Okla. Admin. Code § 340:15-3-1

Current through Vol. 42, No. 7, December 16, 2024

Section 340:15-3-1 - Eligibility and available services

(a)Supplemental Security Income-Disabled Children's Program (SSI-DCP). SSI-DCP is established, per Sections 504 and 1615 of the Social Security Act, Sections 704 and 1382d of Title 42 of the United States Code. SSI-DCP is a federally-funded social services program for children with special health care needs, and is supported by the Maternal and Child Health Services Title V Block Grant. Pursuant to Section 175.5 of Title 10 of the Oklahoma Statutes, Oklahoma Human Services (OKDHS) administers the Children with Special Health Care Needs Program, and Adult and Family Services (AFS) oversees SSI-DCP.

(1) AFS Health Related and Medical Services (HR&MS) staff pre-approves SSI-DCP services and equipment except supplemental formula. AFS HR&MS staff considers many factors in deciding which services or equipment to approve including, but not limited to:

(A) the child's needs;

(B) the availability of other resources;

(C) whether the child is in a stable or temporary living situation;

(D) the cost of the service or equipment; and

(E) the availability of funding.

(2) A third party service provider accepts the service request, determines eligibility, and provides supplemental formula. AFS HR & MS oversees this provider through the contracting process.

(b)Eligibility. Any child from birth to 18 years of age may be eligible for SSI-DCP services when the child receives an SSI payment. SSA establishes financial and medical eligibility for the SSI disability payment. When the child becomes 18 years of age, he or she is no longer eligible for SSI-DCP services.

(c)Child in OKDHS custody. When a child is in OKDHS custody and OKDHS retains the child's SSI, the child's SSI is used to pay for needed services and equipment prior to accessing SSI-DCP funds.

(d)Service plan. Except for supplemental formula and when the child does not have a current service plan with another program within OKDHS or another agency, the AFS worker completes a service plan prior to providing SSI-DCP services to the child.

(1) The AFS worker interviews the parent, guardian, or caretaker by phone, in the office, or during a scheduled home visit to complete Form 08MA017E, SSI-DCP Service Plan. The service plan is reviewed yearly. When the child receives State Supplemental Payment, the AFS worker completes Form 08MA017E in conjunction with the eligibility renewal.

(2) When the child receives services from another agency that requires a current social service plan, such as early intervention services through SoonerStart or special education services through the local public school, the SSI-DCP service plan is not necessary.

(3) Within OKDHS, the child may receive services from Child Welfare Services (CWS), Developmental Disabilities Services (DDS), or Aging Services (AS) for State Plan Personal Care. When applicable, the AFS worker collaborates with CWS or DDS to:

(A) address the child's current and future social service needs; and

(B) avoid duplication in providing services.

(e)Services. SSI-DCP provides funding for the services described in (1) and (2) of this subsection. The parent, guardian, or caretaker requests interaction and integration services through an AFS worker. A third party service provider handles supplemental formula requests. When a service provider is responsible for providing the service and the parent, guardian, or caretaker contacts an AFS worker, the worker provides the provider's contact information.

(1)Formula. A health care professional provides a prescription naming the brand of formula the child needs for oral consumption. The parent, guardian, or caretaker must provide an updated prescription each year.

(2)Interaction and integration services. Non-medical services aimed at strengthening the child physically or mentally; providing opportunities for social interaction; or assisting with mobility may be approved when recommended by an education or health care professional and the recommendation clearly defines the goals and objectives for the child. Examples of such services include, but are not limited to, swimming or horseback riding lessons, sports activities, or a health club membership. Due to budget constraints, services are available as a temporary supplement on a short-term basis.

(f)Equipment. Equipment approved through SSI-DCP is used to aid the child in accessibility or mobility. Equipment available through SSI-DCP is pre-approved by AFS HR&MS staff. Available equipment that may be approved is described in (1) and (2) of this subsection. The parent, guardian, or caretaker provides a written recommendation from an education or health care professional with knowledge concerning the child's equipment needs. HR&MS staff does not approve requests for equipment the child can obtain through other sources, such as SoonerCare (Medicaid) or through the child's school.

(1)Developmental aid. A developmental aid is any device or equipment adapted to meet the needs of a child with disabilities. An education or healthcare professional provides a written explanation concerning the goals and objectives this developmental aid meets before it is approved. Educational or classroom devices, equipment, or supplies not adapted for the child's needs are not in the scope of the program.

(2)Van lifts. Van lifts are devices used for vehicular transportation of wheelchairs. Van lifts may be approved when needed to transport a child in a wheelchair. A van lift is not approved for a child in OKDHS or tribal custody or in the DDS Home and Community-Based Waiver Program. Modifications to the van are not approved.

(A) The parent, guardian, or caretaker must own the van as verified by title registration and license verification, and the van must be in operating condition.

(B) The family provides estimates from two van lift dealers who employ certified van lift installation technicians.

(C) When the request is approved, HR&MS staff contacts the family and approved vendor to arrange van lift installation.

(D) Only a certified van lift specialist is approved to install the van lift and the van lift must have factory and dealership warranties equal to the private purchase warranty.

(E) HR&MS staff does not approve replacement of a van lift within 10 years of the purchase date.

(F) SSI-DCP staff does not pay for van or van lift repairs not purchased with SSI-DCP funds.

(g)Exclusions. Items or supplies not in the scope of SSI-DCP are not approved. Examples of excluded items or supplies include, but are not limited to:

(1) learning programs;

(2) psychological programs;

(3) books;

(4) video or audio tapes;

(5) paper, pencils, or art supplies;

(6) computers, tablet computers, or computer software;

(7) televisions; and

(8) video games.

(h)Purchasing procedures. SSI-DCP orders are processed through AFS HR&MS. Purchased equipment is shipped to the local OKDHS office.

(i)SSI-DCP notices. When an SSI-DCP request is denied, AFS HR&MS staff sends Form 08MP038E, Client Notice of Action Taken, to inform the child's parent, guardian, or caretaker the item is not approved for purchase through SSI-DCP funding. The family may request a fair hearing by completing Form 13MP001E, Request for a Fair Hearing, within 30-calendar days from the issuance date of Form 08MP038E.

(j)Respite Voucher Program. The Respite Voucher Program provides financial assistance in the form of vouchers to families to pay for respite care. When the family appears eligible for the Respite Voucher Program, the worker gives the client Form 08RV001E, Respite Voucher Application for Children With Special Health Care Needs, to complete. When funding is not available through HR&MS, the worker advises the family to call a designated number to request a respite voucher application from Sooner SUCCESS for the Lifespan Respite Grant Voucher Program. SSI-DCP, other OKDHS programs, and certain public and private agencies provide funding to the Respite Voucher Program.

(1) The caregiver is the person who provides ongoing care for the child. He or she may be a parent, grandparent, other relative, or non-relative.

(2) When respite care is approved the respite provider must be at least 18 years of age. Respite care is not:

(A) designed to pay for ongoing care, such as child care, therapy, in-home assistance, housekeeping, or home health services; and

(B) provided by a member of the child's household.

Okla. Admin. Code § 340:15-3-1

Adopted by Oklahoma Register, Volume 32, Issue 24, September 1, 2015, eff. 9/15/2015

Amended by Oklahoma Register, Volume 36, Issue 24, September 3, 2019, eff. 9/16/2019

Amended by Oklahoma Register, Volume 38, Issue 24, September 1, 2021, eff. 9/15/2021

Amended by Oklahoma Register, Volume 41, Issue 23, August 15, 2024, eff. 9/16/2024