OHCA Policies and Rules

OHCA Policies and Rules Main Page

317:35-19-18. Change in level of long-term medical care

[Revised 09-01-24]

(a) When a member is receiving Personal Care services and requests nursing facility care, a new Uniform Comprehensive Assessment Tool (UCAT) is required. No new medical decision is needed for admission to a nursing facility from home if the period of absence from the nursing facility is less than 90 days. No new medical decision is needed if the member loses financial eligibility but maintains medical eligibility by having a current medical decision and by remaining in the facility during the period of financial ineligibility.

(b) When there is a decision that a member approved for one level of long-term care is eligible for a different level of care, the local office is advised by update of the file.

(c) When the area nurse determines that a new nursing facility member does not meet this level of care, payment may be continued while the member, or other responsible person, makes other arrangements. The length of such continuation of payment depends upon the circumstances, but must allow time for the appropriate advance notice to the member and cannot exceed 60 days from the date of the decision.

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.