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 1 - SERVICES › Section 317:35-9-5 - 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) Home and
				  Community Based Services (HCBS) Waivers for persons with intellectual
				  disabilities or certain persons with related conditions are operated by the
				  Oklahoma Department of Human Services (OKDHS) Developmental Disabilities
				  Services Division (DDSD) per OAC
				  317:40-1-1.
				  Oklahoma's Medicaid agency, the Oklahoma Health Care Authority (OHCA), provides
				  oversight of Waiver operation. HCBS Waivers allow the OHCA to offer certain
				  home and community based services to categorically needy members who, without
				  such services, would be eligible for care in an Intermediate Care Facility for
				  persons with Mental Retardation (ICF/MR).
(b) Members receiving HCBS Waiver services
				  per OAC
				  317:40-1-1
				  are subject to HCBS Waiver service conditions (1)-(11) of this subsection. The
				  rules in this subsection shall not be construed as a limitation of the rights
				  of class members set forth in the Second Amended Permanent Injunction in
				  Homeward Bound vs. The Hissom Memorial Center.
(1) HCBS Waiver services are subject to
				  annual appropriations by the Oklahoma Legislature.
(2) DDSD must limit the utilization of the
				  HCBS Waiver services based on:
(A) the
				  federally-approved member capacity for the individual HCBS Waivers;
				  and
(B) the cost effectiveness of
				  the individual HCBS Waivers as determined according to federal requirements;
				  and
(3) DDSD must limit
				  enrollment when utilization of services under the HCBS Waiver programs is
				  projected to exceed the spending authority.
(4) Members receiving Waiver services must
				  have full access to State plan services for which they are eligible including
				  Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services when
				  children participate in a Waiver.
(5) A member's room and board expenses may
				  not be paid through a Waiver. Room and board expenses must be met from member
				  resources or through other sources.
(6) A member must require at least one Waiver
				  service per month or monthly case management monitoring in order to function in
				  the community.
(7) Waiver services
				  required by a member must be documented in advance of service delivery in a
				  written plan of care.
(8) Members
				  exercise freedom of choice by choosing Waiver services instead of institutional
				  services.
(9) Members have the
				  right to freely select from among any willing and qualified provider of Waiver
				  services.
(10) The average costs of
				  providing Waiver and non-Waiver SoonerCare services must be no more costly than
				  the average costs of furnishing institutional (and other SoonerCare state plan)
				  services to persons who require the same level of care.
(11) Members approved for services provided
				  in a specific Waiver must be afforded access to all necessary services offered
				  in the specific Waiver if the member requires the service.