SECTION 317:30-5-1010. Eligible providers

(a)   Eligible providers. Services are provided by Oklahoma Department of Human Services (OKDHS) Developmental Disabilities Services Division (DDSD) case managers.

(1)   Certification requirements. SoonerCare Developmental Disabilities Services Division Targeted Case Management (DDSDTCM) services must be made available to all eligible members and must be delivered on a statewide basis with procedures that assure 24 hour availability, the protection and safety of members, continuity of services without duplication, and compliance with federal and State mandates and regulations related to servicing the targeted population are met in a uniform and consistent manner. A DDSDTCM case manager must:

(A)   be employed by the OKDHS, DDSD.

(B)   possess knowledge of:

(i)   case management methods, principles and techniques;

(ii)   types of developmental disabilities represented within the caseload;

(iii)   types of providers and services available for members;

(iv)   the behavioral sciences and allied disciplines involved in the evaluation, care and training of persons with developmental disabilities;

(v)   interviewing principles and techniques;

(vi)   counseling principles and techniques; and

(vii)   adaptive communication techniques and non-verbal communication.

(C)   possess skill in:

(i)   managing a caseload;

(ii)   effectively intervening in crisis situations;

(iii)   working cooperatively and effectively with other professionals in a team situation;

(iv)   collecting and analyzing information;

(v)   making decisions relating to services provided to members;

(vi)   developing a logical and practical plan of treatment for members with developmental disabilities;

(vii)   evaluating the progress of members and the quality of their habilitation programs;

(viii)   communicating effectively; and

(ix)   mediating with providers and agencies to resolve problems.

(b)   Provider agreement. A Provider Agreement between the Oklahoma Health Care Authority and the provider for DDSDTCM services must be in effect before reimbursement can be made for compensable services.

(c)   Provider selection. Target group consists of eligible members with developmental disabilities. Providers are limited to providers of case management services capable of ensuring that members with developmental disabilities receive needed services.

[Source: Added at 14 Ok Reg 3704, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff 5-11-98; Amended at 26 Ok Reg 2114, eff 6-25-09]