The following words and terms, when used in this Chapter, shall have the following meanings, unless the context clearly indicates otherwise:
"Active treatment" means aggressive and consistent implementation of a program of specialized and generic training, treatment, and health services directed toward the service recipient's acquisition of skills necessary to function as independently as possible.
"Advisory Committee on Services to Persons with Developmental Disabilities" means the committee appointed by the Director of Oklahoma Department of Human Services (OKDHS) to review and make recommendations on rules and programs of Developmental Disabilities Services Division (DDSD) to the Director and Oklahoma Commission for Human Services.
"Advocate" means a person who speaks for or on behalf of a service recipient, especially when individual rights or interests are at risk.
"Age appropriate" means that aspect of normalization that reinforces recognition of an individual as a person of his or her chronological age.
"Alternative appropriate setting" means a setting, other than a nursing facility, in which needed habilitation services are provided, including an intermediate care facility for the mentally retarded (ICF/MR) or Home and Community-Based Services (HCBS).
"Assessment" means the process of identifying:
- (A) a service recipient's:
- (i) present developmental or functional level;
- (ii) health status;
- (iii) developmental strengths and needs; and
- (iv) environment; and
- (B) other conditions that support or impede the service recipient's development.
"Capacity to give informed consent" means the ability to make and express voluntary decisions, given correct and sufficient information about the nature, purpose, risks, and benefits of a proposed service or action, and has not been adjudicated incapacitated by a court for purposes of the decision.
"Case manager" means a professional who is responsible for ensuring services to a service recipient are planned and provided in a coordinated fashion through independent advocacy, brokerage, and monitoring activities with, and on behalf of, service recipients.
"Challenging behavior" means a behavior that, by its frequency or degree of intensity:
- (A) places at risk a service recipient's physical safety, environment, relationships, or participation in the community; or
- (B) creates a risk of involvement in civil or criminal processes.
"Client Contact Manager (CCM)" means a computer software system used by DDSD case managers to collect and monitor case management data for all service recipients.
"Community Integrated Employment (CIE)" means a service program that provides placement, job training, and short-term or long-term supports to assist service recipients in achieving and maintaining employment within the community.
"Confidential information" means:
- (A) information related to a service recipient generated by OKDHS or contract providers; and
- (B) observations of and discussions concerning service recipients, their families, guardians, or friends.
"Consumer" means a person who is a direct recipient or beneficiary of service planning and delivery and is synonymous with client, service recipient, and individual served.
"Contract provider or agency" means an agency or person rendering services to persons with developmental disabilities under a contractual agreement with OKDHS or Oklahoma Health Care Authority (OHCA).
"Convalescent care" means nursing facility care:
- (A) following a person's release from an acute care hospital that is part of a medically prescribed period of recovery; and
- (B) that is not expected to exceed an established number of days.
"DDSD" means Developmental Disabilities Services Division, an operating unit of OKDHS.
"Developmental disability" means a severe chronic disability of a person that:
- (A) is attributable to a mental or physical impairment or combination of mental and physical impairments;
- (B) is manifested before the person attains age 22;
- (C) is likely to continue indefinitely;
- (D) results in substantial functional limitations in three or more of the areas of major life activity that are:
- (i) self-care;
- (ii) receptive and expressive language;
- (iii) learning;
- (iv) mobility;
- (v) self-direction;
- (vi) capacity for independent living; and
- (vii) economic self-sufficiency; and
- (E) reflects the person's need for a combination and sequence of special, interdisciplinary, or generic care, treatment, or other services that are of lifelong or extended duration and are individually planned and coordinated.
"Family homes" means residences maintained by persons biologically related to a person receiving services.
"Family training" means activities designed to equip family members, significant others, and persons with developmental disabilities with knowledge and skills that allow a family member with developmental disabilities to remain in or return to his or her home.
"Goals" means long-term categorical statements that describe what the service recipient is expected to achieve in a given time frame and are used synonymously with outcomes.
"Guardian" means a person appointed by a court as general or limited guardian of the person, general or limited guardian of property, special guardian or temporary guardian as provided by state statutes to ensure the essential requirements for the health and safety of the ward are met, to manage the estate or financial resources of the ward, or both.
"Guardian ad litem" means a person appointed by a court to represent the interests of a person in a legal action.
"Habilitation services" means goal-directed services and therapy activities:
- (A) designed to assist a service recipient to achieve greater mental, physical, and social development; and
- (B) based on the service recipient's capacity to make progressively independent and responsible decisions about:
- (i) social behavior;
- (ii) quality of life;
- (iii) job satisfaction; and
- (iv) personal relationships.
"Human Rights Committee" means the committee charged with the responsibility for external monitoring and advocacy to address protection of individual rights.
"ICF/MR" means an intermediate care facility for the mentally retarded that is:
- (A) a residential facility licensed in accordance with Oklahoma law; and
- (B) certified by the federal government as a provider of Medicaid services to persons who have mental retardation (MR) or related conditions.
"Incapacitated" means a determination made by the court that a person is unable to provide for and make decisions for the person's own needs and safety.
"Individual Plan (Plan)" means a plan of intervention developed by the Team based upon assessment of need. The Plan:
- (A) specifies outcomes being pursued on behalf of the service recipient, steps being taken to achieve outcomes, and all services and supports necessary to achieve outcomes; and
- (B) is a single, comprehensive plan that encompasses all relevant components of the service recipient's life. Various aspects of the Plan are assigned to those persons or agencies designated by the Team to provide services.
"Intake" means the process by which a person gains access to DDSD services. Intake staff:
- (A) provides answers to specific service inquiries;
- (B) assists in the identification of needs in times of crisis;
- (C) supplies information regarding the range and means of accessing available services;
- (D) provides assistance as necessary in service application; and
- (E) facilitates eligibility determination.
"Integrated employment site" means a location or activity that provides regular interaction for service recipients with persons without disabilities, excluding service providers, to the same extent that a worker without disabilities in a comparable position interacts with others.
"Intrusive procedure" means a procedure that impinges upon the bodily integrity of the service recipient, per OAC 340:100-5-57 and 340:100-5-58. Intrusive procedures include, but are not limited to:
- (A) use of injections or oral medications administered for the sole purpose of controlling behavior;
- (B) physical management or physical restraint; and
- (C) mechanical restraints for medical reasons.
"Job coach" means a person who holds an OKDHS approved job coach certification and provides ongoing support services to service recipients in supported employment placements. Services directly support the service recipient's work activity, including:
- (A) marketing and job development;
- (B) job and work site assessment;
- (C) training and assessment;
- (D) job matching procedures;
- (E) developing co-worker supports; and
- (F) teaching job skills.
"Least restrictive alternative" means services and supports that cause the least disruption or change in the service recipient's circumstances and maximizes the service recipient's independence and freedom.
"Long-term resident" means any resident of a nursing facility with MR or related conditions who has continuously resided in a nursing facility for at least 30 consecutive months prior to the date of the first preadmission screening and resident review (PASRR) disposition.
"Mental retardation (MR)" means a condition, per Diagnostic and Statistical Manual of Mental Disorders (DSM), that:
- (A) refers to substantial limitations in present functioning;
- (B) manifests before age 18; and
- (C) is characterized by significantly subaverage intellectual functioning, existing concurrently with related limitations in two or more of the applicable adaptive skill areas of:
- (i) communication;
- (ii) self-care;
- (iii) home living;
- (iv) social skills;
- (v) use of community resources;
- (vi) self-direction;
- (vii) health and safety;
- (viii) functional academics;
- (ix) leisure; and
- (x) work.
"Natural supports" means assistance provided by a person, such as a service recipient's family, friend, co-worker, or neighbor, or member of a service recipient's club, church, or interest group, or others in the service recipient's community, who:
- (A) is not paid specifically to provide assistance to the service recipient; and
- (B) provides assistance voluntarily.
"Non-prescription medication" means a pharmacological drug that is sold without a prescription and prepackaged for use by the service recipient and labeled in accordance with requirements of state and federal statutes and regulations.
"Nursing facility" means an Oklahoma Medicaid-certified institution providing skilled nursing and related services, excluding a facility certified as ICF/MR.
"Personal Support Team (Team)" means the decision-making body for service planning, implementation, and monitoring of the service recipient's Plan and includes:
- (A) the service recipient; and
- (B) service recipient's:
- (i) case manager;
- (ii) legal guardian; and
- (iii) when applicable, advocate, who may be a parent, family member, friend, or another who knows the service recipient well; and
- (C) others, including service providers, whose participation is necessary to achieve the outcomes desired by the service recipient.
"Physical management" means an intrusive procedure involving any physical guidance of a service recipient to overcome resistance or brief upper body hold to ensure safety per OAC 340:100-5-57.
"Physical restraint" means an intrusive procedure in which the service recipient is physically held to restrict movement.
"Physical Status Review" means Form 06HM007E, Physical Status Review, that is a written assessment identifying a service recipient's ability to attend to activities of daily living based on past and present health history and current treatment modalities. Completed Form 06HM007E assists the service recipient and Team in identifying the:
- (A) service recipient's health care level;
- (B) staff training requirements;
- (C) health care coordination needs; and
- (D) in-depth assessment needs.
"Plan of Care" means a summary listing of services prescribed within the Plan that indicates the amount, duration, and cost of each service recommended for funding through DDSD HCBS Waivers.
"Preadmission screening and resident review (PASRR)" means the process of evaluating, reviewing, and establishing the need for nursing facility services in contrast to other services for persons with MR and related conditions.
"Prescription medication" means any drug ordered by a practitioner of medicine, dentistry, osteopathy, optometry, or podiatry who is licensed by law to prescribe a drug intended to be filled, compounded, or dispensed by a pharmacist.
"p.r.n." means to take or administer a medication as needed.
"Program coordinator" means a person employed by a DDSD residential contract provider agency who is responsible for the supervision, coordination, and monitoring of services provided by the contract agency to a service recipient.
"Program manager" means a person employed by a DDSD employment contract provider agency who is responsible for the supervision, coordination, and monitoring of services provided by the contract agency to a service recipient.
"Psychotropic medication" means a pharmacological drug used to treat a mental disorder, or any drug prescribed to stabilize or improve mood, mental status, or behavior.
"QMRP" means a qualified mental retardation professional who meets ICF/MR regulations specified in Section 483.420 of Title 42 of the Code of Federal Regulations (CFR) (42 CFR § 483.420). A QMRP must have a baccalaureate degree in a human services field, in addition to one year of experience serving persons with MR.
"Related condition" means a severe chronic disability, per 42 CFR § 435.1009, that:
- (A) is attributable to:
- (i) cerebral palsy;
- (ii) epilepsy; or
- (iii) any other condition, including autism. Any other condition excludes mental illness (MI) that is closely related to MR as it results in impairment of general intellectual functioning or adaptive behavior similar to that of persons with MR and requires treatment or services similar to those required for persons with MR;
- (B) is manifested before the person reaches age 21;
- (C) is likely to continue indefinitely; and
- (D) results in substantial functional limitations in three or more areas of major life activity, including:
- (i) self-care;
- (ii) understanding and use of language;
- (iii) learning;
- (iv) mobility;
- (v) self-direction; and
- (vi) independent living.
"Restrictive procedure" or "restriction" means a procedure that results in the limitation of the service recipient's rights, per OAC 340:100-5-57 and 340:100-5-58, and includes:
- (A) limiting communication with others;
- (B) any limitation of access to:
- (i) leisure activities;
- (ii) the service recipient's own money or personal property; and
- (iii) goods or services beyond normal budgetary considerations;
- (C) any limitation of movement at home or in the community; or
- (D) any direct observation procedures, specified as a result of challenging behavior, such as continuous one-to-one staffing during times or places that would otherwise be considered private.
"Sheltered employment" means a service that:
- (A) assists service recipients toward achieving their vocational potential through a controlled work environment;
- (B) provides worker reimbursement in accordance with individual production and Fair Labor Standards Act (FLSA); and
- (C) includes assessment, training, and transitional programming leading to community job placements.
"Sheltered workshop" means a facility that provides vocational training and sheltered employment services for workers with disabilities.
"Short-term resident" means any resident with MR or related conditions who has resided in a nursing facility for less than 30 months prior to the date of the first PASRR disposition.
"Specialized services" means individualized services specified in PASRR evaluations completed by DDSD that, combined with services provided by the nursing facility or other service providers, results in a treatment regimen leading to the continued and ongoing enhancement of independence.
"Supplemental Security Income (SSI)" means a federal income subsidy program administered by Social Security Administration.
"Supported employment" means competitive work in an integrated work setting with ongoing support services for service recipients with severe disabilities for whom competitive employment has not traditionally occurred or has been interrupted or intermittent as a result of severe disabilities.
"Supported living arrangements" means a flexible array of habilitation and support services ranging from 24 hour in-home services to semi-independent living services that provides an opportunity for an adult with developmental disabilities to live in his or her own home.
"Terminal illness" means, as certified by a physician, a person has a medical prognosis of life expectancy of six months or less if the illness runs its natural course.
"Transition" means the planned movement of a service recipient from one service setting to another, occurring as a result of Team recommendation and informed consent of the service recipient.
"Treatment team for specialized services" means the team whose purpose is to develop a prescribed plan of specialized services for each service recipient. The team:
- (A) is composed of the service recipient, guardian or advocate, nursing home representative, and other professionals and para-professionals as needed to develop a comprehensive plan of services; and
- (B) may include a psychologist, physical therapist, speech pathologist, physician, and nurse's aide among others.
"Vocational assessment" means the employment service evaluation, whether standardized procedures are employed, that:
- (A) identifies unique preferences, strengths, and needs of the service recipient;
- (B) evaluates work skills and work behaviors;
- (C) is supplemented by personal interviews and behavioral observations; and
- (D) incorporates information that addresses the service recipient's:
- (i) medical;
- (ii) physical;
- (iii) psychological;
- (iv) social;
- (v) cultural;
- (vi) educational goals and objectives; and
- (vii) present and future employment options.
"Volunteer guardian" means a person unrelated to the service recipient who:
- (A) serves as guardian for the service recipient and is trained and certified by the volunteer guardianship agency; and
- (B) is appointed by and responsible to the court to ensure essential requirements for the health and safety of the service recipient are met.
"Ward" means a person for whom a guardian is appointed by the court.