Current through Vol. 42, No. 1, September 16, 2024
(a)
Eligibility. To ensure the daily living requirements of the class
members are met, Oklahoma Human Services (OKDHS) provides a payment to the
contract residential provider agency serving each person who:
(1) is a member of the class certified in
Case Number 85-C-437-E, United States District Court for the Northern District
of Oklahoma; and
(2) receives Daily
Living Supports services, per Oklahoma Administrative Code (OAC)
317:40-5-153.
(b)
Service expectations. The
provider agency ensures that:
(1) all
applicable OKDHS and Oklahoma Health Care Authority (OHCA) rules are met,
including:
(A) community residential
supports, per OAC
340:100-5-22.1;
(B) daily living supports, per OAC
317:40-5-153;
(C) the Developmental Disabilities Services
(DDS) mission statement and guiding principles, per OAC
340:100-1-3.1;
(D) community records rules, per
OAC
340:100-3-40;
(E) individual plan rules, per OAC
340:100-5-50
through
340:100-5-58;
and
(F) health services rules, per
OAC
340:100-5-26;
and
(2) the class
member's expenses for housing, food, clothing, recreation, utilities, medical
services, property replacement, and transportation, per OAC
340:100-5-22.5.
(c)
Room and board payment. The room and board payments support the
class member's housing, food, clothing, recreation, and utility costs per this
subsection.
(1) Each class member contributes
an amount determined annually by DDS, not to exceed 90 percent of his or her
income, up to a maximum of 90 percent of the current Supplemental Security
Income (SSI) monthly payment for a single individual.
(A) The maximum SSI monthly payment may be
exceeded by prior written agreement between the individual served or his or her
guardian and the provider agency with the written approval of the DDS director
or designee.
(B) OKDHS pays a
supplement, equal to 90 percent of the SSI monthly payment for a single
individual minus 90 percent of the class member's income, on behalf of each
class member whose income and resources are insufficient for the person to
contribute the maximum room and board payment explained in this
paragraph.
(2) To
supplement the individual's funds for meeting daily living requirements, OKDHS
providesa room and board provider payment per the supported living
contract.
(3) The provider agency
completes a written financial agreement with the class member and chosen
advocate(s) or the legal guardian, per OAC
340:100-5-22.1.
(4) Room and board revenues must be accounted
for separately from other provider agency funds.
(A) Room and board revenues from OKDHS are
managed by the provider to meet the needs of all individuals living in
supported living arrangements.
(B)
Payments from OKDHS mentioned in (2) of this subsection are provider payments.
They are not income to the class member and must not be deposited in the class
member's bank account; nor is the provider required to account to the class
member or Personal Support Team (Team) regarding their use.
(C) Room and board payments from individuals
served are used only to meet the needs of that individual.
(5) Unless written approval is secured in
advance from the DDS director or designee, room and board revenues are solely
used for:
(A) housing costs and
utilities;
(C) household maintenance;
(E) personal items and clothing;
(F) household property insurance;
(H) furnishings and appliances.
(6) Room and board payments are
authorized as long as the provider agency supports the individual to maintain a
household.
(7) Room and board
payments cannot be used to support a roommate who does not receive DDS
services, nor can the payment be used to modify or improve the home for the use
or comfort of an existing or potential roommate who is not a DDS services
recipient. Any roommate must contribute a fair share to the cost of operating
the household.
(8) Room and board
payments are used only to support a service recipient in one household and
residence at any given time, except for a transition with a timeframe not to
exceed 45-calendar days.
(d)
Medical supplement. OKDHS
reimburses the provider agency for the cost of necessary medical services not
covered through Medicaid (SoonerCare), Medicare, or other insurance; or for
persons listed in Case Number 85-C-437-E, who are not Medicaid or Medicare
eligible. The medical supplement is not paid at a rate higher than allowed
through the Oklahoma Medicaid Fee-for-Service Program unless approved by the
area DDS field administrator in writing.
(1)
Co-payments for medical services are not covered by the medical supplement.
Co-payments are the responsibility of the class member.
(2) Over-the-counter medications are not
covered by the medical supplement. These are the responsibility of the class
member.
(e)
Property replacement supplement. DDS provider agencies are
reimbursed for replacement of unusable furnishings or necessary furnishings or
appliances for class members per the supported living contract addendum.
Necessary furnishings and appliances include: refrigerators, stoves, washers,
dryers, dining tables and chairs, sofas or love seats, recliners, lamps when
there is no fixed lighting in the room, beds, dressers or chests of drawers,
bookshelves, phones, and safety items, per OAC
340:100-5-22.1.
(1) The provider agency submits a written
property replacement request to the case manager that includes the:
(A) furnishing or appliance to be
purchased;
(B) reason the item is
necessary; and
(C) age of the
furnishing or appliance to be replaced.
(2) The case manager reviews the written
requestand submits it to the area field administrator or designee within
14-calendar days with the case manager's assessment of the need for the
furnishing or appliance.
(3) The
area field administrator or designee reviews and responds to the request and
assessment, within five-calendar days after considering:
(A) whether the request includes necessary
information;
(B) whether the case
manager assessment indicates need;
(C) whether the household has or disposed of
usable items to meet the need; and
(D) that items less than five years old are
repaired whenever feasible; with the exception of lamps, phones, or safety
items.
(4) Expenditures
for property purchased with the property replacement supplement must not be
reported as expenses against the room and board payment.
(5) No reimbursement for replacement of worn
out furnishings may occur during the first year of service.
(6) The disposal of any furnishings purchased
for class members under this supplement meets the requirements of this
paragraph.
(A) Any furnishings purchased
through this supplement become the property of the class member.
(B) Any funds received from the disposal of
property belong to the class member.
(C) The provider must document the disposal
of furnishings in detail.
(D) When
the provider believes that the disposal of property is not in the class
member's best interest, the issue is referred to the Team for
resolution.
(E) The replacement of
usable appliances and furnishings disposed of is the class member's
responsibility.
(f)
Transportation supplement.
OKDHS pays a transportation supplement only when the provider agency supplies a
vehicle for the exclusive use of each household and the combined mileage for
all persons residing in the household totals less than 30 miles per day, per
the supported living addendum to the contract for services.
Waiver transportation is authorized, per OAC
317:40-5-103.
(g)
Fiscal accountability. The
provider agency follows fiscal accountability standards established in this
subsection.
(1) The provider agency expends
all payment supplied, per OAC 340:100-5-22.5, on the specific activities for
which the payment was provided.
(A) Any funds
expended for purposes other than the authorized activities are repaid to
OKDHS.
(B) The room and board fund
balance at the end of the fiscal year cannot exceed five percent of the total
supported living revenues. Any fund balance in excess of five percent is repaid
to OKDHS.
(2) The
provider agency maintains copies of all claims, substantiating documents, and
records regarding provider agency fiscal status within corporate offices in
Oklahoma.
(3) Supported living
expenditures must:
(B) not include
administrative costs of the provider agency; and
(C) be audited annually, per OAC
340:100-3-27.5.
Added at 20 Ok Reg
544, eff 1-21-03 (emergency); Added at 20 Ok Reg 936, eff 6-1-03; Amended at 21
Ok Reg 888, eff 4-26-04; Amended at 27 Ok Reg 838, eff
7-1-10