State of the States in Intellectual and Developmental Disabilities

statewide

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Information used to conduct an initial evaluation is submitted to OHCA by the DHS/DDS Intake Case Manager. This information includes a psychological evaluation that includes a full scale functional and/or adaptive assessment and a statement of age of onset of the disability and intelligence testing that yields a full scale intelligence quotient; a social service summary current within 12 months of requested waiver approval date that includes a developmental history; a medical evaluation current within 90 days of requested waiver approval date; a completed ICF-IID Level of Care Assessment form; and proof of disability according to Social Security Administration (SSA) guidelines. If a disability determination has not been made by SSA, OHCA may make a disability determination using the same guidelines as SSA. During times of emergency declaration, the medical evaluation requirement is waived for initial evaluations. Annual reevaluations are conducted by DHS/DDS Level of Care Reviewers unless a significant change has occurred which questions a member’s qualifying diagnosis. In those cases, the same, but current, information used for the initial evaluation is submitted to OHCA for reevaluation. During times of emergency declaration, the medical evaluation may be current within two years, instead of one year, of the requested waiver approval date. Also, the social summary may be current within 24 months of requested waiver approval date and other required reassessments may be delayed by up to 12 months.

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During times of emergency declaration, alternative settings for Prevocational services and Adult Day services may be authorized prior to updating the member’s service plan. The DHS/DDS Case Manager will update the Individual Plan (Plan) within 60 days following the authorization and may backdate authorizations for waiver services provided during this period of time. The process for Plan development will remain the same as outlined in the approved waiver. Required DHS/DDS case management monitoring visits will be conducted by HIPAA compliant video conferencing, unless an extreme situation warrants an in-person visit. DHS/DDS staff will make site visits only when there is reason to believe the person’s health or safety is at significant risk, i.e., it is reported that required supports are not available and a wellness check by local authorities cannot be secured within 24 hours. The need for an in-person home visit will require approval of the DHS/DDS supervisor. Given the social distancing recommendation, it is not advisable for groups to gather in the same location. As a result, team meetings, including individual planning meetings, may be held via HIPAA compliant teleconference or videoconference. Required signatures, including the date the individual planning meeting was held, may be obtained via mail or electronically. We will suspend the requirements for community activities including efforts to pursue community integrated employment efforts. Suspend requirements for allowing visitors except for certain compassionate care situations, such as an end of life situation. The modification of this right is not required to be justified in the Individual Plan.

Approval for a member to use or be administered a nonprescription (over-the-counter) medication is received in writing from the member’s licensed healthcare provider at least annually. During times of emergency declaration, the requirement for a Medication Administration Technician (MAT) to obtain written approval for non-prescription medication by a licensed healthcare provider is waived during the emergency. If an individual is in isolation or quarantined, at home, due to COVID-19 and is instructed by a licensed health care provider, state or local health official to use or be administered non-prescription medication and an existing written approval is not in place, the provider will ensure medication(s) is administered according to manufacturer’s label instructions and follow documentation requirements, per Oklahoma Administrative Code (OAC) 340:100-5-32, including documenting the response to the non-prescription medication(s). If the instruction contradicts a previous written prescription or the recommendation exceeds the label instruction the primary health care provider should be contacted and a written order should be obtained. If medication is administered by a licensed nurse, the nurse must comply with the Oklahoma Nurse Practice Act. All persons administering medication should be aware of licensing or certification requirements and employer specific rules and regulations. DDS only waives the requirement for annual written approval of non-prescription medication, per Oklahoma Administrative Code (OAC) 340:100-5-32. DHS policy directs providers who have entered into Agreements with OHCA to provide waiver services, as well as DHS/DDS staff, to report critical and non-critical incidents involving the health and welfare of any person receiving services. Contract provider staff report critical and non-critical incidents electronically via the DHS/DDS Provider Reporting System. The DHS/DDS Case Manager is notified immediately when there is a critical incident. If the incident occurs outside regular working hours, the DHS/DDS Case Manager is notified the next working day. During times of emergency declaration, notification of the critical incident via electronic reporting may occur within three business days, with the exception of critical incidents involving death, suspected abuse, neglect or exploitation or unplanned hospital admission, which should be reported by phone within one business day. As long as notification to the DHS/DDS Case Manager and/or the Office of Client Advocacy (OCA) is completed within one business day, the requirement for the submission of an electronic critical incident report is extended to three business days as staff may not be able to access a computer to submit in a more timely manner. Modification of notification does not change requirement by provider and DHS/DDS case manager to ensure the individual is safe following the critical incident, preventative measures are implemented and notification to appropriate entities such as guardian and investigative authority has occurred. Non-critical incidents reports must be provided to DHS/DDS case management within five business days of the incident, instead of three business days, when an emergency declaration has been made. Modification of notification via electronic reporting is effective during declaration of the emergency.

For members with COVID-19 or COVID-19 like symptoms who are in a short-term care facility or hospital during times of declared emergency, a provider with an active OHCA waiver agreement to provide Habilitation Training Specialist (HTS) services may bill for HTS services to assist the member with supports, supervision, communication, and any other supports that the hospital is unable to provide, not to exceed 30 consecutive days.

Providers of Daily Living Supports services and Agency Companion services may receive retainer payments, aka therapeutic leave, for the individual receiving services for 14 consecutive days per event, not to exceed 60 days per member’s plan of care year in order to maintain staff. During emergency declaration, providers of Daily Living Supports and Agency Companion services may receive up to the lesser of 30 consecutive days or the number of bedhold days the State will pay (60 per year). Prevocational, Supported Employment and Adult Day Services include personal care. Providers of these services, per Olmstead Letter #3 dated July 25, 2000, may receive retainer payments up to the lesser of 30 consecutive days or the number of bedhold days the State will pay (60 per year). Retainer payments won’t exceed 60% of the monthly average of total billing for prevocational, supported employment and adult day services for any provider. Retainer payments for prevocational, supported employment and adult day services are limited to 6 hours per day and a total of 5 days per week (Monday – Sunday).

The Participant Directed service delivery method may be used for the delivery of Habilitation Training Specialist services during times of emergency declaration.

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Providers of Physical Therapy, Occupational Therapy, Speech Therapy, Nutritional Services, Family Counseling, Family Training, Nursing and Psychological services may utilize HIPAA compliant video conferencing/telehealth during times of emergency declaration. Temporarily allow prescriptions from a contracted qualified health professional, when authorizing Occupational Therapy, Physical Therapy, Nutrition or Speech Therapy services, to be current within the previous 24 months.