Oklahoma Administrative Code
Title 340 - Department of Human Services
Chapter 100 - Developmental Disabilities Services
Subchapter 3 - Administration
Part 3 - ADMINISTRATION
Section 340:100-3-27.1 - Contract performance surveys and administrative inquiries
Universal Citation: OK Admin Code 340:100-3-27.1
Current through Vol. 42, No. 1, September 16, 2024
Agencies providing services under contract with the Oklahoma Department of Human Services (OKDHS), or through a Home and Community-Based Waiver (HCBW) participate in performance surveys assessing compliance with OKDHS and Oklahoma Health Care Authority (OHCA) contracts and rules.
(1) Performance surveys are conducted:
(A) with providers serving five or
fewer service recipients when deemed necessary by the administrator of
Developmental Disabilities Services Division (DDSD) Quality Assurance (QA);
and
(B) during each state fiscal
year with providers of residential, vocational, or non-medical in-home supports
serving six or more service recipients.
(2) OKDHS conducts interim administrative inquiries that evaluate the validity of allegations of non-compliance with provisions of the provider contract(s).
(A)
Administrative inquiries are authorized by the administrator of DDSD QA in
response to complaints filed by any interested party that represent potentially
serious breaches of service assurances, contract requirements, or OKDHS rules.
The administrator of DDSD QA or designee is authorized to conduct a screening
to determine the potential validity of the complaint.
(B) Administrative inquiries are limited in
scope to the responsibilities described in the provider's contract(s) with or
rules of OKDHS or OHCA including, but not limited to human rights assurances,
service provision, and fiscal accountability.
(C) Allegations of abuse and neglect are
immediately referred to statutorily identified lead agencies for investigation.
OKDHS acts on the findings or recommendations of agencies with statutory
responsibility to ensure provider compliance with provisions of law.
(D) Administrative inquiries are conducted by
staff assigned to DDSD QA although other resources of OKDHS such as Office of
Inspector General may be requested to assist in the investigation of
complaints.
(E) OKDHS is not
required to provide advance notice of an administrative inquiry.
(F) Notifications to providers of findings
and dispositions follow procedures established for performance surveys in
subparagraph (L) of paragraph (3) of this subsection, except that:
(i) written findings of administrative
inquiries may instead be presented to an agency through mail or email and an
exit conference may be conducted by telephone; and
(ii) the DDSD director or designee retains
the authority to initiate an emergency disposition as specified by subsection
(f) of OAC
340:100-3-27.2.
(3) Providers of direct services to six or more service recipients listed in paragraph (1) of this subsection participate in performance surveys assessing success in implementing contractual standards.
(A) Prior to the fiscal
year beginning, a proportionate, representative sample of service recipients
for each Waiver is identified.
(B)
The administrator of DDSD QA or designee may provide written notice to provider
agencies of scheduled performance surveys. DDSD advises the agency in writing
of:
(i) demographic information and documents
that must be provided to DDSD within two weeks of the postmark on the notice;
and
(ii) documents that must be
available on the dates of the performance survey.
(C) Provider agencies may request a change of
the schedule of the performance survey by contacting the administrator of DDSD
QA or designee. Authorization of a change in schedule occurs at the discretion
of the administrator of QA.
(D)
DDSD QA staff conducting performance surveys assess the delivery of services
and realization of outcomes for a sample of people served by each provider
agency. The sample includes those service recipients identified in the
representative sample and at least one service recipient receiving each
discrete service provided through the agency's contract with OKDHS or OHCA. The
size of the sample is adjusted based upon the number of service recipients
served by the agency under contractual agreement with OKDHS or OHCA and the
number of surveyors assigned to the survey.
(i) The sample will be 10 per cent of the
agency population or four service recipients for each surveyor assigned,
whichever is greater.
(ii) The size
of performance survey samples may be increased at the discretion of performance
survey team members.
(E)
Performance surveys and administrative inquiries are conducted by DDSD QA staff
that have completed a minimum of 150 hours of training specific to the
application and interpretation of OKDHS and OHCA contract standards and rules.
Findings of performance survey team members that have not completed 150 hours
of required training are not considered, unless observations are confirmed by
staff who have met this training requirement.
(F) A private work area at the agency site is
made available for surveyors during the course of the survey. If space is
unavailable, the provider makes copies of documents available that may be taken
by the performance survey team for review at another site.
(G) Performance survey team staff meet with
the chief executive officer (CEO) or designee of a provider agency upon arrival
to:
(i) discuss the survey schedule;
(ii) identify the balance of the survey
sample;
(iii) determine locations
where services are provided; and
(iv) make tentative arrangements for an exit
conference.
(H) Agency
staff and agency records are made available to the team as necessary to assess
agency performance with provisions of rules and their contract(s) with OKDHS or
OHCA.
(I) Performance survey teams
observe and meet with service recipients served and staff involved in each type
of service provided by the agency through contract(s) with OKDHS, or with OHCA
for the HCBW services.
(i) Interviews and
observations are conducted in a manner minimizing disruption of service
activities.
(ii) Observations and
interviews occur during varied hours of service delivery.
(J) Performance survey team personnel
evaluate information from observations, interviews, and record reviews in the
context of relevant contract standards and rules.
(K) Performance survey teams immediately
report to appropriate authorities, conditions or actions of agency staff that
are possibly abusive or negligent or that otherwise pose immediate jeopardy to
the health or safety of service recipients.
(L) Performance survey team staff provide a
written summary of findings to the CEO or designee of the provider agency on
the final day of the survey. The summary of findings is presented at least two
hours prior to the scheduled exit conference. The CEO or designee of the
provider agency may waive the two-hour period between presentation of the
summary and the exit conference or the exit conference itself.
(M) The provider agency may structure the
exit conference in a manner determined most beneficial to the agency.
(i) The agency may invite staff, service
recipients, family members, and other citizens to participate.
(ii) Performance survey team personnel
provide an explanation of findings and standards, as requested by the
agency.
(iii) Performance survey
team personnel provide an explanation of the procedures described in this
Section that are available to the agency regarding any disputed
findings.
(iv) During the exit
conference, the agency may submit evidence contesting the citation of
standards. Performance survey team members review presented evidence and for
each contested standard, may:
(I) reverse the
entire citation;
(II) reverse a
portion of the citation; or
(III)
affirm the citation.
(v)
Within two weeks of the exit conference, the agency sends to the administrator
of DDSD QA a written response that identifies a date the agency will comply
with the cited requirement.
(I) Any projected
resolution date beyond two months from the exit conference is accompanied by a
justification.
(II) Approval of
extended resolution dates occurs only upon the presentation of evidence that
extensive change in agency management systems or extensive expenditures is
essential to resolution of the problem.
(III) The agency presents plans and time
frames to implement incremental changes necessary to achieve contract
conformance when an interval of more than two months is requested.
(vi) The agency may send
supplemental information to the administrator of QA contesting the findings of
the performance survey team within two weeks of the exit conference. An appeal
does not relieve the agency from the responsibility to achieve resolution of
contract deficiencies within two months from the date of the exit conference,
if the request for reversal is not supported through procedures described in
paragraph (5) of this subsection.
(4) The findings of performance surveys and administrative inquiries, as well as any appeals, are reviewed by the administrator of DDSD QA or designee.
(5) The QA administrator or designee issues, within 30 days of the report detailing findings, a preliminary determination regarding:
(A) any standard citation appeal by
the agency;
(B) acceptance or
revision of resolution dates proposed by the provider to achieve conformance
with the provisions of the contract(s) or rules; and
(C) when necessary, specific corrective
action(s) is undertaken by the agency, including that:
(i) the agency reimburse OKDHS or OHCA for
unsubstantiated or unauthorized claims;
(ii) the agency reimburse service recipients
for the balance of funds managed by the agency contrary to the expectations of
OAC
340:100-3-4;
and
(iii) service provision is
immediately suspended or modified when it is determined there is imminent risk
to the health or safety of service recipients.
(6) Performance survey teams conduct focused re-surveys to assess resolution of identified contract deficiencies.
(A) Focused re-surveys including a new random
sample are conducted at any time following the established resolution
date.
(B) Focused re-surveys
require no advance notice.
(C)
Focused re-surveys may, at the discretion of the performance survey team be
expanded to include any new performance issue identified.
(D) Focused re-surveys evaluate whether the
provider has corrected identified deficiencies by the approved resolution date.
The written report provided to the provider includes any new performance issues
identified as well as the:
(i) resolution of
conditions resulting in the citation of a standard; and
(ii) continued existence of a
deficiency.
(E)
Following a focused re-survey the provider is informed of the results.
(i) The provider may submit evidence
contesting a citation.
(ii) New
citations found during the focused re-survey are added to the report of the
original survey for consideration by the Performance Review
Committee.
(7) Failure to cooperate. Provider agencies failing to cooperate with provisions or providing false information in response to any inquiry per OAC 340:100-3-27.1 are subject to sanctions identified, including contract termination.
(8) 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 OKDHS authorized agent. Authorized agents are OKDHS staff whose responsibilities include administration, supervision, or oversight of DDSD services, including all DDSD and Office of Client Advocacy staff.
Added at 19 Ok Reg 2948, eff 8-1-02 (emergency); Added at 20 Ok Reg 936, eff 6-1-03; Amended at 23 Ok Reg 1026, eff 5-11-06; Amended at 29 Ok Reg 822, eff 7-1-12
Disclaimer: These regulations may not be the most recent version. Oklahoma may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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