1. (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. (1) Member eligibility determination;
   2. (2) Member "freedom of choice";
   3. (3) Member health and welfare;
   4. (4) ADvantage certified and SoonerCare contracted providers on the plan;
   5. (5) Member acceptance of the plan;
   6. (6) Qualified case managers;
   7. (7) Plan services are goal-oriented services; and,
   8. (8) Plan of care costs are within cost cap guidelines.
2. (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.

<i>¹This emergency action expired on 7-14-08 before being superseded by a permanent action.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 by permanent action on 7-25-08.</i>

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