Okla. Admin. Code § 317:30-5-763.1

Current through Vol. 41, No. 19, June 17, 2024

Section 317:30-5-763.1 - Medicaid agency monitoring of the ADvantage program

(a) The OHCA's monitoring of the ADvantage Program is a quality assurance activity. The agency evaluates the ADvantage program on a continual basis to ensure quality, through the review of various performance measures set forth in the waiver document. The areas evaluated include:

(1) Member eligibility determination;

(2) Member "freedom of choice";

(3) Member health and welfare;

(4) ADvantage certified and SoonerCare contracted providers on the plan;

(5) Member acceptance of the plan;

(6) Qualified case managers;

(7) Plan services are goal-oriented services; and,

(8) Plan of care costs are within cost cap guidelines.

(b) Deficiencies found by the OHCA are reported to the AA for correction and/or explanation. Additionally, a quality management report is submitted to the Centers for Medicare and Medicaid Services annually.

Okla. Admin. Code § 317:30-5-763.1

Added at 18 Ok Reg 2962, eff 5-17-01 (emergency) ; Added at 19 Ok Reg 1067, eff 5-13-02 ; Amended at 25 Ok Reg 660, eff 2-1-08 through 7-14-08 (emergency) ¹ ; Amended at 25 Ok Reg 2685, eff 7-25-08 ; Amended at 26 Ok Reg 756, eff 4-1-09 (emergency) ; Amended at 27 Ok Reg 963, eff 5-13-10 ; Amended at 30 Ok Reg 1179, eff 7-1-13

¹ This emergency action expired on 7-14-08 before being superseded by a permanent action. Upon expiration of an emergency amendatory action, the last effective permanent text is reinstated. Therefore, on 7-15-08 (after the 7-14-08 expiration of the emergency action), the text of 317:30-5-763.1 reverted back to the permanent text that became effective 5-13-02, as was last published in the 2006 Edition of the OAC, and remained as such until amended again by permanent action on 7-25-08.