SECTION 340:100-5-22.5. Supported living services

(a)   Eligibility. To assure that the daily living requirements of the class members are met, the Oklahoma Department of Human Services (OKDHS) provides a payment to the contract residential provider agency serving each person who:

(1)   is a member of the class certified in Case Number 85-C-437-E, United States District Court for the Northern District of Oklahoma; and

(2)   receives Daily Living Supports services per OAC 317:40-5-153.

(b)   Service expectations. The provider agency ensures that:

(1)   all applicable rules of OKDHS and the Oklahoma Health Care Authority (OHCA) are met including:

(A)   Community Residential Supports, OAC 340:100-5-22.1;

(B)   Daily Living Supports, OAC 317:40-5-153;

(C)   the Developmental Disabilities Services Division (DDSD) mission statement and guiding principles, OAC 340:100-1-3.1;

(D)   community records rules, OAC 340:100-3-40;

(E)   Individual Plan rules, OAC 340:100-5-50 through 100-5-58; and

(F)   health services rules, OAC 340:100-5-26; and

(2)   the class member's expenses for housing, food, clothing, recreation, utilities, medical services, property replacement, and transportation are met per OAC 340:100-5-22.5.

(c)   Room and board payment. The room and board payments support the class member's housing, food, clothing, recreation, and utility costs in accordance with this subsection.

(1)   Each class member contributes an amount determined annually by DDSD, not to exceed 90% of his or her income, up to a maximum of 90% of the current Supplemental Security Income (SSI) payment for a single individual.

(A)   The maximum may be exceeded by prior written agreement between the individual served or his or her guardian and the provider agency with the written approval of the director of DDSD or designee.

(B)   OKDHS pays a supplement, equal to 90% of the SSI monthly payment for a single individual minus 90% of the class member's income, on behalf of each class member whose income and resources are insufficient for the person to contribute the maximum room and board payment explained in this paragraph.

(2)   To supplement the individual's funds for meeting daily living requirements, OKDHS provides:

(A)   a room and board provider payment at $14 per day; and

(B)   a residence size supplement provider payment to support the cost of a home, based on the number of individuals living in the home.

(i)   For an individual with no roommate, the residence size supplement is $10 per day.

(ii)   For an individual who has one roommate, the residence size supplement is $6 per day.

(iii)   There is no residence size supplement for an individual living with more than one roommate.

(iv)   For the purposes of this subparagraph, an individual not listed in Case Number 85-C-437-E is not considered a roommate.

(3)   The provider agency completes a written financial agreement with the class member and chosen advocate(s) or the legal guardian per OAC 340:100-5-22.1.

(4)   Room and board revenues must be accounted for separately from other provider agency funds.

(A)   Room and board revenues from OKDHS are managed by the provider to meet the needs of all individuals living in supported living arrangements.

(B)   Payments from OKDHS mentioned in paragraph (2) of this subsection are provider payments. They are not income to the class member and must not be deposited in the class member's bank account; nor is the provider required to account to the class member or Team regarding their use.

(C)   Room and board payments from individuals served are used only to meet the needs of that individual.

(5)   Room and board revenues must be used, unless written approval is secured in advance from the DDSD programs administrator for community services, solely for:

(A)   housing costs and utilities;

(B)   groceries;

(C)   household maintenance;

(D)   recreation;

(E)   personal items and clothing;

(F)   household property insurance;

(G)   yard care; and

(H)   furnishings and appliances.

(6)   Room and board payments are authorized as long as the provider agency supports the individual to maintain a household.

(7)   Room and board payments cannot be used to support a roommate who does not receive DDSD services, nor can the payment be used to modify or improve the home for the use or comfort of an existing or potential roommate that is not a recipient of DDSD services. Any roommate must contribute a fair share to the cost of operating the household.

(8)   Room and board payments are used only to support a service recipient in one household and residence at any given time, except for a timeframe not to exceed 45 days for a transition.

(d)   Medical supplement. OKDHS reimburses the provider agency for the cost of necessary medical services that are not covered through Medicaid, Medicare, or other insurance; or for persons who are not Medicaid or Medicare eligible for any individual listed in Case Number 85-C-437-E. The medical supplement is not paid at a rate higher than allowed through the Oklahoma Medicaid Fee-for-Service Program unless approved by the DDSD area manager in writing.

(1)   Co-payments for medical services are not covered by the medical supplement. Co-payments are the responsibility of the class member.

(2)   Non-prescription (over-the-counter) medications are not covered by the medical supplement. These are the responsibility of the class member.

(e)   Property replacement supplement. A maximum of $850 per class member per fiscal year is reimbursed for replacement of unusable furnishings or necessary furnishings or appliances. Necessary furnishings and appliances include: refrigerators, stoves, washers, dryers, dining tables and chairs, sofas or love seats, recliners, lamps when there is no fixed lighting in the room, beds, dressers or chests of drawers, bookshelves, telephones, and safety items per OAC 340:100-5-22.1.

(1)   The provider agency submits a written property replacement request to the case manager that includes:

(A)   the furnishing or appliance to be purchased;

(B)   the reason the item is necessary; and

(C)   the age of the furnishing or appliance to be replaced.

(2)   The case manager reviews the written request, submits it to the area manager or designee within 14 days with a statement of their assessment of the need for the furnishing or appliance.

(3)   The area manager or designee reviews and responds to the request and assessment, within five days after considering:

(A)   whether the request includes necessary information;

(B)   whether the case manager assessment indicates need;

(C)   whether the household has or has disposed of usable items to meet the need; and

(D)   that items less than five years old are repaired whenever feasible; with the exception of lamps, telephones, or safety items.

(4)   Expenditures for property purchased with the property replacement supplement must not be reported as expenses against the room and board payment.

(5)   No reimbursement for replacement of worn out furnishings may occur during the first year of service.

(6)   The disposal of any furnishings purchased for class members under this supplement meets the requirements of this paragraph.

(A)   Any furnishings purchased through this supplement become the property of the class member.

(B)   Any funds received from the disposal of property belong to the class member.

(C)   The provider must document the disposal of furnishings in detail.

(D)   When the provider believes that the disposal of property is not in the best interest of the class member, the issue is referred to the Personal Support Team for resolution.

(E)   The replacement of usable appliances and furnishings that have been disposed of is the class member's responsibility.

(f)   Transportation supplement. OKDHS pays a transportation supplement only when the provider agency supplies a vehicle for the exclusive use of each household and the combined mileage for all persons residing in the household totals less than 30 miles per day.

(1)   To calculate the authorization for the transportation supplement:

(A)   for a class member who does not require adapted transportation, subtract from 30 the number of authorized miles per day supplied to the individual, and multiply by $0.25; or

(B)   for an individual who requires adapted transportation, subtract from 30 the number of authorized miles per day supplied to the individual, and multiply by $0.70.

(2)   Waiver transportation is authorized per OAC 317:40-5-103.

(g)   Fiscal accountability. The provider agency follows fiscal accountability standards established in this subsection.

(1)   The provider agency expends all payment supplied per OAC 340:100-5-22.5 on the specific activities for which the payment was provided.

(A)   Any funds expended for purposes other than the authorized activities are repaid to OKDHS.

(B)   The room and board fund balance at the end of the fiscal year cannot exceed five percent of the total supported living revenues. Any fund balance in excess of five percent is repaid to OKDHS.

(2)   The provider agency maintains copies of all claims, substantiating documents, and records regarding provider agency fiscal status within corporate offices in Oklahoma.

(3)   Supported living expenditures must:

(A)   be documented;

(B)   not include administrative costs of the provider agency; and

(C)   be audited annually per OAC 340:100-3-27.5.

[Source: Added at 20 Ok Reg 544, eff 1-21-03 (emergency); Added at 20 Ok Reg 936, eff 6-1-03; Amended at 21 Ok Reg 888, eff 4-26-04; Amended at 27 Ok Reg 838, eff 7-1-10]