Library: Policy

317:30-5-951. Coverage by category

Revised 8-2-06

SoonerCare payment is made to agencies, on behalf of SoonerCare members, for personal care services (PC services) provided in the member's home. Personal Care services may be provided in an educational or employment setting to assist the member in achieving vocational goals identified on an approved care plan. Personal care services prevent or minimize a member's physical health regression and deterioration. Tasks performed during the provision of PC services include, but are not limited to, assisting an individual in performing tasks of personal hygiene, dressing and medication. Tasks may also include meal preparation, light housekeeping, errands, and laundry directly related to the recipient's personal care needs. Personal care does not include the provision of care of a technical nature. For example, tracheal suctioning, bladder catheterization, colostomy irrigation and operation/maintenance of technical machinery is not performed as part of PC services. PC skilled nursing service is an assessment of the member's needs to determine the frequency of PC services and tasks performed, development of a PC service care plan to meet identified personal care needs, service delivery oversight and annual re-assessment and updating of care plan. It may also include more frequent re-assessment and updating of the care plan if changes in the member's needs require.

(1) Adults. Payment for services provided by a PC services agency is made on behalf of eligible individuals who have needs requiring the service in accordance with OAC 317:35-15-4 as determined through an assessment utilizing the Uniform Comprehensive Assessment Tool (UCAT). Before PC services can begin the individual must:

(A) require a care plan involving the planning and administration of services delivered under the supervision of professional personnel;
(B) have a physical impairment or combination of physical and mental impairments;
(C) lack the ability to meet personal care needs without additional supervision or assistance, or to communicate needs to others; and
(D) require assistance, not of a technical nature, to prevent or minimize physical health regression and deterioration.

(2) Children. Coverage for persons under 21 years of age is the same as for adults.