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Part       AGENCY COMPANION, SPECIALIZED FOSTER CARE, DAILY LIVING SUPPORTS, GROUP HOMES, AND COMMUNITY TRANSITION SERVICES

317:30⊂chapter=5∂=43--420.Home and Community-Based Services Waivers for persons with an intellectual disability or certain persons with related conditions
[Revised 06-25-12]
The Oklahoma Health Care Authority (OHCA) administers Home and Community-Based Services (HCBS) Waivers for persons with an intellectual disability and certain persons with related conditions that are operated by the Oklahoma Department of Human Services Developmental Disabilities Services Division (DDSD). The Community Waiver and Homeward Bound Waiver allow payment for residential supports as defined in the waiver approved by the Centers for Medicare and Medicaid Services (CMS).

317:30⊂chapter=5∂=43--421.Coverage
[Revised 10-01-07]
Residential supports must be included in the member's Individual Plan (IP). Arrangements for care under this program must be made through the member's case manager.

317:30⊂chapter=5∂=43--422.Description of services
[Revised 09-01-15]

Residential supports include:

(1) agency companion services (ACS) per Oklahoma Administrative Code (OAC)317:40-5;

(2) specialized foster care (SFC) per OAC 317:40-5;

(3) daily living supports (DLS):

(A) Community Waiver per OAC 317:40-5-150; and

(B) Homeward Bound Waiver per OAC 317:40-5-153;

(4) group home services provided per OAC 317:40-5-152; and

(5) community transition services (CTS).

(A) Minimum qualifications.  The provider must enter into contractual agreements with the Oklahoma Health Care Authority (OHCA) to provide ACS, habilitation training specialist (HTS) services, or DLS, in addition to a contract to provide CTS.

(B) Description of services.  CTS is a one-time setup expense for members transitioning from an intermediate care facility for individuals with intellectual disabilities (ICF/IID) or provider-operated residential setting to the member's own home or apartment.  The cost per member of CTS cannot exceed limitations set forth by OHCA.  The member's name must be on the lease, deed or rental agreement.  CTS:

(i) are furnished only when the member is unable to meet such expense and must be documented in the member's Individual Plan (IP);

(ii) include security deposits, essential furnishings, such as major appliances, dining table/chairs, bedroom set, sofa, chair, window coverings, kitchen pots/pans, dishes, eating utensils, bed/bath linens, kitchen dish towel/potholders, a one month supply of laundry/cleaning products, and setup fees or deposits for initiating utility service, including phone, electricity, gas, and water .  CTS also includes moving expenses, services/items necessary for the member's health and safety, such as pest eradication, allergen control, a one-time cleaning prior to occupancy, flashlight, smoke detector, carbon monoxide detector, first aid kit, fire extinguisher, and a tempering valve or other anti-scald device when determined by the Team necessary to ensure the member's safety; and

(iii) does not include:

(I) recreational items, such as television, cable, satellite, internet, video cassette recorder (VCR), digital video disc (DVD) player, compact disc (CD) player, MP3 player, or computer used primarily as a  diversion or recreation;

(II) monthly rental or mortgage expenses;

(III) food;

(IV) personal hygiene items;

(V) disposable items, such as paper plates/napkins, plastic utensils, disposable food storage bags, aluminum foil, and plastic wrap;

(VI) items that are considered decorative, such as rugs, pictures, bread box, canisters, or a clock;

(VII) any item not considered an essential, one-time expense; or

(VIII) regular ongoing utility charges;

(iv) prior approval for exceptions and/or questions regarding eligible items and/or expenditures are directed to the programs manager for community transition services at DHS DDS state office

(v) authorizations are issued for the date a member transitions;

(vi) may only be authorized for members approved for the Community Waiver; and (vii) may not be authorized for items purchased more than 30 days after the date of transition.

317:30⊂chapter=5∂=43--423.Coverage limitations
[Revised 06-25-12]
(a) Coverage limitations for residential supports for members with an intellectual disability are:
(1) Description: agency companion services (ACS); Unit: one day; Limitation: 366 units per year;
(2) Description: specialized foster care (SFC); Unit: one day; Limitation: 366 units per year;
(3) Description: daily living supports (DLS); Unit: one day; Limitation: 366 units per year; and
(4) Description: group home services; Unit: one day; Limitation: 366 units per year.
(b) Members may not receive ACS, SFC, DLS and group home services at the same time.
(c) Community transition services (CTS) are limited to $2,400 per eligible member.
(1) CTS is limited to one transition over the member's lifetime. If the member's situation changes after receipt of CTS and hospitalization or readmission to an intermediate care facility for the mentally retarded (ICF/MR) is necessary, CTS is not authorized upon transition back into the community.
(2) Members moving into a group home, SFC, or ACS arrangement in the companion's home are not eligible to receive CTS.
317:30⊂chapter=5∂=43--424.Diagnosis code [REVOKED]
[Revoked 07-01-13]

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.