Okla. Admin. Code § 317:35-17-1 - [Effective 9/14/2024] Overview of long-term medical care services; relationship to Qualified Medicare Beneficiary Plus (QMBP), Specified Low-Income Medicare Beneficiary (SLMB), and other Medicaid (SoonerCare) services eligibility
(a) Long-term medical care for the
categorically needy includes:
(1) Care in a
long-term care facility per Oklahoma Administrative Code (OAC) 317:35-19;
(2) Care in a public or private
intermediate care facility for the intellectually disabled(ICF/IID), per OAC
317:35-9;
(3) Care of persons
sixty-five (65) years of age and older in mental health hospitals, per OAC
317:35-9;
(4) Home and
Community-Based waiver services for persons with intellectual disabilities, per
OAC 317:35-9;
(5) Personal Care
services, per OAC 317:35-15; and
(6) Home and Community-Based waiver services
(ADvantage waiver) for frail elderly, sixty-five (65) years of age and older;
and a targeted group of adults with physical disabilities, twenty-one (21) to
sixty-four (64) years of age and older, who do not have an intellectual
disability or a cognitive impairment related to a developmental disabilityper
OAC
317:35-17-3.
(b) When an individual
is certified as eligible for SoonerCare coverage of long-term care, he or she
is also eligible for other SoonerCare services. ADvantage waiver members do not
have a copayment for ADvantage services except for prescription drugs. For
members residing in an ADvantage assisted living center, any income beyond
one-hundred and fifty percent(150%) of the federal benefit rate is available to
defray the cost of the assisted living services received. The member is
responsible for payment to the assisted living services center provider for
days of service, from the first day of each full-month in which services were
received, until the vendor pay obligation is met. When an individual is aged,
blind, or disabled and is determined eligible for long-term care, a separate
eligibility determination must be made for QMBP or SLMB benefits. An ADvantage
program member may reside in a licensed assisted living services center only
when the assisted living services center is a certified ADvantage assisted
living services center provider from whom the member is receiving ADvantage
assisted living services.
Notes
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