Chapter 35. Medical Assistance for Adults and Children-Eligibility  


Subchapter 1. General Provisions
SECTION 317:35-1-1. Purpose
SECTION 317:35-1-2. Definitions
SECTION 317:35-1-3. Legal bases
Subchapter 3. Coverage and Exclusions
SECTION 317:35-3-1. Reimbursement
SECTION 317:35-3-2. SoonerCare transportation and subsistence
SECTION 317:35-3-3. Prior authorization requirements [revoked]
Subchapter 5. Eligibility and Countable Income
Part 1. DETERMINATION OF QUALIFYING CATEGORICAL RELATIONSHIPS
Part 3. NON-MEDICAL ELIGIBILITY REQUIREMENTS
Part 5. COUNTABLE INCOME AND RESOURCES
Part 7. APPLICATION AND ELIGIBILITY DETERMINATION PROCEDURES
Subchapter 6. Soonercare for Pregnant Women and Families With Children
Part 1. GENERAL
Part 3. APPLICATION PROCEDURES
Part 5. DETERMINATION OF ELIGIBILITY FOR SOONERCARE HEALTH BENEFITS FOR PREGNANT WOMEN AND FAMILIES WITH CHILDREN
Part 6. COUNTABLE INCOME FOR MAGI
Part 7. CERTIFICATION, REDETERMINATION AND NOTIFICATION
Subchapter 7. Medical Services
Part 1. GENERAL
Part 3. APPLICATION PROCEDURES
Part 5. DETERMINATION OF ELIGIBILITY FOR MEDICAL SERVICES
Part 7. CERTIFICATION, REDETERMINATION AND NOTIFICATION
Subchapter 9. ICF/IID, HCBW/IID, and Individuals Age 65 or Older in Mental Health Hospitals
Part 1. SERVICES
Part 2. MEDICAID RECOVERY PROGRAM
Part 3. APPLICATION PROCEDURES
Part 5. DETERMINATION OF MEDICAL ELIGIBILITY FOR ICF/IID, HCBW/IID, AND INDIVIDUALS AGE 65 OR OLDER IN MENTAL HEALTH HOSPITALS
Part 7. DETERMINATION OF FINANCIAL ELIGIBILITY
Part 9. CERTIFICATION, REDETERMINATION AND NOTIFICATION
Part 11. PAYMENT, BILLING, AND OTHER ADMINISTRATIVE PROCEDURES
Subchapter 10. Other Eligibility Factors for Families With Children and Pregnant Women
Part 1. GENERAL PROVISIONS
Part 3. RESOURCES
Part 5. INCOME
Part 7. BUDGETING AND ASSISTANCE PAYMENTS
Part 9. CONDITIONS OF ELIGIBILITY-AGE AND RESIDENCE
Part 11. CONDITIONS OF ELIGIBILITY-RELATIONSHIP OF PAYEE TO CHILD
Part 13. CONDITIONS OF ELIGIBILITY-DEPRIVATION OF PARENTAL SUPPORT OR CARE BY A NATURAL OR ADOPTIVE PARENT
Part 15. CONDITIONS OF ELIGIBILITY-SCHOOL ATTENDANCE
Part 17. CONDITIONS OF ELIGIBILITY - ALIENAGE
Subchapter 11. Projects
SECTION 317:35-11-1. Grants and local projects
SECTION 317:35-11-2. Poison control services [revoked]
Subchapter 13. Member Rights and Responsibilities
SECTION 317:35-13-1. Civil rights
SECTION 317:35-13-2. Courteous and prompt action
SECTION 317:35-13-3. Choice of providers
SECTION 317:35-13-4. Release of medical information
SECTION 317:35-13-5. Overpayments
SECTION 317:35-13-6. Fraud
SECTION 317:35-13-7. Program Abuse and Administrative Sanctions
Subchapter 15. Personal Care Services
SECTION 317:35-15-1. Overview of long-term medical care services; relationship to QMBP, SLMB, and other SoonerCare service eligibility
SECTION 317:35-15-2. Personal care services
SECTION 317:35-15-3. Application for Personal Care
SECTION 317:35-15-4. Determination of medical eligibility for Personal Care
SECTION 317:35-15-5. General financial eligibility requirements for Personal Care
SECTION 317:35-15-6. Determining financial eligibility of categorically needy individuals
SECTION 317:35-15-7. Certification for Personal Care
SECTION 317:35-15-8. Agency personal care service authorization and monitoring
SECTION 317:35-15-8.1. Agency Personal Care services; billing, and problem resolution
SECTION 317:35-15-9. Redetermination of financial eligibility for Personal Care
SECTION 317:35-15-10. Redetermination of medical eligibility for personal care services
SECTION 317:35-15-11. Case transfer between categories [revoked]
SECTION 317:35-15-12. Case changes
SECTION 317:35-15-13. Personal Care contractor; billing, training, and program administration [revoked]
SECTION 317:35-15-13.1. Individual personal care service management
SECTION 317:35-15-13.2. Individual personal care assistants (IPCA) provider contractor; billing, training, and problem resolution
SECTION 317:35-15-14. Billing procedures for personal care
SECTION 317:35-15-15. Referral for social services
Subchapter 17. Advantage Waiver Services
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 services eligibility
SECTION 317:35-17-2. Level of care medical eligibility determination
SECTION 317:35-17-3. ADvantage program services
SECTION 317:35-17-4. Application for ADvantage services
SECTION 317:35-17-5. ADvantage program medical eligibility determination
SECTION 317:35-17-6. Pre-admission screening [revoked]
SECTION 317:35-17-7. PASRR screening process [revoked]
SECTION 317:35-17-8. Level II screen for PAS [revoked]
SECTION 317:35-17-8.1. PASRR appeals process [revoked]
SECTION 317:35-17-9. General financial eligibility requirements for the ADvantage program
SECTION 317:35-17-10. Determining financial eligibility/categorical relationship for the ADvantage program
SECTION 317:35-17-11. Determining financial eligibility for ADvantage program services
SECTION 317:35-17-12. Certification for ADvantage program services
SECTION 317:35-17-13. Certification for ADvantage program services [revoked]
SECTION 317:35-17-14. Case management services
SECTION 317:35-17-15. Redetermination of eligibility for ADvantage services
SECTION 317:35-17-16. Member annual level of care re-evaluation and annual service plan reauthorization
SECTION 317:35-17-17. Supplemental process for expedited eligibility determination (SPEED) [revoked]
SECTION 317:35-17-18. ADvantage services during hospitalization or NF placement
SECTION 317:35-17-19. Closure or termination of ADvantage services
SECTION 317:35-17-20. Case transfer between categories [revoked]
SECTION 317:35-17-21. Case changes
SECTION 317:35-17-21.1. ADvantage and agency Personal Care provider certification
SECTION 317:35-17-22. Billing procedures for ADvantage services
SECTION 317:35-17-23. Disclosure of information on health care providers and contractors
SECTION 317:35-17-24. Referral for social services
SECTION 317:35-17-25. Address Confidentiality Program
SECTION 317:35-17-26. Ethics of Care Committee
Subchapter 18. Programs of All-Inclusive Care for the Elderly
SECTION 317:35-18-1. Programs of All-Inclusive Care for the Elderly (PACE)
SECTION 317:35-18-2. Introduction
SECTION 317:35-18-3. Definitions
SECTION 317:35-18-4. Provider regulations
SECTION 317:35-18-5. Eligibility criteria
SECTION 317:35-18-6. PACE program benefits
SECTION 317:35-18-7. Appeals process
SECTION 317:35-18-8. Enrollment
SECTION 317:35-18-9. Continuation of enrollment
SECTION 317:35-18-10. Disenrollment (voluntary and involuntary)
SECTION 317:35-18-11. Data collection and reporting
SECTION 317:35-18-12. Medicaid Payments
Subchapter 19. Nursing Facility Services
SECTION 317:35-19-1. Implementation of gatekeeping in NF [revoked]
SECTION 317:35-19-2. Nursing Facility (NF) program medical eligibility determination
SECTION 317:35-19-3. Services in a Nursing Facility (NF)
SECTION 317:35-19-4. Medicaid recovery
SECTION 317:35-19-5. Application for nursing facility care; forms
SECTION 317:35-19-6. Application procedures for NF
SECTION 317:35-19-7. Determination of medical eligibility for care in NF [revoked]
SECTION 317:35-19-7.1. Level of care medical eligibility determination
SECTION 317:35-19-8. Pre-admission screening and resident review
SECTION 317:35-19-9. PASRR screening process
SECTION 317:35-19-10. Level II screen for PAS [revoked]
SECTION 317:35-19-11. Annual Resident Review (ARR) [revoked]
SECTION 317:35-19-12. Level I screen for ARR [revoked]
SECTION 317:35-19-13. Level II screen for ARR [revoked]
SECTION 317:35-19-14. New admissions, readmissions, interfacility transfers, and same level of care program transfers
SECTION 317:35-19-15. PASARR tracking system [revoked]
SECTION 317:35-19-16. PASRR appeals process
SECTION 317:35-19-17. Determination of continued medical eligibility for care in a nursing facility [revoked]
SECTION 317:35-19-18. Change in level of long-term medical care
SECTION 317:35-19-19. General financial eligibility requirements for NF and skilled nursing care
SECTION 317:35-19-20. Determining financial eligibility of categorically needy individuals
SECTION 317:35-19-21. Determining financial eligibility for care in NF
SECTION 317:35-19-22.1. Discharge planning
SECTION 317:35-19-22. Certification for Nursing Facility (NF)
SECTION 317:35-19-23. Redetermination of eligibility for NF care
SECTION 317:35-19-24. Case transfer between categories
SECTION 317:35-19-25. Case changes
SECTION 317:35-19-26. Payment to NF
SECTION 317:35-19-27. Billing procedures for NF
SECTION 317:35-19-28. Management of client's funds while receiving care in NF
SECTION 317:35-19-29. Disclosure of information on health care providers and contractors
SECTION 317:35-19-30. Referral for social services
SECTION 317:35-19-31. Special procedures for release of adults in mental health hospitals to Nursing Facilities
Subchapter 21. Oklahoma Cares Breast and Cervical Cancer Treatment Program
SECTION 317:35-21-1. Oklahoma Cares Breast and Cervical Cancer Treatment program
SECTION 317:35-21-2. Scope of coverage
SECTION 317:35-21-3. CDC screening
SECTION 317:35-21-4. Creditable coverage
SECTION 317:35-21-5. In need of treatment
SECTION 317:35-21-6. Age requirements
SECTION 317:35-21-7. Citizenship and Residence
SECTION 317:35-21-8. Social security number
SECTION 317:35-21-9. Income
SECTION 317:35-21-10. Resources
SECTION 317:35-21-11. Certification for BCC
SECTION 317:35-21-12. Changes after certification/continued need for treatment
SECTION 317:35-21-13. Redetermination
SECTION 317:35-21-14. Appeals and reconsiderations
Subchapter 22. Pregnancy Related Benefits Covered Under Title XXI
SECTION 317:35-22-1. Pregnancy related benefits covered under Title XXI
SECTION 317:35-22-2.1. Non-covered services
SECTION 317:35-22-2. Scope of coverage for Title XXI Pregnancy
SECTION 317:35-22-3. Need for pregnancy related services for the unborn child
SECTION 317:35-22-4. Citizenship
SECTION 317:35-22-5. Social Security number
SECTION 317:35-22-6. Income
SECTION 317:35-22-7. Resources
SECTION 317:35-22-8. Period of eligibility
SECTION 317:35-22-9. Notification of eligibility
SECTION 317:35-22-10. Denials
SECTION 317:35-22-11. Closures
Subchapter 23. Living Choice Program
SECTION 317:35-23-1. Living Choice program
SECTION 317:35-23-2. Eligibility criteria
SECTION 317:35-23-3. Participant disenrollment
SECTION 317:35-23-4. Re-enrollment

Note


[Authority: Federal Social Security Act, Title XIX; Immigration and Reform Act of 1936; 42 CFR, §§ 440.167, 440.181, and 440.155; P.L. 111-148 and 111-152; 10 O.S., §§ 175.1, 1415, and 1417; 56 O.S., §§ 28.1 et seq., 161 et seq., 162, 164, 175, 177, and 1025.1 through 1025.3; 63 O.S., §§ 5003 through 5016]
[Source: Codified 7-27-95]