AFS Policy: Long Term Care (LTC)

Last Updated

LTC – is an acronym for long term care.  Long-term medical care for the categorically needy includes care in a nursing facility, public and private intermediate care facility for individuals with intellectual disabilities, persons age 65 years or older in mental health hospitals, Home and Community Based Waiver Services for the Intellectually Disabled, and Home and Community Based Waiver Services for frail elderly and a targeted group of adults with physical disabilities age 21 and over who have not been determined to have a developmental disability, an intellectual disability or a related condition. Personal Care provides services in the own home for categorically needy individuals.  Policy regarding this term is located at:

SoonerCare (Medicaid)

  • ICF/IID, HCBW/ID, and Individuals Age 65 or Older in Mental Health Hospitals;
    • 317:35-9-1. Overview of long-term medical care services; relationship to QMB, SLMB, and other Medicaid services eligibility, and spenddown calculation
    • 317:35-9-4. Services in Intermediate Care Facility for Individuals with Intellectual Disabilities (public and private)
    • 317:35-9-5. Home and Community – Based Services (HCBS) Waivers for persons with intellectual disabilities or certain persons with related conditions
    • 317:35-9-7. Services for persons age 65 or older in mental health hospitals
    • 317:35-9-15. Medicaid recovery
    • 317:35-9-25. Application for ICF/IID, HCBW/ID, and persons aged 65 or over in mental health hospitals
    • 317:35-9-26. Application procedures for private ICF/IID
    • 317:35-9-27. Application procedures for public ICF/IID
    • 317:35-9-28. Application procedures for services provided by Developmental Disability Services Division (DDSD)
    • 317:35-9-29. Application procedures for persons age 65 or older in mental health hospitals
    • 317:35-9-45. Determination of medical eligibility for care in a private Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)
    • 317:39-9-48. Determination of medical eligibility for care in public ICF/IID
    • 317:35-9-48.1 Determining ICF/IID institutional level of care for TEFRA children
    • 317:35-9-49. Determination of medical eligibility for Home and Community Waiver Service for the Intellectually Disabled
    • 317:35-9-50. Determination of medical eligibility for persons age 65 or older in mental health hospitals
    • 317:35-9-65. General financial eligibility requirements for ICF/IID. HCBW/ID and individuals age 65 or older in mental health hospitals
    • 317:35-9-67. Determining financial eligibility of categorically needy individuals
    • 317:35-9-68. Determining financial eligibility for care in an ICF/IID (public and private), for HCBW/IID services, and for persons age 65 or older in mental health hospitals
    • 317:35-9-75. Certification for long-term medical care through ICF/IID, HCBW/IID services and to persons age 65 and older in a mental health hospital
    • 317:35-9-76. Redetermination of financial eligibility for long-term medical care
    • 317:35-9-77. Case transfer between categories
    • 317:35-9-78. Case changes
    • 317:35-9-95. Payment to ICF/IID (public and private)
    • 317:35-9-97. Payment for Home and Community Based Waiver services for the Intellectually Disabled (HCBW/ID)
    • 317:35-9-98. Payment to mental health hospitals
  • State Plan Personal Care Services
    • 317:35-15-1. Overview of long-term medical care services; relationship to QMBP, SLMB and other SoonerCare services and eligibility
    • 317:35-15-2. State Plan Personal Care services
    • 317:35-15-3. Application for State Plan Personal Care
    • 317:35-15-4. State Plan Personal Care services medical eligibility determination
    • 317:35-15-5. General financial eligibility requirements for State Plan Personal Care
    • 317:35-15-6. Determining financial eligibility of categorically needy individuals
    • 317:35-15-7. Certification for State Plan Personal Care
    • 317:35-15-8. Agency Personal State Plan Care Service Authorization and Monitoring
    • 317:35-15-8.1. Agency State Plan Personal Care services; billing, and issue resolution
    • 317:35-15-9. Redetermination of financial eligibility for Personal Care
    • 317:35-15-10. Redetermination of medical eligibility for Personal Care services
    • 317:35-15-12. Case Changes
    • 317:35-15-13.1. Individual Personal Care service management
    • 317:35-15-13.2. Individual Personal Care contractor; billing, training, and problem resolution
    • 317:35-15-14. Billing procedures for State Plan Personal Care
    • 317:35-15-15. Referral for social services
  • ADvantage Waiver Services
    • 317:35-17-1. Overview of long-term medical services; relationship to QMBP, SLMB and other Medicaid services eligibility
    • 317:35-17-2. Level of care medical eligibility determination
    • 317:35-17-3. ADvantage program services
    • 317:35-17-4. Application for ADvantage services
    • 317:35-17-5. ADvantage program medical eligibility determination
    • 317:35-17-9. General financial eligibility requirements for the ADvantage program
    • 317:35-17-10. Determining financial eligibility/categorical relationship for the ADvantage program
    • 317:35-17-11. Determining financial eligibility for ADvantage program services
    • 317:35-17-12. Certification for ADvantage programs services
    • 317:35-17-14. Case Management services
    • 317:35-17-16. Member annual leave of care of re-evaluation and annual re-authorization of service plan
    • 317:35-17-18. ADvantage services during hospitalization or NF placement
    • 317:35-17-19. Closure or termination of ADvantage services
    • 317:35-17-21. Case changes
    • 317:35-17-21.1. ADvantage and agency Personal Care provider certification
    • 317:35-17-22. Billing procedures for ADvantage services
    • 317:35-17-23. Disclosure of information of health care providers and contractors
    • 317:35-17-24. Referral for social services
    • 317:35-17-25. Address Confidentiality Program
  • Nursing Facility Services
  • Living Choice Waiver
  • Medically Fragile Waiver
  • Programs of All-Inclusive Care for the Elderly
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