Current through Vol. 42, No. 1, September 16, 2024
The Oklahoma Health Care Authority (OHCA) is responsible
for periodic inspections of care and services in each ICF/MR providing services
for Title XIX applicants and recipients. The inspection of care reviews are
made by the OHCA or its designated agent. The frequency of inspections is based
on the quality of care and service being provided in a facility and the
condition of recipients in the facility. However, the care and services
provided to each recipient in the facility must be inspected at least annually.
No notification of the time of the inspection will be given to the facility
prior to the inspections.
(1) The
purpose of periodic inspections is to determine:
(A) The level of care required by each
patient for whom Title XIX benefits have been requested or approved.
(B) The adequacy of the services available in
the particular facility to meet the current health, rehabilitative and social
needs of each recipient in an ICF/MR and promote the maximum physical, mental,
and psychosocial functioning of the recipient receiving care in such
facility.
(C) The necessity and
desirability of the continued placement of each patient in such
facility.
(D) The feasibility of
meeting the health care needs and the recipient's rehabilitative needs through
alternative institutional or noninstitutional services.
(E) If each recipient in an institution for
the mentally retarded or persons with related conditions is receiving active
treatment.
(2) Each
applicant and recipient record will be reviewed for the purpose of determining
adequacy of services, unmet needs and appropriateness of placement. Personal
contact with and observation of each recipient will occur during the visit.
This may necessitate observing recipients at sites outside of the facility.
(A) Record reviews will include confirmation
of whether:
(i) All required evaluations
including medical, social and psychological are complete and current.
(ii) The habilitation plan is complete and
current.
(iii) All ordered services
are provided and properly recorded.
(iv) The attending physician reviews
prescribed medications at least quarterly.
(v) Tests or observations of each recipient
indicated by his medication regimen are made at appropriate times and properly
recorded.
(vi) Physicians, nurse,
and other professional progress notes are made as required and appear
consistent with the observed condition of the recipient.
(vii) There is a habilitation plan to prevent
regression and reflects progress toward meeting objectives of the
plan.
(viii) All recipient needs
are met by the facility or through arrangements with others.
(ix) The recipient needs continued placement
in the facility or there is an appropriate plan to transfer the recipient to an
alternate method of care.
(B) Observations and personal contact with
recipients will include confirmation of whether:
(i) The habilitation plans are
followed.
(ii) All ordered services
are provided.
(iii) The condition
of the recipient is consistent with progress notes.
(iv) The recipient is clean and is receiving
adequate hygiene services.
(v) The
recipient is free of signs of malnutrition, dehydration and preventable
injuries.
(vi) The recipient is
receiving services to maintain maximum physical, mental, and psychosocial
functioning.
(vii) The recipient
needs any service that is not furnished by the facility or through arrangements
with others.
(3) A full and complete report of
observations, conclusions and recommendations are required concerning:
(A) The adequacy, appropriateness, and
quality of all services provided in the facility or through other arrangements,
including physician services to recipients; and
(B) Specific findings about individual
recipients in the facility.
(4) The inspection report must include the
dates of the inspection and the names and qualifications of the individuals
conducting the inspection. A copy of each inspection report will be sent to:
(A) The facility inspected;
(B) The facility's utilization review
committee;
(C) The agency
responsible for licensing, certification, or approval of the facility for
purposes of Medicare and Medicaid; and
(D) Other state agencies that use the
information in the reports to perform their official function, including if
inspection reports concern Institutions for Mental Diseases (IMDs), the
appropriate State mental health authorities.
(5) The Oklahoma Health Care Authority will
take corrective action as needed based on required reports and
recommendations.
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 13 Ok Reg 2317, eff 4-30-96 (emergency); Amended at 14 Ok
Reg 265, eff 9-17-96 (emergency); Amended at 14 Ok Reg 1780, eff
5-27-97
