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OHCA Policies and Rules

317:30-5-1161. Targeted case management

[Issued 06-25-07]

(a) Case management is a set of interrelated activities under which responsibility for locating, coordinating and monitoring appropriate services for an individual rests with a specific person within the case management agency. Services under case management are not comparable in amount duration and scope.

(b) Case management is designed to assist a individual in gaining access to needed medical, social, educational and other services essential to meeting basic human needs, and is not restrictive in nature.

(c) Major components of the services include working with the individual in the use of basic community resources, referral, linkage and advocacy.

(d) In order to ensure that case management services are not duplicated by other staff, case management activities will be provided in accordance with a comprehensive individualized treatment/service plan. The development of this plan includes clinical staff participation, thus ensuring that staff knows a client has a case manager.

(e) Case management services for first time mothers must provide necessary coordination with providers of non-medical services, such as nutrition, psycho social or health education programs, when services provided by these entities are needed. The case manager coordinates these services with needed medical services. The purpose of case management services for first time mothers and their infants/children is to:

(1) assist first time mothers and their infants/children in gaining access to needed medical, social, educational and other services;

(2) encourage the use of appropriate medical providers; and

(3) discourage over utilization or duplication of services.

(f) Targeted case management does not include:

(1) SoonerCare eligibility determinations and re-determinations;

(2) SoonerCare intake processing;

(3) SoonerCare preadmission screening for inpatient care;

(4) Prior Authorization for SoonerCare services and utilization review;

(5) SoonerCare outreach;

(6) physically escorting or transporting a member to scheduled appointments or staying with a member during an appointment;

(7) monitoring financial goals;

(8) providing specific services such as shopping or payment of bills; or

(9) delivering bus tickets, food stamps, money, etc.

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.