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OAC 317:35-17-3. ADvantage program services

OklahomaregulationOklahoma Health Care Authority· effective 2024-09-01

What this rule requires your agency to do

  • 1Individuals determined ineligible for ADvantage program services must be notified in writing by CAP of the determination and of their right to appeal. (OAC 317:35-17-3(i))(OAC 317:35-17-3. ADvantage program services)
  • 2The case manager must provide the ADvantage Administration with professional or other credible documentation to support a recommendation for redetermination of program eligibility, and service providers must continue providing services per the person-centered service plan as provider safety permits until the individual is removed from the program. (OAC 317:35-17-3(h))(OAC 317:35-17-3. ADvantage program services)
  • 3Members may receive services in a shelter or temporary housing only in emergency situations for a period not to exceed sixty (60) calendar days. (OAC 317:35-17-3(c)(3))(OAC 317:35-17-3. ADvantage program services)
  • 4To receive ADvantage services an individual must meet a target-group category, require long-term care facility level of care per OAC 317:35-17-2, and meet the service and program eligibility criteria of OAC 317:35-17-3(f) and (g). (OAC 317:35-17-3(b))(OAC 317:35-17-3. ADvantage program services)
  • 5ADvantage members are not eligible to receive services while residing in an unlicensed institutional living arrangement or an institutional setting, unless the facility is an ADvantage assisted living center. (OAC 317:35-17-3(c)(1))(OAC 317:35-17-3. ADvantage program services)
  • 6The estimated cost of providing an individual's care outside the LTC facility cannot exceed the annual cost of caring for that individual in a LTC facility. (OAC 317:35-17-3(d))(OAC 317:35-17-3. ADvantage program services)
  • 7Members may receive ADvantage respite services in a long-term care facility for a continuous period not to exceed thirty (30) calendar days. (OAC 317:35-17-3(c)(5))(OAC 317:35-17-3. ADvantage program services)
  • 8Eligibility for ADvantage program services is contingent on an individual requiring one or more waiver services at least monthly to avoid institutionalization. (OAC 317:35-17-3(a))(OAC 317:35-17-3. ADvantage program services)

Applies to: ADvantage waiver providers and members; case management agencies; home care agencies

Defines the ADvantage HCBS waiver, its target populations, eligible living arrangements, the twenty covered services (including State Plan and ADvantage personal care), and the service and program eligibility/ineligibility criteria.

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