Current through Vol. 42, No. 1, September 16, 2024
(a)
Purpose. Developmental Disabilities Services (DDS) quality
assurance (QA) activities assess and encourage delivery of supports consistent
with:
(1) the service recipient's preferences
and needs;
(2) Oklahoma Human
Services (OKDHS) rules;
(3)
applicable Oklahoma Health Care Authority (OHCA) rules;
(4) OKDHS and OHCA contract requirements for
Home and Community-Based Services (HCBS);
(5) regulatory standards applicable to
services; and
(6) federal and state
laws.
(b)
Case
manager monitoring. DDS case managers assess services rendered to each
service recipient to ensure service effectiveness in meeting the service
recipient's needs. The case manager periodically observes service provision to
assess implementation of the service recipient's Individual Plan (Plan). The
requirements per this Section are minimum expectations for face-to-face visits
with service recipients. Case management may require additional visits to
ensure the service recipient's health and welfare.
(1) The DDS case manager conducts
face-to-face visits to monitor the service recipient's health and welfare and
service effectiveness in meeting his or her needs.
(A) Face-to-face visits include observation
of, and talking with, the service recipient regarding his or her health and
welfare and satisfaction with services.
(B) The case manager may:
(i) observe service provision and related
documentation in any location where services are provided; and
(ii) talk with family members and providers
regarding service provision and the service recipient's health and
welfare.
(C) For service
recipients receiving services through an In-Home Supports Waiver:
(i) a face-to-face visit is completed at
least semi-annually with one visit occurring between January and June and one
between July and December; and
(ii)
at least one of the two visits occurs at the site where the majority of
services are provided.
(D) For service recipients receiving services
through the Community Waiver:
(i) a
face-to-face visit occurs during each calendar month in the residential service
recipient's home, per Oklahoma Administrative Code (OAC)
340:100-5-22.1, or the group home
service recipient's home, per OAC
317:40-5-152. Case managers
certify home visits on Form 06MP070E, Access to Record and Verification of
Monitoring Requirements, located per OAC
340:100-3-40;
(ii) a face-to-face visit is completed each
calendar-year quarter, coinciding with the quarters established per OAC
340:100-5-52 for a quarterly
summary of progress reports, for service recipients who do not receive
residential services or group home services, with at least two of these visits
occurring at the site where the majority of services are provided;
and
(iii) the case manager visits
the employment or day services site at least semi-annually, with one visit
occurring between January and June, and one between July and December, when
services are funded through the Community Waiver unless the Personal Support
Team (Team) requests a DDS area manager or designee approved
exception.
(E) For
service recipients receiving services through the Homeward Bound Waiver:
(i) a face-to-face visit occurs in the home
during each calendar month. Case managers certify home visits on Form 06MP070E
located within the home record per OAC
340:100-3-40; and
(ii) the case manager visits the employment
site each calendar-year quarter, coinciding with the quarters established, per
OAC 340:100-5-52, for quarterly
summary of progress reports, unless the Team requests a DDS area manager or
designee approved exception.
(F) For Homeward Bound class members who
reside in an intermediate care facility for individuals with intellectual
disabilities, the case manager visits monthly.
(2) The DDS case manager may conduct virtual
monitoring as a substitute for the required minimum face-to-face visits
utilizing Health Insurance Portability and Accountability Act (HIPAA) compliant
phone calls or video conferencing as identified in (A) through (F) of this
paragraph. The DDS area manager or designee approves virtual monitoring.
(A) Virtual visits are limited to two,
non-consecutive calendar months per calendar year for service recipients who
receive;
(i) daily living supports;
and
(ii) traditional or community
living group home services, specialized foster care (SFC), agency companion
services and Prader-Willi Services.
(B) Virtual visits are limited to one time
per calendar year for service recipients who receive non-residential services
on the Community Waiver and only when the member does not receive Remote
Supports (RS) service.
(C) Virtual
visits are not permitted when heightened need for visits is required such as
during the first 30-calendar days after a service recipient transitions to a
new residential placement or when there are concerns of unmet health and safety
needs.
(D) Virtual visits may not
be substituted for the required minimum face-to-face visits for service
recipients who:
(i) receive services through
the Homeward Bound Waiver;
(ii)
receive services through the In-Home Supports Waiver;
(iii) receives RS services;
(iv) reside in an Alternative Group Home;
or
(v) are in custody of OKDHS,
Child Welfare Services.
(E) Virtual visits in addition to the
required minimum face-to-face visits utilizing HIPAA compliant phone calls or
video conferencing may also be conducted.
(3) DDS case managers review and ensure Plan
implementation. The case manager completes a quarterly review for service
recipients receiving services through HCBS Waivers, documenting the review in
the service recipient's electronic record.
(4) When the DDS case manager believes the
service recipient is at risk of harm, the case manager takes immediate steps to
protect the service recipient and notifies the DDS case management supervisor
and other appropriate authorities.
(5) When the DDS case manager determines a
provider is not effectively addressing a service recipient's needs or meeting
contractual responsibilities or policies, steps in (A) through (C) of this
paragraph are followed.
(A) The case manager
consults with the relevant provider to secure a commitment for necessary
service changes within an agreed time frame.
(B) When necessary changes are not
accomplished within the specified time frame, the case management supervisor
intervenes to secure commitments from the provider.
(C) When the service deficiency is not
resolved as a result of the case management supervisor's intervention, an
administrative inquiry referral is initiated, per OAC
340:100-3-27.1.
(6) If, during a contract survey,
administrative inquiry, SFC monitoring, or area survey, DDS QA staff discovers
a situation that requires correction by DDS staff, a system administrative
inquiry is initiated.
(A) DDS QA staff emails
notification to DDS staff to correct the situation, establishing a reasonable
time frame for correction.
(B) When
the identified staff is unable to correct the situation within the established
time frame, DDS QA staff emails notification to the DDS staff supervisor,
establishing a reasonable time frame for correction.
(C) When the staff supervisor is unable to
correct the situation within the established time frame, DDS QA staff notifies
his or her supervisor, who notifies the DDS area manager, establishing a
reasonable time frame for correction.
(D) When the area manager is unable to
correct the situation within the established time frame, he or she notifies the
DDS State Office QA unit, to resolve the situation with the community services
unit deputy director.
(c)
SFC monitoring. DDS QA staff
monitors the SFC program in each area for DDS and OHCA policy compliance.
Monitoring is based on a proportionate, representative sample of individuals
receiving SFC supports identified for the fiscal year for each area. Monitoring
includes a visit to the service recipient's SFC home. A home visit may be
conducted virtually if the home has electronic equipment that allows for
face-to-face communication unless health and safety issues are reported that
require on-site review.
(d)
Consumer Service Evaluation. At least annually, service recipients
and families receiving supports are provided the opportunity to complete a
service evaluation per OKDHS Publication No. 89-10, Consumer Service
Evaluation.
(1) Confidentiality is maintained
unless the respondent authorizes OKDHS to reveal his or her name to those
responsible for service delivery. OKDHS Publication No. 89-10 may be completed
anonymously.
(2) DDS QA staff
distributes OKDHS Publication No. 89-10 to service recipients or his or her
legal guardians at least annually.
(3) OKDHS Publication No. 89-10, when
completed is returned to the DDS State Office QA Unit.
(4) Results are forwarded to the respective
DDS area office when authorized by the service recipient or legal guardian for
resolution of concerns or staff recognition.
(5) A response analysis is completed and
distributed to DDS area offices, DDS State Office, or OKDHS for action. Data is
available upon request.
(e)
Oklahoma Advocates Involved in
Monitoring (OK AIM). Service recipients and families receiving supports
participate in contact providers' formal assessments to promote service
enhancement, consistent with service recipient expectations.
(1) OK AIM operates under direction of the
Oklahomans for Quality Services Committee (OQSC).
(A) OQSC is composed of 15 persons who
receive or have a family member receiving DDS services. All areas of Oklahoma
are represented.
(i) OQSC members may be
nominated by the public at large, current OQSC members, or DDS
representatives.
(ii) Appointment
of OQSC members occurs as a result of joint consensus by the OQSC chair and DDS
director or designee following a determination of the nominee's:
(I) commitment to promote the interests of
persons with developmental disabilities; and
(II) capacity to dedicate the necessary time
to fulfill his or her responsibilities.
(iii) OQSC members have the authority to
elect officers based on a simple majority vote and establish by-laws governing
the conduct of business.
(B) OQSC:
(i) develops and refines procedures and the
survey instrument used, based on feedback from service recipients and their
families, providers, and other key constituents;
(ii) participates in the selection of
agencies submitting proposals to conduct OK AIM activities; and
(iii) serves as a resource for education and
coordination of agencies conducting OK AIM monitoring activities.
(2) OKDHS issues and
awards a Request for Proposal (RFP) per the Oklahoma Central Purchasing Act,
Sections 85.1 through
85.44E of Title 74 of the Oklahoma
Statutes (74 O.S. §§ 85.1 through 85.44E) and the approved OKDHS
Internal Purchasing Procedures, and solicits proposals from qualified
organizations to participate in the OK AIM initiative. Qualified organizations
include agencies that:
(A) are incorporated
non-profit agencies dedicated to representing persons with developmental
disabilities and their family members;
(B) are not involved in service delivery
funded through DDS or HCBS Waivers; and
(C) meet additional requirements set forth by
federal and state laws as indicated in the RFP.
(3) OQSC is consulted regarding bids
submitted in response to an RFP.
(4) Agencies selected to conduct OK AIM
monitoring and reporting activities are responsible for:
(A) soliciting, screening, and training
volunteers to conduct OK AIM site visits;
(B) scheduling site visits with all service
providers referenced in the RFP within counties for which the agency assumed
responsibility;
(C) ensuring
consistency of volunteer and staff activities with:
(i) OQSC-approved procedures and
protocols;
(ii) federal and state
laws; and
(iii) OKDHS and OHCA
rules;
(D) accurately
recording OK AIM monitoring activities findings;
(E) ensuring provision of findings to
provider agencies and DDS; and
(F)
immediately notifying the DDS area office of any issue identified during OK AIM
monitoring activities that presents risk to the service recipient's health or
welfare.
(5) DDS area
managers identify OKDHS staff responsible for resolving concerns identified
during OK AIM monitoring activities and notify the agencies responsible on how
to contact staff during business, evening, and weekend hours.
(6) OQSC with DDS State Office, DDS area
offices, and agencies conducting OK AIM activities participation, identifies
conditions determined to present significant risks to service recipients.
(A) Conditions determined to present imminent
risks to service recipients are reported immediately to the:
(i) statutory investigatory
authority;
(ii) DDS area office;
and
(iii) provider agency chief
executive officer (CEO) or designee.
(B) Issues determined to pose potential risks
to service recipients are reported to DDS area office staff, who notify the
provider agency CEO or designee, no later than at the close of the first
business-day following observation.
(C) OK AIM monitors report any other
significant issues to designated DDS area office staff within time frames OK
AIM determines appropriate.
(7) DDS staff immediately identifies DDS area
office staff to assume responsibility for verification and correction of
problems posing imminent or potential risks.
(A) The DDS area manager approves resolution
time frames for validated concerns based on the degree of risk.
(B) All identified concerns are resolved
within 30-calendar days from initial notification to the DDS area office,
unless the DDS area manager authorizes an extension in circumstances that pose
no jeopardy to any service recipient.
(C) Concerns presenting immediate and
significant risk to service recipients are corrected
immediately.
(8) Each DDS
area manager designates staff to:
(A) track
resolution of each identified concern; and
(B) advise agencies conducting OK AIM
monitoring activities of the steps taken to resolve each
concern.
(9) OK AIM staff
summarizes findings of each home visit volunteers conduct, and staff notes
performance in regards to the established OQSC expectations as published in the
OK AIM training manual.
(A) Recommendations
for service enhancement are presented to the relevant DDS area office for
review within 30-calendar days of a home visit.
(B) DDS area office staff shares this
information with the provider and collaborates on recommendations as well as
other alternatives to achieve targeted service enhancement. Plans developed as
a result are shared with OK AIM staff during the next meeting. Provider
comments or action plans are maintained with the OK AIM report in area office
files.
(10) OQSC
re-assesses the OK AIM survey process at least annually and does so based on
feedback solicited from service recipients, DDS area office staff, providers,
and other constituencies affected by or involved in the
process.
(f)
Independent assessments. An independent authority annually
assesses service outcomes for a sample of service recipients receiving
residential services funded or administered through DDS or HCBS Waivers.
(1) Assessments employ standardized measures,
facilitating individual as well as congregate data analysis over
time.
(2) Assessment protocols
provide for identification and resolution of circumstances posing immediate
risks to service recipients.
(g)
Failure to cooperate.
Provider agencies failing to cooperate with provisions, or providing false
information in response to inquiries per this Section, are subject to
identified sanctions including contract termination.
(h)
Findings of non-compliance.
Findings of significant non-compliance with human rights, laws, or rules are
immediately reported to the DDS director and other relevant authorities for
appropriate action, including disciplinary action of OKDHS employees or
sanction imposition, including suspension or contract termination with provider
agencies, per OAC
340:100-3-27.2.
(i)
Retaliation. Provider
agencies and OKDHS employees are prohibited from any form of retaliation
against any service recipient, employee, or agency for reporting or discussing
possible performance deficiencies with any authorized OKDHS agent. Authorized
agents are OKDHS staff whose responsibilities include administration,
supervision, or oversight of DDS services, including all DDS and Office of
Client Advocacy staff.
(j)
QA
functions. Additional DDS QA program components are found in OAC
340:100-3-27.1 through OAC
340:100-3-27.5.
(k)
Reports. Reports generated
by QA discovery activities are distributed as described in (1) through (4) of
this subsection.
(1) Reports of performance
surveys and administrative inquiries are provided to the administrator of the
provider agency surveyed, are stored electronically, and made accessible to:
(A) DDS staff;
(B) OHCA;
(C) Office of Inspector General;
and
(D) appropriate Office of
Client Advocacy staff.
(2) Performance survey reports with personal
identifying information removed are available to interested citizens upon
request.
(3) Reports of
administrative inquiries are not released.
(4) Unless otherwise authorized by the
individual or the legal guardian, OK AIM reports and case manager reports are
available only to the:
(A) referenced
individual(s) served;
(B)
individual's legal guardian;
(C)
agencies providing supports;
(D)
relevant DDS area manager;
(E) DDS
QA administrator; and
(F) other
relevant DDS personnel.
Amended at 8 Ok Reg
2163, eff 5-13-91 (emergency); Amended at 9 Ok Reg 1549, eff 4-27-92; Amended
at 10 Ok Reg 2505, eff 5-24-93 (emergency); Amended at 11 Ok Reg 2303, eff
5-26-94; Amended at 11 Ok Reg 4107, eff 6-29-94 (emergency); Amended at 12 Ok
Reg 1761, eff 6-12-95; Amended at 15 Ok Reg 2125, eff 5-5-98 (emergency);
Amended at 16 Ok Reg 544, eff 12-31-98 (emergency); Amended at 16 Ok Reg 1056,
eff 4-26-99; Amended at 19 Ok Reg 2948, eff 8-1-02 (emergency); Amended at 20
Ok Reg 936, eff 6-1-03; Amended at 21 Ok Reg 888, eff 4-26-04; Amended at 23 Ok
Reg 1026, eff 5-11-06; Amended at 25 Ok Reg 986, eff 5-15-08; Amended at 29 Ok
Reg 822, eff 7-1-12
