APA WF 23-01 State Plan Personal Care Services for Expansion Adults, TEFRA Eligible Children and Certain MAGI Populations
The proposed rules will add new policy to delineate eligibility requirements, definitions, medical eligibility criteria for personal care, and the process for medical eligibility determinations. Additionally, rules will be added to reflect the current business practice for approving the TEFRA population and any EPSDT members who meet medical necessity to receive personal care services.
Please view the circulation document here: APA WF # 23-01 and submit feedback via the comment box below.
Circulation Date: 01/03/2023
Comment Due Date: 01/18/2023
Medical Advisory Committee (MAC) Meeting: 03/02/2023
Board Meeting: 03/22/2023
Comments
Dianna Berry:
Thank you for the opportunity to comment.
Per 317:35-16-1(e)(2):
(1) Is there specific criteria that will be used by the OHCA supervisor to evaluate a member's request for SPPC services while residing in the home of the PCA?
317:35-16-2:
(1) The same medical eligibility requirements for the OKDHS-administered SPPC program are being used to assess eligibility for the OHCA-administered program (has a physical impairment or combination of physical and mental impairment as documented on the UCAT III; same ADL, IADL, Nutrition, and MSQ scores. See 317:35-15-4(c)). As such, it would seem that any member who qualifies for SPPC services under the OHCA-administered program would be a candidate for referral to OKDHS for a disability review under 317:35-16-2(d)(1). Can you provide the criteria that will be used to distinguish eligibility for SPPC services under the OHCA-administered program and the type of information from the UCAT III that would justify a referral to OKDHS?
(2) If a member applying for SPPC services is referred to OKDHS for a disability review and its determined that the member meets OKDHS disability criteria, will the member be transferred from an OHCA-related category group (i.e., HAP/Expansion Adult) to a OKDHS-related category group (i.e. disabled)?
(3) If yes to (2), will the member become subject to new income (100% fpl instead of 138% fpl) and asset limits to qualify for SPPC services and continued medical coverage under SoonerCare?
(4) If yes to (2) and (3), will the member be notified prior to completing an application for SPPC services that the information submitted may result in a change to his/her eligibility-related category and more stringent income requirements that could render the member ineligible for continued SoonerCare coverage?
(5) Can the member withdraw his/her application for SPPC services at any time without adversely impacting the SoonerCare eligibility group for which he/she initially qualified?
(6) Under 317:35-16-2(d)(2):
Should the language read: "Upon receipt of the application (instead of referral)...?"
