OHCA Policies and Rules

317:40-5-155. Extensive residential supports

[Issued 10-25-24]

(a) Introduction. ERS are provided by an agency, approved by Developmental Disabilities Services (DDS), that has a valid Oklahoma Health Care Authority contract for the service.

(1) ERS provide up to twenty-four (24) hours per day of direct support services, including the provision of more than one staff when the needs of the member indicate additional supports are required.

(2) ERS provides a level of supervision necessary to keep the member safe in the home and in the community and to assist the member with obtaining desired outcomes identified in the member's Individual Plan (Plan).

(b) Provider approval criteria. Prospective providers of ERS must demonstrate a history of effective services and supports to persons with challenging behaviors per OAC 340:100-5-57(c), emotional challenges or community protection needs. Provider approval requires review of historical information, when available, from DDS Quality Assurance Unit and Residential Unit. The DDS director or designee must approve the location of the home prior to the implementation of services. Each prospective provider submits written documentation of:

(1) a history of services to persons who present challenging behaviors, emotional challenges, or community protection needs, including:

(A) past experience;

(B) number of persons served;

(D) provider's philosophy for service provision;

(2) financial viability through fiscal information when requested, including the anticipated budget related to the rate for ERS services;

(3) service provision plans, including:

(A) anticipated number of homes;

(B) location;

(D) population to be served; and

(E) availability of psychological, psychiatric, vocational and educational services in the proposed location;

(4) plans for staffing and program coordination; and

(5) staff qualifications, including any additional training provided.

(c) Services provided. Services and supports are based on person-centered principles and practices and consistent with OAC 317:40-1-3. The service includes but is not limited to:

(1) program supervision and oversight, which includes:

(A) 24-hour availability of response staff to:

(i) meet schedules or unpredictable needs in a way that promotes maximum dignity and independence; and

(ii) provide supervision, safety and security consistent with the program described in the member's Plan; and

(B) staff who are available to respond to a crisis to:

(i) help ensure safety; and

(ii) assist the member to self-regulate to help prevent placement disruption;

(2) behavioral support, which includes supporting the member in being a valued member of the community. Challenging interactions may include but are not limited to:

(A) physical or verbal aggression;

(B) sexually unsafe behaviors or actions;

(D) property destruction;

(E) self-harm;

(F) suicidal ideations or attempts; and

(G) stealing or other illegal behavior;

(3) activities of daily living, which includes instruction, hands-on support, supervision, modeling or prompting to:

(A) eat;

(B) bathe;

(D) toilet;

(E) complete personal hygiene;

(F) transfer;

(G) complete housework;

(H) manage money;

(I) engage in community safety;

(J) participate in recreation;

(K) engage in socialization;

(L) manage health;

(M) manage medication; or

(N) attend school and other community-based educational opportunities;

(4) coordinating overall safety and supports in the home;

(5) self-advocacy training and support, which includes, but is not limited to:

(A) training and assistance in supported decision making;

(B) accessing needed services;

(D) recognizing and reporting abuse, neglect, mistreatment, or exploitation of self,

(E) responsibility for one's own actions; and

(F) participation in all meetings;

(6) development of communication skills;

(7) assistance with:

(A) emergency planning;

(B) safety planning;

(D) crisis intervention;

(8) community access support to enhance the abilities and skills necessary for the member to access typical activities and functions of community life.

(A) Accessing the community includes providing a wide variety of opportunities which may include:

(i) development of social, communication and other skills needed to successfully participate in the desired communities;

(ii) facilitating and building natural relationships in the desired communities;

(iii) participating in community education experiences or training;

(iv) participating in volunteer activities the member finds interesting and desirable;

(v) exploring and understanding available public transportation options; and

(vi) participating in pre-employment and employment activities;

(B) Services are conducted in a variety of settings in which members interact with individuals without disabilities. Services may include:

(i) social skill development;

(ii) adaptive skill development; and

(iii) personnel to accompany and support the member in community settings; and

(9) implementation of recommended and approved follow-up counseling, behavioral, or other therapeutic interventions;

(10) implementation of services delivered under the direction of a licensed or certified professional in that discipline including, but not limited to:

(A) family training;

(B) psychological services;

(D) physical therapy;

(E) occupational therapy; and

(F) speech therapy;

(11) medical and health care services that are integral to meeting the daily needs of the member, which include, but are not limited to:

(A) routine administration of medications; and

(B) tending to the medical needs of members;

(12) the provision of staff training per Oklahoma Administrative Code (OAC) 340:100-3-38.14, to meet the specific needs of the member; and

(13) assisting the member in obtaining services and supplies.

(d) Eligibility. ERS are provided to members who:

(1) have challenging behaviors, emotional challenges, or community protection needs and require additional supports to enable them to reside successfully in community settings. These services are designed to assist members to acquire, retain and improve the self-help, socialization, and adaptive skills necessary to remain in the community;

(2) have needs that cannot be met in other traditional community settings;

(3) participate in the DDS Community Waiver, per OAC 317:40-1-1;

(4) need community residential services outside the family home;

(5) do not receive:

(A) home-and community-based services options per OAC 340:100-5-22.1;

(B) group home services per OAC 317:40-5-152;

(D) respite care per OAC 317:30-5-517;

(E) homemaker per OAC 317:30-5-535; and

(F) intensive personal supports per OAC 317:40-5-151; and

(6) are eighteen (18) years of age or older, unless approved by the DDS director or designee.

(e) Service requirements. ERS must be:

(1) included in the member's Plan per OAC 340:100-5-51, including a description of the type(s) and intensity of supervision and assistance that must be provided to the member;

(2) authorized in the member's Plan of Care (POC);

(3) provided by the contracted provider agency chosen by the member or guardian;

(4) delivered per OAC 340:100-5-22.1; and

(5) provided directly to the member.

(f) Home Requirements. ERS are provided to eligible members living outside the family's home in a home:

(1) licensed by Oklahoma Human Services (OKDHS) Child Care Services when the member is a child in custody of OKDHS, Child Welfare Services; or

(2) leased or owned by the member receiving services.

(g) Responsibilities of provider agencies. Each agency providing ERS ensures:

(1) ongoing supports are available as needed when the member is out of the home visiting family and friends, or hospitalized for psychiatric or medical care;

(2) compliance with all applicable DDS policy found at OAC 340:100; and

(3) that trained staff are available to the member as described in the Plan.

(4) a trainer of a nationally recognized person-centered planning program approved by DDS is employed as a member of the provider’s leadership team or is contracted with the provider.

(5) A background investigation is conducted on staff per OAC 340:100-3-39.

(6) staff identified to work with children complete a Federal Bureau of Investigation (FBI) national criminal history search, which is based on the staff's fingerprints.

(h) ERS claims. No more than one unit of ERS per day may be billed.

(1) The provider agency claims one unit of service for each day during which the member receives ERS. A day is defined as the period between 12:00 a.m. and 11:59 p.m.

(2) Claims must not be based on budgeted amounts.

(3) When a member changes provider agencies, only the outgoing service provider agency claims for the day that the member moves.

(i) Therapeutic leave. ERS provides for therapeutic leave payments to enable the provider agency to retain direct support staff.

(1) Therapeutic leave is claimed when the member does not receive ERS services for 24-consecutive hours from 12:00 a.m. to 11:59 p.m. because of:

(A) a visit with family or friends without direct support staff;

(B) vacation without direct support staff; or

(C) hospitalization, whether direct support staff are present or not. ERS staff may be present with the member in the hospital as approved by the member's Personal Support Team (Team) in the Plan but are not responsible for the care of the patient.

(2) Therapeutic Leave must be authorized and documented in the POC.

(3) A member may receive therapeutic leave for no more than fourteen (14) consecutive days per event, not to exceed sixty (60) calendar days per POC year.

(4) The payment for a day of therapeutic leave is the same amount as the per diem rate for ERS.

(5) To promote continuity of staffing in the member's absence, the provider agency pays the staff member the salary that he or she would have earned if the member was not on therapeutic leave or provides the staff member a temporary, alternative work opportunity.

(j) Transition. Teams plan for a service recipient's transition to appropriate services when it is determined ERS is no longer necessary.

(1) Within six months of the service recipient's admission to ERS, the Team develops measurable, reasonable criteria for the service recipient's transition to a less restrictive environment that are:

(A) based on findings of the risk assessment completed by the Team per OAC 340:100-5-56.

(B) included in a written plan submitted to designated DDS State Office staff; and

(2) All transitions from ERS must be approved by designated DDS State Office staff. DDS State Office staff may adjust the transition date when necessary.

(k) DDS-initiated transition. The DDS director or designee may initiate the transition process for a member receiving ERS who can be effectively served in another residential environment.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.