(a) Introduction to HCBS Waivers for Persons with intellectual disabilities.  The Medicaid Home and Community-Based Services (HCBS) Waiver programs are authorized in accordance with Section 1915(c) of the Social Security Act.

• (1) Oklahoma Department of Human Services (OKDHS) Developmental Disabilities Services Division (DDSD) operates HCBS Waiver programs for persons with intellectual disabilities (mental retardation) and certain persons with related conditions.  Oklahoma Health Care Authority (OHCA), as the State's single Medicaid agency, retains and exercises administrative authority over all HCBS Waiver programs.
• (2) Each waiver allows for the provision of specific SoonerCare-compensable services that assist members to reside in the community and avoid institutionalization.
• (3) Waiver services:
  • (A) complement and supplement services available to members through SoonerCare or other federal, state, or local public programs, as well as informal supports provided by families and communities;
  • (B) can only be provided to persons who are SoonerCare eligible, outside of a nursing facility, hospital, or institution; and
  • (C) are not intended to replace other services and supports available to members.
• (4) Any waiver service must be:
  • (A) appropriate to the member's needs; and
  • (B) included in the member's Individual Plan (IP).
    • (i) The IP:
    • (I) is developed annually by the member's Personal Support Team, per OAC 340:100-5-52; and
    • (II) contains detailed descriptions of services provided, documentation of amount and frequency of services, and types of providers to provide services.
    • (ii) Services are authorized in accordance with OAC 340:100-3-33 and 340:100-3-33.1.
• (5) DDSD furnishes targeted case management to members as a Medicaid State Plan service under Section 1915(g)(1) of the Social Security Act in accordance with OAC 317:30-5-1010 through 317:30-5-1012.

(b) Eligible providers.  All providers must have a current provider agreement with OHCA to provide HCBS for persons with mental retardation or related conditions.

• (1) All providers, except pharmacy, specialized medical supplies and durable medical equipment providers must be reviewed by OKDHS DDSD.  The review process verifies:
  • (A) the provider meets the licensure, certification or other standards as specified in the approved HCBS Waiver documents; and
  • (B) organizations that do not require licensure wishing to provide HCBS services meet program standards, are financially stable and use sound business management practices.
• (2) Providers who do not meet the standards in the review process will not be approved for a provider agreement.
• (3) Provider agreements with providers that fail to meet programmatic or financial requirements may not be renewed.

(c) Coverage.  All services must be included in the member's IP.  Arrangements for services must be made with the member's case manager.