COMMENT DUE DATE:
March 17, 2016
DATE:
February 16, 2016
Ray Hester, Programs manager (405) 522-8094
Dena Thayer, OIRP Programs administrator (405) 521-4326
RE:
APA WF 15-04
The proposed policy is Permanent . This proposal is subject to Administrative Procedures Act
A public hearing is scheduled for 9:00 a.m. on March 25, 2016 at the Oklahoma Department of Human Services, Sequoyah Memorial Office Building, 2400 N. Lincoln Boulevard, Oklahoma City, OK73105, Room C-48. Anyone who wants to speak must sign in at the door by 9:05 a.m.
SUBJECT:CHAPTER100. DEVELOPMENTAL DISABILITIES SERVICES
Subchapter 3. Administration
Part 1. General Administration
OAC 340:100-3-14 [AMENDED]
OAC 340:100-3-15 [REVOKED]
Part 3. Administration
OAC 340:100-3-29 [REVOKED]
Subchapter 5. Client Services
Part 5. Individual Planning
OAC 340:100-5-50 through 340:100-5-52 [AMENDED]
OAC 340:100-5-56 through 340:100-5-57 [AMENDED]
(Reference WF 15-04)
SUMMARY:The proposed revisions to Chapter 100 Subchapters 3 and 5 amend and revoke 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); and Sections, 441.301, 441.302, 441.715, 441.720, and 441.725 of Title 42 of the Code of Federal Regulations.
Rule Impact Statement
To:Programs administrator
Office of Intergovernmental Relations and Policy
From:Marie Moore, Interim Director
Developmental Disabilities Services
Date:January 20, 2016
Re:CHAPTER100. DEVELOPMENTAL DISABILITIES SERVICES
Subchapter 3. Administration
Part 1. General Administration
OAC 340:100-3-14 [AMENDED]
OAC 340:100-3-15 [REVOKED]
Part 3. Administration
OAC 340:100-3-29 [REVOKED]
Subchapter 5. Client Services
Part 5. Individual Planning
OAC 340:100-5-50 through 340:100-5-52 [AMENDED]
OAC 340:100-5-56 through 340:100-5-57 [AMENDED]
(Reference WF 15-04)
Contact:Ray Hester, Programs manager 405-522-8094
A.Brief description of the purpose of the proposed rule:
Purpose.The proposed revisions to Chapter 100 Subchapters 3 and 5 amend and revoke rules to implement changes recommended during the annual Developmental Disabilities Services (DDS) rule review process.
Strategic Plan Impact.
The proposed amendments position 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) 340:100-3-14 is amended to:(1) provide clear guidelines indicating prior review and approval of the use of restrictive or intrusive procedures as required except in emergency situations; (2) provide direction for submitting protective intervention protocols containing restrictive or intrusive procedures; (3) ensure person-centered planning principles and positive procedures are utilized in protective intervention protocols; (4) at the request of DDS provider agencies transfer the provider Human Rights Committee functions from providers to DDS; this will eliminate the provider agency expenses associated with maintaining their own human rights committees; and (4) provide directions for the review of protective intervention protocols when the person is served by the Robert M. Greer Center.
OAC 340:100-3-15 is revoked because the DDS contract with SoonerStart is no longer in effect.
OAC 340:100-3-29 is revoked because DDS released the Foster Grandparent Program to Aging Services.
Subchapter 5. Client Services
Part 5. Individual Planning
OAC 340:100-5-50 is amended to:(1) ensure compliance with key provisions of the 1915(c) Home- and Community-Based Services (HCBS) Waiver Final Rule (CMS 2249-F/2296-F); and ensure DDS service planning is developed through a person-centered planning process that addresses health, long-term services, and support needs in a way that reflects the service recipient's individual preferences and goals.
OAC 340:100-3-5-51 is amended to ensure the completion or update of a person-centered assessment at least annually and as needed when there is a significant change in the service recipient's life.
OAC 340:100-5-52 is amended to:(1) ensure the plan is developed and agreed to with the informed consent of the individual or his or her guardian; (2) ensure the plan is signed by all individuals and providers responsible for the implementation of the plan; and (3) provide guidelines to avoid conflict of interests between service recipients and DDS staff.
OAC 340:100-5-53 is amended to update commonly used terms.
OAC 340:100-5-56 is amended to describe the approaches, supports services, and actions needed or used to reduce or eliminate safety risks identified in the assessment of risk for the service recipient.
OAC 340:100-5-57 is amended to:(1) include outcomes that target skill enhancement, health improvement, choice making, development of meaningful relationships, and community participation; (2) include guidelines when the Individual Plan (Plan) is amended when high risk events occur or are likely to reoccur; and (3) provide guidelines for mechanical restraint in a medical context.
Reasons.
The proposed amendments update and clarify DDS rules in accordance with federal and state laws and regulations. The Center for Medicare and Medicaid Services (CMS) issued a final rule on January 10, 2014, defining person-centered planning requirements.The proposed amendments meet those new requirements and provide clear guidance to staff to implement person-centered planning principles.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); and Sections, 441.301, 441.302, 441.715, 441.720, and 441.725 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 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 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 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 22, 2015; modified September 1, 2015; modified December 17, 2015; January 20, 2016.
SUBCHAPTER 3. ADMINISTRATION
PART 1. GENERAL ADMINISTRATION
340:100-3-14. Statewide Human Rights and Behavior Review Committee (SBRC) (SHRBRC)
Revised 9-15-16
(a) Purpose.Review and approval is required prior to the use of a restrictive or intrusive procedure except in emergencies per Oklahoma Administrative Code (OAC) 340:100-5-57.The Statewide Behavior Review Committee (SBRC) (SHRBRC) is established to review each restrictive or intrusive procedure included in a behavioral, protective intervention plan with restrictive or intrusive procedures protocol to ensure that the plan complies compliance with Development Disabilities Services Division (DDSD) (DDS) policy on the use of restrictive or intrusive procedures given in per OAC 340:100-5-57.
(1) The Personal Support Team (Team):
(A) ensures the protective intervention protocol complies with requirements per OAC 340:100-5-57;
(B) documents review, revision, and approval of the protective intervention protocol; and
(C) ensures the service recipient or his or her guardian participates in the development of the protective intervention protocol and provides written informed consent for protocol implementation.
(2) The case manager submits a protective intervention protocol containing restrictive or intrusive procedures to the SHRBRC for review per this Section.
(1)(3) The SBRC SHRBRC ensures that:
(A) each protective intervention plan protocol complies with requirements found in per OAC 340:100-5-57;
(B) each protective intervention plan protocol focuses on:
(i) prevention person-centered principles and positive procedures;
(ii) education to maximize the individual's growth and skill development in areas, such as communication and choice making;
(iii) staff training and conduct; and
(iv) other positive approaches; environmental and programmatic changes.
(C) due process is provided prior to the use of a each restrictive or intrusive procedure. is:
(i) Proper consents must be obtained. justified based on the severity and frequency of risk;
(ii) The restrictive or intrusive procedure must be the least restrictive alternative. and used only after less intrusive methods were determined ineffective; and
(iii) The protective intervention plan must comply with all applicable DDSD policy used only with the continued use of positive procedures.
(iv) Educational procedures must be in place to assist the individual in restoring the restricted right(s).
(v) Personal Support Team (Team) participation in developing the positive protective intervention plan must be documented.
(2)(4) In addition to review of protective intervention plans protocols containing restrictive or intrusive procedures, the SBRC SHRBRC may:
(A) review protective intervention plans protocols without restrictive or intrusive procedures if when requested by a member of the Team, or to address relevant concerns of committee members or others; or
(B) identify systems issues and make recommendations as appropriate to the DDS director of DDSD.
(b) Membership.The SBRC SHRBRC members are appointed by the DDS director of DDSD.
(1) The committee is chaired by the DDSD DDS director of psychological and behavioral supports or his or her designee.
(2) Other members are appointed in writing by the DDS director of DDSD for a three-year term of three years.Members and may be re-appointed.
(3) An associate chair is appointed by the chair to conduct committee business in the absence of the chair.
(4) The SBRC SHRBRC includes:
(A) at least three professional members with expertise in areas relating to the duties of the committee, including:
(i) positive behavior supports and educational methodologies;
(ii) issues involving client rights;
(iii) related medical or psychiatric issues; or
(iv) other qualifying experience as accepted by the DDSD DDS director.Documentation of members' additional credentials is maintained in the SBRC file of membership resumes by DDS;
(B) at least two individuals who receive DDSD DDS services or are a family member, guardian, or advocate of an individual who receives DDSD DDS services; and
(C) ex-officio, non-voting members as appropriate to assist in the business of the committee.The positive support field specialist serves as a non-voting member, when presenting proposals or plans present to discuss protective intervention protocols submitted by the Team.
(5)(4) At least one-half of the voting committee members must be present to conduct business.
(6)(5) No A professional whose protective intervention plan protocol is the subject of review may not vote on the his or her protocol approval of that plan.
(7)(6) No A member may not vote on an issue or recommendation if when there is a professional, pecuniary, or familial conflict of interest.
(8)(7) Members are required to protect the confidentiality of all records and information disclosed in carrying out the duties and activities of the committee.
(A) Each committee member is required to sign a confidentiality statement.
(B) Confidentiality is protected in all communications of the committee to non-members.
(c) Review by the positive support field specialist.The case manager, or provider agency program coordination staff member if there is no DDSD case manager, submits all protective intervention plans to the positive support field specialist for review to determine if the plan contains:
(1) restrictive or intrusive procedures requiring approval by the SBRC; or
(2) any significant deviation from acceptable standards of positive behavior supports.
(d) Due process.Due process is required prior to use of a restrictive or intrusive procedure, except in an emergency as defined in subsection (f) of OAC 340:100-5-57.For persons in a resource center or the Greer Center, review and approval by the resource center Behavior Review Committee (BRC) and Human Rights Committee (HRC) are required when restrictive or intrusive procedures are planned.
(e) Documentation of SBRC minutes and tracking SHRBRC reviews.The SBRC SHRBRC chairperson of the SBRC must maintain:
(1) a record of each meeting that includes:
(A) a summary of the disposition of each protective intervention plan protocol reviewed;
(B) a record of attendance; and
(C) the date of the meeting; and
(D) documentation of other issues discussed by the committee;
(2) a tracking system that allows for retrieval of information pertinent to:
(A) individual programs protective intervention protocols;
(B) program protective intervention protocol authors; and
(C) types of restrictions;
(D) general questions regarding programming which involve restrictive or intrusive procedures; and
(E) matters specific to the SBRC such as attendance and protective intervention plan review activities.
(f) Standards for protective intervention plans.Committee members examine each protective intervention plan developed in accordance with subsection (d) of OAC 340:100-5-57 to determine whether the plan meets all standards defined in OAC 340:100-5-57.
(g)(d) Recommendations Findings of the SBRC SHRBRC.All recommendations for required changes, or requests for additional information, and SHRBRC recommendations are supported by a consensus of the committee.
(1) Protective intervention plans protocols must be modified to accommodate the recommendations of the SBRC required SHRBRC changes and approved in accordance with per this Section prior to implementing the proposed restrictive or intrusive procedure(s).
(2) Educational supports in addition to those required by the protective intervention plan protocol may be required recommended by the SBRC SHRBRC to assist the Team in maximizing the individual's growth and skill development.Recommended supports address specific educational needs of the individual or training needs of the support staff and are designed to reduce or eliminate the need for restrictive or intrusive procedures.
(3) Additional medical evaluation(s) may be required recommended by the SBRCSHRBRC to determine if challenging behaviors are due to physical or medical conditions.
(4) If When the Team is resistant to positive approaches and preventions, the SBRC SHRBRC may recommend administrative action when deemed necessary.
(5) The SBRC SHRBRC is the final approval authority for protective intervention plans protocols that include a restrictive or intrusive procedure(s) procedures.
(6) SBRC approval is for no longer than one year and Continued use of the restrictive or intrusive procedure must be renewed reviewed and approved annually as long as the restrictive or intrusive procedure is in place.
(h)(e) Notification of the Team.The SBRC SHRBRC sends a copy of the SBRC minutes and a copy of protective intervention plan protocol review summary to the case manager.The review summary specifies whether the protective intervention plan protocol is:
(1) approved by a consensus of the committee;
(2) conditionally approved, with required information or changes to be provided within a time period SBRC SHRBRC specified by the SBRC time period; or
(3) conditionally approved with required educational supports or staff training as specified; or
(4) not approved, with required information or changes to be provided within a time period specified by the SBRC.The case manager convenes the Team within ten working 10-business days of receipt of the SBRC minutes and summary for SHRBRC review and makes necessary modifications to the protective intervention plan protocol.
(i)(f) Revisions and addenda to protective intervention plans protocols.Changes, revisions, and addenda Revisions to protective intervention plans protocols are conspicuously clearly marked when re-submitted to the SBRC SHRBRC.
(1) If When the information or revision requested by the SBRC SHRBRC is not provided within the time frame SHRBRC specified by the SBRC, the SBRC may require additional, more current information time period, the restrictive or intrusive procedure contained in the protective intervention protocol is considered not approved for use.
(2) If the Team's revision of the protective intervention plan does not contain the requested changes or information:When the Team is unclear on how to meet the SHRBRC requirements, they may request technical assistance from the positive support field specialist.
(A) the SBRC may request an administrative inquiry as provided by OAC 340:100-3-27 if the SBRC believes there are service deficiencies associated with the development of the protective intervention plan;
(B) the Team may request technical assistance from the positive support field specialist if they are unclear how to meet the requests of the SBRC; or
(3) The SHRBRC may request an administrative inquiry per OAC 340:100-3-27.1 when it determines there are service deficiencies associated with the development of the protective intervention protocol.
(4) the The Team may request a SHRBRC hearing of the SBRC, when presenting the later revision revisions, to provide an opportunity to further explain the direction taken in the protective intervention plan protocol.
(g) The Robert M. Greer Center (Greer).For persons served by Greer, review and approval by the center's Behavior Review Committee and HRC are required when restrictive or intrusive procedures are proposed.
340:100-3-15. SoonerStart [REVOKED]
Revised 5-15-08
(a) Purpose.SoonerStart Early InterventionProgram (SoonerStart) is a statewide, interagency, multidisciplinary system of services to families with children, birth to 36 months, who have developmental delays.Focusing on the family, SoonerStart seeks to:
(1) enhance the development of children served and minimize their potential for developmental delay;
(2) enhance and strengthen the abilities of families to meet the needs of children with developmental delays;
(3) reduce the need for special education and related services as these children reach school age; and
(4) maximize each child's potential for leading a productive life in the community as an adult.
(b) Eligibility.SoonerStart is available to all children deemed eligible regardless of income, custody status, or eligibility for other Oklahoma Department of Human Services (OKDHS) programs.A child who is eligible for SoonerStart must be age birth through two years, 0 to 36 months, and:
(1) exhibit a delay in his or her development of 50 percent or score two standard deviations below the mean in one or more domains of:
(A) cognitive development;
(B) physical development;
(C) communication development;
(D) social or emotional development; or
(E) adaptive development;
(2) exhibit a delay in his or her development of 25 percent or score one and one-half standard deviations below the mean in two or more domains of:
(A) cognitive development;
(B) physical development;
(C) communication development;
(D) social or emotional development; or
(E) adaptive development; or
(3) have a diagnosed physical or mental condition that has a high probability of resulting in delay, including, but not limited to:
(A) chromosomal disorders;
(B) neurological abnormalities;
(C) inborn errors of metabolism;
(D) genetic disorders;
(E) congenital malformation of the brain;
(F) congenital infections;
(G) sensory abnormalities and impairments; or
(H) other identified syndromes.
(c) Background and authority.SoonerStart is authorized by Section 1471 of Title 20 of the United States Code (20 U.S.C. § 1471) and Section 13-121 et seq. of Title 70 of the Oklahoma Statutes (70 O.S. § 13-121 et seq.), Oklahoma Early Intervention Act.
(1) 70 O.S. § 13-121 et seq. sets forth joint participation in funding and provision of services from:
(A) Oklahoma State Department of Education (OSDE);
(B) OKDHS;
(C) Oklahoma State Department of Health (OSDH); and
(D) Oklahoma Department of MentalHealth and Substance Abuse Services (ODMHSAS).
(2) OSDE is the designated lead agency for general administration, supervision, and monitoring of the SoonerStart program and activities.
(A) OSDH provides or arranges designated early intervention services.
(B) Oklahoma Commission on Children and Youth (OCCY) administers the Interagency Coordinating Council (ICC) for Early Childhood Intervention that advises and assists OSDE.ICC is composed of 15 to 25 members appointed by the Governor, including parents of children with disabilities and public and private agency representatives.
(d) Structure.SoonerStart is a multidisciplinary program that capitalizes on the resources and functions of participating agencies.
(1) OSDE, OSDH, OKDHS, and OCCY have designated staff to serve as SoonerStart coordinators for their agencies.The OKDHS SoonerStart coordinator is located in the Developmental Disabilities Services Division (DDSD).¢ 1
(2) Oklahoma is divided into ten service delivery regions with 26 SoonerStart sites.Larger regions have several SoonerStart sites that cover several counties.Each region consists of a regional coordinator and resource coordinators employed by OSDE and service providers employed by OSDH.
(A) The resource coordinators provide case management services to children and families.
(B) The regional coordinator supervises the resource coordinators and is responsible for direct linkage between the community, other agencies, local schools, and service providers in SoonerStart.
(C) OSDH service providers are responsible for the direct services to children and families.
(e) Direct services.SoonerStart uses a family-centered approach to arrange services for the child while helping the parent(s) understand and enhance the child's development.Services may include:
(1) diagnostic and evaluation services;
(2) case management;
(3) family training, counseling, and home visits;
(4) certain health and medical services;
(5) nursing services;
(6) nutrition services;
(7) occupational, physical, and speech-language therapy;
(8) audiological services;
(9) special instruction;
(10) social work services; and
(11) psychological services.
(f) Service provision.A multidisciplinary team evaluates the child for eligibility purposes and assesses the child's individual needs.The parent(s) participates in all aspects of the evaluation process.
(1) A written Individualized Family Service Plan (IFSP) is developed by the family and service providers based on the child's evaluation.
(2) The IFSP is the plan of action for services to the child and family taking into consideration the child's and family's strengths, priorities, and resources.
(3) Services are provided in the child's natural environment, such as the home, day care center, or other community setting that best meets the child's needs.
(g) Funding.There is no direct cost to families for services.Funding sources include Individuals with Disabilities Education Act, Medicaid (Title XIX), Maternal and Child Health (Title V), and state appropriated dollars.
(h) Referrals.Referrals are encouraged and accepted from all sources.¢ 2A parent(s) or other referral source may contact SoonerStart by phone, written, or personal contact.
(1) The referral process includes gathering information, such as child's name and birth date, parent(s)' name, phone number, and address, reason for referral, and other available information.
(2) When possible, the parent(s) is informed when a SoonerStart referral is made on behalf of the child.If the parent(s) is unsure about the referral or in need of more information, then SoonerStart may be contacted directly.The information can be mailed to the referral source to be shared with the parent(s) or mailed directly to the parent(s).
(i) Children in foster care.Children, younger than three years of age, placed in foster care through OKDHS are referred to SoonerStart.¢ 3Under the Oklahoma Early Intervention Act and special education federal regulations, the foster parent(s) serves as the child's parent(s) in giving consent for services and releasing information from SoonerStart to other agencies, including OKDHS.
(j) Transition.Eligibility for SoonerStart ends when the child attains three years of age.The child may then be eligible for special education services through the local school district.Children who do not meet the criteria for special education services are referred to appropriate community programs.
INSTRUCTIONS TO STAFF 340:100-3-15 [REVOKED]
Revised 5-15-08
1.Role of Oklahoma Department of Human Services (OKDHS) SoonerStart coordinator.The OKDHS SoonerStart coordinator is responsible for SoonerStart program maintenance within OKDHS that includes:
(1) serving as co-chair of SoonerStart Public Awareness Committee and coordinating with OKDHS Publications Unit to produce and publish SoonerStart brochures for distribution;
(2) coordinating with all agencies within the SoonerStart program as a representative of OKDHS;
(3) coordinating with OKDHS county office staff as a liaison for OKDHS SoonerStart;
(4) coordinating and tracking OKDHS Child Welfare Services referrals to SoonerStart; and
(5) training appropriate OKDHS staff on SoonerStart policy and procedures.
2.Role of OKDHS county office staff.The role of the OKDHS county office staff in the SoonerStart program includes:
(1) being knowledgeable about the SoonerStart program;
(2) making SoonerStart referrals for children who are potentially eligible for SoonerStart.If a child appears to experience developmental delays due to a health condition, premature birth, or any other factor, the child must be referred to SoonerStart to determine eligibility;
(3) assisting families with children receiving SoonerStart services to obtain any other services to further enhance the child's development; and
(4) contacting the OKDHS SoonerStart coordinator for information or inquiries concerning SoonerStart.
3.Children in foster care.Referrals to SoonerStart are made in accordance with OAC 340:75-6-88 Instructions to Staff.
PART 3. ADMINISTRATION
340:100-3-29. Foster Grandparent Program [REVOKED]
Revised 7-1-13
All foster grandparent volunteer activities and requests for volunteers 55 years of age or older are recorded and monitored through the Oklahoma Department of Human Services (OKDHS) Foster Grandparent Program Office, in accordance with the Domestic Volunteer Service Act (DVSA) of 1973, Public Law (P.L.) 93-113, as stated in the current Foster Grandparent Program Operations Handbook.
(1) Foster Grandparent Program volunteers provide services to persons younger than 22 years of age.
(2) Volunteers receive an hourly stipend if his or her total household income is within the National Senior Service Corps (NSSC) guideline.
(3) Volunteers provide services no more than 2,088 hours per year.
(4) Volunteers receive all benefits as stipulated in the Corporation for National and Community Service, CNCS Foster Grandparent Program Operations Handbook.
(5) Required criminal background and ongoing registry checks for potential foster grandparents.Prior to serving as volunteers and:
(A) annually thereafter, the volunteer must consent to his or her name being checked on the:
(i) Sex Offender Registry; and
(ii) Mary Rippy Violent Crime Offenders Registry;
(B) every three years thereafter, the volunteer must complete:
(i) the Developmental Disabilities Services Division (DDSD) Community Services Worker Registry;
(ii) an Oklahoma State Bureau of Investigation name and criminal records history search; and
(iii) a Department of Public Safety history.
(C) an Oklahoma State Bureau of Investigation name and criminal records history search;
(D) the Mary Rippy Violent Crime Offenders Registry; and
(E) a Department of Public Safety history.
(6) Prior to volunteering and annually thereafter, the foster grandparent must have an OKDHS vendor contract in force for travel, meals, or stipend reimbursement, when applicable.
(7) DDSD staff submits monthly expenditure reports to the OKDHS Finance Division federal programs accountant.
SUBCHAPTER 5. CLIENT SERVICES
PART 5. INDIVIDUAL PLANNING
340:100-5-50. Principles of individual planning
Revised 9-15-16
The intent of the Developmental Disabilities Services Division (DDSD) (DDS) is to secure services and supports for persons with developmental disabilities to live, work, and participate in their communities.The principles in this subsection Section provide direction and purpose in designing services and supports for persons with developmental disabilities.
(1) Understanding the ways in which a person with a developmental disability communicates with others is critical.Case managers, program coordinators, and other involved Personal Support Team (Team) members must actively solicit, listen to, and respond to the person's needs, ideas, and choices, whether these are communicated verbally or non-verbally.
(2) DDSD DDS employs a service person-centered planning, implementation, and monitoring process which focuses on the needs, desires, and choices that is an individually focused approach identifying the needs, preferences, goals, and desired outcomes of the person receiving services.
(3) The Individual Plan (Plan) process assures that ensures people receiving services have access to quality services and supports which that foster:
(A) independence, learning, and growth;
(B) choices in everyday life;
(C) meaningful relationships with family, friends, and neighbors;
(D) presence and full participation in their his or her communities community;
(E) dignity and respect;
(F) positive approaches aimed at focused on skill enhancement; and
(G) health and safety.
(4) The case manager ensures that the Team makes maximum use of services which are available to all citizens.
(5) Services and supports are provided, based on assessed needs as explained in per Oklahoma Administrative Code (OAC) 340:100-5-51.
(6) The case manager assures that ensures the services and supports developed by the Team support the person's own network of personal natural resources.The willing efforts of family members or friends to support areas of the person's life are not replaced with paid supports.¢ 1
(7) Planning focuses on the needs and outcomes which the person receiving services wishes wants to achieve.The Team first considers the preferences of the person receiving services first and then family, friends, and advocates secondarily.
(8) Each person served has a single, unified Plan.All services and supports are an integrated part parts of the Plan.Programs involving professional and specialized services are jointly developed to assure ensure integration of service outcomes.The Team ensures that services and supports:
(A) are integrated into the individual's daily activities important for the person to meet the needs identified through an assessment of functional need;
(B) take advantage of every opportunity for social inclusion are important to the person with regard to preferences for service delivery;
(C) reflect positive approaches aimed at skill enhancement are commensurate with the person's level of need and the scope of services available through Home and Community-Based Services (HCBS) Waivers; and
(D) make use of the least intrusive and least restrictive options. are integrated into the person's daily living;
(E) take advantage of every opportunity for social inclusion;
(F) reflect positive approaches focused on skill enhancement; and
(G) use the least intrusive and restrictive options.
(9) The case manager assures that ensures the Team identifies needed services and supports.
(A) If When services and supports are unavailable near the area of the person's home community, the case manager submits a list of such services and supports to the area manager for resource development.
(B) If When the Team identifies a lack of available services and supports as a barrier, the Team develops alternative strategies, using currently available services and supports, pending the development of additional resources.
(C) If When an identified service is not within the scope of the State's programs, the Team creatively seeks methods to meet the need.
INSTRUCTIONS TO STAFF 340:100-5-50
Revised 9-15-15
1.When the Personal Support Team develops strategies which that include the active involvement of family members and friends, the case manager ensures that those individuals fully understand what is asked of them and can realistically complete the necessary tasks.
340:100-5-51. Individual assessment
Revised 5-15-089-15-16
An individual assessment process forms the basis for developing an Individual Plan (Plan).
(1) Psychological, medical, social, and functional assessments are completed prior to the development of an initial Plan.
(2) The medical, social, and functional assessments are reviewed and updated at least annually.
(3) Consistent with the service recipient-directed focus of an In-Home Supports Waiver planning, the Developmental Disabilities Services Division (DDSD) (DDS) case manager completes a needs ensures completion or update of a person-centered assessment, and necessary assessments to support the need for services, with the service recipient at least annually, with the service recipient to form the basis for developing the Plan of Care.
(4) Consistent with a service recipient-centered focus, the DDSD case manager ensures completion of a review and update at least annually of necessary assessments to support the need for services, as well as assessment of the skills, supports, and needs of the service recipient through the Community Waiver and Homeward Bound Waiver.
(A) Assessments address the service recipient's needs and choices for supports and services related to:
(i) personal relationships;
(ii) home;
(iii) employment, education, or both;
(iv) transportation;
(v) health and safety;
(vi) leisure;
(vii) social skills; and
(viii) communication.
(B) The DDSD DDS case manager ensures early intervention and prevention by the Personal Support Team when changes occur.Events, such as the loss of a loved one, change in roommates, staff, schedules, health changes, or loss of a job prompt a re-assessment of needs, services, and supports.¢ 1
INSTRUCTIONS TO STAFF 340:100-5-51
Issued 9-15-16
1.The case manager requests a person-centered facilitator assist the Team when the service recipient:
(A) is new to residential services;
(B) has an increased number or intensity of behavioral incidents; or
(C) is dissatisfied with services.
340:100-5-52. The Personal Support Team (Team)
Revised 7-1-119-15-16
(a) The Personal Support Team (Team) is composed of people selected by the service recipient who know and work with the service recipient or whose participation is necessary to achieve the outcomes desired by the service recipient recipient's desired outcomes.
(1) To respect the service recipient's dignity and privacy of the service recipient, the Team is no larger than is necessary to plan for and implement the services needed to achieve the service recipient's desired outcomes.The Team is large enough to possess the expertise and capacity necessary to address the service recipient's needs, but not so large as to intimidate the service recipient or to stifle the service recipient's participation on the part of the service recipient or that of his or her representatives.
(2) At its The core, the Team includes the service recipient, his or her case manager, the legal guardian, and advocate(s), if there is one when applicable and, who may be a parent, a family member, a friend, or another individual who knows the service recipient well.The service recipient is assured the of his or her opportunity to select an individual to serve as an advocate.
(3) Depending on the service recipient's needs of the service recipient and the issues to be addressed, the Team may include others.The selection of these additional Team members reflects the service recipient's choices of the service recipient.
(b) The Team role of the Team is explained detailed in this subsection.
(1) Team members implement responsibilities identified in the Individual Plan (Plan) or in the Oklahoma Department of Human Services (OKDHS) (DHS) or Oklahoma Health Care Authority (OHCA) rules.Implementation of the Plan may only be delegated to persons who are appropriately qualified and trained.
(2) The Team develops the Plan and reviews and approves strategies, plans protocols, and guidelines developed to implement services or supports.
(3) The service recipient or his or her guardian participate in the development of the Plan and provide written, informed consent for the Plan's implementation.
(3)(4) The Team implements the Plan upon approval of the Plan of Care, and inclusion of service providers' signatures on the Plan signature sheet.
(4)(5) A copy of the Plan is maintained per Oklahoma Administrative Code (OAC) 340:100-3-40.All staff implementing the Plan must be knowledgeable about its contents and have access to a copy of the Plan.
(5)(6) Each Team member responsible for services identified in the Plan sends a quarterly summary of progress on assigned outcomes and action steps to the case manager.
(A) The quarterly summary of progress is due by the tenth 10th of:
(i) April for services rendered in January, February, and March;
(ii) July for services rendered in April, May, and June;
(iii) October for services rendered in July, August, and September; and
(iv) January for services rendered in October, November, and December, unless an alternative schedule is specified in the Plan.
(B) The quarterly summary of progress includes:
(i) whether services were provided as specified in per the Plan, and if not why; and
(ii) if the outcomes have been were achieved; or
(iii) the outcome progress status, of progress on the outcome if not achieved.
(c) The case manager role of the case manager is detailed in this subsection.
(1) Prior to the initial and each annual Team meeting, the case manager meets with the service recipient and the service recipient's his or her advocate or legal guardian, if there is one when applicable, to review the individual situation, including the service recipient's desired vision and progress in attaining the vision.Among the questions explored are whether the service recipient is satisfied with the results of the Plan and whether outcomes need to be revised, based on the progress achieved, or on changing circumstances in the service recipient's life.This review provides a clear agenda for the Team meeting and assures ensures the service recipient's input and participation.
(2) The case manager identifies available service providers for selection by the service recipient or legal guardian.
(3) The case manager ensures that the size and composition of the Team support the person-centered planning process.
(A) The case manager plans for the participation of people whom the service recipient desires to have wants on the Team, people whose services are needed to achieve identified outcomes, and people who know the service recipient best.The case manager sends written notice of the annual meeting to all Team members written notice of the meeting, at least two weeks in advance of the annual Team meeting.¢ 1
(B) Planning may occur in Team meetings or through individual or small group consultation according to the desires service recipient's wants and needs of the service recipient.
(C) The case manager notifies a Team member by letter that when his or her services on the Team are no longer required:
(i) at the request of the service recipient or the legal guardian; or
(ii) if when the performance of the Team member reveals a course of action that:
(I) is not in the best interest of the service recipient;
(II) is destructive toward the collaborative process of the Team; or
(III) violates OKDHS DHS or OHCA rules or accepted standards of professional practice.
(4) Unless the service recipient elects to chair his or her own meetings, the case manager serves as chair of the Team.
(5) The case manager empowers and supports the service recipient in setting the direction for the Team and in actively participating in Team meetings.
(6) The case manager writes or revises the Plan based on input from the Team.
(7) The case manager assists the Team in developing strategies, plans protocols, and guidelines to achieve the outcomes desired service recipient's preferred or needed by the service recipient outcomes.
(8) The case manager monitors all aspects of the Plan's implementation per OAC 340:100-3-27.
(9) The case manager routinely asks the service recipient, and his or her family, guardian, or advocate about their satisfaction with services and supports, and initiates appropriate action to identify and resolve barriers to consumer satisfaction.¢ 2
(10) The case manager convenes Team meetings as needed.
(A) The Team, as needed, evaluates whether if the Plan and its components are meeting the service recipient's objectives of the service recipient.
(B) The case manager convenes may convene a Team meeting, when needed, at the request of any Team member.
(C) Meetings are held at times and locations convenient for the service recipient.¢ 3
(11) Case manager responsibilities are carried out by provider-agency program coordination staff when the service recipient receives state funded employment, state funded group home, or assisted living services without waiver supports.Each person filling this role in a provider agency must have a minimum of four years of any combination of college level education and full-time equivalent experience in serving persons with disabilities, unless this requirement is waived in writing by the DDSD DDS director or designee.
(12) The planning process must:
(A) reflect the service recipient's cultural considerations;
(B) be provided in plain language in an accessible manner; and
(C) provide needed language services or aids.
(13) In order to avoid a conflict of interest, DDS staff including the case manager, case management supervisor, and plan of care reviewer must not:
(A) be related by blood or marriage to the service recipient, or any paid service provider for the service recipient;
(B) be financially responsible for the service recipient;
(C) be empowered to make financial or health related decisions for the service recipient; or
(D) hold a financial interest in any entity paid to provide care for the service recipient.
INSTRUCTIONS TO STAFF 340:100-5-52
Revised 6-1-109-15-16
1.If When a key person cannot attend the meeting, the case manager secures written or verbal input from that person prior to the meeting.
2.Since the absence of a complaint does not necessarily imply satisfaction, the case manager initiates action to resolve barriers when:
(1) progress towards toward identified outcomes is not occurring; and
(2) the person's identified needs are not addressed or met.
3.When applicable, the case manager coordinates the times and locations of meetings with the service recipient's legal guardian.
340:100-5-56. Risk assessment
Revised 9-15-16
The personal support team (Team) completes an assessment which that identifies:
(1) potential areas in which where the individual's service recipient's safety is at risk, including physical, emotional, medical, financial, or legal risks, or risk to community participation; and
(2) the frequency and degree of potential harm to the individual or others; and
(3) why, when, where, and how often the risk to safety may occur, including:;
(A) issues such as circumstances, places, conditions, or times in the individual's surroundings;
(B) early signs, clues, or other indicators of potential safety risks;
(C) the actions and communications of the individual and others, including staff;
(D) the individual's understanding of risk;
(E) the individual's skills and concepts which impact safety risks, including:
(i) communication;
(ii) coping;
(iii) educational;
(iv) social;
(v) self-reliance;
(vi) leisure;
(vii) vocational; and
(viii) relationships;
(F) the individual's past experience;
(G) medical, psychiatric, or pharmacological issues;
(H) recent or predictable changes in the person's life; and
(I) previous incidents in which the individual's safety was at risk;
(4) discussion of previous supports, services, and strategies that have been effective or ineffective in preventing or reducing the risks; and
(5) services and supports which are needed.
(3) the approaches, supports, services, and the actions needed or used to reduce or eliminate the risk, including:
(A) assisting the service recipient in having as much control and decision-making abilities as possible;
(B) changes in the environment to reduce stressors;
(C) communication between team members;
(D) consistency of provider-agency support staff;
(E) daily activities;
(F) frequency and quality of supervision;
(G) offering positive activities;
(H) prescribing staff training when additional training is needed;
(I) recognition of early signs or indicators of potential risks;
(J) skill building;
(K) supporting the individual in communicating choices;
(L) teaching coping skills;
(M) temporarily avoiding situations too difficult or uncomfortable for the service recipient; and
(N) understanding how and what the person is communicating.
340:100-5-57. Protective intervention plan protocol
Revised 5-15-089-15-16
(a) Purpose.The purpose of protective intervention protocol is to ensure the service recipient's safety, if when physical, emotional, medical, financial, legal, or community participation issues place the service recipient at risk.
(b) Elements of the protective intervention plan protocol.The protective intervention plan protocol is part of the Individual Plan (Plan) developed with the participation of the service recipient and Personal Support Team (Team).
(1) The protective intervention plan protocol:
(A) addresses all the elements of the risk assessment uses the least restrictive approaches necessary to address safety risks identified in the safety risk assessment, per Oklahoma Administrative Code (OAC) 340:100-5-56;
(B) identifies the early signs, clues, or other indicators of potential safety risks;
(B)(C) describes preventative supports, services, and actions to be taken take in order to reduce or eliminate safety risks; as needed, including:
(i) requirements or changes in theservice recipient's environment; and
(ii) program and service requirements including:
(I) consistency of support staff;
(II) frequency and quality of supervision and oversight of support staff;
(III) communication between Team members;
(IV) daily activities;
(V) an educational plan with teaching methods for learning skills and concepts;
(VI) detailed instructions for staff interaction with the service recipient or others if necessary; and
(VII) recognition of early signs, clues, or other indications of potential safety risk;
(C)(D) describes detailed instructions and procedures to be taken by staff and Team members during a situation that places the safety of the service recipient or others at risk, including:
(i) procedures that to keep the service recipient and others who may be affected as safe as possible;
(ii) steps to defuse, reduce, or eliminate the harm or injury; and
(iii) protocols procedures for securing assistance from other Team members or provider agency staff;
(D)(E) includes education components that: outcomes targeting skill enhancement, health improvement, choice making, development of meaningful relationships, and participation in the community;
(i) assess and identify educational objectives and specify how the objectives relate to the challenging issues;
(ii) describe teaching methods in sufficient detail to provide clear direction to support staff to assist the service recipient in learning relevant skills; and
(iii) affirm the dignity of the service recipient;
(E)(F) prescribes staff training when additional training is needed describes teaching methods in sufficient detail to provide clear direction to provider agency support staff to assist the service recipient learn relevant skills;
(F)(G) identifies methods and time frames to evaluate the effectiveness of the protective intervention plan protocol;
(G)(H) is revised when circumstances change or the plan protective intervention protocol is no longer effective;
(H)(I) treats the service recipient with dignity and is reasonable, humane, practical, not controlling, and the least restrictive alternative; and
(I)(J) is submitted to the positive support field specialist and Human Rights Committee (HRC) for review at least annually, if when the plan imposes a restrictive or intrusive procedure; and
(2) The Team may request the services of appropriate professionals, if needed, in the development of protective intervention plans is submitted to the Statewide Human Rights Behavior Review Committee (SHRBRC) per OAC 340:100-3-14.
(3) Staff instructions regarding management of risks or challenging issues are prohibited unless developed by the Team per OAC 340:100-5-57.
(4) Staff meets all training and in-service requirements set forth in OAC 340:100-3-38.
(c) Serious risk or dangerous behavior.If When a protective intervention plan protocol addresses challenging behaviors that create serious risk of physical injury or harm to the service recipient or others, creates a risk of involvement in the civil or criminal processes, or places at serious risk the service recipient's physical safety, environment, relationships, or community participation, the protective intervention plan protocol must be developed and overseen by the Team and an appropriately licensed professional or a family trainer approved by Developmental Disabilities Services Division (DDSD) (DDS) with the assistance of the positive support field specialist.
(d) Restrictive or intrusive procedures.If When the Team determines restrictive or intrusive procedures, per OAC 340:100-1-2, are essential for safety, the Team must develop a protective intervention plan protocol with the assistance of a DDSD DDS positive support field specialist.
(1) In addition to the requirements of in OAC 340:100-5-57(b) of this Section, each protective intervention plan containing a restrictive or intrusive procedure the Team must:
(A) include sufficient justification for the use of a restrictive or intrusive procedure, including:
(i) current information on describe the severity and frequency of the problem risk or dangerous behavior;
(ii) summary of relevant incident reports over the last six months; and
(iii) any other related information;
(B) address any limitations placed on the service recipient's access to goods, services, and activities, and document the Team's plan to restore access to such;
(C) include instructions to staff on how to:
(i) calm the service recipient during dangerous or disruptive episodes;
(ii) take appropriate action to protect the service recipient, staff, and others when the service recipient's behavior is dangerous;
(iii) call for assistance when necessary; and
(iv) prevent the misuse of restrictive and intrusive procedures identify positive approaches used prior to implementing the restrictive or intrusive procedure;
(D) collect and report data for the prescribing physician per OAC 340:100-5-26.1 ensure the procedures cause no harm to the service recipient; and
(E) include a description of describe methods to help the service recipient develop skills that serve the same function as, or reduce or eliminate the possibility of, the dangerous behavior or serious risk.These methods must be individualized and provide clear direction to provider agency support staff to develop the service recipient's pro-social and coping skills.
(2) The Team must submit each protective intervention plan containing a restrictive or intrusive procedure to the HRC and Statewide Behavior Review Committee (SBRC).
(e) Physical management.Physical management or restraint, per OAC 340:100-1-2, is used only used to prevent physical injury.Prompting that does not restrict the service recipient's movement or choice is not considered physical management or restraint. Any protective intervention plan protocol that includes a physical management component requires the Team to:
(1) identify whether if the service recipient has any health concerns related to the use of physical management, or restraint, or any other intrusive method proposed;
(2) ask the service recipient's physician or the University of Oklahoma College of Pharmacy DDS pharmacy director to assess whether the current medication regimen would pose poses any risk for the service recipient under due to the stress of the physical management procedure;
(3) include in the planning sessions a DDSD DDS approved trainer of physical management procedures in the planning sessions.
(A) The trainer:
(i) makes recommendations about the effectiveness and safety of the physical management procedure in particular environments;
(ii) assists the Team in identifying alternative approaches when standard procedures do not appear appropriate for the service recipient or the situation; and
(iii) identifies existing physical obstacles to the implementation of a procedure for particular staff.
(B) The Team includes the trainer's recommendations in the physical management component;
(4) identify any situation in which physical management procedures cannot be used as such use would be because they are unsafe or ineffective per this subsection; and
(5) comply with OAC 340:100-5-57(f) of this Section; and
(6) submit the protective intervention plan to the SBRC or resource center Behavior Review Committee (BRC) per OAC 340:100-3-14.The SBRC or resource center BRC notifies the Team:
(A) to proceed with implementation of the protective intervention plan; or
(B) when the physical management component is not approved and must be redrafted or removed pursuant to recommendations.
(f) Emergency intervention.Emergency intervention is the use of a restrictive or intrusive procedure not included in a protective intervention plan protocol, in response to an unanticipated and unpredictable situation or event or the sudden occurrence of an event so severe and dangerous that urgent action precludes less restrictive measures.Physical management, per OAC 340:100-1-2, is only used only during emergencies to ensure physical safety and prevent injury.
(1) Emergency intervention:
(A) cannot be used as a substitute for positive approaches or a protective intervention plan protocol; and
(B) is used for no longer than necessary to eliminate the clear and present danger of serious physical harm to the service recipient or others.
(2) Physical management must be terminated as soon as the service recipient is calm or the threat has ended and must not exceed two minutes at a time with attempts to release every two minutes to ensure the safety of the service recipient.
(3) When responding to an emergency, no one may authorize or use an amount of force that exceeds that which what is reasonable and necessary under the circumstances to protect the service recipient or others.
(4) Any person who has reason to believe that abuse has occurred is responsible to contact the appropriate authorities.
(g) Expedited Temporary approval of restrictive or intrusive procedures.After the first use of an emergency restrictive or intrusive procedure, if when the Team in consultation with the positive support field specialist determines the use of a restrictive or intrusive procedure must be continued to ensure the safety of the service recipient or others, the positive support field specialist or DDSD DDS director of psychological and behavioral supports may provide temporary immediate approval of for continued use of restrictive or intrusive procedures.
(1) The DDSD DDS case manager contacts the positive support field specialist to request expedited temporary approval of restrictive or intrusive procedures to protect the service recipient or others from serious physical harm.
(2) The positive support field specialist approves or denies the request for use of emergency interventions using Form 06MP042E, Request for Expedited Temporary Approval of Restrictive Procedures.
(A) If the expedited temporary request is approved, the positive support field specialist assists the Team in ensuring needed structure and training are in place for safe and proper implementation of the emergency interventions.
(B) Expedited Temporary approval of use of emergency interventions lasts no longer than 45 60-calendar days.
(3) Form 06MP042E must be completed and provide sufficient information to demonstrate positive supports were attempted, and the danger of severe harm still exists.At a minimum, required information includes all incident reports from the last three months, with details on the harm caused and other indications of severity, as well as a description of existing positive supports and services.
(4) A DDS trainer of DDSD approved physical management procedures provides training regarding the authorized intrusive procedure.
(5) To continue using the temporarily approved restrictive or intrusive, procedure, the Team must submit, within 25 60-calendar days following approval, a protective intervention plan protocol that incorporates the requested procedures.If When the submitted protective intervention plan protocol does not receive SBRC SHRBRC approval, SBRC SHRBRC may extend the expedited temporary approval if when SBRC SHRBRC determines conditions warrant extension, for a maximum of 45 an additional 60-calendar days.
(h) Review and revision of the Individual Plan (Plan).The Plan is reviewed and, as necessary, revised when an unexpected high risk event occurs and is likely to reoccur.
(1) Review and revision to the Plan is appropriate when the:
(A) service recipient was recently seen in a hospital emergency room due to a behavioral crisis;
(B) service recipient was recently admitted to a psychiatric facility for stabilization;
(C) police were called to intervene because the service recipient is displaying challenging behavior; and
(D) service recipient was placed in police custody as the result of his or her challenging behavior.
(2) Team planning shall include, at a minimum:
(A) consultation with the positive support field specialist;
(B) a review of recent events, including challenging behaviors;
(C) identification of the signs or behaviors indicating the event may reoccur;
(D) assisting the service recipient to develop an individualized safety plan;
(E) detailed action steps for provider agency support staff to follow, when the predicted situation occurs; and
(F) consultation with other professional services, when appropriate.
(i) Mechanical restraint in a medical context.Restraints and mechanical supports used in a medical context are exempt from (d) of this Section requirements.These exemptions include, but are not limited to:
(1) sedation prescribed by a physician or dentist prior to a medical or dental procedure;
(2) restraints used to control the movement of the service recipient during a time sensitive and necessary medical or dental procedure;
(3) time limited restraints to promote healing following a medical procedure or injury;
(4) devices prescribed by a physician, physical therapist, or an occupational therapist to maintain body alignment or otherwise support or position a service recipient;
(5) devices normally used for safety reasons, such as car seats or seat belts;
(6) helmets used to protect a service recipient from injury during or following a seizure;
(7) bed rails used to keep a service recipient from falling out of bed; or
(8) wheelchair brakes, unless used for the purpose of restricting mobility.
