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Part 9      SERVICE PROVISIONS

317:40-5-100.Assistive technology (AT) devices and services

[Revised 09-01-15]

(a) Applicability.  The rules in this Section apply to AT services and devices authorized by the Oklahoma Department of Human Services (DHS) Developmental Disabilities Services (DDS) through Home and Community Based Services (HCBS) Waivers.

(b) General information.

(1) AT devices include the purchase, rental, customization, maintenance, and repair of devices, controls, and appliances.  AT devices include:

(A) visual alarms;

(B) telecommunication devices (TDDS);

(C) telephone amplifying devices;

(D) other devices for protection of health and safety of members who are deaf or hard of hearing;

(E) tape recorders;

(F) talking calculators;

(G) specialized lamps;

(H) magnifiers;

(I) braille writers;

(J) braille paper;

(K) talking computerized devices;

(L) other devices for protection of health and safety of members who are blind or visually impaired;

(M) augmentative and alternative communication devices including language board and electronic communication, devices;

(N) competence based cause and effect systems, such as switches;

(O) mobility and positioning devices including:

(i) wheelchairs;

(ii) travel chairs;

(iii) walkers;

(iv) positioning systems;

(v) ramps;

(vi) seating systems;

(vii) standers;

(viii) lifts;

(ix) bathing equipment;

(x) specialized beds; and

(xi) specialized chairs;

(P) orthotic and prosthetic devices, including:

(i) braces;

(ii) prescribed modified shoes; and

(iii) splints;

(Q) environmental controls or devices;

(R) items necessary for life support, and devices necessary for the proper functioning of such items, including durable and non-durable medical equipment not available through SoonerCare; and

(S) devices for the protection of the member's health and safety.

(2) AT services include:

(A) sign language interpreter services for members who are deaf;

(B) reader services;

(C) auxiliary aids;

(D) training the member and provider in the use and maintenance of equipment and auxiliary aids;

(E) repair of AT devices; and

(F) evaluation of the member's AT needs.

(3) AT devices and services must be included in the member's Individual Plan (IP) and arrangements for this HCBS service must be made through the member's case manager.

(4) AT devices are provided by vendors with a Durable Medical Equipment (DME) contract with the Oklahoma Health Care Authority (OHCA).

(5) AT devices and services are authorized in accordance with requirements of The Oklahoma Central Purchasing Act, other applicable statutory provisions, Oklahoma Administrative Code OAC 580:15 and DHS approved purchasing procedures.

(6) AT services are provided by an appropriate professional services provider with a current HCBS contract with OHCA and current, unrestricted licensure and certification with their professional board, when applicable.

(7) AT devices or services may be authorized when the device or service:

(A) has no utility apart from the needs of the person receiving services;

(B) is not otherwise available through SoonerCare, an AT retrieval program, Oklahoma Department of Rehabilitative Services, or any other third party or known community resource;

(C) has no less expensive equivalent that meets the member's needs;

(D) is not solely for family or staff convenience or preference;

(E) is based on the assessment and Personal Support Team (Team) consideration of the member's unique needs;

(F) is of direct medical or remedial benefit to the member;

(G) enables the member to maintain, increase, or improve functional capabilities;

(H) is supported by objective documentation included in a professional assessment, except as specified per OAC 317:40-5-100;

(I) is within the scope of assistive technology per OAC 317:40-5-100;

(J) is the most appropriate and cost effective bid if applicable; and

(K) exceeds a cost of $50.   AT devices or services with a cost of $50 or less, are not authorized through DDS HCBS Waivers.

(8) The homeowner must sign a written agreement for any AT equipment that attaches to the home or property.

(c) Assessments.  Assessments for AT devices or services are performed by a licensed professional service provider and reviewed by other providers whose services may be affected by the type of device selected.  A licensed professional must:

(1) determine whether the member's identified outcome can be accomplished through the creative use of other resources, such as:

(A) household items or toys;

(B) equipment loan programs;

(C) low-technology devices or other less intrusive options; or

(D) a similar, more cost-effective device;

(2) recommend the most appropriate AT based on the member's:

(A) present and future needs, especially for members with degenerative conditions;

(B) history of use of similar AT, and ability to use the device currently and for at least the foreseeable future no less than 5 years; and

(C) outcomes;

(3) complete an assessment, including a decision making review and device trial that provides supporting documentation for purchase, rental, customization, or fabrication of an AT device.  Supporting documentation must include:

(A) a review of the device considered;

(B) availability of the device rental with discussion of advantages and disadvantages;

(C) how frequently, and in what situations the device will be used in daily activities and routines;

(D) how the member and caregiver(s) will be trained to safely use the AT device; and

(E) the features and specifications of the device necessary for the member, including rationale for why other alternatives are not available to meet the member's needs; and

(4) provide a current, unedited videotape or pictures of the  member using the device, including the time frames of the trials recorded, upon request by DDS staff.

(d) Authorization of repairs, or replacement of parts.  Repairs to AT devices, or replacement of device parts, do not require a professional assessment or recommendation.  DDS area office resource development staff with assistive technology experience may authorize repairs and replacement of parts for previously recommended assistive technology.

(e) Retrieval of assistive technology devices.  When devices are no longer needed by a member, DHS DDS staff may retrieve the device.

(f) Team decision-making process. The member's Team reviews the licensed professional's assessment and decision-making review.  The Team ensures the recommended AT:

(1) is needed by the member to achieve a specific, identified functional outcome.

(A) A functional outcome, in this Section, means the activity is meaningful to the member, occurs on a frequent basis, and would require assistance from others, if the member could not perform the activity independently, such as self-care, assistance with eating, or transfers.

(B) Functional outcomes must be reasonable and necessary given a member's age, diagnosis, and abilities;

(2) allows the member receiving services to:

(A) improve or maintain health and safety;

(B) participate in community life;

(C) express choices; or

(D) participate in vocational training or employment;

(3) will be used frequently or in a variety of situations;

(4) will easily fit into the member's lifestyle and work place;

(5) is specific to the member's unique needs; and

(6) is not authorized solely for family or staff convenience.

(g) Requirements and standards for AT devices and service providers.

(1) Providers guarantee devices, work, and materials for one calendar year, and supply necessary follow-up evaluation to ensure optimum usability.

(2) Providers ensure a licensed occupational therapist, physical therapist, speech therapist, or rehabilitation engineer evaluates the need for AT, and individually customizes AT devices as needed.

(h) Services not covered through AT devices and services.  Assistive technology devices and services do not include:

(1) trampolines;

(2) hot tubs;

(3) bean bag chairs;

(4) recliners with lift capabilities;

(5) computers except as adapted for individual needs as a primary means of oral communication and approved per OAC 317:40-5-100;

(6) massage tables;

(7) educational games and toys; or

(8) generators.

(i) Approval or denial of AT.  DDS approval, conditional approval for pre-determined trial use, or denial of the purchase, rental, or lease/purchase of the AT is determined per OAC 317:40-5-100.

(1) The DDS case manager sends the AT request to designated DDS area office resource development staff with AT experience.  The request must include:

(A) the licensed professional's assessment and decision making review;

(B) a copy of the Plan of Care (POC);

(C) documentation of current Team consensus, including consideration of issues per OAC 317:40-5-100; and

(D) all additional documentation to support the need for the AT device or service.

(2) The designated area office resource development staff, with AT experience, approves or denies the AT request when the device costs less than $2500.

(3) The State Office programs manager for AT approves or denies the AT request when the device has a cost of $2500 or more.

(4) 10 business days of receipt of a complete request.

(A) If the AT is approved, a letter of authorization is issued.

(B) If additional documentation is required by the area office resource development staff with AT experience, to authorize the recommended AT, the request packet is returned to the case manager for completion.

(C) When necessary, the case manager contacts the licensed professional to request the additional documentation.

(D) The authorization of a $2,500 or more AT is completed per (2) of this subsection, except that the area office resource development staff with AT experience:

(i) solicits three bids for the AT;

(ii) submits the AT request, bids, and other relevant information to the DDS State Office AT programs manager within five business days of receipt of the required bids; and

(iii) the State Office AT programs manager or designee issues a letter of authorization, a written denial, or a request for additional information within five business days of receipt of all required documentation for the AT.

(j) Approval of vehicle adaptations.  Vehicle adaptations are assessed and approved per OAC 317:40-5-100.  In addition, the requirements in (1) through (3) of this subsection must be met.

(1) The vehicle to be adapted must be owned or in the process of being purchased by the member receiving services or his or her family.

(2) The AT request must include a certified mechanic's statement that the vehicle and adaptations are mechanically sound.

(3) Vehicle adaptations are limited to one vehicle in a 10-calendar year period per member.  Authorization for more than one vehicle adaptation in a 10-year period must be approved by the DDS division administrator or designee.

(k) Denial.  Procedures for denial of an AT device or service are described in (1) through (3) of this subsection.

(1) The person denying the AT request provides a written denial to the case manager citing the reason for denial per OAC 317:40-5-100.

(2) The case manager sends DHS FORM 06MP004E, the Notice of Action, to the member and his or her family or guardian.

(3) Denial of AT services may be appealed through the DHS hearing process, per OAC 340:2-5.

(l) Return of an AT device.  When, during a trial use period or rental of a device, the therapist or Team including the licensed professional when available, who recommended the AT, determines the device is not appropriate, the licensed professional sends a brief report describing the reason(s) for the change of device recommendation to the DDS case manager.  The case manager forwards the report to the designated area office resource development staff, who arranges for the return of the equipment to the vendor or manufacturer.

(m) Rental of AT devices.  AT devices are rented when the licensed professional or area office resource development staff with AT experience determines rental of the device is more cost effective than purchasing the device or the licensed professional recommends a trial period to determine if the device meets the member's needs.

(1) The rental period begins on the date the manufacturer or vendor delivers the equipment to the member, unless otherwise stated in advance by the manufacturer or vendor.

(2) Area office resource development staff with AT experience monitor use of equipment during the rental agreement for:

(A) cost effectiveness of the rental time frames;

(B) conditions of renewal; and

(C) the Team's, including the licensed professional, re-evaluation of the member's need for the device per OAC 317:40-5-100.

(3) Rental costs are applied toward the purchase price of the device whenever such option is available from the manufacturer or vendor.

(4) When a device is rented for a trial use period, the Team, including the licensed professional, decides within 90 calendar days whether:

(A) the equipment meets the member's needs; and

(B) to purchase the equipment or return it.

(n) Assistive Technology Committee.  The committee reviews equipment requests when deemed necessary by the DHS DDS State Office programs manager for AT.

(1) The AT committee is comprised of:

(A) DDS professional staff members of the appropriate therapy;

(B) DDS AT State Office programs manager;

(C) the DDS area manager or designee; and

(D) an AT expert not employed by DHS.

(2) The AT committee performs a paper review, providing technical guidance, oversight, and consultation.
(3) The AT committee may endorse or recommend denial of a device or service, based on criteria provided in this Section.  Any endorsement or denial includes a written rationale for the decision and, if necessary, an alternative solution, directed to the case manager within 20 business days of the receipt of the request.  Requests reviewed by the AT committee result in suspension of time frames specified per OAC 317:40-5-100.

317:40-5-101.Architectural modifications

[Revised 06-25-12]
(a) Applicability. The rules in this Section apply to architectural modification (AM) services authorized by the Oklahoma Department of Human Services (OKDHS) Developmental Disabilities Services Division (DDSD) through Home and Community Based Services (HCBS) Waivers.
(b) General information. Architectural Modification services:
(1) are provided by building contractors who have contractual agreements with the Oklahoma Health Care Authority to provide Home and community Based Services. Providers must meet requirements of the International Code Council (ICC), formerly the Building Official and Code Administrators (BOCA), for building, electrical, plumbing and mechanical inspections;
(2) include the installation of ramps, grab-bars, widening of doorways, modification of a bathroom or kitchen facilities, specialized safety adaptations such as scald protection devices, stove guards, and modifications required for the installation of specialized equipment, which are necessary to ensure the health, welfare and safety of the member or that enable the member to function with greater independence in the home;
(3) must be recommended by the member's Team and included in the member's IP. Arrangements for this service must be made through the member's case manager;
(4) are performed on homes of eligible members who have disabilities that limit accessibility or require modifications to ensure health and safety;
(5) are provided based on the:
(A) assessment and Personal Support Team (Team) consideration of the member's unique needs per OAC 317:40-5-101(b);
(B) scope of architectural modifications per OAC 317:40-5-101;
(C) most appropriate and cost effective bid, if applicable, ensuring the quality of materials and workmanship;
(D) lack of a less expensive equivalent, such as assistive technology, that meets the member's needs; and
(E) safety and suitability of the home.
(6) are limited to modifications of two different residences within any seven year period beginning with the member's first request for an approved architectural modification service;
(7) are provided with assurance of plans for the member to remain in the residence for at least five years;
(8) may be denied when DDSD determines the home is unsafe or otherwise unsuitable for architectural modifications.
(A) DDSD area office resource development staff with architectural modification experience screens a home for safety and suitability for architectural modifications prior to home acquisition.
(B) Members needing home modification services and provider agencies assisting members to locate rental property identify several homes, when possible, for screening in order to select a home with the fewest or most cost effective modifications;
(9) are provided to eligible members with the homeowner's signed permission;
(10) are not authorized to modify homes solely for family or staff convenience or for cosmetic preference;
(11) are provided on finished rooms complete with wiring and plumbing;
(12) services that do not meet the requirements of OAC 317:40-5-101 may be approved by the DDSD division administrator or designee in exceptional circumstances; and
(13) are authorized in accordance with requirements of The Oklahoma Central Purchasing Act 74 O.S., ' 85.1 et. Seq., Chapter 15 of Title 580 of the Department of Central Services, and other applicable statutory provisions.
(c) Assessment and Team process.
(1) Architectural modification assessments are performed by:
(A) DDSD area office resource development staff with architectural modification experience, when the requested architectural modification complies with minimum applicable national standards for persons with physical disabilities as applicable to private homes; or
(B) a licensed occupational therapist or physical therapist, at the request of designated DDSD area office resource development staff or area program supervisory staff, when the requested architectural modification exceeds or requires a variance to applicable national standards for persons with physical disabilities, or when such expertise is deemed necessary by DDSD area office resource development staff or area program supervisory staff.
(2) The Team considers the most appropriate architectural modifications based on the:
(A) member's needs;
(B) member's ability to access his or her environment; and
(C) possible use of assistive technology instead of architectural modification.
(3) The Team considers architectural modifications that:
(A) are necessary to ensure the health, welfare, and safety of the member; and
(B) provide the member increased access to the home to reduce dependence on others for assistance in daily living activities.
(d) Requirements and standards for architectural modification contractors and construction. All contractors must meet applicable federal, state and local requirements.
(1) Contractors are responsible for:
(A) obtaining all permits required by the municipality where construction is performed;
(B) following all applicable building codes; and
(C) taking and providing pictures to area office resource development staff of each completed architectural modification project within five working days of project completion and prior to payment of the architectural modification claim. Area office resource development staff may take pictures of the completed architectural modification projects when requested by the contractor.
(2) Any penalties assessed for failure to comply with requirements of the municipality are the sole responsibility of the contractor.
(3) New contractors must provide three references of previous work completed.
(4) Contractors must provide evidence of:
(A) liability insurance;
(B) vehicle insurance;
(C) worker's compensation insurance or affidavit of exemption; and
(D) lead paint safety certificate.
(5) All modifications meet national standards for persons with physical disabilities as applicable to private homes unless a variance is required by the assessment.
(6) Contractors complete construction in compliance with written assessment recommendations from the:
(A) DDSD area office resource development staff with architectural modification experience; or
(B) a licensed professional.
(7) All architectural modifications must be completed by using high standard materials and workmanship, in accordance with industry standard.
(8) Ramps are constructed using the standards in (A) through (G) of this paragraph.
(A) All exterior wooden ramps are constructed of number two pressure treated wood.
(B) Surface of the ramp has a rough, non-skid texture.
(C) Ramps are assembled by the use of deck screws.
(D) Hand rails on ramps, if required, are sanded and smooth.
(E) Ramps can be constructed of stamped steel.
(F) Support legs on ramps are no more than six feet apart.
(G) Posts on ramps must be set or anchored in concrete.
(9) Roll-in showers are constructed to meet standards in (A) through (E) of this paragraph.
(A) The roll-in shower includes a new floor that slopes uniformly to the drain at not less than one-fourth nor more than one-half inch per foot.
(B) The material around the drain is flush, without an edge on which water can catch before going into the drain.
(C) Duro-rock, rather than sheet rock, is installed around the shower area, at least 24 inches up from the floor, with green board above the duro-rock.
(D) Tile, shower insert, or other appropriate water resistant material is installed to cover the duro-rock and green board.
(E) The roll-in shower includes a shower pan, or liner if applicable.
(F) Roll in showers may also be constructed with a one piece pre-formed material.
(10) DDSD area office resource development staff inspect any or all architectural modification work, prior to payment of an architectural modifications claim, to ensure:
(A) architectural modifications are completed in accordance with assessments; and
(B) quality of workmanship and materials used comply with requirements of OAC 317:40-5-101.
(e) Architectural modifications when members change residences.
(1) When two or more members share a home that has been modified and the member will no longer be sharing the home, the member whose Plan of Care authorized the modifications is given the first option of remaining in the residence.
(2) Restoration of architectural modifications is performed only for members of the Homeward Bound class when a written agreement between the homeowner and DDSD director, negotiated before any architectural modifications begin, describes in full the extent of the restoration. If no written agreement exists between the DDSD director and homeowner, OKDHS is not responsible to provide, pay for, or authorize any restorative services.
(f) Services not covered under architectural modifications. Architectural modifications do not include adaptations or improvements to the home which are of general utility and are not of direct medical or remedial benefit to the member, construction, reconstruction, or remodeling of any existing construction in the home, such as floors, sub-floors, foundation work, roof, or major plumbing.
(1) Square footage is not added to the home as part of an architectural modification.
(2) Architectural modifications are not performed during construction or remodeling of a home.
(3) Modifications not authorized by the OKDHS include, but are not limited to:
(A) roofs;
(B) installation of heating or air conditioning units;
(C) humidifiers;
(D) water softener units;
(E) fences;
(F) sun rooms;
(G) porches;
(H) decks;
(I) canopies;
(J) covered walkways;
(K) driveways;
(L) sewer lateral lines or septic tanks;
(M) foundation work;
(N) room additions;
(O) carports;
(P) concrete for any type of ramp, deck, or surface other than a five by five landing pad at the end of a ramp, as described in applicable national standards for persons with physical disabilities as applicable to private homes;
(Q) non-adapted home appliances;
(R) carpet or floor covering that is not part of an approved architectural modification that requires and includes a portion of the floor to be re-covered such as a roll in shower, a door widening; or
(S) a second ramp or roll in shower in a home.
(4) A sidewalk is not authorized unless needed by the member to move between the house and vehicle.
(g) Approval or denial of architectural modification services. DDSD approval or denial of an architectural modification service is determined in accordance with (1) through (3) of this subsection.
(1) The architectural modification request provided by the DDSD case manager to DDSD area office resource development staff includes:
(A) documentation from the member's Team confirming the need and basis for architectural modification, including the architectural modification assessment;
(B) documentation of current Team consensus, including consideration of issues per OAC 317:40-5-101;
(C) lease, proof of home ownership, or other evidence that the member is able to live in the modified residence for at least 12 months; and
(D) an assurance by the member or legal guardian, if applicable, that the member plans to reside in the residence for five years.
(2) The DDSD area office:
(A) authorizes architectural modification services less than $2500 when the plan of care is less than the state office reviewer limit; and
(B) provides all required information to the DDSD State Office architectural modification programs manager for authorization of services when the plan of care is more than the area office limit or is $2500 or more.
(3) Architectural modifications may be denied when the requirements of OAC 317:40-5-101 are not met.
(h) Appeals. The denial of acquisition of an architectural modification request may be appealed per OAC 340:2-5.
(i) Resolving problems with services. If the member, family member, or legal guardian, or Team is dissatisfied with the architectural modification, the problem resolution process per OAC 340:100-3-27 is initiated.

317:40-5-102.Nutrition Services
[Revised 06-11-10]
(a) Applicability. The rules in this Section apply to nutrition services authorized for members who receive services through Home and Community-Based Services (HCBS) Waivers operated by the Oklahoma Department of Human Services (OKDHS) Developmental Disabilities Services Division (DDSD).
(b) General information. Nutrition services include nutritional evaluation and consultation to members and their caregivers, are intended to maximize the member's health and are provided in any community setting as specified in the member's Individual Plan (IP). Nutrition services must be prior authorized, included in the member's Individual Plan (IP) and arrangements for this service must be made through the member's case manager. Nutrition service contract providers must be licensed in the state where they practice and registered as a dietitian with the Commission of Dietetic Registration. Each dietitian must have a current provider agreement with the Oklahoma Health Care Authority (OHCA) to provide Home and Community Based Services, and a SoonerCare provider agreement for nutrition services. Nutrition Services are provided per Oklahoma Administrative Code (OAC) 340:100-3-33.1. In order for the member to receive Waiver-funded nutrition services, the requirements in this Section must be fulfilled.
(1) The member must be assessed  by the case manager to have a possible eating problem or nutritional risk.
(2) The member must have a physician's order for nutrition services current within one year.
(3) Per OAC 340:100-5-50 through 58, the team identifies and addresses member needs.
(4) Nutrition services may include evaluation, planning, consultation, training and monitoring.
(5) A legally competent adult or legal guardian who has been informed of the risks and benefits of the service has the right to refuse nutrition services per OAC 340:100-3-11. Refusal of nutrition services must be documented in the Individual Plan.
(6) A minimum of 15 minutes for encounter and record documentation is required.
(7) A unit is 15 minutes.
(8) Nutrition services are limited to 192 units per Plan of Care year.
(c) Evaluation. When arranged by the case manager, the nutrition services contract provider evaluates the member's nutritional status and completes the Level of Nutritional Risk Assessment.
(1) The evaluation must include, but is not limited to:
(A) health, diet, and behavioral history impacting on nutrition;
(B) clinical measures including body composition and physical assessment.
(C) dietary assessment, including:
(i)nutrient needs;
(ii) eating skills;
(iii) nutritional intake; and
(iv) drug-nutrient interactions; and
(D) recommendations to address nutritional risk needs, including:
(i) outcomes;
(ii) strategies;
(iii) staff training; and
(iv) program monitoring and evaluation.
(2) The nutrition services contract provider and other involved professionals make recommendations for achieving positive nutritional outcomes based on the risks identified on the OKDHS Level of Nutritional Risk Assessment.
(3) The nutrition services contract provider sends a copy of the Level of Nutritional Risk Assessment to the case manager within ten working days of receipt of the authorization.
(4) If the evaluation shows the member rated as High Nutritional Risk, the nutrition services contract provider sends a copy of the Level of Nutritional Risk Assessment to the DDSD area nutrition therapist or DDSD area professional support services designee as well as the case manager within 10 working days of receipt of the authorization.
(d) Planning. The DDSD case manager, in conjunction with the Team, reviews the identified nutritional risks that impact the member's life.
(1) Desired nutritional outcomes are developed and integrated into the Individual Plan using the least restrictive, least intrusive, most normalizing measures that can be carried out across environments.
(2) The Team member(s) identified responsible in the Individual Plan develops methods to support the nutritional outcomes, which may include:
(A) Stragegies;
(B) Staff training; or
(C) Program monitoring.
(3) When the member has been receiving nutrition services and nutritional status is currently stable and the Team specifies that nutrition services are no longer needed, the Team will identify individual risk factors for the member that would indicate consideration of the resumption of nutrition services and assigns responsibility to a named Team Member(s) for monitoring and reporting the members status regarding these factors.
(4) Any member who receives paid 24 hour per day supports and requires constant physical assistance and mealtime intervention to eat safely, or is identified for risk of choking or aspiration must have an individualized mealtime assistance plan developed and reviewed at least annually by the Team member(s) identified responsible in the Individual Plan. Team members may include a nutrition services contract provider and a speech therapy contract provider or occupational therapy contract provider with swallowing expertise (mealtime therapists). Documentation should delineate responsibilities to insure there is no duplication of services. The mealtime assistance plan includes but is not limited to:
(A) a physician ordered diet;
(B) diet instructions;
(C) positioning needs;
(D) assistive technology needs;
(E) communication needs;
(F) eating assistance techniques;
(G) supervision requirements;
(H) documentation requirements;
(I) monitoring requirements; and
(J) training and assistance.
(5) For those members receiving paid 24 hour per day supports and nutrition through a feeding tube, the Team develops and implements strategies for tube feeding administration that enables members to receive nutrition in the safest manner and for oral care that enables optimal oral hygiene and oral-motor integrity as deemed possible per OAC 340:100-5-26. The Team reviews the member's ability to return to oral intake following feeding tube placement and annually thereafter in accordance with the member's needs.
(e) Implementation, Consultation and Training. Strategies are implemented by the assigned person within a designated time frame established by the Team based on individual need(s).
(1) Direct support staff members are trained per the Individual Plan and OAC 340:100-3-38.
(2) All special diets, nutritional supplements, and aids to digestion and elimination must be prescribed and reviewed at least annually by a physician.
(3) Consultation to members and their caregivers is provided as specified in the IP.
(4) Program documentation is maintained in the member's home record for the purpose of evaluation and monitoring.
(5) The contract professional provider(s) sends documentation regarding the member's program concerns, recommendations for remediation of any problem area and progress notes to the case manager per OAC 340:100-5-52.
(A) The designated professional(s) reviews the program data submitted for:
(i) completeness;
(ii) consistency of implementation; and
(iii) positive outcomes.
(B) When a member is identified by the Level of Nutritional Risk Assessment to be at high nutritional risk, he or she receives increased monitoring by the nutrition services contract provider and health care coordinator, as determined necessary by the Team.
(C) Significant changes in nutritional status must be reported to the case manager by the health care coordinator.
(D) The Level of Nutritional Risk Assessment:
(i) is used by the nutrition services contract provider to reassess members at high risk on a quarterly basis; and
(ii) must be submitted by the nutrition services contract provider to the DDSD area nutrition therapist or DDSD area professional support services designee within 15 days following the end of each quarter.

 

317:40-5-103.Transportation
[Revised 09-01-17]

(a) Applicability.  The rules in this Section apply to transportation services provided through the Oklahoma Department of Human Services (DHS), Developmental Disabilities Services (DDS); Home and Community Based Services (HCBS) Waivers.

(b) General Information.  Transportation services include adapted, non-adapted, and public transportation.

(1) Transportation services are provided to promote inclusion in the community, access to programs and services, and participation in activities to enhance community living skills. Members are encouraged to utilize natural supports or community agencies that can provide transportation without charge before accessing transportation services. 

(2) Services include, but are not limited to, transportation to and from medical appointments, work or employment services, recreational activities, and other community activities within the number of miles authorized in the Plan of Care.

(A) Adapted or non-adapted transportation may be provided for each eligible person.

(B) Public transportation may be provided up to a maximum of $5,000 per Plan of Care year. The DDS director or designee may approve requests for public transportation services totaling more than $5,000 per year when public transportation is the most cost-effective option.  For the purposes of this Section, public transportation is defined as:

(i) services, such as an ambulance when medically necessary, a bus, or a taxi; or

(ii) a transportation program operated by the member's employment services or day services provider.

(3) Transportation services must be included in the member's Individual Plan (Plan) and arrangements for this service must be made through the member's case manager.

(4) Authorization of Transportation Services is based on:

(A) Personal Support Team (Team) consideration, per Oklahoma Administrative Code (OAC) 340:100-5-52, of the unique needs of the person and the most cost effective type of transportation services that meets the member's need, per (d) of this Section; and

(B) the scope of transportation services as explained in this Section.

(c) Standards for transportation providers. All drivers employed by contracted transportation providers must have a valid and current Oklahoma driver license, and the vehicle(s) must meet applicable local and state requirements for vehicle licensure, inspection, insurance, and capacity.

(1) The provider must ensure that any vehicle used to transport members:

(A) meets the member's needs;

(B) is maintained in a safe condition;

(C) has a current vehicle tag; and

(D) is operated in accordance with local, state, and federal law, regulation, and ordinance.

(2) The provider maintains liability insurance in an amount sufficient to pay for injuries or loss to persons or property occasioned by negligence or malfeasance by the agency, its agents, or employees.

(3) The provider ensures all members wear safety belts during transport.

(4) Regular vehicle maintenance and repairs are the responsibility of the transportation provider. Providers of adapted transportation services are also responsible for maintenance and repairs of modifications made to vehicles. Providers of non-adapted transportation with a vehicle modification funded through HCBS assistive technology services may have repairs authorized per OAC 317:40-5-100.

(5) Providers must maintain documentation, fully disclosing the extent of services furnished that specifies the:

(A) service date;

(B) location and odometer mileage reading at the starting point and destination; or trip mileage calculation from Global Positioning System(GPS) software;

(C) name of the member transported; and

(D) purpose of the trip.

(6) A family member, including a family member living in the same household of an adult member may establish a contract to provide transportation services to:

(A) work or employment services;

(B) medical appointments; and

(C) other activities identified in the Plan as necessary to meet the needs of the member, per OAC 340:100-3-33.1.

(7) Individual transportation providers must provide verification of vehicle licensure, insurance and capacity to the DDS area office before a contract may be established and updated verification of each upon expiration. Failure to provide updated verification of a current and valid Oklahoma driver license and/or vehicle licensure may result in cancellation of the contract.

(d) Services not covered.  Services that cannot be claimed as transportation services include:

(1) services not approved by the Team;

(2) services not authorized by the Plan of Care;

(3) trips that have no specified purpose or destination;

(4) trips for family, provider, or staff convenience;

(5) transportation provided by the member;

(6) transportation provided by the member's spouse;

(7) transportation provided by the biological, step or adoptive parents of the member or legal guardian, when the member is a minor;

(8) trips when the member is not in the vehicle;

(9) transportation claimed for more than one member per vehicle at the same time or for the same miles, except public transportation;

(10) transportation outside Oklahoma unless:

(A) the transportation is provided to access the nearest available medical or therapeutic service; or

(B) advance written approval is given by the DDS area manager or designee;

(11) services that are mandated to be provided by the public schools pursuant to the Individuals with Disabilities Education Act;

(12) transportation that occurs during the performance of the member's paid employment, even when the employer is a contract provider; or

(13) transportation when a closer appropriate location was not selected.

(e) Assessment and Team process.  At least annually, the Team addresses the member's transportation needs.  The Team determines the most appropriate means of transportation based on the:

(1) present needs of the member. When addressing the possible need for adapted transportation, the Team only considers the member's needs. The needs of other individuals living in the same household are considered separately;

(2) member's ability to access public transportation services; and

(3) availability of other transportation resources including natural supports, and community agencies.

(f) Adapted transportation. Adapted transportation may be transportation provided in modified vehicles with wheelchair or stretcher-safe travel systems or lifts that meet the member's medical needs that cannot be met with the use of a standard passenger vehicle, including a van when the modification to the vehicle was not funded through HCBS assistive technology service and is owned or leased by the DDS HCBS provider agency.

(1) Adapted transportation is not authorized when a provider agency leases an adapted vehicle from a member or a member's family.

(2) Exceptions to receive adapted transportation services for modified vehicles other than those with wheelchair/stretcher safe travel systems and lifts may be authorized by the DDS programs manager for transportation services when documentation supports the need, and there is evidence the modification costs exceeded $10,000. All other applicable requirements of OAC 317:40-5-103 must be met.

(3) Adapted transportation services do not include vehicles with modifications including, but not limited to:

(A) restraint systems;

(B) plexi-glass windows;

(C) barriers between the driver and the passengers;

(D) turney seats; and

(E) seat belt extenders.

(4) The Team determines if the member needs adapted transportation according to:

(A) the member's need for physical support when sitting;

(B) the member's need for physical assistance during transfers from one surface to another;

(C) the portability of the member's wheelchair;

(D) associated health problems the member may have; and

(E) less costly alternatives to meet the need.

(5) The transportation provider and the equipment vendor ensure that the Americans with Disabilities Act requirements are met.

(6) The transportation provider ensures all staff assisting with transportation is trained according to the requirements specified by the Team and the equipment manufacturer.

(g) Authorization of transportation services.  The limitations in this subsection include the total of all transportation units on the Plan of Care, not only the units authorized for the identified residential setting.

(1) Up to 12,000 units of transportation services may be authorized in a member's Plan of Care per OAC 340:100-3-33 and OAC 340:100-3-33.1.

(2) When there is a combination of non-adapted transportation and public transportation on a Plan of Care, the total cost for transportation cannot exceed the cost for non-adapted transportation services at the current non-adapted transportation reimbursement rate multiplied by 12,000 miles for the Plan of Care year.

(3) The DDS area manager or designee may approve:

(A) up to 14,400 miles per Plan of Care year for people who have extensive needs for transportation services; and

(B) a combination of non-adapted transportation and public transportation on a Plan of Care, when the total cost for transportation does not exceed the cost for non-adapted transportation services at the current, non-adapted transportation reimbursement rate multiplied by 14,400 miles for the Plan of Care year.

(4) The DDS division director or designee may approve:

(A) transportation services in excess of 14,400 miles per Plan of Care year in extenuating situations when person-centered planning identified specific needs that require additional transportation for a limited period; or

(B) any combination of public transportation services with adapted or non-adapted transportation; or

(C) public transportation services in excess of $5,000, when it is the most cost effective service option for necessary transportation.

317:40-5-104.Specialized medical supplies
[Revised 06-11-10]
(a) Applicability. The rules in this section apply to specialized medical supplies provided through Home and Community Based Services (HCBS) Waivers operated by the Oklahoma Department of Human Services (OKDHS) Developmental Disabilities Services Division (DDSD).
(b) General information. Specialized medical supplies include supplies specified in the plan of care that enable the member to increase his or her ability to perform activities of daily living. Specialized medical supplies include the purchase of ancillary supplies not available through SoonerCare.
(1) Specialized medical supplies must be included in the member's plan and arrangements for this service must be made through the member's case manager. Items reimbursed with Home and Community Based Services (HCBS) funds are in addition to any supplies furnished by SoonerCare.
(2) Specialized medical supplies meet the criteria for service necessity given in OAC 340:100-3-33.1.
(3) All items meet applicable standards of manufacture, design, and installation.
(4) Specialized medical supplies providers must hold a current SoonerCare Durable Medical Equipment (DME) and/or Medical Supplies Provider Agreement with the Oklahoma Health Care Authority, and be registered to do business in Oklahoma or the state in which they are domiciled. Providers must enter into the agreement giving assurance of ability to provide products and services and agree to the audit and inspection of all records concerning goods and services provided.
(5) Items that can be purchased as specialized medical supplies include:
(A) incontinence supplies, as described in subsection (b) of this Section;
(B) nutritional supplements;
(C) supplies for respirator or ventilator care;
(D) decubitus care supplies;
(E) supplies for catheterization; and
(F) supplies needed for health conditions.
(6) Items that cannot be purchased as specialized medical supplies include:
(A) over the counter medications(s);
(B) personal hygiene items;
(C) medicine cups;
(D) items that are not medically necessary; and
(E) prescription medication(s).
(7) Specialized medical supplies must be:
(A) necessary to address a medical condition;
(B) of direct medical or remedial benefit to the member;
(C) medical in nature; and
(D) consistent with accepted health care practice standards and guidelines for the prevention, diagnosis, or treatment of symptoms of illness, disease, or disability.
(c) Limited coverage. Items available in limited quantities through specialized medical supplies include:
(1) incontinence wipes, 300 wipes per month;
(2) non-sterile gloves, as approved by the Team;
(3) disposable underpads, 60 pads per month; and
(4) incontinence briefs, 180 briefs per month.
(A) Adult briefs are purchased only in accordance with the implementation of elimination guidelines developed by the Team.
(B) Exceptions to the requirement for implementation of elimination guidelines may be approved by the DDSD nurse when the member has a medical condition that precludes implementation of elimination guidelines, such as atonic bladder, neurogenic bladder, or following a surgical procedure.
(d) Exceptions. Exceptions to the requirements of this Section are explained in this subsection.
(1) When a member's Team determines that the member needs medical supplies that:
(A) are not available through SoonerCare and for which no Health Care Procedure Code exists, the case manager e-mails pertinent information regarding the member's medical supply need to the programs manager responsible for Specialized Medical Supplies. The e-mail includes all pertinent information that supports the need for the supply, including but not limited to, quantity and purpose; or
(B) exceed the limits stated in subsection(c) of this Section, the case manager documents the need in the Individual Plan for review and approval per 340:100-33.
(2) Approval or denial of exception requests is made on a case by case basis and does not override the general applicability of this Section.
(3) Approval of a specialized medical supplies exception does not exceed one plan of care year.
317:40-5-110.Authorization for Habilitation Training Specialist Services
[Revised 07-20-12]
(a) Habilitation Training Specialist (HTS) Services are:
(1) authorized as a result of needs identified by the team and informed selection by the SoonerCare member;
(2) shared among SoonerCare members who are members of the same household or being served in the same community location;
(3) authorized only during periods when staff are engaged in purposeful activity which directly or indirectly benefits the service recipient. Staff must be physically able and mentally alert to carry out the duties of the job. At no time are HTS services authorized for periods during which the staff are allowed to sleep;
(4) not authorized to be provided in the home of the HTS unless the SoonerCare member and HTS reside in the same home; and
(5) directed toward the development or maintenance of a skill in order to achieve a specifically stated outcome. The service provided is not a function which the parent would provide for the individual without charge as a matter of course in the relationship among members of the nuclear family when the member resides in a family home.
(b) HTS Services may be provided in a group home as defined in 317:40-5-152 or community residential service settings defined in OAC 340:100-5-22.1 including:
(1) agency companion services as described in OAC 317:40-5-1 through 40-5-39;
(2) as provided in accordance with Daily Living Supports policy at OAC 317:40-5-150; and,
(3) as provided in accordance with Specialized Foster Care Policy at OAC 317:40-5-50 through 40-5-76; or
(4) services for people with Prader Willi syndrome.
(c) HTS Services are based on need and limited to no more than 12 hours per day per household in any setting other than settings described in OAC 340:100-5-22.1, Community Residential Supports, except with approval in accordance with OAC 340:100-3-33, Service authorization, that the increased services are necessary to avoid institutional placement due to:
(1) the complexity of the family or caregiver support needs. Consideration must be given to:
(A) the age and health of the caregiver;
(B) the number of household members requiring the caregiver's time; and
(C) the accessibility of needed resources; and
(2) the resources of the family, caregiver, or household members that are available to the service recipient. Consideration must be given to the number of family members able to assist the caregiver and available community supports; and
(3) the resources of other agencies or programs available to the SoonerCare member or family. Consideration must be given to services available from:
(A) the public schools;
(B) the Oklahoma Health Care Authority;
(C) the Oklahoma Department of Rehabilitative Services;
(D) other OKDHS programs; and
(E) services provided by other local, state, or federal resources.
(d) When it appears that approval of an exception is needed to prevent institutional placement, the case manager submits the request which identifies the circumstances supporting the need for an exception to the area manager.
(e) The DDSD area manager or designee must approve, deny, or notify the case manager of issues preventing approval within 10 working days.
(f) HTS providers may not perform any job duties associated with other employment, including on call duties, at the same time they are providing HTS services.
(g) HTS services are limited to no more than 40 hours per week when the HTS resides in the same home as the service recipient. If additional hours of service are needed, they must be provided by someone living outside the home. Exceptions may be authorized when needed for members who receive services through the Homeward Bound Waiver.
(h) When the member is out of the home for school, work, adult day services or other non-HTS supported activities, the total number of hours of HTS and hours away from the home cannot exceed 12 hours per day unless an exception is granted in accordance with subsection c of this policy.
(i) In accordance with OAC 340:100-3-33.1, services must be provided in the most cost effective manner. When the need for HTS services is expected to continue to exceed 9 hours daily, cost effective community residential services must be considered and requested in accordance with OAC 317:40-1-2. For adults, continuation of non-residential services in excess of 9 hours per day for more than one plan of care year will not be authorized except:
(1) when needed for members who receive services through the Homeward Bound Waiver;
(2) when determined by the division administrator or designee to be the most cost effective option; or
(3) as a transition period of 120 days or less to allow for identification of and transition to a cost effective residential option. Members who do not wish to receive residential services will be assisted to identify options that meet their needs within an average of 9 hours daily.
317:40-5-111.Authorization for Habilitation Training Specialist Services in the Homeward Bound Waiver
[Revised 06-11-10]
(a) Habilitation Training Specialist (HTS) Services are authorized as a result of needs identified by the Personal Support Team and informed service recipient selection.
(b) HTS Services may be provided in the Homeward Bound waiver in service settings including:
(1) agency companion services as described in OAC 317:40-5-1 through OAC 317:40-5-39;
(2) daily living supports as described in OAC 317:40-5-153;
(3) specialized foster care as described in OAC 317:40-5-50 through OAC 317:40-5-76;
(4) group home services as described in OAC 317:40-5-152; and
(5) the class member's own home, family's home, or other community residential setting.
(c) HTS services are authorized only during periods when staff are engaged in purposeful activity that directly or indirectly benefits the person receiving services.
(1) Staff must be physically able and mentally alert to carry out the duties of the job.
(2) At no time are HTS services authorized for periods during which the staff are allowed to sleep.
317:40-5-112.Dental services

[Revised 09-01-17]
(a) Applicability.  Coverage applies to members:

(1) receiving dental services through the Homeward Bound Waiver; and

(2) 21 years of age and older receiving dental services through the Community Waiver or In-Home Supports Waiver for adults.

(b) Description of services.  Dental services include services per OAC 317:30-5-482. Preventative, restorative, replacement, and repair services to achieve or restore functionality are provided after appropriate review, when required per OAC 317:40-5-112(e).

(c) Standard of care.  Comprehensive diagnostic and treatment services are authorized for each member eligible to receive such services from qualified personnel including licensed dentists and dental hygienists per applicable Home and Community-Based Services (HCBS) Waiver limits. Part 79 of OAC 317:30-5 and dental guidelines published by the Oklahoma Health Care Authority (OHCA) must be followed.

(d) Providers.  Providers of dental services must have a non-restrictive license to practice dentistry in Oklahoma or the state where treatment is rendered.

(e) Treatment plan.  A proposed dental treatment plan must be submitted to the member and Personal Support Team (Team) for review.

(1) All arrangements for services must be made with the Developmental Disabilities Services (DDS) case manager and be specified in the member's Individual Plan (IP).

(2) Requests for pre-authorization must propose services that are the most cost effective to restore dental health per OHCA published dental guidelines.

(f) Frequency of examination.  The dentist and Team determine frequency of examinations on an individual basis.

(g) Documentation of dental services.  The dental provider summarizes dental services on the Oklahoma Department of Human Services (DHS) Form 06HM005E, Referral Form for Examination or Treatment, or comparable form for members who receive residential services.

(h) Prevention.  The member's IP must address the prevention of dental disease and promotion of dental health.  Independence in oral hygiene care is promoted. When the member is unable to maintain adequate oral hygiene as determined by the dentist and Team, direct assistance and responsibility must be assigned to appropriate Team members in the IP.

317:40-5-113.Adult Day Services
[Revised 06-25-12]
(a) Introduction. Adult Day Services are provided by agencies approved by the Developmental Disabilities Services Division (DDSD) of the Oklahoma Department of Human Services (OKDHS) that have a valid Oklahoma Health Care Authority contract for providing Adult Day Services. This service is available through the Community Waiver, Homeward Bound Waiver and through the In-Home Supports Waiver for Adults. Adult Day Services is a structured, comprehensive program that provides a variety of health, social, and related support services in a protective environment for some portion of a day. Individuals who participate in adult day services receive these services on a planned basis during specified hours. Adult day services are designed to work toward the goals of:
(1) promoting the member's maximum level of independence;
(2) maintaining the member's present level of functioning as long as possible, preventing or delaying further deterioration;
(3) assisting the member in achieving the highest level of functioning possible;
(4) providing support, respite, and education for families and other caregivers; and
(5) fostering socialization and peer interaction.
(b) Eligibility requirements. Adult Day Services are provided to eligible members whose teams have determined the service is appropriate to meet their needs. Members must:
(1) require ongoing support and supervision in a safe environment when away from their own residence;
(2) be 18 years of age or older; and
(3) not pose a threat to others.
(c) Provider requirements. Provider agencies must:
(1) meet the licensing requirements set forth by Section 1-873 et seq of Title 63 of the Oklahoma Statutes;
(2) comply with OAC 310:605, Adult Day Care Centers;
(3) allow DDSD staff to make announced and unannounced visits to the facility during the hours of operation;
(4) provide the DDSD case manager a copy of the individualized plan of care;
(5) submit incident reports per OAC 340:100-3-34;
(6) maintain a copy of the member's Individual Plan (Plan);
(7) submit Oklahoma Department of Human Services (OKDHS), Provider Progress Report for each member receiving services per OAC 340:100-5-52; and
(8) serve as a member of the Personal Support Team and meet the Personal Support Team requirements per OAC 340:100-5-52.
(d) Coverage. The member's Plan contains detailed descriptions of services to be provided and documentation of hours of services. All services must be authorized in the Plan and reflected in the approved plan of care. Arrangements for care must be made with the member's case manager.

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.