SECTION 317:40-1-2. Authorization for Residential Supports in the Community Waiver

(a)   Applicability. The rules in this Section apply to services provided through the Community Waiver, specifically:

(1)   those services identified in OAC 340:100-5-22.1, Community Residential Supports; and

(2)   group home services.

(b)   General Information. Waiver services are provided to supplement, and do not replace, existing non-Waiver, natural, or informal supports a service recipient receives. Waiver services support the service recipient to remain with his or her family and in the community. Service recipients and their Teams must examine all other service options prior to seeking residential supports. The criteria in subsection (c) of this Section are used to determine the necessity of residential supports.

(c)   Necessity of Residential Supports. If the service recipient is unable to care for himself or herself, the Team may request residential supports if the supports requested comply with OAC 340:100-3-33.1, Criteria to establish service necessity, and:

(1)   there is no caretaker to provide needed care to the service recipient;

(2)   the service recipient's caretaker, as defined in Section 10-103 of Title 43A of the Oklahoma Statutes:

(A)   has moved into a nursing facility;

(B)   is age 70 or older;

(C)   is permanently incapacitated; or

(D)   has died;

(3)   there is a risk of abuse or neglect to a service recipient in the current home as evidenced by;

(A)   recurrent involvement of the Oklahoma Department of Human Services Division of Children and Family Services (DCFS) or Adult Protective Services (APS) as documented by the case manager that indicates the service recipient's health and safety cannot be assured and attempts to resolve the situation are not effective with DCFS or APS involvement; or

(B)   removal from the home by DCFS or APS;

(4)   direct support services required to enable a service recipient to remain in his or her current home exceed the cost of residential supports;

(5)   the behavior of the service recipient is such that others are at risk of being seriously harmed by the service recipient, and sufficient supervision cannot be provided to ensure the safety of those in the home or community as evidenced by:

(A)   documentation from DCFS or APS;

(B)   medical records from previous injuries;

(C)   incident reports or other documentation from service providers; or

(D)   police reports;

(6)   the service recipient's medical, psychiatric, or behavioral challenges are such that the service recipient is seriously injuring or harming himself or herself, or is in imminent danger of doing so as evidenced by any of the items listed in subparagraphs (A) through (D) of paragraph (5) of this subsection;

(7)   the Legislature has appropriated special funds to serve a specific group or a specific class of individuals;

(8)   as a temporary resolution to an emergency situation as defined in subsection (e) of this Section; or

(9)   if residential supports are approved as part of a transition plan for a person leaving an ICF/MR.

(d)   Approval of Residential Supports. When the Team requests residential supports, the case manager submits the documentation of relevant factors from subsection (c) of this Section to the Developmental Disabilities Services Division (DDSD) division director or designee. The director or designee approves or denies the request prior to the delivery of residential supports.

(e)   Emergency temporary residential supports. Emergency temporary residential supports are authorized as described in this subsection.

(1)   When an emergency situation exists in which temporary residential supports are requested by the Team, the case manager submits the justification for the services and a signed proposal developed by DDSD and the caregiver to the DDSD division director or designee. The proposal must include:

(A)   criteria of what must occur for the service recipient to return to his or her home;

(B)   a projected timeframe for the service recipient to return to his or her home; and

(C)   an acknowledgment by the caregiver that residential services are temporary.

(2)   The division director or designee reviews the documentation and approves or denies the request prior to the delivery of emergency temporary residential supports.

(3)   If an extension is required, the case manager submits additional information regarding the need for the extension and the new projected date for the service recipient to return to his or her home. Any extensions which are granted must also:

(A)   be approved prior to service delivery;

(B)   be time limited; and

(C)   include criteria for return home.

(f)   Appeals. The denial of a request for residential supports may be appealed through the hearing process described in OAC 340:2-5-61.

(g)   Options. When community residential supports, as defined in OAC 340:100-5-22.1, are needed, as described in OAC 340:100-3-33.1, the service recipient or guardian selects a community residential option that meets the needs of the service recipient, taking into consideration the available resources.

(1)   The options are:

(A)   Specialized Foster, as described in OAC 317:40-5-50 through 40-5-76;

(B)   Group Home services, as described in Oac 317:40-5-152;

(C)   Agency Companion, as described in OAC 317:40-5-1 through 40-5-39;

(D)   Daily Living Supports, as described in OAC 317:40-5-150 and OAC 317:40-5-152; and

(E)   Prader-Willi services.

(2)   The Team plans community residential supports to meet the service recipient's needs in accordance with:

(A)   DDSD community residential supports rules found at OAC 340:100-5-22.1; and

(B)   the program policy established for the specific community residential option cited in paragraph (1) of this subsection.

[Source: Added at 23 Ok Reg 1396, eff 5-25-06]