OHCA Policies and Rules

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317:30-5-970. Eligible providers

[Revised 09-14-20]

(a) Case management agency qualifications. As the provider agency, the Oklahoma Office of Juvenile Affairs (OJA) must meet applicable state and federal laws governing the participation of providers in the Medicaid program. The Office of Juvenile Affairs Targeted Case Management (OJATCM) program must:

(1) Be available to all eligible members;

(2) Be delivered on a statewide basis with procedures that assure twenty-four (24) hour availability, the protection and safety of recipients, and continuity of services without duplication;

(3) Ensure compliance with federal and state mandates and regulations related to serving the targeted population are met in a consistent and uniform manner;

(4) Meet applicable state and federal laws governing the participation of providers in the Medicaid program, including, but not limited to, the ability to meet federal and state requirements for documentation billing and audits;

(5) Demonstrate that its staff has experience working with the target population and a minimum of five (5) years' experience in providing all core elements of case management including:

(A) Individual strengths and needs assessment;

(B) Needs-based service planning;

(C) Service coordination and monitoring; and

(D) Ongoing assessment and treatment plan revision.

(6) Have adequate administrative capacity to fulfill state and federal requirements;

(7) Have financial management capacity and systems that provide documentation of services and costs in accordance with Generally Accepted Government Auditing Standards (GAGAS);

(8) Have the capacity to document and maintain individual case records in accordance with state and federal requirements;

(9) Have a minimum of five (5) years' experience in providing and meeting the case management and service needs of the target population;

(10) Have responsibility for planning and coordinating statewide juvenile justice and delinquency prevention services in accordance with Title 10A of the Oklahoma Statutes (O.S.), Section ( ' ) 2-2-102; and

(11) Have the ability to evaluate the effectiveness, accessibility, and quality of targeted case management (TCM) services on a community-wide basis.

(b) Interagency agreement. An agreement between the Oklahoma Health Care Authority (OHCA) and OJA for TCM services must be in effect before Medicaid reimbursement can be made for compensable services.

(c) Case manager qualifications. A targeted case manager for the OJATCM program must:

(1) Be employed by OJA;

(2) Possess a minimum of a bachelor's degree in a behavioral science, or a bachelor's degree and one (1) year of professional experience in juvenile justice or a related field;

(3) Possess knowledge of:

(A) Laws, regulations, legislation, policies, and procedures as they pertain to the State's administration of juvenile justice and the investigation of juvenile delinquency;

(B) Community resources;

(C) Human developmental stages, developmental disorders, and social work theory and practices;

(D) Adverse childhood experiences and the impact of trauma on the developing brain;

(E) The risk and protective factors of child delinquency;

(F) Solution-focused practices and the critical role protective factors play in intervention planning;

(G) Sensitivity of cultural diversity; and

(H) Clinical and counseling techniques and treatment of juvenile delinquency;

(4) Possess skills in:

(A) Crisis intervention;

(B) Gathering necessary information to determine the needs of the child;

(C) Casework management;

(D) Courtroom testimony, terminology, and procedures;

(E) Effective communication;

(F) Developing, evaluating, and modifying, as appropriate, intervention planning on an ongoing basis;

(G) Establishing and maintaining supportive relationships with children and their families;

(H) Assisting children and families to access needed resources and supports; and

(I) Working with courts and law enforcement entities; and

(5) Have the ability to access multi-disciplinary staff, when needed. This includes, at a minimum, medical professionals and a child protective services social worker.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.