The OHCA may execute agreements to provide care only with
facilities which are properly licensed by the state licensing agency. The
agreement is initiated by application from the facility and expires on a
specified date, or with termination of the facility license, or shall be
automatically terminated on notice to this Authority that the facility is not
in compliance with Medicaid (or other federal long-term care)
requirements.
(1) In the event that a
facility changes ownership, the agreement with the previous owner may be
extended to the new owner, pending certification of the new owner to provide
care to individuals during the change of ownership. In the event that the new
owner is not showing good faith in pursuit of certification, the OHCA will
begin planning for alternate placement of Medicaid patients. The county office
is immediately notified of any relevant change in facility status.
(2) Payment for long-term care is made only
for those individuals who have been approved by the Department of Human
Services for such care. The amount of payment is based on the actual time the
individual received care (including therapeutic leave) from a nursing facility
during any given month. Payment for nursing care cannot be made for any period
during which the care has been temporarily interrupted for reasons other than
therapeutic leave. Therapeutic leave is any planned leave other than
hospitalization that is for the benefit of the patient. Therapeutic leave must
be clearly documented in the patient's plan of care before payment for a
reserved bed can be made by the OHCA.
(3) Effective July 1, 1994, the nursing
facility may receive payment for a maximum of seven days of therapeutic leave
per calendar year for each eligible individual to reserve the bed.
(4) The Statement of Compensable Therapeutic
Leave Only form is used by the facility to record use of therapeutic leave.
This form is to be made available by the local office to the nursing facility
upon request.
(5) No payment shall
be made for hospital leave.
Notes
Okla. Admin. Code §
317:35-19-26
Added at 12 Ok Reg 753,
eff 1-6-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3133, eff 7-27-95;
Amended at 13 Ok Reg 927, eff 8-1-95 (emergency); Amended at 13 Ok Reg 415, eff
1-1-96 (emergency); Amended at 14 Ok Reg 56, eff 4-30-96 (emergency); Amended
at 13 Ok Reg 1677, eff 5-27-96; Amended at 14 Ok Reg 1802, eff 5-27-97; Amended
at 17 Ok Reg 2410, eff 6-26-00
Amended by
Oklahome
Register, Volume 33, Issue 23, August 15, 2016, eff.
9/1/2016
