OHCA Policies and Rules

317:40-9-1. Self-directed services (SDS)

[Revised 09-01-2026]

(a) Applicability. This Section applies to SDS provided through Home and Community-Based Services (HCBS) Waivers operated by the Oklahoma Human Services (OKDHS) Developmental Disabilities Services (DDS).

(b) Member option. Traditional service delivery methods are available for eligible members who do not elect to self-direct services. Members may also choose to self-direct part or all of their services as permitted within this section.

(c) General information. SDS are an option for members receiving HCBS through the In-Home Supports Waiver (IHSW) for Adults, IHSW for Children, and the Community Waiver when the member lives in a non-residential setting. SDS provides members the opportunity to exercise choice and control in identifying, accessing, and managing specific Waiver services and supports in accordance with his or her needs and personal preferences. SDS are Waiver services OKDHS DDS specifies may be directed by the member or representative using employer and budget authority.

(1) SDS may be directed by:

(A) An adult member, when the member has the ability to self-direct;

(B) A member's legal representative including a parent, spouse or legal guardian; or

(2) The person directing services:

(A) Is eighteen (18) years of age or older;

(B) Complies with DDS and Oklahoma Health Care Authority (OHCA) rules and regulations;

(D) Signs an agreement with DDS;

(E) Is a member or legal representative approved to act in a representative capacity;

(F) Demonstrates knowledge and understanding of the member's needs and preferences;

(G) Does not serve as the Self-Directed (SD) habilitation training specialist (HTS) for the member when he or she is directing the member's services.

(H) Must reside within sixty-miles of the Oklahoma state border when they reside in another state. Exceptions to this rule must be approved by the DDS Director or designee;

(I) Participates in the Individual Planning process; and

(J) Submits quarterly progress reports to the Case Manager according to OAC 340:100-5-52.

(d) The SDS program includes:

(1) The SDS budget. Members who receive services through the IHSW may elect to self-direct part or the entire amount allowed for the IHSW. Members who receive services through the community waiver may not exceed limits for SD-HTS services as described in OAC 340:100-5-35.

(A) The SDS budget is developed annually at the time of the annual plan and updated. Individuals who participate in the budget development include, the member, case manager, parent, legal guardian, and others the member invites to participate.

(B) Payment may only be authorized for goods and services (GS) not covered by SoonerCare, or other generic funding sources, and must meet service necessity criteria, per OAC 340:100-3-33.1.

(C) The member's SDS budget includes the actual cost of administrative activities including fees for financial management services (FMS) subagent, workers' compensation insurance, and the amount identified for SD-HTS, SD Job Coaching, SD-community based services, and Self-directed goods and services (SD-GS). The SDS budget may also include fees for background checks and CPR/First Aid training for SD-HTS, SD-Job Coach and prevocational staff providing SD-community-based vocational services.

(D) The member's employment services costs, excluding transportation services, cannot exceed limits set forth in OKDHS Appendix D-26, Developmental Disabilities Services Rates Schedule, per POC year.

(2) The SD-HTS supports the member's self-care and the daily living and leisure skills needed to reside successfully in the community. Services are provided in community-based settings in a manner that contributes to the member's independence, self-sufficiency, community inclusion, and well-being. SD-HTS services must be included in the approved SDS budget. Payment is not made for routine care and supervision that is typically provided by a family member or the member's spouse. SD-HTS services are provided only during periods when staff is engaged in purposeful activity that directly or indirectly benefits the member. At no time are SD-HTS services authorized for periods when staff is allowed to sleep. Legally responsible individuals may serve as a paid SD-HTS, per OAC 340:100-3-33.2. Payment does not include room and board, maintenance, or upkeep or improvements to the member's or family's residence. An SD-HTS:

(A) Is eighteen (18) years of age and older;

(B) Passes a background check, per OAC 340:100-3-39;

(D) Completes required training, per OAC 340:100-3-38 et seq.;

(E) Signs an agreement with DDS and the member;

(F) Is physically able and mentally alert to carry out the job's duties;

(G) Does not work as an SD-HTS more than forty (40) hours in any week;

(H) Does not implement prohibited procedures, per OAC 340:100-5-58;

(I) Provides services to only one (1) member at any given time. This does not preclude providing services in a group setting where services are shared among group members; and

(J) Does not perform any job duties associated with other employment, including on-call duties, at the same time they are providing SD-HTS services.

(3) SD-Job Coaching (SD-JC) services per OAC 317:40-7-7:

(A) SD-JC services are only available for individual placements;

(B) An SD-Job Coach signs an agreement with DDS and the member; and

(4) SD-Community Based (SD-CB) Services per OAC 317:40-7-5.

(A) SD-CB services are only available for individual placements.

(B) Prevocational staff who provide SD-CB signs an agreement with DDS and the member

(5) SD-Transportation per OAC 317:40-5-103.

(6) SD-GS are incidental, non-routine, and promote the member's self-care, daily living, adaptive functioning, general household activities, meal preparation, and leisure skills needed to reside successfully in the community. SD-GS do not duplicate other services authorized in the member's POC. These SD-GS must be included in the Individual Plan (Plan) and approved SDS budget. SD-GS must meet the requirements listed in (A) through (F) of this paragraph.

(A) The item or service is justified by a recommendation from a licensed professional that:

(i) Is updated annually;

(ii) Is dated;

(iii) Includes a recommendation for all goods and services requested; and

(iv) Identifies how all goods and services requested will directly benefit the individual.

(B) The item or service is not prohibited by federal or state statutes and regulations.

(C) The item or service meets one (1) or more of the criteria listed in (i) through (iii) of this subparagraph. The item or service:

(i) Increases the member's functioning related to the disability;

(ii) Increases the member's safety in the home environment; or

(iii) Decreases dependence on other SoonerCare funded services.

(D) SD-GS may include, but are not limited to:

(i) Fitness items that can be purchased at retail stores when accessing a gym in the community is not an option;

(ii) Short duration camps lasting fourteen (14) consecutive calendar days or less;

(iii) Adaptive bikes;

(iv) A specialized swing set for outdoors;

(v) Sensory toys;

(vi) Weight loss programs when:

(I) There is an identified weight loss or increased physical activityneed;

(II) Justified by outcomes related to weight loss, increased physical activity or stamina; and

(III) In subsequent POC year requests, documentation is provided that supports the member's progress toward weight loss, increased physical activity, or stamina;

(vii) Swimming lessons;

(viii) Recreational classes such as equine therapy (horseback riding), music lessons, dance lessons, cheer classes, karate lessons, etc.;

(ix) Uniform, costume, recital fees required for authorized recreational classes or lessons;

(x) Enrollment fees or equipment costs for authorized gyms, recreational classes or lessons;

(xi) Adult Activity Centers for members 18 years of age and over; and

(xii) Gym memberships.

(E) SD-GS is not used for:

(i) Medical services co-payments;

(ii) Over-the-counter medications;

(iii) Items or treatments not approved by the Food and Drug Administration;

(iv) Homeopathic services;

(v) Services available through any other funding source, such as SoonerCare, Medicare, private insurance, the public school system, rehabilitation services, or natural supports;

(vi) Room and board including deposits, rent, and mortgage payments;

(vii) Personal items and services not directly related to the member's disability;

(viii) Vacation expenses;

(ix) Insurance;

(x) Vehicle maintenance or other transportation related expense;

(xi) Costs related to internet access;

(xii) Clothing;

(xiii) Tickets and related costs to attend recreational events;

(xiv) Services, goods, or supports benefiting persons other than the member;

(xv) Experimental goods or services;

(xvi) Personal trainers;

(xvii) Spa treatments or massage therapy;

(xviii) Goods or services with costs that significantly exceed community norms for the same or similar goods or services.

(xix) Any service available through a traditional DDS waiver, whether or not the service is included in the waiver in which the member is enrolled;

(xx) Daycare or after school care services for minor children;

(xxi) Educational programs and materials for members eligible for Individuals with Disabilities Education Act; or

(xxii) Medications.

(F) SD-GS are reviewed and approved by the DDS director or designee.

(e) Member Responsibilities. When the member chooses the SDS option, the member or member's representative who is the employer of record (EOR) and:

(1) Completes the DDS-sanctioned self-direction training course before enrolling in SDS. The training covers:

(A) Staff recruitment;

(B) Hiring of staff as an employer of record;

(D) Staff supervision including scheduling and service provisions;

(E) Staff evaluation;

(F) Staff discharge;

(G) SD philosophy

(H) OHCA SD policy;

(I) Individual budgeting;

(J) SD support plan development;

(K) Cultural diversity; and

(L) Rights, risks, and responsibilities, and

(2) Signs the SDS agreement form;

(3) Agrees to utilize the FMS subagent services;

(4) Agrees to pay administrative costs for background checks, FMS subagent fees, and workers' compensation insurance from his or her SDS budget;

(5) Complies with federal and state employment laws and ensures no employee works more than forty (40) hours per week in an SD-HTS capacity;

(6) Ensures that each employee is qualified to provide the services for which he or she is employed to do and that all billed services are actually provided;

(7) Ensures that each employee complies with all DDS training requirements per OAC 340:100-3-38 et seq.;

(8) Recruits, hires, supervises, and discharges all employees providing SDS, when necessary;

(9) Verifies employee qualifications;

(10) Obtains background screenings on all employees providing SD-HTS services per OAC 340:100-3-39;

(11) Sends progress reports per OAC 340:100-5-52.

(12) Participates in the Plan and SDS budget process;

(13) Notifies the DDS case manager of any emergencies or changes in circumstances that may require modification of the type or amount of services provided for in the member's Plan or SDS budget;

(14) Waits for budget modification approval before implementing changes;

(15) Complies with DDS and OHCA administrative rules;

(16) Cooperates with DDS monitoring requirements per OAC 340:100-3-27;

(17) Cooperates with FMS subagent requirements to ensure accurate records and prompt payroll processing including:

(A) Reviewing and signing employee time cards;

(B) Verifying the accuracy of hours worked; and

(18) Completes all required documents within established timeframes, including submission of incident reports per OAC 340:100-3-34;

(19) Pays for services incurred in excess of the budget amount;

(20) Pays for services not identified and approved in the member's SDS budget. The EOR is responsible for any costs resulting when a vendor payment request is not submitted within five (5) months after the service is rendered;

(21) Pays for services provided by an unqualified provider or an unauthorized vendor;

(22) Determines staff duties and qualifications and specifies service delivery practices consistent with SD-HTS Waiver service specifications;

(23) Orients and instructs staff in duties;

(24) Evaluates staff performance;

(25) Identifies and trains back-up staff, when required;

(26) Determines amount paid for services within plan limits;

(27) Schedules staff and the services provisions;

(28) Ensures SD-HTS do not implement prohibited procedures per OAC 340:100-5-58; and

(29) Signs an agreement with the SD-HTS.

(f) FMS. The FMS subagent is an entity that DDS designates as an agent to act on a member's behalf who has employer and budget authority.The FMS subagent's purpose is to manage payroll tasks for the member's employee(s) and SD-GS payments as authorized in the member's plan. FMS subagent duties include, but are not limited to:

(1) Compliance with all DDS and OHCA administrative rules and contract requirements;

(2) Compliance with DDS or OHCA random and targeted audits;

(3) Tracking individual expenditures and monitoring SDS budgets;

(4) Processing the member's employee payroll, withholding, filing and paying of applicable federal, state, and local employment-related taxes and insurance;

(5) Employee time sheets collection and processing and making payment to member's employees;

(6) SD-GS invoice collection and processing as authorized in the member's SDS budget;

(7) Providing each member with information that assists with the SDS budget management;

(8) Providing reports members and member representatives, as well as providing monthly reports to DDS and to OHCA upon request;

(9) Providing DDS and OHCA authorities access to individual member's accounts through a web-based program;

(10) Assisting members in verifying employee citizenship status;

(11) Maintaining separate accounts for each member's SDS budget;

(12) Tracking and reporting member funds, balances, and disbursements;

(13) Receiving and disbursing funds for SDS payment per OHCA agreement; and

(14) Executing and maintaining a contractual agreement between DDS and the SD-HTS (employee).

(g) DDS case management responsibilities in support of SDS.

(1) The DDS case manager develops the member's plan per OAC 340:100-5-50 through 340:100-5-58.

(2) The DDS case manager meets with the member or, when applicable, the member's representativeor legal guardian to discuss the Waiver service delivery options in (A) and (B) of this paragraph:

(A) Traditional Waiver services; and

(B) SDS including information regarding scope of choices, options, rights, risks, and responsibilities associated with SDS.

(3) When the member chooses SDS, the DDS case manager:

(A) Discusses the available amount in the budget with the member or the member's representative;

(B) Assists the member or representative in developing and modifying the SDS budget;

(D) Assists the member or representative developing or revising an emergency back-up plan;

(E) Monitors plan implementation per OAC 340:100-3-27;

(F) Ensures services are initiated within required time frames;

(G) Conducts ongoing monitoring of plan implementation and of the member's health and welfare; and

(H) Ensures the SD-HTS does not implement prohibited procedures, per OAC 340:100-5-58. If the Team determines restrictive or intrusive procedures are necessary to address behavioral challenges, requirements must be met, per OAC 340:100-5-57.

(h) Government fiscal/employer agent model. DDS serves as the Organized Health Care Delivery System (OHCDS) and FMS provider in a Centers for Medicare and Medicaid Services approved government fiscal/employer agent model. DDS has an interagency agreement with OHCA.

(i) Voluntary termination of self-directed services. Members may discontinue SDS without disruption at any time, provided traditional Waiver services are in place. Members or representatives may not choose the SDS option again until the next annual planning meeting, with services resuming no earlier than the beginning of the next POC. A member desiring to file a complaint must follow procedures per OAC 340:2-5-61.

(j) SDS involuntary termination.

(1) Members may be involuntarily terminated from SDS and offered traditional Waiver services when the DDS director or designee has determined that any of the criteria in (A) through (F) of this paragraph exist:

(A) Immediate health and safety risks associated with self-direction, such as, imminent risk of death or irreversible or serious bodily injury related to Waiver services;

(B) Intentional misuse of funds following notification, assistance and support from DDS;

(D) Suspected fraud or abuse of funds;

(E) A member no longer receives a minimum of one (1) SDS Waiver service per month and DDS is unable to monitor the member; or

(F) Reliable information shows the employer of record or SD-HTS engaged in illegal activity.

(2) When action is taken to involuntarily terminate the member from SDS, the case manager assists the member in assessing needed and appropriate services through the traditional Waiver services option.The case manager ensures that no lapse in necessary services occurs for which the member is eligible.

(3) The Fair Hearing process, per OAC 340:100-3-13 applies.

(k) Reporting requirements. While operating as an OHCDS, DDS provides OHCA reports detailing provider activity in the format and at times OHCA requires.

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.