Provider's Post  

  Provider Letters:  

 2013-32 Revisions to Waiver Services
 2013-36 Provider Rate Increases for LTCWO Living Choice and Waiver Services
 2014-02 Program Update letter II-1-8-14
 2014-05 Transitional Funds Letter 2014
 2014-06 Alternative Funds Letter 2014

 

 

 FAQs

Q: What is Living Choice Demonstration?
A: The Money Follows the Person (MFP) Rebalancing Demonstration is a grant opportunity made available to states from the Centers of Medicare and Medicaid Services (CMS) to rebalance their Medicaid long-term care systems. The grant is designed to transition individuals with disabilities and long-term illnesses from the institution back into their homes in the community.  

The Living Choice Project is Oklahoma’s brand name for the Money Follows the Person grant, and is administered by the Oklahoma Health Care Authority (OHCA). Oklahoma’s Living Choice Project is designed to transform the current long-term care system by promoting community based services instead of institutional services.  For more info, see Living Choice.

Q: How do you make a referral for Living Choice or Medically Fragile?
A: You may access our website at www.okhca.org/ltc and click on the Living Choice Referral tab or the Medically Fragile Referral tab.  This section will take you to the eligibility requirements and directions for filling out a referral.  You may now submit referrals online.

Q: What are the qualifications for the Living Choice Program and Waivers?
A: See Eligibility.

Q: If I am new to The Living Choice Demonstration and have no training, who can I call or talk to?
A: We ask that you contact your supervisor first.  If you need additional training or direction, please call us at 1-888-287-2443. 

Q: What happens after an individual has completed 365 days in the Living Choice Demonstration?
A: Once a member has completed his or her 365 days (Demonstration period) on the Living Choice Grant, the member will transition into the ADvantage waiver program. Please be aware that the Living Choice transition to ADvantage will be initiated by DHS in the month that the Living Choice transition is due to end and NO REFERRAL IS NECESSARY or needed.  DHS will initiate the transition process as it will allow for the member to transition into the ADvantage waiver at the appropriate time as dictated by their end date in Living Choice. Making a referral to ADvantage will prolong the transition process and delay the start date for the Living Choice member’s transition into ADvantage.  Please do not make a referral to DHS for ADvantage, let the ADvantage workers initiate this transition. ADvantage has a list of all the transition dates and will initiate the transitions accordingly.

If you have any questions please contact Laura Bigger at 580-490-3661 or Lisa Reuter at 918-933-4942. 

Q: How does someone qualify for the Medically Fragile Waiver Program and is it the same as ADvantage?
A: A person must be at least 19 years of age who meets hospital and/or skilled nursing level of care, SoonerCare financial eligibility and must be living at home or a residential setting.  The Medically Fragile Waiver Program and ADvantage are two separate programs with different eligibility requirements and services. For more information see Medically Fragile or ADvantage.

Q: Where are the new forms located and how do we access them?
A: All of our forms are located in the Forms, Publications and Manuals tab.  All forms are created in PDF fillable format for typing and legible reading.  You click on the form you want to use, save it to your computer then type in the form.  We strongly urge that all of our TC/CM’s type on our forms.  However, we understand that for addendums and other forms, this may cause a problem and we are working to address those issues.  If you absolutely have to write then we ask that you would please print legibly. 

Q: Are CM progress notes to be submitted only until the participant transitions to the community or the entire year they are on the Living Choice Program?
A: Yes, TC/CM’s are to submit progress notes each month during the pre-transition (prior to community transition) period only. If the participant is in the pipeline (still in NF), send case notes; if the participant is newly transitioned (1st month in community), send 5 Day Follow-Up and once the participant has been in the community longer than one month (2-12 months), send Monthly Monitoring Form. Again, this is to be completed and submitted by the 5th of each month.

Q: Are we still supposed to send the RN Evaluation in with our reassessments/new plans?
A: Yes. As we come into compliance with the new rule surrounding Conflict Free Case Management, the member must select a Home Health Provider separate from their Case Management Provider. This would allow the Home Health Providers to appropriately assess the member to help determine the members' needs and staffing placement. This assessment is required every six months thereafter.

Q: Please explain how the housing waivers work and are they available in every county?
A: Currently, we work with the Oklahoma Housing Finance Agency to help our participants seek housing in the State of Oklahoma. We have access to Housing Choice Vouchers (HCV) to help provide rental assistance to eligible persons with disabilities, who meet OHFA's definition of disabled, transitioning from a nursing home or assisted living facility. The application can be accessed at www.ohfa.org. Once the application has been submitted, the applicant will receive immediate confirmation. If they do not receive immediate confirmation, the application was not submitted successfully and they will need to submit the application again. Applications will be selected from the waiting list on a first-come first-served basis (and contingent on available funds). Applications with a verified preference (homeless or disabled) will be selected from the waiting list before applications without a verified preference. Most of your clients should qualify for the disabled preference (see definition below). Verification of a preference must be mailed or faxed to OHFA (see instructions on application).  

Disabled Definition

42 U.S.C. Section 423 d)(1)(A) defines disability as inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.; A disabled person whose physical impairment is expected to be long, continued and of indefinite duration and substantially impedes his or her ability to live independently, and is of such a nature that such a disability could be improved by more suitable housing.

The Developmental Disabilities Assistance Bill of Rights Act (42 U.S.C. 6001 (8) defines disability as a severe, chronic disability of a person 5 years of age or older which: is attributable to a mental or physical impairment or combination of mental and physical impairments; is manifested before the person attains age twenty-two; is likely to continue indefinitely.

Under the Forms, Publications and Manuals tab download the Housing Authorization to Release to Information and the Referral Form. If your members wish to give OHFA staff permission to speak with their LC Transition Coordinators about their application/assistance, the form will need to be completed and returned to OHFA. This will allow OHFA to track clients in the LC program. As of Feb. 3, 2015, the housing waiting list is open.

Q: Is it the TC /CM responsibility for emergency contact with apartment / housing and security of personal belongings?
A
: We ask that the TC/CM lists their names as an emergency contact for our members.  Personal belongings remain the property of the member, family or representative. However, all DME medical equipment purchased by OHCA for the use of our members remains the property of the State of Oklahoma and will need to be reported if lost or stolen.

Q: Clarify non-billable activities related to Inter-Agency Communications and Supervisory Communications? What about staffing and documentation requirements?
A:
According to OAC 317:50-3-14(1) Ancillary activities such as clerical tasks like mailing, copying, filing, faxing, drive time or supervisory/administrative activities are not billable case management activities, although the administrative cost of these activities and other normal and customary business overhead costs have been included in the reimbursement rate for billable activities.  Examples not listed, please contact the waiver programs for assistance. 

Q: What is Self-Direction and how is it different from CD-PASS?
A:
Members on the Living Choice Demonstration and Waiver Programs will have greater flexibility to self-direct their services through three approaches to self-direction: self-direction, self-direction with supports and the common law model of self-direction.  With the self-direction service model, members of the waiver will be able to recruit, hire and train their personal care attendants. With this option, members can also develop their own 24 hour back up plans with assistance from their planning team. The member is also the employer of record and has budget authority in terms of the salary of the personal care attendant.

In the self-direction with supports model, the individual is the employer of record, but he or she shares the other responsibilities of recruiting, hiring and training staff with an agency or an advocate. Individuals who choose either of these self-direction options will receive assistance from the fiscal agency contracted with the OHCA to provide these services.  Individuals may also choose the common law employer model of self-direction. The individual supervises, hires and discharges directly. The member or the member's representative is responsible for the performance of necessary employment-related tasks and uses the fiscal agent. Self-Direction and CD-PASS are very similar in structure and format. The Self-Direction Program does allow our members to participate Statewide. For more inquires about Self-Direction please call us at 1-888-287-2443. 

Q: How do we submit Alternative Funds?
A:
Effective March 1, 2014 we ask that all requests for alternative funds be submitted to the Oklahoma Health Care Authority (OHCA) LTCWO Division by the fifth working day of each month.  The request must have case notes and any other relevant documentation attached.  After review by the Living Choice staff, you will receive confirmation of the approved number of units and amount payable. Your Agency is then responsible for submitting an invoice to the OHCA LTCWO Division by the 20th of each month for the approved amount. We ask that you submit one invoice per month, per agency. You may claim multiple members on one invoice; however, the claimed amounts for each individual must be on one line with a total of all monies requested. 

All invoices must include the following:

  • Company Name &  Address
  • Invoice Number
  • Invoice Date
  • Bill To Name: OHCA- Living Choice Program
  • Bill to Address: 4345 N. Lincoln Blvd., OKC, OK 73105
  • Dates of Service (From and To)
  • Member SoonerCare ID #
  • Number of Units
  • Payment Rate (Rural or Standard)
  • Subtotal
  • Total

Q: How do we submit Transitional Funds?
A:
Effective March 1, 2014, a timeframe of one plan year (LCP Demonstration Year) has been established for use of documented expenditures of Transitional Funds not to exceed $2,400 per member.  Documentation of purchases (official receipts) is required for final approval of transitional funds and must be submitted within thirty (30) days of the date of purchase.  Documentation received after the underlined timeframe will not be approved for reimbursement.  

All receipts must contain the following:

  • All receipts must be legible upon submission
  • All receipts must contain
  • Vendor Information and/or Printed & Signed Name
  • Address
  • Phone number
  • Date
  • Itemized Purchased items

The following is a list of items that are not allowed for reimbursement:

  • Fast food purchases
  • Purchases of personal items (ex. candy, cologne, clothing)
  • Items covered under the lease agreement for an apartment or home, such as cleaning and repairs of air conditioners, stoves, etc.
  • Rent

Q: If an applicant and Case Management Agency receives a letter of medical denial, does this letter serve as notice of closure or do the TC's still need to complete a voluntary withdrawal/discharge form?  

A: If the member has been notified that they are medically denied for the Living Choice Demonstration, then yes, that does warrant a closure and no voluntary withdrawal/discharge form is needed. However, keep in mind that the member does have the right and option to appeal that decision and if the decision is reversed, then we are required to re-open the case and continue in the transition process.

Q: Should a Provider Agency hire on new Transitional Coordinators/Case Managers, whose responsibility is it to make sure that the new hires are properly trained on the Living Choice and OHCA Waiver programs? 

A: So this is how it works: 

  1.       We are planning to come out and train each Provider Agency as part of our T.A. visit. 
  2.       Afterwards, the Training is posted online on the Forms, Publications and Manuals Page.
  3.       The Agency is then responsible for training all new staff on the materials and will be held strictly accountable if policies and procedures are not followed. 
  4.       We are open for comments, questions and concerns, however, we also try to address all questions with answers on our website on the FAQ Page.
  5.      
If you have not contacted us for your Technical Assistance visit, please do so immediately at 1-888-287-2443 or email us at info@oklivingchoice.org