Library: Policy

317:30-5-410. Home and Community-Based Services Waivers for persons with an intellectual disability or certain persons with related conditions

Revised 6-25-12

(a) The Oklahoma Health Care Authority (OHCA) administers Home and Community-Based Services (HCBS) Waivers for persons with an intellectual disability and certain persons with related conditions that are operated by the Oklahoma Department of Human Services (OKDHS) Developmental Disabilities Services Division (DDSD).   Each waiver allows payment for family support services as defined in the waiver approved by the Centers for Medicare and Medicaid Services (CMS).  Waiver services:

• (1) when utilized with services normally covered by SoonerCare, other generic services, and natural supports provide for health and developmental needs of members who otherwise would not be able to live in a home or community setting;

• (2) are provided with the goal of promoting independence through strengthening the member's capacity for self-care and self-sufficiency;

• (3) are centered on the needs and preferences of the member and support the integration of the member within his/her community; and

• (4) do not include room and board.  The costs associated with room and board must be met by the member.

(b) The DDSD case manager develops the Individual Plan (IP) and Plan of Care (Plan) per OAC 340:100-5-53.  The IP contains descriptions of the services provided, documentation of the amount, frequency and duration of the services, and types of service providers.

• (1) Services:

• (A) are authorized per OAC 340:100-3-33 and 100-3-33.1.

• (B) provided prior to the development of the IP or not included in the IP are not compensable.  The Plan may not be backdated;

• (C) may be provided on an emergency basis when approved by the area manager or designee.  The plan must be revised to reflect the additional services; and

• (D) are provided by qualified provider entities contracted with the OHCA.

• (2) Members have freedom of choice of providers and in the selection of HCBS or institutional services.