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317:35-17-1.Overview of long-term medical care services; relationship to Qualified Medicare Beneficiary Plus (QMBP), Specified Low-Income Medicare Beneficiary (SLMB), and other Medicaid services eligibility

[Revised 09-01-17]
(a) Long-term medical care for the categorically needy includes:

(1) care in a nursing facility. Refer to Oklahoma Administrative Code (OAC) 317:35-19;

(2) care in a public or private intermediate care facility for the intellectually disabled. Refer to OAC 317:35-9;

(3) care of persons age 65 years and older in mental health hospitals. Refer to OAC 317:35-9;

(4) Home and Community Based Services Waivers for persons with intellectual disabilities. Refer to OAC 317:35-9;

(5) Personal Care services. Refer to OAC 317:35-15; and

(6) the Home and Community Based Services Waiver (ADvantage Waiver) for frail elderly (65 years of age or older), and a targeted group of adults with physical disabilities 21 to 64 years of age and older who do not have an intellectual disability or a cognitive impairment related to a developmental disability.

(b) When an individual is certified as eligible for SoonerCare coverage of long-term care, he or she is also eligible for other SoonerCare services. ADvantage Waiver members do not have a copayment for ADvantage services except for prescription drugs. For members residing in an ADvantage Assisted Living Center, any income beyond 150 percent of the federal benefit rate is available to defray the cost of the assisted living services received. The member is responsible for payment to the assisted living services center provider for days of service from the first day of each full-month in which services were received until the vendor pay obligation is met. When an individual is aged, blind, or disabled and is determined eligible for long-term care, a separate eligibility determination must be made for QMBP or SLMB benefits. An ADvantage program member may reside in a licensed assisted living services center only when the assisted living services is a certified ADvantage assisted living services center provider from whom the member is receiving ADvantage assisted living services.

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.