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OHCA Policies and Rules

317:30-5-763.1. Medicaid agency monitoring of the ADvantage program

[Revised 07-01-13]

(a) The OHCA's monitoring of the ADvantage Program is a quality assurance activity.  The agency evaluates the ADvantage program on a continual basis to ensure quality, through the review of various performance measures set forth in the waiver document.  The areas evaluated include:

(1) Member eligibility determination;

(2) Member "freedom of choice";

(3) Member health and welfare;

(4) ADvantage certified and SoonerCare contracted providers on the plan;

(5) Member acceptance of the plan;

(6) Qualified case managers;

(7) Plan services are goal-oriented services; and,

(8) Plan of care costs are within cost cap guidelines.

(b) Deficiencies found by the OHCA are reported to the AA for correction and/or explanation. Additionally, a quality management report is submitted to the Centers for Medicare and Medicaid Services annually.

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.