(a) Introduction.  Daily Living Supports are provided by an agency with a valid OHCA contract, approved by DDSD, for the service.

• (1) Daily Living Supports require meeting the daily support needs of the people living in the home.
  • (A) In accordance with the needs of the class member, Daily Living Supports include hands-on assistance, supervision, or prompting so that the person performs the task, such as eating, bathing, dressing, toileting, transferring, personal hygiene, light housework, money management, community safety, recreation, social, health, or medication management.
  • (B) Daily Living Supports also include assistance with cognitive tasks or provision of services to prevent an individual from harming self or others, in accordance with the needs of the person receiving services.
  • (C) Daily Living Supports also include:
    • (i) the provision of staff training to meet the specific needs of the service recipient;
    • (ii) program supervision; and
    • (iii) program oversight.
• (2) Daily Living Supports are used to provide and fund up to eight hours per day of supports for class members receiving supported living services as detailed in OAC 340:100-5-22.5.

(b) Eligibility.  Daily Living Supports, as described in this Section, are provided to individuals who:

• (1) are members of the class certified in Case Number 85-C-437-E, U.S. District Court for the Northern District of Oklahoma;
• (2) receive community residential services in their own home; and
• (3) do not simultaneously receive any other community residential or group home services.

(c) Responsibilities of provider agencies.  Each provider agency providing Daily Living Supports must:

• (1) ensure ongoing supports as needed to all service recipients living in the home when one or more service recipients is out of the home visiting family and friends, or hospitalized for psychiatric or medical care;
• (2) ensure compliance with all applicable DDSD policy found at OAC 340:100; and
• (3) provide for the welfare of all service recipients living in the home.

(d) Criteria for direct support staff services in the Homeward Bound Waiver beyond eight hours per day.  Additional direct support services including HTS, Homemaker, or Intensive Personal Supports, beyond the average of eight hours per day referenced in subsection (a) of this Section, are provided based on needs identified by the Personal Support Team.

(e) Daily Living Supports claims.  No more than 365 units of Daily Living Supports may be billed per year, except Leap Year, for each individual receiving services.

• (1) The provider agency claims one unit of service for each day the individual receives Daily Living Supports.
• (2) Providers must claim at least monthly for all days that Daily Living Supports were actually provided during the preceding month.  Claims must not be based on budgeted amounts.
• (3) When an individual changes provider agencies, only the outgoing service provider agency claims for the day that the individual moves.

(f) Billing for other support services.  The provider agency may claim separately for additional support services such as HTS, Intensive Personal Supports, or Homemaker Services provided to an individual receiving Daily Living Supports, if:

• (1) additional support services have been authorized in the person's Plan of Care; and
• (2) eight hours of direct staff support, excluding Nursing, have already been provided to the person that day.  If support services are provided to multiple individuals residing in the same household at the same time, the provider agency cannot count these hours toward each individual's eight-hour minimum.  For example, three hours of HTS provided simultaneously by a single direct contact staff to three residents in the same household may only be counted as three hours of HTS for one of the individuals, not three hours for each resident.

(g) Therapeutic leave.  Therapeutic leave is a Medicaid payment made to the Daily Living Supports contract provider to enable the service recipient to retain direct support services.

• (1) Therapeutic leave is claimed when the service recipient does not receive Daily Living Supports services for 24 consecutive hours because of:
  • (A) a visit with family or friends without direct support staff;
  • (B) vacation without direct support staff; or
  • (C) hospitalization, whether direct support staff are present or not.  Daily living supports staff are present with the individual in the hospital as approved by the person's Team in the Individual Plan.
• (2) An individual may receive therapeutic leave for no more than 14 consecutive days per event, not to exceed 60 days per Plan of Care year.
• (3) The payment for a day of therapeutic leave is the same amount as the per diem rate for Daily Living Supports.
• (4) If, because of the service recipient's absence, the direct support staff member is unable to work, the provider pays the staff member the salary that he or she would have earned if the service recipient were not on therapeutic leave.