340:15-3-1 Eligibility and available services

(a) Children and Youth with Special Health Care Needs (CYSHCN). Per Sections 504 and 1615 of the Social Security Act, Sections 704 and 1382d of Title 42 of the United States Code, and Section 175.5 of Title 10 of the Oklahoma Statutes, CYSHCN 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. (b) Eligibility. Any child from birth to 18 years of age may be eligible for CYSHCN services when the child receives a Supplemental Security Income (SSI) payment or has a special health care need. The Social Security Administration (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 CYSHCN services. The service provider and Health Related and Medical Services (HR&MS) staff considers many factors in deciding which services or equipment to approve including, but not limited to: (1) the child's needs; (2) the availability of other resources; (3) whether the child is in a stable or temporary living situation; (4) the cost of the service or equipment; and (5) the availability of funding. (c) Service plan. When the child does not have a current service plan with another program within Oklahoma Human Services (OKDHS) or another agency, such as early intervention services through SoonerStart or special education services through the local public school, HR&MS staff completes a service plan prior to providing services to the child. (1) The HR&MS staff interviews the parent, guardian, or caretaker by phone, in the office, or during a scheduled home visit to complete Form 08MA017E, CYSHCN Service Plan. The service plan is reviewed yearly. (2) 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 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 CYSHCN funds. When applicable, the provider collaborates with CWS or DDS to: (A) address the child's current and future social service needs; and (B) avoid duplicative services. (d) Services. CYSHCN provides funding for the services and equipment described in this subsection. The parent, guardian, or caretaker requests services and equipment through the provider. An Adult and Family Services (AFS) worker provides the provider's contact information when requested. A third-party service provider accepts the request for professional services and adaptive equipment, pre-approves services and equipment, and delivers any equipment or formula. Due to budget constraints, services are available as a temporary supplement on a short-term basis. (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) Professional 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: (A) swimming; (B) horseback riding lessons; (C) sports activities; or (D) a health club membership. (3) Adaptive equipment. Equipment approved through CYSHCN is used to aid the child in accessibility or mobility. The parent, guardian, or caretaker provides a written recommendation from an education or health care professional with knowledge concerning the child's equipment needs. Service provider staff does not approve requests for equipment the child can obtain through other sources, such as SoonerCare (Medicaid) or through the child's school. Examples of adaptive equipment include, but are not limited to: (A) developmental aids; (B) portable ramps; (C) adaptive utensils; and (D) communication mechanisms. (e) Exclusions. Items or supplies not in the scope of CYSHCN 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. (f) 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 and Youth With Special Health Care Needs, to complete. AFS HR&MS determines eligibility for this Respite Voucher. When funding is not available, 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. CYSHCN, 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. (g) Phenylketonuria (PKU). Persons younger than 21 years of age who are diagnosed with the genetic disorder PKU may receive assistance for specialized formula supplements through CYSHCN funds when they do not qualify for SoonerCare (Medicaid). SoonerCare (Medicaid) recipients are automatically entitled to access the supplements through their SoonerCare (Medicaid) coverage. The AFS worker establishes eligibility. (h) CYSHCN notices. When a CYSHCN request is denied, the service provider notifies AFS HR&MS staff of the denial. 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 CYSHCN 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.