OHCA Policies and Rules

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317:35-17-19. Closure or termination of ADvantage services

[Revised 09-01-24]

(a) Voluntary closure of ADvantage services. When the member requests a lower level of care than ADvantage services, or agrees that ADvantage services are no longer needed to meet his or her needs, a medical level of care decision by the area nurse or nurse designee, is not needed. The closure request is completed and signed by the member and the ADvantage case manager and sent to the ADvantage Administration (AA) for processing in the electronic system. When the member's written request for closure cannot be secured, the reasons for the voluntary termination of services and alternatives for services are documented in the electronic system.

(b) Closure due to financial or medical ineligibility. The process for closure due to financial or medical ineligibility is described in this subsection.

(1) Financial ineligibility. When the local Oklahoma Human Services (OKDHS) office determines a member does not meet financial eligibility criteria, the DHS office notifies the area nurse or area nurse designee who closes the member's authorization and notifies the member and AA of financial ineligibility by system-generated mail. The AA notifies the member's providers of the decision. A medical eligibility redetermination is not required when a financial ineligibility period does not exceed the medical certification period.

(2) Medical ineligibility. When the OKDHS office is notified by the area nurse or designee of a decision that the member is no longer medically eligible for ADvantage services, the OKDHS office notifies the member and AA of the decision. Refer to Oklahoma Administrative Code (OAC) 317:35-17-16 (d). The AA notifies the member's providers of the decision.

(c) Closure due to other reasons. Refer to OAC 317:35-17-3(e) - (h).

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.