Library: Policy

317:50-1-13. Coverage

Issued 8-1-10

     Individuals receiving Waiver services must have been determined to be eligible for the program and must have an approved plan of care.  Any Medically Fragile Program service provided must be listed on the approved plan of care and must be necessary to prevent institutionalization of the member.  Waiver services which are expansions of Oklahoma Medicaid State Plan services may only be provided after the member has exhausted these services available under the State Plan.

• (1) To allow for development of administrative structures and provider capacity to adequately deliver Self-Directed  services and Supports, availability of Self-Direction is limited to Medically  Fragile Program members that reside in counties that have sufficient provider capacity to offer the Self-Directed Service option as determined by OHCA.

• (2) Case Managers within the Self-Directed Services approved area will provide information and materials that explain the service option to the members.  The OHCA provides information and material on Self-Direction to Case Managers for distribution to members. 

• (3) The member may request to Self-Direct their services from their Case Manager or call the Medically Fragile Program  toll-free number to request the Self-Directed Services option.