Guidelines For Making A Referral

• All out of state referrals require prior medical review.
• If the treatment facility where the member is inpatient can provide overnight accommodations for the escort, or if the escort chooses to stay onsite, then overnight lodging is not authorized.
• Hospital Social Workers may continue to issue lodging and/or meals vouchers up to 14 days per medical stay (verification with member is required regarding number of days that they have been receiving lodging and /or meals services).
• Lodging &/or Meals Voucher may be discontinued at any time if criteria for visitation is not met.
• Lodging and/or Meals Authorization form (voucher)
• Room and Board Providers (list of lodging providers) 
• If lodging and/or meals services are needed beyond 14 days per medical stay, a referral must be submitted to OHCA Care Management for review.
• When submitting documents for a lodging and/or meals referral, documents are to be faxed for review 3 business days before the date lodging and/or meals services are needed; fax to OHCA Care Management – Attention: Social Services at 405-530-3217.

For Initial Referrals

• Fax a completed SoonerCare Lodging &/or Meals Request form or member’s proof of appointment.
• SoonerCare Lodging and/or Meals Request form (referral form).
• Proof of appointment must include the member’s name, phone number and SoonerCare ID number; the date, check in time, and duration of the appointment or procedure.

For Extended Stays (submit referral at least 3 business days before the 14th day limit)

• Fax an updated letter of medical necessity or the member’s most recent nursing progress notes/medical records.  Include the anticipated length of stay.
• Notify Care Management by phone or fax of the dates that the escort is requesting lodging and/or meals services, and how many days have already been approved for the member or escort.
• For NICU, the escort’s visitation log is required. Visitation must total a minimum of 6 hours per 24 hours to be eligible for continued lodging and/or meals services. (also, see note below)

Notes

• Meals will be reimbursed only if an overnight stay occurs and the stay meets the lodging criteria. OAC 317:35-3-2.
• If the member and/or escort meets the criteria for lodging services and stays overnight, but does not receive SoonerCare assistance for lodging, then the member and/or escort may still be eligible for meals assistance/reimbursement.
• The member and/or escort are not eligible for reimbursement for meals if the lodging provider submits a claim for meal reimbursement because they are providing meals/food to the member.
• If criteria for lodging and/or meals services are met, then the escort for the NICU infant can be approved for the first 7 days. The escort must maintain a visitation log showing sign in/out times at the NICU.