Medicaid - Sooner Seniors Waiver
Oklahoma Living Choice Project
Oklahoma Health Care Authority
The program provides the opportunity for older persons with disabilities or long-term illnesses who have successfully completed 365 days in the Living Choice Demonstration, graduate into the Sooner Seniors Waiver. This waiver provides a similar service package that participants received in the Living Choice Project. Services provided under the Sooner Seniors Waiver include assistive technology as well as other services, which may relate to assistive technology including audiology, dental, nutrition, occupational therapy, physical therapy, speech therapy, environmental modifications and specialized medical supplies.
Beverly Couch, Coordinator
Oklahoma Health Care Authority
2401 NW 23rd, Ste 1A
Oklahoma City, OK 73107
(800) 757-5979 (TDD)
FAX: (405) 530-3426
- Individuals must continue to meet SoonerCare financial eligibility requirements;
- must be 65 years of age or older;
- have transtioned to a home or community-based setting through the Living Choice Demonstration waiver; and
- continue to meet nursing facility level of care on an annual basis.
AT SERVICES PROVIDED/COVERED
- Assessment for the need of assistive technology/auxiliary aids
- Training the service recipient/provider in the use and maintenance of equipment/auxiliary aids
- Repair of adaptive devices
AT DEVICES PROVIDED/COVERED
- Aids for Daily Living
- Speech Communication
- Aids for Hearing Impaired
- Environmental Adaptations
- Aids for Vision Impaired
- Mobility/Seating & Positioning
- Members work with their transition coordinator/case manager to determine the need for assistive technology services.
- The appeals process allows a member to appeal a decision involving medical services, prior authorizations for medical services, or discrimination complaints.
- In order to file an appeal, the member files a LD-1 form within 20 days of the triggering event. The triggering event occurs at the time when the member knew or should have known of such condition or circumstance for appeal. The staff advises the Appellant that if there is a need for assistance in reading or completing the grievance form that arrangements will be made.
- If the LD-1 form is not received within 20 days of the triggering event or if the form is not completely filled out with all necessary documentation, OHCA sends the Appellant a letter stating the appeal will not be heard.
- Upon receipt of the member’s appeal, a fair hearing before the Administrative Law Judge (ALJ) will be scheduled. The member will be notified in writing of the date and time for this procedure. The member must appear at this hearing. The ALJ’s decision may be appealed to the CEO, which is a record review at which the parties do not appear.
PIECES OF THE PUZZLE
- Each member will continue work with a transition coordinator/case manager to update the service plan as the member’s needs change.
- The Sooner Seniors Waiver provides medical services along with other home and community-based services (i.e. housekeeping, meal prep, laundry) to members upon graduation from Living Choice.
- Sooner Seniors Waiver members have a transition coordinator/case manager that assesses and monitors the member’s need for services and other life changes that may affect delivery of services.
- The annual cost of waiver services cannot exceed the aggregate average cost of providing care in a nursing facility. Services are approved and reimbursed by OHCA.
- The Sooner Seniors Waiver will soon offer participants self-directed services which will provide the individual the opportunity to direct decisions regarding personal care services. Self-directed services enable the individuals with personal care needs the opportunity to recruit, hire, train, supervise, and when necessary, fire their personal care assistant. Participants are not required to utilize the self-directed service option.
- Any participant who no longer meets nursing facility level of care may qualify for State Plan or other community based services to meet their needs.