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OHCA Policies and Rules

317:30-5-991.  Coverage by category

[Issued 08-01-97]

Payment is made for case management service as set forth in this Section.

(1) Adults.  There is no coverage for adults.

(2) Children.  Payment is made for services to persons under age 18 as follows:

(A) Description of case management services.  The target group for CWTCM services are persons under age 18 who are in emergency, temporary or permanent custody of the Department of Human Services (DHS) or in voluntary status who are placed in out-of home care or trial adoption.

(i) Case management services are activities that assist the target population in gaining access to needed medical, social, educational and other services. These services include services covered under the Oklahoma Medicaid State Plan as well as those services not covered under the State Plan.

(ii) Case management is designed to assist individuals in accessing services. The client has the right to refuse case management and cannot be restricted from services because of a refusal for Case Management Services.

(iii) Case management does not include:

(I) Physically escorting or transporting a client to scheduled appointments or staying with the client during an appointment;

(II) Monitoring financial goals;

(III) Providing specific services such as shopping or paying bills; or

(IV) Delivering bus tickets, food stamps, money, etc.

(B) Non-Duplication of services.  To the extent any eligible recipient in the identified target population are receiving CWTCM services from another provider agency as a result of being members of other covered target groups (i.e., SoonerStart Early Intervention), the provider agency assures that case management activities are coordinated to avoid unnecessary duplication of service.

(C) Providers.  Case management services must be provided by case management agencies.

(3) Individuals eligible for Part B of Medicare.  Case Management Services provided to Medicare eligible recipients are filed directly with the fiscal agent.

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.