(a) Findings of performance surveys, administrative inquiries, or focused re-surveys are reviewed by the Performance Review Committee (PRC) when the:
- (1) provider submits an appeal of any decision of the administrator of Quality Assurance or designee within 14 days from mailing of the preliminary determination;
- (2) provider fails to correct all identified deficiencies by the approved resolution date or if new deficiencies are identified in accordance with subparagraph (6)(E) of 340:100-3-27.1; or
- (3) administrator of Quality Assurance or designee determines that sanctions may be required as a result of gross or perpetual violation of the contract.
(b) The PRC consists of representatives of major units of the division appointed by the Developmental Disabilities Services Division (DDSD) director, except the administrator of Quality Assurance does not serve as a voting member.
(c) The PRC meets monthly to review and issue a determination on referrals. Available determinations include:
- (1) acceptance, denial, or modification of an appeal;
- (2) a determination that sanctions are not warranted;
- (3) invocation of one or more sanctions including:
- (A) vendor hold, which precludes the admission to the agency of any person whose services are to be funded by DDSD or Waiver services;
- (B) suspension of funding pending resolution of conditions violating terms of the contract;
- (C) a daily penalty calculated at the rate of .0002 (2/10,000) times the agency's combined annual payments for DDSD state-funded services and Home and Community-Based Waiver (HCBW) services funded through the Oklahoma Health Care Authority (OHCA) for the previous state fiscal year, to a maximum of $500 per day, pending resolution of conditions violating terms of the contract with the Department of Human Services (DHS).
- (i) The daily penalty is imposed when it is found that the agency has not resolved all previously cited deficiencies by the approved resolution date(s), unless the PRC determines, based on evidence submitted by the agency within one week of a focused re-survey, that actions essential to compliance were beyond the control of the agency.
- (ii) The daily penalty is suspended on the day the agency provides notice to the DDSD Quality Assurance state office staff that all identified deficiencies have been resolved. A focused re-survey is conducted on the earliest possible date. The penalty is terminated as of the date of provider notice if all previously identified deficiencies are resolved. The penalty is reinstated, as of the date of the initial notice by the provider, if it is found that all previously identified deficiencies are not resolved.
- (iii) Proceeds from any daily penalties are used by DHS to fund one-time or emergency supports for persons on the DDSD waiting list;
- (D) disallowance of claims for services by staff whose:
- (i) training has not been completed in accordance with OAC 340:100-3-38; or
- (ii) pre-employment screening does not comply with OAC 340:100-3-39;
- (E) termination of contract with DHS;
- (F) recommendation for termination of contract with OHCA; and
- (G) the requirement that the provider employ sufficient program coordination staff to provide one program coordinator for each ten individuals receiving residential supports as defined in OAC 340:100-5-22.1.
- (i) The program coordination staff ratio may be invoked when a violation(s) of program coordination requirements in OAC 340:100-5-22.1 remains uncorrected 60 days following the provider's receipt of a written report of the findings.
- (ii) The provider maintains the 1:10 program coordinator ratio for one year, unless the requirement is extended by the PRC based on subsequent deficiencies.
- (iii) The provider must maintain the 1:10 program coordinator ratio for each caseload that includes a person receiving residential supports.
(d) Agencies are notified in writing of the determinations made by the PRC. The president of the agency's board of directors is provided a copy by mail when a sanction, as described at subsection (c) of this Section, is authorized.
(e) The DDSD director retains the authority to supersede the decisions of the administrator of Quality Assurance or the PRC.
(f) The DDSD director or designee may issue an emergency determination, independent of review by the PRC or written input by a provider agency when evidence is presented indicating risk of immediate and substantial jeopardy to the health or safety of a person receiving supports.
- (1) The DDSD director or designee may use any DHS resource considered appropriate to further investigate such circumstance, but is not required to do so.
- (2) Emergency determinations:
- (A) include the scope of options defined in subsection (c) of this Section, waiving any stated time frame for implementation; and
- (B) are not subject to appeal.