Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 35 - Medical Assistance for Adults and Children-Eligibility › Subchapter 19 - Nursing Facility Services › Section 317:35-19-31 - Special procedures for release of adults in mental health hospitals to Nursing Facilities

Current through Vol. 41, No. 20, July 1, 2024
(a)
Procedures.
Adult patients in state mental health hospitals being
				considered for release to nursing facilities due to their physical conditions
				may be predetermined eligible for Medicaid.
(b)
Responsibility of mental
				hospitals.
The mental health hospital social and reimbursement staff
				works with the Social Security Administration to secure the approval for
				Supplemental Security Income (SSI) for individuals not currently eligible who
				may qualify for SSI. They will also assist the patient with the application for
				Medicaid medical services. By forwarding the completed Medical Assistance
				Application form and the Capital Resources Information form to the county
				office, the determination of financial eligibility by the DHS county social
				worker can proceed at the same time that SSA is determining SSI eligibility. If
				the individual has other income (Social Security, VA, etc.) and does not
				qualify for SSI, the mental health hospital social and reimbursement staff
				evaluates the known resources. If the resources do not exceed the maximum as
				shown on DHS Appendix C-1, Schedule VIII. D., individuals may be referred for a
				decision of eligibility for care in a nursing facility and, if necessary,
				categorical relationship. If the individual appears to meet the requirements as
				set out in this Subchapter, the mental health hospital social and reimbursement
				staff will submit a copy of the admitting history and physical progress notes,
				psychiatric examination and a physician's recommendation for a specific level
				of care, based on the individual's physical condition, to the Department of
				Mental Health and Substance Abuse Services, Central Office, Long-Term Care
				Division for review. If release to an NF appears appropriate, the medical
				information is submitted to LOCEU at the same time that the application forms
				are submitted to the county.
(c)
Responsibility of LOCEU.
The LOCEU reviews the hospital records,
				the social summary, the physician's recommendation for level of care as well as
				categorical relationship, if necessary. A Level II PASRR screen is initiated by
				LOCEU at this point, if indicated. The MEDATS file is updated advising the DHS
				county office of LOCEU decision.
(d)
Responsibility of county
				office.
The county office (in the county where the hospital is located)
				has the responsibility for the case number assignment, placing the case in
				application status and the subsequent determination of financial eligibility.
				The case is not certified until the patient enters an approved nursing
				facility.
(1) Once the patient is determined
				financially and medically eligible a letter (including the assigned case
				number) is sent to the Department of Mental Health and Substance Abuse
				Services, Central Office, Long-Term Care Division.
(2) If the patient is determined to be
				ineligible, the denial is teleprocessed and a computer generated notice sent to
				the client or responsible person.