340:100-3-27. Quality assurance
(a) Purpose. Developmental Disabilities Services (DDS) quality assurance (QA) activities assess and encourage delivery of supports consistent with:
(1) the service recipient's preferences and needs;
(2) Oklahoma Human Services (OKDHS) rules;
(3) applicable Oklahoma Health Care Authority (OHCA) rules;
(4) OKDHS and OHCA contract requirements for Home and Community-Based Services (HCBS);
(5) regulatory standards applicable to services; and
(6) federal and state laws.
(b) Case manager monitoring. DDS case managers assess services rendered to each service recipient to ensure service effectiveness in meeting the service recipient's needs. The case manager periodically observes service provision to assess implementation of the service recipient's Individual Plan (Plan). The requirements per this Section are minimum expectations for face-to-face visits with service recipients. Case management may require additional visits to ensure the service recipient's health and welfare.
(1) The DDS case manager conducts face-to-face visits to monitor the service recipient's health and welfare and service effectiveness in meeting his or her needs.
(A) Face-to-face visits include observation of, and talking with, the service recipient regarding his or her health and welfare and satisfaction with services.
(B) The case manager may:
(i) observe service provision and related documentation in any location where services are provided; and
(ii) talk with family members and providers regarding service provision and the service recipient's health and welfare.
(C) For service recipients receiving services through an In-Home Supports Waiver:
(i) a face-to-face visit is completed at least semi-annually with one visit occurring between January and June and one between July and December; and
(ii) at least one of the two visits occurs at the site where the majority of services are provided.
(D) For service recipients receiving services through the Community Waiver:
(i) a face-to-face visit occurs during each calendar month in the residential service recipient's home, per Oklahoma Administrative Code (OAC) 340:100-5-22.1, or the group home service recipient's home, per OAC 317:40-5-152. Case managers certify home visits on Form 06MP070E, Access to Record and Verification of Monitoring Requirements, located per OAC 340:100-3-40;
(ii) a face-to-face visit is completed each calendar-year quarter, coinciding with the quarters established per OAC 340:100-5-52 for a quarterly summary of progress reports, for service recipients who do not receive residential services or group home services, with at least two of these visits occurring at the site where the majority of services are provided; and
(iii) the case manager visits the employment or day services site at least semi-annually, with one visit occurring between January and June, and one between July and December, when services are funded through the Community Waiver unless the Personal Support Team (Team) requests a DDS area manager or designee approved exception.
(E) For service recipients receiving services through the Homeward Bound Waiver:
(i) a face-to-face visit occurs in the home during each calendar month. Case managers certify home visits on Form 06MP070E located within the home record per OAC 340:100-3-40; and
(ii) the case manager visits the employment site each calendar-year quarter, coinciding with the quarters established, per OAC 340:100-5-52, for quarterly summary of progress reports, unless the Team requests a DDS area manager or designee approved exception.
(F) For Homeward Bound class members who reside in an intermediate care facility for individuals with intellectual disabilities, the case manager visits monthly.
(2) The DDS case manager may conduct virtual monitoring as a substitute for the required minimum face-to-face visits utilizing Health Insurance Portability and Accountability Act (HIPAA) compliant phone calls or video conferencing as identified in (A) through (F) of this paragraph. The DDS area manager or designee approves virtual monitoring.
(A) Virtual visits are limited to two, non-consecutive calendar months per calendar year for service recipients who receive;
(i) daily living supports; and
(ii) traditional or community living group home services, specialized foster care (SFC), agency companion services and Prader-Willi Services.
(B) Virtual visits are limited to one time per calendar year for service recipients who receive non-residential services on the Community Waiver and only when the member does not receive Remote Supports (RS) service.
(C) Virtual visits are not permitted when heightened need for visits is required such as during the first 30-calendar days after a service recipient transitions to a new residential placement or when there are concerns of unmet health and safety needs.
(D) Virtual visits may not be substituted for the required minimum face-to-face visits for service recipients who:
(i) receive services through the Homeward Bound Waiver;
(ii) receive services through the In-Home Supports Waiver;
(iii) receives RS services;
(iv) reside in an Alternative Group Home; or
(v) are in custody of OKDHS, Child Welfare Services.
(E) Virtual visits in addition to the required minimum face-to-face visits utilizing HIPAA compliant phone calls or video conferencing may also be conducted.
(3) DDS case managers review and ensure Plan implementation. The case manager completes a quarterly review for service recipients receiving services through HCBS Waivers, documenting the review in the service recipient's electronic record.
(4) When the DDS case manager believes the service recipient is at risk of harm, the case manager takes immediate steps to protect the service recipient and notifies the DDS case management supervisor and other appropriate authorities.
(5) When the DDS case manager determines a provider is not effectively addressing a service recipient's needs or meeting contractual responsibilities or policies, steps in (A) through (C) of this paragraph are followed.
(A) The case manager consults with the relevant provider to secure a commitment for necessary service changes within an agreed time frame.
(B) When necessary changes are not accomplished within the specified time frame, the case management supervisor intervenes to secure commitments from the provider.
(C) When the service deficiency is not resolved as a result of the case management supervisor's intervention, an administrative inquiry referral is initiated, per OAC 340:100-3-27.1.
(6) If, during a contract survey, administrative inquiry, SFC monitoring, or area survey, DDS QA staff discovers a situation that requires correction by DDS staff, a system administrative inquiry is initiated.
(A) DDS QA staff emails notification to DDS staff to correct the situation, establishing a reasonable time frame for correction.
(B) When the identified staff is unable to correct the situation within the established time frame, DDS QA staff emails notification to the DDS staff supervisor, establishing a reasonable time frame for correction.
(C) When the staff supervisor is unable to correct the situation within the established time frame, DDS QA staff notifies his or her supervisor, who notifies the DDS area manager, establishing a reasonable time frame for correction.
(D) When the area manager is unable to correct the situation within the established time frame, he or she notifies the DDS State Office QA unit, to resolve the situation with the community services unit deputy director.
(c) SFC monitoring. DDS QA staff monitors the SFC program in each area for DDS and OHCA policy compliance. Monitoring is based on a proportionate, representative sample of individuals receiving SFC supports identified for the fiscal year for each area. Monitoring includes a visit to the service recipient's SFC home. A home visit may be conducted virtually if the home has electronic equipment that allows for face-to-face communication unless health and safety issues are reported that require on-site review.
(d) Consumer Service Evaluation. At least annually, service recipients and families receiving supports are provided the opportunity to complete a service evaluation per OKDHS Publication No. 89-10, Consumer Service Evaluation.
(1) Confidentiality is maintained unless the respondent authorizes OKDHS to reveal his or her name to those responsible for service delivery. OKDHS Publication No. 89-10 may be completed anonymously.
(2) DDS QA staff distributes OKDHS Publication No. 89-10 to service recipients or his or her legal guardians at least annually.
(3) OKDHS Publication No. 89-10, when completed is returned to the DDS State Office QA Unit.
(4) Results are forwarded to the respective DDS area office when authorized by the service recipient or legal guardian for resolution of concerns or staff recognition.
(5) A response analysis is completed and distributed to DDS area offices, DDS State Office, or OKDHS for action. Data is available upon request.
(e) Oklahoma Advocates Involved in Monitoring (OK AIM). Service recipients and families receiving supports participate in contact providers' formal assessments to promote service enhancement, consistent with service recipient expectations.
(1) OK AIM operates under direction of the Oklahomans for Quality Services Committee (OQSC).
(A) OQSC is composed of 15 persons who receive or have a family member receiving DDS services. All areas of Oklahoma are represented.
(i) OQSC members may be nominated by the public at large, current OQSC members, or DDS representatives.
(ii) Appointment of OQSC members occurs as a result of joint consensus by the OQSC chair and DDS director or designee following a determination of the nominee's:
(I) commitment to promote the interests of persons with developmental disabilities; and
(II) capacity to dedicate the necessary time to fulfill his or her responsibilities.
(iii) OQSC members have the authority to elect officers based on a simple majority vote and establish by-laws governing the conduct of business.
(i) develops and refines procedures and the survey instrument used, based on feedback from service recipients and their families, providers, and other key constituents;
(ii) participates in the selection of agencies submitting proposals to conduct OK AIM activities; and
(iii) serves as a resource for education and coordination of agencies conducting OK AIM monitoring activities.
(2) OKDHS issues and awards a Request for Proposal (RFP) per the Oklahoma Central Purchasing Act, Sections 85.1 through 85.44E of Title 74 of the Oklahoma Statutes (74 O.S. §§ 85.1 through 85.44E) and the approved OKDHS Internal Purchasing Procedures, and solicits proposals from qualified organizations to participate in the OK AIM initiative. Qualified organizations include agencies that:
(A) are incorporated non-profit agencies dedicated to representing persons with developmental disabilities and their family members;
(B) are not involved in service delivery funded through DDS or HCBS Waivers; and
(C) meet additional requirements set forth by federal and state laws as indicated in the RFP.
(3) OQSC is consulted regarding bids submitted in response to an RFP.
(4) Agencies selected to conduct OK AIM monitoring and reporting activities are responsible for:
(A) soliciting, screening, and training volunteers to conduct OK AIM site visits;
(B) scheduling site visits with all service providers referenced in the RFP within counties for which the agency assumed responsibility;
(C) ensuring consistency of volunteer and staff activities with:
(i) OQSC-approved procedures and protocols;
(ii) federal and state laws; and
(iii) OKDHS and OHCA rules;
(D) accurately recording OK AIM monitoring activities findings;
(E) ensuring provision of findings to provider agencies and DDS; and
(F) immediately notifying the DDS area office of any issue identified during OK AIM monitoring activities that presents risk to the service recipient's health or welfare.
(5) DDS area managers identify OKDHS staff responsible for resolving concerns identified during OK AIM monitoring activities and notify the agencies responsible on how to contact staff during business, evening, and weekend hours.
(6) OQSC with DDS State Office, DDS area offices, and agencies conducting OK AIM activities participation, identifies conditions determined to present significant risks to service recipients.
(A) Conditions determined to present imminent risks to service recipients are reported immediately to the:
(i) statutory investigatory authority;
(ii) DDS area office; and
(iii) provider agency chief executive officer (CEO) or designee.
(B) Issues determined to pose potential risks to service recipients are reported to DDS area office staff, who notify the provider agency CEO or designee, no later than at the close of the first business-day following observation.
(C) OK AIM monitors report any other significant issues to designated DDS area office staff within time frames OK AIM determines appropriate.
(7) DDS staff immediately identifies DDS area office staff to assume responsibility for verification and correction of problems posing imminent or potential risks.
(A) The DDS area manager approves resolution time frames for validated concerns based on the degree of risk.
(B) All identified concerns are resolved within 30-calendar days from initial notification to the DDS area office, unless the DDS area manager authorizes an extension in circumstances that pose no jeopardy to any service recipient.
(C) Concerns presenting immediate and significant risk to service recipients are corrected immediately.
(8) Each DDS area manager designates staff to:
(A) track resolution of each identified concern; and
(B) advise agencies conducting OK AIM monitoring activities of the steps taken to resolve each concern.
(9) OK AIM staff summarizes findings of each home visit volunteers conduct, and staff notes performance in regards to the established OQSC expectations as published in the OK AIM training manual.
(A) Recommendations for service enhancement are presented to the relevant DDS area office for review within 30-calendar days of a home visit.
(B) DDS area office staff shares this information with the provider and collaborates on recommendations as well as other alternatives to achieve targeted service enhancement. Plans developed as a result are shared with OK AIM staff during the next meeting. Provider comments or action plans are maintained with the OK AIM report in area office files.
(10) OQSC re-assesses the OK AIM survey process at least annually and does so based on feedback solicited from service recipients, DDS area office staff, providers, and other constituencies affected by or involved in the process.
(f) Independent assessments. An independent authority annually assesses service outcomes for a sample of service recipients receiving residential services funded or administered through DDS or HCBS Waivers.
(1) Assessments employ standardized measures, facilitating individual as well as congregate data analysis over time.
(2) Assessment protocols provide for identification and resolution of circumstances posing immediate risks to service recipients.
(g) Failure to cooperate. Provider agencies failing to cooperate with provisions, or providing false information in response to inquiries per this Section, are subject to identified sanctions including contract termination.
(h) Findings of non-compliance. Findings of significant non-compliance with human rights, laws, or rules are immediately reported to the DDS director and other relevant authorities for appropriate action, including disciplinary action of OKDHS employees or sanction imposition, including suspension or contract termination with provider agencies, per OAC 340:100-3-27.2.
(i) 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 authorized OKDHS agent. Authorized agents are OKDHS staff whose responsibilities include administration, supervision, or oversight of DDS services, including all DDS and Office of Client Advocacy staff.
(j) QA functions. Additional DDS QA program components are found in OAC 340:100-3-27.1 through OAC 340:100-3-27.5.
(k) Reports. Reports generated by QA discovery activities are distributed as described in (1) through (4) of this subsection.
(1) Reports of performance surveys and administrative inquiries are provided to the administrator of the provider agency surveyed, are stored electronically, and made accessible to:
(A) DDS staff;
(C) Office of Inspector General; and
(D) appropriate Office of Client Advocacy staff.
(2) Performance survey reports with personal identifying information removed are available to interested citizens upon request.
(3) Reports of administrative inquiries are not released.
(4) Unless otherwise authorized by the individual or the legal guardian, OK AIM reports and case manager reports are available only to the:
(A) referenced individual(s) served;
(B) individual's legal guardian;
(C) agencies providing supports;
(D) relevant DDS area manager;
(E) DDS QA administrator; and
(F) other relevant DDS personnel.