340:5-5-4. Special referral considerations
(a) Referrals regarding Indian tribal members.
(1) When a Memorandum of Understanding (MOU) exists between the State of Oklahoma and a sovereign Indian Nation the procedures outlined in the MOU are followed.
(2) When an MOU does not exist prior to entry on tribal land, the Indian Nation or United States Marshall Service is notified of the Adult Protective Services (APS) referral and APS procedures are followed in collaboration with the Indian Nation whenever possible. • 1
(b) Referrals involving two or more counties. When a referral involves two or more counties, such as when the alleged victim (AV) lives in one county and the alleged perpetrator (AP) lives in another county or when the AV moves, temporarily or permanently to another county before the investigation is completed, APS staff from both county offices are involved in the investigation. • 2
(c) Referrals involving Soonercare (Medicaid) fraud. When an APS investigation indicates fraud by a provider receiving Medicaid funds, APS staff immediately notifies the Office of the Oklahoma Attorney General Medicaid Fraud Control Unit (MFCU). APS cooperates with any MFCU investigation. When MFCU declines to investigate, APS staff completes the investigation and sends a summary report to MFCU.
(d) Referrals involving provider agencies. Providers subject to APS investigations include, but are not limited to, home health providers, adult day care centers, independent living centers, residential care facilities, and assisted living centers. These investigations include all elements of an APS investigation. • 3
(e) Referrals involving other licensed or certified persons. APS staff sends findings to any state agency with concurrent jurisdiction over persons or issues identified in the investigation including, where appropriate, the Oklahoma State Department of Health (OSDH), the Oklahoma Board of Nursing, and other appropriate state licensure or certification boards, agencies, or registries. • 4
(f) Referrals alleging exploitation. When referrals involve large amounts of funds, resources, or the need to access complex records regarding financial transactions, the APS specialist is authorized to request assistance from the OKDHS Office of Inspector General (OIG). • 5 When OIG declines to investigate, the APS specialist completes the investigation. • 6
(g) Persons referred to OKDHS by the courts. Courts are not authorized to remand criminal defendants to OKDHS based on a finding of lack of competency to stand trial. Courts are authorized to refer the alleged incompetent defendant to OKDHS for consideration of voluntary assistance or conditionally release the incompetent defendant, per Section 1175.6 of Title 22 of the Oklahoma Statutes. In order to qualify for such disposition, the court must make findings described in (1) or (2) of this subsection.
(1) Referral for voluntary services or conditional release occurs when the court finds the person is incompetent for reasons other than the AV is a person requiring treatment, per 43A O.S, and is found not to be dangerous.
(2) When a court, the district attorney, or the attorney for a criminal defendant notifies the APS specialist that a referral for voluntary OKDHS services or conditional release is made, the APS specialist obtains a copy of the order from the person making the referral. When, after evaluation, it appears to the APS specialist that the AV may also have a developmental disability, the APS specialist immediately contacts the Developmental Disabilities Services (DDS) Area Intake office and requests their involvement in the process of determining, in consultation with OKDHS Legal Services if voluntary services are available and adequate, or whether to propose a plan of services for conditional release. This is a joint effort between the APS specialist and the DDS case manager. • 7
INSTRUCTIONS TO STAFF 340:5-5-4
1. (a) When possible tribal membership is indicated, the Adult Protective Services (APS) specialist consults with the APS specialist IV or designee to determine if a Memorandum of Understanding (MOU) exists. When a MOU is in effect, the procedures outlined in the MOU are followed.
(b) APS staff is encouraged to establish and continue working relationships with tribal social services to provide services for Native American clients. Tribal notification of all referrals and investigations is considered best practice and the tribe or United States Marshall Services is notified when possible prior to entry on tribal land; however, a referral or investigation may proceed prior to tribal notice, when tribal notice is impossible.
(c) APS staff may contact the United States Marshall for assistance on restricted land, as appropriate.
(d) Information from an APS investigation may be shared with the Bureau of Indian Affairs and tribal governments.
2. (a) APS staff in the county of residence of the alleged victim (AV) has primary responsibility for the investigation. APS specialists in other involved counties cooperate fully and as quickly as possible to obtain information for the investigation. All requested information is forwarded to the county office in the AV's county of residence for case completion. This includes, but is not limited to, interviews with collateral contacts, such as family members, alleged perpetrators (AP), or other persons determined to have knowledge pertinent to the investigation and conducting property searches, obtaining bank records, or other material pertinent to the investigation.
(1) Staff in the county office of the county of the AV's residence may request APS staff in the county where the AP lives to conduct the interview with the AP. All efforts to involve the AP with APS staff in the county of residence are exhausted before this option is exercised. The same APS specialist interviews the AV and the AP if possible.
(2) When the back-up APS specialist interviews the AP, the back-up APS specialist documents the interview in the APS Computer System Interview Section within five-business days.
(b) When the AV is temporarily housed in another county, the APS specialist IV or designee in the resident county where the AV normally resides may request that the back-up specialist in the temporary county:
(1) completes and documents the initial face-to-face interview as soon as possible;
(2) completes and documents the Risk, Needs, and Capacity Assessment; and
(3) contacts and documents any collaterals.
(c) Staff in the resident county is responsible for completing the investigation and takes into consideration the input from the temporary county's APS specialist. The time frame for initiating the investigation remains the same per Oklahoma Administrative Code (OAC) 340:5-5-2.
(d) When it is determined that the AV relocated to another county prior to the conclusion of the investigation, the referral may be transferred to the new county. The APS specialist IV or designee of the initial county contacts the APS specialist IV or designee of the receiving county as soon as this determination is known in order to timely complete the investigation.
(e) When problems with coordination occur between APS staff in different county offices or there are delays in documenting information, county APS staff contacts the APS district director or designee for resolution.
3. (a) These investigations include all elements of an APS investigation with special emphasis on:
(1) interviewing agency staff and other residents or participants who may have knowledge of the reported incident;
(2) obtaining copies of applicable charts and records;
(3) reviewing medication lists and schedules;
(4) taking photographs;
(5) examining habilitation or other care plans;
(6) examining financial records and other money management documentation;
(7) reviewing time schedules and time sheets; and
(8) requesting any other information needed to complete the investigation.
(b) When assistance is needed to assess medical issues, Oklahoma Human Services (OKDHS) Long-Term Care (LTC) nurse involvement may be requested.
(c) Any corrective action plan on the part of the provider agency becomes a part of the APS case record. When the provider agency fails to cooperate in addressing the substantiated elements of the investigation, APS staff notifies the licensing agency, any appropriate governing board, and the district attorney's office of the failure to cooperate.
(d) The APS specialist may request the involvement of an OKDHS LTC nurse in investigations involving agency providers or when a nursing assessment is needed. The nurse's role is to:
(1) act as a resource in the interpretation of physical observations the APS specialist makes;
(2) accompany the APS specialist to visit the vulnerable adult when approved by the area nurse;
(3) assist the APS specialist in determining a course of action on the vulnerable adult's behalf; and
(4) assist in the follow-up of the vulnerable adult in the home, as appropriate.
(e) In order to involve the OKDHS LTC nurse in an APS investigation, the APS specialist must determine that the need exists for an in-home medical assessment. This conclusion may be reached after discussion with the APS specialist IV or designee, the OKDHS LTC nurse, or both.
(1) When the OKDHS LTC nurse is not available, the specialist may call the area nurse.
(2) When a nurse cannot be reached or is geographically unavailable for prompt response, the APS specialist determines if other nursing resources are available, such as the Developmental Disabilities Services (DDS) nurse or the local Oklahoma State Department of Health (OSDH) nurse.
(3) When the situation demands immediate attention and a nursing resource is unavailable, the APS specialist initiates the home visit immediately.
(f) When assistance from the OKDHS LTC nurse is appropriate either at the initial home visit or at follow-up visits, the APS specialist accompanies the nurse to visit the vulnerable adult.
(1) When the OKDHS LTC nurse accompanies the APS specialist on the initial home visit, the specialist and OKDHS LTC nurse assess the need for further action.
(2) After a visit to the vulnerable adult, the OKDHS LTC nurse completes all items on Form 08AP003E, Adult Protective Services Nursing Assessment, and submits the original to the APS specialist for scanning and inclusion in the APS Computer System.
4. (a) Contact information for OSDH includes:
(1) mailing address, 1000 N.E. 10th Street, Oklahoma City, Oklahoma 73111;
(2) phone number, 405-271-6868; toll-free phone number, 1-800-747-8419; fax number, 405-271-2206; and toll-free fax, 1-866-239-7553; or
(3) email at, LTCComplaints@health.state.ok.gov.
(b) Contact information for the Oklahoma State Board of Nursing includes, the:
(1) mailing address, 2915 N. Classen Blvd., Suite 524, Oklahoma City, Oklahoma 73106; and
(2) phone number, 405-962-1800.
5. The APS specialist makes the referral to the OKDHS Office of Inspector General on Form 19MP001E, Referral Form, and emails the referral to OIGFraud2@okdhs.org.
6. Protective services that may be provided in cases of exploitation include:
(a) suspending a vulnerable adult's benefits pending appointment of a payee or a change of payee;
(b) changing the representative payee;
(c) freezing all of the vulnerable adult's assets;
(d) petitioning the court for an order allowing access to records;
(e) redirecting or stopping the flow of the vulnerable adult's assets into the AP's account(s); and
(f) stopping perpetrator access to the AV's account(s).
7. When an AV is named a defendant in a criminal case and is referred to OKDHS for services, the assigned APS specialist makes periodic reports to the court regarding the status, activities, and well-being of the AV, per Section 1175.6b of Title 22 of the Oklahoma Statutes. Periodic reports are made annually or more often when court ordered.
(1) Assigned county staff in the vulnerable adult's county of residence maintain any existing original case records. The APS specialist enters new referrals in the APS Computer System Intake Section with references to existing cases, if any.
(2) When the county of the vulnerable adult's residence is different from the county of court jurisdiction, an APS specialist in the county of residence is assigned as back-up for the purpose of a face-to-face visit with the vulnerable adult, documenting the contact, and preparing reports as needed.
(3) When in the APS specialist's or the DDS case manager's professional judgment, the AV appears to have achieved competency to stand trial, the APS specialist reports this in writing to the court. The court then sets another hearing for the purpose of determining competency.
8. (a) APS staff provides information to DDS staff to assist in evaluation of a vulnerable adult known or suspected to have a developmental disability. The case manager for a vulnerable adult receiving DDS services facilitates and cooperates with the APS investigation by providing requested information and accompanying the APS specialist on home visits when needed.
(1) When DDS staff assists APS staff on a case, APS staff routes a copy of Adult Protective Services Report of Investigation to the appropriate DDS case manager when the investigation is completed.
(2) An example of APS and DDS staff coordinating activities is when the AV has developmental disabilities and is facing criminal charges, or may be the victim of a crime, and a prompt social service response is needed.
(b) When a vulnerable adult receiving APS services appears to have developmental disabilities, but does not receive DDS services, DDS Intake staff or other appropriate staff may accompany the APS specialist, when necessary, on home visits and assist in making application for DDS services. When DDS staff assists APS staff on a case, APS staff routes a copy of Adult Protective Services Report of Investigation to the appropriate DDS case manager when the investigation is completed.
(c) When the APS specialist suspects the AV has developmental disabilities, the APS specialist checks Information Management System (IMS) to determine if the vulnerable adult receives DDS Waiver services or is on the waiting list. To make a referral for DDS Waiver services or DDS state-funded services, the APS specialist contacts the appropriate DDS Area Intake office.
(1) DDS has three Area Intake offices:
(A) Area I includes Oklahoma City and Enid and the toll-free phone number is 1-800-522-1064;
(B) Area II includes Tulsa and the toll-free phone number is 1-800-522-1075; and
(C) Area III includes Pauls Valley and the toll-free phone number is 1-800-522-1086.
(2) The APS specialist describes the situation and gives details to the DDS intake worker regarding the person who may be in need of DDS services. Details include the AV's:
(B) Social Security number;
(C) date of birth;
(E) phone number;
(G) medical information;
(H) responsible party's or legal guardian's name; and
(I) other pertinent information.
(3) The DDS intake worker explains to the APS specialist what DDS services are available, if any, and how to access services or make application for services.
(d) When, after consultation with DDS staff, it appears the AV may be eligible for DDS Waiver services but is not receiving them, the APS specialist informs the AV or the AV's responsible party or legal guardian that the AV may be eligible for DDS Waiver services. The APS specialist advises how to apply for services and offers to assist in completing and signing the DDS Waiver application and obtaining all required documents, such as physical and psychological reports.
(1) When the family does not want or need the APS specialist's help in applying for DDS Waiver services, the APS specialist provides the family with the appropriate DDS Area Intake number so they can apply. In this case the APS specialist informs local DDS staff that the family was referred to the DDS Area Intake office and may need services. When there is no family, responsible party, or legal guardian, or these persons are the APs, the APS specialist may assist the DDS intake worker with the application.
(2) DDS maintains a waiting list of clients when resources are unavailable for persons to be added to services funded through the Home and Community-Based Services (HCBS) Waiver. The HCBS Waiver request list is maintained in chronological order based on the date of receipt of a written request for services. For emergency situations exceptions to the chronological order may be made per OAC 317:40-1-1(f).
(e) The APS specialist routes a copy of Adult Protective Services Report of Investigation to DDS Quality Assurance when the APS investigation involving vulnerable adults receiving DDS services is completed.
(f) When a complaint alleges abuse, neglect, or exploitation of a person with developmental disabilities by an OKDHS employee, refer to OAC 340:5-3-6(c).
(g) When, in the course of an investigation, the APS specialist discovers the vulnerable adult is a Hissom class or Balance class member, or the AP is a Medicaid provider, the APS specialist immediately routes the report to the Office of Client Advocacy for investigation.
9. (a) Primary method for notification: The APS specialist emails final investigative findings in summary form to OSDH. Alternate method for notification: the APS specialist mails the summary to OSDH. Refer to Instruction # 4 of this Section for OSDH contact information.
(b) To notify the Oklahoma State Board of Examiners for Long-Term Care Administrators (OSBELTCA), the APS specialist:
(1) downloads a pre-formatted letter from the APS Computer System Documents Section;
(2) obtains a signature from the APS specialist IV or designee; and
(3) sends the letter to OSBELTCA, 2401 N.W. 23rd Street, Suite 2H, Oklahoma City, Oklahoma 73107.