SECTION 317:35-9-5. Home and Community - Based Services (HCBS) Waivers for persons with intellectual disabilities or certain persons with related conditions

(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.

[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 17 Ok Reg 2410, eff 6-26-00; Amended at 26 Ok Reg 2139, eff 6-25-09; Amended at 28 Ok Reg 1534, eff 6-25-11; Amended at 29 Ok Reg 1162, eff 6-25-12]