Okla. Admin. Code § 317:40-5-3

Current through Vol. 42, No. 4, November 1, 2024

Section 317:40-5-3 - Agency companion services (ACS)

(a) ACS are:

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

(2) Provider Agency independent contractors and provide a shared living arrangement developed to meet the member's specific needs that include 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 eighteen (18) years of age or older who are eligible for services through Community or Homeward Bound Waivers. Persons under eighteen (18) years of age may be served with approval from Oklahoma Human Services (OKDHS) Developmental Disabilities Services (DDS) director or designee; and

(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) Households are limited to one (1) individual companion provider. Exceptions for two individual companion providers are allowed in a household when each provides companion services to different members. Exceptions may be approved by the DDS director or designee. Agency companions may not simultaneously serve more than four (4) members through any combination of companion or respite services. An agency companion:

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

(2) May provide companion services for one (1) member. Exceptions to serve as companion for two (2) members may be approved by the DDS director or designee. Exceptions for up to two (2) members 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 (2) members. Exceptions for additional members may be granted when the DDS director or designee determines an emergency situation exists and there is no other resolution, and the companion demonstrates the skill and ability required to serve as a companion;

(3) May not provide companion services to more than two (2) household members at any time; and

(4) 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:

(i) Employment is approved in advance by the DDS area residential services programs manager;

(ii) The 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

(iii) The companion ensures the employment is such that the member's needs are met by the companion if the member's outside activities are 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 thirty (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 employment.

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

(1) Therapeutic leave:

(A) Is a SoonerCare (Medicaid) 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 twenty-four (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; and

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

(D) Cannot be carried over from one (1) POC year to the next.

(2) The therapeutic leave daily rate is the same amount as the ACS 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 seven-hundred and twenty (720) hours.

(1) The daily respite rate is used when respite is provided for a full twenty-four (24) hour day. A day is defined as the period between 12:00 am and 11:59 pm.

(2) The hourly respite rate is used when respite is provided for a partial day.

(3) The provider may serve more than one (1) member through shared staffing, but may not bill HTS or the hourly respite rate for multiple members at the same time.

(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 the member not:

(A) Sleeping at night; or

(B) Working or attending employment, educational, or day services; and

(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 maintains the placement or provides 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 Personal Support Team (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 OAC 317:40-5-3(g)(2)(A) through (C); and

(2) Re-evaluated when the member has a change in individual companion providers.

(A)Close level of support. Close level of support is authorized when the member requires assistance in at least two (2) of the services in (i) through (iii) of this subparagraph.

(i) Minimal to extensive assistance 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.

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

(B)Enhanced level of support. Enhanced level of support is authorized when the member requires the level of assistance outlined in (g)(2)(A) and meets at least one (1) of the criteria in (i) through (iii) of this subparagraph. 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; or

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

(iii) Has behavioral issues that require a protective intervention protocol (PIP) with a restrictive or intrusive procedure, per OAC 340:100-1-2. The PIP must:

(I) Be approved by the Statewide Human Rights Behavior Review Committee, per OAC 340:100-3-14; or

(II) Have received temporary approval, per OAC 340:100-5-57.

(C)Pervasive level of support. Pervasive level of support is authorized when the memberis in OKDHS Child Welfare Services custody and efforts to place in traditional foster care have failed due to the extensive level of support required by the member. It is reevaluated only when the member is eighteen (18) years of age or older and his or her individual companion provider changes.

(i) This level of support may continue to be authorized when the member requires:

(I) The level of assistance outlined in (g)(2)(B); and

(II) Additional professional level support to remain in an agency companion setting due to pervasive behavioral or emotional challenges.

(ii) Providers of this level of support:

(I) Deliver direct support to the companion by a licensed or certified behavioral health professional with a minimum of a master's degree;

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

(III) Provide professional level and ongoing support as part of the ACS and not billed as a separate service. Waiver services may be authorized for the development of a PIP, per OAC 340:100-5-57; and

(IV) Market, recruit, screen, and train potential companions for the identified member.

(h) Authorization for payment of ACS 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 is scheduled to move to the companion's home. When a member transitions from a DDS placement funded by a pier diem the incoming provider may request eight (8) hours of HTS for the first day of service.

(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) The room and board payment may include all but one-hundred and fifty dollars ($150) per month of the member's income, up to a maximum of ninety (90) percent of the current minimum Supplemental Security Income payment for a single individual.

Okla. Admin. Code § 317:40-5-3

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 by Oklahoma Register, Volume 32, Issue 23, August 17, 2015, eff. 8/27/2015

Amended by Oklahoma Register, Volume 38, Issue 23, August 16, 2021, eff. 9/1/2021

Amended by Oklahoma Register, Volume 40, Issue 24, September 1, 2023, eff. 9/11/2023