Library: Policy

340:100-5-26. Health and wellness

Revised 9-15-2021

(a) Scope and applicability. Oklahoma Administrative Code (OAC) 340:100-5-26 applies to service recipients receiving services funded by Developmental Disabilities Services (DDS) or Home and Community-Based Services (HCBS) Waivers that promote health and well-being.

(1) Oklahoma State Department of Health (OSDH) guidelines for universal precautions, and infection control practices are used to prevent the transmission of communicable diseases.

(2) DDS staff and contract providers implement procedures to promote the health and wellness of each service recipient, including procedures related to:

(A) accessing emergency medical intervention;

(B) initiating first aid and cardio pulmonary resuscitation (CPR), unless a Do-Not-Resuscitate Consent Form is signed, per Section 3131.1 et. seq. of Title 63 of the Oklahoma Statutes;

(D) addressing issues associated with aging;

(E) medication administration, per OAC 340:100-5-32;

(F) health related services, per OAC 340:100-5-26.3;

(G) assisting the service recipient to access medical and dental services when needed; and

(H) identifying and addressing service recipient needs, per OAC 340:100-5-50 through 340:100-5-58.

(b) Service recipient responsibilities.

(1) The right of a service recipient to refuse service is respected, per OAC 340:100-3-11. However the:

(A) Personal Support Team (Team) meets to discuss the service recipient's decision;

(B) service recipient must cooperate with eligibility assessments and provide documents necessary to continue HCBS Waiver services;

(C) service recipient must cooperate with the case manager and provider to obtain necessary assessments and health care provider orders when assistance by a paid HCBS Waiver provider is identified in the Individual Plan (Plan); and

(D) except as provided for in OAC 340:100-5-22.5, the service recipient is responsible for health and medical costs including:

(i) over-the-counter medications and other medications not covered by insurance;

(ii) health insurance co-payments;

(iii) dental treatments and appliances not covered by dental insurance or within the allowable annual limits of the HCBS Waiver, when eligible;

(iv) medical treatments not covered by health insurance;

(v) dietary supplements including, but not limited to:

(I) vitamins; and

(II) herbal and dietary treatments;

(vi) treatment supplies not medically necessary for:

(I) nutrition;

(II) incontinence;

(III) respirator or ventilator care;

(IV) decubitus care;

(V) catheterization;

(VI) health conditions; or

(VII) infection control; and

(vii) treatments and supplies outside the allowable limits of the HCBS Waiver.

(2) The service recipient or his or her family assumes the responsibility for making appointments when residing in his or her own home or family home, unless a health care coordinator (HCC), per OAC 340:100-5-26(e)(3)(F), is required and identified in the Plan.

(c) Assessment of needs. The DDS case manager ensures an individual assessment is completed for each service recipient, per OAC 340:100-5-51.

(d) Planning and implementation requirements.

(1) Health and wellness support and services and the roles of various individuals are specifically noted in the service recipient's Plan, per OAC 340:100-5-50 through 340:100-5-58.

(2) For a service recipient who receives minimal services to maintain residence in his or her own home or family home or to maintain employment, the service recipient and his or her Team determines the appropriate roles for members of the Team per applicable policy.

(3) For a service recipient who receives residential, group home, or extensive health supports to remain in his or her own home or family home or maintain employment, the Team identifies specific roles and protocols necessary to provide support as listed in (A) –(I) of this paragraph.

(A) The Team identifies desired health care outcomes or necessary supports through the Team process.

(B) Health issues identified through health care evaluations and assessments that impact the service recipient's life are incorporated and integrated by the Team into the Plan.

(C) When assessing health care services or implementation strategies involving discipline-specific services, a representative from that discipline participates in a consulting role.

(D) For service recipients who receive HCBS Waiver community residential supports or group home services, invasive procedures are reviewed by the Team, including participation from any other service provider as appropriate. Consent is assessed, per OAC 340:100-3-5.

(i) An invasive procedure is a procedure or surgery that requires moderate to deep sedation or general anesthesia, changes the service recipient’s functional level following the procedure, or requires changes to the Plan.

(ii) Invasive procedures reviewed by the Team comprise both scheduled and emergency procedures.

(iii) Team review of a scheduled invasive procedure occurs prior to implementation of the proposed procedure and includes, but is not limited to, a discussion of risk, benefit, and possible alternatives. For both scheduled and emergency invasive procedures the Team assesses service and support needs to promote healing or rehabilitation.

(E) The community residential supports or group home provider is responsible for providing health care coordination.

(F) For a service recipient who requires extensive health supports to remain in his or her own home or maintain employment, the HCC is identified in the Plan when the HCC is a paid support.

(G) The Team identifies a HCC to ensure implementation and coordination of health care services for the service recipient. The HCC:

(i) is a person who has an understanding of the service recipient's health care needs and lifestyle, and may be the service recipient, service recipient's family member, foster parent, companion, residential provider staff, or other person who is familiar with the service recipient's needs;

(ii) receives DDS required training;

(iii) documents that health concerns are addressed, monitored, and communicated;

(iv) supports the person to directly communicate to the health care provider the reason for the medical consultation whenever possible, or communicate on the service recipient's behalf;

(v) keeps the health care provider advised of medical status and data regarding any target symptoms;

(vi) communicates health care provider orders to core Team members and other service providers as appropriate;

(vii) presents Form 06HM005E, Referral Form for Examination or Treatment, for HCBS Waiver recipients to the health care provider at the time of the visit ensuring:

(I) Form 06HM005E is completed by the HCC prior to the visit; and

(II) the health care provider completes a short written summary of the findings;

(viii) presents Form 06HM073E, Referral Form for Psychiatric Examination or Treatment, for HCBS Waiver recipients to the psychiatric health care provider at the time of the visit ensuring:

(I) Form 06HM073E is completed by the HCC prior to the visit; and

(II) the psychiatric health care provider completes a short written summary of the findings; and

(ix) when employed by a contract provider, the employer develops and implements a procedure to ensure appropriate backup if the HCC is unable, for any reason, to perform these duties.

(H) For service recipients who receive HCBS Waiver community residential supports or group home services, the DDS case manager submits a referral for a clinical pharmacist review:

(i) when requested by a Team member or clinician participating with the Team;

(ii) when a review performed by the assigned DDS case manager or nurse determines a referral is indicated;

(iii) annually or as needed when the service recipient:

(I) receives five or more routine medications;

(II) is experiencing potential medication-related issues not resolved through other medical intervention;

(III) uses a p.r.n. medication routinely for more than three months with an average use of three per week or 10 per month;

(IV) takes two or more psychotropic medications, per OAC 340:100-5-26.1; or

(V) takes three or more anticonvulsant medications; or

(iv) when a service recipient receives an order for a medication administered p.r.n for behavioral control, per OAC 340:100-5-26.1.

(I) The Team meets to review pharmacy recommendations within 30-business days of receipt of a completed clinical pharmacy review.

(J) For service recipients who receive community residential supports or group home services and are hospitalized the DDS case manager identifies preventative measures, and reviews needed services and supports. When the service recipient is admitted to a:

(i) non-psychiatric hospital the Team holds a discharge planning meeting; or

(ii) psychiatric facility a review is completed, per OAC 340:100-5-57. A Team meeting is held if changes to the Plan are identified.

(e) Implementation procedures for HCBS Waiver skilled nursing services.

(1) Skilled nursing services are implemented, per OAC 317:30-5-390 through 317:30-5-393.

(2) Community service workers are trained and carry out implementation strategies addressing health care outcomes.

(3) Accurate and current medical and program information is maintained in the home record by the residential provider and is available for review by authorized Oklahoma Human Services staff.

(f) Case management monitoring responsibilities for HCBS Waiver service recipients.

(1) The case manager monitors implementation of the Plan, per OAC 340:100-5-52 and 340:100-3-27.

(2) For the purpose of monitoring and evaluation, designated DDS staff has access at all times to the service recipient's medical and programmatic information.

(3) The case manager monitors the service recipient's access to medical and dental services.

(4) The case manager may assist the service recipient in locating health care providers.