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Chapter 35MEDICAL ASSISTANCE FOR ADULTS AND CHILDREN-ELIGIBILITY
SubChapter 1GENERAL PROVISIONS
317:35-1-1.Purpose
317:35-1-2.Definitions
317:35-1-3.Legal bases
SubChapter 3COVERAGE AND EXCLUSIONS
317:35-3-1.Reimbursement
317:35-3-2.SoonerCare transportation and subsistence
317:35-3-3.Prior authorization requirements
SubChapter 5ELIGIBILITY AND COUNTABLE INCOME
Part 1DETERMINATION OF QUALIFYING CATEGORICAL RELATIONSHIP
317:35-5-1.Scope and applicability
317:35-5-2.Categorically related programs
317:35-5-3.Determining categorical relationship to the aged
317:35-5-4.Determining categorical relationship to the disabled
317:35-5-4.1.Special level of care and cost effectiveness application procedures for TEFRA
317:35-5-4.2.Determining nursing facility level of care for TEFRA children
317:35-5-4.3.Determining acute hospital level of care for TEFRA children
317:35-5-5.Determining categorical relationship to the blind
317:35-5-6.Determining categorical relationship to pregnancy-related services
317:35-5-6.1.Determining categorical relationship for pregnancy related services covered under Title XXI
317:35-5-7.Determining categorical relationship to the children and parent and caretaker relative groups
317:35-5-8.Determining categorical relationship for the Family Planning Waiver Program
Part 3NON-MEDICAL ELIGIBILITY REQUIREMENTS
317:35-5-25.Citizenship/alien status and identity verification requirements
317:35-5-26.Residence requirements; residents of public institutions; homeless persons; and residents of IHS, BIA or Tribal controlled dormitories
317:35-5-27.Social Security number
Part 5COUNTABLE INCOME AND RESOURCES
317:35-5-40.Scope and applicability
317:35-5-41.Determination of capital resources for individuals categorically related to aged, blind and disabled
317:35-5-41.1.Home/real property
317:35-5-41.2.Miscellaneous Personal property
317:35-5-41.3.Automobiles, pickups, and trucks
317:35-5-41.4.Stocks and bonds
317:35-5-41.5.Purchase of promissory notes, loans, or mortgages
317:35-5-41.6.Trust accounts
317:35-5-41.7.Retirement funds
317:35-5-41.8.Eligibility regarding long-term care services
317:35-5-41.9.Resource disregards
317:35-5-41.10.Changes in capital resources
317:35-5-41.11.Maximum resources
317:35-5-42.Determination of countable income for individuals categorically related to aged, blind and disabled
317:35-5-43.Third party resources; insurance, workers' compensation and Medicare
317:35-5-44.Child/spousal support
317:35-5-45.Determination of income and resources for children and parents and caretaker relatives
317:35-5-46.Determination of income and resources for categorical relationship to pregnancy-related services
317:35-5-47.Determination of income and resources for categorical relationship to Disability for TB infected individuals
317:35-5-48.Reserved
317:35-5-49.Determination of income and resources for categorical relationship to TEFRA
Part 7APPLICATION AND ELIGIBILITY DETERMINATION PROCEDURES
317:35-5-60.Application for SoonerCare; forms
317:35-5-61.[RESERVED]
317:35-5-62.[RESERVED]
317:35-5-62.1.Electronic Notices
317:35-5-63.Agency responsible for determination of eligibility
317:35-5-64.Cooperation in determination of eligibility
SubChapter 6SOONERCARE FOR PREGNANT WOMEN AND FAMILIES WITH CHILDREN
Part 1GENERAL
317:35-6-1.Scope and applicability
Part 3APPLICATION PROCEDURES
317:35-6-15.Application for SoonerCare for Pregnant Women and Families with Children; forms
Part 5DETERMINATION OF ELIGIBILITY FOR SOONERCARE HEALTH BENEFITS FOR PREGNANT WOMEN AND FAMILIES WITH CHILDREN
317:35-6-35.General eligibility consideration
317:35-6-36.Financial eligibility of individuals categorically related to AFDC or pregnancy-related services
317:35-6-37.Financial eligibility of categorically needy individuals related to AFDC or pregnancy-related services
317:35-6-38.Hospital Presumptive Eligibility
317:35-6-39.General calculation of countable income for MAGI eligibility groups
317:35-6-40.MAGI household composition; taxpayers and tax dependents
317:35-6-41.MAGI household composition; tax filers
317:35-6-42.MAGI household composition; exceptions to tax filer rules
317:35-6-43.MAGI household composition; non-filers
317:35-6-44.Determination of whether a household member's income is counted
Part 6COUNTABLE INCOME FOR MAGI
317:35-6-50.Countable sources of income
317:35-6-51.Exceptions to Internal Revenue Code rules
317:35-6-52.Adjustments to income
317:35-6-53.Determination of current monthly income
317:35-6-54.Determination of current monthly amount of adjustments to income
Part 7CERTIFICATION, REDETERMINATION AND NOTIFICATION
317:35-6-60.Certification for SoonerCare for pregnant women and families with children
317:35-6-60.1.Changes in circumstances
317:35-6-61.Redetermination of eligibility for persons receiving SoonerCare
317:35-6-62.Notification of eligibility
317:35-6-63.Denials
317:35-6-64.Closures
317:35-6-64.1.Transitional Medical Assistance (TMA)
317:35-6-65.Transfer of case records between counties
SubChapter 7MEDICAL SERVICES
Part 1GENERAL
317:35-7-1.Scope and applicability
Part 3APPLICATION PROCEDURES
317:35-7-15.Application for Medical Services; forms [REVOKED]
317:35-7-16.Special application procedures for children in OKDHS custody
317:35-7-17.Special application procedures for children in emergency shelters [REVOKED]
317:35-7-18.Special application procedures for a child in Children's Hospital of Oklahoma (CHO) [REVOKED]
317:35-7-19.Special application procedures for categorically needy pregnant women and young children [REVOKED]
Part 5DETERMINATION OF ELIGIBILITY FOR MEDICAL SERVICES
317:35-7-35.General eligibility consideration; categorically related family members [REVOKED]
317:35-7-36.Financial eligibility of individuals categorically related to ABD
317:35-7-37.Financial eligibility of individuals categorically related to AFDC, or pregnancy-related services [REVOKED]
317:35-7-38.Financial eligibility of categorically needy individuals related to ABD
317:35-7-39.Financial eligibility of medically needy individuals [REVOKED]
317:35-7-40.Eligibility as Qualified Medicare Beneficiary Plus
317:35-7-41.Eligibility as Qualified Disabled and Working Individual
317:35-7-42.Presumptive eligibility for pregnant women [REVOKED]
317:35-7-43.Eligibility as Specified Low-Income Medicare Beneficiaries
317:35-7-44.Eligibility for TB related services
317:35-7-45.Eligibility for catastrophic illness [REVOKED]
317:35-7-46.Eligibility as Qualifying Individuals
317:35-7-48.Eligibility for the SoonerPlan Family Planning Program
Part 7CERTIFICATION, REDETERMINATION AND NOTIFICATION
317:35-7-60.Certification for SoonerCare
317:35-7-60.1.Certification for the SoonerPlan Family Planning Program.
317:35-7-61.Redetermination of eligibility for persons receiving ABD or TANF
317:35-7-61.1.Special redetermination procedures for TEFRA
317:35-7-62.Special redetermination procedures for children in custody or subsidized adoptions
317:35-7-63.Notification of eligibility [REVOKED]
317:35-7-64.Denials [REVOKED]
317:35-7-65.Closures [REVOKED]
317:35-7-66.Transfer of case records between counties [REVOKED]
SubChapter 9ICF/IID, HCBW/IID, AND INDIVIDUALS AGE 65 OR OLDER IN MENTAL HEALTH HOSPITALS
Part 1SERVICES
317:35-9-1.Overview of long-term medical care services; relationship to QMB, SLMB, and other Medicaid services eligibility, and spenddown calculation
317:35-9-2.Services in a Nursing Facility (NF) [REVOKED]
317:35-9-3.ADvantage program services [REVOKED]
317:35-9-4.Services in Intermediate Care Facility for Individuals with Intellectual Disabilities (public and private)
317:35-9-5.Home and Community - Based Services (HCBS) Waivers for persons with an intellectual disability or certain persons with related conditions
317:35-9-5.1.Home and Community Based Waiver Services for individuals with mental retardation and related conditions [REVOKED]
317:35-9-6.Non-Technical Medical Care in own home [REVOKED]
317:35-9-7.Services for persons age 65 or older in mental health hospitals
Part 2MEDICAID RECOVERY PROGRAM
317:35-9-15.Medicaid recovery
Part 3APPLICATION PROCEDURES
317:35-9-25.Application for ICF/MR, HCBW/MR, and persons aged 65 or over in mental health hospitals.
317:35-9-26.Application procedures for private ICF/MR
317:35-9-27.Application procedures for public ICF/MR
317:35-9-28.Application procedures for services provided by Developmental Disability Services Division (DDSD)
317:35-9-29.Application procedures for persons age 65 or older in mental health hospitals
317:35-9-30.Special application procedures for children in DHS custody [REVOKED]
Part 5DETERMINATION OF MEDICAL ELIGIBILITY FOR ICF/IID, HCBW/IID, AND INDIVIDUALS AGE 65 OR OLDER IN MENTAL HEALTH HOSPITALS
317:35-9-45.Determination of medical eligibility for care in a private Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)
317:35-9-45.1.Determination of medical eligibility for Non-Technical Medical Care [REVOKED]
317:35-9-46.Determination of continued medical eligibility for care in NF and private ICF/MR [REVOKED]
317:35-9-47.Determination of continued medical eligibility for NTMC [REVOKED]
317:35-9-48.Determination of medical eligibility for care in public ICF/MR
317:35-9-48.1.Determining ICF/IID institutional level of care for TEFRA children
317:35-9-49.Determination of medical eligibility for Home and Community Based Waiver Services for the Intellectually Disabled
317:35-9-50.Determination of medical eligibility for persons age 65 or older in mental health hospitals
317:35-9-51.Change in level of long-term medical care [REVOKED]
317:35-9-52.Determination of medical eligibility for the ADvantage waiver [REVOKED]
Part 7DETERMINATION OF FINANCIAL ELIGIBILITY
317:35-9-65.General financial eligibility requirements for ICF/MR, HCBW/MR, and individuals age 65 or older in mental health hospitals
317:35-9-66.Determining financial eligibility for ADvantage waiver [REVOKED]
317:35-9-67.Determining financial eligibility of categorically needy individuals
317:35-9-68.Determining financial eligibility for care in an ICF/MR (public and private), for HCBW/MR services, and for persons age 65 or older in mental health hospitals
Part 9CERTIFICATION, REDETERMINATION AND NOTIFICATION
317:35-9-75.Certification for long-term medical care through ICF/MR, HCBW/MR services and to persons age 65 and older in a mental health hospital
317:35-9-76.Redetermination of financial eligibility for long-term medical care
317:35-9-77.Case transfer between categories
317:35-9-78.Case changes
Part 11PAYMENT, BILLING, AND OTHER ADMINISTRATIVE PROCEDURES
317:35-9-95.Payment to ICF/MR (public and private)
317:35-9-96.Non-Technical Medical Care providers; billing, training, and program administration [REVOKED]
317:35-9-97.Payment for Home and Community Based Waiver services for the Intellectually Disabled (HCBW/ID)
317:35-9-98.Payment to mental health hospitals
317:35-9-99.Billing procedures for ICF/MR, HCBW/MR services and services for individuals 65 older in a mental health hospital
317:35-9-100.Management of client's funds while receiving care in NF, ICF/MR (public and private) or for persons age 65 or older in mental health hospitals
317:35-9-101.Disclosure of information on health care providers and contractors
317:35-9-102.Referral for social services
317:35-9-103.Special procedures for release of adults in mental health hospitals to long-term care facilities
SubChapter 10OTHER ELIGIBILITY FACTORS FOR FAMILIES WITH CHILDREN AND PREGNANT WOMEN
Part 1GENERAL PROVISIONS
317:35-10-1.[RESERVED]
317:35-10-2.[RESERVED]
Part 3RESOURCES
317:35-10-10.Capital resources
317:35-10-11.Home property [TERMINATED]
317:35-10-12.Real property other than home property [TERMINATED]
317:35-10-13.Personal property [TERMINATED]
317:35-10-14.Trust accounts [TERMINATED]
317:35-10-15.Transfer or disposal of capital resources [TERMINATED]
317:35-10-16.Resources acquired while receiving assistance [TERMINATED]
317:35-10-17.Family relations as a resource [TERMINATED]
317:35-10-18.Maximum reserve [TERMINATED]
Part 5INCOME
317:35-10-25.Income defined
317:35-10-26.Income
317:35-10-27.Gross income maximum [REVOKED]
317:35-10-28.Lump sum payments [REVOKED]
317:35-10-29.Irregular income [REVOKED]
317:35-10-30.Consideration of income of a relative-payee other than a natural or adoptive parent [REVOKED]
317:35-10-31.Earned income [REVOKED]
317:35-10-32.Determination of earned income [REVOKED]
317:35-10-33.Individual Earned income exemptions [REVOKED]
317:35-10-34.Conditions under which exemptions are not allowed [REVOKED]
317:35-10-35.Formula for determining the individual's net earned income [REVOKED]
317:35-10-36.Income other than earned income [REVOKED]
317:35-10-37.Income disregards [REVOKED]
317:35-10-38.Temporary absence from the home.
Part 7BUDGETING AND ASSISTANCE PAYMENTS
317:35-10-55.Structure of the assistance unit [REVOKED]
317:35-10-56.Special considerations in budgeting [REVOKED]
317:35-10-57.Income determination procedures [REVOKED]
317:35-10-58.Budgeting [REVOKED]
Part 9CONDITIONS OF ELIGIBILITY-AGE AND RESIDENCE
317:35-10-65.Age [REVOKED]
317:35-10-66.Residence [REVOKED]
317:35-10-67.Homeless individuals [REVOKED]
317:35-10-68.Institutional residence [REVOKED]
Part 11CONDITIONS OF ELIGIBILITY-RELATIONSHIP OF PAYEE TO CHILD
317:35-10-75.Relationship of payee to child [REVOKED]
317:35-10-76.Definition of "living with a relative" [REVOKED]
317:35-10-77.Verification of relationship [REVOKED]
Part 13CONDITIONS OF ELIGIBILITY-DEPRIVATION OF PARENTAL SUPPORT OR CARE BY A NATURAL OR ADOPTIVE PARENT
317:35-10-85.Deprivation of parental support or care by a natural or adoptive parent [REVOKED]
317:35-10-86.Procedures for determining continued absence [REVOKED]
317:35-10-87.Requirement for assignment of support rights and cooperation [REVOKED]
317:35-10-88.Good cause [REVOKED]
317:35-10-89.DHS responsibilities in relation to support payments [REVOKED]
317:35-10-90.Physical or mental incapacity of natural or adoptive parent [REVOKED]
317:35-10-91.Transportation and subsistence necessary to determine incapacity [REVOKED]
317:35-10-92.Determination of incapacity at specified times other than at time of application [REVOKED]
317:35-10-94.Notification of denial or closure [REVOKED]
317:35-10-95.Unemployed parent [REVOKED]
Part 15CONDITIONS OF ELIGIBILITY-SCHOOL ATTENDANCE
317:35-10-100.School attendance [REVOKED]
Part 17CONDITIONS OF ELIGIBILITY- CITIZENSHIP AND ALIENAGE
317:35-10-105.Requirements [TERMINATED]
317:35-10-106.Citizenship [TERMINATED]
317:35-10-107.Alienage [TERMINATED]
317:35-10-108.Immigrants [TERMINATED]
317:35-10-109.Permanent residence under color of law (PRUCOL) [TERMINATED]
317:35-10-110.Parolees [TERMINATED]
317:35-10-111.Refugees [TERMINATED]
317:35-10-112.Conditioned entries of aliens made available by the Attorney General of the United States for emergent reasons or for reasons deemed strictly in the public interest [TERMINATED]
317:35-10-113.Special provisions relating to Kickapoo Indians [TERMINATED]
SubChapter 11PROJECTS
317:35-11-1.Grants and local projects
317:35-11-2.Poison control services [REVOKED]
SubChapter 13MEMBER RIGHTS AND RESPONSIBILITIES
317:35-13-1.Civil rights
317:35-13-2.Courteous and prompt action
317:35-13-3.Choice of providers
317:35-13-4.Release of medical information
317:35-13-5.Overpayments
317:35-13-6.Fraud
317:35-13-7.Program Abuse and Administrative Sanctions
SubChapter 15PERSONAL CARE SERVICES
317:35-15-1.Overview of long-term medical care services; relationship to QMBP, SLMB, and other SoonerCare services and eligibility
317:35-15-2.Personal care services
317:35-15-3.Application for Personal Care
317:35-15-4.Determination of medical eligibility for Personal Care
317:35-15-5.General financial eligibility requirements for Personal Care
317:35-15-6.Determining financial eligibility of categorically needy individuals
317:35-15-7.Certification for Personal Care
317:35-15-8.Agency personal care service authorization and monitoring
317:35-15-8.1.Agency Personal Care services; billing, and problem resolution
317:35-15-9.Redetermination of financial eligibility for Personal Care
317:35-15-10.Redetermination of medical eligibility for personal care services
317:35-15-11.Case transfer between categories [REVOKED]
317:35-15-12.Case changes
317:35-15-13.Personal Care contractor; billing, training, and program administration [REVOKED]
317:35-15-13.1.Individual personal care service management
317:35-15-13.2.Individual personal care assistants (IPCA) provider contractor; billing, training, and problem resolution
317:35-15-14.Billing procedures for personal care
317:35-15-15.Referral for social services
SubChapter 17ADVANTAGE WAIVER SERVICES
317:35-17-1.Overview of long-term medical care services; relationship to Qualified Medicare Beneficiary Plus (QMBP), Specified Low-Income Medicare Beneficiary (SLMB), and other Medicaid services eligibility
317:35-17-2.Level of care medical eligibility determination
317:35-17-3.ADvantage program services
317:35-17-4.Application for ADvantage services
317:35-17-5.ADvantage program medical eligibility determination
317:35-17-6.Pre-admission screening [REVOKED]
317:35-17-7.PASRR screening process [REVOKED]
317:35-17-8.1.PASRR appeals process [REVOKED]
317:35-17-9.General financial eligibility requirements for the ADvantage program
317:35-17-10.Determining financial eligibility/categorical relationship for the ADvantage program
317:35-17-11.Determining financial eligibility for ADvantage program services
317:35-17-12.Certification for ADvantage program services
317:35-17-13.Certification for ADvantage program services [REVOKED]
317:35-17-14.Case management services
317:35-17-15.Redetermination of eligibility for ADvantage services
317:35-17-16.Member annual level of care re-evaluation and annual re-authorization of service plan
317:35-17-17.Supplemental process for expedited eligibility determination (SPEED)
317:35-17-18.ADvantage services during hospitalization or NF placement
317:35-17-19.Closure or termination of ADvantage services
317:35-17-20.Case transfer between categories [REVOKED]
317:35-17-21.Case changes
317:35-17-21.1.ADvantage and agency Personal Care provider certification
317:35-17-22.Billing procedures for ADvantage services
317:35-17-23.Disclosure of information on health care providers and contractors
317:35-17-24.Referral for social services
317:35-17-25.Address Confidentiality Program
SubChapter 18PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY
317:35-18-1.Programs of All-Inclusive Care for the Elderly (PACE)
317:35-18-2.Introduction
317:35-18-3.Definitions
317:35-18-4.Provider regulations
317:35-18-5.Eligibility criteria
317:35-18-6.Program benefits
317:35-18-7.Appeals process
317:35-18-8.Enrollment
317:35-18-9.Continuation of enrollment
317:35-18-10.Disenrollment (voluntary and involuntary)
317:35-18-11.Data collection and reporting
317:35-18-12.Medicaid Payments
SubChapter 19NURSING FACILITY SERVICES
317:35-19-1.Implementation of gatekeeping in NF [REVOKED]
317:35-19-2.Nursing Facility (NF) program medical eligibility determination
317:35-19-3.Services in a Nursing Facility (NF)
317:35-19-4.Medicaid recovery
317:35-19-5.Application for nursing facility care; forms
317:35-19-6.Application procedures for NF
317:35-19-7.Determination of medical eligibility for care in NF [REVOKED]
317:35-19-7.1.Level of care medical eligibility determination
317:35-19-8.Pre-admission screening and resident review
317:35-19-9.PASRR screening process
317:35-19-10.Level II screen for PAS [REVOKED]
317:35-19-11.Annual Resident Review (ARR) [REVOKED]
317:35-19-12.Level I screen for ARR [REVOKED]
317:35-19-13.Level II screen for ARR [REVOKED]
317:35-19-14.New admissions, readmissions, interfacility transfers, and same level of care program transfers
317:35-19-15.PASARR tracking system [REVOKED]
317:35-19-16.PASRR appeals process
317:35-19-18.Change in level of long-term medical care
317:35-19-19.General financial eligibility requirements for NF and skilled nursing care
317:35-19-20.Determining financial eligibility of categorically needy individuals
317:35-19-21.Determining financial eligibility for care in NF
317:35-19-22.Certification for NF
317:35-19-22.1.Discharge planning
317:35-19-23.Redetermination of eligibility for NF care
317:35-19-24.Case transfer between categories
317:35-19-25.Case changes
317:35-19-26.Payment to NF
317:35-19-27.Billing procedures for NF
317:35-19-28.Management of client's funds while receiving care in NF
317:35-19-29.Disclosure of information on health care providers and contractors
317:35-19-30.Referral for social services
317:35-19-31.Special procedures for release of adults in mental health hospitals to Nursing Facilities
SubChapter 21OKLAHOMA CARES BREAST AND CERVICAL CANCER TREATMENT PROGRAM
317:35-21-1.Oklahoma Cares Breast and Cervical Cancer Treatment program
317:35-21-2.Scope of coverage
317:35-21-3.CDC screening
317:35-21-4.Creditable coverage
317:35-21-5.In need of treatment
317:35-21-6.Age requirements
317:35-21-7.Citizenship and Residence
317:35-21-8.Social security number
317:35-21-9.Income
317:35-21-10.Resources
317:35-21-11.Certification for BCC
317:35-21-12.Changes after certification/continued need for treatment
317:35-21-13.Redetermination
317:35-21-14.Appeals and reconsiderations
SubChapter 22PREGNANCY RELATED BENEFITS COVERED UNDER TITLE XXI
317:35-22-1.Pregnancy related benefits covered under Title XXI
317:35-22-2.Scope of coverage for Title XXI Pregnancy
317:35-22-2.1.Non-covered services
317:35-22-3.Need for pregnancy related services for the unborn child
317:35-22-4.Citizenship
317:35-22-5.Social Security number
317:35-22-6.Income
317:35-22-7.Resources
317:35-22-8.Period of eligibility
317:35-22-9.Notification of eligibility
317:35-22-10.Denials
317:35-22-11.Closures
SubChapter 23LIVING CHOICE PROGRAM
317:35-23-1.Living Choice program
317:35-23-2.Eligibility criteria
317:35-23-3.Participant disenrollment
317:35-23-4.Re-enrollment

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.