OHCA Policies and Rules
317:35-9-49 Determination of medical eligibility for Home and Community Based Waiver Services for the Intellectually Disabled
[Revised 6-25-12]
Determinations of medical eligibility for Home and Community Based Waiver Services for the Intellectually Disabled (HCBW/ID) is made through referral to the DHS DDSD case manager.
(1) Referral. If the county receives an application, Form K-13 is forwarded to the DDSD case manager, who is responsible for securing a HCBW/ID medical determination and a disability decision, if needed.
(2) Initial request. If the initial request is through DDSD, Form K-13 is forwarded to the county for completing the application process.
(3) Plan of care packet. The DDSD case manager submits the necessary information to LOCEU for medical determination and a disability decision if needed.
(4) County notification. LOCEU notifies the county and DDSD case manager of determination by updating the MEDATS file.
(5) Procedures for an individual returning home. If referral is from a public ICF/MR for an individual returning to the home, the DDSD case manager forwards to the worker the medical eligibility determination for HCBW/ID along with the latest application form and redetermination of eligibility form used to determine eligibility for institutional care. A new application will not be required. A case number will be assigned retaining the application date, certification date and redetermination of eligibility date.
(6) Determination of continued eligibility for HCBW/ID. The case manager is responsible for assuring that the individual's needs are re-evaluated and that recertification is established annually. Determination of continued medical eligibility is not necessary unless there is a significant change in the client=s condition. The DDSD cases manager will notify LOCEU if this is the case.
Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.
