Library: Policy

317:30-5-952. Prior authorization

Revised 4-1-09

         Eligible members receiving personal care services must have an approved care plan developed by a PC services skilled nurse.  For persons receiving ADvantage Program services, the nurse works with the member's ADvantage Program Case Manager to develop the care plan.  The amount and frequency of the service, to be provided to the member, is listed on the care plan.  The amount and frequency of PC services is approved by the OKDHS nurse or authorized in the ADvantage Program Service Plan.  At the time of a member's initial referral to a PC services agency, OKDHS/ASD authorizes PC services, skilled nursing for PC services, needs assessment and care plan development.  The number of units of PC services or PC skilled nursing the member is eligible to receive is limited to the amounts approved on the care plan as authorized by OKDHS/ASD.  Care plans are authorized for no more than one year from the date of care plan authorization.  Services provided without prior authorization are not compensable.