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Oklahoma - Assisted Living Facility — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Oklahoma State Department of Health (OSDH) licenses Assisted Living Centers under OAC 310:663 to provide personal care, nursing supervision, and housing, which are funded for eligible Medicaid members through the ADvantage Waiver Program. The ADvantage Waiver, operated by the Oklahoma Human Services (OKDHS) Community Living, Aging and Protective Services division, allows frail elderly adults and adults with physical disabilities to receive congregate care as an alternative to institutional nursing facility placement.

Before enrolling as a SoonerCare provider through the Oklahoma Health Care Authority (OHCA), a facility must secure an active OSDH Assisted Living Center license and obtain specific certification from the ADvantage Administration (AA). Facilities cannot bill Medicaid for room and board; waiver reimbursement covers only the direct care and supervision components outlined in the member's person-centered service plan.

1. Service Definition and Scope

Under the Oklahoma ADvantage Waiver, Assisted Living services provide personal care, homemaker, chore, attendant care, and medication oversight in a licensed congregate setting. The service is designed to promote independence while ensuring 24-hour supervision and assistance with activities of daily living (ADLs).

Medicaid reimbursement is strictly limited to the delivery of care services. Room and board costs are explicitly excluded from SoonerCare reimbursement and must be paid directly by the resident, typically using their Social Security or other personal income.

2. Regulatory and Oversight Agencies

Oversight of Assisted Living in Oklahoma is divided among three primary state entities. The Oklahoma State Department of Health (OSDH) handles facility licensure, architectural review, and life safety inspections.

Oklahoma Human Services (OKDHS), through its ADvantage Administration, manages waiver certification and programmatic oversight. The Oklahoma Health Care Authority (OHCA) serves as the single state Medicaid agency, handling provider enrollment and claims processing.

3. Gatekeeping Prerequisites: Who Can Even Apply

Oklahoma does not require a Certificate of Need (CON) for Assisted Living Centers, distinguishing them from Nursing Facilities and ICF/IIDs which do require CON approval. The primary structural prerequisite is obtaining the OSDH Assisted Living Center license before applying for ADvantage Waiver certification.

There are currently no closed networks, moratoria, or Request for Proposal (RFP) procurement limitations for ADvantage Assisted Living providers. Enrollment is open to any entity that successfully completes OSDH licensure and OKDHS waiver certification.

4. Licensure and Certification Requirements

Licensure requires submitting an application to OSDH Protective Health Services, passing architectural plan reviews, and undergoing an initial life safety and health survey. Facilities must comply with OAC 310:663 regulations regarding physical plant standards and resident care.

Before construction or conversion of a building, architectural plans must be approved by the OSDH Engineering Division. The State Fire Marshal must also approve the facility for fire safety before OSDH will conduct the initial licensure survey.

5. Medicaid Provider Enrollment

After securing OSDH licensure and OKDHS certification, providers enroll via the OHCA SoonerCare Provider Portal. The facility must sign a Title XIX provider agreement to participate in the ADvantage waiver.

Providers must submit their OSDH license, ADvantage certification letter, W-9, and National Provider Identifier (NPI) during the electronic enrollment process. Revalidation is required periodically to maintain active billing status.

6. Staffing, Training and Background Checks

Assisted Living Centers must employ a designated administrator and sufficient direct care staff to meet the 24-hour needs of residents as outlined in their service plans. All direct access staff must pass criminal history background checks.

Unlicensed staff who administer medications must complete specific state-approved training. Facilities must maintain documentation of all staff training, including first aid and CPR certifications.

7. Documentation, Policies and Records

Providers must maintain comprehensive resident records, including the OKDHS-approved ADvantage person-centered service plan, medication administration records (MARs), and incident reports. Clear financial agreements are also mandatory.

Facilities must have written policies for reporting critical incidents, such as abuse, neglect, or exploitation, to OKDHS Adult Protective Services and OSDH within mandated timeframes.

8. Billing, Rates and Claims

Claims for ADvantage Assisted Living services are submitted to OHCA via the SoonerCare portal using standard HCBS procedure codes. Reimbursement is based on a per diem rate established by OHCA.

Providers must ensure that billed services exactly match the units and dates authorized on the member's ADvantage service plan. Room and board cannot be billed to SoonerCare under any circumstances.

9. Approval Sequence and Timeline

The approval process begins with local zoning and architectural plan reviews, followed by facility construction or renovation. Once the physical plant is ready, OSDH conducts its initial licensure survey.

After OSDH issues the Assisted Living Center license, the facility applies for OKDHS ADvantage certification. Finally, the certified facility submits its enrollment application to OHCA to become a SoonerCare provider.

10. Common Denials and Survey Findings

OSDH and OKDHS frequently cite facilities for medication administration errors, inadequate service plan implementation, and failure to properly separate room and board costs from care costs in resident agreements.

Background check violations, such as allowing staff to provide direct care before OSBI clearance is received, are also common grounds for survey deficiencies or enrollment delays.

11. Key Contacts and Resources

Prospective providers should consult OSDH for physical plant and licensing rules, OKDHS for ADvantage waiver programmatic requirements, and OHCA for Medicaid billing and enrollment support.

The official state administrative codes (OAC) provide the detailed regulatory framework for both facility licensure and waiver service delivery.

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