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Library: Policy

317:30-5-970. Eligible providers

Issued 5-11-98

(a) Case management agencies. Services are provided by case management agencies established for the purpose of providing case management services.  Medicaid Office of Juvenile Affairs Targeted Case Management (OJATCM) services must be made available to all eligible recipients and must be delivered by provider agencies on a statewide basis with procedures that assure 24 hour availability, the protection and safety of recipients, continuity of services without duplication, and compliance with federal and State mandates and regulations related to servicing the targeted population are met in a uniform and consistent manner.  The agency must demonstrate that their staff has:  

  • (1) experience working with the target population.
  • (2) a minimum of five years experience in providing all core elements of case management services including:
    • (A) individualized strengths and needs assessment;
    • (B) needs-based service planning;
    • (C) service coordination and monitoring; and
    • (D) on-going assessment and treatment plan revision.
  • (3) adequate administrative capacity to fulfill State and federal requirements.
  • (4) a financial management capacity and system that provides documentation of services and costs.
  • (5) a capacity to document and maintain individual case records in accordance with State and federal requirements.
  • (6) ability to meet all State and federal laws governing the participation of providers in the State Medicaid program including, but not limited to, the ability to meet federal and State requirements for documentation, billing and audits.
  • (7) statutory authority to care for, supervise and provide services to the targeted population on a statewide basis.
  • (8) a minimum of five years experience in providing case management services that coordinate and link the community resources required by the target population.
  • (9) a minimum of five years experience in meeting the case management and service needs of the target population, including the statewide contract management/oversight and administration of services funded through the Oklahoma Children's Initiative.
  • (10) responsibility for planning and coordinating statewide juvenile justice and delinquency prevention services in accordance with Title 10, Section 7302-3.1A. of Oklahoma Statutes.

(b) Provider agreement. A Provider Agreement between the Oklahoma Health Care Authority and the provider agency for OJATCM services must be in effect before reimbursement can be made for compensable services.

(c) Qualifications of individual case managers.  A targeted case manager for the OJATCM program must:

  • (1) be employed by the provider agency or its contractor.
  • (2) posses a minimum of a bachelor's degree in a behavioral science or a bachelor's degree and one year of professional experience in juvenile justice or a related field.
  • (3) possess knowledge of laws, rules, regulations, legislation, policies and procedures as they pertain to:
    • (A) the State administration of juvenile justice and the investigation of juvenile delinquency;
    • (B) community resources;
    • (C) human developmental stages and related dysfunctions;
    • (D) social work theory and practices;
    • (E) emotional, physical and mental needs of children and families;
    • (F) sensitivity to cultural diversity; and
    • (G) clinical and counseling techniques and treatment of juvenile delinquency.
  • (4) possess skill in:
    • (A) crisis intervention;
    • (B) gathering necessary information to determine the needs of the child;
    • (C) casework management;
    • (D) courtroom testimony, terminology and procedures;
    • (E) effective communication;
    • (F) developing, evaluating and modifying an intervention plan on an ongoing basis;
    • (G) establishing and maintaining constructive relationships with children and their families;
    • (H) helping families become and maintain as functional family units; and
    • (I) working with courts and law enforcement entities.

(d) Provider selection.  Provision of case management services must not restrict an individual's free choice of providers.  Eligible recipients must have free choice of providers of case management as well as providers of other medical care under the plan.

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