Current through Vol. 42, No. 1, September 16, 2024
Individuals receiving ADvantage Program services must be
determined eligible for the program and must have an approved person-centered
service plan. Any ADvantage Program service provided must be listed on the
approved person-centered service plan to prevent institutionalization of the
member. Waiver services that are expansions of Oklahoma Medicaid State Plan
services may only be provided after the member has exhausted services available
under the State Plan.
(1)
Consumer-Directed Personal Assistance Services and Supports (CD-PASS), services
are available to ADvantage Program members in every county.
(2) ADvantage case managers provide
information and materials that explain the CD-PASS service option to members.
The ADvantage Administration (AA) provides information and material on CD-PASS
to case managers for distribution to members.
(3) The member may request CD-PASS services
from his or her case manager or call an AA-maintained toll-free number to
request CD-PASS services.
(4) The
AA uses the following criteria to determine an ADvantage member's service
eligibility to participate in CD-PASS , the:
(A) member's health and safety with CD-PASS
services can reasonably be assured based on a review of service history records
and review of a member's capacity and readiness to assume employer
responsibilities under CD-PASS with any one of the following findings as basis
to deny a request for CD-PASS due to inability to assure member health and
safety , when the member:
(i) does not have
the ability to make decisions about his/her care or service planning and the
member's authorized representative is unwilling to assume CD-PASS
responsibilities ; or
(ii) is
unwilling to assume responsibility, or to enlist an authorized representative
to assume responsibility, in one or more areas of CD-PASS , such as in service
planning assuming the role of employer of the personal services assistant (PSA)
or advanced personal services assistant (APSA) provider, in monitoring and
managing health or in preparation for emergency backup ; or
(iii) member has a recent history of
self-neglect or self-abuse as evidenced by Adult Protective Services
intervention within the past 12 months and does not have an authorized
representative with capacity to assist with CD-PASS responsibilities;
(B) member voluntarily
makes an informed choice to receive CD-PASS services. As part of the informed
choice decision-making process for CD-PASS, the AA staff or case manager
provides consultation and assistance as the member completes a self-assessment
of preparedness to assume the role of employer of his or her PSA or APSA. The
orientation and enrollment process provides the member with a basic
understanding of what is expected of them under CD-PASS, the supports available
to assist them to successfully perform employer responsibilities and an
overview of the potential risks involved.
(5) The AA uses the following criteria to
determine that based upon documentation, a person is no longer allowed to
participate in CD-PASS:
(A) the member does
not have the ability to make decisions about his or her care or service
planning and the member's authorized representative is unwilling to assume
CD-PASS responsibilities;
(B) the
member is unwilling to assume responsibility or to enlist an authorized
representative to assume responsibility in one or more areas of CD-PASS , such
as in service planning or in assuming the role of employer of the PSA or APSA
provider, or in monitoring and managing health or in preparation for emergency
backup;
(C) the member has a
recent history of self-neglect or self-abuse as evidenced by Adult Protective
Services intervention and does not have an authorized representative with
capacity to assist with CD-PASS responsibilities;
(D) the member abuses or exploits the
employee;
(E) the member falsifies
time-sheets or other work records;
(F) the member, even with CM/CDA and
Financial Management Services assistance, is unable to operate within his or
her Individual Budget Allocation; or
(G) inferior quality of services provided by
the member's PSA or APSA provider(s), inability of the PSA or APSA provider(s)
to provide the number of service units the member requires jeopardizing the
member's health and/or safety.
Added at 12 Ok Reg
751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
7-27-95; Amended at 18 Ok Reg 265, eff 11-21-00 (emergency); Amended at 18 Ok
Reg 1130, eff 5-11-01; Amended at 22 Ok Reg 2731, eff 5-4-05 (emergency);
Amended at 23 Ok Reg 1366, eff 5-25-06; Amended at 25 Ok Reg 660, eff 2-1-08
through 7-14-08 (emergency)1; Amended at 25 Ok Reg
2685, eff 7-25-08
1This emergency action expired
on 7-14-08 before being superseded by a permanent action. Upon expiration of an
emergency amendatory action, the last effective permanent text is reinstated.
Therefore, on 7-15-08 (after the 7-14-08 expiration of the emergency action),
the text of 317:30-5-762 reverted back to the permanent text that became
effective 5-25-06, as was last published in the 2006 Edition of the OAC, and
remained as such until amended again by permanent action on
7-25-08.
