SECTION 340:100-3-27. Quality assurance

(a)   Purpose. Developmental Disabilities Services (DDS) quality assurance (QA) activities assess and encourage delivery of supports consistent with:

(1)   the preferences and needs of service recipients;

(2)   Oklahoma Department of Human Services (DHS) rules;

(3)   applicable Oklahoma Health Care Authority (OHCA) rules;

(4)   DHS and OHCA contract requirements for Home and Community-Based Services (HCBS);

(5)   regulatory standards applicable to services; and

(6)   federal and state laws.

(b)   Case manager monitoring. DDS case managers assess services rendered to each service recipient to ensure effectiveness of services in meeting the service recipient's needs. The case manager periodically observes service provision to assess implementation of the service recipient's Individual Plan (Plan). The requirements per this Section are minimum expectations for face-to-face visits with service recipients. Case management may require additional visits to ensure the service recipient's health and welfare.

(1)   The DDS case manager conducts face-to-face visits to monitor the service recipient's health and welfare and service effectiveness in meeting his or her needs.

(A)   Face-to-face visits must include observation of, and talking with the service recipient regarding the service recipient's health and welfare and satisfaction with services.

(B)   The case manager may:

(i)   observe service provision and related documentation in any location where services are provided; and

(ii)   talk with family members and providers regarding service provision and the service recipient's health and welfare.

(C)   For service recipients receiving services through an In-Home Supports Waiver (IHSW):

(i)   a face-to-face visit must be completed at least semi-annually with one visit occurring between January and June and one between July and December; and

(ii)   at least one of the two visits must occur at the site where the majority of services are provided.

(D)   For service recipients receiving services through a Community Waiver:

(i)   a face-to-face visit must occur during each calendar month in the person's home who receives residential services per OAC 340:100-5-22.1 or group home services per OAC 317:40-5-152. Case managers must certify home visits on Form 06MP070E, Access to Record and Verification of Monitoring Requirements, located per OAC 340:100-3-40;

(ii)   a face-to-face visit must be completed each calendar year quarter, coinciding with the quarters established per OAC 340:100-5-52 for a quarterly summary of progress reports, for service recipients who do not receive residential services or group home services, with at least two of these visits occurring at the site where the majority of services are provided; and

(iii)   the case manager visits the employment or day services site at least semi-annually, with one visit occurring between January and June, and one between July and December, when services are funded through the Community Waiver unless the Personal Support Team (Team) requests a DDS area manager or designee approved exception.

(E)   For service recipients receiving services through the Homeward Bound Waiver:

(i)   a face-to-face visit must occur in the home during each calendar month. Case managers must certify home visits on Form 06MP070E located within the home record per OAC 340:100-3-40; and

(ii)   the case manager must visit the employment site each calendar year quarter, coinciding with the quarters established per OAC 340:100-5-52 for quarterly summary of progress reports, unless the Team requests a DDS area manager or designee approved exception.

(F)   For members of the Homeward Bound class who reside in an intermediate care facility for individuals with intellectual disabilities(ICF/IID), the case manager visits monthly.

(2)   DDS case managers review and ensure Plan implementation. The case manager completes a quarterly review for service recipients receiving services through the Home and Community Based Services (HCBS) Waivers, documenting the review in Client Contact Manager (CCM).

(3)   When the DDS case manager believes the service recipient is at risk of harm, the case manager takes immediate steps to protect the service recipient and notifies the DDS case management supervisor and other appropriate authorities.

(4)   When the DDS case manager determines the service recipient's needs are not effectively addressed by a provider or contractual responsibilities or policies are not met by the provider, steps in (A) through (C) of this paragraph are followed.

(A)   The case manager consults with the relevant provider to secure a commitment for necessary service changes within an agreed time frame.

(B)   When necessary changes are not accomplished within the specified time frame, the case management supervisor intervenes to secure commitments from the provider.

(C)   When the service deficiency is not resolved as a result of the intervention of the case management supervisor, a referral for administrative inquiry is initiated per OAC 340:100-3-27.1.

(5)   If, during a contract survey, administrative inquiry, specialized foster care (SFC) monitoring, or area survey, QA staff discovers a situation that requires correction by DDS staff, a system administrative inquiry is initiated.

(A)   QA staff emails notification to DDS staff to correct the situation, establishing a reasonable time frame for correction.

(B)   When the identified staff is unable to correct the situation within the established time frame, QA staff emails notification to the DDS staff supervisor, establishing a reasonable time frame for correction.

(C)   When the staff supervisor is unable to correct the situation within the established time frame, QA staff notifies his or her supervisor, who notifies the DDS area manager, establishing a reasonable time frame for correction.

(D)   When the area manager is unable to correct the situation within the established time frame, he or she notifies the DDS State Office QA unit, to resolve the situation with the community services unit deputy director.

(c)   SFC monitoring. QA staff monitors the SFC program in each area for DDS and OHCA policy compliance. Monitoring is based on a proportionate, representative sample of individuals receiving SFC supports identified for the fiscal year for each area. Monitoring includes a visit to the service recipient's SFC home.

(d)   Consumer Service Evaluation. At least annually, service recipients and families receiving supports are provided the opportunity to complete a service evaluation per DHS Publication No. 89-10, Consumer Service Evaluation.

(1)   Confidentiality is maintained unless the respondent authorizes DHS to reveal his or her name to those responsible for service delivery. DHS Publication No. 89-10 may be completed anonymously.

(2)   QA staff distributes DHS Publication No. 89-10 to service recipients or his or her legal guardians at least annually.

(3)   DHS Publication No. 89-10, when completed is returned to the DDS State Office QA Unit.

(4)   Results are forwarded to the respective DDS area office when authorized by the service recipient or legal guardian for resolution of concerns or staff recognition.

(5)   An analysis of responses is completed and distributed to DDS area offices, DDS State Office, or DHS for action. Data is available upon request.

(e)   Oklahoma - Advocates Involved in Monitoring (OK AIM). Service recipients and families receiving supports participate in formal assessments of contract providers to promote service enhancement, consistent with service recipient expectations.

(1)   OK AIM operates under direction of the Oklahomans for Quality Services Committee (OQSC).

(A)   OQSC is composed of 15 persons who receive or have a family member receiving DDS services. All areas of Oklahoma are represented.

(i)   OQSC members may be nominated by the public at large, current OQSC members, or DDS representatives.

(ii)   Appointment of OQSC members occurs as a result of joint consensus by the OQSC chair and DDS director or designee following a determination of the nominee's:

(I)   commitment to promote the interests of persons with developmental disabilities; and

(II)   capacity to dedicate the necessary time to fulfill his or her responsibilities.

(iii)   OQSC members have the authority to elect officers based on a simple majority vote and establish by-laws governing the conduct of business.

(B)   OQSC:

(i)   develops and refines procedures and the survey instrument used, based upon feedback received from service recipients and their families, providers, and other key constituents;

(ii)   participates in the selection of agencies submitting proposals to conduct OK AIM activities; and

(iii)   serves as a resource for education and coordination of agencies conducting OK AIM monitoring activities.

(2)   DDS issues an invitation to bid (ITB) in accordance with state law and DHS rules, and solicits proposals from qualified organizations to participate in the OK AIM initiative. Qualified organizations include agencies that:

(A)   are incorporated non-profit agencies dedicated to the representation of persons with developmental disabilities and their family members;

(B)   are not involved in service delivery funded through DDS or HCBS Waivers; and

(C)   meet additional requirements set forth by federal and state laws as indicated in the ITB.

(3)   OQSC is consulted regarding bids submitted in response to an ITB. Selection of a qualified organization to conduct OK AIM monitoring and reporting activities occurs per state law and DHS rules.

(4)   Agencies selected to conduct OK AIM monitoring and reporting activities are responsible for:

(A)   soliciting, screening, and training volunteers to conduct OK AIM site visits;

(B)   scheduling site visits with all service providers referenced in the ITB within counties for which the agency assumed responsibility;

(C)   ensuring consistency of volunteer and staff activities with:

(i)   OQSC-approved procedures and protocols;

(ii)   federal and state laws; and

(iii)   DHS and OHCA rules;

(D)   accurately recording OK AIM monitoring activities findings;

(E)   ensuring provision of findings to provider agencies and DDS; and

(F)   immediately notifying the DDS area office of any issue identified during OK AIM monitoring activities that presents risk to the service recipient's health or welfare.

(5)   DDS area managers identify DHS staff responsible for resolving concerns identified during OK AIM monitoring activities and notifythe agencies responsible on how to contact staff during business, evening, and weekend hours.

(6)   OQSC with DDS State Office, DDS area offices, and agencies conducting OK AIM activities participation, identifies conditions determined to present significant risks to service recipients.

(A)   Conditions determined to present imminent risks to service recipients are reported immediately to the:

(i)   statutory investigatory authority;

(ii)   DDS area office; and

(iii)   provider agency chief executive officer (CEO) or designee.

(B)   Issues determined to pose potential risks to service recipients are reported to DDS area office staff, who notify the provider agency CEO or designee, no later than at the close of the first business-day following observation.

(C)   OK AIM monitors report any other significant issues to designated DDS area office staff within time frames determined appropriate by OK AIM.

(7)   DDS staff immediately identifies DDS area office staff to assume responsibility for verification and correction of problems posing imminent or potential risks.

(A)   Time frames for resolution of validated concerns are approved by the DDS area manager based on the degree of risk.

(B)   All identified concerns are resolved within 30-calendar days from initial notification to the DDS area office, unless an extension is authorized by the area manager in circumstances that pose no jeopardy to any service recipient.

(C)   Concerns presenting immediate and significant risk to service recipients are corrected immediately.

(8)   Each DDS area manager designates staff to:

(A)   track resolution of each identified concern; and

(B)   advise agencies conducting OK AIM monitoring activities of the steps taken to resolve each concern.

(9)   OK AIM staff summarizes findings of each home visit conducted by volunteers, noting performance in the context of expectations established by OQSC, and published in the OK AIM training manual.

(A)   Recommendations for service enhancement are presented to the relevant DDS area office for review within 30-calendar days of a home visit.

(B)   DDS area office staff shares this information with the provider and collaborates on recommendations as well as other alternatives to achieve targeted service enhancement. Plans developed as a result are shared with OK AIM staff during the next meeting. Provider comments or action plans are maintained with the OK AIM report in area office files.

(10)   The OK AIM survey process is re-assessed at least annually by OQSC based on feedback solicited from service recipients, DDS area office staff, providers, and other constituencies affected by or involved in the process.

(f)   Independent assessments. An independent authority annually assesses service outcomes for a sample of service recipients receiving residential services funded or administered through DDS or HCBS Waivers.

(1)   Assessments employ standardized measures, facilitating individual as well as congregate data analysis over time.

(2)   Assessment protocols provide for identification and resolution of circumstances posing immediate risks to service recipients.

(g)   Failure to cooperate. Provider agencies failing to cooperate with provisions or providing false information in response to inquiries per this Section are subject to identified sanctions including contract termination.

(h)   Findings of non-compliance. Findings of significant non-compliance with human rights, laws, or rules are immediately reported to the DDS director and other relevant authorities for appropriate action, including disciplinary action of DHS employees or the imposition of sanctions, including suspension or contract termination with provider agencies per OAC 340:100-3-27.2.

(i)   Retaliation. Provider agencies and DHS employees are prohibited from any form of retaliation against any service recipient, employee, or agency for reporting or discussing possible performance deficiencies with any authorized DHS agent. Authorized agents are DHS staff whose responsibilities include administration, supervision, or oversight of DDS services, including all DDS and Office of Client Advocacy staff.

(j)   QA functions. Additional components of the DDS QA program are found in OAC 340:100-3-27.1 through OAC 340:100-3-27.5.

[Source: Amended at 8 Ok Reg 2163, eff 5-13-91 (emergency); Amended at 9 Ok Reg 1549, eff 4-27-92; Amended at 10 Ok Reg 2505, eff 5-24-93 (emergency); Amended at 11 Ok Reg 2303, eff 5-26-94; Amended at 11 Ok Reg 4107, eff 6-29-94 (emergency); Amended at 12 Ok Reg 1761, eff 6-12-95; Amended at 15 Ok Reg 2125, eff 5-5-98 (emergency); Amended at 16 Ok Reg 544, eff 12-31-98 (emergency); Amended at 16 Ok Reg 1056, eff 4-26-99; Amended at 19 Ok Reg 2948, eff 8-1-02 (emergency); Amended at 20 Ok Reg 936, eff 6-1-03; Amended at 21 Ok Reg 888, eff 4-26-04; Amended at 23 Ok Reg 1026, eff 5-11-06; Amended at 25 Ok Reg 986, eff 5-15-08; Amended at 29 Ok Reg 822, eff 7-1-12; Amended at 34 Ok Reg 1598, eff 9-15-17]