Okla. Admin. Code § 317:35-9-65 - General financial eligibility requirements for ICF/MR, HCBW/MR, and individuals age 65 or older in mental health hospitals
Financial eligibility for these types of long-term medical care is determined using the rules on income and resources according to OAC 317:35-7-36.
(1) Income, resources and expenses are
evaluated on a monthly basis for all individuals requesting payment for
long-term medical care.
(2) To be
eligible for long-term care in an ICF/MR (private and public), HCBW/MR services
and for persons 65 years or older in mental health hospitals, the individual
must be determined categorically needy.
(3) If the individual's gross income exceeds
the categorically needy standard as shown on OKDHS Form 08AX001E, Schedule
VIII. B. 1., refer to OAC
317:35-5-41.6(a)(6)(B)
for rules on establishing a Medicaid Income Pension Trust.
(4) When eligibility for long-term care has
been determined, the vendor payment amount, if applicable, is determined based
on type of care, community spouse, etc. Individuals determined eligible for
HCBW/MR services will not have a vendor payment.
(5) The vendor payment is applied to the
first claim(s) received on behalf of the individual.
(6) For an individual eligible for long-term
care in an ICF/MR (private and public) or for an individual 65 years or older
in a mental health hospital, the vendor payment is not prorated over the month.
As SoonerCare is the payer of last resort, the full amount of the vendor
payment must first be applied to the facility's charges before SoonerCare
reimbursement begins.
Notes
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