- (a) Any individual who has been adversely affected by any Preadmission Screening and Resident Review (PASRR) determination made by the State in the context of either a preadmission screening or an annual resident review may appeal that determination by requesting a fair hearing. If the individual does not consider the PASRR decision a proper one, the individual or their authorized representative must contact the local county Oklahoma Department of Human Services (DHS) office to discuss a hearing. Forms for requesting a fair hearing (DHS Form 13MP001E, Request for a Fair Hearing), as well as assistance in completing the forms, can be obtained at the local county DHS office. Any request for a hearing must be made no later than thirty (30) days following the date of written notice. Appeals of these decisions are available under Oklahoma Administrative Code (OAC) 317:2-1-2. There is no distinction between the SoonerCare and non-SoonerCare patient; therefore, all individuals seeking an appeal have the same rights, regardless of source of payment. Level I determinations are not subject to appeal.
- (b) When the individual is found to experience Mental Illness (MI), Intellectual Disability (ID), or related condition through the Level II screen, the PASRR determination made by the ID/MI authorities cannot be countermanded by the Oklahoma Health Care Authority, either in the claims process or through other utilization control/review processes, or by the Oklahoma State Department of Health. Only appeals determinations made through the fair hearing process may overturn a PASRR determination made by the ID/MI authorities.
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 17 Ok Reg 2410, eff 6-26-00
Amended at 23 Ok Reg 817, eff 3-9-06 (emergency)
Amended at 23 Ok Reg 2586, eff 6-25-06
Amended at 24 Ok Reg 2866, eff 6-1-07 (emergency)
Amended at 25 Ok Reg 1227, eff 5-25-08
Amended at 36 Ok Reg 958, eff 9-1-19