ADULT HEALTH CARE SERVICES PROVIDER IN OKLAHOMA

Fatumata Kaba
Sep 8
4 min read

DELIVERING PERSON-CENTERED MEDICAL AND SUPPORTIVE CARE TO PROMOTE HEALTH, DIGNITY, AND INDEPENDENCE FOR OKLAHOMA’S ADULT POPULATION

Adult Health Care Services in Oklahoma encompass a range of Medicaid-funded medical and personal support services for adults with disabilities, chronic illnesses, or aging-related needs. These services are designed to maintain health, manage chronic conditions, and support daily living activities — enabling individuals to remain in their homes or community settings. Services are authorized under SoonerCare (Oklahoma Medicaid) and several Home and Community-Based Services (HCBS) Waiver programs, including the ADvantage Waiver, Medically Fragile Waiver, and Living Choice Program.

1. GOVERNING AGENCIES

Agency: Oklahoma Health Care Authority (OHCA)

Role: Administers SoonerCare (Medicaid), oversees provider enrollment, and reimburses approved adult health care services.

Agency: Oklahoma Department of Human Services (OKDHS) – Aging Services & DDS

Role: Coordinates and authorizes services for adults enrolled in HCBS waivers.

Agency: Oklahoma State Department of Health (OSDH)**

Role: Regulates health-related licenses for in-home care and health professionals (e.g., RNs, home health aides).

Agency: Centers for Medicare & Medicaid Services (CMS)**

Role: Ensures state programs meet federal Medicaid and HCBS standards.

2. ADULT HEALTH CARE SERVICES OVERVIEW

These services include skilled and non-skilled care delivered in-home or in adult day health settings to help individuals maintain health and independence.

Approved providers may deliver:

Skilled Nursing Services: Medication administration, wound care, and chronic condition monitoring.
Personal Care Services: Assistance with bathing, grooming, dressing, toileting, and transfers.
Health Monitoring: Checking vitals, recognizing symptoms, and ensuring medication compliance.
Therapeutic Support Services: Physical, occupational, or speech therapy (with proper licensure).
Nutrition Support: Meal planning, preparation, and feeding assistance.
Adult Day Health Care (optional): Daytime supervision, meals, and health checks in licensed settings.
Care Coordination & Documentation: Plan of care development, shift notes, and Medicaid billing records.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Oklahoma Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Apply to OHCA for Medicaid enrollment under appropriate provider types (e.g., Home Care, Personal Care, Adult Day Health).
Obtain licensure through OSDH for home care or adult day health services, if applicable.
Maintain liability, workers’ comp, and malpractice insurance (if skilled staff employed).
Develop an Adult Health Care Services Policy & Procedure Manual.

4. OKLAHOMA PROVIDER ENROLLMENT PROCESS

Step 1: Establish your business entity and secure required licenses and insurance.

Step 2: Submit Medicaid enrollment through the SoonerCare Provider Portal.

Step 3: For home health or adult day health care, apply for OSDH facility licensure.

Step 4: Complete documentation review and readiness verification.

Step 5: Begin receiving service authorizations and participant referrals.

5. REQUIRED DOCUMENTATION

Business license and Articles of Incorporation
EIN and NPI confirmation
Insurance certificates (general, workers’ comp, professional)
OSDH licensure (for facilities/home care)
Adult Health Care Services Policy & Procedure Manual including:
- Plan of care development and service delivery procedures
- Medication and health monitoring protocols
- Personal care and safety policies
- Documentation standards and shift reporting
- HIPAA compliance and participant rights policies
- Quality assurance and incident tracking
- Medicaid billing templates

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN) / Clinical Supervisor

Requirements: Active Oklahoma license; oversees care plans, medication management, and staff training.

Role: Certified Home Health Aide / Personal Care Aide

Requirements: OSDH certification, background check, and CPR/First Aid.

Role: Program Coordinator (for Adult Day Health)

Requirements: Experience in adult care, staff oversight, and DHS compliance.

Role: Licensed Therapists (optional)

Requirements: Licensed PT, OT, or SLP for waiver-authorized therapy services.

All staff must complete:

HIPAA and documentation training
Abuse prevention and participant safety education
Annual skills assessments and competency checks
Emergency preparedness and infection control protocols

7. MEDICAID WAIVER PROGRAMS

Adult Health Care Services are available through:

ADvantage Waiver – for frail elders and adults with disabilities
Medically Fragile Waiver – skilled nursing and high-level care coordination
Living Choice Program – for adults transitioning from nursing facilities
State Plan SoonerCare Services – for qualifying home health and personal care needs
In-Home Supports & DDS Waivers – for adults with IDD requiring health support in the home