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Part 3      APPLICATION PROCEDURES

317:35-9-25.Application for ICF/MR, HCBW/MR, and persons aged 65 or over in mental health hospitals.

[Revised 6-25-12]
(a) Application procedures for long-term medical care. An application for these types of services consists of the Medical Assistance Application. The Medical Assistance Application is signed by the patient, parent, spouse, guardian or someone else acting on the patient's behalf. 
(1) All conditions of eligibility must be verified and documented in the case record. When current information already available in the local office establishes eligibility, such information may be used by recording source and date of information. If the applicant also wishes to apply for a State Supplemental Payment, either the applicant or his/her guardian must sign the application form.
(2) At the request of an individual in an ICF/MR or receiving Home and Community Based Waiver Services for the Intellectually Disabled or the community spouse, if application for Medicaid is not being made, an assessment of the resources available to each spouse is made by use of DHS Form MA-11, Assessment of Assets. Documentation of resources must be provided by the individual and/or spouse. This assessment reflects all countable resources of the couple (owned individually or as a couple) and establishes the spousal share to be protected when subsequent determination of Medicaid eligibility is made. A copy of Form MA-11 is provided to each spouse for planning in regard to future eligibility. A copy is retained in the county office in case of subsequent application.
(3) If assessment by Form MA-11 was not done at the time of entry into the ICF/MR or HCBW/ID services, assessment by use of Form MA-11 must be done at the time of application for Medicaid. The spousal share of resources is determined in either instance for the month of entry into the ICF/MR or HCBW/ID services. If the individual applies for Medicaid at the time of entry into the ICF/MR or HCBW/ID services, Form MA-11 is not appropriate. However, the spousal share must be determined using the resource information provided on the Medicaid application form and computed using DHS Form MA-12, Title XIX Worksheet.
(b) Date of application. When application is made in the county office the date of application is the date the applicant or someone acting on his/her behalf signs the application form. When the application is initiated outside the county office, the date of application is the date the application is stamped into the county office. When a request for Medicaid is first made by an oral request, and the application form is signed later, the date of the oral request is entered in "red" above the date the form is signed. The date of the oral request is the date of application.

317:35-9-26.Application procedures for private ICF/MR

[Revised 01-01-09]
Individuals may apply for private ICF/MR at the OKDHS human services center (HSC) of their choice. A written application is not required for an individual who has an active SoonerCare case. The OKDHS Notification Regarding Patient in a Nursing Facility, Intermediate Care Facility for the Mentally Retarded or Hospice form 08MA083E, when received in the HSC, also constitutes an application request and is handled the same as an oral request. The local HSC will send the ICF/MR OKDHS form 08MA038E within three working days of receipt of OKDHS forms 08MA083E and 08MA084E, Management of Recipient's Funds, indicating actions that are needed or have been taken regarding the member.

317:35-9-27.Application procedures for public ICF/MR
[Revised 6-26-00]
When an individual is admitted to a public ICF/MR, an application for payment of long-term care in the facility is made at the time of admission. A designated worker from the county office in the county where the facility is located assists in this part of the admission process. The superintendent of the facility may sign the application on behalf of the individual if the responsible parent or guardian is not available. A case record is set up, in the county where the facility is located, for each applicant of the public ICF/MR. If the individual leaves the facility, the county case is transferred, if necessary, to the county of residence.

317:35-9-28.Application procedures for services provided by Developmental Disability Services Division (DDSD)
[Revised 6-26-00]
(a) Application. The county office is responsible for taking a new application for Medicaid if an active case is not already in existence. The worker must determine if the individual would be financially eligible for Medicaid benefits as categorically needy according to DHS Appendix C-1, Schedule VIII. B.
(1) When DHS/DDSD resources are sufficient for initiation of HCBW services, the DDSD case manager notifies the DHS county office of the request by DHS form K-13. The application date is the date Form K-13 is received in the county office.
(2) When a request for HCBW originates in the county office, the DHS social worker refers the applicant to the DHS/DDSD Area Office for completion of DHS form DDS-1, Application for Developmental Disabilities Services.
(3) The DHS/DDSD case manager determines whether or not a categorical relationship decision is necessary.
(b) Existing Medicaid case. A new application is not required on existing cases when referral is from a public ICF/MR or nursing facility for an individual returning to the community. The DDSD case manager verifies receipt of Medicaid benefits and notifies the county social worker of the medical eligibility determination (M-S-52) for HCBW/MR by the use of the DHS form K-13 requesting the computer system be updated with the client's new mailing and finding address and the appropriate waiver code. A case number is assigned if necessary, retaining the application date, certification date and redetermination of eligibility date from the existing case with the institutional case number.

317:35-9-29.Application procedures for persons age 65 or older in mental health hospitals
[Revised 6-26-00]
Under contracts between the OHCA and mental health hospitals, Medicaid applications for payment of care on behalf of individuals 65 years of age or older may be completed by the mental health hospital staff on behalf of these persons.
(1) An application for payment of care is made only on those patients age 65 years of age or older who are not eligible for (or who have exhausted) benefits under Title XVIII, Part A (Medicare, Part A), for the type of medical services for which they are now requesting payment under Medicaid. The completed application forms are forwarded to the local DHS office. A statement that the patient is not eligible under Medicare for the type of care for which payment is being requested must be attached.
(2) When there is a spouse who is not a patient in the mental health hospital or there is a guardian, the spouse or guardian's name and address is shown on the application form in addition to the patient's name in order that notifications are sent to the responsible person.

317:35-9-30.Special application procedures for children in DHS custody [REVOKED]
[Revoked 6-26-00]

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.