Current through Vol. 42, No. 1, September 16, 2024
(a)
Case
management providers. Services are provided by case managers certified
by the State Department of Education as meeting the requirements for providing
case management. SoonerCare School-Based Targeted Case Management (SBTCM)
services must be made available to all eligible members and must be delivered
on a statewide basis with procedures that ensure continuity of service without
duplication and in compliance with federal and state mandates and regulations
related to servicing the targeted population in a uniform and consistent
manner. The case managers must be certified by the single state Medicaid agency
as meeting the following:
(1) a minimum of
five (5) years experience in meeting the case management and service needs of
the target population.
(2) a
minimum of five (5) years experience in providing all core elements of case
management services, including:
(A)
individualized strengths and needs assessment;
(B) needs-based service planning;
(C) service coordination, monitoring and
advocacy;
(D) service plan review;
and
(E) crisis assistance
planning.
(3) a minimum
of five (5) years experience in developing and implementing Individualized
Education Programs (IEP) and/or Individualized Family Service Plans (IFSP) and
in meeting the requirements of the IDEA, in accordance with State and Federal
law. Each IEP and/or IFSP is dependent upon the needs of the individual student
as determined by consultation that may include any or all of the professions in
(A) through (F) of this paragraph. Those providing input must meet state or
national licensure, registration or certification requirements of the
profession in which they practice and include:
(A) special education,
(B) school psychologist,
(C) occupational therapist,
(D) physical therapist,
(E) speech language specialist, or
(F) school counselor and other specialists as
identified.
(4) a
demonstrated ability to collaborate with public and private services
providers.
(5) experience in
providing and coordinating education support services, including but not
limited to Student Assistance, Special Education, Psychology and Counseling
Services.
(6) adequate
administrative capacity to fulfill state and federal requirements.
(7) a financial management capacity and
system that provides documentation of services and costs.
(8) a capacity to document and maintain
individual case records in accordance with state and federal
requirements.
(9) a demonstrated
ability to meet all state and federal laws governing participation of providers
in the SoonerCare program including, but not limited to, the ability to meet
federal and state requirements for documentation, billing and audits.
(b)
Provider
agreement. A Provider Agreement between the Oklahoma Health Care
Authority and the providers for case management services must be in effect
before reimbursement can be made for compensable services.
(c)
Qualifications of individual case
managers. A targeted case manager for the SBTCM program must:
(1) be employed by the school or their
contractor;
(2) possess an
appropriate certificate, or meet other comparable requirements as applicable to
the profession or discipline in which a person is providing special education,
early intervention or related services, in accordance with the requirements of
the Oklahoma State Department of Education; or
(3) be licensed, certified or registered as a
health care professional in the State, and meet the qualifications for related
services staff under the most current provisions of Part B or Part C of the
Individuals with Disabilities Education Act.
(d)
Provider selection.
Provision of case management services must not restrict an individual's free
choice of providers. Eligible members must have free choice of the providers of
other medical care under the plan.
Added at 16 Ok Reg
1927, eff 6-11-99; Amended at 17 Ok Reg 2399, eff
6-26-00
