WF 13-01

COMMENT DUE DATE:

March 20, 2014

DATE:

February 12, 2014

Jennifer Case, Aging Services (405) 521-4489

Dena Thayer, OIRP Programs Administrator (405) 521-4326

Nancy Kelly, OIRP Policy Specialist (405) 522-6703

RE:

APA WF 13-01

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 the Administrative Procedures Act

SUBJECT:

CHAPTER 105. Aging Services ~~Division~~

Subchapter 10. Policies and Procedures Manual for Title III of the Older Americans Act of 1965, as Amended

Part 7. Program Standards for Services Funded Under Title III

OAC 340:105-10-50.1 through 340:105-10-51 [AMENDED]

OAC 340:105-10-75 [AMENDED]

(Reference WF 13-01)

SUMMARY:

The proposed revisions to Subchapter 10 Policies and Procedures Manual for Title III of the Older Americans Act of 1965, As Amended of Chapter 105 Aging Services Division amend the rules to match changes in state and federal legislation and rules.

OAC 340:105-10-50.1 is amended to change policy to match FY 2012 Congressional appropriations that now require the Older Americans Act (OAA) Title III D funding to only be used for programs and activities demonstrated to be evidence-based.

OAC 340:105-10-51 is amended to change policy to add signage requirement to projects and sites in relation to Senate Bill (SB) 1733 Open Carry Law effective November 1, 2012.

OAC 340:105-10-75 is amended to change policy to implement provisions of House Bill (HB) 1418, the Josephine Meade Anti-Hunger Act at the instruction of legislators.

PERMANENT APPROVAL:

Permanent rulemaking is requested.

LEGAL AUTHORITY:

Director of Human Services; Section 162 of Title 56 of the Oklahoma Statutes (56 O.S. § 162); and The Older Americans Act of 1965, as Amended, Sections 305 and 307.

Rule Impact Statement

To:Programs Administrator

Policy Management Unit

From:Lance Robertson, Division Director

Aging Services

Date:January 24, 2014

Re:CHAPTER 105. Aging Services ~~Division~~

Subchapter 10. Policies and Procedures Manual for Title III of the Older Americans Act of 1965, as Amended

Part 7. Program Standards for Services Funded Under Title III

OAC 340:105-10-50.1 through 340:105-10-51 [AMENDED]

OAC 340:105-10-75 [AMENDED]

(Reference WF 13-01)

Contact:Jennifer K. Case 405-521-4489

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

Purpose.The proposed revisions to Subchapter 10 Policies and Procedures Manual for Title III of the Older Americans Act of 1965, As Amended of Chapter 105 Aging Services Division amend the rules to match changes in state and federal legislation and rules.

Strategic Plan impact.The proposed rules achieve Oklahoma Department of Human Services (DHS) goals by continuously improving systems and processes.

Substantive changes.

OAC 340:105-10-51 is amended to change policy to add signage requirement to projects and sites in relation to Senate Bill (SB) 1733 Open Carry Law effective November 1, 2012.

OAC 340:105-10-75 is amended to change policy to implement provisions of House Bill (HB) 1418, the Josephine Meade Anti-Hunger Act at the instruction of legislators.

Reasons.The proposed amendments implement new legislative changes and federally defined program activities.These changes:(1) will require projects to post signage not allowing weapons on any project premises per SB 1733; and (2) to allow participants to take uneaten food from dining sites per HB 1488.These changes also ensure projects will provide approved evidence-based health promotions for Older Americans Act participants.

Repercussions.The proposed rules ensure Aging Services and its contractors comply with state and federal legislation.

Legal authority.Director of Human Services; Section 162 of Title 56 of the Oklahoma Statutes (56 O.S. § 162); and The Older Americans Act of 1965, as Amended, Sections 305 and 307.

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 most likely to be affected by the proposed rules are contractors and participants of the Older Americans Act (OAA) Title III services.The affected classes of persons will bear no costs associated with implementation of the rules.

C.A description of the classes of persons who will benefit from the proposed rule:The classes of persons who will benefit are contractors of OAA Title III services who will continue to remain in compliance with state and federal legislation.In addition, participants of OAA Title III services will benefit from improved health promotion activities.

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:The revised rules do not have an economic impact on the affected entities.There are no fee changes associated with the revised rules.

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.The revised rules will result in enhanced delivery of service to ensure OAA participants receive improved health promotion activities, the ability for participants to take leftover food home when desired, and provide clear guidelines as to open carry of weapons.

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 rules do not have an economic impact on any political subdivision, nor will the cooperation of any political subdivisions be required in implementation or enforcement of 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:There are no anticipated adverse effects 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 non-regulatory methods or less intrusive methods for achieving the purpose of the proposed rule:There are no less costly or non-regulatory methods nor less intrusive methods for complying with HB 1418, SB 1733, or the Older Americans Act of 1965, as Amended.

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:Implementation of the proposed rules will bring the rules into compliance with HB 1418, SB 1733, and the Older Americans Act of 1965, as Amended positively impact the health, safety, and well-being of older Oklahomans who participate in OAA services.

J.A determination of any detrimental effect on the public health, safety, and environment if the proposed rule is not implemented:If the proposed rules are not implemented, Aging Services contractors will not be in compliance with HB 1418, SB 1733, and the Older Americans Act of 1965, as Amended.

K.The date the rule impact statement was prepared and, if modified, the date modified:Prepared May 10, 2013; modified 7-31-13; modified January 24, 2014.

CHAPTER 105. AGING SERVICES ~~DIVISION~~

SUBCHAPTER 10. POLICIES AND PROCEDURES MANUAL for TITLE III of the OLDER AMERICANS ACT of 1965, as AMENDED

PART 7. PROGRAM STANDARDS FOR SERVICES FUNDED UNDER TITLE III of the OLDER AMERICANS ACT of 1965, as AMENDED

340:105-10-50.1. Title III services taxonomy

(a) Rule.Parts B, C, D, and E of Title III of the Older Americans Act of 1965, as Amended, authorize the development of a variety of services to meet the needs of older persons.A comprehensive listing of services that may be funded, service definitions, and service units are included in (1) through (15) of this ~~paragraph~~ subsection.

(1) Personal care - one hour; provides personal assistance, stand-by assistance, supervision, or cues.

(2) Homemaker - one hour; provides assistance preparing meals, shopping for personal items, managing money, using the telephone, or doing light housework.

(3) Chore - one hour; provides assistance with heavy housework, yard work, or sidewalk maintenance.

(4) Home delivered meal - one meal; provides a qualified person at the person's place of residence a meal that:

(A) complies with the most recent Dietary Guidelines for Americans~~, published by the Secretary and the Secretary of Agriculture~~;

(B) provides, if when one meal is served, a minimum of 33 and 1/3 percent of the current dietary reference intakes (DRI) as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences;

(D) provides, if when three meals are served together, 100 percent of the DRI allowances.

(5) Adult day care or adult day health - one hour; provides personal care for dependent adults in a supervised, protective, and congregate setting during some portion of a day.Services offered in conjunction with adult day care or adult day health typically include social and recreational activities, training, counseling, and services, such as rehabilitation, ~~medications~~ medication assistance, and home health aide services for adult day health.

(6) Case management - one hour; provides assistance either in the form of access or care coordination in circumstances where the older person is experiencing diminished functioning capacities, personal conditions, or other characteristics requiring the provision of services by formal service providers or family caregivers.Case management activities include:

(A) assessing needs;

(B) developing care plans;

(D) providing follow-up and reassessment, as required.

(7) Congregate meal - one meal; provides a qualified person in a congregate or group setting, a meal that:

(A) complies with the most recent Dietary Guidelines for Americans, published by the Secretary and the Secretary of Agriculture;

(B) provides, if when one meal is served, a minimum of 33 and 1/3 percent of the DRI as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences;

(D) provides, if when three meals are served together, 100 percent of the DRI allowances.

(8) Nutrition counseling - one session per participant; provides individualized guidance to a person who is at nutritional risk because of health or nutrition history, dietary intake, ~~medications use~~ medication use, or chronic illnesses, or to caregivers.Counseling is provided one-on-one by a registered dietician and addresses the options and methods for improving nutrition status.

(9) Assisted transportation - one one-way trip; provides assistance and transportation, including escort, to a person who has difficulties, physical or cognitive, using regular vehicular transportation.

(10) Transportation - one one-way trip; provides transportation using a vehicle for a person who requires help in going from one location to another and does not include any other activity.

(11) Legal assistance - one hour; provides legal advice, counseling, and representation by an attorney or other person acting under the supervision of an attorney.

(12) Nutrition education - one session per participant; a program promoting better health by providing accurate and culturally sensitive nutrition, physical fitness, or health information, as it relates to nutrition, information, and instruction to participants, caregivers, or both, in a group or individual setting overseen by a dietitian or person of comparable expertise.

(13) Information and assistance - one contact; a one-on-one contact between a service provider and an older client or caregiver.Activities involving contact with multiple current or potential clients or caregivers, such as publications, publicity campaigns, and other mass media activities, are not counted as a unit of service.Internet website hits are counted only if when information is requested and supplied.This service:

(A) provides older persons with current information on services available within their communities;

(B) links older persons with the opportunities and services available within their communities; and

(14) Outreach - one contact; provides persons with intervention initiated by an agency or organization for the purpose of identifying potential clients or their caregivers and encouraging their use of existing services and benefits.Outreach is a one-on-one contact between a service provider and an older client or caregiver.Activities involving contact with multiple current or potential clients or caregivers, such as publications, publicity campaigns, and other mass media activities, are not counted as a unit of service.

(15) Funded "Other" category.

(A) Advocacy or representation - one hour; provides action taken on behalf of an older person to secure the person's rights or benefits.Advocacy or representation includes receiving, investigating, and working to resolve disputes or complaints.It does not include services provided by an attorney or person under the supervision of an attorney.

(B) Education or training - one session; provides formal and informal opportunities for older persons to acquire knowledge, experience, or skills.Includes individual or group events designed to increase awareness.

(C) Health promotion - one event; provides health promotion or disease prevention ~~information, instruction, or activities, such as exercise~~ programs and activities demonstrated to be evidence-based to participants, caregivers, or both, in a group or individual setting.The Administration on Community Living uses a graduated or tiered set of criteria for defining evidence-based interventions.Health promotion programs can fall within any of the tiers with the goal for all activities to move toward the highest-level criteria.~~Examples include:~~

~~(i) individual health screenings such as blood pressure screenings.The event is documented by a participant sign-in sheet at the time of the screening; or~~

~~(ii) a health promotion program in an individual or group setting.The program is counted as one event.~~

(D) Home repair - one job; provides minor repairs, modifications, or maintenance on a home owned and occupied by an eligible participant, up to $250 annually, per participant.

(E) Coordination of services - unit to be determined by Aging Services ~~Division~~ (ASD); provides for the administration or delivery of a service for which direct cost is not funded by Title III.The Area Agency on Aging (AAA) contacts ~~ASD~~ AS regarding use of this category.

(F) National Family Caregiver Support Program service categories are:

(i) information services - one activity; provides caregivers information on resources and services available to the public or persons within their communities.Information services are for activities directed to large audiences of current or potential caregivers, such as disseminating publications, conducting media campaigns, and other similar activities;

(ii) access assistance – one contact; assists caregivers in obtaining access to the services and resources available within their communities.To the maximum extent practicable, access assistance ensures persons receive the services needed by establishing adequate follow-up procedures.Internet website hits are counted only when information is requested and supplied;

(iii) counseling - one session per participant; assists caregivers in the areas of health, nutrition, and financial literacy, and in making decisions and solving problems relating to their caregiver roles.This includes counseling to persons, support groups, and caregiver training of individual caregivers and families;

(iv) respite care - one hour; provides temporary, substitute supports or living arrangements for care recipients in order to provide a brief period of relief or rest for caregivers.When the specific service units purchased via a direct payment, such as cash or voucher, can be tracked or estimated, the service unit is reported by hour; otherwise, the unit of service is one payment.Respite care is:

(I) in-home respite, such as personal care, homemaker, and other in-home respite;

(II) respite provided by attendance of the care recipient at a senior center or other nonresidential program; or

(III) institution respite provided by placing the care recipient in an institutional setting, such as a nursing home for a short period of time as a respite to the caregiver or summer camp as a respite for grandparents caring for children; and

(v) supplemental services – provides services on a limited basis to complement the care provided by caregivers.The unit and service are determined by ASD.The AAA contacts ASD regarding use of this category.

(b) Authority.The authority for this Section is the Office of Management and Budget Notice of Action 0985-0008 and Sections 339 and 371 through 373 of the Older Americans Act of 1965, as ~~amended~~ Amended.

(1) incorporates provisions of the rule into its policies and procedures manual;

(2) provides technical assistance to prospective service project applicants regarding the rule in the development of services; and

(3) utilizes the rule as an indicator in the evaluation of service project proposals.

(d) Cross references.~~See OAC~~ Refer to Oklahoma Administrative Code 340:105-10-40 and 340:105-10-51.

INSTRUCTIONS TO STAFF

Issued 7-1-14

1.Use the following graduated criteria, (tiers), for defining evidence-based interventions.

1. Minimal criteria is:

(1) demonstrated through evaluation to be effective for improving the health and wellbeing or reducing disease, disability and/or injury among older adults; and

(2) ready for translation, implementation, and/or broad dissemination by community-based organizations using appropriately credentialed practitioners.

2. Intermediate criteria is:

(1) published in a peer-review journal;

(2) proven effective with older adult population, using some form of a control condition, such as pre-post study, or case control design; and

(3) some basis in translation for implementation by community level organization.

3. Highest-level criteria is:

(1) undergone experimental or quasi-experimental design;

(2) level at which full translation has occurred in a community site; and

(3) level at which dissemination products are developed and available to the public.

340:105-10-51. General Title III service standards

Revised 7-1-14

(a) Policy.Parts B, C, D, and E of Title III of the Older Americans Act of 1965, as Amended, (OAA) provide funding for a variety of services to meet the needs of older persons.All services meet service specific standards and the general standards in this subsection.

(1) Project sponsors who are the recipients of grant awards may be public, private for-profit, or nonprofit agencies or organizations, institutions, political subdivisions of the state, or Indian tribal organizations demonstrating to the Area Agency on Aging (AAA) a capacity for the effective delivery of nutrition, supportive services, or both, throughout the project service area (PSA).Project sponsors serve all eligible persons in the PSA and do not limit participation to their own membership or residents, such as church memberships or residents of a day care program.

(2) Project services are provided to persons 60 years of age and older unless otherwise allowed for in the eligibility requirements of a specific service.

(3) Project services are located in communities with the greatest occurrence of older persons in greatest economic and social need with particular attention to low income minority persons and older persons residing in rural areas.The project documents in the written grant agreement with the AAA:

(A) assurance that, to the extent possible, the project serves low income minority persons and older persons residing in rural areas in accordance with their need for services;

(B) specific objectives outlining how the project satisfies the service needs of low income minority persons and older persons residing in rural areas served by the project.These objectives reflect the Area Plan objectives for targeting these persons;

(C) information on the extent the project met its objectives for serving low income minority persons and older persons residing in rural areas during the previous fiscal year, if previously funded; and

(D) other targeting activities required for specific funded services, as appropriate, such as targeting activities for outreach services.

(4) Projects provide recipients with the opportunity to contribute to the cost of services, with the restrictions in this paragraph.

(A) Contributions are voluntary and no otherwise eligible person is denied service because he or she chooses not to or cannot contribute to the cost of services.

(B) Participants are advised of the opportunity to contribute to the cost of programs through:

(i) individual consultation when they enter the program to include a written suggested contribution schedule;

(ii) written brochures about the program and written schedules of activities of the program; and

(iii) signs posted at the project site.

(D) The project advisory council develops a suggested contribution schedule for funded services and takes into consideration the income ranges of older persons in the community and the project's other means of income.Means testing is not used to determine suggested contributions.

(E) Congregate and home delivered meals participants are allowed to use United States (U.S.) Department of Agriculture food benefits to contribute toward the cost of their meals.

(F) The project uses appropriate procedures to safeguard and account for all contributions.

(G) The project uses participant contributions to expand funded services.

(5) Projects conform to the Title III fiscal accounting and program reporting systems as implemented by ~~the State Agency~~ Aging Services (AS) and AAAs.All records are managed according to the guidelines in this paragraph.OAA grantees:

(A) maintain adequate and separate accounting and fiscal records, and account for all funds provided by any source to pay the cost of the OAA funded project;

(B) permit audit, examination, or both, of all such records, procedures, and accounts at any reasonable time by authorized personnel of the U.S. Department of Health and Human Services, the Oklahoma Department of Human Services (OKDHS), the State Auditor and Inspector, and other appropriate state entities;

(C) allow authorized personnel open and complete access to the grantees' accounting records and practices, and to any other items of the service provider pertinent to the performance or payment of the grant in order to audit, examine, and make excerpts of records;

(D) retain for at least three years all financial and program records, supporting documents, statistical records, and other records pertaining to the Title III services.

(i) In the case of litigation, claim negotiation, audit, or other pending action before the end of the three year period, the records are retained until such action is completed, and until all issues arising from it have been resolved, or until the end of the regular three year period, whichever is later.

(ii) Permanent records are maintained at the project office; and

(E) provide the appropriate security, confidentiality, and accommodations for the proper maintenance and organization of program records and reports.

(6) Where feasible and appropriate, projects make arrangements for the availability of services to older persons in weather related emergencies and other local and national emergencies, including terrorist acts and flu pandemics.

(7) Projects assist participants in taking advantage of benefits or services under other programs.

(8) Project staff reports to the appropriate officials any situation that places the participant, participant's household, or both, in imminent danger.

(9) Project staff ensures that signage is posted appropriately informing all persons that, with the exception of law enforcement, no firearms are to be permitted within the project office, maintenance buildings, and all nutrition site-dining areas.

~~(9)~~(10) Projects coordinate Title III services with other appropriate services in the community, including Title VI Native American nutrition programs.Appropriate coordination efforts include:

(A) joint planning;

(B) information sharing; and

~~(10)~~(11) Projects establish and maintain an advisory council to advise the projects on all matters relating to the delivery of project services, per ~~OAC~~ Oklahoma Administrative Code340:105-10-52.

~~(11)~~(12) Projects ensure appropriate intake information is gathered on each participant.

(A) Participants receiving Title III:

(i) personal care, homemaker, chore, home repair, home delivered meals, adult day health or adult day care, or case management services, information is gathered on Form 02AG002E, Older Americans Act Assessment, Part I, and Form 02AG003E, Older Americans Act Assessment, Part II, and includes at a minimum:

(I) identifying information;

(II) household composition;

(III) ability to perform activities of daily living (ADLs);

(IV) ability to perform instrumental ~~activities of daily living~~ ADLs;

(V) support system;

(VI) participant signature or witness signature if when the participant is unable to sign;

(VII) explanation of donation system;

(VIII) release of information authorization; and

(IX) status related to poverty level;

(ii) congregate meals, nutrition counseling, assisted transportation, outreach, or information and assistance, information is gathered on Form 02AG002E, Part I, and includes at a minimum:

(I) identifying information;

(II) household composition;

(III) participant signature or witness signature if when the participant is unable to sign;

(IV) explanation of donation system;

(V) release of information authorization; and

(VI) status related to poverty level;

(iii) home delivered meals, congregate meals, case management, or nutrition counseling, project staff ensures Form 02AG002E, Part I, Determine your nutritional health, is completed; and

(iv) National Family Caregiver Support Program (NFCSP) services, information is gathered on an approved intake form and includes at a minimum:

(I) the family caregiver's identifying information;

(II) the caregiver's relationship to the care receiver;

(III) the care receiver's identifying information; and

(IV) a written description of the caregiver's current situation, including the care receiver's need for assistance due to inability to perform specific ADLs or the need for supervision due to Alzheimer's disease or other dementia.

(B) Project staff:

(i) obtains from participants of other Title III services not given in (A) of this paragraph, or their informants, only information necessary to provide the appropriate Title III service(s) and ~~ensure~~ ensures the safety and well-being of participants;

(ii) ensures assessment procedures are conducted in a confidential manner, with only the intake person, the participant, and other persons approved by the participant in attendance;

(iii) conducts an assessment of each participant upon the participant's entry into a Title III service, with, at a minimum, annual reassessments; and

(iv) at a minimum, conducts a reassessment of in-home service participants every six months~~, at a minimum~~.

(C) Income source information is not required to receive Title III services and may only be used to assist the participant in determining eligibility for programs with income guidelines.

~~(12)~~(13) Projects have procedures, approved by ~~the~~ AAA, to ensure strict confidentiality is maintained regarding all participant information.Projects ensure identifying participant information is disclosed only when staff obtains the informed consent of the participant or the participant's legal representative.Exceptions to the rules in this paragraph include court orders, reporting possible neglect, abuse, or both, and monitoring project records by federal, state, and AAA officials.

~~(13)~~(14) Project staff posts grievance procedures in a public area of the project facility and complies with AAA grievance procedures for Title III participants.

~~(14)~~(15) Projects comply with the Americans with Disabilities Act, Section 504 of The Rehabilitation Act of 1973, and Title VI of The Civil Rights Act of 1964.A public notice of civil rights compliance is posted in a public area in all project facilities and offices.

~~(15)~~(16) Projects comply with the Oklahoma Open Meetings Act when conducting public meetings.Public meetings are held in handicap accessible facilities with provisions for interpreters, as needed.

~~(16)~~(17) Project staff conducts ongoing public information activities to ensure the general public is aware of each project and the services it provides.All materials produced by, or for the project include a statement that:

(A) the project makes no distinctions on the grounds of race, color, sex, age, ancestry, national origin, religion, or disability; and

(B) a portion of the project costs are met by state and federal OAA funds from ~~the~~ AAA and OKDHS ~~Aging Services Division~~ AS.

~~(17)~~(18) Project staff provides or arranges for orientation and ongoing training for all staff engaged in the implementation of the project.Training is designed to enhance staff performance as related to specific job responsibilities of each staff person.Projects authorize staff time to attend AAA and ~~State Agency~~ AS sponsored training as funds permit.Minimum orientation or training topics include:

(A) the OAA, as amended, and related regulations;

(B) the OKDHS Policies and Procedures Manual for Title III of the OAA, as amended;

(D) all program and fiscal reports, as appropriate;

(E) assessment procedures;

(F) the aging network; and

(G) specific job duties.

~~(18)~~(19) Project staff participates in regularly scheduled assessments and evaluations by the AAA.

(A) The AAA schedules assessments at least 30 calendar days in advance at a time mutually convenient for the AAA and the project.

(B) The AAA informs the project director of ~~the~~ areas ~~to be~~ covered during the assessment.

~~(19)~~(20) The project allows unscheduled or unannounced visits by the AAA for the purposes of:

(A) investigating alleged problems;

(B) monitoring corrective action; or

(b) Authority.The authority for this Section is Sections 1321.11, 1321.51, 1321.63(b), 1321.65, and 1321.67 of Title 45 of the Code of Federal Regulations.

(1) incorporate the standards into the AAA policies and procedures manual;

(2) provide training on the standards to Title III project directors and other appropriate staff;

(3) monitor the compliance of Title III projects with the standards; and

(4) provide ongoing technical assistance to Title III projects regarding the standards.

(d) Cross references.~~See OAC~~ Refer to Oklahoma Administrative Code 340:105-10-40, 340:105-10-50.1, and 340:105-10-52.

340:105-10-75. Congregate meals planning

Revised ~~7-1-12~~7-1-14

(a) Policy.The congregate meals project conducts appropriate meal planning for the congregate meals service with the consultation of persons competent in the ~~field~~ fields of nutrition, food service, and the needs of older persons.

(b) Authority.The authority for this Section is Section 339 of the Older Americans Act of 1965, as ~~amended~~ Amended and Section 1321.11 of Title 45 of the Code of Federal Regulations.

(1) are prepared or approved by a registered dietitian (RD) who considers the special needs of older persons.The RD ensures ~~that~~ each meal served contains at least:

(A) one-third of the dietary reference intakes as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences; and

(B) 600 calories.The recommended level is 750 to 850 calories;

(2) are planned on a six-month basis with a minimum four-week cycle with seasonal changes.Nutritional adequacy is documented with computer analysis and meal pattern by the RD.

(A) Maintenance of optimal nutritional status through menu planning is reflected in menus moderate in fat, salt, and simple sugars and high in fiber.

(B) Form 02AG018E, Project Menu Plan – Nutrition Program for the Elderly, is submitted quarterly to the area agency on aging (AAA) and is available to the ~~State Agency~~ Aging Services (AS) RD for random review upon request;

(3) are signed by the RD and posted at the nutrition site;

(4) reflect:

(A) special diets to meet the medical needs of eligible participants.When special diets are provided to meet the medical needs of eligible participants:

(i) a valid written physician's order is on file for each participant receiving a special diet.The physician's order indicates the participant is restricted to the special diet and the duration of the special diet.If the participant is consuming a liquid supplement in addition to a meal, the supplement is not reimbursed through the Nutrition Services Incentive Program as a separate meal; and

(ii) special diets are planned and prepared under the supervision of the RD; and

(B) where feasible, religious, ethnic, cultural, or regional dietary requirements or preferences of a major portion of the group of participants at a congregate meals site;

(5) are served as planned unless the RD reviews and approves an appropriate substitution.A complete menu move from one day to another does not constitute a substitution.When substitutions are made, the project maintains and submits to ~~the State Agency~~ AS at the end of each month the:

(A) date of substitution;

(B) original menu item(s); and

(6) are based on accurate production forecasting that does not include a margin for oversized portions or second servings.Leftover foods are not taken from the kitchen by staff, participants, or volunteers; however, participants may take the remainder of their noon meals from the dining site;

(7) may include, where feasible, provisions for the celebration of special occasions for participants, ~~for example~~ such as birthdays and holidays; and

(8) allow for food items within the meat, vegetable and fruit, and dessert groups to vary for the same days of the week, from week-to-week, in order to provide a variety of foods and nutrients.

(d) Cross references.~~See OAC~~ Refer to Oklahoma Administrative Code 340:105-10-50.1(a)(4) and (7), 340:105-10-51, 340:105-10-68 through 340:105-10-74, 340:105‑10-76 through 340:105-10-80, and 340:105-10-86.

INSTRUCTIONS TO STAFF 340:105-10-75

Revised ~~6-1-08~~7-1-14

1.Menus are developed according to the meal pattern~~, which~~ that includes:

(1) meat or meat alternate group ~~which~~ that is three ounces cooked edible portion of meat, fish, fowl, luncheon meats, eggs, or cheese.Meat alternates may be used occasionally and may include cooked dried beans or peas;

(2) vegetable and fruit group ~~which~~ that is two, one-half cup servings of any vegetable or fruit.Fruit used as a dessert is not counted toward the two servings.Full strength fruit or vegetable juices may be counted toward the required servings.Cooked dry beans and peas may be used as vegetables or meat alternates but cannot be counted as both;

(3) bread or bread alternate group ~~which~~ that is one serving of enriched or whole grain breads, biscuits, muffins, rolls, sandwich buns, cornbread, or other hot breads.Bread alternates may include enriched or whole grain cereals or cereal products, such as spaghetti, macaroni, dumplings, pancakes, and waffles;

(4) fat exchange group ~~which~~ that is one teaspoon of butter or margarine;

(5) dessert group ~~which~~ that is one, one-half cup or equivalent serving of desserts, such as puddings, gelatin desserts, ice cream, ice milk, sherbet, cake, pie, cookies, and fruit juices.Fresh or unsweetened fruit is offered, where feasible, to those participants who ~~wish~~ want to limit calories;

(6) milk group ~~which~~ that is one-half pint of fortified whole, skim, or low fat milk or buttermilk.A variety of milks are provided where feasible;

(7) optional beverages.Appropriate servings of coffee, tea, or decaffeinated beverages may be provided.Optional beverages are not provided with project funds; and

(8) other foods.Appropriate servings of other foods may be added to the meal to provide personal satisfaction and additional nutrition.Vitamins and mineral supplements are not provided with project funds.