1915(c) HCBS Medically Fragile Waiver Amendment

The Oklahoma Legislature appropriated and specifically funded a 25% rate increase for their five 1915(c) waiver HCBS providers contracted with Oklahoma Human Services (OHS). The intent is to standardize provider rates across the 1915(c) Home and Community Based Services and the Medically Fragile. Without this additional support, staffing shortages could result in adverse health and safety outcomes for the individuals served.

The Oklahoma Health Care Authority (OHCA) is proposing a rate increase of up to 25% on payments for the Medically Fragile waiver services. The Medically Fragile Waiver serves individuals 19 years of age and older diagnosed with a medically fragile condition who meet skilled nursing or hospital level of care. 

An update to the estimated cost for waiver year five (5) due to a 25% legislatively approved rate increase for waiver providers.  The proposed waiver amendment includes: 

• Case Management;
• Personal Care;
• Advanced Supporative/Restorative;
• Respite;
• Home Delivery Meals;
• Hospice;
• Institutional Case Management;
• Personal Emergency Response System (PERS);
• Private Duty Nursing;
• Skilled Nursing;
• Therapy Services (Respiratory, Occupational, Physical and Speech); and
• Transitional Case Management

This does not include:

• Durable Medical Equipment (DME); covered under State Plan.
• Architectural/Environmental Modifications; priced on an individual rate following a uniform process approved by the Medicaid Agency.

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

Please submit all comments by close of business, August 7, 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.