(a) Purpose. Developmental Disabilities Services Division (DDSD) quality assurance (QA) activities assess and encourage delivery of supports consistent with the preferences and needs of service recipients, Oklahoma Department of Human Services (OKDHS) rules, applicable Oklahoma Health Care Authority (OHCA) rules, OKDHS and OHCA contract requirements for Home and Community‑Based Services (HCBS), regulatory standards applicable to services, and federal and state laws.
(b) Case manager monitoring. DDSD 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 OAC 340:100-3-27 are minimum expectations for face-to-face visits with service recipients. Additional visits may be required at the discretion of case management, to ensure the service recipient's health and welfare.
- (1) The DDSD case manager conducts face-to-face visits to monitor the service recipient's health and welfare and effectiveness of services in meeting the service recipient's needs.
- (A) Face-to-face visits must include observation of and talking with the service recipient regarding the service recipient's health and welfare and satisfaction with services.
- (B) The case manager may:
- (i) observe service provision and related documentation in any location where services are provided; and
- (ii) talk with family members and providers regarding provision of services and the service recipient's health and welfare.
- (C) For service recipients receiving services through an In-Home Supports Waiver (IHSW):
- (i) a face-to-face visit must be completed at least semi-annually with one visit occurring during the January through June period and one during the July through December period; and
- (ii) at least one of the two visits must occur at the site where the majority of services are provided.
- (D) For service recipients receiving services through the Community Waiver:
- (i) a face-to-face visit must occur during each calendar month in the home of all persons receiving 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 Home Record and Verification of Monitoring Requirements, within the home record per OAC 340:100-3-40;
- (ii) a face-to-face visit must be completed at least quarterly, per calendar year quarters and coinciding with the quarters established per OAC 340:100-5-52 for 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
- (iii) the case manager visits the employment or day services site at least semi-annually, with one visit occurring during the January through June period, and one during the July through December period, when services are funded through the Community Waiver, unless the Personal Support Team (Team) requests an exception approved by the DDSD area manager or designee.
- (E) For service recipients receiving services through the Homeward Bound Waiver:
- (i) a face-to-face visit must occur during each calendar month in the home. Case managers must certify home visits on Form 06MP070E within the home record per OAC 340:100-3-40; and
- (ii) the case manager must visit the employment site at least quarterly, per calendar year quarters and coinciding with the quarters established per OAC 340:100-5-52 for quarterly summary of progress reports, unless the Team requests an exception approved by the DDSD area manager or designee.
- (F) For members of the Homeward Bound class who reside in an intermediate care facility for persons with mental retardation (ICF/MR), the case manager visits monthly.
- (2) DDSD case managers review and ensure implementation of the Plan.
- (A) The case manager completes a monthly review for service recipients receiving services through the Community Waiver or Homeward Bound Waiver, documenting the review in Client Contact Manager (CCM).
- (B) For service recipients receiving services through an IHSW, the case manager review occurs every six months and is documented in CCM.
- (3) When the DDSD 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 DDSD case management supervisor and any other appropriate authorities.
- (4) If the DDSD 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) are followed.
- (A) The case manager consults with the relevant provider to secure a commitment for necessary service changes within an agreed upon time frame.
- (B) If necessary changes are not accomplished within the specified time frame, the case management supervisor intervenes to secure commitments from the provider for necessary change.
- (C) If 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 DDSD staff, a system administrative inquiry is initiated.
- (A) QA staff emails notification to DDSD staff responsible to correct the situation, establishing a reasonable time frame for correction.
- (B) If the identified staff is unable to correct the situation within the established time frame, QA staff emails notification of the situation to the DDSD staff supervisor, establishing a reasonable time frame for correction.
- (C) If the staff supervisor is unable to correct the situation within the established time frame, QA staff notifies his or her supervisor, who notifies the DDSD area manager, establishing a reasonable time frame for correction.
- (D) If the area manager is unable to correct the situation within the established time frame, QA supervisor notifies the QA unit programs administrator, who resolves the situation with the community services unit programs administrator.
(c) Specialized Foster Care Monitoring. QA staff monitor the specialized foster care program in each area for compliance with DDSD and OHCA policy. Monitoring is based on a proportionate, representative sample of individuals receiving specialized foster care 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 an evaluation of services per OKDHS Publication No. 89-10, Consumer Service Evaluation.
- (1) Confidentiality is maintained unless the respondent authorizes OKDHS to reveal his or her name to those responsible for service delivery. OKDHS Publication No. 89-10 may be completed anonymously if desired.
- (2) QA staff distributes OKDHS Publication No. 89-10 to service recipients or their legal guardians at least annually.
- (3) Completed OKDHS Publication No. 89-10 is returned to the QA Unit programs administrator.
- (4) Results are forwarded to the respective DDSD area office when authorized by the service recipient or legal guardian for resolution of concerns or recognition of staff as appropriate.
- (5) An analysis of responses is completed and distributed for action to DDSD area offices, DDSD State Office, or OKDHS as appropriate. Data is available to interested persons upon request.
(e) OK-AIM. Service recipients and families receiving supports participate in formal assessments of contract providers in order to promote service enhancement consistent with expectations of service recipients.
- (1) Oklahoma - Advocates Involved in Monitoring (OK-AIM) operates under the direction of Oklahomans for Quality Services Committee (OQSC).
- (A) OQSC is composed of 15 persons who receive or have a family member receiving DDSD services. All areas of Oklahoma are represented.
- (i) OQSC members may be nominated by the public at large, current OQSC members, or DDSD representatives.
- (ii) Appointment of OQSC members occurs as a result of joint consensus by the OQSC chair and DDSD 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 time necessary to fulfill his or her responsibilities.
- (iii) OQSC members have the authority to elect officers based upon a simple majority vote and establish by-laws governing the conduct of business.
- (B) OQSC:
- (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) DDSD issues an invitation to bid (ITB) in accordance with state law and OKDHS rules, soliciting proposals from qualified organizations to participate in the OK-AIM initiative. Qualified organizations include agencies that:
- (A) are incorporated non-profit agencies dedicated to the representation of persons with developmental disabilities and their family members;
- (B) are not involved in service delivery funded through DDSD 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 OKDHS 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 providers of services referenced in the ITB within counties for which the agency has assumed responsibility;
- (C) ensuring consistency of volunteer and staff activities with:
- (i) procedures and protocols approved by OQSC; and
- (ii) federal and state laws and OKDHS and OHCA rules;
- (D) accurately recording findings of OK-AIM monitoring activities;
- (E) ensuring provision of findings to provider agencies and DDSD; and
- (F) immediately notifying the DDSD area office of any issue identified during OK-AIM monitoring activities that presents risk to the service recipient's health and welfare.
- (5) DDSD area managers identify OKDHS staff responsible for resolving concerns identified during OK-AIM monitoring activities and notifying agencies responsible for OK-AIM monitoring activities of how to contact such staff during work, evening, and weekend hours.
- (6) OQSC with the participation of DDSD State Office, DDSD area offices, and agencies conducting OK-AIM activities, identifies conditions determined to present significant risks to service recipients.
- (A) Conditions determined to present imminent risk to service recipients are reported immediately to the:
- (i) statutory investigatory authority;
- (ii) DDSD area office; and
- (iii) provider agency chief executive officer (CEO) or designee.
- (B) Issues determined to pose potential risk to service recipients are reported to DDSD area office staff, who notify the provider agency CEO or designee, no later than the conclusion of the first working-day following observation.
- (C) OK-AIM monitors report any other significant issues to designated DDSD area office staff within time frames determined appropriate by OK-AIM.
- (7) DDSD staff immediately identifies DDSD area office staff to assume responsibility for verification and correction of problems posing imminent or potential risk.
- (A) Time frames for resolution of validated concerns are approved by the DDSD area manager based on the degree of risk involved.
- (B) All identified concerns are resolved within 30 days from initial notification to the DDSD area office, unless an extension is authorized by the area manager in circumstances that pose no jeopardy to any service recipient.
- (C) Concerns presenting immediate and significant risk to service recipients are corrected immediately.
- (8) Each DDSD area manager designates staff to:
- (A) track resolution of each identified concern; and
- (B) advise agencies conducting OK-AIM monitoring activities of 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 DDSD area office for review within 30 days of a home visit.
- (B) DDSD area office staff shares this information with the provider and collaborates on recommendations as well as other alternatives for achieving 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) OK-AIM survey process is re-assessed at least annually by OQSC based upon feedback solicited from service recipients, DDSD 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 DDSD 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 risk to service recipients.
(g) Failure to cooperate. Provider agencies failing to cooperate with provisions or providing false information in response to inquiries per OAC 340:100-3-27 are subject to sanctions identified, including contract termination.
(h) Findings of non-compliance. Findings of significant non-compliance with human rights, laws, or rules are immediately reported to the DDSD director and other relevant authorities for appropriate action, including disciplinary action of OKDHS 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 OKDHS 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 OKDHS agent. Authorized agents are OKDHS staff whose responsibilities include administration, supervision, or oversight of DDSD services, including all DDSD and Office of Client Advocacy staff.
(j) QA functions. Additional components of the DDSD QA program are found in OAC 340:100-3-27.1 through OAC 340:100-3-27.5.