SECTION 340:100-3-33. Service authorization

(a)   Developmental Disabilities Services Division (DDSD) provides services using state and federal funds.

(1)   All Medicaid services are implemented in accordance with Title XIX regulations.

(2)   Oklahoma Health Care Authority (OHCA) authorizes Title XIX compensability of all Home and Community-Based Services (HCBS) Waiver and intermediate care facility for persons with mental retardation (ICF/MR) services.

(3)   HCBS Waiver services are included in the service recipient's Plan of Care (POC) and are identified in accordance with OAC 340:100-5-53.

(4)   Facility administrators of Northern Oklahoma Resource Center of Enid (NORCE), Southern Oklahoma Resource Center (SORC), and Robert M. Greer (Greer) are authorized to approve habilitation and support services required by the service recipient's individual program plan and regulatory standards, including the purchase of adaptive and mobility equipment.

(5)   All authorized state-funded services are implemented in accordance with Oklahoma Department of Human Services (OKDHS) purchasing and contract policy and procedures. Authorization of services is contingent upon the availability of adequate resources.

(b)   DDSD case managers may implement services that are:

(1)   generic non-specialized services accessed when possible;

(2)   approved for DDSD payment;

(3)   identified in the service recipient's POC.

(A)   The amount of HCBS Waiver services must not exceed service specific utilization limitations and comply with related OHCA policy.

(B)   Total expense of HCBS Waiver services must not exceed the statewide congregate average annual cost of HCBS Waiver services per service recipient.

(C)   The total POC cost must not exceed annual per capita limitations, if any, established in the applicable HCBS Waiver; and

(4)   State funds are approved to meet critical needs when there is no other resolution and funds are necessary to resolve an emergency, such as necessary utilities, clothing, furniture, food and shelter. Funds cannot exceed $750.00 per event.

(c)   The DDSD area manager or designee must review and approve implementation of expenditures for:

(1)   HCBS Waiver services prescribed for a service recipient on the POC, exceeding the statewide, congregate average annual HCBS Waiver expenditure by 35% or less per year; and

(2)   short term emergency services required to meet critical needs and ensure the continuity of care when no other resolution exists.

(d)   The DDSD director or designee must review and approve implementation of:

(1)   expenditures for HCBS Waiver services exceeding the statewide, congregate average annual cost of HCBS Waiver services by more than 35%; and

(2)   support or habilitative services not otherwise authorized by OKDHS policy, subject to approval by OKDHS Director, Oklahoma Commission for Human Services or both.

(e)   Service recipients:

(1)   maintain the right to appeal service eligibility determinations as stipulated by the Oklahoma State Medicaid Plan and OKDHS policy; and

(2)   are provided literature and an understandable explanation describing procedures for exercising this right.

[Source: Amended at 8 Ok Reg 2163, eff 5-13-91 (emergency); Amended at 9 Ok Reg 1549, eff 4-27-92; Amended at 11 Ok Reg 4107, eff 6-29-94 (emergency); Amended at 12 Ok Reg 1761, eff 6-12-95; Amended at 26 Ok Reg 922, eff 5-15-09]