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Library: Policy

317:30-5-1202. Benefits for members with physical disabilities

Revised 7-1-13

(a) Living Choice program participants with physical disabilities may receive a range of necessary medical and home and community based services for one year after moving from the institution.  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 to members with physical disabilities are listed in paragraphs (1) through (32) of this subsection:

  • (1) case management;

  • (2) personal care services as described in Part 95 of this Chapter;

  • (3) respite care;

  • (4) adult day health care with personal care and therapy enhancements;

  • (5) architectural modifications;

  • (6) specialized medical equipment and supplies;

  • (7) advanced supportive/restorative assistance;

  • (8) skilled nursing;

  • (9) home delivered meals;

  • (10) therapy services including physical, occupational, speech and respiratory;

  • (11) hospice care;

  • (12) Personal Emergency Response System (PERS);

  • (13) Self-Direction;

  • (14) agency companion services;

  • (15) extended duty nursing;

  • (16) psychological services;

  • (17) audiology treatment and evaluation;

  • (18) non-emergency transportation;

  • (19) assistive technology;

  • (20) dental services (up to $1,000 per person annually);

  • (21) vision services including eye examinations and eyeglasses;

  • (22) pharmacotherapy management;

  • (23) independent living skills training;

  • (24) nutrition services;

  • (25) family counseling;

  • (26) family training;

  • (27) transition coordination;

  • (28) psychiatry services;

  • (29) community transition services as described in OAC 317:30-5-1205;

  • (30) pharmacological evaluations;

  • (31) assisted living services; and

  • (32) SoonerCare compensable medical services.

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