Guidelines For Making A Referral
- All out of state referrals require prior medical review.
- If the treatment facility where the member is inpatient allows one person to stay overnight in the member’s room then overnight lodging is not authorized.
- Hospital Social Workers may continue to issue lodging and/or meals vouchers up to 14 days per medical stay (verification with member is required regarding number of days that they have been receiving lodging and /or meals services).
- Lodging &/or Meals Voucher may be discontinued at any time if criteria for visitation is not met.
- Lodging and/or Meals Authorization form (voucher)
- Room and Board Providers (list of lodging providers)
- If lodging and/or meals services are needed beyond 14 days per medical stay, a referral must be submitted to OHCA Population Care Management for review.
- When submitting documents for a lodging and/or meals referral, documents are to be faxed for review 3 business days before the date lodging and/or meals services are needed; fax to OHCA Population Care Management – Attention: Social Services at 405-530-3217.
For Initial Referrals
- Fax a completed SoonerCare Lodging &/or Meals Request form or member’s proof of appointment.
- SoonerCare Lodging and/or Meals Request Form (referral form).
- Proof of appointment must include the member’s name, phone number and SoonerCare ID number; the date, check in time, and duration of the appointment or procedure.
For Extended Stays (submit referral at least 3 business days before the 14th day limit)
- Fax an updated letter of medical necessity or the member’s most recent nursing progress notes/medical records. Include the anticipated length of stay.
- Notify Care Management by phone or fax of the dates that the escort is requesting lodging and/or meals services, and how many days have already been approved for the member or escort.
- For NICU, the escort’s visitation log showing sign in/out times is required. Visitation MUST total a minimum of 6 hours per day to be eligible for continued lodging and/or meals services.
- Meals will be reimbursed only if meets the lodging criteria and the duration of the trip was 18 hours or more.
- If the member and/or escort meets the criteria for lodging services and stays overnight, but does not request SoonerCare assistance for lodging, then the member and/or escort may still be eligible for meals assistance/reimbursement.
- The member and/or escort are not eligible for reimbursement for meals if the lodging provider submits a claim for meal reimbursement because they are providing meals to the member.