SECTION 317:40-5-110. Authorization for Habilitation Training Specialist Services

(a)   Habilitation Training Specialist (HTS) Services are:

(1)   authorized as a result of needs identified by the team and informed selection by the SoonerCare member;

(2)   shared among SoonerCare members who are members of the same household or being served in the same community location;

(3)   authorized only during periods when staff are engaged in purposeful activity which directly or indirectly benefits the service recipient. Staff must be physically able and mentally alert to carry out the duties of the job. At no time are HTS services authorized for periods during which the staff are allowed to sleep;

(4)   not authorized to be provided in the home of the HTS unless the SoonerCare member and HTS reside in the same home; and

(5)   directed toward the development or maintenance of a skill in order to achieve a specifically stated outcome. The service provided is not a function which the parent would provide for the individual without charge as a matter of course in the relationship among members of the nuclear family when the member resides in a family home.

(b)   HTS Services may be provided in a group home as defined in 317:40-5-152 or community residential service settings defined in OAC 340:100-5-22.1 including:

(1)   agency companion services as described in OAC 317:40-5-1 through 40-5-39;

(2)   as provided in accordance with Daily Living Supports policy at OAC 317:40-5-150; and,

(3)   as provided in accordance with Specialized Foster Care Policy at OAC 317:40-5-50 through 40-5-76; or

(4)   services for people with Prader Willi syndrome.

(c)   HTS Services are based on need and limited to no more than 12 hours per day per household in any setting other than settings described in OAC 340:100-5-22.1, Community Residential Supports, except with approval in accordance with OAC 340:100-3-33, Service authorization, that the increased services are necessary to avoid institutional placement due to:

(1)   the complexity of the family or caregiver support needs. Consideration must be given to:

(A)   the age and health of the caregiver;

(B)   the number of household members requiring the caregiver's time; and

(C)   the accessibility of needed resources; and

(2)   the resources of the family, caregiver, or household members that are available to the service recipient. Consideration must be given to the number of family members able to assist the caregiver and available community supports; and

(3)   the resources of other agencies or programs available to the SoonerCare member or family. Consideration must be given to services available from:

(A)   the public schools;

(B)   the Oklahoma Health Care Authority;

(C)   the Oklahoma Department of Rehabilitative Services;

(D)   other OKDHS programs; and

(E)   services provided by other local, state, or federal resources.

(d)   When it appears that approval of an exception is needed to prevent institutional placement, the case manager submits the request which identifies the circumstances supporting the need for an exception to the area manager.

(e)   The DDSD area manager or designee must approve, deny, or notify the case manager of issues preventing approval within 10 working days.

(f)   HTS providers may not perform any job duties associated with other employment, including on call duties, at the same time they are providing HTS services.

(g)   HTS services are limited to no more than 40 hours per week when the HTS resides in the same home as the service recipient. If additional hours of service are needed, they must be provided by someone living outside the home. Exceptions may be authorized when needed for members who receive services through the Homeward Bound Waiver.

(h)   When the member is out of the home for school, work, adult day services or other non-HTS supported activities, the total number of hours of HTS and hours away from the home cannot exceed 12 hours per day unless an exception is granted in accordance with subsection c of this policy.

(i)   In accordance with OAC 340:100-3-33.1, services must be provided in the most cost effective manner. When the need for HTS services is expected to continue to exceed 9 hours daily, cost effective community residential services must be considered and requested in accordance with OAC 317:40-1-2. For adults, continuation of non-residential services in excess of 9 hours per day for more than one plan of care year will not be authorized except:

(1)   when needed for members who receive services through the Homeward Bound Waiver;

(2)   when determined by the division administrator or designee to be the most cost effective option; or

(3)   as a transition period of 120 days or less to allow for identification of and transition to a cost effective residential option. Members who do not wish to receive residential services will be assisted to identify options that meet their needs within an average of 9 hours daily.

[Source: Added at 18 Ok Reg 517, eff 1-1-01 (emergency); Added at 18 Ok Reg 1168, eff 5-11-01; Amended at 19 Ok Reg 797, eff 1-25-02 (emergency); Amended at 19 Ok Reg 1289, eff 5-28-02 (emergency); Added at 23 Ok Reg 1396, eff 5-25-06; Amended at 27 Ok Reg 1509, eff 6-11-10; Amended at 29 Ok Reg 1793, eff 7-20-12 (emergency); Amended at 30 Ok Reg 1273, eff 7-1-13]