SECTION 317:40-5-150. Daily Living Supports for the Community Waiver

(a)   Introduction. Daily Living Supports (DLS) are provided by an agency, approved by the Developmental Disabilities Services Division (DDSD), that has a valid Oklahoma Health Care Authority contract for the service.

(1)   Daily Living Supports require meeting the daily support needs of the members living in the home.

(A)   In accordance with the needs of the member, Daily Living Supports include hands-on assistance, supervision, or prompting so that the member performs the task, such as eating, bathing, dressing, toileting, transferring, personal hygiene, light housework, money management, community safety, recreation, social, health, or medication management.

(B)   Daily Living Supports also include assistance with cognitive tasks or provision of services, per OAC 340:100-5-57, to prevent a member from harming self or others.

(C)   Daily Living Supports also include:

(i)   the provision of staff training per OAC 340:100-3-38, to meet the specific needs of the member;

(ii)   program supervision that includes the 24-hour availability of response staff to meet schedules and unpredictable needs;

(iii)   program oversight;

(iv)   assisting the member in obtaining services and supplies;

(v)   developing and assuring emergency plans are in place; and

(vi)   coordinating overall safety and supports in the home.

(D)   Direct support services are coordinated and shared among household members receiving services to meet identified needs and are provided by staff who do not live in the home.

(2)   DLS include an average of eight hours daily of direct support services. Members needing direct support services exceeding an average of eight hours per day identify, with case manager assistance, roommates willing to share Daily Living Supports services. Additional direct support services are considered in accordance with subsection (f) of this Section.

(b)   Eligibility. Daily Living Supports are provided to members who:

(1)   are eighteen years of age or older, unless approved by the Director of OKDHS or designee;

(2)   need an average of at least eight hours of direct support services daily;

(3)   are participants in the DDSD Community waiver, per OAC 317:40-1-1;

(4)   need community residential services outside the family home; and

(5)   do not simultaneously receive any other community residential or group home services.

(c)   Service requirements. Daily Living Supports must be:

(1)   included in the member's Individual Plan per OAC 340:100-5-51, including a description of the type(s) and intensity of supervision and assistance that must be provided to the member;

(2)   authorized in the member's Plan of Care;

(3)   provided by the contracted provider agency chosen by the member or guardian;

(4)   delivered in accordance with DDSD Community Residential Supports rules at OAC 340:100-5-22.1; and

(5)   provided directly to the member.

(d)   Home Requirements. Daily Living Supports are provided to eligible members living outside their family's home in a home that:

(1)   is leased or owned by the member(s) or the member's legal guardian; and

(2)   houses no more than three individuals living together. Exceptions for homes shared by four members may be granted in writing by the DDSD director or designee.

(e)   Responsibilities of provider agencies. Each provider agency providing Daily Living Supports must:

(1)   ensure ongoing supports as needed when the member is out of the home visiting family and friends, or hospitalized for psychiatric or medical care;

(2)   ensure compliance with all applicable DDSD policy found at OAC 340:100; and

(3)   provide for the welfare of all members living in the home.

(4)   ensure that trained staff are available to the member as described in the individual plan.

(f)   Criteria for direct support staff services beyond eight hours per day. Additional direct support services including Habilitation Training Specialist(HTS), Homemaker, or Intensive Personal Supports, beyond the average of eight hours per day referenced in subsection (a) of this Section must be approved by the DDSD area manager or designee.

(1)   In order to receive additional direct support staff services, the members living together must have insufficient supports including hourly nursing services to meet their needs for support.

(A)   Additional direct support staffing may be authorized if the member is living with two roommates but still has medical or behavior support needs beyond the capacity of staff shared with the other roommates, including participation by staff providing hourly nursing services.

(B)   Additional direct support staffing is only provided to a member who has one or no roommates if:

(i)   the area manager or designee documents that behavior support issues make it impossible for the member to have a roommate; or

(ii)   in accordance with paragraph (2) of this subsection.

(C)   If a member lives with one or no roommates or requires a second support staff to meet his or her intensive behavior support needs, the Team must provide clear documentation that the member has difficulty establishing compatible relations with others as evidenced by:

(i)   severe and persistent emotional and behavioral disturbances; or

(ii)   a history of difficulty sharing a home with others.

(2)   The area manager or designee may grant conditional approvals for staff beyond an average of eight hours per day per member:

(A)   due to the temporary or permanent departure of a roommate while another roommate is being identified; or

(B)   to facilitate emergency residential placement of a person needing services while roommates are being identified.

(3)   As part of the annual review, the case manager must:

(A)   re-evaluate the member's additional direct support services; and

(B)   implement any alternative solutions that would promote independence and reduce intrusion by paid workers as much as possible. Documentation of such evaluations and the implementation of alternative solutions is included in the case manager's record.

(g)   Daily Living Supports claims. No more than 365 units of Daily Living Supports may be billed per year, except Leap Year, for each member.

(1)   The provider agency claims one unit of service for each day during which the member receives Daily Living Supports. A day is defined as the period between 12:00 a.m. and 11:59 p.m.

(2)   Claims must not be based on budgeted amounts.

(3)   When a member changes provider agencies, only the outgoing service provider agency claims for the day that the member moves.

(h)   Billing for other support services. Additional support services such as HTS, Intensive Personal Supports, or Homemaker Services may be provided to a member receiving Daily Living Supports, if:

(1)   the additional support services have been authorized in the member's Plan of Care. Additional support services cannot be authorized unless 56 hours per week of DLS services are scheduled for the member. The direct support staffing is averaged across the week when the needs of the members in the household vary from day to day; and

(2)   an average of eight hours of DLS has already been provided to the member each day that week.

(A)   The provider cannot bill for additional support services unless 56 hours of DLS have been provided during the week to the member.

(B)   If support services are provided to multiple members residing in the same household at the same time, the provider agency cannot count these hours toward each member's 8-hour minimum. For example, three hours of service provided simultaneously by a single direct contact staff to three members in the same household may only be counted as three hours of service for one of the members, not three hours for each member.

(i)   Therapeutic leave. Therapeutic leave is a SoonerCare payment made to the Daily Living Supports contract provider to enable the member to retain personal care services.

(1)   Therapeutic leave is claimed when the member does not receive Daily Living Supports services for 24 consecutive hours from 12:00 a.m. to 11:59 p.m. because of:

(A)   a visit with family or friends without direct support staff;

(B)   vacation without direct support staff; or

(C)   hospitalization, whether direct support staff are present or not. Daily living supports staff may be present with the member in the hospital as approved by the member's Team in the Individual Plan. Staff are present in the role of a visitor and are not responsible for the care of the patient.

(2)   A member may receive therapeutic leave for no more than 14 consecutive days per event, not to exceed 60 days per Plan of Care year.

(3)   The payment for a day of therapeutic leave is the same amount as the per diem rate for Daily Living Supports.

(4)   To promote continuity of direct support staff in the member's absence, the provider pays the staff member the salary that he or she would have earned if the member were not on therapeutic leave if the provider is unable to provide an alternative work opportunity.

[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 2179, eff 6-27-02; Added at 23 Ok Reg 1396, eff 5-25-06; Amended at 27 Ok Reg 1509, eff 6-11-10]