SECTION 340:100-3-27.1. Contract performance surveys and administrative inquiries

  Agencies providing services under contract with the Oklahoma Department of Human Services (OKDHS), or through a Home and Community-Based Waiver (HCBW) participate in performance surveys assessing compliance with OKDHS and Oklahoma Health Care Authority (OHCA) contracts and rules.

(1)   Performance surveys are conducted:

(A)   with providers serving five or fewer service recipients when deemed necessary by the administrator of Developmental Disabilities Services Division (DDSD) Quality Assurance (QA); and

(B)   during each state fiscal year with providers of residential, vocational, or non-medical in-home supports serving six or more service recipients.

(2)   OKDHS conducts interim administrative inquiries that evaluate the validity of allegations of non-compliance with provisions of the provider contract(s).

(A)   Administrative inquiries are authorized by the administrator of DDSD QA in response to complaints filed by any interested party that represent potentially serious breaches of service assurances, contract requirements, or OKDHS rules. The administrator of DDSD QA or designee is authorized to conduct a screening to determine the potential validity of the complaint.

(B)   Administrative inquiries are limited in scope to the responsibilities described in the provider's contract(s) with or rules of OKDHS or OHCA including, but not limited to human rights assurances, service provision, and fiscal accountability.

(C)   Allegations of abuse and neglect are immediately referred to statutorily identified lead agencies for investigation. OKDHS acts on the findings or recommendations of agencies with statutory responsibility to ensure provider compliance with provisions of law.

(D)   Administrative inquiries are conducted by staff assigned to DDSD QA although other resources of OKDHS such as Office of Inspector General may be requested to assist in the investigation of complaints.

(E)   OKDHS is not required to provide advance notice of an administrative inquiry.

(F)   Notifications to providers of findings and dispositions follow procedures established for performance surveys in subparagraph (L) of paragraph (3) of this subsection, except that:

(i)   written findings of administrative inquiries may instead be presented to an agency through mail or email and an exit conference may be conducted by telephone; and

(ii)   the DDSD director or designee retains the authority to initiate an emergency disposition as specified by subsection (f) of OAC 340:100-3-27.2.

(3)   Providers of direct services to six or more service recipients listed in paragraph (1) of this subsection participate in performance surveys assessing success in implementing contractual standards.

(A)   Prior to the fiscal year beginning, a proportionate, representative sample of service recipients for each Waiver is identified.

(B)   The administrator of DDSD QA or designee may provide written notice to provider agencies of scheduled performance surveys. DDSD advises the agency in writing of:

(i)   demographic information and documents that must be provided to DDSD within two weeks of the postmark on the notice; and

(ii)   documents that must be available on the dates of the performance survey.

(C)   Provider agencies may request a change of the schedule of the performance survey by contacting the administrator of DDSD QA or designee. Authorization of a change in schedule occurs at the discretion of the administrator of QA.

(D)   DDSD QA staff conducting performance surveys assess the delivery of services and realization of outcomes for a sample of people served by each provider agency. The sample includes those service recipients identified in the representative sample and at least one service recipient receiving each discrete service provided through the agency's contract with OKDHS or OHCA. The size of the sample is adjusted based upon the number of service recipients served by the agency under contractual agreement with OKDHS or OHCA and the number of surveyors assigned to the survey.

(i)   The sample will be 10 per cent of the agency population or four service recipients for each surveyor assigned, whichever is greater.

(ii)   The size of performance survey samples may be increased at the discretion of performance survey team members.

(E)   Performance surveys and administrative inquiries are conducted by DDSD QA staff that have completed a minimum of 150 hours of training specific to the application and interpretation of OKDHS and OHCA contract standards and rules. Findings of performance survey team members that have not completed 150 hours of required training are not considered, unless observations are confirmed by staff who have met this training requirement.

(F)   A private work area at the agency site is made available for surveyors during the course of the survey. If space is unavailable, the provider makes copies of documents available that may be taken by the performance survey team for review at another site.

(G)   Performance survey team staff meet with the chief executive officer (CEO) or designee of a provider agency upon arrival to:

(i)   discuss the survey schedule;

(ii)   identify the balance of the survey sample;

(iii)   determine locations where services are provided; and

(iv)   make tentative arrangements for an exit conference.

(H)   Agency staff and agency records are made available to the team as necessary to assess agency performance with provisions of rules and their contract(s) with OKDHS or OHCA.

(I)   Performance survey teams observe and meet with service recipients served and staff involved in each type of service provided by the agency through contract(s) with OKDHS, or with OHCA for the HCBW services.

(i)   Interviews and observations are conducted in a manner minimizing disruption of service activities.

(ii)   Observations and interviews occur during varied hours of service delivery.

(J)   Performance survey team personnel evaluate information from observations, interviews, and record reviews in the context of relevant contract standards and rules.

(K)   Performance survey teams immediately report to appropriate authorities, conditions or actions of agency staff that are possibly abusive or negligent or that otherwise pose immediate jeopardy to the health or safety of service recipients.

(L)   Performance survey team staff provide a written summary of findings to the CEO or designee of the provider agency on the final day of the survey. The summary of findings is presented at least two hours prior to the scheduled exit conference. The CEO or designee of the provider agency may waive the two-hour period between presentation of the summary and the exit conference or the exit conference itself.

(M)   The provider agency may structure the exit conference in a manner determined most beneficial to the agency.

(i)   The agency may invite staff, service recipients, family members, and other citizens to participate.

(ii)   Performance survey team personnel provide an explanation of findings and standards, as requested by the agency.

(iii)   Performance survey team personnel provide an explanation of the procedures described in this Section that are available to the agency regarding any disputed findings.

(iv)   During the exit conference, the agency may submit evidence contesting the citation of standards. Performance survey team members review presented evidence and for each contested standard, may:

(I)   reverse the entire citation;

(II)   reverse a portion of the citation; or

(III)   affirm the citation.

(v)   Within two weeks of the exit conference, the agency sends to the administrator of DDSD QA a written response that identifies a date the agency will comply with the cited requirement.

(I)   Any projected resolution date beyond two months from the exit conference is accompanied by a justification.

(II)   Approval of extended resolution dates occurs only upon the presentation of evidence that extensive change in agency management systems or extensive expenditures is essential to resolution of the problem.

(III)   The agency presents plans and time frames to implement incremental changes necessary to achieve contract conformance when an interval of more than two months is requested.

(vi)   The agency may send supplemental information to the administrator of QA contesting the findings of the performance survey team within two weeks of the exit conference. An appeal does not relieve the agency from the responsibility to achieve resolution of contract deficiencies within two months from the date of the exit conference, if the request for reversal is not supported through procedures described in paragraph (5) of this subsection.

(4)   The findings of performance surveys and administrative inquiries, as well as any appeals, are reviewed by the administrator of DDSD QA or designee.

(5)   The QA administrator or designee issues, within 30 days of the report detailing findings, a preliminary determination regarding:

(A)   any standard citation appeal by the agency;

(B)   acceptance or revision of resolution dates proposed by the provider to achieve conformance with the provisions of the contract(s) or rules; and

(C)   when necessary, specific corrective action(s) is undertaken by the agency, including that:

(i)   the agency reimburse OKDHS or OHCA for unsubstantiated or unauthorized claims;

(ii)   the agency reimburse service recipients for the balance of funds managed by the agency contrary to the expectations of OAC 340:100-3-4; and

(iii)   service provision is immediately suspended or modified when it is determined there is imminent risk to the health or safety of service recipients.

(6)   Performance survey teams conduct focused re-surveys to assess resolution of identified contract deficiencies.

(A)   Focused re-surveys including a new random sample are conducted at any time following the established resolution date.

(B)   Focused re-surveys require no advance notice.

(C)   Focused re-surveys may, at the discretion of the performance survey team be expanded to include any new performance issue identified.

(D)   Focused re-surveys evaluate whether the provider has corrected identified deficiencies by the approved resolution date. The written report provided to the provider includes any new performance issues identified as well as the:

(i)   resolution of conditions resulting in the citation of a standard; and

(ii)   continued existence of a deficiency.

(E)   Following a focused re-survey the provider is informed of the results.

(i)   The provider may submit evidence contesting a citation.

(ii)   New citations found during the focused re-survey are added to the report of the original survey for consideration by the Performance Review Committee.

(7)   Failure to cooperate. Provider agencies failing to cooperate with provisions or providing false information in response to any inquiry per OAC 340:100-3-27.1 are subject to sanctions identified, including contract termination.

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

[Source: Added at 19 Ok Reg 2948, eff 8-1-02 (emergency); Added at 20 Ok Reg 936, eff 6-1-03; Amended at 23 Ok Reg 1026, eff 5-11-06; Amended at 29 Ok Reg 822, eff 7-1-12]