(a) Legal basis.  Authority to operate alternative group homes is found in Section 1020 of Title 56 of the Oklahoma Statutes (56 O.S. § 1020) and 22 O.S. § 1175.6b.  Administrative and program requirements for alternative group homes are described in OAC 317:40-5-152 and OAC 340:100-5-22.6 and 340:100-6.

(b) General information.  Alternative group homes:

• (1) serve up to four service recipients who have:
  • (A) serious behavioral or emotional challenges or community protection issues in addition to mental retardation and require continuous supervision and assistance to remain in the community; or
  • (B) been charged with a felony, determined by the district court as incompetent to stand trial due to mental retardation and dangerous, and placed by the district court in the custody of the public guardian; and
• (2) provide more restrictive measures than other community residential settings to ensure the safety of the service recipient and others.

(c) Provider approval criteria.  In addition to requirements of OAC 340:100-6-12, prospective providers of alternative group home services must demonstrate a history of effective services and supports to persons with serious behavioral or emotional challenges or community protection issues.  Provider approval requires review of historical information, if available, from Developmental Disabilities Services Division (DDSD) Quality Assurance Unit and Area Office.  The location of the alternative group home must be approved in writing by the DDSD director or designee prior to the implementation of services.  Each prospective provider submits written documentation of:

• (1) history of services to persons who present serious behavioral or emotional challenges or community protection issues, including:
  • (A) past experience;
  • (B) number of persons served;
  • (C) provider's perspective on the greatest challenges in serving persons eligible for alternative group home services; and
  • (D) provider's philosophy for service provision;
• (2) fiscal information as requested to determine financial viability, including the anticipated budget related to the rate for alternative group home services;
• (3) service provision plans, including:
  • (A) anticipated number of homes;
  • (B) location;
  • (C) floor plans;
  • (D) gender to be served;
  • (E) population to be served; and
  • (F) availability of psychological, psychiatric, and vocational services in the proposed location;
• (4) plans for staffing and program coordination; and
• (5) staff qualifications, including any additional training to be provided.

(d) Eligibility to receive services.  To be eligible for services in an alternative group home, the person must:

• (1) be in the custody of the public guardian per 22 O.S. § 1175.6b or 1175.6c; or
• (2) meet the criteria for intermediate care facility for the mentally retarded (ICF/MR) level of care; and
  • (A) require 24-hour, on-site, awake staff supervision to ensure safety; and
  • (B) be found by the DDSD Community Services programs administrator or designee to have serious behavioral or emotional challenges or community protection issues, such as:
    • (i) evidence of commitment of a sexually violent offense, sexually predatory act, or crime of sexual violence including, but not limited to:
      • (I) rape;
      • (II) lewd or indecent acts or proposals made to a child, per 21 O.S. § 1123; or
      • (III) forcible sodomy, per 21 O.S. § 888;
    • (ii) history of stalking or opportunistic behavior that demonstrates a likelihood to commit a sexually violent or predatory act;
    • (iii) documented pattern of acts of violence toward others;
    • (iv) experience ongoing, highly disruptive behavioral episodes that:
      • (I) are dangerous per 22 O.S. § 1175.1; and
      • (II) require close supervision and frequent intervention by staff;
    • (v) evidence of commitment of one or more violent offenses, such as:
      • (I) murder or manslaughter;
      • (II) attempted murder;
      • (III) arson;
      • (IV) assault;
      • (V) kidnapping; or
      • (VI) use of a weapon to commit a crime; or
    • (vi) severe ongoing self-injurious behavior.

(e) Services provided.  Services provided are designed to assist service recipients in acquiring, retaining, and improving self-help, socialization, and adaptive skills necessary to reside successfully in a home and community-based setting.

• (1) Services include supports to meet each service recipient's needs including, but not limited to:
  • (A) residential habilitation such as assistance with the acquisition, retention, or improvement of skills related to activities of daily living, such as:
    • (i) personal grooming and cleanliness;
    • (ii) bed making and household chores;
    • (iii) eating and food preparation; and
    • (iv) social and adaptive skills necessary to enable the service recipient to reside in a shared home;
  • (B) program supervision and oversight including 24-hour availability of response staff to meet schedules or unpredictable needs in a way that promotes maximum dignity and independence, while providing for supervision and safety.  In addition to requirements in OAC 340:100-6-55, program coordination staff (PCS) must be provided that:
    • (i) serves no more than 12 service recipients;
    • (ii) ensures staffing levels meet the requirements of OAC 340:100‑5‑22.6(e)(1)(H); and
    • (iii) ensures records are maintained per OAC 340:100-3-40;
  • (C) implementation of community protection precautions and individual program plans per OAC 340:100-5-22.6(f);
  • (D) recreational and leisure activities, including individual and group activities;
  • (E) assistance in money management;
  • (F) health care services provided per OAC 340:100-5-26 and 340:100-5-26.3;
  • (G) medication administration per OAC 340:100-5-32; and
  • (H) management of staffing levels to provide supervision that ensures the safety of the service recipient, community, staff, and other service recipients and meets the requirements of each service recipient's Individual Plan (Plan).
    • (i) An average of 14 hours of staffing per service recipient must be provided per billable day prior to filing a claim for habilitation training staff authorized in accordance with OAC 317:40-5-152.
      • (I) At least two awake staff must be on duty during hours when service recipients are in the home.
      • (II) This requirement may be reduced to one awake staff, when there is only one service recipient in the home.
    • (ii) Sufficient daytime staffing must be provided to:
      • (I) ensure adequate supervision in the home and community; and
      • (II) implement the Plan, except during the time the service recipient is in an employment, vocational, or day services program for which services have been authorized to provide the needed supervision, security, and support.  All staff are trained in accordance with OAC 340:100-3-38.
    • (iii) At least two awake staff must be on duty during hours when service recipients are asleep.
      • (I) The requirement for two awake staff may be reduced to one staff with the approval of the Team when there are only one or two service recipients in the home.
      • (II) Staff on duty must be physically able and mentally alert to carry out the duties of the job.
    • (iv) The provider must:
      • (I) have staff available to provide necessary support and supervision when the service recipient needs to return from employment or other day services;
      • (II) provide activity options and supervision during all periods of time when the service recipient is not participating in authorized employment activities; and
      • (III) ensure effective transition and coordination of supervision between alternative group home and employment programs or other authorized absences from the alternative group home program.
• (2) In addition to the services in OAC 340:100-5-22.6(e)(1), services for wards of the public guardian are designed to ensure the service recipient is not dangerous to self or others.

(f) Alternative group home program requirements.  In addition to compliance with applicable Oklahoma Department of Human Services (OKDHS) and Oklahoma Health Care Authority (OHCA) rules, the provider ensures:

• (1) staff implements security precautions protecting the service recipient, neighbors, children, adults who are vulnerable, animals, and others;
• (2) staff implements outcomes and action steps detailed in the Plan to assist service recipients to function safely in the community and avoid criminal activity;
• (3) collaboration and coordination occur with DDSD staff, employment providers, therapists, and other entities and persons, such as law enforcement, corrections officers, schools, employers, mental health workers, and, when appropriate, the public guardian;
• (4) program designs and behavior support practices beyond those specified in OAC 340:100-5-22.6 comply with OAC 340:100-5-50 through 340:100-5-58;
• (5) written agency policies comply with OKDHS and OHCA rules;
• (6) effective security and supervision of service recipients in the residence and community are provided;
• (7) contingency plans are developed and implemented for:
  • (A) emergency relocation of a service recipient who has created a danger or who is in danger;
  • (B) emergency staffing in the event changes are required to protect staff or others;
  • (C) general emergencies requiring evacuation of the entire home, such as fire or weather emergencies, per OAC  340:100-6-45; and
  • (D) elopement;
• (8) legal and court requirements are followed, including adherence to Oklahoma laws governing registered sexual offenders;
• (9) the health care coordinator or other knowledgeable staff accompanies the service recipient to each medical or psychiatric appointment, taking current data summaries that indicate the rate of occurrence of medication-responsive symptoms or behaviors over the last one to three months.  For visits to the physician prescribing psychotropic medication, the summary covers symptoms or behaviors listed on Form 06HM067E, Semi-annual Psychotropic Medication Review;
• (10) specific offense patterns are considered and addressed when determining appropriate program locations;
• (11) cabinets are locked if they contain any knives or other sharp objects that may be used as weapons or any items specifically identified by the Team as dangerous;
• (12) staff provides arm's-length supervision to each service recipient when outside the home unless another supervision pattern is specifically described in the Plan and approved by designated DDSD State Office staff;
• (13) door and window alarms are used;
• (14) the yard is fenced with a locked gate, unless the requirement for a locked gate is waived in writing by the DDSD director or designee; and
• (15) other necessary restrictive procedures as detailed in the Plan are implemented, that may include:
  • (A) restricted views from or into windows, doors, and other openings;
  • (B) restricted access to certain areas; and
  • (C) for wards of the public guardian, restrictions deemed necessary to keep the service recipient and public safe.

(g) Weapons.  Dangerous or deadly weapons are not permitted in the alternative group home or on the premises.  Providers are prohibited from assisting any service recipient to obtain or possess dangerous or deadly weapons including, but not limited to:

• (1) guns, BB guns, air rifles, or other firearms;
• (2) crossbows;
• (3) paint guns;
• (4) arrows;
• (5) explosives;
• (6) stun guns; and
• (7) knives, except cooking and eating utensils.

(h) Prohibited substances.  Illegal substances and alcohol are not permitted in the alternative group home.

(i) SoonerCare eligibility.  The service recipient and guardian, with necessary support from the provider, establish and maintain SoonerCare eligibility, if possible.

(j) Natural supports.  Persons who agree to provide natural supports to a service recipient living in an alternative group home must:

• (1) work with the Team to develop a schedule, support strategies, or other agreement for support.  Each Plan contains a description of any natural support to be provided that ensures the safety and welfare of the service recipient and community.  No arrangement can be made for natural supports that violate existing court orders, security arrangements, or the Plan;
• (2) keep commitments made regarding supports; and
• (3) document or report to the program coordinator or DDSD case manager regarding supports provided.

(k) Refusal to participate.  If a service recipient or guardian refuses to participate in service delivery as described in the Plan:

• (1) the provider:
  • (A) continues to implement the Plan as written; and
  • (B) immediately notifies the DDSD case manager of the need for a Team meeting;
• (2) the DDSD case manager takes immediate action to convene the Team to address the situation; and
• (3) steps in OAC 340:100-3-11 are followed.

(l) Record keeping.  In addition to requirements of OAC 340:100-3-40, records of service recipients must include:

• (1) documentation of the registration of the service recipient with appropriate law enforcement authorities, if required, and documentation of subsequent notification to DDSD of registration;
• (2) documentation of all agreements or plans with other agencies or persons who support the service recipient, including guardian and family members, that specifies requirements for supervision of the service recipient when staff is not present;
• (3) documentation of any refusal by the service recipient to follow conditions of the Plan, Protective Intervention Plan, or treatment recommendations of treatment professionals; and
• (4) Form 06CB055E, Monthly Summary of Restrictive/Intrusive Procedure Usage, per OAC 340:100-5-57.1.

(m) Transportation.  Providers of alternative group home services must ensure transportation is:

• (1) available as needed for medical emergencies, appointments, day programs, and community activities per OAC 317:40-5-103; and
• (2) supervised per OAC 340:100-5-22.6 in accordance with each service recipient's needs.

(n) Transition.  Teams plan for transition of service recipients to appropriate services when it is determined the alternative group home program is no longer necessary.

• (1) Within three months of the service recipient's admission to an alternative group home, the Team develops reasonable criteria for the service recipient's move to a less restrictive environment that are:
  • (A) included in a written plan submitted to designated DDSD State Office staff; and
  • (B) reviewed at least annually by the Team.
• (2) All transitions from alternative group homes must be approved by designated DDSD State Office staff.  State Office Residential Unit staff may adjust the transition date if necessary.  • 1

(o) DDSD-initiated transition.  DDSD Community Services programs administrator or designee may initiate the transition process for a person receiving alternative group home services who can be effectively served in another residential environment.