Institutional Level of Care

The criteria for institutional level of care is complex, but the following provides a general overview of eligibility and document requirements:

1. ICF/IID - Must be ages 18 years and younger and expected to meet the following criteria for at least 30 days:

Applicants under age 3

• have a diagnosis of a developmental disability; and
• have been evaluated by the SoonerStart Early Intervention Program using the Battelle Developmental Inventory, 2nd edition, with findings of at least -2.0 standard deviations in at least two total domain areas.

Applicants Ages 3 years and older

• have a diagnosis of intellectual disability or a developmental disability; and
• have received a psychological evaluation by a licensed psychologist or school psychologist certified by the Oklahoma Department of Education (ODE) within the last 12 months. The evaluation must include intelligence testing that yields a full-scale intelligence quotient, and a full-scale functional or adaptive assessment that yields a composite functional age. Eligibility for TEFRA ICF/IID level of institutional care requires an IQ of 70 or less, or a full-scale functional or adaptive assessment indicating a functional age composite that does not exceed 50 percent of the child's chronological age. In no case shall eligibility be granted for a functional age greater than 8 years, 0 months.

Children approved for ICF/IID level of care

• Children under the age of 6 will be required to undergo a full psychological evaluation, including both intelligence testing and adaptive/functional assessment, by a licensed psychologist, at age 3 and at age 6 to ascertain continued eligibility for TEFRA under the ICF/MR level of institutional care. The psychological evaluation must be completed and submitted to LOCEU no later than 90 days following the child’s 3rd and 6th birthdays.

2. Nursing Facility – The child must be age 18 years or younger and expected to meet the following criteria for a minimum of 30 days.

• The child must:
  • (i) have a long-term medical or physical condition which significantly diminishes his/her functional capacity;
  • (ii) Requires health-related services that are so inherently complex that it can only be safely and effectively provided by technical or professional medical personnel, such as a registered nurse, licensed practical nurse, etc., and are ordinarily provided in a nursing facility. Without these services, the child is at risk of being institutionalized within a nursing facility; and
  • (iii) Services needed are above general supervision but can be provided safely in the child’s home. The services are usually required 24 hours per day and are ordinarily provided in a nursing facility inpatient basis.
• The service(s) needed has been ordered by a physician. The services needed by the child must be greater than the services provided by an ICF/IID and less than those provided in a hospital.

3. Hospital – The child must be age 18 years or younger and expected to meet the following criteria for at least 60 days.

• The child must need services that:
  • (i) Are ordinarily provided in a hospital setting for the care and treatment of inpatients; and
  • (ii) Are provided in a hospital that is maintained primarily for the care and treatment of patients with disorders other than mental health diagnosis.
• The service(s) needed have been ordered by, and is provided under the direction of, a physician.
• The services needed by the child must be greater than the services provided an ICF/IID and a nursing facility.