible for any other categorically SoonerCare eligibility
				group;
(2) reside in Oklahoma with
				the intent to remain, at the time services are rendered;
(3) have household income at or below 185%
				FPL; and
(4) not be covered by
				creditable insurance, the term creditable insurance means coverage under a
				group health plan or other health insurance as defined in the Health Insurance
				Portability and Accountability Act (HIPAA).
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 22 - Pregnancy Related Benefits Covered Under Title XXI › Section 317:35-22-2 - Scope of coverage for Title XXI Pregnancy

Current through Vol. 41, No. 20, July 1, 2024
(a) Pregnancy related services provided are
				prenatal, delivery, postnatal care when included in the global delivery fee,
				and other related services that are medically necessary to optimize pregnancy
				outcomes within the defined program benefits.
(b) Medical visits for other related services
				to evaluate and/or treat conditions that may adversely impact the pregnancy are
				covered. All visits shall require medical review to deem whether the medical
				visit is within the scope of coverage.
Added at 25 Ok Reg 430,
				  eff 1-1-08 (emergency); Added at 25 Ok Reg 1227, eff
				  5-25-08
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 22 - Pregnancy Related Benefits Covered Under Title XXI › Section 317:35-22-2.1 - Non-covered services

Current through Vol. 41, No. 20, July 1, 2024
Services and benefits provided to evaluate and/or treat
				  maternal conditions that are not related to or impact the pregnancy
				  outcome.
Added at 25 Ok Reg 430,
				  eff 1-1-08 (emergency); Added at 25 Ok Reg 1227, eff
				  5-25-08
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 22 - Pregnancy Related Benefits Covered Under Title XXI › Section 317:35-22-3 - Need for pregnancy related services for the unborn child

Current through Vol. 41, No. 20, July 1, 2024
The woman must be pregnant and not eligible under OAC
				  317:35-5-6.
Added at 25 Ok Reg 430,
				  eff 1-1-08 (emergency); Added at 25 Ok Reg 1227, eff
				  5-25-08
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 22 - Pregnancy Related Benefits Covered Under Title XXI › Section 317:35-22-4 - Citizenship

Current through Vol. 41, No. 20, July 1, 2024
Citizenship is not a factor of eligibility for the pregnant
				  individual. However, as this coverage is intended to benefit the newborn child
				  who will be a U.S. citizens at birth, the pregnant individual will not qualify
				  for this coverage if she intends to leave Oklahoma before the child is
				  born.
Added at 25 Ok Reg 430,
				  eff 1-1-08 (emergency); Added at 25 Ok Reg 1227, eff
				  5-25-08
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 22 - Pregnancy Related Benefits Covered Under Title XXI › Section 317:35-22-5 - Social Security number

Current through Vol. 41, No. 20, July 1, 2024
Social Security Number and Alienage is not a factor of
				  eligibility for pregnant individuals who are covered under this
				  program.
Added at 25 Ok Reg 430,
				  eff 1-1-08 (emergency); Added at 25 Ok Reg 1227, eff
				  5-25-08
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 22 - Pregnancy Related Benefits Covered Under Title XXI › Section 317:35-22-6 - Income

Current through Vol. 41, No. 20, July 1, 2024
Income is determined in accordance with OAC 317:35-10 for
				  individuals categorically related to pregnancy related benefits covered under
				  Title XXI.
Added at 25 Ok Reg 430,
				  eff 1-1-08 (emergency); Added at 25 Ok Reg 1227, eff
				  5-25-08
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 22 - Pregnancy Related Benefits Covered Under Title XXI › Section 317:35-22-7 - Resources

Current through Vol. 41, No. 20, July 1, 2024
There is no resource test for pregnancy related services
				  covered under Title XXI.
Added at 25 Ok Reg 430,
				  eff 1-1-08 (emergency); Added at 25 Ok Reg 1227, eff
				  5-25-08
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 22 - Pregnancy Related Benefits Covered Under Title XXI › Section 317:35-22-8 - Period of eligibility

Current through Vol. 41, No. 20, July 1, 2024
The individual who is covered for pregnancy related benefits
				  under Title XXI retains eligibility for the prenatal period and delivery of the
				  child. Eligibility is terminated at the end of the month of the delivery or
				  upon termination of the pregnancy.
Added at 25 Ok Reg 430,
				  eff 1-1-08 (emergency); Added at 25 Ok Reg 1227, eff
				  5-25-08
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 22 - Pregnancy Related Benefits Covered Under Title XXI › Section 317:35-22-9 - Notification of eligibility

Current through Vol. 41, No. 20, July 1, 2024
When eligibility for the pregnancy benefits covered under
				  Title XXI is established, the appropriate notice is computer generated to the
				  member.
Added at 25 Ok Reg 430,
				  eff 1-1-08 (emergency); Added at 25 Ok Reg 1227, eff 5-25-08; Amended at 26 Ok
				  Reg 2150, eff 6-25-09; Amended at 27 Ok Reg 711, eff 2-4-10 (emergency);
				  Amended at 27 Ok Reg 1471, eff 6-11-10
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 22 - Pregnancy Related Benefits Covered Under Title XXI › Section 317:35-22-10 - Denials

Current through Vol. 41, No. 20, July 1, 2024
If denied the computer input form is updated and the
				  appropriate notice is computer generated to the applicant.
Added at 25 Ok Reg 430,
				  eff 1-1-08 (emergency); Added at 25 Ok Reg 1227, eff 5-25-08; Amended at 26 Ok
				  Reg 2150, eff 6-25-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 22 - Pregnancy Related Benefits Covered Under Title XXI › Section 317:35-22-11 - Closures

Current through Vol. 41, No. 20, July 1, 2024
SoonerCare cases are closed at any time during the
				  certification period that the member becomes ineligible. A computer-generated
				  notice is sent to the member.
Added at 25 Ok Reg 430,
				  eff 1-1-08 (emergency); Added at 25 Ok Reg 1227, eff 5-25-08; Amended at 26 Ok
				  Reg 2150, eff 6-25-09; Amended at 27 Ok Reg 711, eff 2-4-10 (emergency);
				  Amended at 27 Ok Reg 1471, eff 6-11-10
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 23 - Living Choice Program › Section 317:35-23-1 - Living Choice program

Current through Vol. 41, No. 20, July 1, 2024
The Living Choice program is created to promote community
				  living for members with disabilities or long-term illnesses and is authorized
				  by Section
				  6071 of
				  Public Law
				  109-171, the Deficit Reduction Act of
				  2005.
Added at 26 Ok Reg 266,
				  eff 12-1-08 (emergency); Added at 26 Ok Reg 1076, eff
				  5-11-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 23 - Living Choice Program › Section 317:35-23-2 - Eligibility criteria

Current through Vol. 41, No. 20, July 1, 2024
Adults with disabilities or long-term illnesses, members with
				  intellectual disabilities and members with physical disabilities are eligible
				  to transition into the community through the Living Choice program if they meet
				  all of the criteria in paragraphs (1) through (7) of this subsection.
(1) He/she must be at least nineteen (19)
				years of age.
(2) He/she must
				reside in a nursing facility, skilled nursing facility, qualified long term
				care facility, or a public or private Intermediate Care Facility for
				Individuals with Intellectual Disabilities (ICF/IID) for at least sixty (60)
				consecutive days prior to the proposed transition date.
(3) He/she must have at least one (1) day of
				Medicaid paid long-term care services prior to transition.
(4) If transitioning from an out of state
				institution, he/she must be SoonerCare eligible.
(5) He/she requires at least the same level
				of care that necessitated admission to the institution.
(6) He/she must reside in a qualified
				residence after leaving the institution. A qualified residence is defined in
				(A) through (C) of this paragraph.
(A) a home
				owned or leased by the individual or the individual's family member;
(B) an apartment with an individual lease,
				with a locking entrance/exit, and which includes living, sleeping, bathing, and
				cooking areas over which the individual or the individual's family has domain
				and control; and
(C) a residence,
				in a community-based residential setting, in which no more than four (4)
				unrelated individuals reside.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 23 - Living Choice Program › Section 317:35-23-2 - Eligibility criteria

Current through Vol. 41, No. 20, July 1, 2024
Adults with disabilities or long-term illnesses, members
				  with intellectual disabilities and members with physical disabilities are
				  eligible to transition into the community through the Living Choice program if
				  they meet all of the criteria in paragraphs (1) through (7) of this
				  subsection.
(1) He/she must be at
				least nineteen (19) years of age.
(2) He/she must reside in a nursing facility
				or a qualified long term care facility, or a public or private Intermediate
				Care Facility for Individuals with Intellectual Disabilities (ICF/IID) for at
				least sixty (60) consecutive days prior to the proposed transition date. If any
				portion of the sixty (60) days includes time in a skilled nursing facility,
				those days cannot be counted toward the sixty (60) day requirement, if the
				member received Medicare post-hospital extended care rehabilitative
				services.
(3) He/she must have at
				least one (1) day of Medicaid paid long-term care services prior to
				transition.
(4) If transitioning
				from an out of state institution, he/she must be SoonerCare eligible.
(5) He/she requires at least the same level
				of care that necessitated admission to the institution.
(6) He/she must reside in a qualified
				residence after leaving the institution. A qualified residence is defined in
				(A) through (C) of this paragraph.
(A) a home
				owned or leased by the individual or the individual's family member;
(B) an apartment with an individual lease,
				with a locking entrance/exit, and which includes living, sleeping, bathing, and
				cooking areas over which the individual or the individual's family has domain
				and control; and
(C) a residence,
				in a community-based residential setting, in which no more than four (4)
				unrelated individuals reside.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 23 - Living Choice Program › Section 317:35-23-3 - Participant disenrollment

Current through Vol. 41, No. 20, July 1, 2024
(a) A
				member is disenrolled from the program if he/she:
(1) is admitted to a hospital, nursing
				facility, ICF/IID, residential care facility or behavioral health facility for
				more than thirty (30) consecutive days;
(2) is incarcerated;
(3) is determined to no longer meet
				SoonerCare financial eligibility for home and community based
				services;
(4) determined by the
				Social Security Administration or OHCA Level of Care Evaluation Unit to no
				longer have a disability that qualifies for services under the Living Choice
				program; or
(5) moves out of
				state.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 23 - Living Choice Program › Section 317:35-23-4 - Re-enrollment

Current through Vol. 41, No. 20, July 1, 2024
(a)
Members
				in the Living Choice Program
(1) The
				member remains eligible during periods of institutionalization as long as the
				stay does not exceed 30 days.
(2) A
				member with an institutional stay longer than 30 days may re-enroll in the
				program without re-establishing the 90 day institutional residency requirement
				if:
(A) the necessity for the
				institutionalization is documented in the revised individual transition plan;
				and
(B) the member can safely
				return to the community as determined by the transition coordinator, the member
				and the transition planning team.
(3) The re-enrolled member is eligible to
				receive services for any remaining days up to the 365 day limit.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 40 - Developmental Disabilities Services › Subchapter 1 - General Provisions › Section 317:40-1-1 - Home and Community-Based Services (HCBS) Waivers for persons with intellectual disabilities or certain persons with related conditions

Current through Vol. 41, No. 20, July 1, 2024
(a)
Applicability.
This Section applies to services funded through
				Medicaid HCBS Waivers per Oklahoma Administrative Code (OAC)
				317:35-9-5
				and Section 1915(c) of the Social Security Act. Specific Waivers are the
				In-Home Supports Waiver (IHSW) for Adults, IHSW for Children, Community Waiver,
				and Homeward Bound Waiver.
(b)
Program provisions.
Each individual requesting services provided
				through an HCBS Waiver and his or her family or guardian, are responsible for:
(1) Accessing withthe Oklahoma Department of
				Human Services (OKDHS) staff assistance, all benefits available under
				Oklahoma's Medicaid State Plan or other payment sources prior to accessing
				funding for those same services under an HCBS Waiver program;
(2) Cooperating in the determination of
				medical and financial eligibility including prompt reporting of changes in
				income or resources;
(3) Choosing
				between services provided through an HCBS Waiver or institutional care; and
(4) Reporting any changes in
				address or other contact information to OKDHS within thirty (30) calendar days.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 40 - Developmental Disabilities Services › Subchapter 1 - General Provisions › Section 317:40-1-2 - Authorization for Residential Supports in the Community Waiver

Current through Vol. 41, No. 20, July 1, 2024
(a)
Applicability.
The rules in this Section apply to services
				provided through the Community Waiver, specifically:
(1) those services identified in OAC
				340:100-5-22.1,
				Community Residential Supports; and
(2) group home services.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 40 - Developmental Disabilities Services › Subchapter 1 - General Provisions › Section 317:40-1-3 - Requirements for Home and Community-Based Settings

Current through Vol. 41, No. 20, July 1, 2024
(a) The Oklahoma Department of Human Services
				Developmental Disabilities Services Home and Community-Based Services (HCBS)
				Waiver settings have the following qualities defined in federal regulation per
				Section 441.301(c)(4) of Title 42 of the Code of Federal Regulations [
				42 CFR §
										441.301(c)(4) ] based on the
				needs of the individual defined in his or her Individual Plan (Plan).
(1) The setting is integrated and supports
				full access of individuals receiving HCBS Waivers to the greater community,
				including opportunities to:
(A) seek
				employment and work in competitive, integrated settings;
(B) engage in community life;
(C) control personal resources; and
(D) receive services in the community, to the
				same degree as individuals not receiving Medicaid HBCS Waiver
				Services.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 40 - Developmental Disabilities Services › Subchapter 1 - General Provisions › Section 317:40-1-4 - Remote support (RS)

Current through Vol. 41, No. 20, July 1, 2024
(a)
General
				Information.
RS services are intended to promote a member's
				independence. RS services are provided in the member's home, family home, or
				employment site to reduce reliance on in person support while ensuring the
				member's health and safety. RS services are included in the member's Individual
				Plan (Plan) and arrangements for this service are made through the case
				manager. Authorization to provide RS must be obtained from the Developmental
				Disabilities Services (DDS) division director or designee.
(1) RS services are:
(A) Based on the member's needs as documented
				and supported by the Plan and Person-Centered Assessment;
(B) The least-restrictive option and the
				member's preferred method to meet an assessed need;
(C) Provided when all adult members of the
				household; his or her guardians, when applicable; and Personal Support Team
				(Team) agree to the provision of RS services as documented in the Plan;
				and
(D) Reviewed by the Team after
				sixty (60) calendar days of initial installation to determine continued
				appropriateness and approval of services.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 40 - Developmental Disabilities Services › Subchapter 5 - Member Services › Part 1 - AGENCY COMPANION SERVICES › Section 317:40-5-1 - Purpose of Agency Companion Services [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg
					 605, eff 9-8-95 (emergency); Added at 13 Ok Reg 1679, eff 5-27-96; Amended at
					 15 Ok Reg 3855, eff 7-1-98 (emergency); Amended at 16 Ok Reg 1445, eff 5-27-99;
					 Amended at 22 Ok Reg 2531, eff 7-11-05; Revoked at 26 Ok Reg 2151, eff
					 6-25-09
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 40 - Developmental Disabilities Services › Subchapter 5 - Member Services › Part 1 - AGENCY COMPANION SERVICES › Section 317:40-5-2 - Guidelines to staff [EXPIRED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg
					 605, eff 9-8-95 through 5-26-96
					 (emergency)1
1This emergency rule was
					 superseded on 5-27-96 by 18 permanent rules numbered at 317:40-5-3 through
					 317:40-5-15 and 317:40-5-35 through
					 317:40-5-39.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 40 - Developmental Disabilities Services › Subchapter 5 - Member Services › Part 1 - AGENCY COMPANION SERVICES › Section 317:40-5-3 - Agency companion services (ACS)

Current through Vol. 41, No. 20, July 1, 2024
(a) ACS are:
(1) Provided by agencies that have a provider
				  agreement with the Oklahoma Health Care Authority;
(2) Provider Agency independent contractors
				  and provide a shared living arrangement developed to meet the member's specific
				  needs that include supervision, supportive assistance, and training in daily
				  living skills, and integrates the member into the shared experiences of a
				  family in a home owned or rented by the companion;
(3) Available to members eighteen (18) years
				  of age or older who are eligible for services through Community or Homeward
				  Bound Waivers. Persons under eighteen (18) years of age may be served with
				  approval from Oklahoma Human Services (OKDHS) Developmental Disabilities
				  Services (DDS) director or designee; and
(4) Based on the member's need for
				  residential services, per Oklahoma Administrative Code (OAC)
				  340:100-5-22, and support as
				  described in the member's Individual Plan (Plan), per OAC
				  340:100-5-50 through
				  340:100-5-58.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 40 - Developmental Disabilities Services › Subchapter 5 - Member Services › Part 1 - AGENCY COMPANION SERVICES › Section 317:40-5-4

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg
					 1679, eff 5-27-96; Amended at 15 Ok Reg 3837, eff 7-1-98 (emergency); Amended
					 at 16 Ok Reg 1445, eff 5-27-99; Amended at 22 Ok Reg 2531, eff
					 7-11-05
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 40 - Developmental Disabilities Services › Subchapter 5 - Member Services › Part 1 - AGENCY COMPANION SERVICES › Section 317:40-5-5 - Agency companion services (ACS) provider requirements and responsibilities

Current through Vol. 41, No. 20, July 1, 2024
(a)
				  The member or legal guardian, the provider agency, or Oklahoma Human Services
				  (OKDHS) Developmental Disabilities Services (DDS) case manager may identify an
				  applicant to be screened for approval to serve as a companion.
(b) DDS approval for a person to provide
				  contracted Agency Companion Services (ACS) requires the applicant to:
(1) Be twenty-one (21) years of age or
				  older;
(2) Attend DDS or provider
				  agency ACS orientation;
(3)
				  Contract with a provider agency that has a current contract with Oklahoma
				  Health Care Authority (OHCA) to provide ACS;
(4) Complete the DDS application packet
				  within the required time period, per Oklahoma Administrative Code (OAC)
				  317:40-5-40,
				  and to submit the packet to designated DDS staff or the provider agency
				  staff;
(5) Cooperate with
				  designated DDS or provider agency staff in the development and completion of
				  the home profile approval process, per OAC
				  317:40-5-40;
				  and
(6) Complete all training per
				  OAC
				  340:100-3-38,
				  including medication administration training, and all provider agency
				  pre-employment training, per OAC
				  317:40-5-40.
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 40 - Developmental Disabilities Services › Subchapter 5 - Member Services › Part 1 - AGENCY COMPANION SERVICES › Section 317:40-5-6 - Agency Companion contractor requirements [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg
					 1679, eff 5-27-96; Amended at 15 Ok Reg 3837, eff 7-1-98 (emergency); Amended
					 at 16 Ok Reg 1445, eff 5-27-99; Amended at 22 Ok Reg 2531, eff
					 7-11-05
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 40 - Developmental Disabilities Services › Subchapter 5 - Member Services › Part 1 - AGENCY COMPANION SERVICES › Section 317:40-5-7 - Process for approval or disapproval of Agency Companion Services applicants [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg
					 1679, eff 5-27-96; Amended at 15 Ok Reg 3837, eff 7-1-98 (emergency); Amended
					 at 16 Ok Reg 1445, eff 5-27-99; Revoked at 22 Ok Reg 2531, eff
					 7-11-05
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 40 - Developmental Disabilities Services › Subchapter 5 - Member Services › Part 1 - AGENCY COMPANION SERVICES › Section 317:40-5-8 - Agency companion services service authorization budget [REVOKED]

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg
					 1679, eff 5-27-96; Amended at 15 Ok Reg 3855, eff 6-24-98 (emergency); Amended
					 at 16 Ok Reg 1445, eff 5-27-99; Amended at 22 Ok Reg 2531, eff 7-11-05; Amended
					 at 25 Ok Reg 2767, eff 6-1-08 (emergency); Amended at 26 Ok Reg 1077, eff
					 5-11-09; Amended at 27 Ok Reg 1509, eff 6-11-10; Amended at 28 Ok Reg 1550, eff
					 6-25-11; Revoked at 29 Ok Reg 1199, eff 6-25-12
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 40 - Developmental Disabilities Services › Subchapter 5 - Member Services › Part 1 - AGENCY COMPANION SERVICES › Section 317:40-5-9

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg
					 1679, eff 5-27-96; Amended at 15 Ok Reg 3837, eff 7-1-98 (emergency); Amended
					 at 16 Ok Reg 1445, eff 5-27-99; Amended at 22 Ok Reg 2531, eff 7-11-05; Amended
					 at 29 Ok Reg 1199, eff 6-25-12
Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 40 - Developmental Disabilities Services › Subchapter 5 - Member Services › Part 1 - AGENCY COMPANION SERVICES › Section 317:40-5-10

Current through Vol. 41, No. 20, July 1, 2024
Added at 13 Ok Reg
					 1679, eff 5-27-96; Amended at 15 Ok Reg 3837, eff 7-1-98 (emergency); Amended
					 at 16 Ok Reg 1445, eff 5-27-99; Amended at 22 Ok Reg 2531, eff
					 7-11-05