Oklahoma Administrative Code
Title 317 - Oklahoma Health Care Authority
Chapter 30 - Medical Providers-Fee for Service
Subchapter 5 - Individual Providers and Specialties
Part 99 - CASE MANAGEMENT SERVICES FOR UNDER AGE 18 IN EMERGENCY, TEMPORARY OR PERMANENT CUSTODY OR SUPERVISION OF THE DEMENT OF HUMAN SERVICES
Section 317:30-5-991 - Coverage by category
Universal Citation: OK Admin Code 317:30-5-991
Current through Vol. 42, No. 1, September 16, 2024
Payment is made for case management service as set forth in this Section.
(1) Adults. There is no coverage for adults.
(2) Children. Payment is made for services to persons under age 18 as follows:
(A)
Description of case management
services. The target group for CWTCM services are persons under age 18
who are in emergency, temporary or permanent custody of the Department of Human
Services (DHS) or in voluntary status who are placed in out-of home care or
trial adoption.
(i) Case management services
are activities that assist the target population in gaining access to needed
medical, social, educational and other services. These services include
services covered under the Oklahoma Medicaid State Plan as well as those
services not covered under the State Plan.
(ii) Case management is designed to assist
individuals in accessing services. The client has the right to refuse case
management and cannot be restricted from services because of a refusal for Case
Management Services.
(iii) Case
management does not include:
(I) Physically
escorting or transporting a client to scheduled appointments or staying with
the client during an appointment;
(II) Monitoring financial goals;
(III) Providing specific services such as
shopping or paying bills; or
(IV)
Delivering bus tickets, food stamps, money, etc.
(B)
Non-Duplication of
services. To the extent any eligible recipient in the identified target
population are receiving CWTCM services from another provider agency as a
result of being members of other covered target groups (i.e., SoonerStart Early
Intervention), the provider agency assures that case management activities are
coordinated to avoid unnecessary duplication of service.
(C)
Providers. Case management
services must be provided by case management agencies.
(3) Individuals eligible for Part B of Medicare. Case Management Services provided to Medicare eligible recipients are filed directly with the fiscal agent.
Added at 14 Ok Reg 3711, eff 8-1-97 (emergency); Added at 15 Ok Reg 1528, eff 5-11-98
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