SECTION 317:40-5-153. Daily Living Supports for the Homeward Bound Waiver

(a)   Introduction. Daily Living Supports are provided by an agency with a valid Oklahoma Health Care Authority (OHCA) contract.

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

(A)   In accordance with the needs of the class 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 are provided by staff that do not live in the home and include assistance with cognitive tasks or provision of services to prevent a member from harming self or others, in accordance with the needs of the member.

(C)   Daily Living Supports also include:

(i)   the provision of staff training per OAC 340:100-3-30 to meet the specific needs of the member;

(ii)   program supervision that includes 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;

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

(vii)   assisting members with personal money management.

(2)   Daily Living Supports are used to provide and fund up to eight hours per day of supports for class members receiving supported living services per OAC 340:100-5-22.5.

(b)   Eligibility. Daily Living Supports, as described in this Section, are provided to members who:

(1)   are members of the class certified in Case Number 85-C-437-E, U.S. District Court for the Northern District of Oklahoma;

(2)   receive community residential services in their own home; and

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

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

(1)   ensure ongoing supports as needed to all members living in the home when one or more members 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;

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

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

(d)   Criteria for direct support staff services in the Homeward Bound Waiver beyond eight hours per day. Additional direct support services including HTS, Homemaker, or Intensive Personal Supports, beyond the average of eight hours per day referenced in subsection (a) of this Section, are provided based on needs identified by the Personal Support Team and are considered in accordance with subsection (f) of this Section.

(e)   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 the member receives Daily Living Supports.

(2)   Providers must claim at least monthly for all days that Daily Living Supports were actually provided during the preceding month. 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.

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

(1)   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.

(g)   Therapeutic leave. Therapeutic leave is a Medicaid payment made to the Daily Living Supports contract provider to enable the member to retain direct support services.

(1)   Therapeutic leave is claimed when the member does not receive Daily Living Supports services for 24 consecutive hours 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)   If, because of the member's absence, the direct support staff is unable to work, the provider pays the staff the salary that he or she would have earned if the member were not on therapeutic leave.

[Source: Added at 21 Ok Reg 422, eff 11-21-03 (emergency); Added at 21 Ok Reg 1333, eff 5-27-04; Amended at 27 Ok Reg 1509, eff 6-11-10]