SECTION 317:30-5-1011. Coverage by category

  Payment is made for targeted case management service as set forth in this Section.

(1)   Adults. Payment is made for services to persons with an intellectual disability and/or related conditions as follows:

(A)   The target group for Developmental Disabilities Services Division Targeted Case Management (DDSDTCM) services are Medicaid eligible individuals:

(i)   served by the Home and Community Based Waivers operated by the Department of Human Services/Developmental Disabilities Services Division (DHS/DDSD); or

(ii)   residing in institutions who:

(I)   have requested Home and Community Based Waiver services operated by DHS/DDSD, and

(II)   receive targeted case management services during a transition period not to exceed 180 consecutive days immediately prior to entering the Waiver; or

(iii)   who are being assessed for admission to the Home and Community Based Waiver operated by DHS/DDSD.

(B)   Targeted case management services may be provided when the client, the client's family as appropriate, the client's legal representative and case manager have worked together to achieve a plan.

(2)   Children. Services for children are the same as for adults.

(3)   Individuals eligible for Part B of Medicare. Case Management Services provided to Medicare eligible recipients are filed directly with the fiscal agent.

[Source: Added at 14 Ok Reg 3704, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff 5-11-98; Amended at 18 Ok Reg 968, eff 3-21-01 (emergency); Amended at 19 Ok Reg 1067, eff 5-13-02; Amended at 29 Ok Reg 1076, eff 6-25-12]