Library: Policy

340:15-3-1. Eligibility and available services

Revised 9-14-24

(a) Supplemental Security Income-Disabled Children's Program (SSI-DCP). SSI-DCP is established, per Sections 504 and 1615 of the Social Security Act, Sections 704 and 1382d of Title 42 of the United States Code. SSI-DCP is a federally-funded social services program for children with special health care needs, and is supported by the Maternal and Child Health Services Title V Block Grant. Pursuant to Section 175.5 of Title 10 of the Oklahoma Statutes, Oklahoma Human Services (OKDHS) administers the Children with Special Health Care Needs Program, and Adult and Family Services (AFS) oversees SSI-DCP.

(1) AFS Health Related and Medical Services (HR&MS) staff pre-approves SSI-DCP services and equipment except supplemental formula. AFS HR&MS staff considers many factors in deciding which services or equipment to approve including, but not limited to:

(A) the child's needs;

(B) the availability of other resources;

(D) the cost of the service or equipment; and

(E) the availability of funding.

(2) A third party service provider accepts the service request, determines eligibility, and provides supplemental formula. AFS HR&MS oversees this provider through the contracting process.

(b) Eligibility. Any child from birth to 18 years of age may be eligible for SSI-DCP services when the child receives an SSI payment. SSA establishes financial and medical eligibility for the SSI disability payment. When the child becomes 18 years of age, he or she is no longer eligible for SSI-DCP services. • 1

(c) Child in OKDHS custody. When a child is in OKDHS custody and OKDHS retains the child's SSI, the child's SSI is used to pay for needed services and equipment prior to accessing SSI-DCP funds. • 2

(d) Service plan. Except for supplemental formula and when the child does not have a current service plan with another program within OKDHS or another agency, the AFS worker completes a service plan prior to providing SSI-DCP services to the child.

(1) The AFS worker interviews the parent, guardian, or caretaker by phone, in the office, or during a scheduled home visit to complete Form 08MA017E, SSI-DCP Service Plan. The service plan is reviewed yearly. When the child receives State Supplemental Payment, the AFS worker completes Form 08MA017E in conjunction with the eligibility renewal. • 3

(2) When the child receives services from another agency that requires a current social service plan, such as early intervention services through SoonerStart or special education services through the local public school, the SSI-DCP service plan is not necessary. • 4

(3) Within OKDHS, the child may receive services from Child Welfare Services (CWS), Developmental Disabilities Services (DDS), or Aging Services (AS) for State Plan Personal Care. When applicable, the AFS worker collaborates with CWS or DDS to:

(A) address the child's current and future social service needs; and

(B) avoid duplication in providing services. • 5

(e) Services. SSI-DCP provides funding for the services described in (1) and (2) of this subsection. The parent, guardian, or caretaker requests interaction and integration services through an AFS worker. A third party service provider handles supplemental formula requests. When a service provider is responsible for providing the service and the parent, guardian, or caretaker contacts an AFS worker, the worker provides the provider's contact information. • 6

(1) Formula. A health care professional provides a prescription naming the brand of formula the child needs for oral consumption. The parent, guardian, or caretaker must provide an updated prescription each year. • 7

(2) Interaction and integration services. Non-medical services aimed at strengthening the child physically or mentally; providing opportunities for social interaction; or assisting with mobility may be approved when recommended by an education or health care professional and the recommendation clearly defines the goals and objectives for the child. Examples of such services include, but are not limited to, swimming or horseback riding lessons, sports activities, or a health club membership. Due to budget constraints, services are available as a temporary supplement on a short-term basis. • 8

(f) Equipment. Equipment approved through SSI-DCP is used to aid the child in accessibility or mobility. Equipment available through SSI-DCP is pre-approved by AFS HR&MS staff. Available equipment that may be approved is described in (1) and (2) of this subsection. The parent, guardian, or caretaker provides a written recommendation from an education or health care professional with knowledge concerning the child's equipment needs. HR&MS staff does not approve requests for equipment the child can obtain through other sources, such as SoonerCare (Medicaid) or through the child's school. • 9

(1) Developmental aid. A developmental aid is any device or equipment adapted to meet the needs of a child with disabilities. An education or healthcare professional provides a written explanation concerning the goals and objectives this developmental aid meets before it is approved. Educational or classroom devices, equipment, or supplies not adapted for the child's needs are not in the scope of the program.

(2) Van lifts. Van lifts are devices used for vehicular transportation of wheelchairs. Van lifts may be approved when needed to transport a child in a wheelchair. A van lift is not approved for a child in OKDHS or tribal custody or in the DDS Home and Community-Based Waiver Program. Modifications to the van are not approved.

(A) The parent, guardian, or caretaker must own the van as verified by title registration and license verification, and the van must be in operating condition.

(B) The family provides estimates from two van lift dealers who employ certified van lift installation technicians. • 10

(D) Only a certified van lift specialist is approved to install the van lift and the van lift must have factory and dealership warranties equal to the private purchase warranty.

(E) HR&MS staff does not approve replacement of a van lift within 10 years of the purchase date.

(F) SSI-DCP staff does not pay for van or van lift repairs not purchased with SSI-DCP funds.

(g) Exclusions. Items or supplies not in the scope of SSI-DCP are not approved. Examples of excluded items or supplies include, but are not limited to:

(1) learning programs;

(2) psychological programs;

(3) books;

(4) video or audio tapes;

(5) paper, pencils, or art supplies;

(6) computers, tablet computers, or computer software;

(7) televisions; and

(8) video games.

(h) Purchasing procedures. SSI-DCP orders are processed through AFS HR&MS. Purchased equipment is shipped to the local OKDHS office. • 11

(i) SSI-DCP notices. When an SSI-DCP request is denied, AFS HR&MS staff sends Form 08MP038E, Client Notice of Action Taken, to inform the child's parent, guardian, or caretaker the item is not approved for purchase through SSI-DCP funding. • 12 The family may request a fair hearing by completing Form 13MP001E, Request for a Fair Hearing, within 30-calendar days from the issuance date of Form 08MP038E. • 13

(j) Respite Voucher Program. The Respite Voucher Program provides financial assistance in the form of vouchers to families to pay for respite care. When the family appears eligible for the Respite Voucher Program, the worker gives the client Form 08RV001E, Respite Voucher Application for Children With Special Health Care Needs, to complete. • 14 When funding is not available through HR&MS, the worker advises the family to call a designated number to request a respite voucher application from Sooner SUCCESS for the Lifespan Respite Grant Voucher Program. • 15 SSI-DCP, other OKDHS programs, and certain public and private agencies provide funding to the Respite Voucher Program.

(1) The caregiver is the person who provides ongoing care for the child. He or she may be a parent, grandparent, other relative, or non-relative.

(2) When respite care is approved the respite provider must be at least 18 years of age. Respite care is not: • 15

(A) designed to pay for ongoing care, such as child care, therapy, in-home assistance, housekeeping, or home health services; and

(B) provided by a member of the child's household.

INSTRUCTIONS TO STAFF 340:15-3-1

Revised 9-15-24

1. (a) A child must receive at least one dollar of Supplemental Security Income (SSI) to be eligible for the Supplemental Security Income-Disabled Children's Program (SSI-DCP).

(b) To determine if the child receives SSI, the Adult and Family Services (AFS) worker uses the Information Management System "PY" transaction. The worker:

(1) types "PY";

(2) presses the space bar; and

(3) types the child's Social Security number.

2. The AFS worker does not enter SSI-DCP authorizations for Child Welfare Services (CWS) staff.

(1) When CWS staff requests SSI-DCP services for the child from AFS, the AFS worker images the CWS service plan and emails a supervisor. The supervisor emails AFS Health Related & Medical Services (HR&MS) staff for instructions.

(2) When the child receives CWS services and Oklahoma Human Services (OKDHS) retains the child's SSI payment, OKDHS is listed as the payee on the SDX screen. When OKDHS retains the child's SSI, the child's equipment and service needs are normally met using the child's SSI payment or CWS funding.

(3) When OKDHS does not retain the child's SSI payment, HR&MS staff may approve SSI-DCP funds be used for the child in certain circumstances. When approved, CWS staff completes the SSI-DCP authorization.

3. (a) When no other social service program is involved, the AFS worker offers social services to the child's parent, guardian, or caretaker.

(1) The worker:

(A) interviews the parent, guardian, or caretaker by phone, in the office, or during a home visit to assess the child;

(B) evaluates the child's medical, developmental, social, educational, and rehabilitation needs; and

(C) documents social service needs by completing Form 08MA017E, SSI-DCP Service Plan.

(2) The worker images and files completed Form 08MA017E in the case record. Form 08MA017E:

(A) is completed at least once per year when SSI-DCP services are requested or received; and

(B) does not need to be completed yearly when SSI-DCP services are not requested or received.

(3) To approve the child for SSI-DCP, the worker certifies the Social Services tab in the Family Assistance/Client Service (FACS) Eligibility Notebook and adds the child to "social services" in the "benefit" field of the Household tab in the FACS Interview Notebook. The worker may close the Social Services tab when all service requests are completed.

(4) The worker also documents case actions in FACS Case Notes.

(b) At the annual renewal, the AFS worker interviews the parent, guardian, or caretaker by phone, in the office, or during a home visit, and updates the social service plan on Form 08MA017E to reflect changes or new requests.

4. (a) SoonerStart is an early intervention program within the Oklahoma State Department of Health that provides services for children with disabilities or developmental delays, from birth to 3 years of age. SoonerStart staff and the parent, guardian, or caretaker completes an Individualized Family Service Plan to address the child's needs.

(b) Local public school staff and the parent, guardian, or caretaker complete an Individualized Education Program social service plan for children who are 3 years of age and older and require special education and related services.

(c) The AFS worker images the alternate plan and makes a notation in FACS case notes. When the alternate plan is not available, the AFS worker and the parent, guardian, or caretaker complete Form 08MA017E.

5. When the child receives CWS or Developmental Disabilities Services (DDS) services, the child's equipment and service needs are normally met using CWS or DDS funding. When CWS or DDS staff requests SSI-DCP services for the child, the AFS worker images the CWS or DDS service plan in the case record and emails a supervisor. The supervisor emails AFS HR&MS staff for instructions.

6. (a) The worker images and files the written recommendation in the case record and documents the content of the recommendation in FACS case notes.

(b) Effective July 1, 2015, the Oklahoma Health Care Authority (OHCA) provides diapers and other medically necessary incontinence supplies under the Early and Periodic Screening, Diagnosis, and Treatment program through a contract with People First Industries (PFI). Incontinence supplies include diapers, pull-on briefs, liners, underpads, and wipes.

(1) When a child, who is at least 4 years of age, requires medically necessary incontinence supplies, the child's parent, guardian, or caretaker may obtain the supplies through PFI.

(2) The worker advises the child's parent, guardian, or caretaker to take OHCA Form HCA-52, Physician's Order for Incontinent Supplies, to the child's doctor to complete. When the doctor completes the form, he or she emails or faxes the form to PFI at the email address or fax number located on the form. In case of questions, PFI's phone number is 866-895-9956.

(3) After receiving Form HCA-52, PFI staff contacts the parent, guardian, or caretaker to obtain sizing information and to confirm the family's address for shipping.

(4) PFI sends the information to OHCA for approval. When approved, PFI ships the supplies to the family's address.

(c) Persons younger than 21 years of age, who are diagnosed with the genetic disorder phenylketonuria (PKU), may receive assistance for specialized formula supplements through SSI-DCP funds when they do not qualify for SoonerCare (Medicaid). SoonerCare (Medicaid) recipients are automatically entitled to access the supplements through their SoonerCare (Medicaid) coverage. Refer to the Quest article "How Do I Code Phenylketonuria (PKU) Eligibility in FACS?" for PKU eligibility factors and coding instructions.

7. Effective July 1, 2022, Sooner SUCCESS administers supplemental formula. Refer interested persons to:

(1) call (405) 271-2710;

(2) nutrition@ouhsc.edu; or

(3) https://bbmc.ouhsc.edu/redcap/surveys/?s=WXP7CJPF44.

8. Authorized field staff requests services on the AUSN-P screen.

9. (a) The imaged recommendation lists the:

(1) item name and number;

(2) vendor name, address, and phone number;

(3) item cost; and

(4) objectives and goals to be achieved through use of the equipment.

(b) The AFS worker inputs the request on the AUSN-E screen.

(1) The AFS worker contacts a supervisor, and the supervisor emails HR&MS staff prior to entering requests over $1,000 on the AUSN-E screen.

(2) To determine if the request is approved, the worker checks the AUSN screen under the HRS-APR column and looks for an 'A' for approval.

(3) Returned requests have an 'R' under the HRS-APR column along with the reason documented in the description area. HR&MS staff also emails the worker.

10. The AFS worker images and files the two estimates in the case record and inputs the van lift request on the AUSN-E screen to request approval. AFS HR&MS staff inputs the approval or denial on the AUSN-E screen.

11. (a) Orders are shipped to the OKDHS office unless otherwise specified. Heavier equipment items may be shipped directly to the child's home.

(1) The AFS worker ensures items shipped to the home were received intact without damage by phoning or making a home visit to confirm the receipt and condition of the items. When the family reports damage, the AFS worker contacts a supervisor, and the supervisor emails HR&MS staff for instructions. The worker documents the contact in FACS case notes.

(2) When the equipment is shipped to the OKDHS office, the worker is responsible for checking the shipment for accuracy and condition.

(3) Within 10-calendar days of delivery, the worker updates the AUSN-E screen under the CO DATE field to input the date the equipment was received.

(b) HR&MS staff pays for SSI-DCP equipment within 45-calendar days of equipment receipt to avoid interest charges being assessed by the vendor for a late payment. Delayed payment creates a problem for current or future orders because vendors hold orders until all late payments are received.

(c) AFS field staff notifies the family within 10-calendar days to arrange for pick-up or delivery and ensure delivery of all SSI-DCP items to the child. When there are problems with delivery, field staff contacts a supervisor, and the supervisor emails HR&MS for instructions within 20-calendar days of the delivery date.

12. AFS HR&MS staff notes SSI-DCP request denials on the AUSN screen by entering an 'N' for 'not approved' under the HRS-APR column and the reason for not approving the request in the description area for equipment or interaction and integration services.

13. When AFS HR&MS staff denies a request for services or equipment and the family requests an appeal, the AFS worker ensures the family receives Form 12MP001E, Request for a Fair Hearing.

14. (a) After the caregiver returns Form 08RV001E, Respite Voucher Application for Children With Special Health Care Needs, and HR&MS staff approves the application, OKDHS Financial Services staff sends the voucher to the caregiver to purchase respite care. When the application is denied, HR&MS staff sends the client Form 08MP038E, Client Notice of Action Taken, to deny the application and refer the client to Sooner SUCCESS.

(b) The child's caregiver and the respite provider complete the respite voucher and send it to OKDHS Financial Services for payment.

(c) Respite vouchers expire when not used within 90-calendar days of the issue date. When a voucher expires because respite care was not provided within 90-calendar days, the caregiver calls 405-521-3679 to reapply.

15. (a) Caregivers may request a Lifespan Respite Grant Voucher Program application by phoning toll-free 1-877-441-0434 or, in the Oklahoma City metro area, 405-271-5700, extension 47801.

(1) Refer to the Sooner Success website at http://soonersuccess.ouhsc.edu/ and click on Respite under the Services and Programs tab to locate information and eligibility guidelines.

(2) When the family meets Lifespan Respite Grant Voucher Program qualifications, an application is mailed to them.

(b) Additional information about Oklahoma respite voucher programs, including the SSI-DCP Respite Voucher Program and Lifespan Respite Grant Voucher Program, are found on the OKCares website at https://okcares.org. A Respite Locator button is located on the website Home Page.