OHCA Policies and Rules

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[Revised 06-25-12]
(a) Members in the Living Choice Program.
(1) The member remains eligible during periods of institutionalization as long as the stay does not exceed 30 days.
(2) A member with an institutional stay longer than 30 days may re-enroll in the program without re-establishing the 90 day institutional residency requirement if:
(A) the necessity for the institutionalization is documented in the revised individual transition plan; and
(B) the member can safely return to the community as determined by the transition coordinator, the member and the transition planning team. 
(3) The re-enrolled member is eligible to receive services for any remaining days up to the 365 day limit.
(b) Members no longer in the Living Choice Program.
(1) Members who have completed 365 days in the Living Choice Program and have been re-institutionalized for a minimum of 90 consecutive days may be eligible for re-enrollment in the Living Choice Program. Before re-enrollment of a former member, a re-evaluation of the former member's plan of care must be completed and a determination made if the plan of care could not be carried out as a result of:
(A) medical and/or behavioral changes resulting in the necessity of readmission into the inpatient facility;
(B) the lack of community services to support the member that were identified in the original plan of care; or
(C) the plan of care was not supported by the delivery of quality services.
(2) After determining the basis for re-institutionalization and creation of a new plan of care that ensures the health and safety of the former member, he/she may be re-enrolled for an additional 365 days.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.