SECTION 317:50-1-11. Closure or termination of Medically Fragile Waiver services

(a)   Voluntary closure of Medically Fragile Waiver services. If the member requests a lower level of care than Medically Fragile Waiver services or if the member agrees that Medically Fragile Waiver services are no longer needed to meet his/her needs, a medical decision is not needed. The closure request is completed and signed by the member and the case manager and placed in the member's case record. Documentation is made of all circumstances involving the reasons for the voluntary termination of services and alternatives for services if written request for closure cannot be secured.

(b)   Closure due to financial or medical ineligibility. The process for closure due to financial or medical ineligibility is described in this subsection.

(1)   Financial ineligibility. Anytime it is determined that a member does not meet the financial eligibility criteria, the member and provider are notified of financial ineligibility. A medical eligibility redetermination is not required when a financial ineligibility period does not exceed the medical certification period.

(2)   Medical ineligibility. When the member is found to no longer be medically eligible for Medically Fragile Waiver services, the individual and provider are notified of the decision.

(c)   Closure due to other reasons. Refer to OAC 317:50-1-3(e) - (f).

(d)   Resumption of Medically Fragile Waiver services. If a member approved for Medically Fragile Waiver services has been without services for less than ninety (90) days and has a current medical and financial eligibility determination, services may be resumed using the previously approved service plan. If a member decides he/she desires to have his/her services restarted after ninety (90) days, the member must request the services.

[Source: Added at 27 Ok Reg 2769, eff 8-1-10 (emergency); Added at 28 Ok Reg 1589, eff 6-25-11; Amended at 35 Ok Reg 1511, eff 9-14-18]