OKDHS - OAC 317:40-5-3. Agency companion services

317:40-5-3. Agency companion services

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Revised 6-11-10

(a) Agency companion services (ACS):

(1) are provided by agencies that have a provider agreement with the Oklahoma Health Care Authority (OHCA);
(2) provide a living arrangement developed to meet the specific needs of the member that includes a live-in companion providing supervision, supportive assistance, and training in daily living skills provided in a shared home owned or rented by the member, companion, or in a mutually rented or owned home;
(3) are available to members 18 years of age or older who are eligible for services through Community or Homeward Bound Waivers. Persons under the age of 18 years may be served with approval from the DDSD director or designee;
(4) are based on the member's need for residential services per OAC 340:100-5-22 and support as described in the member's Individual Plan (IP), per OAC 340:100-5-50 through 340:100-5-58.

(b) An agency companion:

(1) must be employed by or contract with a provider agency approved by the Oklahoma Department of Human Services Developmental Disabilities Services Division (DDSD);
(2) may provide companion services for one member. Exceptions to serve as companion for two members may be granted only upon approved by the DDSD director or designee. Exceptions 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 members;
(3) household is limited to one individual companion provider. Exceptions for two individual companion providers in a household who each provide companion services to different members may be approved by the DDSD director or designee;
(4) may not provide companion services to more than two members at any time;
(5) household may not serve more than three members through any combination of companion or respite services;
(6) 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) Employment as an agency companion is the companion's primary employment.
(B) The companion may not have other employment when
approved to serve two members regardless of the levels of support required by the members.
(C) The companion may have other employment when:

(i) the personal support Team documents and addresses all related concerns in the member's IP;
(ii) the other employment is approved in advance by the DDSD area manager or designee; and
(iii) 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
(iv) the companion provides assurance the employment is such that the member's needs will be met by the companion should the member's outside activities be disrupted.

(D) If, after receiving approval for other employment, authorized DDSD staff determines the other employment interferes with the care, training, or supervision needed by the member, the companion must terminate, within 30 days:

(E) Homemaker, habilitation training specialist, and respite services are not provided in order for the companion to perform other employment.

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

(A) is a SoonerCare payment made to the contract provider to enable the member to retain services; and
(B) is claimed when:

(C) is limited to no more than 14 consecutive days per event, not to exceed 60 days per Plan of Care year; and
(D) cannot be accrued from one Plan of Care year to the next.

(2) The therapeutic leave daily rate is the same amount as the ACS per diem rate except for the pervasive rate which is paid at the enhanced agency companion per diem rate.
(3) The provider agency pays the agency companion the salary that he or she would earn if the member were not on therapeutic leave.

(d) Levels of support for the member and corresponding payment are:

(1) determined by authorized DDSD staff in accordance with levels described in (A) through(D); and
(2) re-evaluated when the member has a change in agency companion providers which includes a change in agencies or individual companion providers.

(A) Intermittent level of support. Intermittent level of support is authorized when the member:

(i) requires minimal physical assistance with basic daily living skills, such as bathing, dressing, and eating;
(ii) may be able to spend short periods of time unsupervised inside and outside the home; and
(iii) requires assistance with medication administration, money management, shopping, housekeeping, meal preparation, scheduling appointments, arranging transportation or other activities.

(B) Close level of support. Close level of support is authorized when the member:

(i) requires regular, frequent and sometimes constant physical assistance and support to complete daily living skills, such as bathing, dressing, eating, and toileting;
(ii) requires extensive assistance with medication administration, money management, shopping, housekeeping, meal preparation, scheduling appointments, arranging transportation or other activities; and
(iii) requires assistance with health, medication, or behavior interventions that may include the need for specialized training, equipment, and diet.

(C) Enhanced level of support. Enhanced level of support is authorized when the member:

(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;

(ii) demonstrates ongoing complex medical issues requiring specialized training courses per OAC 340:100-5-26; or
(iii) has behavioral issues that requires a protective intervention plan (PIP) with a restrictive or intrusive procedure as defined in OAC 340:100-1-2. The PIP must:

(I) be approved by the Statewide Behavior Review Committee (SBRC), per OAC 340:100-3-14;
(II) be reviewed by the Human Rights Committee (HRC), per OAC 340:100-3-6, or
(III) have received expedited approval per OAC 340:100-5-57.

(D) Pervasive level of support. Pervasive level of support is authorized when the member:

(i) requires additional professional level support to remain in an agency companion setting due to pervasive behavioral or emotional challenges. The support must be provided:

(I) by a licensed professional counselor (LPC) or professional with a minimum of Masters of Social Work (MSW) degree; and
(II) as ongoing support and training to the companion, offering best practice approaches in dealing with specific members; and

(ii) does not have an available personal support system. The need for this service level:

(I) must be identified by the grand staffing committee, per OAC 340:75-8-40; and
(II) requires the provider to market, recruit, screen, and train potential companions for the member identified.

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