1. The medical information includes a proper medical diagnosis of the parent's current medical condition, an explanation of the effect of the medical diagnosis upon the parent's ability to perform his or her usual and customary job skill, as well as a prognosis for the future medical condition of the parent. All pertinent clinical evidence necessary to substantiate or explain the medical diagnosis and medical summary is included, such as results of physical examinations, psychiatric evaluations, x-ray reports, laboratory tests, or any other pertinent medical data. Medical information, along with Form ABCDM-80-D (new form number 08MA022E), Medical Social Summary, is transmitted to the Oklahoma Health Care Authority, Level of Care Evaluation Unit (LCEU).
2. Child care includes feeding, cleaning, and supervision of the child(ren).
3. The worker verifies the receipt of Social Security or Supplemental Security Income (SSI) by seeing the award letter or check. Refer to OAC 340:65-3-4 for Beneficiary and Earnings Data Exchange System (BENDEX) or Supplemental Data Exchange (SDX) when the award letter or check is not available. Verification documentation is recorded in the case record.
4. The request for existing information, which is usually made through correspondence, asks for information regarding the medical findings and diagnosis and is accompanied by Form Information HIPPA-3 (new form number 08HI003E), Authorization to Disclose Medical Records. The reply to the county may be by letter, on forms, or copies of medical charts. If a hospital charges for this service or certification is delayed because of the failure of a hospital to furnish records, the Form ABCDM-80-D (new form number 08MA022E) must contain this information.
5. Such examinations are authorized by use of Form ABCDM-16 (new form numer 08MA016E), Authorization for Examination and Billing, to which is attached Form ABCDM-80 (new form number 08MA022E), Report of Physician's Examination, and Form ADM-12 (new form number 10AD012E), Claim Form. These expenses are paid in the same manner as any other medical service as outlined in OAC 317:35-3-2(23).
6. See Form ABCDM-80-D (new form number 08MA022E) and instructions. The medical social summary is transmitted to LCEU with the appropriate medical information.
7. The worker is notified on the MEDATS file which is accessed by the use of the MDL and MDI transactions. Information regarding the use of these transactions can be accessed by entering M space MDL or M space MDI.
8. If LCEU considers the client medically feasible for services from the Oklahoma Department of Rehabilitation Services (DRS), the worker is notified on the MEDATS file. A referral is made by Form K-13 (new form number 08MP013E), Information/Referral - Social Services. A decision as to the feasibility of services is made by DRS. The services prescribed by DRS becomes a part of the parent's employability plan.
9. This information is available on the MEDATS file.
10.In such an instance, the worker cancels the appointment, makes a new appointment, and submits information regarding the cancellation and the date of the new appointment to LCEU.
11.The worker is notified on the MEDATS file of the decision that the applicant or recipient is not incapacitated and the basis for LCEU's decision. The worker is responsible for explaining the reason incapacity was not determined as well as the parent's right to a fair hearing.
12.In every instance that LCEU originally determined incapacity, the MEDATS file specifies a date on which incapacity is to be redetermined or that further redetermination is not needed.
13.In such instances, if the applicant is otherwise eligible, the worker sends LCEU a notification of eligibility.
14.If none of the circumstances of this subsection exist, a determination of incapacity must be made by LCEU.