1915(c) HCBS Community Waiver Amendment effective: 07/01/2022 through 06/30/2026; contingent upon CMS approval

The Oklahoma Health Care Authority (OHCA) is seeking a waiver amendment of the 1915(c) HCBS Community Waiver. The goal of the program is to provide services for members age three and above with an intellectual disability or related condition who are subject to the provisions of Public Law 100-203; who are Medicaid eligible; and who meet Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) level of care.

The proposed revisions to the Community Waiver are as follows: 

• Appendix A – The Medicaid Agency Oversight of Operating Agency Performance section has been updated to reflect current practice related to sharing of information between OKDHS and OHCA.
   
• Appendix B - Reserved capacity purpose language has been updated to include not only persons transitioning from public ICF/IID's, but also persons transitioning from private ICF/IID’s as well as persons identified through the PASRR process.
  
  
• Appendix C - Due to a statutory language change (Title 56 OS Sec. 1025.1 et seq.: OAC 340:100-3-39), the scope of background investigation language has been updated to include the option of a Federal Bureau of Investigation (FBI) Identity History Summary Check.
    
• Appendix C - The Dental Service Type was updated from Other Service to Extended State Plan Service.  Also, the limit for this service was increased from $1000.00 per member plan of care year to $3500.00 per member plan of care year.
  
  
• Appendix C - The limits section of the Transportation service has been updated to reflect an increased limit for public transportation.  The limit has been increased from $5000.00 to $25,000.00, per 12 months.
  
  
• Appendix C - The Optometry service has been added to the Participant Services section.
  
  
• Appendix C - Oklahoma currently offers a retainer payment for some services.  This payment, which is referred to as therapeutic leave, allows service providers to retain personal care services during the time a member is out of his or home for a period of time in excess of 24 hours without direct care staff because of hospitalization or other absence.  The therapeutic leave payment has been added to the Specialized Foster Care service.
  
  
• Appendix C - The Supported Employment service has been updated to include a statement indicating the service may be provided remotely, with prior approval by the Team.
   
• Appendix C - The Environmental Accessibility Adaptations and Architectural Modification service limit section has been updated to allow a designee, as well as the DHS/DDS Division Administrator, to authorize modification of more than two different residences in a seven year period, in extenuating circumstances.
  
  
• Appendix C - Medicaid certified Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) has been removed as a provider of the Respite Daily service.
   
• Appendix C - The limits section of the Family Training service has been updated to increase the individual limit from $5500.00 per plan of care year to $6500.00 per plan of care year.  The group limit has also been increased from $5500.00 per plan of care year to $6500.00 per plan of care year.  The total for Family Training services may not exceed $13,000.00 per plan of care year.
   
• Appendix C - The Occupational Therapy service definition has been updated to require a prescription by any licensed health care provider, not just a Physician, with appropriate prescriptive authority.
  
  
• Appendix C - The Physical Therapy service definition has been updated to require a prescription by any licensed health care provider, not just a Physician, with appropriate prescriptive authority.
  
  
• Appendix C - A statement indicating the Prevocational service may be provided remotely, with prior approval by the Team, has been added to the Prevocational service definition.
   
• Appendix C - A statement indicating the Daily Living Supports service may be provided remotely, with prior approval by the Team, has been added to the Daily Living Supports service definition.
  
  
• Appendix D - The Service Plan Implementation and Monitoring section has been updated to include language related to case management virtual visits.  Virtual visits that substitute for the required face-to-face visit are limited to twice per year for those receiving residential services, and only when the member does not receive the Remote Supports service.  Virtual visits that substitute for the required face-to-face visit are limited to once per year for those receiving non-residential services, and only when the member does not receive the Remote Supports service.
  
  
• Appendix D - The Service Plan Development section has been updated to allow Team meetings, including Individual Plan meetings, to be conducted via HIPAA compliant teleconference or video conference.
  
  
• Appendix E - The Description of Participant Direction language has been updated.
   
• Appendix I - Specialized Medical Supplies and Assistive Technology service, Rate Determination Method language has been updated.
  
  
• Appendix I - The Optometry service has been added as a Medicaid rate to the Rate Determination Method section.
  
  
• Appendix J - Due to limit increases, the remote supports service rate increase, the addition of therapeutic leave to the Specialized Foster Care service, and new Optometry service, cost neutrality has been adjusted for waiver years 2-5.

Please view the waiver amendment here: 1915(c) HCBS Community Waiver Amendment.

The above amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2022, whichever is earliest. 

Please submit all comments by close of business, February 18, 2022, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a hard copy of the waiver please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.