Oklahoma
Oklahoma’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.
At a glance
- Rate method
- Hybrid
- Case-mix level
- None
- Classification
- None
- Rate updates
- Once a year
- Managed care (LTC)
- No
- Quality program
- Pay-for-Performance (PFP)
- Paid outside the rate
- Small
- Bed hold
- Leave only
- Published rates
- Rates and build‑ups
- Assisted living
- Covered
- Personal needs allowance
- $75 / month
Overview
- Oklahoma pays each regular nursing home one flat daily rate made of three parts.
- The first is a statewide Base Rate written into the state plan ($160.48 from 7/1/2026, which includes the Quality of Care fee).
- The second is an 'Other Cost' add-on that is the same for every home ($25.68).
- The third is a home-specific Direct Care add-on that shares out a fixed pool in proportion to each home's reported nursing wage-and-benefit cost per day, capped at the 90th percentile.
- The money available each year sets the size of the pot, not each home's own total cost.
- That money is provider fee collections, appropriations and federal match, plus resident spend-down.
- The Base Rate and an estimated $5/day quality payment are funded first; 30% of what is left goes to Other Cost and 70% to Direct Care.
- The 7/1/2026 file lists 283 regular homes.
- Posted totals run $225.16-$262.43/day, with a median of $246.26 and an average of $251.07 once the $5 quality add-back is included.
- There is no acuity (case-mix) adjustment.
What matters in Oklahoma
- Each home gets one flat rate, averaging $251.07/day from 7/1/2026, with no acuity or PDPM adjustment.
- 64% of the rate is a legislated $160.48 Base Rate that is the same for every home.
- Only the Direct Care add-on varies ($39.00-$76.27), shared out of a fixed pool by reported nursing cost.
- Quality pay averages $5/day as quarterly lump sums outside posted rates; 27 homes earned $0 in SFY27 Q1.
- The provider fee is $17.57 per patient day (6% of gross receipts) and is built into the Base Rate.
- Nursing homes are paid fee-for-service outside SoonerSelect, with no hospital bed hold or supplemental payments.
Frequently asked
Does Oklahoma's posted nursing facility rate include the Pay-for-Performance quality money?
No. PFP is paid as quarterly lump sums outside the rate. It averages $5 per Medicaid day, but in SFY27 Q1 homes received between $0 and $6.78 per day.
How does Oklahoma set the Direct Care part of a nursing home's Medicaid rate?
It shares 70% of a fixed pool by each home's reported nursing cost per day, capped at the 90th percentile. The add-on ran $39.00-$76.27 in 2026, about 56% of reported direct-care cost.
Does Oklahoma adjust nursing facility Medicaid rates for resident acuity or PDPM?
No. Oklahoma has no case-mix system. Only ventilator ($186.64) and high-acuity tracheostomy ($144.79) residents get add-ons, and both need prior authorization.
How much is paid outside the posted rate in Oklahoma?
Small: PFP lump sums of about $22.7M a year, about 2% of base payments.
What does Oklahoma Medicaid pay on Medicare coinsurance days?
SNF coinsurance is paid at 20% of the Medicare rate, usually less than the full coinsurance.
Does Oklahoma require a minimum share of spending on care?
No spending floor; state staffing ratios are enforced through monthly reports and penalties.
How the rate is set
How the method got here
| Effective | From | To | Change | Headline | Source |
|---|---|---|---|---|---|
| 2000-09-01 | Earlier flat nursing facility rates | Rates recalculated to average audited 1998-99 cost and funded by the new Quality of Care fee, with minimum direct-care staffing ratios tied to the fund (63 O.S. 1-1925.2) | The Quality of Care fee and fund were created, and rates were rebuilt from audited cost and paired with state staffing ratios. | Quality of Care fee and staffing ratios created | https://oklahoma.gov/content/dam/ok/en/okhca/documents/sb1622… |
| 2007-07-01 | Flat statewide rate | Base Rate plus an Other Cost add-on (30% pool) and a facility-specific Direct Care add-on (70% pool), plus Focus on Excellence quality points (1-5% of Base + Other) | Oklahoma adopted the pool method still in use today and added a points-based quality add-on paid in the rate. | Pool method with Focus on Excellence quality add-on | https://oklahoma.gov/content/dam/ok/en/okhca/docs/research/ti… |
| 2014-07-01 | Hospital leave bed hold paid (5 days/year) | No payment for hospital leave; therapeutic leave 7 days/year at 50% | Oklahoma stopped paying nursing homes to hold beds during hospital stays. | Hospital bed-hold payments eliminated | https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-… |
| 2016-01-01 | Medicare SNF coinsurance crossovers paid under the general Part A method | SNF crossovers paid at 20% of the Medicare rate for coinsurance and deductible | Payment of Medicare SNF coinsurance for dual eligibles was limited to 20% of the Medicare rate. | SNF crossover payment limited to 20% of Medicare rate | https://oklahoma.gov/content/dam/ok/en/okhca/docs/research/ti… |
| 2018-05-01 | No supplemental payments | UPL supplemental payments for nursing facilities owned by non-state government entities (IGT-funded) | A supplemental program for publicly owned homes started; it was revoked on 9/14/2020. | Public-owner UPL supplemental program started, later revoked | https://oklahoma.gov/content/dam/ok/en/okhca/documents/a0401/… |
| 2019-10-01 | Focus on Excellence points add-on paid in the rate; Base Rate $108.31 | Under SB 280, rates reset to SFY2018 average audited cost, with 50% of the new money going to the Base Rate (now $120.57). Quality pay moved to the Pay-for-Performance program: $1.25/day per measure on four CMS measures, paid as quarterly lump sums. | SB 280 and SB 1044 raised rates to audited cost and replaced Focus on Excellence with quarterly PFP lump sums. | SB 280 cost reset; Focus on Excellence replaced by PFP | https://oklahoma.gov/content/dam/ok/en/okhca/documents/a0401/… |
| 2023-07-01 | Base Rate $123.47 (2022) | Base Rate $158.56 under SB 32X (2023 special session) | The legislature required a large rate increase that raised the Base Rate by $35.09 and added about $145.5M a year. | SB 32X lifts Base Rate by $35.09 | https://oklahoma.gov/ohca/policies-and-rules/proposed-changes… |
Verified October 11, 2026
Cost basis
- Uses cost reports
Yes
- Cost report
OHCA uniform Nursing Home Cost Report, filed through the OHCA Secure Website for the state fiscal year (July-June). It is due October 31; a 15-day extension is possible. Partial-year reports are required on a change of ownership. Allowable costs follow Medicare PRM-15.
- Base year and rebasing
The pool is recalculated every July 1 by an annual state plan amendment (for example OK SPA 26-0013). The Direct Care add-on uses each home's most recent cost report. The state plan also says that from 10/1/2019, subject to available funds, the average rate equals the statewide average audited SFY2018 cost, inflated. That cost is first adjusted by the average audit adjustment of the prior five years, leaving out the highest and lowest. OHCA's methodology summary says the latest audited cost is trended forward with Global Insight inflators, and the cost of new mandates such as minimum wage is added. An upper payment limit (UPL) is checked against a Medicare-equivalent rate, and OHCA recoups pro rata if total payments exceed it.
- Components
Component Method Notes Base Rate Statewide flat amount written into the state plan; includes the Quality of Care fee $160.48/day from 7/1/2026. It was $159.56 from 7/1/2025, $158.78 from 7/1/2024, $158.56 from 7/1/2023 and $123.47 from 7/1/2022. It is about 64% of the average rate. Other Cost (indirect, administrative and capital) Uniform statewide add-on: 30% of the funds left after the Base Rate and estimated PFP, divided by estimated Medicaid days $25.68/day for every home from 7/1/2026 ($24.95 in 2025, $24.30 in 2024, $18.32 in 2023). Capital and administration are paid through this piece; there is no separate capital or fair-rental component. Direct Care 70% of the remaining funds, shared out in proportion to each home's reported direct-care salary and benefit cost per day (RN, DON, LPN, CNA, CMA, therapy aides), with each home capped at the 90th percentile Add-on = home's capped direct-care cost x (pool / total Medicaid direct-care cost). On 7/1/2026 the average is $59.91, the median $60.10 and the range $39.00-$76.27. Reported direct-care cost runs $69.36-$184.40 per day (median $106.88), so the add-on covers roughly 56% of reported direct-care cost. Homes that do not file a cost report get no Direct Care add-on. Pay-for-Performance (PFP) Quality incentive averaging $5.00 per Medicaid day, paid as quarterly lump sums outside the per diem See quality_incentive. - Inflation
Global Insight (IHS Markit) inflators are applied to the latest audited cost to estimate total cost and the UPL, but available funds set the actual rate level. The ventilator add-on is trended by the DRI Nursing Facility Market Basket forecast.
Verified October 11, 2026
Case mix
- System
None
- Applied at
None
- How it works
No acuity adjustment. Every Medicaid resident in a home is paid the same daily rate; the only difference between homes is the Direct Care add-on, which follows reported nursing cost (OK 4.19-D p.4).
- Classification
none
- Applies to
none
- Acuity measured from
Not applicable
- Updated
Not applicable
- Move to PDPM
None. Oklahoma never used RUGs for Medicaid nursing facility payment and has made no move to PDPM. No acuity proposal appears in OHCA rate notices or proposed-rule postings through 2026, and SPA 26-0013 keeps the same structure.
Verified October 11, 2026
Low-acuity residents
None. Every resident who meets nursing facility level of care (OAC 317:30-5-122; UCAT assessment) is paid the home's single rate, with no reduced rate for low-acuity residents. Checked against 4.19-D and OAC 317:30-5 Part 9.
Verified October 11, 2026
Capital
Paid through the uniform 'Other Cost' add-on ($25.68/day from 7/1/2026, the same for every home). There is no fair rental value system and no home-specific capital payment.
Verified October 11, 2026
Budget adjustment factor
No explicit budget factor, but the whole system is limited by budget. The Other Cost and Direct Care pools equal whatever money is left after funding the Base Rate and PFP ($398.0M pool for SFY2027). Rates therefore move with appropriations and fee collections, not with each home's costs. The plan also requires recoupment if total payments exceed the UPL.
Verified October 11, 2026
Add-ons and money outside the rate
Paid outside the posted rate
- Level
small
- Estimate
About 2% of base Medicaid payments. PFP lump sums run about $22.7M/yr (SFY27 Q1 $5.68M x 4), compared with roughly $1.1B in per diem payments (about 4.5M Medicaid days x about $246). Derived from the SFY27 Q1 PFP summary and the 7/1/2026 rate file.
- Components
PFP quarterly lump sums (~$22.7M/yr). There have been no UPL, IGT or directed payments since the NSGO program was revoked in 2020.
Verified October 11, 2026
Payments by owner type
- Applies
no
- Detail
No current payment depends on owner type. The supplemental program for homes owned by non-state government entities (NSGO, 2018-2020) has been revoked. Public ICFs/IID are paid on cost with settlement, but that does not apply to nursing facilities.
- Funding
Not applicable
Verified October 11, 2026
Quality program
- Active
Yes
- Program
Nursing Facility Pay-for-Performance (PFP) Program, created by SB 280 (2019) and effective 10/1/2019. It replaced Focus on Excellence (2007-2019). OAC 317:30-5-136.1; 4.19-D p.5.
- Funding
Paid from the same annual pot as the rates (Quality of Care fee, appropriations and federal match). OHCA sets aside the estimated PFP payments (average $5/day x Medicaid days) before splitting the rest into the Other Cost and Direct Care pools, so the money comes out of the rate pot rather than being new money.
- Size
About $5.68M per quarter in SFY27 Q1 (1,135,961 covered days x $5.00 average), or roughly $22.7M per year. That is about 2% of base Medicaid nursing facility payments.
- Paid as
Quarterly lump sum (paid in May, August, November and February), calculated per Medicaid covered day. It is not added to the posted per diem; the rate file says rates do not include PFP.
- Measures
Measure Source Weight How points are earned Long-stay high-risk/unstageable pressure ulcers MDS QM (CMS long-stay measure) $1.25/day base (one of four equal measures) 5% relative improvement over the home's own annual baseline, or a score at or better than the CMS national average, each quarter. OHCA listed this measure as inactive in late 2024 while CMS replaced it; it is paid again in SFY26 Q4 and SFY27 Q1. Long-stay residents who lose too much weight (N029.02) MDS QM $1.25/day base 5% relative improvement or the national average Long-stay antipsychotic use (N031.03) MDS QM $1.25/day base 5% relative improvement or the national average. It was not paid in SFY26 Q4 or SFY27 Q1; its money appears as 'Redistribution Payment from Anti Psychotic' added to the other three measures. Long-stay urinary tract infection (N024.02) MDS QM $1.25/day base 5% relative improvement or the national average - Scoring period
Baselines are set once a year (Oct 1-Sep 30) from the latest four CMS (CASPER) quarters. Performance is judged each quarter. Homes submit documentation within 30 days after the quarter ends, and payment follows about a quarter later.
- Payment formula
Each measure met earns $1.25 per Medicaid day on one quarter of the home's covered days. Money not earned (missed measures, forfeits, inactive measures) is pooled and redistributed to homes that met measures, in proportion to their prorated days. SFY27 Q1 results per day: $6.78 for homes meeting all three paid measures (119 homes), about $4.43 for two (84 homes), about $2.09-$2.35 for one, and $0 for 27 homes.
- Eligibility
Any licensed and certified Oklahoma nursing facility; participation is voluntary. Since 7/1/2022, a home cited by OSDH for a survey deficiency at scope/severity 'I' or higher loses the PFP incentive for that quarter. Payments are withheld if requested documentation is not sent within 15 business days.
- Cadence
Scored and paid quarterly; baselines reset once a year
- Scores published
Yes. Per-home quarterly 'PFP Payment Summary' workbooks (covered days, payment by measure, lump sum and per-day amount) are posted on the OHCA Long-Term Care provider page, along with quarterly 'Fast Facts'.
- Notes
Under Focus on Excellence (2007-2019), the add-on was 1-5% of Base + Other depending on points earned, and it was paid in the rate. PFP moved it to lump sums. AIDS facilities can also earn PFP.
Verified October 11, 2026
Provider tax
- Charged
per patient day (uniform statewide fee equal to 6% of average gross receipts per day, by facility type)
- Standard amount
$17.57 per patient day for regular and AIDS nursing facilities from 7/1/2026 (SPA 26-0013 notice); $10.65 for ICF/IID and $13.05 for acute ICF/IID. It is billed monthly on the patient days reported on the Quality of Care Report filed two months earlier and is due on the 15th. Late payment draws a 10% penalty plus 1.25% interest per month.
- Tiers
Who Test Amount Regular and AIDS nursing facilities other $17.57 per patient day (7/1/2026) ICFs/IID (regular / acute 16 beds or less) other $10.65 / $13.05 per patient day (7/1/2026) 100% private-pay facilities other Still pay the fee; the rule collects their penalties through the fee billing - Lower for high-Medicaid homes
no
- Returned in the rate
Built into the Base Rate; the state plan says the Base Rate includes the QOC fee. Fee collections plus federal match are also one of the three sources of the annual rate pool.
Verified October 11, 2026
Provider tax notes
Quality of Care (QOC) fee under 56 O.S. 2002. It is a uniform fee per patient day set at 6% of average gross receipts per day for the facility type, recalculated each July 1. Regular nursing facilities pay $17.57 per patient day from 7/1/2026 (it was $11.48 in SFY2019). The fee is an allowable cost and part of the Base Rate. Collections plus federal match fund the rate pool and the QOC fund.
Verified October 11, 2026
Supplemental payments
None active. A Medicare UPL supplemental program for nursing facilities owned by non-state government entities (NSGO) began 5/1/2018. It was funded by intergovernmental transfers (IGT), drew about $18.6M federal in FFY2019, and was revoked in rule effective 9/14/2020 (OAC 317:30-5-136). There are no directed payments because nursing homes are outside managed care. ICFs/IID (not nursing facilities) have a separate Enhanced Payment Program (OAC 317:30-5-136.2).
Verified October 11, 2026
Other add-ons
Ventilator add-on of $186.64/day, with prior authorization; home rate plus add-on totals $415-$449 in the 7/1/2026 file. Acute tracheostomy add-on of $144.79/day from 10/1/2024, with prior authorization; it was raised temporarily to $339.58 for 1/1/2025-6/30/2025. PASRR specialized-services add-on for residents with intellectual disability, equal to the private ICF/IID base minus the NF base (zero if the ICF/IID base is not higher). Nurse aide training: OHCA reimburses aides directly up to $800 for certified private training if they work in a SoonerCare nursing facility. No COVID add-on remains.
Verified October 11, 2026
Units paid separately
AIDS nursing facilities are paid one statewide rate ($294.30/day from 7/1/2026) plus PFP. Ventilator and high-acuity tracheostomy residents in regular homes are paid the home rate plus a statewide add-on (above), and separate cost reports are required. ICFs/IID are paid statewide flat rates ($174.35 regular, $213.10 acute 16 beds or less); public ICFs/IID are paid on cost with a retroactive settlement. Regular nursing facility residents placed in an acute ICF/IID or AIDS facility are paid $246.07. New homes get the median rate ($246.26).
Verified October 11, 2026
Payment rules
Managed care for long-term care
- Status
no
- Detail
OHCA pays for nursing home care fee-for-service. The SoonerSelect 1915(b) managed care waiver (renewal effective 7/1/2026; plans are Aetna Better Health of Oklahoma, Humana Healthy Horizons and Oklahoma Complete Health) lists 'Reside in Nursing Facility or ICF/MR' as an excluded population, so the plans do not pay for long-stay nursing home days.
Verified October 11, 2026
Who pays
fee_for_service
Verified October 11, 2026
Managed care rate floor
Not applicable. Nursing facility residents are excluded from SoonerSelect, so OHCA pays the posted per diem directly.
Verified October 11, 2026
Included in the daily rate
Routine services (OAC 317:30-5-133.1) are in the rate: room, dietary and special diets, nursing, social services and activities, laundry, personal hygiene and oral care items, routine and first-aid supplies, over-the-counter drugs, transportation and equipment. DME, supplies and appliances, including oxygen, were folded into the per diem from 7/1/2020 with a one-time base-rate adjustment. They may not be billed separately (rule alignment APA WF 25-05, effective 5/1/2025). Ancillary services may be billed separately (OAC 317:30-5-133.2), and prescription drugs go through the pharmacy program.
Verified October 11, 2026
Bed hold
- Hospital stays
Not paid (since 7/1/2014).
- Leave days
Paid for up to 7 days per calendar year at 50% of the home's rate. The leave must be in the plan of care, and a midnight census rule applies.
- Occupancy rule
None
- Notes
ICF/IID rules differ: 60 therapeutic days a year (14 consecutive at most) at 75%.
Verified October 11, 2026
Personal needs allowance
- Per month
$75
- Effective
2019-10-01 (TN OK19-0031A)
- Notes
The same $75 applies to each member of a couple and to AFDC-related children and adults. Residents with a VA pension limited to $90 keep the greater of $90 or $75. ADvantage assisted living residents keep a maintenance standard of 150% of the SSI federal benefit rate instead.
Verified October 11, 2026
Medicare coinsurance days
- Method
partial
- Rule
For Medicare Part A SNF crossover claims for services on or after 1/1/2016, Oklahoma pays coinsurance and deductible 'at 20 percent of the Medicare rate' (Supplement 1 to Attachment 4.19-B, p.3). OAC 317:30-3-25(c) says Medicare Advantage (Part C) cost-sharing follows the state plan method, but no nursing-facility-specific Part C method was found.
- Effect
Homes receive less than the full day 21-100 coinsurance whenever 20% of Medicare's daily rate is below the coinsurance, which is the usual case.
Verified October 11, 2026
Required care spending
- Applies
no
- Rule
No rule requires homes to spend a share of Medicaid revenue on care, and nothing is recouped for underspending. Related rules: homes must meet minimum direct-care staff-to-resident ratios under 63 O.S. 1-1925.2, reported monthly on the Quality of Care Report, and OSDH assesses penalties for violations (not rate recoupment). The Direct Care add-on also pays more to homes that report higher nursing spending, up to the 90th-percentile cap.
Verified October 11, 2026
Occupancy rules
- Applies
no
- Rule
No occupancy minimum or imputed-days rule. The pools are divided by estimated Medicaid days, and every home gets the same Other Cost amount (which includes capital) regardless of occupancy.
Verified October 11, 2026
MDS accuracy penalties
None. There is no case-mix payment, so there are no rate cuts for MDS accuracy. PFP relies on CMS MDS quality measures and OHCA desk audits (at least 30% of homes each quarter), and payment is withheld if documentation is not provided.
Verified October 11, 2026
Published rates and changes
How often rates change
- A home's rate changes
annual
- When
July 1 each year (state fiscal year). The Base Rate, QOC fee, pool size and each home's Direct Care add-on are reset by state plan amendment. PFP lump sums change quarterly. Resident acuity plays no role.
Verified October 11, 2026
When rates change
July 1 (SFY). Some years had mid-year changes by legislation (for example 10/1/2018 and 10/1/2019).
Verified October 11, 2026
Posted rates
- Home-level rates published
Yes
- Format
xlsx
- Cadence
annual (July 1); PFP payment summaries quarterly
- History
Rate files for 7/1/2023, 7/1/2024, 7/1/2025 and 7/1/2026 can be reached on the site (the 7/1/2022 file returned 404). The state plan text lists every Base Rate and pool amount back to 2005/2012.
- Home identifier
Facility name only (no provider number, NPI or CCN).
Verified October 11, 2026
Rate build-ups
- Published
Yes
- What they show
For each home: Base, Other Cost and Direct Care per day, total rate, ventilator and trach rates, and the AIDS rate. Summary statistics cover the median, range, reported direct-care cost range and average share of each component. A two-page 'Rate Setting Methodology Summary' explains the pool math. The pool build-up, Medicaid-day estimates and each home's reported costs are not posted.
- Format
xlsx/pdf
Verified October 11, 2026
Recent changes
| Effective | Change | Headline | Direction | Size | Source |
|---|---|---|---|---|---|
| 2024-07-01 | The annual rebasing raised the rate pool from $251.1M to $351.4M. The average rate rose from $224.64 to $244.78, and the Other Cost add-on from $18.32 to $24.30. | Rebasing lifts average rate about 9 percent | increase | +$87.4M SFY2025 budget impact; average rate +$20.14/day (+9.0%) | https://oklahoma.gov/content/dam/ok/en/okhca/docs/policy/publ… |
| 2024-10-01 | A new statewide add-on for high-acuity tracheostomy residents was created at $144.79/day and raised temporarily to $339.58 for 1/1/2025-6/30/2025. | New tracheostomy add-on of $144.79 per day | increase | $2.08M/yr budget impact (SFY2025-26) | https://oklahoma.gov/content/dam/ok/en/okhca/docs/policy/publ… |
| 2025-05-01 | OHCA aligned its rules with the state plan: DME is included in the nursing facility per diem and may not be billed separately. | Rules confirm DME included in per diem | structural | https://oklahoma.gov/ohca/policies-and-rules/proposed-changes… | |
| 2025-07-01 | The annual rebasing set the Base Rate at $159.56 and the pool at $369.8M; the average rate rose to $247.72. | Annual rebasing raises average rate 1.2 percent | increase | +$13.1M SFY2026; average rate +$2.94/day | https://oklahoma.gov/content/dam/ok/en/okhca/docs/policy/publ… |
| 2025-07-01 | PFP now pays on three measures. Antipsychotic use was not paid in SFY26 Q4 or SFY27 Q1 and its money was redistributed; pressure ulcers had been inactive in late 2024. The start date shown is approximate. | Quality program pays on three of four measures | structural | https://oklahoma.gov/content/dam/ok/en/okhca/docs/providers/t… | |
| 2026-07-01 | The annual rebasing (SPA 26-0013) set the Base Rate at $160.48, the QOC fee at $17.57/day and the pool at $398.0M. The average rate rose to $251.07 and the median to $246.26. | Base rate $160.48; QOC fee $17.57 | increase | +$15.55M SFY2027; average rate +$3.34/day (+1.35%) | https://oklahoma.gov/content/dam/ok/en/okhca/docs/policy/publ… |
Verified October 11, 2026
Assisted living
Medicaid assisted living
- Covered
yes
- Program
ADvantage 1915(c) waiver (OK.0256) for adults 65+ and adults with physical disabilities who meet nursing facility level of care. Assisted living is a waiver service delivered in ADvantage-approved Assisted Living Centers (OAC 317:35-17-3).
- What is paid
Services only. The member pays room and board to the center; for SSI recipients the room-and-board charge may not exceed the SSI payment (plus state supplement). Members keep 150% of the SSI federal benefit rate as their maintenance standard.
- Rate
Three daily tiers based on need. The Waiver Year 1 (7/2021-6/2022) cost estimates in Appendix J-2 are Tier 1 $48.99, Tier 2 $66.11 and Tier 3 $92.47 per day, about $8.7M in total for about 724 users. No current fee schedule was found.
- Limits
Waiver capacity is 24,375 unduplicated participants per year across all ADvantage services, and an open waiver slot is required. Only ADvantage-approved assisted living centers can provide the service.
Verified October 11, 2026
Sources
- Oklahoma Title XIX State Plan (compiled 7/9/2026): Attachment 4.19-D NF pages (TN 25-0011, approved 11/6/2025), 4.19-C bed hold, Supplement 1 to 4.19-B crossovers, Attachment 2.6-A PNA · state plan
- OK SPA 26-0013 NF Rate Rebasing draft pages (eff. 7/1/2026) · state plan
- Public notice OK SPA 26-0013 NF Rebasing (QOC fee $17.57, base $160.48, pool $398.0M) · agency page
- Public notice June 20, 2025 (NF rebasing 7/1/2025) · agency page
- Public notice Regular NF Rebasing OK SPA 24-0013 (7/1/2024) · agency page
- OK SPA 23-0024 NF Rebasing page (SB 32X) · agency page
- Public notice OK SPA 24-0019 (revised): acute tracheostomy add-on · agency page
- Public notice, Oct 2019 NF rate increase and PFP (SB 280 / SB 1044) · agency page
- Public notice, July 2020 NF rates and DME in base rate · agency page
- Public notice OK SPA 22-0017 (PFP forfeit for I-level tags) · agency page
- Public notice: NF Supplemental Payment Program (NSGO, eff. 5/1/2018) · agency page
- OHCA Long Term Care Facility Rate Setting Methodology Summary, revised July 2026 · agency page
- OHCA Long Term Care Rates for July 1, 2026 (xlsx); 7/1/2023-7/1/2025 files also used · rate file
- OHCA Long-Term Care and Waiver Services provider page · agency page
- PFP Payment Summary SFY27 Q1 (xlsx); SFY26 Q4 also used · rate file
- OAC 317:30-5-136.1 Pay-for-Performance program · regulation
- OHCA PFP Fast Facts Oct-Dec 2024 (and PFP page and FAQ) · agency page
- OAC 317:30-5-131.2 Quality of care fund requirements and report · regulation
- OAC 317:30-5-126 Therapeutic leave and hospital leave · regulation
- OAC 317:30-5-136 NF Supplemental Payment Program [REVOKED 9/14/2020] · regulation
- OAC 317:30-5-133.1 / 133.2 routine and ancillary services · regulation
- OAC 317:30-5-133.3 ventilator-dependent and tracheostomy care · regulation
- OAC 317:30-5-132 Cost reports (also 317:30-5-133 payment methodologies, 317:30-5-134 nurse aide training) · regulation
- APA WF 25-05 NF DME alignment (emergency rule eff. 5/1/2025) · agency page
- OAC 317:30-3-25 Crossovers · regulation
- SoonerSelect 1915(b) waiver renewal eff. 7/1/2026 (excluded populations) · agency page
- ADvantage 1915(c) waiver OK.0256.R06 (eff. 7/1/2021) · agency page
- OAC 317:35-17-3 ADvantage program services · regulation
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