Current through Vol. 42, No. 1, September 16, 2024
(a)
Eligible
providers. The SoonerCare Home and Community-Based Services (HCBS)
Waiver programs are authorized per Section 1915(c) of the Social Security Act.
All providers must have current provider agreements with the Oklahoma Health
Care Authority (OHCA) to provide HCBS for persons with intellectual
disabilities or related conditions.
(b)
Application. Requests for
applications to provide daily living supports, agency companion, supported
living, group home, habilitation training services (HTS), homemaker, and
employment services are made to the Oklahoma Department of Human Service (DHS)
Developmental Disabilities Services (DDS) State Office. Applications must
include a narrative describing the applicant's:
(1) existing program, when
applicable;
(2) service and support
philosophies for persons with intellectual disabilities;
(3) proposed plan for providing HCBS, in
compliance with Oklahoma Administrative Code (OAC)
317:40-1-3;
(4) quality assurance program, commitment to
DDS quality assurance processes, and OAC
340:100-3-27,
et. seq. compliance; and
(5)
organizational summary and operational plan, including:
(A) the anticipated number of persons served
in the first three months, first six months, and the first year of
operation;
(B) the counties
served;
(C) an organizational chart
and a key personnel roster; and
(D)
evidence of the applicant's plan for compliance with the United States (U.S.)
Internal Revenue Service, U.S. Worker's Compensation, U.S. Department of Labor,
U.S. Occupational Safety and Health Administration, U.S. Drug-Free Workplace,
and Health Insurance Portability and Accountability Act (HIPAA)
requirements.
(c)
Policies and procedures. All
applications must include the provider's internal policies for:
(1) protection of individual rights per OAC
340:100-3-1.2;
(2) a statement of rights and
responsibilities developed and submitted by the group home provider per OAC
340:100-6-95;
(3) service recipient admission and discharge
procedures;
(4) client
confidentiality;
(5) emergencies
and disasters per OAC
340:100-3-32
including, but not limited to:
(A)
fire;
(B) severe weather;
(C) missing persons;
(D) evacuations;
(E) a plan for continuity of services in the
event of an emergency; and
(F)
provisions for practice drills per OAC
340:100-5-22.1,
and OAC 340-100-6-45, as applicable;
(6) identifying and avoiding conflicts of
interest and nepotism including, but not limited to:
(A) renting and leasing;
(B) staffing;
(C) board membership;
(D) contracted services;
(E) real property and equipment
acquisition;
(F) board membership
and relationships with agency staff and/or contractors;
(G) auditing;
(H) client-staff relationships including the
prohibition of services to individuals for whom agency staff are guardian;
unless the ward is the guardian's spouse, mother, father, sibling, aunt, uncle,
grandparent, adult child, adult grandchild, niece, nephew, or cousin;
and
(I) any other situation with
the potential to result in a conflict of interest;
(7) a means to establish and collect fees for
services not covered by OHCA or DDS per OAC
317:30-3-5.1;
(8) a grievance process that is reviewed and
approved by the Office of Client Advocacy per OAC
340:2-3-2 and OAC
340:2-3-45;
(9) suspected maltreatment reporting per
Section
1025.1 of
Title 56 of the Oklahoma Statutes and OAC
340:2-3-33;
(10) personnel policies that comply with
federal and state employment laws and DHS training requirements per OAC
340:100-3-38
through
340:100-3-38.13;
(11) protection of the service recipient's
personal funds per OAC
340:100-3-4
and for those providing residential supports per OAC
340:100-5-22.1,
and non-residential services per OAC
340:100-5-35;
(12) records maintenance per OAC
340:100-3-40;
(13) health and wellness maintenance per OAC
340:100-5-26;
and
(14) medication administration
per OAC
340:100-5-32
and
340:100-5-33.
(d)
Financial solvency and service
capacity. All applications must include evidence supported by an
operational plan demonstrating the applicant's capacity to provide services in
a financially solvent manner by:
(1) a
description of experience and capacity to operate a business in a
fiscally-responsible manner;
(2)
management and financial strategies ensuring SoonerCare compliance per OAC
317:30, Subchapters One and Three, per the OHCA provider manual;
(3) a description of the proposed
record-keeping system and the methods used to maintain and retain documentation
to successfully complete the annual financial audit;
(4) evidence of sufficient liquid assets or
lines-of-credit in the name of the provider agency or business indicating the
greater of $100,000 or three times the average monthly-budgeted
expenses;
(5) a line-item budget,
accompanied by a description justifying an expense estimate for the first
full-year of operations;
(6) a
written quote for proposed insurance coverage identifying all policy types and
limitations. Insurance requirements are:
(A) a
$250,000 professional liability minimum, when the provider agency receives
$50,000 or less per fiscal year for the delivery of supports funded through DHS
or HCBS Waivers or $1,000,000 when the provider agency receives more than
$50,000;
(B) a $100,000 general
liability minimum, when the provider agency receives $50,000 or less per fiscal
year for the delivery of supports funded through DHS or HCBS Waivers or
$1,000,000 when the provider agency receives more than $50,000;
(C) a $100,000 commercial automobile
liability minimum per occurrence;
(D) a $25,000 minimum employee dishonesty
cov-erage; and
(E) upon coverage
commencement, a copy of the certificate of insurance with a 30-calendar day
cancellation notice is required and, is sent to DDS by the carrier showing DHS
as the certificate of insurance holder;
(7) a State of Oklahoma certificate of
incorporation and the applicant's federal tax identification number;
and
(8) the most recent,
audited-financial statement, when applicable or the most recent tax
return.
(e)
Qualified personnel. All applications must include key personnel's
qualifications and appropriate background searches, including:
(1) administrative and executive position
descriptors and resumes including three references for each;
(2) documentation of an Oklahoma State Bureau
of Investigation (OSBI) background search and Community Services Worker
Registry search for the executive director, program coordinator, program
manager, key business office staff, and management staff who supervise service
delivery;
(3) documentation that
the executive director or program director has a Bachelor's degree from an
accredited college or university and a minimum of two-years supervisory or
management experience;
(4) board of
director meeting minutes listing the authorized individual by name, who
conducts business and has the provider agency's signature authority;
(5) documentation that the program
coordinator meets minimum qualifications per OAC
340:100-5-22.1,
when residential, group home, HTS, or homemaker services are
provided;
(6) documentation that
the provider agency's program manager meets minimum qualifications when
employment services are provided per OAC
317:40-7-20;
and
(7) an attestation that staff
meet training requirements per OAC
340:100-3-38
through
340:100-3-38.13
and that community service workers meet pre-em-ployment screening requirements
per OAC
340:100-3-39.
(f)
Disclosures. Disclosure of
ownership and control by an organization, institution, business, fiscal agent,
or agency requesting a provider agreement is a federal requirement for any
SoonerCare program. The SoonerCare provider is the disclosing entity and the
person(s) making application for a provider agreement with OHCA to provide
HCBS.
(1) SoonerCare providers, other than an
individual practitioner, group of practitioners, or a fiscal agent must
disclose per Section 455.104 of Title 42 of the Code of Federal Regulations (
42
C.F.R. §
455.104) :
(A) the name and address of any person,
individual, or corporation, with an ownership or controlling interest in the
disclosing entity. Corporate entities must include the primary business
address, all business locations, and PO Box addresses, as applicable;
(B) the date of birth and Social Security
number, for an individual;
(C)
other tax identification numbers for a corporation with an ownership or
controlling interest in the disclosing entity or in any subcontractor in which
the disclosing entity has a five percent or more interest; and
(D) if the person, individual, or corporation
with an ownership or controlling interest in the disclosing entity is related
to an individual, such as a spouse, parent, child, or sibling with ownership or
controlling interest in the disclosing entity, or if the person, individual or
corporation, with an ownership or controlling interest in any subcontractor in
which the disclosing entity has a five percent or more interest is related to
another person with ownership or controlling interests in the disclosing entity
as a spouse, parent, child, or sibling; and
(E) the name of any other disclosing entity
in which a person with an ownership or controlling interest in the disclosing
entity has an ownership or controlling interest; and
(F) the name, address, date of birth, and
Social Security number of any managing employee of the disclosing
entity.
(2) SoonerCare
providers, or the person making application, must disclose per
42
C.F.R. §
455.106 the identity of any
person convicted of crimes prior to OHCA issuing or renewing a provider
agreement or when OHCA submits a written request, who:
(A) has ownership or controlling interest in
the provider, is an agent, or is a managing employee of the provider;
and
(B) was convicted of a criminal
offense related to his or her involvement in any program under Medicare,
SoonerCare, or the Title XIX services program since the inception of those
programs.
(g)
Provider orientation. DDS area office staffconducts provider
orientation and OHCA conducts provider-billing training.
(h)
Ownership transfers.
Providers provide DDS with a 30-calendar day notice of intent to transfer
ownership. Services cannot be provided by a new owner until there is a valid
provider agreement contract, with OHCA.
(i)
Provider agreement termination.
DDS may recommend a provider agreement termination to OHCA, when the:
(1) owners, officers, managers, or other
persons with substantial contractual relationships are convicted of certain
crimes or received certain sanctions per Section 1128 of the Social Security
Act;
(2) provider fails to maintain
required licensure or certification;
(3) provider fails to timely correct program
deficiencies per OAC
340:100-3-27.1;
(4) provider is unable to provide the
services per the agreement; or
(5)
provider becomes insolvent.
(j)
Exceptions. Employment
providers requesting a provider agreement to provide services through the
Contracts with Industry program contact the DDS State Office employment
services program supervisor. The provider submits copies of the Oklahoma State
Bureau of Investigation (OSBI) background searches and of the Community
Services Worker Registry checks for assigned job coaches.
Added at 29 Ok Reg
822, eff 7-1-12
