Aging Services LONG-TERM CARE OPTIONS AND RESOURCES

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1 Aging Services LONG-TERM CARE OPTIONS AND RESOURCES

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3 LONG-TERM CARE OPTIONS & RESOURCES TABLE OF CONTENTS Brochure... page 2 Aging Long-Term Care Options... page 4 Report Card... page 18 Service Provided by the Personal Care Attendant... page 19 Sooner Ride... page 24 What is CD-PASS?... page 29 Assisted Living Service Option... page 31 Optimal Use of Medicaid (SoonerCare) Prescription Benefits... Copies of Legal Documents... HIPAA 1 and 2 HIPAA 3 (if applicable) Pre-service Acknowledgement Consents and Rights (ADv1) Medicare Assistance Program... page page FAQ Information Sheet... page 51 Independent Case Manager and Independent Home Care page Provider Listings for Appropriate County (website)... page

4 is the direct link between people who need help and people who can give help NW 23rd Street, Suite 40 Oklahoma City, OK

5 Get Connected. Get Answers. Community-Based Services Disaster Response Military Emergency Management Basic Needs The essence of is in its simplicity is available to everyone across the state and the number is easy to remember is free and confidential 24 hours a day, seven days a week helps deliver services more efficiently by pinpointing what kinds of services are needed and where has proven itself time after time as an invaluable resource after a disaster. 3

6 Nursing Home or Alternative Care in OKLAHOMA Find information on how to obtain quality long-term care for yourself, a friend or a relative, and information describing nursing home care in Oklahoma and community-based options that are available. If you need to choose nursing home care, this information can help you locate the nursing facility that will best meet your needs and provide quality care. The time and effort spent in deciding on the type of care you need, and in choosing the best possible provider of that care, will help you avoid some problems later. If you need further information or assistance, write or phone one of the agencies listed at the end of this guide, or contact the Oklahoma Department of Human Services (DHS), Office of the State Long-Term Care Ombudsman.

7 Alternatives to Nursing Home Care Many older persons do not need nursing home care but do need some health care services or help with daily activities. Home and community-based services such as personal care, home health services, congregate or home delivered meals, adult day services, the ADvantage Program or services available through the Older Americans Act or Eldercare often enable older persons to remain in their own homes. Such arrangements are less costly than nursing home care and are generally more acceptable to the individual. Brief descriptions of the variety of services available in Oklahoma follow. For additional information about local availability of specific services, please contact your Area Agency on Aging (see listing on page 48). Telephone Reassurance is a program through which homebound persons are contacted (by volunteers) at a certain time daily or as often as necessary, to see if they are safe and well. The Congregate Meals program funded through the Older Americans Act provides hot nutritious meals, social services and companionship at centers within the community. The social services available at congregate meal sites include outreach, assisted transportation, information and referral, nutritional information, health counseling and referral, transportation, and recreation. Home-Delivered Meals are nutritious meals delivered to vulnerable, homebound older persons who are physically unable to attend congregate meal sites. For many program recipients, the daily visit from the person delivering their meal may be the only contact with the outside world. The Personal Care Program provides non-technical in-home assistance with health care needs, bathing, grooming, meal preparation, housekeeping and laundry. It does not provide 24-hour care, but provides support to enable a chronically ill or convalescing person to remain safely in his or her own home. Persons eligible for Personal Care services, financed with state and federal Medicaid (Title XIX) funds, include recipients of state supplemental payments to the aged, blind and disabled and others with low income who qualify for medical assistance. Certain public and private agencies also provide in-home care to eligible persons through both Medicare and Medicaid. 5

8 Alternatives to Nursing Home Care Continued The ADvantage Program, administered by DHS and funded through a partnership between the federal and state government via a waiver to the Medicaid program, provides an opportunity for vulnerable elders and adults with physical disabilities to stay at home, instead of residing in a nursing home. Persons served through this program can receive the services they need in their own home or in a family member s home. Each person receiving ADvantage Program services will have a case manager who will be responsible for arranging for care and seeing that service is properly provided. The program services include case management, personal care, skilled nursing care, adult day services, home-delivered meals, home modifications, prescription drugs, specialized medical equipment and supplies, and respite care. Adult Day Care services include rehabilitation, such as physical and speech therapy, hot meals and other assistance for persons who need daytime care while family or other caretakers work. These services are provided at centers located throughout the state. For a current listing of those centers, call your local Area Agency on Aging (see page 48). Senior Citizen Housing includes apartment complexes and highrise buildings and is available in many parts of Oklahoma. These generally provide reduced rental payments and easy access to services of various sorts. Many include senior centers and nutrition sites on or near the premises. Residential Care Homes provide supportive assistance in a residential setting. Housekeeping, help with eating, bathing, dressing and other services are included as supportive assistance to persons who do not routinely require nursing care. Residential care homes must be licensed by the State Department of Health if they serve one or more people. 6 Assisted Living Centers offer, coordinate or provide services to residents who may need assistance with any or all of the following: personal care (meals, dressing, movement, bathing or other personal needs or maintenance, or general supervision of the physical and mental well-being of a person, including assistance with toileting) or nursing supervision; intermittent or unscheduled nursing care; medication assistance, and transfer and/or ambulating. Assisted living centers must be licensed by the State Department of Health, either as a stand-alone assisted living center, or as a part of a Continuum of Care Facility, which includes a nursing home and an assisted living center.

9 If Nursing Home Care Is Needed Nursing facilities are primarily designed for persons convalescing from illness, or to provide longterm nursing care which is not appropriate for a hospital or available through home care programs or other alternatives. A nursing facility is not a hospital. It is not reasonable to expect hospital care in a nursing home. However, it is reasonable to expect a high quality of life and care nothing less is acceptable. Paying for Nursing Home Care There are several ways to meet the financial costs of nursing home care. Income from Social Security, pensions, veterans benefits, long-term care insurance and other sources may cover all or part of the expense. Some health insurance plans include limited nursing home coverage. Contact your agent to see if nursing home care is covered and, if so, for what type of facility. For instance, Medicare nursing home coverage is extremely limited (see Medicare, page 47). Medicare does not pay for long-term care. When a person s savings or other resources have been spent down to the maximum limit allowed by the state and all other income from Social Security, other pensions, etc. is less than the amount needed to pay for care, the individual resident may qualify for Medicaid (medical assistance). Medicaid (Title 19, Social Security Act) Medicaid is a financial assistance program that will pay for nursing home care for an unlimited time for persons who need such care and meet the income and assets guidelines. This program uses federal and state funds. For information about the medical assistance program call the DHS county office in the county where the person needing nursing care is located. This office will be able to advise what information will be required to make application, how soon to expect a decision, and how to ask for a review if found ineligible. In addition, the DHS county office has information about other programs which may be helpful. Medicare (Title 18, Social Security Act) Medicare is a federal health insurance program for persons over age 65 and Medicare-eligible persons under 65, and is administered by the Social Security Administration. It will contribute to the payment of nursing home care for a limited period of time, following certain hospital stays. The guidelines for Medicare payment of nursing home costs are very strict, and few persons qualify for this assistance. You can get information about Medicare benefits for nursing home care from your local Social Security office. Be sure to ask for a Medicare Handbook. 7

10 Choosing a Nursing Home First step As the first step in choosing a nursing home, decide on the area or location most acceptable to the person who will be the resident. If the person wishes to continue using his or her private physician, consider homes close to the hospital that the doctor uses. Being near a hospital or other emergency services can be an advantage. It is also important to consider a location that is convenient to friends or relatives, as visits by familiar people can make a big difference in the resident s progress and general well-being. Remember that the individual s specific situation, needs and wishes are the most important considerations. Talk with the doctor about the kind of care the person needs. By all means, the elderly person should be included in the decision-making and planning. Make a list of nursing homes. To assist in compiling the list, consult with the following resources: Ask doctors, friends or ministers for recommendations. Get names of nursing homes from your local DHS county office, health department, Social Security office or ombudsman, or call the Senior Info-line at Check the yellow pages of the telephone book, under the listing Homes Convalescent. It is helpful to check with more than one resource. This decision is very important. 8 Call the homes on the list. The number of homes you will need to visit can be narrowed down by first asking certain questions by telephone. When calling the nursing home, ask to speak to the administrator or the person in charge of admissions. Some of the questions to ask are: Does the home provide the kind of care the doctor says the person needs? Is the home certified for the Medicaid or Medicare program? (Ask this question if you now need or may need this type of assistance to pay for care.) Does the home have an opening? If not, how long is the waiting period?

11 Choosing a Nursing Home Continued Visit at least two homes. After narrowing the field to homes which meet the general needs of the prospective resident, make an appointment for a visit. If possible, the prospective resident should be included in the visit. He or she is an adult and should be allowed to exercise the right to choose. If transportation to the home is a problem, ask the facility whether transportation can be provided for you to visit. Some offer this service. Try to visit the facility during the noon meal and spend at least one hour. Arrange to meet and talk to the administrator and the nursing director because their attitudes will affect the actual care and quality of life of the residents. Ask to review the last three years State Health Department inspection reports. State law requires these reports be available at the home for public inspection. Ask for a copy of the facility policy. Ask for a tour. This is the most important part of the visit. Observe whether residents are awake and dressed appropriately. Observe the activity calendar posted and whether those planned are taking place. Pay close attention to the interaction between nurses aides (direct care givers) and residents. Are call lights being answered? Are residents treated with respect and dignity? If the potential resident has been unable to accompany you on this visit, please share your comparisons on the following pages with him/her and allow them to participate in the decision-making process. 9

12 Checklist The following checklist is provided for reference and convenience. Use it to prepare for and during the tour of a nursing facility. Observe and ask questions, but respect the privacy of the residents. H Before reaching a final decision, it is suggested a second unannounced visit be made to the facility. This time, plan a visit during the evening hours. Take time to visit with the residents and walk leisurely throughout the facility. Re-check earlier findings. Nursing facilities you have chosen: Nursing facility A is Nursing facility B is Home A Home B yes no yes no General Does the nursing home have the required current state license? Does the administrator have a current state license? Is the home certified to participate the Medicare and/or Medicaid programs? Is the administrator courteous and helpful? If the person you are placing requires special services, such as rehabilitation therapy or a theraputic diet, does the home provide them? Is the general atmosphere of the nursing home warm, pleasant and cheerful? Are staff members cheerful, courteous and enthusiastic? Do staff members show residents genuine interest and affection? Do residents look well cared for and generally content? 10 Are residents allowed to wear their own clothes, decorate their rooms and keep a few prized possessions on hand?

13 Checklist Continued Home A Home B yes no yes no General Is there a place for private visits with family and friends? Is there a written statement of resident s rights? As far as you can tell, are these points being carried out? Do residents, other visitors and volunteers speak favorably about the home? Home A Home B yes no yes no Physical Conditions Is the nursing home clean and orderly? Is the home reasonably free of unpleasant odors? Is the home well-lighted? Are rooms well-ventilated and kept at a comfortable temperature? Home A Home B yes no yes no Safety Is an emergency evacuation plan posted in prominent locations? Is the nursing home free of obvious hazards, such as obstacles to residents and unsteady chairs? Do bathtubs and showers have non-slip surfaces? Are there grab bars in toilet and bathing facilities and handrails on both sides of hallways? Is there an automatic sprinkler system and automatic lighting? Are there portable fire extinguishers? Are exits clearly marked and exit signs lighted? 11

14 Checklist Continued Home A Home B yes no yes no Safety Are exit doors unobstructed and unlocked from inside? Are certain areas posted with no smoking signs? Do staff, residents and visitors observe them? Are wheelchair ramps provided where necessary? Home A Home B yes no yes no Medical, Dental and Other Services In case of medical emergencies, is a physician available? Does the home have arrangements with a nearby hospital for quick transfer of residents in an emergency? Is emergency transportation available? Is oral hygiene adequate? Does the home have an arrangement with an outside dental service to provide dental care when necessary? Home A Home B yes no yes no Pharmaceutical Services Are pharmaceutical services supervised by a qualified consultant pharmacist? Is a locked room set aside for storing and preparing drugs? Home A Home B yes no yes no Nursing Services Is at least one registered nurse (RN) or licensed practical nurse (LPN) on duty 24 hours a day, seven days a week? 12 Does an RN serve as director of nursing services?

15 Checklist Continued Home A Home B yes no yes no Nursing Services Are nurse call buttons within each resident s reach whether in bed or chair and are they located in toilet and bathing facilities? What is the direct care staff-to-resident ratio on each shift? Home A Home B yes no yes no Food Service Is the kitchen clean and reasonably tidy? Is food needing refrigeration promptly stored? Ask to see the meal schedule. Are at least three meals served each day? Are meals served at normal hours, with time for leisurely eating? Are no more than 14 hours allowed between the evening meal and breakfast? Are nutritious between-meal and bedtime snacks available and offered? Are residents given enough food? Does the food look appetizing? Sample a meal. Is the food tasty and served at the proper temperature? Does the meal being served match the posted menu? Are special meals prepared for residents on therapeutic diets? Is the dining room attractive and comfortable? Do residents who need it get help in eating, whether in the dining room or in their rooms? 13

16 Checklist Continued Home A Home B yes no yes no Rehabilitation Therapy Is a full-time program of physical therapy available for residents who need it? Are occupational therapy and speech therapy available for residents who need them? Home A Home B yes no yes no Social Services Are there social services available to aid residents and their families? Does the nursing home have a varied program of recreational, cultural and intellectual activities for residents? Is there an activities coordinator on the staff? Is suitable space available for resident activities? Are tools and supplies provided? Are activities offered for residents who are relatively inactive or confined to their rooms? Look at the activities schedule. Are activities provided each day, including weekends? Do residents have opportunities to attend religious services and talk with clergymen both in and outside the home? Are a barber and beautician available? Home A Home B yes no yes no Resident s Rooms Do all the rooms open onto a hallway? 14 Does each resident have a reading light, a comfortable chair, and a closet and drawers for personal belongings?

17 Checklist Continued Home A Home B yes no yes no Resident s Rooms Does each room have a window to the outside? Is there fresh drinking water within reach? Is there a curtain or screen available to provide privacy for each bed whenever necessary? Do bathing and toilet facilities have adequate privacy? Home A Home B yes no yes no The Nursing Home Is there a lounge where residents can chat, read, play games, watch television or just relax away from their rooms? Is a public telephone available for resident s use? Does the nursing home have an outdoor area where residents can get fresh air and sunshine? Are visiting hours convenient for residents and visitors? Does the facility have a van or other transportation for residents? Home A Home B yes no yes no Financial Matters Do the estimated monthly costs (including extra charges) compare favorably with the cost of other homes? Is a refund made for unused days that were paid for in advance? Are these and other important matters specified in the contract? 15

18 The Ombudsman Program In Oklahoma, the Ombudsman Program is administered by the Aging Services division of the Department of Human Services in coordination with the Area Agencies on Aging. The purpose of the Long-Term Care Ombudsman Program is to help improve the quality of life and the quality of care available to older residents of long-term care facilities, such as nursing homes and other similar adult care homes. A long-term care ombudsman is a person who receives complaints from residents in long-term care facilities, or from friends or relatives of residents, and attempts to resolve those complaints. Staff ombudsmen are assisted by local volunteers committed to improving and enriching the lives of institutionalized older persons. What To Do If You Have A Complaint If you have a complaint about a nursing home, for whatever reason, you have a right to make the complaint known without fear of repercussions to the resident. You can report a complaint to: 1. The nursing facility administrator. 2. The Area Agency on Aging Ombudsman supervisor or a local certified ombudsman volunteer (see page 48 for a list of Area Agencies on Aging and the counties they serve) by calling or through the State Ombudsman office at (405) The resident s caseworker at the local Department of Human Services county office, if the resident is covered by Medicaid. 4. State Long-Term Care Ombudsman, Aging Services, Department of Human Services, P.O. Box 25352, Oklahoma City, OK 73125, (405) Department of Human Services, Long-Term Care Complaint Investigations Unit, Special Unit on Aging, P.O. Box 25352, Oklahoma City, OK 73125, (405) for complaints of resident abuse, neglect or exploitation in a nursing facility 6. Oklahoma State Health Department, Special Health Services Division, 1000 N.E. 10th St., Oklahoma City, OK 73152, (405) Legal Services Projects for the Elderly: Legal Aid of Western Oklahoma, (405) Legal Services of Eastern Oklahoma, University of Oklahoma Legal Clinic, (405) University of Tulsa Law Center, (918) Any other reputable lawyer 8. The Department of Human Services Adult Abuse Hotline, When you suspect abuse, neglect or maltreatment, call the Adult Abuse Hotline. It operates 24 hours a day, seven days a week. 16

19 Suggested Reading Pamphlets are available from the Social Security Administration office, county or state health department, Department of Human Services or public libraries. Nursing Homes Getting Good Care There by Sarah Greene Burger, Virginia Frazer, Sara Hunt and Barbara Frank (a consumer action manual prepared by the National Citizen s Coalition for Nursing Home Reform). American Source Books/Impact Publishers, Other Reference Material: Living in a Nursing Home A Complete Guide for Residents, Their Families and Friends by Sarah Greene Burger, RN, and Martha D Erasmo, RN, The Seabury Press, New York, NY Oklahoma Department of Human Services Info-Line GRAND GATEWAY Area Agency on Aging 333 S. Oak St. P.O. Box Drawer B Big Cabin, OK (918) / Fax: (918) Area 1: Craig, Delaware, Mayes, Nowata, Ottawa, Rogers and Washington counties EODD Area Agency on Aging EODD Building 1012 N. 38th St. P.O. Box 1367 Muskogee, OK (918) /Fax: (918) Area 2: Adair, Cherokee, McIntosh, Muskogee, Okmulgee, Sequoyah and Wagoner counties KEDDO Area Agency on Aging Vo-Tech Administration Addition Highway 2 P.O. Box 638 Wilburton, OK (918) / Fax: (918) Area 3: Choctaw, Haskell, Latimer, Le Flore, McCurtain, Pittsburg and Pushmataha counties SODA Area Agency on Aging 224 W. Evergreen St., Ste. 203 Durant, OK (580) , Fax: (580) Area 4: Atoka, Bryan, Carter, Coal, Garvin, Johnston, Love, Marshall, Murray and Pontotoc COEDD Area Agency on Aging 400 N. Bell Ave. P.O. Box 3398 Shawnee, OK (405) / Fax: (405) Area 5: Hughes, Lincoln, Okfuskee, Pawnee, Payne, Pottawatomie and Seminole counties TULSA Area Agency on Aging 111 S. Greenwood Ave., Ste. 200 Tulsa, OK (918) , Fax: (918) Area 6: Creek, Osage and Tulsa counties NODAArea Agency on Aging 2901 N. Van Buren St. Enid, OK (580) / Area 7: Alfalfa, Blaine, Garfield, Grant, Kay, Kingfisher, Major and Noble counties AREAWIDE Aging Agency Inc. Mayfair Center 3200 N.W. 48th St., Ste. 104 Oklahoma City, OK (405) /Fax: (405) Area 8: Canadian, Cleveland, Logan and Oklahoma counties ASCOG Area Agency on Aging 802 Main St., P.O. Box 1647 Duncan, OK (580) / Fax: (580) Area 9: Caddo, Comanche, Cotton, Grady, Jefferson, McClain, Stephens and Tillman counties SWODA Area Agency on Aging Sherman Industrial Air Park Building 420-Sooner Drive P.O. Box 569 Burns Flat, OK (580) / Fax: (580) Area 10: Beckham, Custer, Greer, Harmon, Kiowa, Jackson, Roger Mills and Washita counties OEDA Area Agency on Aging 330 Douglas Ave. P.O. Box 668 Beaver, OK (580) / Fax: (580) Area 11: Beaver, Cimarron, Dewey, Ellis, Harper, Texas, Woods and Woodward counties 17

20 How well do providers in your area score? Find out with the ADvantage and Medicaid State Plan Personal Care Provider Report Cards Provider Report Cards available at Select Aging Services Then below Online Services select ADvantage & Medicaid State Plan Personal Care Provider Report Cards Or visit

21 Service Provided By The Personal Care Attendant (PCA) Personal Care Program/ADvantage Waiver Program: Assistance with personal hygiene/bathing, dressing, grooming, meal preparation, chores, light housekeeping, laundry and errands related directly to your individual personal care needs. GUIDELINES FOR THE PERSONAL CARE ATTENDANT Light Housekeeping: Housekeeping duties do not include the moving of furniture; spring or fall cleaning; washing windows; taking down and re-hanging of curtains/ drapes/blinds; detailed dusting or cleaning (i.e. small figurines or other items found in china cabinets, on whatnot shelves on top of dressers or tables); decorative kitchenware that is not used on a regular basis; or picking up after others that live in the home or who visit the home.

22 For safety reasons, please do not ask the PCA to climb on ladders, step stools or chairs. If your home has more than one bedroom, bathroom and/ or living area, the PCA will only clean the bedroom, bathroom and/or living area that you most frequently use. Household Equipment and Supplies: To best utilize the time that is allotted to the PCA, please be aware of the condition of all equipent needed to perform assigned tasks. It is not the responsibility of the PCA to repair or maintain the cleaning equipment (vacuums, mops, brooms, etc). Cleaning supplies also need to be readily available for the PCA to use. Due to cost, it is sometimes difficult to keep these supplies on hand, but you must realize that the type of cleaning supplies that are available will determine the level of cleaning performed by the PCA. Laundry: If laundry is a part of your service plan, laundry services will be limited to your laundry only. Please do not ask the PCA to do laundry for others living in the home. If other people use the laundry appliances in the home, they will need to remove their laundry and pick up after themselves before the PCA will be expected to work in that area. Linen changes will be limited to your bed linens only. The PCA will not change linens for guests or other family members living in the home or visiting. 20

23 Shopping/Errands: If possible, prepare a list of items needed from the store. (Your PCA can assist with this if needed). Provide this list, along with the method of payment, to the PCA. The PCA will be expected to purchase items on your list and present the items, along with the receipt and any change from the transaction, back to you. Medications: The PCA can pick up medications from the pharmacy for you and can offer reminders to you to take your medications, but will in no way be responsible for your medications. The PCA will not dispense medications, will not set up your pill planner, and will not be responsible if you do not take your medications. If a PCA is to offer reminders to you and notes that you are not being compliant with the taking of your medications, the PCA is expected to report this to the case manager. Technical/Skilled Nursing Services: This is not provided through your Personal Care/ADvantage Waiver Program when using a Personal Care Assistant. The PCA is not responsible for taking vital signs, checking finger stick blood sugars, specialized feedings ie., gastronomy tubes, nasogastric tubes or use of thickening agents, spoon-feeding where swallowing difficulties are present, suctioning, respiratory treatments, trimming toenails, dressing changes/wound care, bladder catheterization, colostomy irrigations, enemas/bowel programs, and or the operating/maintaining of equipment of any technical nature. *PCA s are not required to be CPR certified or knowledgeable of CPR 21

24 Transportation: This service is not provided through your Personal Care/ADvantage Waiver Program. The PCA is not allowed to transport you. If you are unable to arrange for transportation, call your case manager or local DHS office for transportation programs available through Medicaid. Yard Work: This service is not provided through your Personal Care/ADvantage Waiver Program. The PCA will not perform any yard-work duties. This includes watering outside plants, moving the hoses/sprinklers, sweeping or cleaning front porches/sidewalks, or planting or harvesting of the garden. Pets: This service is not provided through your Personal Care/ADvantage Waiver Program. The PCA will not perform any maintenance care of your pets. This includes, but is not limited to, feeding or watering of animals; vacuuming/sweeping pet hair from all furniture; cleaning/changing cat litter; cleaning bird cages; or cleaning up any pet feces, urine or vomit. The PCA is placed in the home to care for you ONLY. If you are not able to care for your animals, you will need to make other arrangements for your pet s care or placement of the pet outside of the home. Other Reminders: Please do not smoke while the PCA is in your home. They too are not allowed to smoke in your home. 22

25 About the PCA: The PCA is not required to give out their home phone number. You will be given the number of the provider agency. The PCA will not go into your home if you are not there. The PCA is not allowed to work more hours than what is designated on your care plan. If the PCA is unable to complete tasks, contact the case manager. In knowing the specific task and the reason it is not being completed, the problem should be quickly resolved. The PCA is not allowed to perform tasks that are not listed on your Care Plan. If you feel you have unmet needs, contact your case manager. The PCA is expected to leave your home immediately if there is any sort of offensive behavior noted or if drugs, alcohol, pornography, profanity or any other inappropriate activity is occurring. This will be reported to the provider agency, case manager and DHS. The PCA is not allowed to borrow from you. This includes money. The PCA is not to use you as an easy target to sell products to, this includes items that their children may be selling through the school or church. Member or Caregiver Responsibilities: Member must be present when services are being provided in the home Informal caregivers should be available in the home for individuals who lack decision making ability and/or physical ability to respond appropriately to situations that jeopardized their health/safety. Provide a safe environment, free of environmental threats, physical threats, and threats of harm or injury to self and others. There are many reasons why these guidelines must be enforced. While serving you to the best of our ability, we must stay in compliance with state regulations and health safety rules. We want to protect both you and the PCA. If a PCA refused to perform any task, it could be that it is not part of your plan of care, or it may be against our guidelines. If you have any questions related to your plan of care, contact your provider agency or Case Manager. 23

26 How to Access SoonerRide Non-Emergency Transportation for SoonerCare Members SoonerRide Transportation Services If you live in Oklahoma and have a valid SoonerCare ID number, you qualify for SoonerRide, the state s Medicaid transportation service. (SoonerCare members who are residents of a nursing facility also may use SoonerRide.) SoonerRide is designed for people without adequate transportation to medically necessary appointments. SoonerRide does not handle emergency transportation. In case of an emergency, call

27 Making a Reservation Arranging SoonerRide Transportation is easy. To make a reservation, you must call at least three (3) business days before your trip is needed. Hours to call are 8 a.m. to 6 p.m.* Monday through Saturday. When you call SoonerRide, a customer service representative will ask for the following information: Your current SoonerCare ID number The time and day of your medical appointment The name, address and phone number of the health care facility you will be visiting The reason for your medical appointment Whether you will require an escort This information is needed to establish if you qualify for SoonerRide and to determine which type of transportation will best meet your needs. *Urgent trips may be accepted with less notice. Urgent trips are hospital discharges, Patient Advice Line referrals, doctor appointments when deemed necessary by a doctor, or a facility transfer. 25

28 Please note: Trip authorization numbers must be assigned for each trip, including trips that involve a gas reimbursement. Make sure you write down the authorization number you are given when your book your trip. If you have any questions or concerns later, you will need this number for prompt service. Types of transportation available to you through SoonerRide include gas reimbursement, paratransit, bus tickets and stretcher van. Where s My Ride? If transportation is running more than 15 minutes late and you have not heard from your driver, simply call the toll-free Where s My Ride? number, When you call, give your authorization number, and SoonerRide will call your driver and let you know where the driver is and when you can expect your ride to arrive. 26

29 Questions and Answers Q: What if I am hearing impaired? A: If you need TDD services, call or Q: What should I expect from this service and my driver? A: Please remember that SoonerRide is not a taxi service but is intended to assure you have access to your medical appointments. You can expect the following from this service: Vehicles often will transport other members in the same vehicle with you. Drivers cannot make additional stops they can only take you to the destination that has been approved and reserved. Drivers will give assistance into and out of the vehicle but may only pull up to the front door or to a common area of an apartment, clinic, hospital or office building. They do not assume the role of a caretaker. If you need assistance, please bring an escort with you. Drivers should obey all traffic laws. Drivers should notify you if they will be more than 10 minutes late. Occasionally, a driver may ask you if you can be a little flexible with your pick-up time. You are not required to change your pick-up time if asked; however, your flexibility will help to assure more people can get transportation to their health care appointments that day. Q: How do I get picked up from my medical appointment? A: You must schedule both your trip to the medical appointment and your return trip at the same time. When you make your medical appointment, ask for an estimate of how long your appointment will take, and schedule your return trip for a little long (20-30 minutes). Once your appointment is completed, please stay in the pick-up area until your designated pick-up time. Q: What do I do if my appointment is longer than expected? A: Your driver will give you a phone number to call if your appointment goes longer or your vehicle is late. If you do not receive satisfactory service, call If your transportation is more than 15 minutes late, you can call the Where s My Ride? line at , and your driver will be contracted to check on his arrival status. 27

30 Your Responsibilities: You should call SoonerRide at least three (3) business days ahead of your appointment date. You are not guaranteed transportation if you do not call with at least three days notice. If your appointment is canceled, please notify SoonerRide as soon as you know (24-hour advance notice required if possible). This will prevent unnecessary trips for local transportation companies trying to serve others that day. If you have three no-shows in a 90-day period, you risk losing service. Passengers who misuse or abuse the service or behave disruptively may be denied SoonerRide NET Services. You should be ready fifteen (15) minutes before the agreed on pick-up time. The vehicle is considered on time if it arrives 15 minutes before or 15 minutes after the designated pick-up time. The driver is required to wait up to 10 minutes from your pick-up time to transport you. Drivers cannot come into the home, lift passengers, or take wheelchairs up and down stairs. You are responsible for all medication and belongings once aboard the vehicle. Please do not give them to your driver. No eating, drinking, smoking or using other types of tobacco products is allowed in the vehicle. Please be respectful and courteous of other riders and your driver. Please notify SoonerRide when you change your address or no longer need transportation. You are responsible for providing a child safety seat for children younger than 4 or under 60 pounds. An adult must accompany children under the age of 15. People 15 to 18 must have a note from parent or guardian on file with SoonerRide. A maximum of one escort or attendant may accompany a passenger. Children may not accompany adults when the appointment is for the adult. Children may ride only if they have a medical appointment. Reporting a Service Issue: If you would like to report a service issue or make a complaint about a driver or vehicle or vehicle service, please call SoonerRide at A customer service representative will take your information and contact all necessary parties. 28

31 What is CD-PASS? Consumer Directed Personal Assistance Services and Supports Who is eligible for CD-PASS? An individual who is eligible for ADvantage services and: Is able to direct his/her care, with or without an authorized representative s assistance Elects to receive CD-PASS The CD-PASS service option offers ADvantage members the opportunity to direct decisions regarding personal care services. CD-PASS enables members with personal assistance needs to recruit, hire, train, supervise and, when necessary, fire their personal service assistant (PSA). Is CD-PASS right for you? Call

32 The Choice is Yours The ADvantage Program was designed to assist people with long-term care needs to stay in their homes and communities. The program, funded by DHS and Medicaid, provides in-home services to thousands of Oklahomans. The ADvantage Program offers a range of services. These services are approved based on the assessed needs of the individual. ADvantage Personal Care Services provide assistance to individuals who need help with activities such as bathing, preparing meals and running errands. This service is provided to assure the health and safety of individuals and prevent or minimize health deterioration. More advanced assistance in which the service provider requires specialized training is also available. 30 If you require personal care assistance, you have the option of using an agency or hiring the person yourself. If I choose CD-PASS, what are my responsibilities? Work with my interdisciplinary team to evaluate my needs and create a service plan to meet these needs Arrange all backup support and handle emergencies if my employee is late or does not show up for work Notify my team members if my needs change Assure the hours worked by my PSA do not exceed the hours authorized on my service plan Recruit and interview applicants Perform reference checks guidelines Schedule, train and supervise Evaluate work performance Manage and maintain records Review and approve timesheets outlined in the service plan Take responsibility for my health Hire and set wages within approved Follow all employment laws and rules Assure the PSA completes tasks as Watch for changes in my health status and know what to do when changes occur Manage my health by knowing how, when and where to seek medical help Train my employee on what to do in case I experience a health emergency; members may choose to have an authorized representative act on their behalf for employer responsibilities

33 ADvantage Program Assisted Living Service Option The ADvantage Medicaid Waiver The ADvantage Medicaid Waiver program provides Medicaid services to help people stay at home instead of going to a nursing home. The program assists seniors and adults who have physical disabilities. Assisted living is a homelike, non-institutional setting offering services for those who may need daily assistance but not continuous nursing care. Assisted living facilities offer services such as: Daily Meals Housekeeping Laundry Help with Taking Medications Personal Care Intermittent or Unscheduled Nursing Care Assistance with Transfer and Ambulation Social, Recreational and Exercise Opportunities

34 ADvantage Assisted Living Service Option Assisted living facilities also provide 24-hour access to staff to respond to resident needs and provide supervision, safety and security. The ADvantage Assisted Living Service Option provides a case manager assigned to each member to assist with the member s individual needs as determined in an Interdisciplinary Team meeting where an individualized service plan is developed for the member. QUALIFYING FOR ADVANTAGE ASSISTED LIVING SERVICE OPTION First, you must become an ADvantage Program member. To qualify for the ADvantage Program, you must meet all of the following criteria: Be determined medically eligible by DHS nurses Be determined financially eligible by a DHS social worker Meet all categorical factors as determined by the ADvantage Administration Once you are an ADvantage member, to qualify for the ADvantage Assisted Living Service Option, you must meet one of the following criteria: Your current residence is unsafe Your current home has barriers that limit your activities of daily living You are at risk of losing your home At times, you need more care than an in-home provider or caregiver can provide You live in an assisted living facility and need to move, but no other residence is available The ADvantage Assisted Living Service Option is only provided in assisted living facilities contracted with the Oklahoma Department of Human Services (DHS) ADvantage Administration. Call to find an assisted living facility under contract. 32

35 LIVING COSTS The ADvantage Program does not pay for rent or board. The ADvantage member is responsible for paying rent and board, which is no more than 90 percent of the Supplemental Security Income (SSI) Federal Benefit Rate. This amount includes the cost of rent and three meals per day with snacks available daily. Some ADvantage members whose gross income is more than 150 percent of the SSI Federal Benefit Rate may have copay for personal care services received in the assisted living facility. Your ADvantage social worker will discuss your financial obligations when you apply for the ADvantage Assisted Living Service Option. HOW TO APPLY Current ADvantage members should contact their case manager to discuss the ADvantage Assisted Living Service Option. If you are not an ADvantage member, contact the ADvantage Administration at for application information or for more information about the ADvantage Program. You may also visit your local DHS county office to apply. Visit for more information. 33

36 Optimal Use Of Medicaid Prescription Benefits Members receiving the six Medicaid prescriptions each month are eligible to receive a 34-day supply of medicine or 100 units (whichever is greater). See back of this page for policy information. Therefore, if the member takes a medicine one time a day he/she would benefit more by asking the doctor to write the medication amount for 100 units (because that is greater than a 34-day supply). Certain medicines cannot be written for that amount, for example: narcotics, sedatives, etc. (this is determined by your physician). The member would be able to get a three-month supply (100 units) using only one of their refills on their Medicaid card and would not need to have this medicine refilled for the next two months, allowing them to use those punches for other prescriptions.

37 Medicines taken two times daily could also be filled for 100 tabs (because this is still greater than a 34-day supply, which would only be 68 tabs) and would help stretch that medicine out further than having only a one-month supply. Using this system of rotation, a member that takes up to 18 different prescription medicines (that he/she takes once a day) could ideally have ALL of these prescriptions paid for by the state plan. Members may show this letter to their family, doctor or pharmacist so that he/she may understand why this would benefit the client. If you have any questions regarding this information, feel free to contact your local DHS office. This information is per DHS policy: 317: (15) Prescribed drugs. Payment is made to pharmacies with whom the authority has a contract on behalf of categorically needy recipients up to a maximum of three prescriptions (new or refill) per month per eligible recipient. The number of prescriptions per month is not limited for eligible individuals under 21 years of age or for drugs used for the treatment of tuberculosis. Drugs prescribed for the treatment of TB not listed in OAC 317: require prior authorization from the University of Oklahoma College of Pharmacy using form Petition for TB related Therapy. Prescription quantities are limited to a 34-day supply or 100 dosage units, whichever is greater, and only drugs approved by the Food and Drug Administration (FDA) and included in the Drug Rebate Agreement Program are covered. 35

38 Legal Documents

39 *08HI001E-001* OKLAHOMA DEPARTMENT OF HUMAN SERVICES Privacy Notice This notice tells how your health information can be used by the Oklahoma Department of Human Services (OKDHS). This notice also explains how you can get access to your health information. OKDHS follows all federal and state laws to protect the privacy of your health information. This notice tells you about your rights to keep your health information private. This notice also tells you what the law allows OKDHS to do with your health information. Health information rights Right to inspect and copy: You have the right to see your health information that OKDHS has on record. You also have a right to get a copy of this information. You do not have the right to see psychotherapy notes. You also do not have the right to see health information needed for court or administrative actions. Right to request an amendment: If you think the health information OKDHS has is wrong, or part is missing, you can ask OKDHS to make corrections. You must ask in writing. OKDHS can turn down the request if you do not give a reason. Your request can also be turned down if OKDHS did not create the health information or if OKDHS thinks the information is right. Right to an accounting of disclosures: OKDHS does not have to tell you when your health information is disclosed for purposes of your medical treatment, payment for medical treatment, or operation of a health care program operated by OKDHS. If your health information is disclosed for any other reason, you will be given a list of the disclosures if you ask. You will only be given disclosures made after April 14, A maximum of six years of disclosures will be given to you. Right to ask for limits: You can ask OKDHS to only use your health information for medical treatment, payment for medical care, or operation of a health care program. OKDHS does not have to agree to your request. If OKDHS agrees to your request, OKDHS can still use your health information to provide emergency care. Right to request confidential communication: You can ask OKDHS to talk with you about health care in a certain way. For example, you can ask OKDHS to only call you at home. OKDHS will try to meet all reasonable requests. Right to request a paper copy of this notice: You can have a paper copy of this notice. You can also get a copy of this notice at Under category, chose HIPAA and select Form 08HI001E. If you want to use any of these rights, send a written request to: Privacy Officer, Oklahoma Department of Human Services, P.O. Box 53025, Oklahoma City, OK, For more information, contact your worker or OKDHS health care professional. Revised HI001E (HIPAA-1) Page 1 of 2 37

40 08HI001E (HIPAA-1) Privacy Notice What Oklahoma Department of Human Services (OKDHS) can do with your health information OKDHS can use your health care information, as described below. Treatment: People who give you health care can use your health information to design a plan of care for you. These people include nurses, doctors, therapists, and social workers. People who work for OKDHS may share your health information so they can manage your services. Payment: OKDHS can give your health information to a health plan to pay for your services. Your health information can also be given to government programs so your benefits can be managed better. Examples of these programs are Medicaid and Workers' Compensation. Operations: OKDHS can use your health information to make sure that you get good health care. Your health information may be given to people or companies who OKDHS pays to give you health care. These people and companies have to follow the same rules that OKDHS does about keeping your health information private. Other government agencies providing benefits or services: OKDHS can give your health information to other government agencies that are giving you benefits. OKDHS will do this only if it is needed for you to get benefits. Health oversight activities: OKDHS can share your health information with other agencies when required by law for oversight activities. Examples of oversight activities are audits and inspections. Law enforcement: OKDHS will give health information to a law enforcement official only when required by state or federal law. Coroners, medical examiners, and funeral directors: OKDHS will give health information to a coroner, medical examiner, or funeral director when required by law. Organ donors: If you are an organ donor, OKDHS can give your health information to an organization that participates in organ donation or transplant. Stop a serious threat to health or safety: OKDHS can give your health information to stop a serious threat to the health and safety of you or someone else. Military: If you are a veteran, or a current member of the armed forces, OKDHS can be made to give your health information to the military or Veterans Administration. When required by law: OKDHS will give your health information when federal, state, or local law requires. This notice is effective April 14, Page 2 of 2 Revised

41 STATE OF OKLAHOMA DEPARTMENT OF HUMAN SERVICES PRIVACY NOTICE ACKNOWLEDGMENT This form is signed by the client, parent, guardian, or court-ordered personal representative of the client and placed in the client s case record or other appropriate file. I,, hereby acknowledge that I have print name received and reviewed Oklahoma Department of Human Services (OKDHS) Form HIPAA-1, Privacy Notice. Signature Date Relationship to client If the client, parent, guardian, or court-ordered personal representative of the client is unable or unwilling to sign the acknowledgment, briefly explain the circumstances and sign below. OKDHS employee signature Date OKDHS REVISED HI002E (HIPAA-2) 39

42 *08HI003E-001* OKLAHOMA DEPARTMENT OF HUMAN SERVICES Authorization to Disclose Medical Records I, give permission for to give my health care records described below to: for the following purposes: By initialing the spaces below, I specifically give permission to release the following health information: Client or client's personal representative must initial next to the information to be released. HIV/AIDS related information and records Mental health records Genetic testing and records Drug/alcohol abuse information Pathology Other Specify: Specific service date(s) or event(s): History and physical Discharge summary Operative report X-Rays NOTICE The information I authorize for release may include records which may indicate the presence of a communicable or non-communicable disease. I understand information in my records that I have or may have a communicable or non-communicable disease is made confidential by law and cannot be released without my permission except in limited circumstances, including release to the persons who have had risk exposures, release pursuant to an order of the court or the Oklahoma State Department of Health (OSDH), release among health care providers or release for statistical or epidemiological purposes. When such information is released, it cannot contain information from which I could be identified unless release of that identifying information is authorized by me, by an order of the court, or OSDH by law. I understand that if the person or organization who gets my health information is not covered by federal privacy regulations, my information may be redisclosed and no longer protected by those regulations. However, even if the person or organization is not covered by federal privacy regulations, they may be prohibited from disclosing. I also OKDHS revised HI003E (HIPAA-3) Page 1 of 2 40

43 08HI003E (HIPAA-3) Authorization to Disclose Medical Records understand that I do not have to sign this form. If I do not sign this form, it will not keep me from getting treatment, payment, or an eligibility decision. I understand that I can look at and copy any information released under this release. I understand that I can take back my permission to release information. If I want to do this, it has to be in writing, but I cannot take back my permission for information that has already been released. Unless I take back my permission sooner, this authorization will expire in 180 days or Signature of client or client s representative Print client s name Print name of legal representative, if applicable Date Client date of birth Relationship to client Page 2 of 2 OKDHS revised

44 Aging and Medicaid Services Pre-Service Acknowledgement Member Information Member last name First name Middle initial Medicaid number Street address City County OK State Zip Informed Choice Member Choice is a DHS Aging and Medicaid Services philosophy and orientation. Members make informed choices about the services they receive. Members have the primary authority to make decisions based on what works best for them, regardless of the nature or extent of their disability or the source of the payment for the services. A member s right to self-determination does not diminish with aging, physical or mental illness, disability or life circumstance. In addition, all people have the right to freedom of choice and action, and freedom from coercion and control. Member Rights Members have the right to: Be treated with respect, dignity; and be treated as competent to make decisions. Be communicated with effectively, directly, and in a language and format that best meets their needs. Receive accurate, objective, relevant, complete and culturally appropriate information to assist them in making informed health care decisions. Refuse proposed assistance, equipment or treatment. Appeal decisions and register complaints. Fully participate in all decisions related to their service plan, including participation by others as designated. Have healthcare information protected and to be able to communicate with healthcare professionals in confidence. DRAFT Form 02CB026E v.1 10/01/2013 Page 1 of 3 Member Initials 42

45 Member last name First name Middle initial Medicaid number Member Responsibilities The ADvantage Program is a waiver of institutional long-term care services. The State Plan Personal Care program is a Medicaid service that assists with daily living activities at home to assure personal health and safety or to prevent or minimize physical health regression or deterioration. By applying for and accepting Aging and Medicaid services, the member agrees to abide by the following requirements: Participate with their case manager and home care nurse in the development of their service plan and cooperate with the monitoring and delivery of all planned services, such as personal care, case management or skilled nursing visits. Provide a safe environment, free of environmental threats, physical threats, and threats of harm or injury to self and others. Provide honest, accurate and complete information about their condition, circumstances, informal and formal supports including any unexpected changes when they occur. Maintain a working telephone and allow service providers to access the Interactive Voice Recognition Authentication (toll-free number) for verification of services provided. Examples of Violations of Member Responsibilities The following situations are considered incompatible with the delivery of DHS Aging and Medicaid Services: Failure to cooperate or refusal to participate in service development or service delivery; Violence, threats of violence, or intimidation used towards any case managers, nurses, personal care aides, other home health or service providers; Threatening, intimidating, degrading, or sexually inappropriate language/innuendo or behavior directed at service providers or engaged in while a service is being provided, either in the home or through other contact or communications; Illegal activities which place the service provider at increased risk of harm, including but not limited to, illegal drug use or unlawful sales, distribution, or manufacture of prescription or illegal drugs; Unsafe use or display of weapons during the delivery of services; Unsafe environment due to the presence of unrestrained animals that pose a risk to caregivers during the delivery of services; and Providing inaccurate information or withholding information that is necessary to determine program eligibility. DRAFT Form 02CB026E v.1 10/01/2013 Page 2 of 3 Member Initials 43

46 Member last name First name Middle initial Medicaid number Acknowledgement and Signature (Initials) I have received a copy of this form and agree to follow the rights and responsibilities in the Pre-Service Acknowledgement form. (Initials) I understand that violations to my rights should be reported to my service provider s grievance coordinator or the Oklahoma State Department of Health ( ). If on ADvantage, these may also be reported to my case manager or the ADvantage Administration ( ). If on State Plan Personal Care, these may also be reported to my DHS nurse. (Initials) I understand that violations of my responsibilities may result in loss or disruption of services, as well as potential removal from the DHS Aging and Medicaid Services. Member or legal agent signature If member signs with a mark, two witnesses are required Date Witness signature Date Witness signature Date DHS RN signature Date NOTE: A copy is signed and kept at DHS Aging Services and a copy is given to the member at the time of initial assessment. DRAFT Form 02CB026E v.1 10/01/2013 Page 3 of 3 44

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49 Medicare Assistance Program Local Help for People with Medicare MAP.OID.OK.GOV This publication is by the Oklahoma Insurance Department, as authorized by John D. Doak, Oklahoma Insurance Commissioner. Funded by the Centers for Medicare and Medicaid Services. Grant #1N0CMS and Administration on Aging Grant #90MP0082.

50 OUR PARTNER AGENCIES The Oklahoma MAP program contracts with various agencies around the state and trains them to be MAP counselors in their local territories. These contracted agencies are able to educate and enroll beneficiaries in their respective areas. Area Agencies on Aging Area Wide Aging Agency (405) Canadian, Cleveland, Logan and Oklahoma counties Grand Gateway (918) Craig, Delaware, Mayes, Nowata, Ottawa, Rogers and Washington counties EODD (918) Adair, Cherokee, McIntosh, Muskogee, Okmulgee, Sequoyah and Wagoner counties KEDDO (918) Choctaw, Haskell, Latimer, Le Flore, McCurtain, Pittsburg and Pushmataha counties SODA (580) Atoka, Bryan, Carter, Coal, Garvin, Johnston, Love, Marshall, Murray and Pontotoc counties COEDD (405) Huges, Lincoln, Okfuskee, Pawnee, Payne, Pottawatomie and Seminole counties INCOG (918) Creek, Osage and Tulsa counties NODA (580) Alfalfa, Blaine, Garfield, Grant, Kay. Kingfisher, Major and Noble counties ASCOG (580) Caddo, Comanche, Cotton, Grady, Jefferson, McClain, Stephens and Tillman counties SWODA (580) Beckham, Custer, Greer, Harmon, Kiowa, Jackson, Roger Mills and Washita counties OEDA (580) Beaver, Cimarron, Dewey, Ellis, Harper, Texas, Woods and Woodward counties Community Action Agencies CADC (580) Beckham, Cotton, Jefferson, Kiowa, Roger Mills, Tillman and Washita counties CDSA (580) Garfield and Grant counties COCAA Cleveland, Lincoln, Logan, Payne, Pottawatomie and Seminole counties GPIF (580) Comanche County INCA (580) Atoka, Johnston, Marshall and Murray counties KI BOIS (918) Haskell, Latimer, Le Flore, Pittsburg and Sequoyah counties NEOCAA (918) Adair, Cherokee, Craig, Delaware and Ottawa counties SOCAG (580) Greer, Harmon and Jackson counties Washita Valley (405) Caddo and Grady counties Opportunities Inc (580) Alfalfa, Beaver, Blaine, Cimarron, Custer, Dewey, Ellis, Harper, Kingfisher, Major, Texas, Woods and Woodward counties Private Nonprofit Life Senior Services (918) E. 31st St., Tulsa, Ok 74135

51 SERVING INFORMING The Oklahoma Insurance Department s Medicare Assistance Program (MAP) can help answer your questions. We provide objective counseling and assistance for Medicare beneficiaries (either those who are 65 and older or those who have been determined disabled by the Social Security Administration or SSA), their representatives, or people who are soon to be eligible for Medicare. Call us or log on to our website today for the latest information. The Medicare Assistance Program is available to attend health fairs, conferences and retiree meetings to educate the public about the program, discuss changes, and alert about issues such as Medicare fraud. Trained MAP counselors assist and educate Medicare beneficiaries on all components of Medicare. Counselors are available for those who are 65 and older and those who have been determined disabled by the SSA. Counselors educate beneficiaries about what their options are, including basic Medicare, Medicare ADvantage Plus, and Medicare Supplemental plans. Counselors are available year-round. Beneficiaries on low, fixed incomes could be eligible for assistance programs. Counselors are available to help individuals through the process to identify if they qualify for programs such as the Low Income Subsidy (LIS), also known as Extra Help, which will help pay their monthly Part D premium and lower drug copays I MAP.OID.OK.GOV 49

52 PROTECTING MAP counselors help Medicare and Medicaid beneficiaries prevent, detect and report health care fraud. They not only protect older persons, they also preserve the integrity of the Medicare and Medicaid programs. The three most important steps to preventing fraud are: 1 PROTECT: your personal information 2 DETECT: incorrect billing statements 3 REPORT: any discrepancies or concerns to our Medicare Fraud Helpline SERVING The Statewide Resource Hotline: Call this number for local resources who may be able to help with such things as rent assistance, free and limited health clinics, etc. Rx for Oklahoma: Call this number if you need assistance in paying for a prescription drug. Medicare: Call this number if you have specific questions about a claim/bill that was denied, to file an appeal, or if you have questions about why an appeal was denied. Department of Human Services Contact your local DHS office for questions about Medicaid, Medicare Savings Programs, or Supplemental Nutrition Assistance Program (SNAP). Social Security: Call this number if you need to apply for Social Security/ Medicare, need a new Social Security/Medicare Card, or if you have questions about your Social Security benefit I MAP.OID.OK.GOV

53 Frequently Asked Questions For The State Plan Personal Care Program And The ADvantage Program

54 HOW WILL I KNOW IF I HAVE BEEN APPROVED FOR HELP IN THE HOME? If you are approved for either the ADvantage Program or the State Plan Personal Care Program, you will receive a letter from the Department of Human Services telling you of the approval. If you are approved for ADvantage, you will be contacted within 14 calendar days of receiving the Department of Human Services approval letter. The letter may come from a different DHS county office than the one where you applied, as case workers often work in multi-county groups to ensure timely processing of applications. If you are approved for the State Plan Personal Care Program you will be contacted by the Home Care Provider agency that you have chosen, within 10 business days of receiving the Department of Human Services letter. WHAT HAPPENS IF I AM NOT APPROVED FOR HELP IN THE HOME? If you are not approved for help in the home, either because you did not meet the financial guidelines established for either the ADvantage or State Plan Personal Care Program, or because you did not meet the medical level of care guidelines for the programs, you will receive a denial letter in the mail with further information about how to appeal if desired. WHAT HAPPENS IF I AM NOT HAPPY WITH THE AGENCIES I HAVE SELECTED? You have a right to change the agency you selected. If you are receiving ADvantage services you may call either the agency, or you may call the ADvantage Administration Unit at to request a change. If you are receiving State Plan Personal Care Services you may call the provider agency you have selected for services or the local DHS office. 52

55 Independent Case Manager And Independent Home Care Provider Listings For Appropriate County. For more information on Independent Case Manager and Independent Home Care Provider listings for appropriate county, please go to the ADvantage Administration website at 53