Library: Policy
317:35-19-19. General financial eligibility requirements for NF and skilled nursing care
Revised 7-1-13
Rule text available at Oklahoma Health Care Authority website.
INSTRUCTIONS TO STAFF 317:35-19-19
Revised 6-1-21
1. (a) Persons who are enrolled in Medicare Part A are eligible for a skilled care payment. Refer to Quest article, "Skilled Care Overview".
(1) Medicare Part A pays for the first 20-calendar days of skilled care.
(2) It is only necessary to process a SoonerCare (Medicaid) application when the individual remains in skilled care longer than 20-calendar days so the Oklahoma Health Care Authority (OHCA) can pay the coinsurance for the days exceeding 20-calendar days.
(3) The provider bills OHCA for the coinsurance so it is not necessary to enter an authorization for skilled care in the Family Assistance/Client Services (FACS) system.
(b) When the individual's income is over the long-term-care categorically needy income standard, per Oklahoma Human Services (OKDHS) Appendix C-1, Maximum Income, Resource, and Payment Standards, Schedule VIII. B.1, a Medicaid Income Pension Trust (MIPT) can be established to be effective on the 31st day of skilled care. The MIPT must be both set up and funded by the 31st day in skilled care in order for the person to be eligible beginning on the 31st day.
2. When the individual remains in skilled care longer than 20-calendar days but less than 30-calendar days, the individual must meet the Qualified Medicare Beneficiary Plus standard, per OKDHS Appendix C-1, Schedule VI.
