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OHCA Policies and Rules

317:30-5-990. Eligible providers

[Issued 08-01-97]

(a) Case management agencies.  Services are provided by case management agencies established for the purpose of providing case management services. Medicaid Child Welfare Targeted Case Management (CWTCM) services must be made available to all eligible recipients and must be delivered by provider agencies on a statewide basis with procedures that assure 24 hour availability, the protection and safety of recipients, continuity of services without duplication, and compliance with federal and State mandates and regulations related to servicing the targeted population are met in a uniform and consistent manner. The agency must demonstrate that their staff has:

(1) a minimum of five 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 and monitoring; and

(D) on-going assessment and treatment plan revision.

(2) a minimum of five years experience in providing case management services that coordinate and link the community resources required by the target population.

(3) a minimum of five years experience in meeting the case management and service needs of the target population.

(4) an administrative capacity to insure quality of services in accordance with State and federal requirements.

(5) a financial management capacity and system that provides documentation of services and costs.

(6) a capacity to document and maintain individual case records in accordance with State and federal requirements.

(7) ability to meet all State and federal laws governing the participation of providers in the State Medicaid 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 provider for CWTCM 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 CWTCM program must:

(1) be employed by the provider agency.

(2) possess at minimum, a bachelor of social work degree; or a bachelor's degree and one year of experience in professional social work; or a master's degree in behavioral science.

(3) possess knowledge of the principles and practices of:

(A) social work;

(B) laws, rules, regulations, and policies and procedures governing agency programs;

(C) community resources;

(D) human developmental stages and related dysfunctions;

(E) sensitivity to cultural diversity;

(F) emotional, physical and mental needs of clients; and

(G) counseling programs and services.

(4) possess skill in:

(A) interviewing;

(B) getting clients to explore opportunities and extracting information;

(C) casework management;

(D) setting goals in cooperation with clients;

(E) time management;

(F) prioritizing and organizing needs of clients;

(G) courtroom testimony, terminology and procedures;

(H) crisis intervention;

(I) working with a multidisciplinary approach; and

(J) developing, evaluating and modifying an intervention plan on an ongoing basis.

(d) Provider selection.  Provision of case management services must not restrict an individual's free choice of providers. Eligible recipients must have free choice of providers of case management as well as providers of other medical care under the plan.

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.