Guidelines For Making A Referral

  • All out of state referrals require prior medical review.
  • If the treatment facility where the member is inpatient allows one person to stay overnight in the member’s room then overnight lodging is not authorized.
  • Hospital Social Workers may continue to issue lodging and/or meals vouchers up to 14 days per medical stay (verification with member is required regarding number of days that they have been receiving lodging and /or meals services).
  • Lodging &/or Meals Voucher may be discontinued at any time if criteria for visitation is not met.
  • Lodging and/or Meals Authorization form (voucher)  
  • Room and Board Providers (list of lodging providers) 
  • If lodging and/or meals services are needed beyond 14 days per medical stay, a referral must be submitted to OHCA Population Care Management for review.
  • When submitting documents for a lodging and/or meals referral, documents are to be faxed for review 3 business days before the date lodging and/or meals services are needed; fax to OHCA Population Care Management – Attention: Social Services at 405-530-3217.

 For Initial Referrals

  • Fax a completed SoonerCare Lodging &/or Meals Request form or member’s proof of appointment.
  • SoonerCare Lodging and/or Meals Request form (referral form).
  • Proof of appointment must include the member’s name, phone number and SoonerCare ID number; the date, check in time, and duration of the appointment or procedure.

For Extended Stays (submit referral at least 3 business days before the 14th day limit)

  • Fax an updated letter of medical necessity or the member’s most recent nursing progress notes/medical records.  Include the anticipated length of stay.
  • Notify Care Management by phone or fax of the dates that the escort is requesting lodging and/or meals services, and how many days have already been approved for the member or escort.
  • For NICU, the escort’s visitation log showing sign in/out times is required. Visitation MUST total a minimum of 6 hours per day to be eligible for continued lodging and/or meals services.

Notes

  • Meals will be reimbursed only if meets the lodging criteria and the duration of the trip was 18 hours or more.
  • If the member and/or escort meets the criteria for lodging services and stays overnight, but does not request SoonerCare assistance for lodging, then the member and/or escort may still be eligible for meals assistance/reimbursement.
  • The member and/or escort are not eligible for reimbursement for meals if the lodging provider submits a claim for meal reimbursement because they are providing meals to the member.