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Oklahoma Administrative Code (Last Updated: March 11, 2021) |
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TITLE 317. Oklahoma Health Care Authority |
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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 317:35-15-8.2. State Plan Personal Care Eligible Provider Exception |
| 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 317:35-17-2. 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 (Pace) |
| SECTION 317:35-18-1. Programs of All-Inclusive Care for the Elderly (PACE) |
| SECTION 317:35-18-1. Programs of All-Inclusive Care for the Elderly (PACE) |
| SECTION 317:35-18-2. Introduction |
| SECTION 317:35-18-2. Introduction |
| SECTION 317:35-18-3. Definitions |
| SECTION 317:35-18-3. Definitions |
| SECTION 317:35-18-4. Provider regulations |
| SECTION 317:35-18-4. Provider regulations |
| SECTION 317:35-18-5. Eligibility criteria |
| SECTION 317:35-18-5. Eligibility criteria |
| SECTION 317:35-18-6. PACE program benefits |
| SECTION 317:35-18-6. PACE program benefits |
| SECTION 317:35-18-7. Appeals process |
| SECTION 317:35-18-7. Appeals process |
| SECTION 317:35-18-8. Enrollment |
| SECTION 317:35-18-8. Enrollment |
| SECTION 317:35-18-9. Continuation of enrollment |
| SECTION 317:35-18-9. Continuation of enrollment |
| SECTION 317:35-18-10. Disenrollment (voluntary and involuntary) |
| SECTION 317:35-18-10. Disenrollment (voluntary and involuntary) |
| SECTION 317:35-18-11. Data collection and reporting |
| SECTION 317:35-18-11. Data collection and reporting |
| SECTION 317:35-18-12. Medicaid Payments |
| 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. Preadmission 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 nursing facility |
| 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 (BCC) 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]