(a) Purpose. Developmental Disabilities Services (DDS)
quality assurance (QA) activities assess and encourage delivery of supports
(1) the preferences and needs of service recipients;
(2) Oklahoma Department of Human Services (DHS)
(3) applicable Oklahoma Health Care Authority (OHCA)
(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.
visits must include observation of, and talking with the service recipient
regarding the service recipient's health and welfare and satisfaction with
(B) The case
service provision and related documentation in any location where services are
(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):
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
(D) For service
recipients receiving services through a Community Waiver:
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;
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
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
(E) For service
recipients receiving services through the Homeward Bound Waiver:
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
(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
(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
(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
(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.
(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
(A) are incorporated non-profit agencies dedicated to the
representation of persons with developmental disabilities and their family
(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
(C) ensuring consistency of volunteer and staff activities
(i) OQSC-approved procedures and protocols;
(ii) federal and state laws; and
(iii) DHS and OHCA rules;
(D) accurately recording OK AIM monitoring activities
(E) ensuring provision of findings to provider agencies 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 notify the 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
(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)
(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
(C) OK AIM monitors report any other significant issues to
designated DDS area office staff within time frames determined appropriate by
(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
(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
(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 340:100-3-27.1 through OAC 340:100-3-27.5.