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OAC 317:30-5-761. Eligible providers (Part 85, ADvantage Program Waiver Services)

OklahomaregulationOklahoma Health Care Authority· effective 2024-09-01

What this rule requires your agency to do

  • 1When a provider plan of correction is required after audit, the AA may stop new cases and referrals (removal from the Certified Agencies Report) until the POC is approved, implemented, and a follow-up review occurs. (OAC 317:30-5-761(9))(OAC 317:30-5-761. Eligible providers (Part 85, ADvantage Program Waiver Services))
  • 2A spouse or legal guardian serving as paid personal care provider may provide no more than forty (40) service hours in a seven (7) day period, must supply planned work schedules in advance (with variations noted two weeks in advance except emergencies), and must maintain and submit time sheets and required documentation for hours paid. (OAC 317:30-5-761(7)(C))(OAC 317:30-5-761. Eligible providers (Part 85, ADvantage Program Waiver Services))
  • 3When a member uses a spouse or legal guardian as paid provider, the case manager must visit the member at least monthly to monitor continued appropriateness of the policy exception and document findings in the member's electronic record. (OAC 317:30-5-761(7)(D))(OAC 317:30-5-761. Eligible providers (Part 85, ADvantage Program Waiver Services))
  • 4A member's CD-PASS services provider may not also have an active power of attorney for the member. (OAC 317:30-5-761(6))(OAC 317:30-5-761. Eligible providers (Part 85, ADvantage Program Waiver Services))
  • 5All providers, except NF respite, medical equipment and supplies, and environmental modification providers, must meet ADvantage certification requirements verifying licensure, certification, training standards, sound business management, and financial stability. (OAC 317:30-5-761(1))(OAC 317:30-5-761. Eligible providers (Part 85, ADvantage Program Waiver Services))
  • 6Providers must have a current signed SoonerCare (Medicaid) contract on file with the Oklahoma Health Care Authority. (OAC 317:30-5-761)(OAC 317:30-5-761. Eligible providers (Part 85, ADvantage Program Waiver Services))
  • 7All provider service types must agree to and sign the Conditions of Provider Participation and Service Standards. (OAC 317:30-5-761(5))(OAC 317:30-5-761. Eligible providers (Part 85, ADvantage Program Waiver Services))
  • 8Provider financial certification must be re-evaluated at minimum annually. (OAC 317:30-5-761(3))(OAC 317:30-5-761. Eligible providers (Part 85, ADvantage Program Waiver Services))

Applies to: ADvantage program service providers, including home care agencies (skilled nursing, personal care, in-home respite, advanced supportive/restorative assistance, therapy)

Requires ADvantage providers to hold ADvantage Administration certification and a signed SoonerCare contract, sign the Conditions of Provider Participation, undergo annual financial re-evaluation and periodic audits, and sets strict conditions and a 40-hour weekly cap for paid spouse/legal-guardian caregivers.

Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.