SECTION 317:35-15-8. Agency personal care service authorization and monitoring

(a)   Within 10-business days of receipt of the referral for personal care services, the personal care provider agency nurse completes a Service Authorization Model (SAM) visit in the home to assess the member's personal care service needs, completes a SAM packet based on the member's needs and submits the packet to the DHS nurse. The member's SAM packet includes DHS Forms:

(1)   02AG044E, Personal Care Progress Notes;

(2)   02AG030E, Personal Care Planning Schedule/Service Plan; and

(3)   02AG029E, Personal Care Plan.

(b)   When more than one person in the household was referred to receive personal care or ADvantage services, all household members' SAM packets are discussed and developed with the eligible members so service delivery is coordinated to achieve the most efficient use of resources. The number of units of personal care service authorized for each individual is distributed between all eligible family members to ensure that the absence of one family member does not adversely affect the family member(s) remaining in the home. When one or more persons in the same household with a epersonal care member were referred to or are receiving other formal services, such as ADvantage or Developmental Disability Services, then those services are coordinated as well.

(c)   The personal care provider agency receives documentation from DHS as authorization to begin services. The agency delivers a copy of the care plan Form 02AG029E and the Personal Care Planning Schedule/Service Plan to the member upon initiating services.

(d)   Prior to placing a personal care assistant (PCA) in the member's home or other service-delivery setting by the provider agency, an Oklahoma State Bureau of Investigation (OSBI) background check, an Oklahoma State Department of Health Registry check, and an DHS Community Services Worker Registry check must be completed per Sections 1-1944 through 1-1948 of Title 63 of the Oklahoma Statutes. Payment is made for PCAs who provide personal care services and meet criteria OAC 317:35-15-2(c)(1) 1 through 8).

(e)   The provider agency nurse monitors the member's plan of care.

(1)   The personal care provider agency contacts the member within five-business days of receipt of the authorized document in order to ensure services were implemented according to the authorized plan of care.

(2)   The provider agency nurse makes a SAM home visit at least every six months to assess the member's satisfaction with his or her care and to evaluate the SAM packet for adequacy of goals and authorized units. Whenever a home visit is made, the provider agency nurse documents findings in the Personal Care Progress Notes. The provider agency forwards a copy of the Progress Notes to the DHS nurse for review within five-business days of the visit. The monitoring visit may be conducted by a Licensed Practical Nurse (LPN) only when the PCA is not performing hands-on personal care. A Registered Nurse (RN) must also co-sign the progress notes.

(3)   Requests by the provider agency nurse to change the number of units authorized in the SAM packet are submitted to (DHS) and are approved or denied by the (DHS) area nurse or designee, prior to changed number of units unit implementation.

(4)   Annually, or more frequently when the member's needs change, the provider agency nurse re-assesses the member's need's and develops a new SAM packet to meet the member's needs. The provider agency nurse conducts a home visit and completes and submits the annual reassessment documents to the DHS nurse no sooner than 60-calendar days before the existing service plan end-date, and no later than 14-calendar days prior to service.

(5)   When the member is unstaffed, the provider agency communicates with the member and makes efforts to re-staff. It is recommended the provider agency contacts unstaffed members weekly by phone to actively monitor the health and safety of the member and documents ongoing efforts to provide staff. When the member is unstaffed for 30-calendar days, the provider agency notifies the DHS nurse on Form 02AG032E, Provider Communication Form. The DHS nurse contacts the member and when the member chooses, initiates a transfer of the member to another provider agency that can provide staff.

[Source: Added at 12 Ok Reg 753, eff 1-6-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3133, eff 7-27-95; Amended at 14 Ok Reg 56, eff 4-30-96 (emergency); Amended at 14 Ok Reg 1802, eff 5-27-97; Amended at 15 Ok Reg 25, eff 9-18-97 (emergency); Amended at 15 Ok Reg 1554, eff 5-11-98; Amended at 17 Ok Reg 2410, eff 6-26-00; Amended at 18 Ok Reg 2969, eff 5-17-01; Amended at 19 Ok Reg 1071, eff 5-13-02; Amended at 20 Ok Reg 1069, eff 4-1-03 (emergency); Amended at 20 Ok Reg 1943, eff 6-26-03; Amended at 24 Ok Reg 95, eff 8-2-06 (emergency); Amended at 24 Ok Reg 945, eff 5-11-07; Amended at 26 Ok Reg 549, eff 2-1-09 (emergency); Amended at 26 Ok Reg 2140, eff 6-25-09; Amended at 30 Ok Reg 1259, eff 7-1-13; Amended at 32 Ok Reg 1142, eff 8-27-15; Amended at 34 Ok Reg 726, eff 9-1-17]