(a) Eligibility. To assure that the daily living requirements of the class members are met, the Oklahoma Department of Human Services (OKDHS) provides a payment to the contract residential provider agency serving each person who:
- (1) is a member of the class certified in Case Number 85-C-437-E, United States District Court for the Northern District of Oklahoma; and
- (2) receives Daily Living Supports services as described in OAC 317:40-5-150.
(b) Service expectations. The provider agency ensures that:
- (1) all applicable rules of OKDHS and the Oklahoma Health Care Authority (OHCA) are met including:
- (2) the class member's expenses for housing, food, clothing, recreation, utilities, medical services, property replacement, and transportation are met in accordance with subsection (c) of this Section.
(c) Room and board payment. The room and board payments support the class member's housing, food, clothing, recreation, and utility costs in accordance with this subsection.
- (1) Each class member contributes an amount determined annually by DDSD, not to exceed 90% of his or her income, up to a maximum of 90% of the current Supplemental Security Income (SSI) payment for a single individual.
- (A) The maximum may be exceeded by prior written agreement between the individual served or his or her guardian and the provider agency with the written approval of the director of DDSD or designee.
- (B) OKDHS pays a supplement, equal to 90% of the SSI monthly payment for a single individual minus 90% of the class member's income, on behalf of each class member whose income and resources are insufficient for the person to contribute the maximum room and board payment explained in this paragraph.
- (2) To supplement the individual's funds for meeting daily living requirements, OKDHS provides:
- (A) a room and board payment at $14 per day; and
- (B) a residence size supplement payment to support the cost of a home, based on the number of individuals living in the home.
- (i) For an individual with no roommate, the residence size supplement is $10 per day.
- (ii) For an individual who has one roommate, the residence size supplement is $6 per day.
- (iii) There is no residence size supplement for an individual living with more than one roommate.
- (iv) For the purposes of this subparagraph, an individual not listed in Case Number 85-C-437-E is not considered a roommate.
- (3) The provider agency completes a written financial agreement with the class member and chosen advocate(s) or the legal guardian in accordance with OAC 340:100-5-22.1.
- (4) Room and board revenues must be accounted for separately from other provider agency funds.
- (A) Room and board revenues from OKDHS are managed by the provider to meet the needs of all individuals living in supported living arrangements.
- (B) Room and board payments from individuals served are used only to meet the needs of that individual.
- (5) Room and board revenues must be used, unless written approval is secured in advance from the DDSD programs administrator for community services, solely for:
- (A) housing costs and utilities;
- (B) groceries;
- (C) household maintenance;
- (D) recreation;
- (E) personal items and clothing;
- (F) household property insurance;
- (G) yard care; and
- (H) furnishings and appliances.
- (6) Room and board payments are authorized as long as the provider agency supports the individual to maintain a household.
- (7) Payments from OKDHS mentioned in paragraph (2) of this subsection are not income to the class member and must not be deposited in the class member's bank account.
(d) Medical supplement. OKDHS reimburses the provider agency for the cost of necessary medical services that are not covered through Medicaid or for persons who are not Medicaid eligible for any individual listed in Case Number 85-C-437-E. The medical supplement is not paid at a rate higher than allowed through the Oklahoma Medicaid Fee-for-Service Program unless approved by the DDSD area manager in writing.
(e) Property replacement supplement. A maximum of $850 per class member per fiscal year is reimbursed for replacement of unusable furnishings or necessary furnishings or appliances.
- (1) Expenditures for property purchased with the property replacement supplement must not be reported as expenses against the room and board payment.
- (2) No reimbursement for replacement of worn out furnishings may occur during the first year of service.
- (3) The disposal of any furnishings purchased for class members under this supplement meets the requirements of this paragraph.
- (A) Any furnishings purchased through this supplement become the property of the class member.
- (B) Any funds received from the disposal of property belong to the class member.
- (C) The provider must document the disposal of furnishings in detail.
- (D) When the provider believes that the disposal of property is not in the best interest of the class member, the issue is referred to the Personal Support Team for resolution.
(f) Transportation supplement. OKDHS pays a transportation supplement only when the provider agency supplies a vehicle for the exclusive use of each household and the combined mileage for all persons residing in the household totals less than 30 miles per day.
- (1) To calculate the authorization for the transportation supplement:
- (A) for a class member who does not require adapted transportation, subtract from 30 the number of authorized miles per day supplied to the individual, and multiply by $0.25; or
- (B) for an individual who requires adapted transportation, subtract from 30 the number of authorized miles per day supplied to the individual, and multiply by $0.70.
- (2) Waiver transportation continues to be authorized in accordance with OAC 317:40-5-103.
(g) Fiscal accountability. The provider agency follows fiscal accountability standards established in this subsection.
- (1) The provider agency expends all payment supplied in accordance with this Section on the specific activities for which the payment was provided.
- (A) Any funds expended for purposes other than the authorized activities are repaid to OKDHS.
- (B) The room and board fund balance at the end of the fiscal year cannot exceed five percent of the total supported living revenues. Any fund balance in excess of five percent is repaid to OKDHS.
- (2) The provider agency maintains copies of all claims, substantiating documents, and records regarding provider agency fiscal status within corporate offices in Oklahoma.
- (3) Supported living expenditures must:
- (A) be documented;
- (B) not include administrative costs of the provider agency; and
- (C) be audited annually in accordance with OAC 340:100-3-27.5.