Library: Policy

317:30-5-1200. Benefits for members age 65 or older with disabilities or long-term illnesses

Revised 7-1-13

(a) Living Choice program participants age 65 or older with disabilities or long-term illnesses may receive a range of necessary medical and home and community based services for one year after moving from an institutional setting. The one year period begins the day the member occupies a qualified residence in the community. Once this transition period is complete, the member receives services through one of the Opportunities for Living Life home and community based services waivers.

(b) Services must be billed using the appropriate HCPCS or CPT codes and must be medically necessary.

(c) All services must be necessary for the individual to live in the community, require prior authorization, and must be documented in the individual transition plan. The number of units of services the member is eligible to receive is limited to the amounts approved in the transition plan.

(d) Services that may be provided through the Living Choice program for older persons with disabilities or long-term illnesses are listed in paragraphs (1) through (26) of this subsection:

(1) case management;
(2) respite care;
(3) adult day health care;
(4) environmental modifications;
(5) specialized medical equipment and supplies;
(6) therapy services including physical, occupational, speech and respiratory;
(7) advanced supportive/restorative assistance;
(8) skilled nursing;
(9) extended duty nursing;
(10) home delivered meals;
(11) hospice care;
(12) medically necessary prescription drugs;
(13) personal care as described in Part 95 of this Chapter;
(14) Personal Emergency Response System (PERS);
(15) self-direction;
(16) transition coordination;
(17) community transition services as described in OAC 317:30-5-1205;
(18) dental services (up to $1,000 per person annually);
(19) nutrition evaluation and education services;
(20) agency companion services;
(21) pharmacological evaluations;
(22) vision services including eye examinations and eyeglasses;
(23) non-emergency transportation;
(24) family training services;
(25) assisted living services; and
(26) SoonerCare compensable medical services.