SECTION 317:30-3-40. Home and Community-Based Services Waivers (HCBS) for persons with intellectual disabilities or certain persons with related conditions

(a)   Introduction to HCBS waivers for persons with intellectual disabilities. The Medicaid HCBS waiver programs are authorized per Section 1915(c) of the Social Security Act.

(1)   Oklahoma Department of Human Services Developmental Disabilities Services Division (DDS) operates HCBS waiver programs for persons with intellectual disabilities and certain persons with related conditions. The Oklahoma Health Care Authority (OHCA), is the State's Medicaid agency, retains and exercises administrative authority over all HCBS waiver programs.

(2)   Each waiver allows for the provision of specific SoonerCare-compensable services that assist members to reside in the community and avoid institutionalization.

(3)   HCBS waiver services:

(A)   complement and supplement services available to members through the Medicaid State Plan or other federal, state, or local public programs, as well as informal supports provided by families and communities;

(B)   are only provided to persons who are Medicaid eligible, outside of a nursing facility, hospital, or institution;

(C)   are not intended to replace other services and supports available to members; and

(D)   are authorized based solely on current need.

(4)   HCBS waiver services must be:

(A)   appropriate to the member's needs; and

(B)   included in the member's Individual Plan (IP).

(i)   The IP:

(I)   is developed annually by the member's Personal Support Team, per Oklahoma Administrative Code (OAC) 340:100-5-52; and

(II)   contains detailed descriptions of services provided, documentation of amount and frequency of services, and types of providers to provide services.

(ii)   Services are authorized, per OAC 340:100-3-33 and 340:100-3-33.1.

(5)   DDS furnishes case management, targeted case management, and services to members as a Medicaid State Plan services, per Section 1915(g)(1) of the Social Security Act and per OAC 317:30-5-1010 through 317:30-5-1012.

(b)   Eligible providers. All providers must have entered into contractual agreements with OHCA to provide HCBS for persons with an intellectual disability or related conditions.

(1)   All providers, except pharmacy, specialized medical supplies and durable medical equipment providers must be reviewed by DHS DDS. The review process verifies that:

(A)   the provider meets the licensure, certification or other standards specified in the approved HCBS waiver documents; and

(B)   organizations that do not require licensure wanting to provide HCBS services meet program standards, are financially stable and use sound business management practices.

(2)   Providers who do not meet program standards in the review process are not approved for a provider agreement.

(3)   Provider agreements with providers that fail to meet programmatic or financial requirements may not be renewed.

(c)   Coverage. All services must be included in the member's IP and arranged by the member's case manager.

[Source: Added at 12 Ok Reg 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff 7-27-95; Amended at 22 Ok Reg 1007, eff 2-1-05 (emergency); Amended at 21 Ok Reg 2460, eff 7-11-05; Amended at 24 Ok Reg 879, eff 5-11-07; Amended at 27 Ok Reg 1429, eff 6-11-10; Amended at 28 Ok Reg 1401, eff 6-25-11; Amended at 29 Ok Reg 1076, eff 6-25-12; Amended at 36 Ok Reg 879, eff 9-1-19]