340:100-5-22.7. Supplemental room and board funding for persons receiving Home and Community-Based Services (HCBS) Waivers
(a) Applicability. This Section applies to services funded through Medicaid HCBS Waivers, per Oklahoma Administrative Code (OAC) 317:35-9-5, and Section 1915(c) of the Social Security Act. Specific Waivers include service recipients who receive:
(1) daily living supports (DLS), per OAC 317:40-5-150; or
(2) group home services, per OAC 317:40-5-152.
(b) General Information. In an effort to support participation in community life Oklahoma Human Services (OKDHS) Developmental Disabilities Services (DDS) may supplement room and board costs for service recipients with income insufficient to meet the costs of the items listed in (b)(1)(A) through (H). Room and board costs are not a reimbursable waiver expense, per the HCBS service regulations. Room and board expenses in a residential setting may leave a service recipient with insufficient personal funds. DDS State Fund supplemental payments permit a provider to be reimbursed for room and board costs beyond a service recipient's ability to pay with personal benefits income.
(1) Allowable room and board costs are actual monthly expenses that include:
(C) housing supplies;
(E) basic cable or television;
(G) repair and maintenance that are not an obligation of another entity; and
(2) Room and board reimbursement is authorized, per OAC 340-3-33.1. When the need for a supplemental payment is expected to continue, cost effective community living arrangements must be considered and documented in the Individual Plan (IP). The supplemental room and board payment must meet all of the requirements in (A) through (E) of this paragraph.
(A) Funding to meet the service recipient's needs are not available through another source.
(B) The service recipient's room and board expenses are consistent with fair market values for properties in the general area.
(C) The supplemental payment must be necessary to support community living and must be required for other than the preference of the service recipient, family, or provider.
(D) The provider must provide detailed expenses including but not limited to mortgage detail and status. The mortgage can't be a loan with business debt that is greater than the properties fair market value or non-routine costs for non-physical plant excluding the normal escrow items such as taxes and insurance.
(E) The provider must disclose common ownership interests between the provider and mortgage holder or lessor.
(3) The service recipient's Personal Support Team (Team) is responsible for ensuring individuals have a minimum of $100 of personal spending money each month unless a lesser amount is approved by the DDS director or designee.
(4) When possible, the Team develops a plan to resolve the room and board deficiency by identifying lower cost housing options or seeking roommates when there are additional bedrooms available.
(c) Room and board payment. Each service recipient contributes an amount determined by the provider, not to exceed actual expenses. The service recipient retains at least $100 a month in personal spending money. The service recipient must contribute employment income to meet his or her room and board costs.
(1) To ensure Waiver funding is not used for room and board costs when the service recipient has exceptionally low income, a room and board supplement is provided. The supplement is provided when he or she: • 1
(A) does not have adequate income to meet his or her room and board expenses;
(B) is awaiting a medical decision from the Social Security Administration for Supplemental Security income eligibility; or
(C) is unable to achieve sustained employment resulting in a room and board income deficit.
(2) Each month the provider submits OKDHS Form 06CL001E, Room and Board Supplement Claim Form, and OKDHS Form 10AD012E, Claim Form, for reimbursement within three-months of the last date of service.
(3) Proof of payment for all claim expenditures must be included with the initial claim. When the supplement extends beyond six-calendar months the provider must submit proof of payment in six month intervals. For subsequent claims, DDS may request additional claim expenditures when a significant change occurs.
(d) Provider requirements. The provider establishes a written financial agreement with the service recipient or legal guardian that defines the provider and service recipient's responsibilities, per OAC 340:100-5-22.1.
(1) The provider ensures:
(A) service recipient expenses accrue on a monthly basis and are actual expenses;
(B) the Social Security Administration is contacted to review the service recipient's benefits when his or her personal benefits are low; and
(C) the service recipient is employed an average of 30 hours per week. When the service recipient does not participate in 30 hours per week of employment services, the Team develops a plan to address the situation, per OAC 317:40-7-15.
(2) The provider notifies DDS when the service recipient's room and board, income, or expenditures change significantly.
INSTRUCTIONS TO STAFF 340:100-5-22.7
1. (a) When a service recipient has low income, Developmental Disabilities Services (DDS) assists in developing a plan to remedy the cause for reduced personal benefits income.
(1) The Personal Support Team (Team) reviews the service recipient's personal income benefits to ensure he or she is receiving all eligible benefits. When it is discovered that he or she is eligible for additional benefits, the Team assists the service recipient in applying for additional benefits.
(2) When a service recipient resides in daily living supports (DLS), with fewer than two roommates, the DDS field administrator may grant approval for a two-person DLS placement, per Oklahoma Administrative Code 317:40-5-150. When the request is submitted, the DDS field administrator ensures the service recipient can afford his or her living arrangement.
(3) When the service recipient is unable to consistently participate in employment, DDS vocational staff is contacted to provide technical assistance to the Team.