Library: Policy

317:35-19-22. Certification for nursing facility (NF)

Revised 9-14-18

(a) Application date. The date of the application for NF care is most important in determining the date of eligibility. If the applicant is found eligible for SoonerCare, certification may be made retroactive for any service provided on or after the first day of the third month prior to the month of application and for future months. • 1

(b) Time limited approvals for nursing care. A medical certification period of a specific length may be assigned for an individual who is categorically related to Aged, Blind and Disabled or Aid to Families with Dependent Children. This time limit is noted on the system. It is the responsibility of the nursing facility to notify the area nurse thirty (30) days prior to the end of the certification period if an extension of approval is required by the client. Based on the information from the NF the area nurse, or nurse designee, determines whether or not an update of the Uniform Comprehensive Tool (UCAT) is necessary for the extension. The area nurse, or nurse designee, coordinates with appropriate staff for any request for further UCAT assessments.

(c) Certification period for long-term medical care. A financial certification period of twelve (12) months is assigned for an individual who is approved for long-term care.  • 2

INSTRUCTIONS TO STAFF 317:35-19-22

Issued 1-15-19

1. The Oklahoma Health Care Authority no longer issues or prints copies of medical identification (ID) cards. Providers verify a member's eligibility by accessing the Eligibility Verification System, also known as the "Provider Network," at www.okhca.org through the Provider Portal. When members need a physical card for community resources purposes:

(1) Online Enrollment members may log on to their Online Member Account and print the card; and

(2) Non-Online Enrollment members may contact the local Oklahoma Department of Human Services (DHS) county office to obtain a printed version of the card. DHS staff enters the member's information into the Eligibility tab on the Medicaid Management Information System (MMIS) Extranet and clicks on the link "Display Member ID Card" to print a copy of the front and back of the medical ID card.

2. Refer to Quest article ICF/IID Authorizations vs. ICF Authorizations for correct level of care coding instructions.