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COMMENT DUE DATE:  

March 3, 2017

DATE: 

February 1, 2017

Debbie Pumphrey, Developmental Disabilities Services 405-521-4970

Dena Thayer, Programs Administrator 405-521-4326

RE:  

APA WF 17-03

It is very important that you provide your comments regarding the DRAFT COPY of policy by the comment due date. Comments are directed to *STO.LegalServices.Policy@okdhs.org

The proposed policy is  Permanent .  This proposal is subject to Administrative Procedures Act

It is important that you provide your comments regarding the draft copy of policy by the comment due date.Comments are directed to STO.LegalServices.Policy@okdhs.org.The proposed policy is permanent.

SUBJECT:CHAPTER100. DEVELOPMENTAL DISABILITIES SERVICES

Subchapter 3. Administration

Part 1. General Administration

OAC 340:100-3-1 [AMENDED]

OAC 340:100-3-6 [REVOKED]

OAC 340:100-3-10 [REVOKED]

Part 3. Administration

OAC 340:100-3-27 [AMENDED]

OAC 340:100-3-38.1 through 340:100-3-38.5 [AMENDED]

OAC 340:100-3-38.10 [AMENDED]

OAC 340:100-3-38.12 through 340:100-3-38.13 [AMENDED]

Subchapter 5. Client Services

Part 3. Service Provisions

OAC 340:100-5-22.1 [AMENDED]

OAC 340:100-5-22.6 [AMENDED]

OAC 340:100-5-36 [NEW]

Subchapter 6. Group Home Regulations

Part 11. Program Standards

OAC 340:100-6-55 [AMENDED]

Part 19. Involuntary Transfer or Discharge of Service Recipient

OAC 340:100-6-85 [AMENDED]

Part 21. Resident Rights and Responsibilities

OAC 340:100-6-95 [AMENDED]

(Reference WF 17-03)

SUMMARY:The proposed revisions to Chapter 100 Subchapters 3, 5, and 6 amend rules to implement changes recommended during the annual Developmental Disabilities Services (DDS) rule review process.

PERMANENT APPROVAL:Permanent rulemaking is requested.

LEGAL AUTHORITY:Director of Human Services; Section 162 of Title 56 of the Oklahoma Statues (56 O.S. § 162); 61 O.S. § 331; 10 O.S. § 1414; and Sections, 441.301, 441.302, 441.715, 441.720, and 441.710 of Title 42 of the Code of Federal Regulations.

Rule Impact Statement

To:Programs administrator

Legal Services - Policy

From:Marie Moore,Interim Director

Developmental Disabilities Services

Date:January 3, 2017

Re:CHAPTER100. DEVELOPMENTAL DISABILITIES SERVICES

Subchapter 3. Administration

Part 1. General Administration

OAC 340:100-3-1 [AMENDED]

OAC 340:100-3-6 [REVOKED]

OAC 340:100-3-10 [REVOKED]

Part 3. Administration

OAC 340:100-3-27 [AMENDED]

OAC 340:100-3-38.1 through 340:100-3-38.5 [AMENDED]

OAC 340:100-3-38.10 [AMENDED]

OAC 340:100-3-38.12 through 340:100-3-38.13 [AMENDED]

Subchapter 5. Client Services

Part 3. Service Provisions

OAC 340:100-5-22.1 [AMENDED]

OAC 340:100-5-22.6 [AMENDED]

OAC 340:100-5-36 [NEW]

Subchapter 6. Group Home Regulations

Part 11. Program Standards

OAC 340:100-6-55 [AMENDED]

Part 19. Involuntary Transfer or Discharge of Service Recipient

OAC 340:100-6-85 [AMENDED]

Part 21. Resident Rights and Responsibilities

OAC 340:100-6-95 [AMENDED]

(Reference WF 17-03)

Contact:Debbie Pumphrey 405-521-4970

A.  Brief description of the purpose of the proposed rule:

Purpose.  The proposed revisions to Chapter 100 Subchapters 3, 5, and 6 amend rules to implement changes recommended during the annual Developmental Disabilities Services (DDS) rule review process.

Strategic Plan Impact.

     The proposed amendments allow Oklahoma Department of Human Services (DHS) DDS to improve services.  The amendments and revocations support our goals of improving the quality of life of vulnerable Oklahomans by increasing people's ability to lead safer, healthier, and more independent, productive lives.  The proposed amendments comply with federal requirements.

Substantive changes.

Subchapter 3. Administration

Part 1. General Administration

     Oklahoma Administrative Code (OAC) 340:100-3-1 is amended to update the terminology used in this section to reflect current usage. 

     OAC 340:100-3-6 is revoked to remove the Human Rights Committee requirement from provider agencies.  This rule change was suggested by DDS provider agencies as a possible way to provide administrative relief and reduce costs to help offset the impact of the 3.5 percent provider rate reductions effective September 1, 2015. 

     OAC 340:100-3-10 is revoked as DHS has an Institutional Review Board that provides oversight and protects the rights and welfare of people who are participating in ongoing research.

Part 3. Operations

     OAC 340:100-3-27 is amended to change DDS case manager reviews from monthly to quarterly to conform with quarterly reporting requirements for provider agencies.

     OAC 340:100-3-38.1 through 340:100-3-38.5, 340:100-3-38.12, and 340:100-3-38.13 are amended to identify the person designated by the team to provide individual specific training by position in the individual plan and not by name. The use of terminology is revised to reflect current usage.

     OAC 340:100-3-38.10 is amended to provide a two-year certification to replace the one-year certification for the medication administration training course for individuals who administer medications as paid certified staff within the two-year period.  This rule change was suggested by DDS provider agencies as a possible way to provide administrative relief and reduce costs to help offset the impact of the 3.5 percent provider rate reductions effective September 1, 2015. 

Subchapter 5. Client Services

Part 3. Service Provisions

     OAC 340:100-5-22.1 is amended to increase program coordinator (PC) ratios for community residential and in-home supports waiver PC caseload from 1:20 to up to 1:27, and to amend the calculating factors to allow non-residential cases to be counted as 1:5, an increase from 1:3.  This rule change was suggested by DDS provider agencies as a possible way to provide administrative relief and reduce costs to help offset the impact of the 3.5 percent provider rate reductions effective September 1, 2015. 

     OAC 340:100-5-22.6 is amended to revise the rule to bring it into compliance with Section 441.301 of Title 42 of the Code of Federal Regulations for Home and Community-Based Waiver settings, and to increase the alternative group home program coordinator caseload rations from 1:12 to up to 1:18, due to the 3.5 percent provider agency rate reductions that were effective September 1, 2015.

     OAC 340:100-5-36 is created to set forth requirements for the use of the Southern Oklahoma Resource Center lease and royalty revenues per Section 331 of Title 61 of the Oklahoma Statutes. 

Part 6. Group Home Regulations

     OAC 340:100-6-55 is amended to remove the requirement that group homes retain the services of a registered nurse to act as a consultant.  This rule change was suggested by DDS provider agencies as a possible way to provide administrative relief and reduce costs to help offset the impact of the 3.5 percent provider rate reductions effective September 1, 2015. 

     OAC 340:100-6-85 is amended to remove the requirement that provider agency Human Rights Committee's review all proposed discharges.  This rule change was suggested by DDS provider agencies as a possible way to provide administrative relief and reduce costs to help offset the impact of the 3.5 percent provider rate reductions effective September 1, 2015. 

     OAC 340:100-6-95 is amended to remove provider agency Human Rights Committee references.

Reasons.

     The proposed amendments update and clarify DDS rules per federal and state laws.  The proposed amendments provide clear guidance to DDS partners and staff.  The proposed amendments position DDS to adhere to "best practice" standards. 

Repercussions.

     The proposed amendments contribute to the health and safety of vulnerable Oklahomans.

Legal authority.

Director of Human Services; Section 162 of Title 56 of the Oklahoma Statues (56 O.S. § 162); 61 O.S. § 331; 10 O.S. § 1414; and Sections, 441.301, 441.302, 441.715, 441.720, and 441.710 of Title 42 of the Code of Federal Regulations.

Permanent rulemaking approval is requested.

B.  A description of the classes of persons who most likely will be affected by the proposed rule, including classes that will bear the costs of the proposed rule, and any information on cost impacts received by the Agency from any private or public entities:  The classes of persons affected by the proposed amendments are individuals receiving services from DDS, who bear no costs associated with the implementation of the rule.

C.  A description of the classes of persons who will benefit from the proposed rule:  The classes of persons who benefit are individuals receiving services from DDS.

D.  A description of the probable economic impact of the proposed rule upon the affected classes of persons or political subdivisions, including a listing of all fee changes and, whenever possible, a separate justification for each fee change:  There is no economic impact on individuals who receive services from DDS.

E.  The probable costs and benefits to the Agency and to any other agency of the implementation and enforcement of the proposed rule, the source of revenue to be used for implementation and enforcement of the proposed rule and any anticipated effect on state revenues, including a projected net loss or gain in such revenues if it can be projected by the Agency:The probable cost to DHS includes the cost of printing and distributing the rules, estimated to be less than $20.

F.  A determination whether implementation of the proposed rule will have an impact on any political subdivisions or require their cooperation in implementing or enforcing the rule:  The proposed amendments do not have an impact on any political subdivisions or require their cooperation in enforcing the rules.

G. A determination whether implementation of the proposed rule will have an adverse economic effect on small business as provided by the Oklahoma Small Business Regulatory Flexibility Act:  The proposed amendments do not have an adverse effect on small business as provided by the Oklahoma Small Business Regulatory Flexibility Act.

H.  An explanation of the measures the Agency has taken to minimize compliance costs and a determination whether there are less costly or nonregulatory methods or less intrusive methods for achieving the purpose of the proposed rule:  The proposed amendments do not increase compliance costs.  There are no less costly or non-regulatory methods or less intrusive methods.

I.   A determination of the effect of the proposed rule on the public health, safety, and environment and, if the proposed rule is designed to reduce significant risks to the public health, safety, and environment, an explanation of the nature of the risk and to what extent the proposed rule will reduce the risk:  The proposed amendments bring the rules into compliance with federal and state law, thereby increasing program effectiveness positively impacting the health, safety, and well-being of affected persons.

J.  A determination of any detrimental effect on the public health, safety, and environment if the proposed rule is not implemented:  If the proposed amendments are not implemented, the rules will not be in compliance with federal and state law.  The proposals are intended to comply with federal and state law, thereby contributing to the health, safety, and well-being of vulnerable Oklahomans.

K.  The date the rule impact statement was prepared and, if modified, the date modified:  Prepared April 6, 2016; modified July 25, 2016; modified November 21, 2016; modified January 3, 2017.

SUBCHAPTER 3. ADMINISTRATION

PART 1. GENERAL ADMINISTRATION

340:100-3-1. Eligibility determination for Developmental Disabilities Services Division state-funded services

Revised 7-1-119-15-17

Developmental Disabilities Services Division (DDSD) (DDS) services are state-funded through the state without federal subsidy are and available to persons meeting eligibility requirements.

(1) To be eligible for state-funded DDSD DDS services a person must:

(A) present a psychological assessment with a diagnosis of mental retardation (MR) intellectual disability (ID) that includes a full scale intelligence quotient (IQ) of 75 or less; or

(B) be determined disabled, with a diagnosis of MR ID, by the Social Security Administration;

(C) be a resident of Oklahoma; and

(D) have achieved an age defined within the provisions of each state-funded program per Oklahoma Administrative Code (OAC) 340:100.

(2) Persons approved for DDSD DDS state-funded services prior to January 1, 1990, maintain their eligibility for services.

(3) Members of the Homeward Bound class, who are not eligible for services through Home and Community-Based Services (HCBS) Waivers because they do not meet the intermediate care facility for persons with mental retardation (ICF/MR) individuals with intellectual disabilities (ICF/IID) level of care, receive state-funded services.

(4) Members of the Homeward Bound class who are not eligible for services through the HCBS Waiver because they do not meet financial eligibility requirements must resolve financial eligibility issues within a 90-calendar day period.Members may continue to receive services included in their plan of care with state funding for a maximum 90-calendar day period while resolving financial eligibility issues.If issues are not resolved, the member may receive state-funded services available to non-Medicaid eligible persons including group homes, assisted living services without supports, community integrated employment services, and sheltered workshop services.The member may also receive such other services as the member may choose to purchase.The member is not eligible for other Medicaid services until eligibility issues are resolved.Case management is provided.

(5) Per Section 1414 of Title 10 of the Oklahoma Statutes, the Oklahoma Department of Human Services Director may authorize delivery of services to persons whose capacities exceed criteria per OAC 340:100-3-1 this Section.

(6) Eligibility for the Family Support Assistance Payment Program is in accordance with OAC 340:100-13-1.

340:100-3-6. Human Rights Committee [REVOKED]

Revised 7-1-12

(a) Human Rights Committee (HRC).Each service recipient participating in services or programs operated by or under contract with Developmental Disabilities Services Division (DDSD) is represented by a HRC.

(b) HRC role and function.The role and function of each HRC is to provide external monitoring and advocacy, separate and apart from the provision of services specifically addressing issues of protection of individual rights, program conditions, policy and procedure review, and resolution of complaints or concerns related to the protection of individual rights.Each HRC:

(1) reviews at least annually, each protective intervention plan containing a restrictive or intrusive procedure per OAC 340:100-1-2 and advises each service recipient or if applicable, legal guardian of the perceived benefits and risks of proposed programs.

(A) The review includes an evaluation to determine whether proposed procedures conform to DDSD and provider agency policy.

(B) Service recipients or legal guardians retain the right to provide, refuse, or withdraw consent for proposed procedures regardless of HRC recommendations as long as this consent does not result in the implementation of a program that does not comply with DDSD policies;

(2) reviews and approves with the DDSD director of psychological and behavioral supports all research proposals involving service recipients, prior to the initiation of research per OAC 340:100-3-10;

(3) reviews complaints by service recipients or other persons on behalf of service recipients and makes recommendations regarding resolution;

(4) reviews allegations of abuse, neglect, or exploitation.

(A) The provider agency notifies the HRC when an allegation of abuse, neglect, or exploitation is made.

(B) The HRC confirms whether the agency acted appropriately in reporting the allegation, protecting the service recipient, and cooperating with investigating authorities.

(5) reviews all incident reports involving emergency use of restrictive or intrusive procedures;

(6) reviews and comments on provider agency policies and practices as they affect service recipients.HRC comments are provided to the governing body of the provider agency and others determined appropriate by the governing body; and

(7) participates at least quarterly, in activities designed to promote familiarity with service recipients, staff, and agency practices.These activities may include, but are not limited to:

(A) home visitation;

(B) attendance at agency functions; and

(C) social or recreational events.

(c) Resource center HRC.Southern Oklahoma Resource Center (SORC), Northern Oklahoma Resource Center of Enid (NORCE), and Robert M. Greer Center (Greer) HRC composition and practices conform to Title XIX requirements, per Section 483.440 of Title 42 of the Code of Federal Regulations (CFR).

(d) Provider agency HRC.

(1) Each provider agency HRC must have at least four members.

(A) Members cannot be employed by an agency providing services to service recipients.

(B) At least one member is a service recipient or a family member of a service recipient.

(C) One member must be a professional with expertise in areas relating to HRC duties, such as:

(i) positive behavior supports and educational methodologies;

(ii) issues involving client rights; or

(iii) related medical or psychiatric issues.

(2) Service recipients served by multiple agencies funded by DDSD or Oklahoma Health Care Authority (OHCA) are represented by the HRC of the agency providing residential supports.

(3) Each provider agency HRC develops by-laws that specify:

(A) persons represented by the HRC;

(B) time and location of routine meetings, held no less than quarterly;

(C) methods to ensure access by service recipients to HRC members for private communication;

(D) time frames for review of grievances, complaints, and protective intervention plans.Protective intervention plans are reviewed within 30 days of agency receipt;

(E) term of appointment for members; and

(F) routine rules of operation such as:

(i) selection of chairperson; and

(ii) recording and distribution of meeting minutes.

(e) HRC meetings.

(1) HRC rules for recording and distribution of meeting minutes include, but are not limited to:

(A) identification of any protective intervention plan containing rights restrictions or restrictive or intrusive procedures that were reviewed, specifying the nature of the restriction or restrictive or intrusive procedure in each case;

(B) recommendations if any, from the HRC for each protective intervention plan reviewed, including a copy of any checklist or review form used;

(C) names and titles of persons who attended;

(D) other key issues discussed; and

(E) notation, if a pattern of frequent use of restrictive or intrusive procedures or frequent injury is emerging from the HRC review of incident reports.

(2) Each HRC distributes copies of:

(A) the form used to review the protective intervention plan, along with any other information needed to clarify the HRC recommendation, to the service recipient's DDSD case manager; and

(B) meeting minutes to each service recipient's case manager, when issues other than a protective intervention plan are reviewed with names deleted of persons who are not in that case manager's caseload

(f) HRC training.HRC members are trained, using curriculum consisting only of materials approved by the DDSD director of psychological and behavioral supports and the DDSD director of human resource development.The HRC may receive training from:

(1) a qualified DDSD trainer;

(2) Statewide Behavior Review Committee (SBRC); or

(3) a fully trained HRC member approved by the DDSD director of psychological and behavioral supports and DDSD director of human resource development.

(g) HRC advocacy.The HRC may seek assistance when HRC advocacy recommendations are not carried out.When HRC:

(1) recommendations regarding a rights restriction are not implemented, HRC may request an administrative inquiry from DDSD Quality Assurance (QA) Unit;

(2) recommendations regarding a protective intervention plan containing restrictive or intrusive procedures are not followed, HRC must refer the plan to SBRC; and

(3) is aware of the use of a restrictive or intrusive procedure not in accordance with OAC 340:100-5-57, HRC must request an administrative inquiry from DDSD QA Unit.

340:100-3-10. Research initiatives [REVOKED]

Revoked 9-15-17

DDSD supports research initiatives that contribute to the advancement of knowledge about the causes of mental retardation, prevention and treatment strategies, and activities which promote accelerated realization of functional independence.

(1) Research proposals must include evidence of benefit to participants prior to authorization.

(2) All research activities will comply with the strictest standards of professional ethics and conduct.

(3) Research initiatives employing use of painful stimuli are prohibited.

(4) Research activities that may place a client's rights at risk are:initiated only with the informed consent of clients/guardians/advocates; and with the authorization of the respective Area Human Rights Committee(s) and Local Administrator(s).

(5) Research designs using control groups will ensure appropriate therapy or treatment for all individuals participating in the study.

(6) Clients/Guardians maintain the right to refuse or withdraw from participation in research activities.

(7) Clients/Guardians are informed of the intent, scope and, if desired, aggregate findings of formalized studies conducted to assess the impact of services delivered through provisions of the IHP.Formalized service studies required as a condition of service participation are subject to oversite by a committee including consumer representation.

(8) Client privacy, confidentiality, and rights are insured in the design and conduct of any research initiative inclusive of formalized service studies.

PART 3. ADMINISTRATION

340:100-3-27. Quality assurance

Revised 7-1-129-15-17

(a) Purpose.Developmental Disabilities Services Division (DDSD) (DDS) quality assurance (QA) activities assess and encourage delivery of supports consistent with:

(1) the preferences and needs of service recipients,;

(2) Oklahoma Department of Human Services (OKDHS) (DHS) rules,;

(3) applicable Oklahoma Health Care Authority (OHCA) rules,;

(4)OKDHS DHS 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.DDSD DDS case managers assess services rendered to each service recipient to ensure effectiveness of services 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 OAC 340:100-3-27 this Section are minimum expectations for face-to-face visits with service recipients.Additional Case management may require additional visits may be required at the discretion of case management, to ensure the service recipient's health and welfare.

(1) The DDSD DDS case manager conducts face-to-face visits to monitor the service recipient's health and welfare and service effectiveness of services in meeting the service recipient's his or her needs.

(A) Face-to-face visits must include observation of, and talking with the service recipient regarding the service recipient's 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 of services and the service recipient's health and welfare.

(C) For service recipients receiving services through an In-Home Supports Waiver (IHSW):

(i) a face-to-face visit must be completed at least semi-annually with one visit occurring during the between January through and June period and one during the between July through and December period; and

(ii) at least one of the two visits must occur at the site where the majority of services are provided.

(D) For service recipients receiving services through the a Community Waiver:

(i) a face-to-face visit must occur during each calendar month in the person's home of all persons receiving who receives residential services per OAC 340:100-5-22.1 or group home services per OAC 317:40-5-152.Case managers must certify home visits on Form 06MP070E, Access to Home Record and Verification of Monitoring Requirements, located within the home record per OAC 340:100-3-40;

(ii) a face-to-face visit must be completed at least quarterly, per each calendar year quarters and 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 during the between January through and June period, and one during the between January through and December period, when services are funded through the Community Waiver, unless the Personal Support Team (Team) requests an a DDS area manager or designee approved exception approved by the DDSD area manager or designee.

(E) For service recipients receiving services through the Homeward Bound Waiver:

(i) a face-to-face visit must occur in the home during each calendar month in the home.Case managers must certify home visits on Form 06MP070E located within the home record per OAC 340:100-3-40; and

(ii) the case manager must visit the employment site at least quarterly, per each calendar year quarters and quarter, coinciding with the quarters established per OAC 340:100-5-52 for quarterly summary of progress reports, unless the Team requests an a DDS area manager or designee approved exception approved by the DDSD area manager or designee.

(F) For members of the Homeward Bound class who reside in an intermediate care facility for persons with mental retardation individuals with intellectual disabilities (ICF/MR)(ICF/IID), the case manager visits monthly.

(2) DDSD DDS case managers review and ensure Plan implementation of the Plan.

(A) The case manager completes a monthly quarterly review for service recipients receiving services through the Community Waiver or Homeward Bound Waiver Home and Community Based Services (HCBS) Waivers, documenting the review in Client Contact Manager (CCM).

(B) For service recipients receiving services through an IHSW, the case manager review occurs every six months and is documented in CCM.

(3) When the DDSD 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 (DDSD) DDS case management supervisor and any other appropriate authorities.

(4) If When the DDSD DDS case manager determines the service recipient's needs are not effectively addressed by a provider or contractual responsibilities or policies are not met by the provider, 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 upon time frame.

(B) If When necessary changes are not accomplished within the specified time frame, the case management supervisor intervenes to secure commitments from the provider for necessary change.

(C) If When the service deficiency is not resolved as a result of the intervention of the case management supervisor, a referral for administrative inquiry is initiated per OAC 340:100-3-27.1.

(5) If, during a contract survey, administrative inquiry, specialized foster care (SFC) monitoring, or area survey, QA staff discovers a situation that requires correction by DDSD DDS staff, a system administrative inquiry is initiated.

(A) QA staff emails notification to DDSD DDS staff responsible to correct the situation, establishing a reasonable time frame for correction.

(B) If When the identified staff is unable to correct the situation within the established time frame, QA staff emails notification of the situation to the DDSD DDS staff supervisor, establishing a reasonable time frame for correction.

(C) If When the staff supervisor is unable to correct the situation within the established time frame, QA staff notifies his or her supervisor, who notifies the DDSD DDS area manager, establishing a reasonable time frame for correction.

(D) If When the area manager is unable to correct the situation within the established time frame, QA supervisor he or she notifies the DDS State Office QA unit programs administrator, who resolves to resolve the situation with the community services unit programs administrator deputy director.

(c) Specialized Foster Care Monitoring SFC monitoring.QA staff monitor monitors the specialized foster care SFC program in each area for compliance with DDSD DDS and OHCA policy compliance.Monitoring is based on a proportionate, representative sample of individuals receiving specialized foster care SFC supports identified for the fiscal year for each area.Monitoring includes a visit to the service recipient's SFC home.

(d) Consumer Service Evaluation.At least annually, service recipients and families receiving supports are provided the opportunity to complete an a service evaluation of services per OKDHS DHS Publication No. 89-10, Consumer Service Evaluation.

(1) Confidentiality is maintained unless the respondent authorizes OKDHS DHS to reveal his or her name to those responsible for service delivery.OKDHS DHS Publication No. 89-10 may be completed anonymously if desired.

(2) QA staff distributes OKDHS DHS Publication No. 89-10 to service recipients or their his or her legal guardians at least annually.

(3) Completed OKDHS DHS Publication No. 89-10, when completed is returned to the DDS State Office QA Unit programs administrator.

(4) Results are forwarded to the respective DDSD DDS area office when authorized by the service recipient or legal guardian for resolution of concerns or staff recognition of staff as appropriate.

(5) An analysis of responses is completed and distributed for action to DDSD DDS area offices, DDSD DDS State Office, or OKDHS as appropriate DHS for action.Data is available to interested persons upon request.

(e) OK-AIM Oklahoma - Advocates Involved in Monitoring (OK AIM).Service recipients and families receiving supports participate in formal assessments of contract providers in order to promote service enhancement, consistent with service recipient expectations of service recipients.

(1) Oklahoma - Advocates Involved in Monitoring (OK-AIM) OK AIM operates under the direction of the Oklahomans for Quality Services Committee (OQSC).

(A) OQSC is composed of 15 persons who receive or have a family member receiving DDSD DDS services.All areas of Oklahoma are represented.

(i) OQSC members may be nominated by the public at large, current OQSC members, or DDSD DDS representatives.

(ii) Appointment of OQSC members occurs as a result of joint consensus by the OQSC chair and DDSD 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 time necessary time to fulfill his or her responsibilities.

(iii) OQSC members have the authority to elect officers based upon on a simple majority vote and establish by-laws governing the conduct of business.

(B) OQSC:

(i) develops and refines procedures and the survey instrument used, based upon feedback received from service recipients and their families, providers, and other key constituents;

(ii) participates in the selection of agencies submitting proposals to conduct OK-AIM OK AIM activities; and

(iii) serves as a resource for education and coordination of agencies conducting OK-AIM OK AIM monitoring activities.

(2) DDSD DDS issues an invitation to bid (ITB) in accordance with state law and OKDHS DHS rules, soliciting and solicits proposals from qualified organizations to participate in the OK-AIM OK AIM initiative.Qualified organizations include agencies that:

(A) are incorporated non-profit agencies dedicated to the representation of persons with developmental disabilities and their family members;

(B) are not involved in service delivery funded through DDSD DDS or HCBS Waivers; and

(C) meet additional requirements set forth by federal and state laws as indicated in the ITB.

(3) OQSC is consulted regarding bids submitted in response to an ITB.Selection of a qualified organization to conduct OK-AIM OK AIM monitoring and reporting activities occurs per state law and OKDHS DHS rules.

(4) Agencies selected to conduct OK-AIM OK AIM monitoring and reporting activities are responsible for:

(A) soliciting, screening, and training volunteers to conduct OK-AIM OK AIM site visits;

(B) scheduling site visits with all service providers of services referenced in the ITB within counties for which the agency has assumed responsibility;

(C) ensuring consistency of volunteer and staff activities with:

(i) OQSC-approved procedures and protocols approved by OQSC; and

(ii) federal and state laws; and OKDHS

(iii) DHS and OHCA rules;

(D) accurately recording findings of OK-AIM OK AIM monitoring activities findings;

(E) ensuring provision of findings to provider agencies and DDSD DDS; and

(F) immediately notifying the DDSD DDS area office of any issue identified during OK-AIM OK AIM monitoring activities that presents risk to the service recipient's health and or welfare.

(5) DDSD DDS area managers identify OKDHS DHS staff responsible for resolving concerns identified during OK-AIM OK AIM monitoring activities and notifying notify the agencies responsible for OK-AIM OK AIM monitoring activities of on how to contact such staff during work business, evening, and weekend hours.

(6) OQSC with the participation of DDSD DDS State Office, DDSD DDS area offices, and agencies conducting OK-AIM OK AIM activities participation, identifies conditions determined to present significant risks to service recipients.

(A) Conditions determined to present imminent risk risks to service recipients are reported immediately to the:

(i) statutory investigatory authority;

(ii) DDSD DDS area office; and

(iii) provider agency chief executive officer (CEO) or designee.

(B) Issues determined to pose potential risk risks to service recipients are reported to DDSD DDS area office staff, who notify the provider agency CEO or designee, no later than at the conclusion close of the first working business-day following observation.

(C) OK-AIM OK AIM monitors report any other significant issues to designated DDSD DDS area office staff within time frames determined appropriate by OK-AIM OK AIM.

(7) DDSD DDS staff immediately identifies DDSD DDS area office staff to assume responsibility for verification and correction of problems posing imminent or potential risk risks.

(A) Time frames for resolution of validated concerns are approved by the DDSD DDS area manager based on the degree of risk involved.

(B) All identified concerns are resolved within 30-calendar days from initial notification to the DDSD DDS area office, unless an extension is authorized by the area manager 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 DDSD DDS area manager designates staff to:

(A) track resolution of each identified concern; and

(B) advise agencies conducting OK-AIM OK AIM monitoring activities of the steps taken to resolve each concern.

(9) OK-AIM OK AIM staff summarizes findings of each home visit conducted by volunteers, noting performance in the context of expectations established by OQSC, and published in the OK-AIM OK AIM training manual.

(A) Recommendations for service enhancement are presented to the relevant DDSD DDS area office for review within 30-calendar days of a home visit.

(B) DDSD DDS area office staff shares this information with the provider and collaborates on recommendations as well as other alternatives for achieving to achieve targeted service enhancement.Plans developed as a result are shared with OK-AIM OK AIM staff during the next meeting.Provider comments or action plans are maintained with the OK-AIM OK AIM report in area office files.

(10) OK-AIM The OK AIM survey process is re-assessed at least annually by OQSC based upon on feedback solicited from service recipients, DDSD 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 DDSD 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 risk risks to service recipients.

(g) Failure to cooperate.Provider agencies failing to cooperate with provisions or providing false information in response to inquiries per OAC 340:100-3-27 this Section are subject to identified sanctions identified, including contract termination.

(h) Findings of non-compliance.Findings of significant non-compliance with human rights, laws, or rules are immediately reported to the DDSD DDS director and other relevant authorities for appropriate action, including disciplinary action of OKDHS DHS employees or the imposition of sanctions, including suspension or contract termination with provider agencies per OAC 340:100-3-27.2.

(i) Retaliation. Provider agencies and OKDHS DHS 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 DHS agent.Authorized agents are OKDHS DHS staff whose responsibilities include administration, supervision, or oversight of DDSD DDS services, including all DDSD DDS and Office of Client Advocacy staff.

(j) QA functions.Additional components of the DDSD DDS QA program are found in OAC 340:100-3-27.1 through OAC 340:100-3-27.5.

340:100-3-38.1. Training requirements for staff providing residential supports

Revised 7-1-119-15-17

(a) Applicability.Oklahoma Administrative Code (OAC) 340:100-3-38.1 sets forth training requirements for staff, or volunteers, and direct supervisors providing either full-time or part-time direct supports for a service recipient receiving:

(1) daily living supports (DLS), per OAC 317:40-5-150;

(2) Prader-Willi Syndrome services;

(3) agency companion services (ACS), per Part 1 of OAC317:40-5; or

(4) group home services, per OAC 340:100-6.

(b) New employee training.No later than 30-calendar days following the date of hire date, staff providing direct supports or supervising at any level the delivery of direct supports at any level must complete the online or first available Developmental Disabilities Services Division (DDSD) (DDS)-approved foundation training course and effective teaching course.The first available class is the first unfilled class held within 60 miles of the staff's work location following the staff's date of hire date.

(c) First aid and cardio-pulmonary resuscitation (CPR).All direct Direct support staff must be certified in an approved course of first aid and CPR before providing services alone or with other untrained staff.

(1) First aid and CPR certification of each staff must occur within 90-calendar days following employment the staff's hire date.

(2) The service recipient's Personal Support Team (Team) may determine, based on the service recipient's needs, that staff must receive first aid and CPR certification in less than 90-calendar days.

(d) Medication administration training.Staff must be certified in an approved medication administration course, per OAC 340:100-3-38.10, before administering medication to a service recipient or assisting with a service recipient's medication support plan.

(e) Individual-specific in-service training.Individual-specific in-service training is identified for direct support staff in the service recipient's Individual Plan (Plan).

(1) Training requirements are based on the service recipient's identified needs through team Team discussion and review of available assessment information.

(2) A service recipient's Team specifies required completion time frames for completion of individual-specific in-service training.If When time frames are not identified in the Plan, required individual-specific in-service training must be completed before working with the service recipient.

(3) As the service recipient's needs require changes in supports or programs, the Team documents in the Plan, or in addenda to the Plan, any new or additional in-service training required, with completion time frames for completion.

(4) Individual-specific training is provided by the person or persons designated by the Team and identified by name position in the Plan, in accordance with policy per rule, statute, and professional practice regulations, if when applicable.

(5) The responsible Team member verifies staff has knowledge and skills necessary to provide the identified services.Videos may be used when approved by the Team.

(f) Job-specific training.

(1) Staff must complete:

(A) within 90-calendar days after assignment date of assignment:

(i) Health course; and

(ii) Ethical and Legal Issues course; and

(B) within six months after assignment date of assignment:

(i) Communication course;

(ii) Skill Building course;

(iii) Connections course; and

(iv) Nuts and Bolts course.

(2) Staff who work works in both residential and employment or other settings must meet the job-specific training requirements of both jobs.Transfers to avoid required training completion of required training are prohibited.

(g) Specialized training.Additional specialized training may be required for direct support staff working with service recipients who have significant health, physical and behavior support issues.

(1) Staff supporting a service recipient with a protective intervention plan protocol (PIP) that includes non-restrictive intervention techniques must be trained on these techniques before use.

(2) Completion of an approved behavior support course is required for staff supporting a service recipient with a protective intervention plan PIP that:

(A) addresses challenging behavior that places the service recipient's physical safety, environment, relationships, or community participation at serious risk; and

(B) contains one or more of these procedures in (i) through (iv).:

(i) Physical physical guidance to overcome resistance.;

(ii) Physical physical guidance to move to safety.; or

(iii) Physical physical hold to restrict movement.

(iv) Intensified staffing to ensure safety.

(3) Staff must complete the approved:

(A) behavior support course before working alone or with other untrained staff, but no later than 60-calendar days after starting work with the service recipient; and

(B) physical management course before using any technique of physical management identified in a protective intervention plan the PIP.

(i) All staff to be trained must complete foundation training with the approved effective teaching course and behavior support course.

(ii) Staff working with the service recipient implements the positive components of the protective intervention plan PIP, as well as non-intrusive procedures to assist the service recipient during a crisis.

(iii) The protective intervention plan PIP must be reviewed by the provider agency Human Rights Committee and approved by the Statewide Human Rights and Behavior Review Committee.

(iv) Only staff and staff supervisors providing support to the service recipient are trained on the use of a physical management procedure.

(v) Staff formally trained to use physical management procedures do does not use those techniques with other service recipients, except in emergencies per OAC 340:100-5-57.

(vi) Training curricula regarding behavior support are approved by the DDSD director ofDDS human resource development and DDSD director of psychological and behavioral supports director.

(4) Training regarding physical management procedures must be obtained from trainers approved by the director ofDDS human resource development director.

(5) Staff must complete annual retraining on physical management or physical restraint procedures in the approved protective intervention plan PIP.

(h) Ongoing training.All direct Direct support staff employed by provider agencies complete completes eight hours of approved annual training.

(1) Annual training may come from:

(A) required re-certification classes in first aid, CPR, and or medication administration training;

(B) courses per OAC 340:100-3-38(b)(1);

(C) courses, conferences, or workshops approved by the DDSD director of DDS human resource development director;

(D) individual-specific training; or

(E) agency-specific in-services.

(2) Any direct Direct support staff who supervises other staff must take 12 hours of supervisory training annually that may be included in the hours required per OAC 340:100-3-38.1 this Section.

(3) Direct support staff may challenge or test out of required annual recertification when an approved option is available.Training completion hours will be are granted equal to the number of hours for the standard recertification class.

(i) Exceptions.Exceptions to training requirements per OAC 340:100-3-38.1 this Section may be made by the DDSD DDS director or designee.

340:100-3-38.2. Training requirements for staff providing employment services

Revised 7-1-119-15-17

(a) Applicability.Oklahoma Administrative Code (OAC) 340:100-3-38.2 sets forth training requirements for provider agency staff, or volunteers, and direct supervisors providing either full-time or part-time direct supports for a service recipient receiving:

(1) center-based services;

(2) community-based services;

(3) sheltered workshop services;

(4) job coaching services, excluding services per OAC 317:40-7-8; or

(5) other supported employment services.

(b) New employee training.No later than 30-calendar days following the hire date of hire, staff providing direct supports or supervising at any level the delivery of direct supports at any level must complete the online or first available Developmental Disabilities Services Division (DDSD) (DDS)-approved foundation training course and effective teaching course.The first available class is the first unfilled class held within 60 miles of the staff's work location following the staff's date of hire date.

(c) First aid and cardio-pulmonary resuscitation (CPR).All direct Direct support staff must be certified in an approved course of first aid and CPR before providing services alone or with other untrained staff.

(1) First aid and CPR certification of each staff must occur within 90-calendar days following employment the staff's hire date.

(2) The service recipient's Personal Support Team (Team) may determine, based on the service recipient's needs, that staff must receive first aid and CPR certification in less than 90-calendar days.

(d) Medication administration training.Staff must be certified in an approved medication administration course, per OAC 340:100-3-38.10, before administering medication to a service recipient or assisting with a service recipient's medication support plan.

(e) Individual-specific in-service training.Individual-specific in-service training is identified for direct support staff in the service recipient's Individual Plan (Plan).

(1) Training requirements are based on the service recipient's identified needs through team discussion and review of available assessment information.

(2) The service recipient's Team specifies required completion time frames for completion of individual-specific in-service training.If When time frames are not identified in the Plan, required individual-specific in-service training must be completed before working with the service recipient.

(3) As the service recipient's needs require changes in supports or programs, the Team documents in the Plan, or in addenda to the Plan, any new or additional in-service training required, with completion time frames for completion.

(4) Individual-specific training is provided by the person or persons designated by the Team and identified by name position in the Plan, in accordance with policy per rule, statute, and professional practice regulations, if when applicable.

(5) The responsible Team member verifies staff has knowledge and skills necessary to provide the identified services.Videos may be used when approved by the Team.

(f) Job-specific training.

(1) Staff must complete:

(A) general employment training within 90-calendar days after assignment date of assignment; and

(B) employment specialist training within six months after assignment date of assignment as job coach or other position providing supported employment service.¢ 1

(2) Staff who work works in both residential and employment or other settings must meet the job-specific training requirements of both jobs.Transfers to avoid completion of required training completion are prohibited.

(g) Specialized training.Additional specialized training may be required for direct support staff working with service recipients who have significant health, and physical, or behavior support issues or behavior support issues.

(1) Staff supporting a service recipient with a protective intervention plan protocol (PIP) that includes non-restrictive intervention techniques must be trained on these techniques before use.

(2) Completion of an approved behavior support course is required for direct support staff supporting a service recipient with a protective intervention plan PIP that:

(A) addresses challenging behavior that places the service recipient's physical safety, environment, relationships, or community participation at serious risk; and

(B) contains one or more of these procedures in (i) through (iv).:

(i) Physical physical guidance to overcome resistance.;

(ii) Physical physical guidance to move to safety.; or

(iii) Physical physical hold to restrict movement.

(iv) Intensified staffing to ensure safety.

(3) The approved behavior support course is identified in the Plan and must be completed before working alone or with other untrained staff, but no later than 60-calendar days after starting work with the service recipient.

(4) Staff must complete the approved physical management course before using any technique of physical management identified in a protective intervention plan PIP.

(A) All staff to be trained must complete foundation training with the approved effective teaching course and behavior support course.

(B) Staff working with the service recipient implements the positive components of the plan, PIP and non-intrusive procedures to assist the service recipient during a crisis.

(C) The protective intervention plan PIP must be reviewed by the provider agency Human Rights Committee and approved by the Statewide Human Rights and Behavior Review Committee.

(D) Training in physical management procedures occurs only within the requirements of OAC 340:100-3-38.2(g) this subsection.

(E) Only staff and staff supervisors who provide support to the service recipient are trained on the use of a physical management procedure.

(F) Staff formally trained to use physical management procedures, do does not use those techniques with other service recipients, except in emergencies per OAC 340:100-5-57.

(G) Training curricula regarding behavior support are approved by the DDSD director ofDDS human resource development and DDSD director of psychological and behavioral supports director.

(5) Training regarding physical management procedures must be obtained from trainers approved by the director ofDDS human resource development director.

(6) Staff must complete an annual retraining on the physical management or physical restraint procedures in the approved protective intervention plan PIP.

(h) Ongoing training.All direct Direct support staff employed by provider agencies complete completes 12 hours of approved annual training.

(1) Annual training may come from:

(A) required re-certification classes in first aid, CPR, and medication administration training;

(B) courses per OAC 340:100-3-38(b)(1);

(C) courses, conferences, or workshops approved by the DDSD director of DDS human resource development director;

(D) individual-specific training; or

(E) agency-specific in-services.

(2) Any direct Direct support staff who supervises other staff must take 12 hours of supervisory training annually that may be included in the hours required per OAC 340:100-3-38.2 this Section.

(3) Direct support staff may challenge or test out of required annual recertification when an approved option is available.Training completion hours will be are granted equal to the number of hours for the standard recertification class.

(i) Exceptions.Exceptions to training requirements per OAC 340:100-3-38.2 this Section may be made by the DDSD DDS director or designee.

INSTRUCTIONS TO STAFF 340:100-3-38.2

Revised 7-1-11

1.Approved employment specialist training courses are:

(1) Employment Training Specialist Orientation I (ETSO I); or

(2) Oklahoma Department of Rehabilitation Services Job Coach Training.

340:100-3-38.3. Training requirements for staff providing supports in family's or service recipient's home through Community Waiver or Homeward Bound Waiver, other than residential supports

Revised 7-1-119-15-17

(a) Applicability.Oklahoma Administrative Code (OAC) 340:100-3-38.3 sets forth training requirements for provider agency staff, or volunteers, and direct supervisors providing direct supports funded through the Community Waiver or Homeward Bound Waiver in the family's or service recipient's home.Staff providing:

(1) services through an In-Home Supports Waiver must complete training per OAC 340:100-3-38.5; and

(2) residential supports per OAC 340:100-5-22.1 must complete training per OAC 340:100-3-38.1.

(b) New employee training.No later than 30-calendar days following the date of hire date, staff providing direct supports or supervising at any level the delivery of direct supports at any level must complete the online or first available Developmental Disabilities Services Division (DDSD) (DDS)-approved foundation training course and effective teaching course.The first available class is the first unfilled class held within 60 miles of the staff's work location following the staff's date of hire date.

(c) First aid and cardio-pulmonary resuscitation (CPR).All direct Direct support staff must be certified in an approved course of first aid and CPR before providing services alone or with other untrained staff.

(1) First aid and CPR certification of each staff must occur within 90-calendar days following employment the staff's hire date.

(2) The service recipient's Personal Support Team (Team) may determine, based on the needs of the service recipient, that staff must receive first aid and CPR certification in less than 90-calendar days.

(d) Medication administration training.Staff must be certified in an approved medication administration course, per OAC 340:100-3-38.10, before administering medication to a service recipient or assisting with a service recipient's medication support plan.

(e) Individual-specific in-service training.Individual-specific in-service training is identified for direct support staff in the service recipient's Individual Plan (Plan).

(1) Training requirements are based on the service recipient's identified needs through team discussion and review of available assessment information.

(2) The service recipient's Team specifies required time frames for completion of individual-specific in-service training completion.If When time frames are not identified in the Plan, required individual-specific in-service training must be completed before working with the service recipient.

(3) As the service recipient's needs require changes in supports or programs, the Team documents in the Plan, or in addenda to the Plan, any new or additional in-service training required, with completion time frames for completion.

(4) Individual-specific training is provided by the person or persons designated by the Team and identified by name position in the Plan, in accordance with policy per rule, statute, and professional practice regulations, if when applicable.

(5) The responsible Team member verifies staff has knowledge and skills necessary to provide the identified services.Videos may be used when approved by the Team.

(f) Job-specific training.Staff must complete:

(1) within 90-calendar days after date of assignment date, Health course; and

(2) within six months after date of assignment date:

(A) Skill Building course; and

(B) Communication course.

(g) Specialized training.Additional specialized training may be required for direct support staff working with service recipients who have significant health, physical, or behavior support issues.

(1) Staff supporting a service recipient with a protective intervention plan protocol (PIP) that includes non-restrictive intervention techniques must be trained on these techniques before use.

(2) Completion of an approved behavior support course is required for staff supporting a service recipient with a protective intervention plan PIP that:

(A) addresses challenging behavior that places the service recipient's physical safety, environment, relationships, or community participation at serious risk; and

(B) contains one or more of these procedures in (i) through (iv).:

(i) Physical physical guidance to overcome resistance.;

(ii) Physical physical guidance to move to safety.; or

(iii) Physical physical hold to restrict movement.

(iv) Intensified staffing to ensure safety.

(3) The approved behavior support course must be completed before working alone or with other untrained staff, but no later than 60-calendar days after starting work with the service recipient.

(4) Staff must complete the approved physical management course before using any technique of physical management identified in a protective intervention plan PIP.

(A) All staff must complete foundation training with the approved effective teaching course and behavior support course.

(B) Staff working with the service recipient implements the positive components of the plan, as well as non-intrusive procedures to assist the service recipient during a crisis.

(C) The protective intervention plan PIP must be reviewed by the provider agency Human Rights Committee and approved by the Statewide Human Rights andBehavior Review Committee.

(D) Training in physical management procedures occurs only within the requirements per OAC 340:100-3-38.3(g) this subsection.

(E) Only staff and staff supervisors who provide support to the service recipient are trained on use of a physical management procedure.

(F) Staff formally trained to use physical management procedures do does not use those techniques with other service recipients, except in emergencies per OAC 340:100-5-57.

(G) Training curricula regarding behavior support are approved by the DDSD director ofDDS human resource development and DDSD director of psychological and behavioral supports director.

(5) Training regarding physical management procedures must be obtained from trainers approved by the director of DDS human resource development director.

(6) Staff must complete an annual retraining on the physical management or physical restraint procedures in the approved protective intervention plan PIP.

(h) Ongoing training.All direct Direct support staff employed by provider agencies complete completes eight hours of approved annual training.

(1) Annual training may come from:

(A) required re-certification classes in first aid, CPR, and medication administration training;

(B) courses per OAC 340:100-3-38(b)(1);

(C) courses, conferences, or workshops approved by the DDSD director of DDS human resource development director;

(D) individual-specific training; or

(E) agency-specific in-services.

(2) Any direct Direct support staff who supervises other staff must take 12 hours of supervisory training annually that may be included in the hours required per OAC 340:100-3-38.2 this Section.

(3) Direct support staff may challenge or test out of required annual recertifications re-certification when an approved option is available.Training completion hours are granted equal to the number of hours for the standard recertification class.

(i) Exceptions.Exceptions to training requirements per OAC 340:100-3-38.2 this Section may be made by the DDSD DDS director or designee.

340:100-3-38.4. Training requirements for persons providing specialized foster care

Revised 7-1-119-15-17

(a) Applicability.Oklahoma Administrative Code (OAC) 340:100-3-38.4 sets forth training requirements for persons providing specialized foster care (SFC).

(b) Initial training.Prior to the contractual agreement with the Oklahoma Health Care Authority (OHCA), SFC providers must complete the:

(1) online or first available Developmental Disabilities Services Division (DDSD) (DDS) approved foundation training course and effective teaching course.The first available class is the first unfilled class held within 60 miles of the SFC provider's work location; and

(2) SFC orientation training as approved by the DDSD DDS director of human resource development.

(c) First aid and cardio-pulmonary resuscitation (CPR).Prior to the contractual agreement with OHCA, SFC providers must be certified in an approved course of first aid and CPR.

(d) Medication administration training.Prior to the contractual agreement with OHCA, SFC providers must be certified in an approved medication administration course, per OAC 340:100-3-38.10.

(e) Individual-specific in-service training.Individual-specific in-service training is identified for direct support staff in the service recipient's Individual Plan (Plan).

(1) Training requirements are based on the service recipient's identified needs through team discussion and review of available assessment information.

(2) A service recipient's Team specifies required completion time frames for completion of individual-specific in-service training.If When time frames are not identified in the Plan, required individual-specific in-service training must be completed before working with the service recipient.

(3) As the service recipient's needs require changes in supports or programs, the Team documents in the Plan, or in addenda to the Plan, any new or additional in-service training required, with completion time frames for completion.

(4) Individual-specific training is provided by the person or persons designated by the Team and identified by name position in the Plan, in accordance with policy rule, statute, and professional practice regulations, if when applicable.

(5) The responsible Team member verifies staff has knowledge and skills necessary to provide the identified services.Videos may be used when approved by the Team.

(f) Job-specific training.SFC providers working in both residential and employment or other settings must meet the job-specific training requirements of both jobs.The SFC provider must complete:

(1) within 90-calendar days after receipt of the approved OHCA contractual agreement:

(A) Health course;

(B) Ethical and Legal Issues course; and

(2) within six months after receipt of the approved OHCA contractual agreement:

(A) Communication course;

(B) Skill Building course;

(C) Connections course; and

(D) Nuts and Bolts course.

(g) Specialized training.Additional specialized training courses may be required for SFC providers working with service recipients who have significant health, physical, or behavior support issues.

(1) Staff supporting a service recipient with a protective intervention plan protocol (PIP) that includes non-restrictive intervention techniques must be trained on these techniques before use.

(2) Completion of an approved behavior support course is required for SFC providers supporting a service recipients recipient with a protective intervention plan PIP that:

(A) addresses challenging behavior that places the service recipient's physical safety, environment, relationships, or community participation at serious risk; and

(B) contains one or more of these procedures in (i) through (iv).:

(i) Physical physical guidance to overcome resistance.;

(ii) Physical physical guidance to move to safety.; or

(iii) Physical physical hold to restrict movement.

(iv) Intensified staffing to ensure safety.

(3) The SFC provider must complete the approved:

(A) behavior support course before working alone or with other untrained staff, but no later than 60-calendar days after starting work with the service recipient; and

(B) physical management course before using any technique of physical management identified in a protective intervention plan PIP.

(i) The SFC provider implements the positive components of the plan Plan, as well as non-intrusive procedures to assist the person during a crisis.

(ii) The protective intervention plan PIP must be reviewed by a Human Rights Committee and approved by the Statewide Human Rights and Behavior Review Committee.

(iii) Training in physical management procedures occurs only within the requirements of OAC 340:100-3-38.4(g) this subsection.

(iv) Only SFC providers who provide support to the service recipient are trained on use of a physical management procedure.

(v) The SFC provider formally trained to use physical management procedures does not use those techniques with other service recipients, except in emergencies per OAC 340:100-5-57.

(vi) Training curricula regarding behavior support are approved by the DDSD director ofDDS human resource development and DDSD director of psychological and behavioral supports director.

(4) Training regarding physical management procedures must be obtained from trainers approved by the director of DDS human resource development director.

(5) The SFC provider must complete an annual retraining on the physical management or physical restraint procedures in the approved protective intervention plan PIP.

(h) Ongoing training.All SFC providers complete 12 hours of approved annual training.

(1) Annual training may come from:

(A) required re-certification classes in first aid, CPR, and medication administration training;

(B) courses per OAC 340:100-3-38(b)(1);

(C) courses, conferences, or workshops approved by the DDSD director of DDS human resource development director;

(D) individual-specific training; or

(E) Oklahoma Department of Human Services in-services.

(2) Direct support staff may challenge or test out of required annual recertification when an approved option is available.Training completion hours will be are granted equal to the number of hours for the standard recertification class.

(i) Exceptions. Exceptions to training requirements per OAC 340:100-3-38.4 this Section may be made by the DDSD DDS director or designee.

340:100-3-38.5. Training requirements for staff providing supports in family's or service recipient's home through an In-Home Supports Waiver

Revised 7-1-119-15-17

(a) Applicability.Oklahoma Administrative Code (OAC) 340:100-3-38.5 sets forth training requirements for staff providing direct supports funded through an In-Home Supports Waiver (IHSW) in the family's or service recipient's home.Staff providing employment supports must complete training per OAC 340:100-3-38.2.

(b) New employee training.No later than 30-calendar days following the date of hire date, staff providing direct supports or supervising at any level the delivery of direct supports must complete the online or first available Developmental Disabilities Services Division (DDSD) (DDS)-approved foundation training course and effective teaching course.The supervisory staff training requirement does not apply to the service recipient or representative who is self-directing services per OAC 317:40-5-114 317:40-9-1.The person directing services per OAC 317:40-5-114 317:40-9-1 must complete the approved self-directed services training course.The first available class is the first unfilled class held within 60 miles of staff's work location following staff's date of hire date.

(c) First aid and cardio-pulmonary resuscitation (CPR).All direct Direct support staff must be certified in an approved course of first aid and CPR before providing services alone or with other untrained staff.

(1) First aid and CPR certification of staff must occur within 90-calendar days following employment the staff's hire date.

(2) The service recipient's Personal Support Team (Team) may determine, based on the service recipient's needs, if that staff must receive first aid and CPR certification in less than 90-calendar days.

(d) Medication administration training.Staff must be certified in an approved medication administration course, per OAC 340:100-3-38.10, before administering medication to a service recipient or assisting with a service recipient's medication support plan.

(e) Individual-specific in-service training.Individual-specific in-service training is identified for direct support staff in the service recipient's Individual Plan (Plan).

(1) Training requirements are based on the service recipient's identified needs through team discussion and review of available assessment information.

(2) The service recipient's Team specifies required completion time frames for completion of individual-specific in-service training.If When time frames are not identified in the Plan, required individual-specific in-service training must be completed before working with the service recipient.

(3) As the service recipient's needs require changes in supports or programs, the Team documents in the Plan, or in addenda to the Plan, any new or additional in-service training required, with completion time frames for completion.

(4) The Team identifies the person responsible for providing individual-specific training and verifies staff has knowledge and skills necessary to provide the identified services.Videos may be used when approved by the Team.

(f) Job-specific training.Staff must complete:

(1) within 90-calendar days after date of assignment date, Health course; and

(2) within six months after date of assignment date:

(A) Communication course; and

(B) Skill Building course.

(g) Specialized training.Additional specialized training courses may be required for direct support staff working with service recipients who have significant health, physical or behavior support issues.

(1) Staff supporting a service recipient with a protective intervention plan protocol (PIP) that includes non-restrictive intervention techniques must be trained on these techniques before use.

(2) Completion of an approved behavior support course is required for staff supporting a service recipient with a protective intervention plan PIP that:

(A) addresses challenging behavior that places the service recipient's physical safety, environment, relationships, or community participation at serious risk; and

(B) contains one or more of these procedures:

(i) physical guidance to overcome resistance;

(ii) physical guidance to move to safety; or

(iii) physical hold to restrict movement; or

(iv) intensified staffing to ensure safety.

(3) The approved behavior support course must be completed before working alone or with other untrained staff, but no later than 60-calendar days after starting work with the service recipient.

(4) Staff must complete the approved physical management course before using any technique of physical management identified in a protective intervention plan PIP.

(A) All staff must complete foundation training with the approved effective teaching course and behavior support course.

(B) Staff working with the service recipient implements the positive components of the plan Plan, as well as non-intrusive procedures to assist the service recipient during a crisis.

(C) The protective intervention plan PIP must be reviewed by the provider agency, Human Rights Committee, and approved by the Statewide Human Rights and Behavior Review Committee.

(D) Training in physical management procedures occurs only within the requirements per OAC 340:100-3-38.5(g) this subsection.

(E) Only staff and staff supervisors who provide providing support to the service recipient are trained on use of a physical management procedure.

(F) Staff formally trained to use physical management procedures do does not use those techniques with other service recipients, except in emergencies per OAC 340:100-5-57.

(G) Training curricula regarding behavior support are approved by the DDSD director ofDDS human resource development director and DDSD director of psychological and behavioral supports director.

(5) Training regarding physical management procedures must be obtained from trainers approved by the director of DDS human resource development director.

(6) Staff must complete annual retraining on the physical management or physical restraint procedures in the approved protective intervention plan PIP.

(h) Ongoing training.All direct Direct support staff employed by contract approved provider agencies that provide services funded through an IHSW complete 12 hours of annual training.

(1) Annual training may come from:

(A) required re-certification classes in first aid, CPR, and medication administration training;

(B) courses per OAC 340:100-3-38(b)(1);

(C) courses, conferences, or workshops approved by the DDSD director of DDS human resource development director;

(D) individual-specific training; or

(E) agency-specific in-services.

(2) Direct support staff may challenge or test out of required annual recertification when an approved option is available.Training completion hours will be are granted equal to the number of hours for the standard recertification class.

(i) Certification of competency.If When the service recipient, if applicable, legal guardian, or parent(s) of a minor service recipient determines the person chosen to provide services has demonstrated competency in providing care to the service recipient, the service recipient, legal guardian, or parent(s) may exempt the person from training requirements, per OAC 340:100-3-38.5 this Section, by signing Form 06IS037E, In-Home Supports Waiver - Certificate of Competency.

(1) The exemption from training is intended to allow services to be provided by a friend, neighbor, family member, or other person who has been trained and deemed competent by the service recipient, or if applicable, legal guardian or parent(s) of a minor service recipient to provide services.

(A) No person may coerce or in any way influence a service recipient, legal guardian, or family member to sign Form 06IS037E.

(B) Violation of this prohibition may result in sanctions per OAC 340:100-3-27.

(2) If When a service recipient, if applicable, legal guardian, or parent(s) of a minor service recipient chooses to exempt staff from training, neither the Oklahoma Department of Human Services (OKDHS) (DHS) nor the employing contract agency is liable in the event of harm, attributable to lack of training, to the service recipient while in the care of contract agency staff.

(3) If When an adult service recipient without a legal guardian chooses to exempt staff from training, training requirements are not waived without written concurrence, on Form 06IS038E, In-Home Supports Waiver - Family Member's Statement, from a parent(s) or family member closest to the service recipient.

(4) The provider agency employing the staff may require training not included in the exemption.

(5) All staff, regardless of signed Form 06IS037E, must successfully complete:

(A) certification in first aid and CPR before working alone or with untrained staff, but no later than 90-calendar days after starting work with the service recipient;

(B) an approved medication administration course per OAC 340:100-3-38.10; and

(C) individual-specific in-service training per OAC 340:100-3-38.5(e) of this Section.

(6) Form 06IS037E:

(A) is valid for no longer than one year from the signature date; and

(B) may be withdrawn at any time by the service recipient, if applicable, legal guardian, or parent(s) of a minor service recipient by writing to the DDSD DDS case manager and provider agency.

(7) OKDHS DHS may withdraw the exemption from training at any time.

(j) Exceptions.Exceptions to training requirements per OAC 340:100-3-38.5 this Section may be made by the DDSD DDS director or designee.

340:100-3-38.10. Medication administration training

Revised 7-1-139-15-17

(a) General requirements.Staff must be certified in a medication administration-training course approved by the Developmental Disabilities Services Division (DDSD) (DDS) human resource development director before administering medication(s) to a person receiving services or assisting with a person's medication support plan.

(1) The DDSD DDS human resource development director may approve medication administration certification from another state when supplied with a copy of an acceptable course curriculum.

(2) A licensed nurse who maintains a current, unrestricted license is exempt from the training requirements of this paragraph.

(A) Licensed practical nurses (LPNs) and registered nurses (RNs) may administer medications in accordance with their training.

(B) The employer must maintain a copy of the nurse's license in the nurse's personnel file or make the license available for review.

(3) Certification or re-certification to administer medications is valid for one year two- calendar years from the date of issuance, as long as the person administered medications as a paid, certified staff within the two-calendar year period.

(A) If When a person allows his or her medication administration certification to expire, he or she cannot administer medication(s) or assist with a medication support plan.If When the person's certification has been was expired for less than 60-calendar days, the person's certification is renewed by taking the one-day update training.

(B) If When the person's medication administration certification has been was expired for 60-calendar days or more, the person does not administer medication(s) or assist with a medication support plan and must complete an approved initial medication administration class.

(4) All provider agencies must:

(A) establish written policies rules that assure ensure compliance with the rules in this Section and with applicable federal and state laws;

(B) provide documentation that staff have been were given an in-service training in agency-specific practices, including, but not limited to, medication storage requirements, documentation forms, and procedures for a medication event, per Oklahoma Administrative Code (OAC) 340:100-3-34; and

(C) maintain a copy of each employee's current certification in his or her personnel file.

(b) Medication administration training provided by provider agencies.DDSD DDS provider agencies may conduct medication administration training under the conditions listed in this subsection.

(1) Any provider agency wishing planning to conduct medication administration training or re-certification classes must submit the prospective trainer's credentials to the DDSD DDS human resource development director for approval.The provider agency is responsible for ensuring that the instructor adheres to the rules in this Section.

(A) The prospective instructor must be an RN or LPN working under the supervision of an RN.

(i) The nurse's license must be current and active through the Oklahoma State Board of Nursing.

(ii) Any exception to the requirement that the instructor be an RN or LPN must be approved in writing by the DDSD DDS human resource development director and the DDSD director of nursing.

(B) Potential instructors with other types of medical experience or licensure may seek approval to teach medication administration training classes by submitting credentials to the DDSD DDS human resource development director.

(C) Each instructor must request and receive approval every two years to teach medication administration training.

(2) The DDSD program manager for health and professional services and DDS human resource development director must approve or deny the agency's request in writing.A letter designating approval of an instructor to conduct medication administration training must be maintained in the instructor's personnel file at the agency.

(3) Approved instructors only use only course materials approved by the DDSD DDS human resource development director.

(4) Each participant in an initial medication training course receives an approved training manual.

(5) Each agency approved to provide medication administration training must implement an internal monitoring system, subject to DDSD DDS random review, to review and document the consistency of the training and use of the approved curriculum that is subject to DDS random review.

(6) All medication administration training must be conducted according to the specific requirements of the course, the rules in this Section, and DDSD DDS training rules per OAC 340:100-3-38.

(7) Instructors provide Certificate Number C-0226, Certificate of Medication Administration Training, signed verification of completion for each participant based on the competency criteria provided in this paragraph.

(A) Each person must satisfactorily complete the course with a minimum passing score of 85 percent for each test or subtest.If When a person does not achieve a score of at least 85 percent after taking the exam two times, he or she must repeat the class.

(B) The instructor is responsible for administering a written test to each participant and directly observing test completion.

(8) The agency providing the training maintains documentation of completed medication administration training.Documentation must include the:

(A) name of the agency providing the training;

(B) name(s) of the instructor(s);

(C) name of the training, include whether it is an initial medication administration training or update training;

(D) training date(s);

(E) participant names;

(F) agency name employing each participant; and

(G) each participant's pass or fail status.

(9) The DDSD DDS human resource development director may revoke an instructor's approval to provide medication training for violating rules in this Section.

340:100-3-38.12. Training requirements for direct support staff providing respite, homemaker, or homemaker respite services

Revised 7-1-119-15-17

(a) Applicability.Oklahoma Administrative Code (OAC) 340:100-3-38.12 sets forth training requirements for direct support staff, or provider agency volunteers, and direct supervisors providing only respite, homemaker, or homemaker respite services through the Community Waiver, an In-Home Supports Waiver (IHSW), or Homeward Bound Waiver in the family's or service recipient's home or in any community setting as specified per the service recipient's Individual Plan (Plan).

(1) If When Form 06IS037E, In-Home Supports Waiver - Certificate of Competency, is in place for IHSW participants per OAC 340:100-3-38.5, staff does not have to meet the this Section's requirements of OAC 340:100-3-38.12.

(2) Direct support staff providing services beyond respite, homemaker, or homemaker respite services completes training appropriate to staff jobs per OAC 340:100-3-38.

(b) New employee training.No later than 30-calendar days following the date of hire date, staff providing direct supports or supervising at any level the delivery of direct supports at any level must complete the online or first available Developmental Disabilities Services Division (DDSD) (DDS)-approved foundation training course and effective teaching course.The first available class is the first unfilled class held within 60 miles of the staff's work location following the staff's date of hire date.

(c) First aid and cardio-pulmonary resuscitation (CPR).All direct Direct support staff must be currently certified in an approved course of first aid and CPR before providing services alone or with other untrained staff.

(1) First aid and CPR certification of each staff must occur within 90-calendar days following employment the staff's hire date.

(2) The service recipient's Personal Support Team (Team) may determine, based on the service recipient's needs, that staff must receive first aid and CPR certification in less than 90-calendar days.

(d) Medication administration training.Staff must be certified in an approved medication administration course, per OAC 340:100-3-38.10, before administering medication to a service recipient or assisting with a service recipient's medication support plan.

(e) Individual-specific in-service training.Individual-specific in-service training is identified for direct support staff in the service recipient's Individual Plan (Plan).

(1) Training requirements are based on the service recipient's identified needs through team discussion and review of available assessment information.

(2) A service recipient's Team specifies required time frames for completion of individual-specific in-service training completion.If When time frames are not identified in the Plan, required individual-specific in-service training must be completed before working with the service recipient.

(3) As the service recipient's needs require changes in supports or programs, the Team documents in the Plan, or in addenda to the Plan, any new or additional in‑service training required, with completion time frames for completion.

(4) Individual-specific training is provided by the person or persons designated by the Team and identified by name position in the Plan, in accordance with policy per rules, statute, and professional practice regulations, if when applicable.

(5) The responsible Team member verifies staff has knowledge and skills necessary to provide the identified services. Videos may be used when approved by the Team.

(f) Ongoing training.All direct Direct support staff employed by provider agencies complete completes eight hours of approved annual training.

(1) Annual training may come from:

(A) required re-certification classes in first aid, CPR, and medication administration training;

(B) courses per OAC 340:100-3-38(b)(1);

(C) courses, conferences, or workshops approved by the DDSD director of DDS human resource development director;

(D) individual-specific training; or

(E) agency-specific in-services.

(2) Direct support staff may challenge or test out of required annual recertification when an approved option is available.Training completion hours are granted equal to the number of hours for the standard recertification class.

(g) Exceptions.Exceptions to training requirements per OAC 340:100-3-38.12 this Section may be made by the DDSD DDS director or designee.

340:100-3-38.13. Training requirements for staff providing supports in alternative group homes

Revised 7-1-119-15-17

(a) Applicability.Oklahoma Administrative Code (OAC) 340:100-3-38.13 sets forth training requirements for staff, or volunteers, and direct supervisors providing direct supports for a service recipient in an alternative group home per OAC 340:100-5-22.6.

(b) New employee training.No later than 30-calendar days following the hire date of hire, staff providing direct supports or supervising at any level the delivery of direct supports at any level must complete the online or first available Developmental Disabilities Services Division (DDSD) DDS-approved foundation training course and effective teaching course.The first available class is the first unfilled class held within 60 miles of the staff's work location following the staff's date of hire date.

(c) First aid and cardio-pulmonary resuscitation (CPR).All direct Direct support staff must be certified in an approved course of first aid and CPR before providing services alone or with other untrained staff.

(1) First aid and CPR certification of each staff must occur within 90-calendar days following employment the staff's hire date.

(2) The service recipient's Personal Support Team (Team) may determine, based on the service recipient's needs, that staff must receive first aid and CPR certification in less than 90-calendar days.

(d) Medication administration training.Staff must be certified in an approved medication administration course, per OAC 340:100-3-38.10, before administering medication to a service recipient or assisting with a service recipient's medication support plan.

(e) Individual-specific in-service training.Individual-specific in-service training is identified for direct support staff in the service recipient's Individual Plan (Plan).

(1) Training requirements are based on the service recipient's identified needs through team Team discussion and review of available assessment information.

(2) A service recipient's Team specifies required completion time frames for completion of individual-specific in-service training.If When time frames are not identified in the Plan, required individual-specific in-service training must be completed before working with the service recipient.

(3) As the service recipient's needs require changes in supports or programs, the Team documents in the Plan, or in addenda to the Plan, any new or additional in‑service training required, with completion time frames for completion.

(4) Individual-specific training is provided by the person or persons designated by the Team and identified by name position in the Plan in accordance with policy per rule, statute, and professional practice regulations, if when applicable.

(5) The responsible Team member verifies staff has knowledge and skills necessary to provide the identified services.Videos may be used when approved by the Team.

(f) Job-specific training.

(1) Staff must complete:

(A) within 90-calendar days after assignment date of assignment:

(i) Health course; and

(ii) Ethical and Legal Issues course; and

(B) within six months after date of assignment:

(i) Communication course; and

(ii) Skill Building course.

(2) Staff working who work in both residential and employment or other settings must meet job-specific training requirements of both jobs.Transfers to avoid completion of required training completion are prohibited.

(g) Specialized training.Additional specialized training is required for each direct service support staff working with service recipients in the an alternative group home.

(1) Staff supporting a service recipient with a protective intervention plan protocol (PIP) that includes non-restrictive intervention techniques must be trained on these techniques before use.

(2) Completion of an approved behavior support course is required for staff supporting a service recipient with a protective intervention plan PIP that:

(A) addresses challenging behavior that places the service recipient's physical safety, environment, relationships, or community participation at serious risk; and

(B) contains one or more of these procedures in (i) through (iv).:

(i) Physical physical guidance to overcome resistance.;

(ii) Physical physical guidance to move to safety.; or

(iii) Physical physical hold to restrict movement.

(iv) Intensified staffing to ensure safety.

(3) Staff must complete the approved:

(A) behavior support course before working alone or with other untrained staff, but no later than 60-calendar days after starting work with the service recipient; and

(B) physical management course before using any technique of physical management contained identified in a protective intervention plan the PIP.

(i) Staff working with the service recipient implements the positive components of the plan Plan, as well as non-intrusive procedures to assist the service recipient during a crisis prior to using physical management techniques.

(ii) Only staff and staff supervisors providing support to the service recipient are trained on the use of a physical management procedure.

(iii) Training curricula regarding behavior support are approved by the DDSD director ofDDS human resource development and DDSD director of psychological and behavioral supports director.

(4) Training regarding physical management procedures must be obtained from DDSD DDS trainers approved by the director of DDS human resource development director.

(5) Staff must complete:

(A) an annual retraining on the physical management or physical restraint procedures in the approved protective intervention plan; and

(B) the DDSD DDS approved orientation specific to community protection issues within 60-calendar days of starting work with the service recipient.

(h) Ongoing training.All direct Direct support staff employed by provider agencies complete 12 hours of approved annual training.

(1) Annual training may come from:

(A) required re-certification classes in first aid, CPR, and medication administration training;

(B) courses per OAC 340:100-3-38(b)(1);

(C) courses, conferences, or workshops approved by the DDSD director of DDS human resource development director;

(D) individual-specific training; or

(E) agency-specific in-services.

(2) Any direct Direct support staff supervising other staff must take 12 hours of supervisory training annually that may be included in the hours required per OAC 340:100-3-38.13 this Section.

(3) Direct support staff may challenge or test out of required annual recertification when an approved option is available.Training completion hours are granted equal to the number of hours for the standard recertification class.

(i) Exceptions.Exceptions to training requirements per OAC 340:100-3-38.13 this Section may be made by the DDSD DDS director or designee.

SUBCHAPTER 5. CLIENT SERVICES

PART 3. SERVICE PROVISIONS

340:100-5-22.1. Community residential supports

Revised 7-1-119-15-17

(a) Applicability.Community residential supports are funded through contracts with the Oklahoma Department of Human Services (OKDHS) DHS, Oklahoma Health Care Authority (OHCA), or both, and must meet standards per OAC 340:100-5-22.1 this Section.

(1) A service recipient is considered receiving community residential supports when the service recipient receives:

(A) daily living supports (DLS), per Oklahoma Administrative Code (OAC) 317:40-5-150;

(B) Prader-Willi Syndrome services;

(C) agency companion services (ACS), per Part 1 of OAC 317:40-5; or

(D) specialized foster care (SFC), per Part 5 of OAC 317:40-5.

(2) OAC 340:100-5-22.1 This Section does not apply to:

(A) group home services, per OAC 340:100-6; or

(B) services provided to service recipients who receive assisted living services, per OAC 340:100-5-22.2.

(b) General information.

(1) Services for children are provided in family settings unless approved by the Developmental Disabilities Services Division (DDSD) DDS Community Services Unit programs administrator or designee.

(2) In addition to OAC 340:100-5-50 through 340:100-5-58, the DDSD DDS case manager ensures each Personal Support Team (Team) assesses and addresses the service recipient's needs regarding:

(A) safety in the home, including:

(i) storage of toxic chemicals, cleaning supplies, and combustibles; and

(ii) use of a tempering valve or other anti-scald device or lowered, hot water tank temperature to control water temperature;

(B) financial issues in addition to OAC 340:100-3-4, including:

(i) a household budget that provides adequate resources for housing, food, clothing, furnishings, personal supplies, and recreational opportunities; and

(ii) assistance needed by the service recipient in money management;

(C) selection, adaptation, and maintenance of a home;

(D) community inclusion and access to work, recreation, and therapies;

(E) transportation; and

(F) water safety.

(3) Each service recipient is responsible for his or her room and board expenses, including recreational activities, clothing, furnishings, food, and other expenses for services or supports not funded through OKDHS DHS, except as:

(A) provided to members of the Homeward Bound class; or

(B) approved in emergency circumstances per OAC 340:100-3-33 or 340:100‑5‑3.

(c) Homes.Community residential supports are provided in the service recipient's home.The provider agency ensures:

(1) the home and yard are clean, well-maintained, safe, free from hazards hazard free, and adapted to the service recipient's needs;

(2) the home has:

(A) utility service and adequate heating, cooling, and plumbing;

(B) safety items in operating condition located in strategic locations in the home, such as a:

(i) flashlight;

(ii) smoke detector;

(iii) carbon monoxide detector;

(iv) first aid kit;

(v) fire extinguisher; and

(vi) a tempering valve or other anti-scald device, when determined by the Team necessary to ensure the service recipient's safety;

(C) phone service that is available and accessible to the service recipient.Emergency numbers are available at each phone, including:

(i) DDSD the DDS toll-free number;

(ii) the fire, police, ambulance, hospital, and poison control, if when not in a 911 area;

(iii) a physician name and number; and

(iv) a nursing agency number, if when applicable;

(D) at least two means of exit;

(E) a bedroom of at least 80 square feet for each service recipient living in the home.If When a service recipient shares a bedroom with another individual, the bedroom must have 120 square feet or more;

(F) adequate enclosed storage space available for personal items;

(G) laundry equipment, if when in the home, located in a safe, well ventilated, and clean area, with dryers vented to the outside;

(H) an address that is clearly visible from the street;

(I) a bathroom that:

(i) includes a:

(I) flush toilet;

(II) fixed basin; and

(III) shower or bath tub that meets the service recipient's needs;

(ii) is in proper working order;

(iii) provides privacy;

(iv) is adapted if when needed; and

(v) provides hot and cold running water; and

(J) a kitchen and equipment to store, prepare, and serve food in a sanitary manner;

(3) dangerous or deadly weapons are not permitted in the home, except as provided in OAC 317:40-5-40.Provider agency staff is prohibited from assisting any service recipient to obtain or possess dangerous or deadly weapons.Dangerous or deadly weapons include, but are not limited to:

(A) guns, BB guns, air rifles, or other firearms;

(B) crossbows;

(C) paint guns;

(D) arrows;

(E) explosives;

(F) stun guns; and

(G) knives, except cooking and eating utensils; and

(4) illegal substances are not permitted in the home.

(d) Pre-service requirements.The DDSD DDS case manager and service recipient, or, if when applicable, legal guardian, complete and approve steps in (1) through (3) when community residential supports are initiated, when the service recipient changes provider agencies, and before the service recipient moves to a new home.The documentation of such is maintained in the home record and the case manager record.

(1) Prior to service delivery, the provider completes an emergency housing back-up plan for review and approval by the service recipient's Team per OAC 340:100-5-52.

(A) The back-up plan contains the:

(i) service recipient's name;

(ii) description of the living arrangement;

(iii) name and phone number for back-up staff;

(iv) back-up housing location;

(v) written agreement by the:

(I) service recipient or legal guardian;

(II) direct provider of service, if when an ACS or SFC provider;

(III) agency program coordination staff (PCS), as applicable;

(IV) provider agency administrative representative, as applicable; and

(V) DDSD DDS case manager;

(vi) dates for provider review of back-up plan, required quarterly and as changes occur; and

(vii) review date by DDSD the DDS case manager.

(B) When the location for the back-up plan is a hotel or motel, the provider agency is responsible for including a plan to pay the cost without additional reimbursement from OKDHS DHS.

(C) OKDHS DHS must complete a home profile on a private home prior to the Team's identification of the home in the back-up plan or use of the home to provide back-up services to the service recipient.A home profile is not required if when the service recipient stays in the private home of a relative, per OAC 340:100‑5‑22.1(f)(4)(A) of this Section.

(D) The ACS or SFC provider is responsible for re-establishing a residence if when his or her home becomes uninhabitable.

(2) The provider agency cooperates with the service recipient and Team to establish and maintain a household budget based on the service recipient's earned and unearned income.

(A) Expenses associated with supporting the household are maintained in an auditable fashion sufficient to track the use of money collected from the service recipient by the contract provider.

(B) Upon request, the contract provider furnishes to the service recipient, service recipient's family, and legal guardian:

(i) a record of all funds collected from the service recipient;

(ii) documentation of how the money was used; and

(iii) the amount of remaining money held by the provider.

(C) Upon termination of residential supports from the contract provider, unused funds are returned to the service recipient within ten 10-calendar days of service termination date.

(3) Form 06CB034E, Residential Pre-Service Checklist, is completed, and all requirements of OAC 340:100-5-22.1 this Section's requirements are satisfied.

(e) Service requirements.

(1) Unless the service recipient demonstrates the ability under varying conditions to independently and appropriately respond to emergency situations, the provider agency assists in conducting fire drills at least quarterly and weather emergency drills two times annually twice a year.The dates, times, and outcomes of the drills are available in the home for review.

(2) The provider:

(A) ensures all requested financial information necessary for maintaining the service recipient's financial eligibility is provided to OKDHS DHS in a timely manner;

(B) when serving as payee, ensures the service recipient maintains financial eligibility for benefits and services by notifying appropriate authorities of a change in the service recipient's income;

(C) when a change of payee is necessary, cooperates to ensure the change is made in a timely manner;

(D) establishes a written financial agreement with the service recipient or legal guardian that defines financial responsibilities of the provider's and service recipient's financial responsibilities of the agency and service recipient.The financial agreement:

(i) accurately reflects the ongoing financial arrangement between the provider and service recipient;

(ii) clearly defines who purchases personal items;

(iii) is renewed annually and when changes occur; and

(iv) is available to the service recipient, legal guardian, Office of Client Advocacy (OCA) advocate, and DDSD DDS case manager;

(E) as a member of the service recipient's Team, assists in determining safeguards necessary to protect the service recipient's assets;

(F) allows service recipients to select stores for the purchase of food, clothing, and personal items;

(G) implements the service recipient's Individual Plan (Plan);

(H) provides necessary assistance, including staff support for each service recipient's active participation in community life;

(I) assists the service recipient in maintaining an adequate supply of seasonal clothing that fits appropriately, personal grooming materials, and linens.All items are maintained in good condition;

(J) promotes the service recipient's health and welfare, including providing meals that meet the service recipient's nutritional needs;

(K) promotes visitation and contact with each service recipient's natural family, legal guardian, and friends, according to the service recipient's desires;

(L) promotes friendships with neighbors, co-workers, and peers, according to the service recipient's desires;

(M) when the service recipient, legal guardian, or provider wishes wants to discontinue services, cooperates in securing alternative services and continues to serve the service recipient until the Team confirms all essential services are in place;

(N) while providing services, ensures staff is engaged at all times in purposeful activity that directly or indirectly benefits the service recipient;

(O) ensures the service recipient attends scheduled medical and therapy appointments.

(i) Transportation to the appointment is provided.

(ii) Adequate records, needed materials, and equipment accompany the service recipient to the appointment.

(iii) If When the service recipient requires support in describing illness, issues, or concerns to the practitioner health care provider, knowledgeable staff accompanies the service recipient;

(P) ensures the service recipient's prescriptions are filled and administered as prescribed, per OAC 340:100-5-32;

(Q) ensures the Plan in a positive manner addresses in a positive manner any issues related to maintaining the home per OAC 340:100-5-22.1(c) of this Section;

(R) ensures the service recipient has transportation to programs and services.

(i) Transportation is provided to and from:

(I) medical or therapy appointments;

(II) personal shopping;

(III) leisure or recreational activities;

(IV) vocational or employment activities;

(V) religious or cultural activities;

(VI) Team meetings;

(VII) appointments necessary to secure or maintain needed services; and

(VIII) voting.

(ii) All vehicles used to transport the service recipient meet local and state requirements for licensing, inspection, insurance, and capacity requirements.

(iii) A vehicle used to transport a service recipient with physical disabilities is adapted to meet the service recipient's needs.

(iv) Drivers of vehicles have valid and appropriate driver licenses.

(S) ensures that the hot water temperature for the home is set to no more than 120 degrees Fahrenheit.The provider tests the hot water temperature of the home at least annually, after any servicing of the home's water system, and any time the water temperature is believed to have increased above 120 degrees Fahrenheit.The provider will maintain maintains test documentation of tests performed, and this the documentation will at minimum include includes the test date of the test and the temperature of the home's hot water temperature.The documentation is maintained in the home and available for inspection.The provisions within this paragraph will henceforth be known as the Julie Teenor Anti-Scald Protocol; and

(T) ensures reasonable precautions are employed for safety with hot food, cooking oils, and other hot liquids.

(f) Provider agency policies, practices, and procedures.The provider agency develops and maintains written policies and procedures that are consistent with OKDHS DHS rules and govern all aspects of service provision.

(1) Provider agency policies are made available to each service recipient, the service recipient's parent(s), legal guardian, or advocate, provider agency staff, and OKDHS DHS.

(2) Provider agency policies and procedures include, but are not limited to:

(A) service recipient rights protection;

(B) services provided;

(C) admission and discharge criteria;

(D) grievance procedures;

(E) prevention and reporting of abuse, neglect, and/or exploitation;

(F) confidentiality;

(G) emergency management;

(H) fees paid by service recipient;

(I) health and safety precautions; and

(J) safeguarding service recipient funds.

(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.

(4) The provider agency is responsible for recruitment, screening, training, and supervision of staff or volunteers providing direct services, ensuring direct support staff:

(A) is 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 provides back-up services is available and has received training per OAC 340:100-3-38;

(C) is at least 18 years of age;

(D) is present in sufficient numbers to ensure the service recipient's health, and welfare, as authorized by the service recipient's Plan of Care;

(E) is physically able and mentally alert to carry out the job duties of the job;

(F) implements and follows the service recipient's Plan;

(G) does not take the service recipient to visit staff's home unless the Team has provided prior written approval; and

(H) must meet requirements of OAC 317:40-5-40 when overnight visits are going to occur.

(5) The provider agency ensures the Program Coordinator Staff (PCS) supervises, guides, and oversees all aspects of programming associated with receipt of community residential supports.

(A) The PCS must:

(i) get to know the service recipient and his or her needs;

(ii) make announced and unannounced visits to the service recipient's home.The PCS makes a minimum of three face-to-face visits per month, to monitor the service recipient's needs of the service recipient and for staff supervision of staff.Agency administration staff who meet the requirements of meeting (f)(5)(A)(xii) requirements of this Section, may complete these visits in addition to program coordination staff.At least two of the three visits must be unannounced.Of the unannounced visits:

(I) at least one visit each month must occur on Saturday or Sunday; or

(II) between 8:00 p.m. and 7:00 a.m. on a weekday;

(iii) Monthly visits may be reduced to one unannounced face-to-face visit to the service recipient's home when the home:

(I) has fully trained staff,;

(II) has had no turn-over for the past year,;

(III) does not require restrictive or intrusive procedures,; and

(IV) has had no medication errors during the previous calendar year.

(iv) provide support and assistance to any service recipient who is experiencing an emotional, behavioral, or medical crisis;

(v) be accessible to direct service staff 24 hours per day and available to respond, in person if when necessary, to an emergency;

(vi) supervise direct contact staff to promote achievement of outcomes in the Plan;

(vii) ensure staffing levels meet the requirements of the service recipient's Plan, with staff trained in accordance with per OAC 340:100-3-38;

(viii) ensure records are maintained according to DDSD DDS community records per OAC 340:100-3-40;

(ix) ensure basic household requirements are always in place, including:

(I) utilities and phone service;

(II) furniture;

(III) food supplies that meet the service recipient's nutritional needs;

(IV) linens;

(V) personal items;

(VI) adaptive equipment; and

(VII) prescription medications;

(x) assist the DDSD 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;

(xi) ensure applicable OKDHS DHS and OHCA rules are followed;

(xii) complete necessary training per OAC 340:100-3-38; and

(xiii) 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 DDSD DDS director or designee.

(B) Provider agencies ensure that residential PCS caseloads do not exceed 20 27 with the following calculations:

(i) calculate one for persons receiving community residential supports and group home services; and

(ii) calculate one for every three five persons receiving In-home Supports Waiver services, assisted living services, or any other non-residential service on the PCS caseload.

(C) Provider agencies providing community residential supports for less than one calendar year ensure the caseload of each PCS numbers no more than 15 service recipients when the PCS serves service recipients receiving community residential supports.

(D) The DDSD DDS director may grant a written exception to the PCS ratios per OAC 340:100-5-22.1 this Section upon written request and adequate justification from the provider.

(E) Provider agencies who fail to meet program coordination requirements per OAC 340:100-5-22.1(f) this subsection may be required to provide a reduced PCS ratio in accordance with sanctions per OAC 340:100-3-27.

(6) Staff, who assist 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. The staff 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.

340:100-5-22.6. Alternative group homes

Revised 7-1-119-15-17

(a) Legal basis.Authority to operate alternative group homes is based on the Group Homes for Persons with Developmental or Physical Disabilities Act per Section 1430.1 through 1430.41 of Title 10 of the Oklahoma Statutes.Administrative and program requirements for alternative group homes are described in Oklahoma Administrative Code (OAC) 317:40-5-152, and OAC 340:100-5-22.6 this Section, and OAC 340:100-6.

(b) General information.Alternative group homes:

(1) serve up to four service recipients who have:

(A) have serious behavioral or emotional challenges or community protection issues in addition to mental retardation intellectual disabilities and require continuous supervision and assistance to remain in the community; or

(B) been were charged with a felony, determined by the district court as incompetent to stand trial due to intellectual disability formerly known as mental retardation and dangerous, and placed by the district court in the custody of the public guardian; and

(2) provide more restrictive measures than other community residential settings to ensure the safety of the service recipient and others for the development of skills to assist service recipients to lead healthy, independent, and productive lives to the fullest extent possible.

(c) Provider approval criteria.In addition to requirements of OAC 340:100-6-12 requirements, prospective providers of alternative group home services must demonstrate a history of effective services and supports to persons with serious behavioral or emotional challenges or community protection issues.Provider approval requires review of historical information, if when available, from Developmental Disabilities Services Division (DDSD) (DDS) Quality Assurance Unit and area office.The location of the alternative group home must be approved in writing by the DDSD DDS director or designee prior to the implementation of services.Each prospective provider submits written documentation of:

(1) a history of services to persons who present serious behavioral or emotional challenges or community protection issues, including:

(A) past experience;

(B) number of persons served;

(C) provider's perspective on the greatest challenges in serving persons eligible for alternative group home services; and

(D) provider's philosophy for service provision;

(2) financial viability through fiscal information when requested, including the anticipated budget related to the rate for alternative group home services;

(3) service provision plans, including:

(A) anticipated number of homes;

(B) location;

(C) floor plans;

(D) gender to be served;

(E) population to be served; and

(F) availability of psychological, psychiatric, and vocational services in the proposed location;

(4) plans for staffing and program coordination; and

(5) staff qualifications, including any additional training to be provided.

(d) Eligibility to receive services.To be eligible for services in an alternative group home, the person must:

(1) be in public guardian the custody of the public guardian per Section 1175.6b or 1175.6b.A of Title 22 of the Oklahoma Statutes (22 O.S. § 1175.6b or 1175.6c); or

(2) meet the criteria for an intermediate care facility for the mentally retarded (ICF/MR) individuals with intellectual disabilities (ICF/IID) level of care; and

(A) require 24-hour, on-site, awake staff supervision to ensure safety; and

(B) be found by the DDSD Community Services programs administrator DDS director or designee to have serious behavioral or emotional challenges or community protection issues, such as:

(i) evidence of commitment of a sexually violent offense, sexually predatory act, or crime of sexual violence including, but not limited to:

(I) rape;

(II) lewd or indecent acts or proposals made to a child, per Section 1123 of Title 21 of the Oklahoma Statutes (21 O.S. § 1123); or

(III) forcible sodomy, per Section 888 of Title 21 of the Oklahoma Statutes (21 O.S. § 888);

(ii) history of stalking or opportunistic behavior that demonstrates a likelihood to commit a sexually violent or predatory act;

(iii) documented pattern of acts of violence toward others;

(iv) experience ongoing, highly disruptive behavioral episodes that:

(I) are dangerous per Section 1175.1 of Title 22 of the Oklahoma Statutes (22 O.S. § 1175.1); and

(II) require close supervision and frequent intervention by staff;

(v) evidence of commitment of one or more violent offenses, such as:

(I) murder or manslaughter;

(II) attempted murder;

(III) arson;

(IV) assault;

(V) kidnapping; or

(VI) use of a weapon to commit a crime; or

(vi) severe ongoing self-injurious behavior.

(e) Services provided.Services provided are designed to assist service recipients in acquiring, retaining, and improving self-help, socialization, and adaptive skills necessary to reside successfully in a home and community-based setting.

(1) Services include supports to meet each service recipient's needs including, but not limited to:

(A) residential habilitation, such as assistance with the acquisition, retention, or improvement of skills related to activities of daily living, such as:

(i) personal grooming and cleanliness;

(ii) bed-making and household chores;

(iii) eating and food preparation; and

(iv) social and adaptive skills necessary to enable the service recipient to reside in a shared home;

(B) program supervision and oversight including 24-hour availability of response staff to meet schedules or unpredictable needs in a way that promotes maximum dignity and independence, while providing for supervision and safety.In addition to requirements in OAC 340:100-6-55, program coordination staff (PCS) must:

(i) serve no more than 12 18 service recipients;

(ii) ensure staffing levels meet the requirements of OAC 340:100‑5‑22.6(e)(1)(H) of this subsection requirements; and

(iii) ensure records are maintained per OAC 340:100-3-40;

(C) implementation of community protection precautions and individual program plans per OAC 340:100-5-22.6(f) of this Section;

(D) recreational and leisure activities, including individual and group activities;

(E) assistance in money management;

(F) health care services provided per OAC 340:100-5-26 and OAC 340:100-5-26.3;

(G) medication administration per OAC 340:100-5-32; and

(H) management of staffing levels that provides supervision to ensure the safety of the service recipient, community, staff, and other service recipients, and implementation of each service recipient's Individual Plan (Plan).

(i) An average of 14 hours of staffing per service recipient must be provided per billable day prior to filing a claim for habilitation training staff authorized per OAC 317:40-5-152.

(I) At least two awake-staff must be on duty during daytime and evening hours when service recipients are in the home.

(II) This requirement may be reduced to one awake-staff, when there are only one or two service recipients in the home.

(ii) Sufficient daytime staffing must be provided to:

(I) ensure adequate supervision in the home and community; and

(II) implement the Plan, except during the time the service recipient is in an authorized employment, vocational, or day services program that provide provides the needed supervision, security, and support identified in the Plan.All staff are Staff is trained per OAC 340:100-3-38.

(iii) At least one awake-staff must be on duty during hours when service recipients are asleep.

(I) The agency must have a provision to immediately provide additional staff in the home should the need arise.

(II) Staff on duty must be physically able and mentally alert to carry out the duties of the job.

(iv) The provider must:

(I) have staff available to provide necessary support and supervision when the service recipient needs to return from employment or other day services;

(II) provide activity options and supervision during all times when the service recipient is not participating in authorized employment activities; and

(III) ensure effective transition and coordination of supervision between alternative group home and employment programs or other authorized absences from the alternative group home program.

(2) In addition to the services in OAC 340:100-5-22.6(e)(1) of this subsection, services for wards of the public guardian are designed to ensure the service recipient is not dangerous to self or others.

(f) Alternative group home program requirements.In addition to compliance with applicable Oklahoma Department of Human Services (OKDHS) (DHS) and Oklahoma Health Care Authority (OHCA) rules, the provider ensures:

(1) staff implements security precautions protecting the service recipient, neighbors, children, vulnerable adults who are vulnerable, animals, and others;

(2) staff implements outcomes and action steps detailed in the Plan to assist service recipients to function safely in the community and avoid criminal activity;

(3) collaboration and coordination occur with DDSD DDS staff, employment providers, therapists, and other entities and persons, such as law enforcement, corrections officers, schools, employers, mental health workers, and, when appropriate, the public guardian;

(4) written agency policies comply with OKDHS DHS and OHCA rules;

(5) effective security and supervision of service recipients in the residence and community are provided;

(6) contingency plans are developed and implemented for:

(A) emergency relocation of a service recipient who has created a danger or who is in danger;

(B) emergency staffing in the event changes are required to protect staff or others;

(C) general emergencies requiring evacuation of the entire home, such as fire or weather emergencies, per OAC 340:100-6-45; and

(D) elopement;

(7) legal and court requirements are followed, including adherence to Oklahoma laws governing registered sexual offenders;

(8) the health care coordinator (HCC) or other knowledgeable staff accompanies the service recipient to each medical or psychiatric appointment, taking current data summaries that indicate the rate of occurrence of medication-responsive symptoms or behaviors over the last one to three months.For visits to the physician prescribing psychotropic medication, the summary covers symptoms or behaviors listed on Form 06HM067E, Semi-annual Psychotropic Medication Review HCC presents Form 06HM073E, Referral Form for Psychiatric Treatment or Examination, per OAC 340:100-5-26;

(9) specific offense patterns are considered and addressed when determining appropriate program locations; and

(10) cabinets are locked if they contain any knives or other sharp objects that may be used as weapons or any items specifically identified by the Team as dangerous; any modifications to the Plan including restrictive or intrusive procedures is supported by a specific, assessed need, and justified in the person-centered plan per OAC 317:40-1-3(b).When the Team determines restrictive or intrusive procedures are essential for safety, the Team must develop a protective intervention protocol per OAC 340:100-5-57.

(11) staff provides arm's-length supervision to each service recipient when outside the home unless another supervision pattern is specifically described in the Plan approved by designated DDSD State Office staff;

(12) door and window alarms are used;

(13) the yard is fenced with a locked gate, unless the requirement for a locked gate is waived in writing by the DDSD director or designee; and

(14) other necessary restrictive procedures as detailed in the Plan are implemented, that may include:

(A) restricted views from or into windows, doors, and other openings;

(B) restricted access to certain areas;

(C) for wards of the public guardian, restrictions deemed necessary to maintain the safety of the service recipient and public; and

(D) room and personal searches.

(g) Weapons.Dangerous or deadly weapons are not permitted in the alternative group home or on the premises.Providers are prohibited from assisting any service recipient to obtain or possess dangerous or deadly weapons including, but not limited to:

(1) guns, BB guns, air rifles, or other firearms;

(2) crossbows;

(3) paint guns;

(4) arrows;

(5) explosives;

(6) stun guns; and

(7) knives, except cooking and eating utensils.

(h) Substances and items prohibited in alternative group homes are:

(1) illegal substances; and

(2) alcohol; and

(3) cell phones, except for staff who have written authorization from the program coordinator.

(i) SoonerCare eligibility.The service recipient and guardian, with necessary support from the provider, establish and maintain SoonerCare eligibility, if when possible.

(j) Natural supports.Persons who agree to provide natural supports to a service recipient living in an alternative group home must:

(1) work with the Team to develop a schedule, support strategies, and agreement for support.Each Plan contains a description of any natural support to be provided that ensures the safety and welfare of the service recipient and community.No arrangement can be is made for natural supports that violate existing court orders, security arrangements, or the Plan;

(2) keep commitments made, regarding supports; and

(3) document or report to the program coordinator or DDSD DDS case manager regarding supports provided.

(k) Refusal to participate.If When a service recipient or guardian refuses to participate in service delivery as described in the Plan:

(1) the provider:

(A) continues to implement the Plan as written; and

(B) immediately notifies the DDSD DDS case manager of the need for a Team meeting;

(2) the DDSD DDS case manager takes immediate action to convene the Team to address the situation; and

(3) steps in OAC 340:100-3-11 are followed.

(l) Record keeping.In addition to requirements of OAC 340:100-3-40, records of service recipients must include documentation of:

(1) documentation of the registration of the service recipient recipient's registration with appropriate law enforcement authorities, if when required, and documentation of subsequent registration notification to DDSD DDS of registration;

(2) documentation of all agreements or plans with other agencies or persons who support the service recipient, including the guardian and family members, that specifies requirements for supervision of the service recipient recipient's supervision requirements when staff is not present; and

(3) documentation of any refusal by the service recipient to follow conditions of the Plan, Protective Intervention Plan protective intervention protocols, or treatment recommendations of treatment professionals; and

(4) Form 06CB055E, Monthly Summary of Restrictive/Intrusive Procedure Usage, per OAC 340:100-5-57.1.

(m) Training.Staff or volunteers, and their supervisors providing direct supports for service recipients in an alternative group home are required to complete the necessary training requirements per OAC 340:100-3-38.13.

(n) Transportation.Providers of alternative group home services must ensure transportation is:

(1) available as needed for medical emergencies, appointments, day programs, and community activities per OAC 317:40-5-103; and

(2) supervised per OAC 340:100-5-22.6 this Section in accordance with each service recipient's needs.

(o) Transition.Teams plan for transition of a service recipients recipient's transition to appropriate services when it is determined the alternative group home program is no longer necessary.

(1) Within three months of the service recipient's admission to an alternative group home, the Team develops reasonable criteria for the service recipient's move transition to a less restrictive environment that are:

(A) included in a written plan submitted to designated DDSD DDS State Office staff; and

(B) reviewed at least annually by the Team.

(2) All transitions from alternative group homes must be approved by designated DDSD DDS State Office staff.DDS State Office Residential Unit staff may adjust the transition date if when necessary.¢ 1

(p) DDSD DDS-initiated transition.DDSD Community Services programs administrator The DDS director or designee may initiate the transition process for a person receiving alternative group home services who can be effectively served in another residential environment.

INSTRUCTIONS TO STAFF 340:100-5-22.6

Revised 6-1-109-15-17

1.(a) The Developmental Disabilities Services Division (DDSD) (DDS) case manager:

(1) reviews any existing legal documents and court minutes to determine if the transition would require requires modification of an existing court order;

(2) immediately notifies DDSD DDS State Office Residential Unit staff of any transition plans being considered by the Team and when a transition must occur for any reason.A six-week advance notice of the planned transition date is provided to Residential Unit DDS State Office staff; and

(3) reports any alternative group home vacancy immediately to Residential Unit DDS State Office staff; and.

(b) DDSD DDS State Office Residential Unit staff:

(1) reviews any existing court limitations or placement issues; and

(2) notifies the DDSD DDS case manager of approval or denial of the transition.

(c) DDSD Area DDS area staff completes tasks necessary for approved transition.

340:100-5-36. Community maintenance services

Issued 9-15-17

(a) Supplemental property replacement.When funding is available, a maximum of $300 per service recipient per fiscal year is reimbursed for replacement of unusable, necessary furniture or appliances.Necessary furniture and appliances include refrigerators, stoves, washers, dryers, dining tables and chairs, sofas, love seats, chairs and recliners, beds, dressers, or chests of drawers.The Oklahoma Department of Human Services (DHS) provides a payment to the contracted residential provider agency to establish and maintain community households per Section 331 of Title 61 of the Oklahoma Statutes (61 O.S. § 331).To be eligible the service recipient must receive community residential supports services per Oklahoma Administrative Code 340:100-5-22.1.

(1) The provider agency submits a written property replacement request to the case manager that includes:

(A) the furniture or appliance to be purchased;

(B) the reason the item is necessary;

(C) the age of the furniture or appliance to be replaced; and

(D) verification that other resources are not available to purchase the item.

(2) The case manager reviews the written request, submits it to the area manager or designee within five-business days of receipt from the provider agency, and includes a statement of the need for the furniture or appliance.

(3) The area manager or designee reviews the written request and when the request meets the criteria in this Section, submits it to the DDS director or designee within five-business days of receipt from the case manager.

(4) The DDS director or designee reviews and responds to the request within five-business days of receipt from the area manager or designee after considering if:

(A) funding is available;

(B) the request includes the required information;

(C) the case manager assessment indicates need;

(D) the household unnecessarily disposed of usable items that may have otherwise met the need for which the payment is requested;

(E) other resources are available to provide the necessary item; and

(F) items less than five years old can feasibly be repaired.

(5) No reimbursement for replacement of worn out furniture may occur during the first year of service.

(b) Goods and services.When funding is available, DHS provides a payment to the contracted residential provider agency to purchase necessary goods and services to establish and maintain community households per 61 O.S. § 331.Goods and services are incidental, non-routine goods and services that promote the service recipients' health, safety, self-care, and daily living skills needed to reside successfully in the community, and do not duplicate other services authorized in the member's plan of care.

SUBCHAPTER 6. GROUP HOME REGULATIONS

PART 11. PROGRAM STANDARDS

340:100-6-55. Staffing requirements

Revised 9-15-159-15-17

Group homes must employ sufficient staff who are appropriately qualified and trained to provide the essential services of the home.

(1) Sufficient staff.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.

(A) There must be at least one designated person in charge of the home and its operation available for each home when service recipients are present.Staff support and supervision must be provided as needed for each service recipient in the home.Staff must be physically able and mentally alert to carry out the duties of the job.

(B) In addition to direct support staff, each service recipient in a group home must have a staff person who serves as program coordinator.In addition to duties required by Oklahoma Administrative Code (OAC) 340:100-5-52, program coordination staff must:

(i) get to know the service recipient and the service recipient's needs;

(ii) make announced and unannounced visits to the group home that include a minimum of three monitoring visits per month, to monitor the service recipient's needs of the service recipients and the staff's need for supervision of staff.The visits should occur at times when it would reasonably be anticipated that the majority of the residents are home.Agency administration staff meeting the requirements of this Section may complete these visits in addition to program coordination staff.At least two of the visits must be unannounced, unless the:

(I) home has fully trained staff;

(II) home has had no turn-over for the past year;

(III) the service recipients do not require restrictive or intrusive procedures; and

(IV) there have been were no medication errors for the previous year, in which case the unannounced visits may be reduced to one per month.Of the unannounced visits, at least one visit must occur each month on Saturday or Sunday or between 8:00 p.m. and 7:00 a.m. on a weekday;

(iii) provide support and assistance to any service recipient who is experiencing an emotional, behavioral, or medical crisis;

(iv) be accessible to direct support staff 24 hours per day and available to respond, in person when necessary, to an emergency;

(v) supervise direct support staff to promote achievement of outcomes in the service recipient's Individual Plan (Plan);

(vi) ensure staffing levels meet the requirements of the service recipient's Plan, with staff trained per OAC 340:100-3-38;

(vii) ensure each service recipient's needs are always met, including, but not limited to:

(I) utilities and phone service;

(II) furniture;

(III) food supplies that meet the service recipient's nutritional needs;

(IV) linens;

(V) personal items;

(VI) adaptive equipment; and

(VII) prescription medications;

(viii) assist the Developmental Disabilities Services (DDS) case manager as requested to prepare for and implement the service recipient's Plan and its revisions per OAC 340:100-5-50 through 340:100-5-58;

(ix) ensure Oklahoma Department of Human Services and Oklahoma Health Care Authority rules are followed; and

(x) complete necessary training per OAC 340:100-3-38.

(C) All group home providers must have a signed, written agreement with a registered nurse to:

(i) act as a consultant;

(ii) review medication issues and administration quarterly, or more often when required; and

(iii) provide technical assistance upon request.Documentation of the use of the nurse consultant must be maintained by the group home provider.

(D) Service recipients do not supervise other service recipients.

(2) Staff qualifications.

(A) The group home has an administrator and program coordinator who must:

(i) be at least 21 years of age; and

(ii) have a minimum of four years of any combination of college level course work 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.Both roles may be filled by the same person.

(B) All other staff must be at least 18 years of age.

(C) The provider agency is responsible for recruitment, screening, training, and supervision of staff or volunteers providing direct services, ensuring direct support staff is not supervised by a relative or person living in the staff's home.A relative includes a wife, husband, child, parent, stepparent, parent-in-law, grandchild, grandparent, brother, sister, stepchild, brother-in-law, sister-in-law, son-in-law, daughter-in-law, aunt, uncle, niece, nephew, first cousin, or any such person with whom the employee shares a foster relationship.

(D) The provider agency must comply with OAC 340:100-3-39 regarding pre-employment screening for community services workers.

(3) Staff training.To ensure all providers achieve and maintain a level of competency necessary to meet the needs of each service recipient in the group home, provider agency staff must complete training per OAC 340:100-3-38.

PART 19. INVOLUNTARY TRANSFER OR DISCHARGE OF SERVICE RECIPIENT

340:100-6-85. Transfer or discharge

Revised 9-15-17

(a) A group home provider must not involuntarily transfer or discharge a service recipient residing in a group home except for:

(1) medical reasons;

(2) the service recipient's safety or the safety of other residents;

(3) violations of the agreement between the service recipient and group home provider; or

(4) nonpayment for the service recipient's stay unless limited by the federal Social Security Act.

(b) Involuntary transfer or discharge of a service recipient for violations of the agreement must be subject to:

(1) review of the agreement and notification to the service recipient of specific violations;

(2) discharge only after all appropriate attempts are made to resolve any violations.Attempts must be documented in the service recipient's record; and

(3) review of all proposed discharges by the grouphome Human Rights Committee prior to discharge to determine compliance with due process requirements.

(c) When a service recipient changes provider agencies, only the out-going provider agency claims for services provided on the day the service recipient moves.

PART 21. RESIDENT RIGHTS AND RESPONSIBILITIES

340:100-6-95. Resident rights and responsibilities

Revised 9-15-17

(a) Each resident is responsible for making a room and board payment to the group home provider in accordance with the financial agreement.

(b) Unless otherwise indicated in the resident's Individual Plan, each resident is responsible for participation in meaningful activities, including employment, vocational training, or adult day services that occur outside the group home for a minimum of five hours per weekday.

(c) Each resident is represented by a Human Rights Committee per OAC 340:100-3-6.

(d) A statement of rights and responsibilities, developed by each group home, including, but not limited to, each resident's right to:

(1) civil and religious liberties, including the right to independent personal decisions and knowledge of available choices, that must not be infringed.The provider must encourage and assist in the exercise of these rights;

(2) private communications and consultations with the resident's physician or attorney or any other person of the resident's choice, including sending and promptly receiving unopened personal mail;

(3) without fear of reprisal, present grievances, and join with other residents or persons within or outside of the group home to work for improvements in resident care;

(4) manage his or her financial affairs, unless the resident delegates the responsibility in writing, to the provider.The resident must have at least a quarterly accounting of any personal financial transactions undertaken on the resident's behalf by the group home provider during any period of time the resident delegates such responsibilities to the provider;

(5) receive adequate and appropriate medical care consistent with established and recognized medical practice standards within the community.Each resident:

(A) must be fully informed by the attending physician of his or her medical condition and proposed treatment in terms and language the resident can understand understands; and

(B) has the right to refuse medication and treatment after being fully informed of, and understanding the consequences of such actions;

(6) respect and privacy in the resident's medical care program;.

(A) Discussion, consultation, examination, and treatment must remain confidential and be conducted discreetly.

(B) Personal and medical records must be confidential;

(7) retain and use personal clothing and possessions, unless prohibited by law, and security in the storage and use of such clothing and possessions;

(8) be treated courteously and respectfully;

(9) be free from mental and physical abuse, and free from physical and chemical restraints, except for those physical and chemical restraints authorized in writing by a physician health care professional, per Oklahoma Department of Human Services (OKDHS) rules, for a specified period of time;

(10) receive a statement of the group home provider guidelines and an explanation of the resident's responsibility to comply with all reasonable group home regulations of the group home and to respect the other resident's personal rights and private property of the other residents;

(11) receive a statement, if when adjudicated incapacitated, stating the rights and responsibilities provided in OAC 340:100-6-95 per this Section must be exercised by a court‑appointed guardian;

(12) privacy for conjugal visits.A resident may share a room with a spouse, if when the spouse resides in the same group home;

(13) all rights specified in OAC 340:100-3-1.2; and

(14) not perform services for a group home provider, except for normal, shared household tasks.

(e) Upon admission of a resident and at least annually thereafter, or upon request, each resident and resident's advocate or legal guardian must be provided a copy of:

(1) the resident's rights; and

(2) procedures for grievances and appeal, per OAC 340:2-3-54.

(f) The rights enumerated in OAC 340:100-6-95 this Section may be limited for residents of an alternative group home.

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