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Part 11      OTHER COMMUNITY RESIDENTIAL SUPPORTS

317:40-5-150.Daily Living Supports
[Revised 06-11-10]
(a) Introduction. Daily Living Supports (DLS) are provided by an agency, approved by the Developmental Disabilities Services Division (DDSD), that has a valid Oklahoma Health Care Authority contract for the service.
(1) Daily Living Supports require meeting the daily support needs of the members living in the home.
(A) In accordance with the needs of the member, Daily Living Supports include hands-on assistance, supervision, or prompting so that the member performs the task, such as eating, bathing, dressing, toileting, transferring, personal hygiene, light housework, money management, community safety, recreation, social, health, or medication management.
(B) Daily Living Supports also include assistance with cognitive tasks or provision of services, per OAC 340:100-5-57, to prevent a member from harming self or others.
(C) Daily Living Supports also include:
(i) the provision of staff training per OAC 340:100-3-38, to meet the specific needs of the member;
(ii) program supervision that includes the 24-hour availability of response staff to meet schedules and unpredictable needs;
(iii) program oversight;
(iv) assisting the member in obtaining services and supplies;
(v) developing and assuring emergency plans are in place; and
(vi) coordinating overall safety and supports in the home.
(D) Direct support services are coordinated and shared among household members receiving services to meet identified needs and are provided by staff who do not live in the home.
(2) DLS include an average of eight hours daily of direct support services. Members needing direct support services exceeding an average of eight hours per day identify, with case manager assistance, roommates willing to share Daily Living Supports services. Additional direct support services are considered in accordance with subsection (f) of this Section.
(b) Eligibility. Daily Living Supports are provided to members who:
(1) are eighteen years of age or older, unless approved by the Director of OKDHS or designee;
(2) need an average of at least eight hours of direct support services daily;
(3) are participants in the DDSD Community waiver, per OAC 317:40-1-1;
(4) need community residential services outside the family home; and
(5) do not simultaneously receive any other community residential or group home services.
(c) Service requirements. Daily Living Supports must be:
(1) included in the member's Individual Plan per OAC 340:100-5-51, including a description of the type(s) and intensity of supervision and assistance that must be provided to the member;
(2) authorized in the member's Plan of Care;
(3) provided by the contracted provider agency chosen by the member or guardian;
(4) delivered in accordance with DDSD Community Residential Supports rules at OAC 340:100-5-22.1; and
(5) provided directly to the member.
(d) Home Requirements. Daily Living Supports are provided to eligible members living outside their family's home in a home that:
(1) is leased or owned by the member(s) or the member's legal guardian; and
(2) houses no more than three individuals living together. Exceptions for homes shared by four members may be granted in writing by the DDSD director or designee.
(e) Responsibilities of provider agencies. Each provider agency providing Daily Living Supports must:
(1) ensure ongoing supports as needed when the member is out of the home visiting family and friends, or hospitalized for psychiatric or medical care;
(2) ensure compliance with all applicable DDSD policy found at OAC 340:100; and
(3) provide for the welfare of all members living in the home.
(4) ensure that trained staff are available to the member as described in the individual plan.
(f) Criteria for direct support staff services beyond eight hours per day. Additional direct support services including Habilitation Training Specialist(HTS), Homemaker, or Intensive Personal Supports, beyond the average of eight hours per day referenced in subsection (a) of this Section must be approved by the DDSD area manager or designee.
(1) In order to receive additional direct support staff services, the members living together must have insufficient supports including hourly nursing services to meet their needs for support.
(A) Additional direct support staffing may be authorized if the member is living with two roommates but still has medical or behavior support needs beyond the capacity of staff shared with the other roommates, including participation by staff providing hourly nursing services.
(B) Additional direct support staffing is only provided to a member who has one or no roommates if:
(i) the area manager or designee documents that behavior support issues make it impossible for the member to have a roommate; or
(ii) in accordance with paragraph (2) of this subsection.
(C) If a member lives with one or no roommates or requires a second support staff to meet his or her intensive behavior support needs, the Team must provide clear documentation that the member has difficulty establishing compatible relations with others as evidenced by:
(i) severe and persistent emotional and behavioral disturbances; or
(ii) a history of difficulty sharing a home with others.
(2) The area manager or designee may grant conditional approvals for staff beyond an average of eight hours per day per member:
(A) due to the temporary or permanent departure of a roommate while another roommate is being identified; or
(B) to facilitate emergency residential placement of a person needing services while roommates are being identified.
(3) As part of the annual review, the case manager must:
(A) re-evaluate the member's additional direct support services; and
(B) implement any alternative solutions that would promote independence and reduce intrusion by paid workers as much as possible. Documentation of such evaluations and the implementation of alternative solutions is included in the case manager's record.
(g) Daily Living Supports claims. No more than 365 units of Daily Living Supports may be billed per year, except Leap Year, for each member.
(1) The provider agency claims one unit of service for each day during which the member receives Daily Living Supports. A day is defined as the period between 12:00 a.m. and 11:59 p.m.
(2) Claims must not be based on budgeted amounts.
(3) When a member changes provider agencies, only the outgoing service provider agency claims for the day that the member moves.
(h) Billing for other support services. Additional support services such as HTS, Intensive Personal Supports, or Homemaker Services may be provided to a member receiving Daily Living Supports, if:
(1) the additional support services have been authorized in the member's Plan of Care. Additional support services cannot be authorized unless 56 hours per week of DLS services are scheduled for the member. The direct support staffing is averaged across the week when the needs of the members in the household vary from day to day; and
(2) an average of eight hours of DLS has already been provided to the member each day that week.
(A) The provider cannot bill for additional support services unless 56 hours of DLS have been provided during the week to the member.
(B) If support services are provided to multiple members residing in the same household at the same time, the provider agency cannot count these hours toward each member's 8-hour minimum. For example, three hours of service provided simultaneously by a single direct contact staff to three members in the same household may only be counted as three hours of service for one of the members, not three hours for each member.
(i) Therapeutic leave. Therapeutic leave is a SoonerCare payment made to the Daily Living Supports contract provider to enable the member to retain personal care services.
(1) Therapeutic leave is claimed when the member does not receive Daily Living Supports services for 24 consecutive hours from 12:00 a.m. to 11:59 p.m. because of:
(A) a visit with family or friends without direct support staff;
(B) vacation without direct support staff; or
(C) hospitalization, whether direct support staff are present or not. Daily living supports staff may be present with the member in the hospital as approved by the member's Team in the Individual Plan. Staff are present in the role of a visitor and are not responsible for the care of the patient.
(2) A member may receive therapeutic leave for no more than 14 consecutive days per event, not to exceed 60 days per Plan of Care year.
(3) The payment for a day of therapeutic leave is the same amount as the per diem rate for Daily Living Supports.
(4) To promote continuity of direct support staff in the member's absence, the provider pays the staff member the salary that he or she would have earned if the member were not on therapeutic leave if the provider is unable to provide an alternative work opportunity.
317:40-5-151.Intensive Personal Supports
[Revised 6-27-02]
(a) Introduction. Intensive Personal Supports are support services which are provided to eligible persons who need a more enhanced level of direct support in order to successfully reside in a community based setting. Intensive Personal Supports build upon the level of support provided by a Habilitation Training Specialist or Daily Living Supports staff by utilizing a second staff person on duty to provide assistance and training in self-care, daily living, recreational, and habilitation activities.
(b) Eligibility. Intensive Personal Supports are provided by OHCA contracted provider agencies to individuals who:
(1) are eighteen years of age of older, unless approved by the Director of DHS or designee;
(2) receive Daily Living Supports and meet the criteria for additional Daily Living Supports given in subsection (f) of OAC 317:40-5-150; and
(3) require a second support staff in order to meet their intensive behavioral or medical support needs, when there is no other resolution.
(c) Service requirements. Intensive Personal Supports, which are limited to 24 hours per day must be:
(1) included in the person's Individual Plan in accordance with OAC 340:100-5-51;
(2) authorized in the Plan of Care; and
(3) provided in conjunction with Habilitation Training Services.
(d) Responsibilities of provider agencies. Each provider agency providing Intensive Personal Supports must:
(1) have current, valid contracts with OHCA and DHS/DDSD; and,
(2) ensure that any staff member providing Intensive Personal Supports has completed the training in accordance with OAC 340:100-3-38.
(e) Shared staff. Direct support services are coordinated and shared among household members receiving services to meet identified needs.

317:40-5-152.Group home services for persons with an intellectual disability or certain persons with related conditions

[Revised 09-01-15]

(a) General Information.  Group homes provide a congregate living arrangement offering up to 24-hour per day supervision, supportive assistance, and training in daily living skills to persons who are eligible and 18 years of age or older.  Upon approval of the Oklahoma Department of Human Services DHS Developmental Disabilities Services DDS director or designee, persons younger than 18 years of age may be served.

(1) Group homes ensure members reside and participate in the community.  Services are provided in homes located in close proximity to generic community services and activities.

(2) Group homes must be licensed by DHS per Section 1430.1 et seq. of Title 10 of the Oklahoma Statutes.

(3) Residents of group homes receive no other form of residential supports.

(4) Habilitation training specialist (HTS) services or homemaker services for residents of group homes may only be approved by the DDS director or designee:

(A) for a resident of a group home to resolve a temporary emergency when no other resolution exists; or

(B) for a resident of a community living group home when the resident's needs are so extensive that additional supports are needed for identified specific activities; and

(C) weekly average of 56 hours of direct contact staff must be provided to the resident before HTS services may be approved.

(b) Minimum provider qualifications.  Approved providers must have a current contract with the Oklahoma Health Care Authority (OHCA) to provide DDS Home and Community-Based Services (HCBS) for persons with an intellectual disability or related conditions.

(1) Group home providers must have a completed and approved application to provide DDS group home services.

(2) Group home staff must:

(A) complete the DHS DDS-sanctioned training curriculum per OAC 340:100-3-38; and

(B) fulfill requirements for pre-employment screening per OAC 340:100-3-39.

(c) Description of services.

(1) Group home services:

(A) meet all applicable requirements of OAC 340:100; and

(B) are provided in accordance with each member's  Individual Plan (IP) developed per OAC 340:100-5-50 through 340:100-5-58.

(i) Health care services are secured for each member per OAC 340:100-5-26.

(ii) Members are offered recreational and leisure activities maximizing the use of generic programs and resources, including individual and group activities.

(2) Group home providers:

(A) follow protective intervention practices per OAC 340:100-5-57 and 340:100-5-58;

(B) in addition to the documentation required per OAC 340:100-3-40, must maintain:

(i) staff time sheets that document the hours each staff was present and on duty in the group home; and

(ii) documentation of each member's presence or absence on the daily attendance form provided by DDS; and

(C) ensure program coordination staff (PCS) meet staff qualifications and supervise, guide, and oversee all aspects of group home services per OAC 340:100-5-22.6 and 340:100-6, as applicable.

(d) Coverage limitations.  Group home services are provided up to 366 days per year.

(e) Types of group home services.  Three types of group home services are provided through HCBS Waivers.

(1) Traditional group homes.  Traditional group homes serve no more than 12 members per OAC 340:100-6.

(2) Community living homes.  Community living homes serve no more than 12 members.

(A) Members who receive community living home services:

(i) have needs that cannot be met in a less structured setting; and

(ii) require regular, frequent, and sometimes constant assistance and support to complete daily living skills, such as bathing, dressing, eating, and toileting; or

(iii) require supervision and training in appropriate social and interactive skills, due to on-going behavioral issues to remain included in the community.

(B) Services offered in a community living home include:

(i) 24-hour awake supervision when a member's IP indicates it is necessary; and

(ii) program supervision and oversight including hands-on assistance in performing activities of daily living, transferring, positioning, skill-building, and training.

(C) Services may be approved for individuals in a traditional group home at the community living service rate when the member has had a change in health status or behavior and meets the requirements to receive community living home services.  Requests to receive community living home services are sent to the DDS Community Services Residential Unit.

(3) Alternative group homes.  Alternative group homes serve no more than four members who have evidence of behavioral or emotional challenges in addition to an intellectual disability and require extensive supervision and assistance in order to remain in the community.

(A) Members who receive alternative group home services must meet criteria per in OAC 340:100-5-22.6.

(B) A determination must be made by the DDS Community Services Unit that alternative group home services are appropriate.

 

317:40-5-153.Daily Living Supports for the Homeward Bound Waiver
[Revised 06-11-10]
(a) Introduction. Daily Living Supports are provided by an agency with a valid Oklahoma Health Care Authority (OHCA) contract.
(1) Daily Living Supports require meeting the daily support needs of the member living in the home.
(A) In accordance with the needs of the class member, Daily Living Supports include hands-on assistance, supervision, or prompting so that the member performs the task, such as eating, bathing, dressing, toileting, transferring, personal hygiene, light housework, money management, community safety, recreation, social, health, or medication management.
(B) Daily Living Supports are provided by staff that do not live in the home and include assistance with cognitive tasks or provision of services to prevent a member from harming self or others, in accordance with the needs of the member.
(C) Daily Living Supports also include:
(i) the provision of staff training per OAC 340:100-3-30 to meet the specific needs of the member;
(ii) program supervision that includes 24-hour availability of response staff to meet schedules and unpredictable needs;
(iii) program oversight;
(iv) assisting the member in obtaining services and supplies;
(v) developing and assuring emergency plans are in place;
(vi) coordinating overall safety and supports in the home; and
(vii) assisting members with personal money management.
(2) Daily Living Supports are used to provide and fund up to eight hours per day of supports for class members receiving supported living services per OAC 340:100-5-22.5.
(b) Eligibility. Daily Living Supports, as described in this Section, are provided to members who:
(1) are members of the class certified in Case Number 85-C-437-E, U.S. District Court for the Northern District of Oklahoma;
(2) receive community residential services in their own home; and
(3) do not simultaneously receive any other community residential or group home services.
(c) Responsibilities of provider agencies. Each provider agency providing Daily Living Supports must:
(1) ensure ongoing supports as needed to all members living in the home when one or more members is out of the home visiting family and friends, or hospitalized for psychiatric or medical care;
(2) ensure compliance with all applicable DDSD policy found at OAC 340:100;
(3) provide for the welfare of all members living in the home; and
(4) ensure that trained staff are available as described in the member's individual plan.
(d) Criteria for direct support staff services in the Homeward Bound Waiver beyond eight hours per day. Additional direct support services including HTS, Homemaker, or Intensive Personal Supports, beyond the average of eight hours per day referenced in subsection (a) of this Section, are provided based on needs identified by the Personal Support Team and are considered in accordance with subsection (f) of this Section.
(e) Daily Living Supports claims. No more than 365 units of Daily Living Supports may be billed per year, except Leap Year, for each member.
(1) The provider agency claims one unit of service for each day the member receives Daily Living Supports.
(2) Providers must claim at least monthly for all days that Daily Living Supports were actually provided during the preceding month. Claims must not be based on budgeted amounts.
(3) When a member changes provider agencies, only the outgoing service provider agency claims for the day that the member moves.
(f) Billing for other support services. Additional support services such as HTS, Intensive Personal Supports, or Homemaker Service may be provided to a member receiving Daily Living Supports, if:
(1) additional support services have been authorized in the member's Plan of Care. Additional support services cannot be authorized unless 56 hours per week of DLS services are scheduled for the member. The direct support staffing is averaged across the week when the needs of the members in the household vary from day to day; and
(2) an average of eight hours of DLS has already been provided to the member each day that week.
(g) Therapeutic leave. Therapeutic leave is a Medicaid payment made to the Daily Living Supports contract provider to enable the member to retain direct support services.
(1) Therapeutic leave is claimed when the member does not receive Daily Living Supports services for 24 consecutive hours because of:
(A) a visit with family or friends without direct support staff;
(B) vacation without direct support staff; or
(C) hospitalization, whether direct support staff are present or not. Daily living supports staff may be present with the member in the hospital as approved by the member's Team in the Individual Plan. Staff are present in the role of a visitor and are not responsible for the care of the patient.
(2) A member may receive therapeutic leave for no more than 14 consecutive days per event, not to exceed 60 days per Plan of Care year.
(3) The payment for a day of therapeutic leave is the same amount as the per diem rate for Daily Living Supports.
(4) If, because of the member's absence, the direct support staff is unable to work, the provider pays the staff the salary that he or she would have earned if the member were not on therapeutic leave.
317:40-5-154.Intensive Personal Supports in the Homeward Bound Waiver
[Issued 11-21-03]
(a) Introduction. Intensive Personal Supports are support services provided to class members who need an enhanced level of direct support in order to successfully reside in a community based setting. Intensive Personal Supports build upon the level of support provided by a Habilitation Training Specialist or Daily Living Supports staff by utilizing a second staff person on duty to provide assistance and training in self-care, daily living, recreational, and habilitation activities.
(b) Eligibility. Intensive Personal Supports are provided by OHCA contracted provider agencies to class members who:
(1) are eighteen years of age or older, unless approved by the Director of OKDHS or designee; and
(2) require a second support staff in order to meet their needs, when there is no other resolution.
(c) Service requirements. Intensive Personal Supports are limited to 24 hours per day and must be:
(1) included in the class member's Individual Plan in accordance with OAC 340:100-5-53;
(2) authorized in the Plan of Care; and
(3) provided in conjunction with Habilitation Training Services.
(d) Responsibilities of provider agencies. Each provider agency providing Intensive Personal Supports must:
(1) have current, valid contracts with OHCA and OKDHS/DDSD; and
(2) ensure that any staff member providing Intensive Personal Supports has completed the training in accordance with OAC 340:100-3-38.

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.