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317:40-7-21.Exception process for employment services through Home and Community-Based Services Waivers

[Revised 06-25-12]
(a) All exceptions to rules in OAC 317:40-7 are:
(1) approved per OAC 317:40-7-21 prior to service implementation;
(2) intended to result in the Personal Support Team (Team) development of an employment plan tailored to meet the member's needs;
(3) identified in the Individual Plan (Plan) process per OAC 340:100-5-50 through 340:100-5-58; and
(4) documented and recorded in the Individual Plan by the Developmental Disabilities Services Division (DDSD) case manager after Team approval.
(b) A request for an exception to the minimum of 30 hours per week of employment services, per OAC 317:40-7-15, includes documentation of the Team's: 
(1) discussion of:
(A) current specific situation that requires an exception;
(B) all employment efforts, successful and unsuccessful, made by the member and Team in the past year; and
(C) progress toward previous exception strategies or plans;
(2) plan with specific steps and target dates to address the situation throughout the Plan of Care year so the exception may be lessened or no longer necessary at the end of the Plan of Care year; and
(3) specific residential schedule to provide integrated activities outside the home while the plan to increase to 30 hours is implemented.
(c) A request for an exception to the maximum limit of 15 hours per week for center-based services, per OAC 317:40-7-6, or continuous supplemental supports, per OAC 317:40-7-13, for a member receiving services through the Homeward Bound Waiver includes documentation of the Team's:
(1) discussion of:
(A) current specific situation that requires an exception;
(B) all employment efforts, successful and unsuccessful, made by the member and Team in the past year; and
(C) progress toward previous exception strategies or plans; and
(2) plan with specific steps and target dates to address the situation throughout the Plan of Care year so the exception may be lessened or no longer necessary at the end of the Plan of Care year.
(d) A request for an alternative to required community-based activities per OAC 317:40-7-5 includes documentation of the Team's:
(1) discussion of:
(A) current specific situation that requires an exception;
(B) all employment efforts, successful and unsuccessful, made by the member and Team in the past year; and
(C) progress toward previous exception strategies or plans; and
(2) plan with specific steps and target dates to address the situation throughout the Plan of Care year so the exception may be lessened or no longer necessary at the end of the Plan of Care year.
(e) Exception requests per OAC 340:40-7-21(f) are documented by the DDSD case manager after Team consensus and submitted to the DDSD area manager or designee within ten working days after the annual IP or interim Team meeting.   The area manager approves or denies the request with a copy to the DDSD area office claims staff and case manager based on the thoroughness of the Team's discussion of possible alternatives and reasons for rejection of the other possible alternatives.
(1) State dollar reimbursement for absences of a member receiving services through the Community Waiver in excess of 10% of authorized units up to 150 units is approved for medical reasons only. The request includes:
(A) Team's discussion of current specific situation that requires an exception;
(B) specific medical issues necessitating the exception request; and
(C) a projection of units needed to complete the State fiscal year.
(2) A request for any other exception to rules in OAC 317:40-7-21 requires documentation of the Team's discussion of:
(A) current specific situation that requires an exception;
(B) all employment efforts, successful and unsuccessful, made by the member and Team in the past year; and
(C) progress toward previous exception strategies or plans.
(f) The DDSD director or designee may review exceptions granted per OAC 317:40-7-21, directing the Team to provide additional information, if necessary, to comply with OAC 340:100-3-33.1 and other applicable rules.

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.