SECTION 317:35-17-1. Overview of long-term medical care services; relationship to Qualified Medicare Beneficiary Plus (QMBP), Specified Low-Income Medicare Beneficiary (SLMB), and other Medicaid (SoonerCare) services eligibility

(a)   Long-term medical care for the categorically needy includes:

(1)   Care in a long-term care facility per Oklahoma Administrative Code (OAC) 317:35-19;

(2)   Care in a public or private intermediate care facility for the intellectually disabled (ICF/IID), per OAC 317:35-9;

(3)   Care of persons sixty-five (65) years of age and older in mental health hospitals, per OAC 317:35-9;

(4)   Home and Community-Based waiver services for persons with intellectual disabilities, per OAC 317:35-9;

(5)   Personal Care services, per OAC 317:35-15; and

(6)   Home and Community-Based waiver services (ADvantage waiver) for frail elderly,sixty-five (65) years of age and older; and a targeted group of adults with physical disabilities,twenty-one (21) to sixty-four (64) years of age and older, who do not have an intellectual disability or a cognitive impairment related to a developmental disability per OAC 317:35-17-3.

(b)   When an individual is certified as eligible for SoonerCare coverage of long-term care, he or she is also eligible for other SoonerCare services. ADvantage waiver members do not have a copayment for ADvantage services except for prescription drugs. For members residing in an ADvantage assisted living center, any income beyond one-hundred and fifty percent (150%) of the federal benefit rate is available to defray the cost of the assisted living services received. The member is responsible for payment to the assisted living services center provider for days of service, from the first day of each full-month in which services were received, until the vendor pay obligation is met. When an individual is aged, blind, or disabled and is determined eligible for long-term care, a separate eligibility determination must be made for QMBP or SLMB benefits. An ADvantage program member may reside in a licensed assisted living services center only when the assisted living services center is a certified ADvantage assisted living services center provider from whom the member is receiving ADvantage assisted living services.

[Source: Added at 12 Ok Reg 753, eff 1-6-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3133, eff 7-27-95; Amended at 14 Ok Reg 56, eff 4-30-96 (emergency); Amended at 14 Ok Reg 1802, eff 5-27-97; Amended at 15 Ok Reg 3715, eff 5-18-98 (emergency); Amended at 16 Ok Reg 1438, eff 5-27-99; Amended at 17 Ok Reg 2410, eff 6-26-00; Amended at 18 Ok Reg 277, eff 11-21-00 (emergency); Amended at 18 Ok Reg 1139, eff 5-11-01; Amended at 20 Ok Reg 376, eff 1-1-03 (emergency); Amended at 20 Ok Reg 1979, eff 6-26-03; Amended at 26 Ok Reg 1008, eff 5-1-09 (emergency); Amended at 27 Ok Reg 973, eff 5-13-09; Amended at 29 Ok Reg 1172, eff 6-25-12; Amended at 34 Ok Reg 726, eff 9-1-17; Amended at 37 Ok Reg 1660, eff 9-14-20]