SECTION 317:40-5-3. Agency companion services

(a)   Agency companion services (ACS) are:

(1)   provided by agencies that have a provider agreement with the Oklahoma Health Care Authority (OHCA);

(2)   provided by independent contractors of the provider agency and provide a shared living arrangement developed to meet the specific needs of the member that includes supervision, supportive assistance, and training in daily living skills, and integrates the member into the shared experiences of a family in a home owned or rented by the companion;

(3)   available to members 18 years of age or older who are eligible for services through Community or Homeward Bound Waivers. Persons under 18 years of age may be served with approval from the Oklahoma Department of Human Services Developmental Disabilities Services (DDS) director or designee;

(4)   based on the member's need for residential services per Oklahoma Administrative Code (OAC) 340:100-5-22 and support as described in the member's Individual Plan (Plan), per OAC 340:100-5-50 through 340:100-5-58.

(b)   An agency companion:

(1)   must have an approved home profile per OAC 317:40-5-3 and contract with a provider contract with a provider agency approved by DDS;

(2)   may provide companion services for one member. Exceptions to serve as companion for two members may be approved by the DDS director or designee. Exceptions may be approved when members have an existing relationship and to separate them would be detrimental to their well being and the companion demonstrates the skill and ability required to serve as companion for two members;

(3)   household is limited to one individual companion provider. Exceptions for two individual companion providers in a household who each provide companion services to different members may be approved by the DDS director or designee;

(4)   may not provide companion services to more than two members at any time;

(5)   household may not serve more than three members through any combination of companion or respite services;

(6)   may not have employment, volunteer activities, or personal commitments that prevent the companion from fulfilling his or her responsibilities to the member per OAC 317:40-5.

(A)   The companion may have employment when the:

(i)   personal support team (Team) documents and addresses all related concerns in the member's Plan;

(ii)   employment is approved in advance by the DDS area manager or designee; and

(iii)   companion's employment does not require on-call duties and occurs during time the member is engaged in outside activities such as school, employment or other routine scheduled meaningful activities; and

(iv)   companion provides assurance the employment is such that the member's needs will be met by the companion should the member's outside activities be disrupted.

(B)   If, after receiving approval for employment, authorized DDS staff determines the employment interferes with the care, training, or supervision needed by the member, the companion must terminate, within 30 calendar days:

(i)   his or her employment; or

(ii)   his or her contract as an agency companion.

(C)   Homemaker, habilitation training specialist, and respite services are not provided for the companion to maintain other employment.

(c)   Each member may receive up to 60 days per year of therapeutic leave without reduction in the agency companion's payment.

(1)   Therapeutic leave:

(A)   is a SoonerCare payment made to the contract provider to enable the member to retain services; and

(B)   is claimed when the:

(i)   member does not receive ACS for 24 consecutive hours due to:

(I)   a visit with family or friends without the companion;

(II)   vacation without the companion; or

(III)   hospitalization, regardless of whether the companion is present; or

(ii)   companion uses authorized respite time;

(C)   is limited to no more than 14 consecutive, calendar days per event, not to exceed 60 days per Plan of Care (POC) year; and

(D)   cannot be carried over from one POC year to the next.

(2)   The therapeutic leave daily rate is the same amount as the ACS per diem rate except for the pervasive rate that is paid at the enhanced agency companion per diem rate.

(3)   The provider agency pays the agency companion the payment he or she would earn if the member were not on therapeutic leave.

(d)   The companion may receive a combination of hourly or daily respite per POC year equal to 660 hours.

(e)   Habilitation Training Specialist (HTS) services:

(1)   may be approved by the DDS director or designee when providing ACS with additional support represents the most cost-effective placement for the member when there is an ongoing pattern of not:

(A)   sleeping at night; or

(B)   working or attending employment, educational, or day services;

(2)   may be approved when a time-limited situation exists in which the companion provider is unable to provide ACS, and the provision of HTS will maintain the placement or provide needed stability for the member, and must be reduced when the situation changes;

(3)   must be reviewed annually or more frequently as needed, which includes a change in agencies or individual companion providers; and

(4)   must be documented by the Team and the Team must continue efforts to resolve the need for HTS.

(f)   The contractor model does not include funding for the provider agency for the provision of benefits to the companion.

(g)   The agency receives a daily rate based on the member's level of support. Levels of support for the member and corresponding payment are:

(1)   determined by authorized DDS staff per levels described in (A) through (D); and

(2)   re-evaluated when the member has a change in agency companion providers that includes a change in agencies or individual companion providers.

(A)   Intermittent level of support. Intermittent level of support is authorized when the member:

(i)   requires minimal physical assistance with basic daily living skills, such as bathing, dressing, and eating;

(ii)   may be able to spend short periods of time unsupervised inside and outside the home; and

(iii)   requires assistance with medication administration, money management, shopping, housekeeping, meal preparation, scheduling appointments, arranging transportation or other activities.

(B)   Close level of support. Close level of support is authorized when the member requires:

(i)   regular, frequent and sometimes constant physical assistance and support to complete daily living skills, such as bathing, dressing, eating, and toileting;

(ii)   extensive assistance with medication administration, money management, shopping, housekeeping, meal preparation, scheduling appointments, arranging transportation or other activities; and

(iii)   assistance with health, medication, or behavior interventions that may include the need for specialized training, equipment, and diet.

(C)   Enhanced level of support. Enhanced level of support is authorized when the member:

(i)   is totally dependent on others for:

(I)   completion of daily living skills, such as bathing, dressing, eating, and toileting; and

(II)   medication administration, money management, shopping, housekeeping, meal preparation, scheduling appointments, and arranging transportation or other activities;

(ii)   demonstrates ongoing complex medical issues requiring specialized training courses per OAC 340:100-5-26; or

(iii)   has behavioral issues that requires a protective intervention plan (PIP) with a restrictive or intrusive procedure per OAC 340:100-1-2. The PIP must:

(I)   be approved by the Statewide Behavior Review Committee (SBRC), per OAC 340:100-3-14;

(II)   be reviewed by the Human Rights Committee (HRC), per OAC 340:100-3-6, or

(III)   have received expedited approval per OAC 340:100-5-57.

(D)   Pervasive level of support. Pervasive level of support is authorized when the member:

(i)   requires additional professional level support to remain in an agency companion setting due to pervasive behavioral or emotional challenges. The support must be provided:

(I)   by a licensed professional counselor (LPC) or professional with a minimum of Masters of Social Work (MSW) degree; and

(II)   as ongoing support and training to the companion, offering best practice approaches in dealing with specific members; and

(ii)   does not have an available personal support system. The need for this service level:

(I)   must be identified by the grand staffing committee, per OAC 340:75-8-40; and

(II)   requires the provider to market, recruit, screen, and train potential companions for the member identified.

(h)   Authorization for payment of Agency Companion Service is contingent upon receipt of:

(1)   the applicant's approval letter authorizing ACS for the identified member;

(2)   an approved relief and emergency back-up plan addressing a back-up location and provider;

(3)   the Plan;

(4)   the POC; and

(5)   the date the member moved to the companion home.

(i)   The Plan reflects the amount of room and board the member pays to the companion. The provider must use the room and board reimbursement payment to meet the member's needs. Items purchased with the room and board reimbursement payment include housing and food.

(j)   If the amount exceeds $500, the additional amount must be:

(1)   agreed upon by the member and, when applicable, legal guardian;

(2)   recommended by the Team; and

(3)   approved by the DDS area manager or designee.

[Source: Added at 13 Ok Reg 1679, eff 5-27-96; Amended at 15 Ok Reg 3855, eff 7-1-98 (emergency); Amended at 16 Ok Reg 1445, eff 5-27-99; Amended at 22 Ok Reg 2531, eff 7-11-05; Amended at 24 Ok Reg 952, eff 5-11-07; Amended at 25 Ok Reg 2767, eff 6-1-08 (emergency); Amended at 26 Ok Reg 2151, eff 6-25-09; Amended at 27 Ok Reg 1509, eff 6-11-10; Amended at 29 Ok Reg 1199, eff 6-25-12; Amended at 32 Ok Reg 615, eff 2-9-15 (emergency); Amended at 32 Ok Reg 1170, eff 8-27-15]