(a) Purpose. The rules in this Section are established to ensure that nutrition services to sustain quality of life and ensure optimal nutritional status are provided to individuals with developmental disabilities who receive Home and Community-Based Waiver services.
(b) General information. Nutrition services are based on the individual's need as specified by the Individual Plan and include evaluation of the service recipient's nutritional status.
-
(1) If nutrition services from funding sources other than Waiver services are available to the service recipient, the service recipient uses those services before using Waiver services. In order for the service recipient to receive Waiver-funded nutrition services, the requirements in this Section must be fulfilled.
-
(2) A legally competent adult or legal guardian who has been informed of the risks and benefits of the service has the right to refuse nutrition services.
-
(A) Refusal of nutrition services must be documented in the Individual Plan.
-
(B) If the service recipient has been receiving nutrition services and nutritional status is currently stable, the Team may specify that nutrition services are not needed. The Team specifies individual risk factors for the service recipient that would necessitate resumption of nutrition services and assigns responsibility to a named Team Member(s) for monitoring and reporting the service recipient's status regarding these factors.
-
(3) Staff of the Oklahoma Department of Human Services Developmental Disabilities Services Division (DDSD) and contract agents implement procedures for nutritional risk identification, implementation of needed services, and nutritional risk monitoring to maintain and improve the nutritional health status of each person served.
(c) Services for persons not receiving residential supports. If the service recipient does not receive residential supports as defined in OAC 340:100-5-22.1, or group home services:
-
(1) the Individual Plan must justify the need for nutrition services as described in OAC 340:100-3-33.1, Criteria to establish service necessity; and
-
(2) procedures described in subsections (e) through (j) are followed unless other procedures are approved in writing by the DDSD area manager or designee.
(d) Services for persons receiving residential supports. If the service recipient receives residential supports as defined in OAC 340:100-5-22.1, or group home services:
-
(1) the service recipient must have an updated OKDHS Form DDS-7 (new form number 06HM007E), Physical Status Review (PSR), in accordance with OAC 340:100-5-26, identifying an eating problem or nutritional risk indicated by a score of 3 or 4 on Eating, 4 on Gastrointestinal, 4 on Skin Breakdown, 4 on bowel Function, or 3 or 4 on the Nutrition section of the PSR. The Team must address these risks in the Individual Plan and identify appropriate professional oversight; and
-
(2) the requirements in subsections (e) through (j) of this Section are followed.
(e) Assessment. The nutrition therapist evaluates the service recipient's nutritional status and completes OKDHS Form DDS-40 (new form number 06HM040E), Level of Nutritional Risk Assessment.
-
(1) The assessment must include, but is not limited to:
-
(A) health, diet, and behavioral history impacting on nutrition;
-
(B) clinical measures including body composition and physical assessment.
-
(C) dietary assessment, including:
-
(D) recommendations to address nutritional risk needs, including:
-
(2) The nutrition therapist and other involved professionals make recommendations for achieving positive nutritional outcomes based on the risks identified on the OKDHS form DDS-40 (new form number 06HM040E).
-
(3) The nutrition therapist sends a copy of the DDS-40 (new form number 06HM040E) to the case manager within ten working days of the authorization.
-
(4) If the assessment shows the service recipient rated as "High Nutritional Risk", the nutrition therapist sends a copy of the DDS-40 (new form number 06HM040E) to the DDSD area nutrition therapist or DDSD area professional support services designee as well as the case manager within 10 working days of the authorization.
(f) Planning. The DDSD case manager, in conjunction with the Team, reviews the identified nutritional issues that impact the service recipient's life.
-
(1) Any service recipient with a PSR score of 3 or above on Section A, Eating, must have an individualized mealtime assistance plan developed and reviewed at least annually by the Team member(s) identified responsible in the Individual Plan. The mealtime assistance plan includes but is not limited to:
-
(A) a diet or meal plan;
-
(B) positioning needs;
-
(C) adaptive equipment needs;
-
(D) communication needs;
-
(E) food presentation;
-
(F) documentation requirements;
-
(G) monitoring requirements; and
-
(H) training and assistance requirements.
-
(2) In accordance with OAC 340:100-5-26, the Team:
-
(A) discusses any gastrostomy or jejunostomy tube placement, including discussion of less intrusive alternatives, prior to implementation of the proposed procedure; or
-
(B) reviews emergency placement of any gastrostomy or jejunostomy tube within five working days after placement.
-
(3) The Team annually develops, and documents in the Individual Plan a review of, a plan for return to oral intake, in accordance with individual needs, for each service recipient who receives nutrition through a tube.
-
(4) Desired nutritional outcomes are developed and integrated into the Individual Plan using the least restrictive, least intrusive, most normalizing measures that can be carried out across environments.
-
(5) The Team member(s) identified responsible in the Individual Plan develops methods to support the nutritional outcomes, which include:
(g) Implementation. Strategies are implemented by the assigned person within a designated time frame established by the Team based on individual need(s).
-
(1) Direct support staff members are trained in accordance with the Individual Plan and OAC 340:100-3-38.
-
(2) All special diets, nutritional supplements, and aids to digestion and elimination must be prescribed and reviewed at least annually by a physician.
(h) Documentation. Program documentation as determined necessary by the Team is maintained in the service recipient's home record for the purpose of evaluation and monitoring. The professional provider(s) sends documentation regarding the service recipient's progress on the nutrition outcomes, program concerns, and recommendations for remediation of any problem area to the case manager each month, or as often as deemed necessary by the Team.
(i) Evaluation and monitoring. A review to evaluate the success of the program is performed at least once each month or as deemed necessary in the Individual Plan by the professional(s) designated by the Team. The area manager or designee may require a specified schedule for service recipients with a high nutritional risk.
-
(1) The designated professional(s) reviews the program data submitted for:
-
(2) DDSD professional support services personnel provide administrative oversight and quality assurance monitoring on an ongoing basis to service recipients with eating risk or nutritional risk identified through the PSR using:
-
(A) on-site visits; and
-
(B) record reviews.
-
(3) When a service recipient is identified by the DDS-40 (new form number 06HM040E) to be at high nutritional risk, he or she receives increased monitoring by:
-
(A) the nutrition therapist and health care coordinator, as determined necessary by the Team; and
-
(B) the DDSD area nutrition therapist or DDSD area professional support services designee.
-
(4) Significant changes in nutritional status must be reported to the case manager by the health care coordinator.
-
(5) The DDS-40 (new form number 06HM040E):
-
(A) is used by the contract nutrition provider to reassess service recipients at high risk on a quarterly basis; and
-
(B) must be submitted by the contract nutrition provider to the DDSD area nutrition therapist or DDSD area professional support services designee within 15 days following the end of each quarter (March, June, September, December).
-
(6) The DDSD area nutrition therapist or designee, in conjunction with DDSD support services professionals, provides technical assistance to resolve individual nutrition issues and makes recommendations for additional technical assistance if needed.
(j) Technical Assistance. Professional contract providers serving as management consultants provide technical assistance as authorized. Technical assistance may be requested using OKDHS form DDS-41 (new form number 06HM041E), Physical-Nutritional Management Consultation Request, by the Team or DDSD support services staff to address:
-
(1) unresolved nutritional management issues;
-
(2) gastrostomy or jejunostomy tube placement or removal;
-
(3) individualized mealtime assistance plan development; or
-
(4) any aspect of assessment, planning, implementation, evaluation, or monitoring of nutrition services.