OK SB640

Oklahoma Health Care Authority shall make Medicaid payments to nursing facilities for individuals meeting financial requirements and needing skilled nursing services daily, substantial assistance with activities of daily living, or 24-hour supervision due to cognitive impairment.

Same eligibility requirements apply to home and community-based waiver services as alternatives to nursing facility admission for aged and disabled individuals determined at high risk for nursing home placement.

Authority must use the Minimum Data Set 3.0 Resident Assessment Instrument (MDS-RAI) to determine medical necessity, with consultation from technical experts and stakeholders by January 1, 2016, and hire an independent contractor to administer requirements.

Recipients must undergo redetermination of medical necessity on a quarterly basis or upon significant changes in condition to continue receiving services.

Provisions apply to individuals initially applying for nursing facility or home and community-based services on or after January 1, 2016, but do not apply to individuals with intellectual disabilities; act effective September 1, 2015.