Okla. Admin. Code § 317:35-19-16 - PASRR appeals process
(a) Any
individual who has been adversely affected by any Preadmission Screening and
Resident Review (PASRR) determination made by the State in the context of
either a preadmission screening or an annual resident review may appeal that
determination by requesting a fair hearing. If the individual does not consider
the PASRR decision a proper one, the individual or their authorized
representative must contact the local county Oklahoma Department of Human
Services (DHS) office to discuss a hearing. Forms for requesting a fair hearing
(DHS Form 13MP001E, Request for a Fair Hearing), as well as assistance in
completing the forms, can be obtained at the local county DHS office. Any
request for a hearing must be made no later than thirty (30) days following the
date of written notice. Appeals of these decisions are available under Oklahoma
Administrative Code (OAC)
317:2-1-2. There is no
distinction between the SoonerCare and non-SoonerCare patient; therefore, all
individuals seeking an appeal have the same rights, regardless of source of
payment. Level I determinations are not subject to appeal.
(b) When the individual is found to
experience Mental Illness (MI), Intellectual Disability (ID), or related
condition through the Level II screen, the PASRR determination made by the
ID/MI authorities cannot be countermanded by the Oklahoma Health Care
Authority, either in the claims process or through other utilization
control/review processes, or by the Oklahoma State Department of Health. Only
appeals determinations made through the fair hearing process may overturn a
PASRR determination made by the ID/MI authorities.
Notes
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