Library: Policy

317:35-19-16. PASRR appeals process

Revised 9-1-19

(a) Any individual who has been adversely affected by any Preadmission Screening and Resident Review (PASRR) determination made by the State in the context of either a preadmission screening or an annual resident review may appeal that determination by requesting a fair hearing.If the individual does not consider the PASRR decision a proper one, the individual or their authorized representative must contact the local county Oklahoma Department of Human Services (DHS) office to discuss a hearing.Forms for requesting a fair hearing (DHS Form 13MP001E, Request for a Fair Hearing), as well as assistance in completing the forms, can be obtained at the local county DHS office.Any request for a hearing must be made no later than thirty (30) days following the date of written notice.Appeals of these decisions are available under Oklahoma Administrative Code (OAC) 317:2-1-2.There is no distinction between the SoonerCare and non-SoonerCare patient; therefore, all individuals seeking an appeal have the same rights, regardless of source of payment.Level I determinations are not subject to appeal.

(b) When the individual is found to experience Mental Illness (MI), Intellectual Disability (ID), or related condition through the Level II screen, the PASRR determination made by the ID/MI authorities cannot be countermanded by the Oklahoma Health Care Authority, either in the claims process or through other utilization control/review processes, or by the Oklahoma State Department of Health.Only appeals determinations made through the fair hearing process may overturn a PASRR determination made by the ID/MI authorities.