340:100-5-35. Non-Residential Habilitation Training Specialist (HTS) services
(a) Applicability. Habilitation Training Specialist (HTS) services, per OAC 317:30-5-482, are authorized per OAC 317:40-5-110 or 317:40-5-111 and OAC 340:100-3-33 and applies to nonresidential HTS services provided to service recipients not receiving community residential or group home services, per OAC 340:100-5-22.1 or OAC 340:100-6.
(b) General information.
(1) Non-residential HTS services are authorized:
(A) as a result of needs identified by the Developmental Disabilities Services (DDS) Personal Support Team (Team) and informed selection by the service recipient;
(B) only during periods when staff are engaged in purposeful activity that directly or indirectly benefits the service recipient;
(C) when directed toward the development or maintenance of a skill in order to achieve a specifically stated outcome; and
(D) when the service provided is not a function that the parent would provide for the individual without charge as a matter of course in the relationship among members of the nuclear family when the member resides in a family home.
(2) Non-residential HTS services are not authorized when a service recipient is in need of:
(A) sleep time supervision; or
(B) assistance responding to emergencies, in which case a residential alternative, per OAC 317:40-1-2, must be selected, unless unpaid natural supports are available to meet these needs and identified in the Individual Plan (Plan).
(3) Non-residential HTS services are not authorized for:
(A) services provided in the home of the HTS, unless the service recipient and the HTS reside in the same home;
(B) employment supports that are provided, per OAC 317:40-7;
(C) respite services provided, per OAC 317:30-5-517;
(D) homemaker services provided, per OAC 317:30-5-537;
(E) adult day services provided, per OAC 317:40-5-113;
(F) child care services; or
(G) services provided by the legal guardian, biological or adoptive parent of a minor child, per OAC 340:100-3-33.2.
(4) In accordance with OAC 340:100-3-33.1, services must be provided in the most cost effective manner. When the need for HTS services is expected to continue to exceed an average of nine hours daily, cost effective community residential services must be considered and requested, per OAC 317:40-1-2. For adults, continuation of non-residential services in excess of nine hours per day for more than one plan of care year is not authorized except:
(A) when needed for members who receive services through the Homeward Bound Waiver;
(B) when determined by the division administrator or designee to be the most cost effective option; or
(C) as a transition period of 120-calendar days or less to allow for identification of and transition to a cost effective residential option. Members who do not want to receive residential services are assisted to identify options that meet their needs within an average of nine hours daily.
(5) Non-residential HTS providers may not perform any job duties associated with other employment, including on call duties at the same time they are providing HTS services.
(6) Non-residential HTS services are limited to no more than 40 hours per week for the household when the HTS resides in the same home as the service recipients. When one or more service recipient lives in the same household, services provided by individuals living in the home may not exceed a total of 40 hours per week. If additional hours of service are needed, they must be provided by someone living outside the home. Exceptions may be authorized when needed for service recipients who receive services through the Homeward Bound Waiver.
(7) When the service recipient also receives nursing or Homemaker services or is out of the home for school, work, adult day services, or other non-HTS supported activities, the total number of hours of non-residential HTS, Homemaker, and hours away from the home cannot exceed 12 hours per day, unless an exception is granted, per OAC 317:40-5-110.
(c) Service location.
(1) Non-residential HTS services are provided in the:
(A) service recipient's home; or
(2) Non-residential HTS services are not provided in:
(A) a school;
(B) a nursing facility;
(C) an intermediate care facility for persons with intellectual disabilities (ICF/ID);
(D) an unlicensed facility-based program;
(E) a private home except the service recipient's home or the home of a relative, unless the home was approved, per OAC 317:40-5-40; or
(F) the service recipient's employment setting or any other employment setting.
(d) Backup plan. Prior to service delivery, an emergency backup plan must be developed and specify how the service recipient's needs will be met when paid staff are unavailable. The emergency backup plan is included in the Plan.
(e) Service requirements.
(1) The provider:
(A) implements the service recipient's Plan;
(B) promotes community inclusion;
(C) promotes the service recipient's health and welfare, increased independence, self-sufficiency; and
(D) cooperates in securing alternative services while continuing to provide services when the service recipient, legal guardian, or provider wants to discontinue services until the Team confirms all essential services are in place.
(2) The provider develops and maintains written policies and procedures that are consistent with Oklahoma Human Services (OKDHS) rules and govern all aspects of service provision, with the exception of services provided, per OAC 317:40-9-1.
(A) Provider agency policies are made available to each service recipient, service recipient's parent(s), legal guardian, advocate, provider agency staff, and OKDHS.
(B) Provider agency policies and procedures include, but are not limited to:
(i) service recipient rights protection;
(ii) services provided;
(iii) admission and discharge criteria;
(iv) grievance procedures;
(v) prevention and reporting of abuse, neglect, and exploitation;
(vii) emergency management;
(viii) fees paid by service recipient;
(ix) health and safety precautions;
(x) safeguarding service recipient funds;
(xi) medication administration; and
(xii) incident reporting.
(3) The provider agency designates one person who, in the absence of the agency administrator, is responsible for the administration of the agency and is empowered to act on behalf of the provider agency, with the exception of services provided, per OAC 317:40-9-1.
(4) The provider agency is responsible for recruitment, screening, training, and supervision of staff or volunteers providing direct services, and ensuring direct support staff:
(A) are not supervised by a relative or person living in the staff's home. A relative includes wife, husband, children, parents, stepparents, parents-in-law, grandchildren, grandparents, brothers, sisters, stepchildren, brothers-in-law, sisters-in-law, sons-in-law, daughters-in-law, aunts, uncles, nieces, nephews, first cousins or any such person with whom the employee shares a foster relationship;
(B) who provide backup services are available and have received training, per OAC 340:100-3-38;
(C) are at least 18 years of age;
(D) are present as specified in the Plan and as authorized by the service recipient’s Plan of Care;
(E) are physically able and mentally alert to carry out the job duties;
(F) implement and follow the service recipient's Plan; and
(G) do not take the service recipient to visit staff's home, unless the Team provided advance written approval of any visit with the purpose specified in the Plan.
(5) The provider agency ensures supervision, guidance, and oversight of all aspects of programming associated with receipt of non-residential HTS supports.
(A) The program coordination staff (PCS) must:
(i) ensure staff are familiar with Plan requirements;
(ii) make supervisory visits to the service site. The PCS makes a minimum of one monitoring visit per:
(I) month, when a service recipient receives an average of 30 or more hours of HTS weekly; or
(II) quarter based on calendar year quarters, when a service recipient receives an average of 29 or fewer hours of HTS weekly;
(iii) supervise direct contact staff to promote achievement of Plan outcomes;
(iv) ensure staffing levels meet the requirements of the service recipient’s Plan, with staff trained, per OAC 340:100-3-38;
(v) ensure records are maintained, per OAC 340:100-3-40;
(vi) assist the DDS case manager as requested to prepare for and implement the Plan and its revisions, per OAC 340:100-5-50 through 340:100-5-58;
(vii) ensure applicable OKDHS and Oklahoma Health Care Authority (OHCA) rules are followed;
(viii) complete necessary training, per OAC 340:100-3-38; and
(ix) have a minimum of four years of any combination of college level education or full-time equivalent experience in serving persons with disabilities, or full-time equivalent experience in a supervisory position, unless this requirement is waived in writing by the DDS director or designee.
(B) Provider agencies assign PCS caseloads, per OAC 340:100-5-22.1.
(6) Staff, when assisting a service recipient with bathing or showering, must ensure the water temperature is safe and comfortable for the service recipient. The requirements of this paragraph are enforced even when an anti-scald device is used. Staff:
(A) tests the water temperature by touch or with a thermometer designed to test hot liquids, before the service recipient enters the water. The water must be determined safe and comfortable for the service recipient, not merely comfortable for the staff.
(B) is trained by his or her employer in the unique needs of each service recipient, including tolerance to water temperature and bathing or showering needs; and
(C) does not leave a service recipient who is unable to attend to safety considerations, alone in the bath or shower.