(a) Voluntary closure of ADvantage services. If the member requests a lower level of care than ADvantage services or if the member agrees that ADvantage services are no longer needed to meet his/her needs, a medical decision by the area nurse, or nurse designee, is not needed. The closure request is completed and signed by the member and the case manager and sent to the AA to be placed in the member's case record. The AA notifies the OKDHS county office of the voluntary closure and effective date of closure. The case manager documents in the case record all circumstances involving the reasons for the voluntary termination of services and alternatives for services if written request for closure cannot be secured.
(b) Closure due to financial or medical ineligibility. The process for closure due to financial or medical ineligibility is described in this subsection.
(1) Financial ineligibility. Anytime the local OKDHS office determines a member does not meet the financial eligibility criteria, the local OKDHS office notifies the, member provider, and AA of financial ineligibility. A medical eligibility redetermination is not required when a financial ineligibility period does not exceed the medical certification period.
(2) Medical ineligibility. Any time the local OKDHS office is notified through MEDATS of a decision that the individual is no longer medically eligible for ADvantage services, the local office notifies the individual, AA and provider of the decision.
(c) Closure due to other reasons. Refer to OAC 317:35-17-3(e) - (h).
(d) Resumption of ADvantage services. If a member approved for ADvantage services has been without services for less than 90 days and has a current medical and financial eligibility determination, services may be resumed using the previously approved service plan. If a member decides he/she desires to have his/her services restarted after 90 days, the member must request the services as a new referral through the county office. If an individual is determined to be eligible for Advantage services and is transitioning from a hospital or a nursing facility to a community setting, an ADvantage case manager may provide Institution Transition case managemet services to assist the individual to establish or re-establish him or herself safely in the home.