Library: Policy

340:100-3-27.2. Performance Review Committee (PRC), sanctions, and emergency determinations

Issued 9-15-15

(a) Findings of performance surveys, administrative inquiries, or focused re-surveys are reviewed by the PRC when the:

• (1) provider submits an appeal of any decision of the Quality Assurance (QA) administrator or designee within 14 calendar days from mailing of the preliminary determination;

• (2) provider fails to correct all identified deficiencies by the approved resolution date or if new deficiencies are identified per Oklahoma Administrative Code (OAC) 340:100-3-27.1(6)(E); or

• (3) QA administrator or designee determines sanctions may be required as a result of gross or perpetual violation of the contract.

(b) The PRC consists of representatives of major units of the division appointed by the Developmental Disabilities Services (DDS) director, except the QA administrator does not serve as a voting member.

(c) The PRC meets monthly to review and issue a determination on referrals.  Available determinations include:

• (1) acceptance, denial, or modification of an appeal;

• (2) a determination that sanctions are not warranted;

• (3) invocation of one or more sanctions including:

  • (A) a vendor hold that precludes the admission to the agency of any person whose services are funded by DDS or Waiver services.  The agency may not provide services to a participant who was not being served before the vendor hold was issued;

  • (B) suspension of funding pending resolution of conditions violating terms of the contract;

  • (C) disallowance of claims for services by staff whose:

    • (i) training was not completed per OAC 340:100-3-38; or

    • (ii) pre-employment screening does not comply with OAC 340:100-3-39;

  • (D) termination of contract with the Oklahoma Department of Human Services (DHS);

  • (E) recommendation for termination of contract with the Oklahoma Health Care Authority (OHCA); and

  • (F) the requirement the provider employ sufficient program coordination staff to provide one program coordinator for every 10 individuals receiving residential supports per OAC 340:100-5-22.1.

    • (i) The program coordination staff ratio may be invoked when a violation(s) of program coordination requirements in OAC 340:100-5-22.1 remains uncorrected for 60 calendar days following the provider's receipt of a written report of the findings.

    • (ii) The provider maintains the 1:15 program coordinator ratio for one year, unless the requirement is extended by the PRC based on subsequent deficiencies.

    • (iii) The provider must maintain the 1:15 program coordinator ratio for each caseload that includes a person receiving residential supports.

(d) Agencies are notified in writing of the determinations made by the PRC.  The president of the agency's board of directors is provided a copy by mail when a sanction, as described in (c) of this Section is authorized.

(e) When DDS receives an appeal of any decision of the PRC in writing within 14 calendar days from the mailing of the determination, the DDS director retains the authority to supersede the decisions of the QA administrator or the PRC.

(f) Failure to comply with pre-employment screening requirements of criminal background checks and registry checks for community services workers per OAC 340:100-3-39 result in placement of agencies on immediate vendor hold.  Per OAC 340:100-3-27.2, agencies have 60 calendar days to correct all deficiencies.  Following the re-survey, if all deficiencies are not corrected, DDS pursues recoupment in those instances where services were delivered by an unqualified provider.

(g) The DDS director or designee may issue an emergency determination independent of review by the PRC or written input by a provider agency when evidence is presented indicating risk of immediate and substantial jeopardy to the health or safety of a person receiving supports.

• (1) The DDS director or designee may use any DHS resource considered appropriate to further investigate such circumstance, but is not required to do so.

• (2) Emergency determinations:

  • (A) include the scope of options defined in (c) of this Section, waiving any stated time frame for implementation; and

  • (B) are not subject to appeal.