SECTION 317:40-5-102. Nutrition Services

(a)    Applicability. The rules in this Section apply to nutrition services authorized for members who receive services through Home and Community-Based Services (HCBS) Waivers operated by the Oklahoma Department of Human Services (OKDHS) Developmental Disabilities Services Division (DDSD).

(b)   General information. Nutrition services include nutritional evaluation and consultation to members and their caregivers, are intended to maximize the member's health and are provided in any community setting as specified in the member's Individual Plan (IP). Nutrition services must be prior authorized, included in the member's Individual Plan (IP) and arrangements for this service must be made through the member's case manager. Nutrition service contract providers must be licensed in the state where they practice and registered as a dietitian with the Commission of Dietetic Registration. Each dietitian must have a current provider agreement with the Oklahoma Health Care Authority (OHCA) to provide Home and Community Based Services, and a SoonerCare provider agreement for nutrition services. Nutrition Services are provided per Oklahoma Administrative Code (OAC) 340:100-3-33.1. In order for the member to receive Waiver-funded nutrition services, the requirements in this Section must be fulfilled.

(1)   The member must be assessed by the case manager to have a possible eating problem or nutritional risk.

(2)   The member must have a physician's order for nutrition services current within one year.

(3)   Per OAC 340:100-5-50 through 58, the team identifies and addresses member needs.

(4)   Nutrition services may include evaluation, planning, consultation, training and monitoring.

(5)   A legally competent adult or legal guardian who has been informed of the risks and benefits of the service has the right to refuse nutrition services per OAC 340:100-3-11. Refusal of nutrition services must be documented in the Individual Plan.

(6)   A minimum of 15 minutes for encounter and record documentation is required.

(7)   A unit is 15 minutes.

(8)   Nutrition services are limited to 192 units per Plan of Care year.

(c)    Evaluation. When arranged by the case manager, the nutrition services contract provider evaluates the member's nutritional status and completes the Level of Nutritional Risk Assessment.

(1)   The evaluation must include, but is not limited to:

(A)   health, diet, and behavioral history impacting on nutrition;

(B)   clinical measures including body composition and physical assessment.

(C)   dietary assessment, including:

(i)   nutrient needs;

(ii)   eating skills;

(iii)   nutritional intake; and

(iv)   drug-nutrient interactions; and

(D)   recommendations to address nutritional risk needs, including:

(i)   outcomes;

(ii)   strategies;

(iii)   staff training; and

(iv)   program monitoring and evaluation.

(2)   The nutrition services contract provider and other involved professionals make recommendations for achieving positive nutritional outcomes based on the risks identified on the OKDHS Level of Nutritional Risk Assessment.

(3)   The nutrition services contract provider sends a copy of the Level of Nutritional Risk Assessment to the case manager within ten working days of receipt of the authorization.

(4)   If the evaluation shows the member rated as High Nutritional Risk, the nutrition services contract provider sends a copy of the Level of Nutritional Risk Assessment to the DDSD area nutrition therapist or DDSD area professional support services designee as well as the case manager within 10 working days of receipt of the authorization.

(d)   Planning. The DDSD case manager, in conjunction with the Team, reviews the identified nutritional risks that impact the member's life.

(1)   Desired nutritional outcomes are developed and integrated into the Individual Plan using the least restrictive, least intrusive, most normalizing measures that can be carried out across environments.

(2)   The Team member(s) identified responsible in the Individual Plan develops methods to support the nutritional outcomes, which may include:

(A)   Stragegies;

(B)   Staff training; or

(C)   Program monitoring.

(3)   When the member has been receiving nutrition services and nutritional status is currently stable and the Team specifies that nutrition services are no longer needed, the Team will identify individual risk factors for the member that would indicate consideration of the resumption of nutrition services and assigns responsibility to a named Team Member(s) for monitoring and reporting the members status regarding these factors.

(4)   Any member who receives paid 24 hour per day supports and requires constant physical assistance and mealtime intervention to eat safely, or is identified for risk of choking or aspiration must have an individualized mealtime assistance plan developed and reviewed at least annually by the Team member(s) identified responsible in the Individual Plan. Team members may include a nutrition services contract provider and a speech therapy contract provider or occupational therapy contract provider with swallowing expertise (mealtime therapists). Documentation should delineate responsibilities to insure there is no duplication of services. The mealtime assistance plan includes but is not limited to:

(A)   a physician ordered diet;

(B)   diet instructions;

(C)   positioning needs;

(D)   assistive technology needs;

(E)   communication needs;

(F)   eating assistance techniques;

(G)   supervision requirements;

(H)   documentation requirements;

(I)   monitoring requirements; and

(J)   training and assistance.

(5)   For those members receiving paid 24 hour per day supports and nutrition through a feeding tube, the Team develops and implements strategies for tube feeding administration that enables members to receive nutrition in the safest manner and for oral care that enables optimal oral hygiene and oral-motor integrity as deemed possible per OAC 340:100-5-26. The Team reviews the member's ability to return to oral intake following feeding tube placement and annually thereafter in accordance with the member's needs.

(e)   Implementation, Consultation and Training. Strategies are implemented by the assigned person within a designated time frame established by the Team based on individual need(s).

(1)   Direct support staff members are trained per the Individual Plan and OAC 340:100-3-38.

(2)   All special diets, nutritional supplements, and aids to digestion and elimination must be prescribed and reviewed at least annually by a physician.

(3)   Consultation to members and their caregivers is provided as specified in the IP.

(4)   Program documentation is maintained in the member's home record for the purpose of evaluation and monitoring.

(5)   The contract professional provider(s) sends documentation regarding the member's program concerns, recommendations for remediation of any problem area and progress notes to the case manager per OAC 340:100-5-52.

(A)   The designated professional(s) reviews the program data submitted for:

(i)   completeness;

(ii)   consistency of implementation; and

(iii)   positive outcomes.

(B)   When a member is identified by the Level of Nutritional Risk Assessment to be at high nutritional risk, he or she receives increased monitoring by the nutrition services contract provider and health care coordinator, as determined necessary by the Team.

(C)   Significant changes in nutritional status must be reported to the case manager by the health care coordinator.

(D)   The Level of Nutritional Risk Assessment:

(i)   is used by the nutrition services contract provider to reassess members at high risk on a quarterly basis; and

(ii)   must be submitted by the nutrition services contract provider to the DDSD area nutrition therapist or DDSD area professional support services designee within 15 days following the end of each quarter.

[Source: Reserved at 18 Ok Reg 1168, eff 5-11-01; Added at 19 Ok Reg 795, eff 1-25-02; Added at 19 Ok Reg 1289, eff 5-28-02; Amended at 23 Ok Reg 1396, eff 5-25-06; Amended at 27 Ok Reg 1509, eff 6-11-10]