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Part 71      EARLY INTERVENTION CASE MANAGEMENT SERVICES

317:30-5-620.Eligible providers
[Revised 6-11-99]
Services are provided statewide by case management providers established for the purpose of providing early intervention case management services. Services must be made available to all eligible recipients on a statewide basis, in a manner that ensures continuity of services, without duplication and in compliance with federal and state mandates and regulations related to servicing the targeted population in a uniform and consistent manner.
(1) Department of Education criteria. OHCA will reimburse case managers who meet program criteria set by the Oklahoma State Department of Education (OSDE), the certification agency. Case manager qualifications are:
(A) Knowledge or community-based, facility and institutional resources available to the target group and the experience to link to said resources;
(B) Experience in working in education, health or human service field;
(C) Administrative experience to meet state and federal requirements as well as requirements set out by the certifying agency;
(D) Ability to maintain programmatic and financial records required by the certifying agency including the capacity to document case records consistent with program standards and state and federal requirements;
(E) Graduation from an accredited college or university with a bachelor's degree in education, social work, health-related field and one year of experience in one of more of these fields;
(F) Receipt of approved State Department of Education Training; and
(2) Provider agreement.
(A) A memorandum of agreement between the Oklahoma Health Care Authority (OHCA) and the Oklahoma State Department of Education (OSDE) for Medicaid reimbursement of early intervention case management services must be in effect before reimbursement can be made for compensable services. The agreement outlines the contractual requirements for reimbursement.
(B) Provision of case management services will not restrict an individual's free choice of medical providers. Eligible case management providers must be certified by the OSDE in keeping with certification standards referenced in State Law Title 70, Section 3-104, Part 9 to ensure that the case managers for the targeted group of recipients are capable of assisting the recipients in receiving the full range of services they need. Recipients will have free choice of providers of other medical care under the plan.

317:30-5-621.Coverage by category
[Revised 6-11-99]
Payment is made for early intervention case management services as set forth in this Section.
(1) Adults. There is no coverage.
(2) Children. Coverage for children (age o to age 3) is as follows:
(A) Description.
(i) Services under case management are not comparable in amount, duration and scope. The target group for case management services are developmentally disabled infants and toddlers (ages 0-3) who are eligible for early intervention services under Oklahoma's implementation plan to meet provisions of the Individuals with Disabilities Education Act(IDEA), Amendments of 1997.
(ii) Case management refers to services provided to assist a client in gaining access to needed medical, social, educational and other services essential to meeting basic human needs. Case management may include, but is not limited to:
(I) referral, coordination and linkage to needed services;
(II) arranging for service delivery to ensure access to needed services;
(III) monitoring and follow-up of client's activities to insure access, quality and delivery of needed services; and
(IV) preparation of case record documentation documenting the above activities.
(B) Non-Duplication of services. To the extent any eligible recipients in the identified targeted population are receiving TCM services from another provider agency, as a result of being members of other covered targeted groups, the providers assure that case management activities are coordinated to avoid unnecessary duplication of service. To the extent any of the services required by the client are a Medicaid covered benefit of a managed care organization of which the client is a member, the provider will assure that timely referrals are made and that coordination of care occurs. Case management services shall be directed through a case manager who is an individual solely dedicated to that function. OHCA reimbursement will require that case managers may not provide clinical services and clinical staff may not provide case management services.
(C) Providers. Case management services must be provided by a qualifying provider of early intervention case management as certified by the State Department of Education, pursuant to the requirements of the Individuals with Disabilities Education Act, Amendments of 1997.
(3) Special Health Care Needs program. For children who are not eligible for Medicaid, and the application has been approved for Special Health Care Needs services through the Oklahoma Department of Human Services, a request for prior authorization for services must be submitted to the Medical Authorization Unit of OHCA for review and approval.
(4) Individuals eligible for Part B of Medicare. Case Management Services provided to Medicare eligible recipients should be filed directly with the fiscal agent.

317:30-5-622.Reimbursement
[Revised 6-27-02]
Reimbursement for early intervention case management services will be based on a unit of service of 10 minutes.

317:30-5-623.Billing [REVOKED]
[Revoked 6-27-02]

317:30-5-624.Documentation of records
[Issued 1-05-95]
All early intervention case management services rendered must be reflected by documentation in the records. When billing for procedures which are reimbursed on a time frame basis, documentation should be placed in the patient's chart as to the beginning and ending times for the services claimed.

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.