1. (a) Voluntary closure of ADvantage services. When the member requests a lower level of care than ADvantage services or agrees that ADvantage services are no longer needed to meet his or her needs, a medical level of care decision by the area nurse or nurse designee is not needed. The closure request is completed and signed by the member and the ADvantage case manager and sent to the ADvantage Administration (AA) for processing in the electronic system. When the member's written request for closure cannot be secured, the reasons for the voluntary termination of services and alternatives for services are documented in the electronic system.
2. (b) Closure due to financial or medical ineligibility. The process for closure due to financial or medical ineligibility is described in this subsection.
3. (1) Financial ineligibility. When the local Oklahoma Human Services (OKDHS) office determines a member does not meet financial eligibility criteria, the DHS office notifies the area nurse or area nurse designee who closes the member's authorization and notifies the member and AA of financial ineligibility by system-generated mail. The AA notifies the member's providers of the decision. A medical eligibility redetermination is not required when a financial ineligibility period does not exceed the medical certification period.
4. (2) Medical ineligibility. When the OKDHS office is notified by the area nurse or designee of a decision that the member is no longer medically eligible for ADvantage services, the OKDHS office notifies the member and AA of the decision. Refer to Oklahoma Administrative Code (OAC) 317:35-17-16 (d). The AA notifies the member's providers of the decision.
5. (c) Closure due to other reasons. Refer to OAC 317:35-17-3(e) - (h).

Added at 12 Ok Reg 753, eff 1-6-95 through 7-14-95 (emergency)

Added at 12 Ok Reg 3133, eff 7-27-95

Amended at 14 Ok Reg 56, eff 4-30-96 (emergency)

Amended at 14 Ok Reg 1802, eff 5-27-97

Amended at 15 Ok Reg 3715, eff 5-28-98 (emergency)

Amended at 16 Ok Reg 1438, eff 5-27-99

Amended at 17 Ok Reg 2410, eff 6-26-00

Amended at 20 Ok Reg 1958, eff 6-26-03

Amended at 21 Ok Reg 2252, eff 6-25-04

Amended at 29 Ok Reg 1172, eff 6-25-12

Amended at 35 Ok Reg 1497, eff 9-14-18

Amended at 41 Ok Reg, Number 23, effective 9-1-24