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340:100-5-26. Health services
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Revised 5-15-08
(a) Purpose. Service recipients receive equal access to the quality and range of health care services available to all persons. Services are provided according to applicable federal and state laws, Oklahoma Department of Human Services (OKDHS) Developmental Disabilities Services Division (DDSD) rules, and recommendations made by the service recipient's Personal Support Team (Team).
(b) Scope and applicability. OAC 340:100-5-26 applies to service recipients receiving residential services or group home services funded or licensed by DDSD or Home and Community-Based Services (HCBS) Waivers.
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(1) DDSD health services are secured based on the service recipient's needs and service requests by the service recipient, service recipient's parent(s), spouse, legal guardian, or Team, as specified by the service recipient's Individual Plan (Plan).
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(2) Services outside the scope of programs funded by OKDHS or Oklahoma Health Care Authority (OHCA) are provided contingent upon available resources.
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(3) Oklahoma State Department of Health (OSDH) recommendations for immunizations, communicable disease testing, universal precautions, and infection control practices are used to prevent the transmission of communicable diseases.
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(4) DDSD staff and contract providers implement procedures to maintain and improve the health of each service recipient, including procedures related to:
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(A) providing emergency medical intervention, including initiation of first aid and cardio-pulmonary resuscitation (CPR) and accessing emergency service systems;
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(B) preventing disease;
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(C) aging; and
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(D) following physician orders.
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(5) When health needs exceed the scope of DDSD services, the service recipient is referred to an appropriate licensed community health care setting.
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(6) DDSD staff and contract providers acknowledge the right of the service recipient, next of kin, legal guardian, or physician to execute:
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(A) an advance directive made in accordance with Section 3101.1 of Title 63 of the Oklahoma Statutes ( 63 O.S § 3101.1); or -
(B) a Do‑Not‑Resuscitate Order (DNR) made in accordance with 63 O.S § 3131.1.
(c) Health-related assessments and record keeping requirements. Each service recipient:
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(1) or, if applicable, legal guardian identifies a primary care physician or provider from available resources. Specialty consultation and services are obtained when needed; and
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(2) receiving residential services has an annual physical examination. The physician's report of the annual physical examination, documentation of medical visits, and reports of all other health-related assessments are maintained in the home record.
(d) Physical status review (PSR) requirements.
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(1) The service recipient's primary care physician, nursing, and health care assessments identify the need for health care services.
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(2) The DDSD case manager ensures Form 06HM007E, Physical Status Review, is initially completed for each service recipient.
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(3) The service recipient's health care needs are addressed by the Team, using Form 06HM007E.
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(A) Form 06HM007E is a review tool that objectively identifies a service recipient's functional ability to attend to activities of daily living based on past and present health history and current treatment modalities.
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(B) The PSR assesses the service recipient's needs in the areas of:
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(i) functional abilities;
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(ii) behaviors;
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(iii) physiological needs;
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(iv) safety considerations; and
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(v) frequency of service.
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(C) The interviewer who completes Form 06HM007E is trained to complete the form.
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(D) To complete Form 06HM007E, the interviewer communicates with the service recipient or someone who knows the service recipient's medical history, current trends in overall health and behavior, daily care needs, medical or nursing treatments, the past year's medical incidents, emergency room visits, hospitalizations, and medication regimen.
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(4) Form 06HM007E is completed annually, no more than 60 days prior to the annual Team meeting.
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(5) Immediate action is taken to provide any emergency interventions required in a situation of acute health deterioration.
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(6) When a significant change in the service recipient's function or health treatment occurs that requires additional staff training or health care services, the Team completes a new Form 06HM007E and revises the Plan as necessary.
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(7) The PSR is the Team's mechanism to identify a health care level based on the service recipient's health status.
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(A) A DDSD nurse assesses the responses documented by the interviewer, formulates a raw score, and computes the health care level, based on specific criteria.
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(i) Level I, service recipient ordinarily has no body system compromised. The service recipient is assisted or has the ability to access the health care system.
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(ii) Level II, service recipient ordinarily has a chronic condition, but the health status is stable.
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(iii) Level III, service recipient ordinarily has two or more chronic co‑existing conditions with no occurrences within the past year.
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(iv) Level IV, service recipient ordinarily has two or more existing health conditions that require close observation for symptoms and specialized health training.
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(v) Level V, service recipient ordinarily meets all criteria for Level IV and has health needs that require licensed nursing treatment one or more times daily.
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(vi) Level VI, service recipient ordinarily has several existing health issues that are unstable and require treatment by a nurse more frequently than every two hours over a 24-hour period.
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(B) Based on the health care level, the DDSD nurse develops recommendations for staff health training, level of nursing supports, and level of nursing monitoring to be delivered.
(i) Level I, annual PSR is ordinarily the only nursing service needed.
(e) Planning requirements.
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(1) The Team identifies desired health care outcomes during the Team process.
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(2) Health issues identified through health care evaluations and assessments that impact the service recipient's life are incorporated and integrated by the Team into the Plan through goals and objectives.
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(3) Plans for health care needs are developed in terms of individual outcomes, not units of clinically specific service.
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(4) When plans for health care needs or implementation strategies are developed involving discipline-specific services, a representative from that discipline participates in at least a consulting role.
(f) Team review requirements for invasive or intensive procedures.
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(1) Any invasive or intensive professional service or procedure is subject to review by the Team, including participation from any other service provider as appropriate.
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(2) Team review of an invasive or intensive service or procedure includes discussion, prior to implementation, of the proposed service or procedure, and of possible alternatives.
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(3) Invasive procedures subject to review by the Team comprise both scheduled and emergency procedures, including major surgery, that:
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(A) produce a significant change in daily function or health;
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(B) require additional staff training or health care services; and
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(C) include, but are not limited to:
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(4) An invasive or intensive professional service or procedure implemented on an emergency basis is subject to review by the Team as soon as possible, but within five working days. Emergency procedures subject to review include, but are not limited to emergency:
(g) Health care coordination requirements.
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(1) The Team identifies a health care coordinator (HCC) for the service recipient to ensure implementation and coordination of health care services. The HCC:
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(A) is a person who has an overview of the service recipient's health care needs and lifestyle, and may be the service recipient, service recipient's family member, foster parent, companion, residential provider staff, or other person who is familiar with the service recipient's needs;
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(B) is trained by DDSD staff;
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(C) serves as a health care facilitator and follows requirements in OAC 340:100‑5-26;
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(D) documents that health concerns are acted upon, monitored, and communicated and staff are trained;
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(E) accompanies the service recipient to the physician and communicates to the physician the reason the service recipient is seen;
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(F) keeps the physician advised of medical status and data regarding any target symptoms;
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(G) communicates any physician's order obtained during such visit to core Team members and other service providers as appropriate; and
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(H) presents Form 06HM005E, Referral Form for Examination or Treatment, to the physician at the time of the visit.
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(2) If the HCC is employed by a contract provider, the employer develops and implements a procedure to ensure appropriate backup if the HCC is unable, for any reason, to perform these duties.
(h) Implementation procedures.
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(1) When a service recipient receives physician-prescribed nursing services, a written nursing care plan is developed and monitored by the contract nurse.
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(2) Direct support staff is trained and carries out implementation strategies addressing health care outcomes.
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(3) Adequate current medical and program information is maintained in the home record by the residential provider and available for review by authorized OKDHS staff.
(i) Evaluation and monitoring requirements.
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(1) Medication reviews are completed by the HCC each month utilizing Form 06HM006E, Health Status and Medication Review.
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(2) The DDSD case manager makes a referral for a pharmacological review by an independent clinical pharmacist or physician: • 1
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(A) upon request of a Team member or clinician participating with the Team;
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(B) when the review performed by the assigned DDSD case manager and nurse determines a referral to an independent clinical pharmacist or physician is indicated. The DDSD case manager and nurse perform a review when the service recipient:
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(i) receives five or more medications, prescription or non-prescription; or
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(ii) has an unusual physical sign or symptom during the month in review that is not resolved through other medical interventions; or
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(C) when the service recipient:
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(i) uses a p.r.n. medication routinely for more than three months;
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(ii) takes two or more psychotropic medications; or
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(iii) takes more than two anticonvulsant medications used for a seizure disorder.
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(3) If the service recipient continues to meet criteria per OAC 340:100-5-26(i)(2)(A), (B), or (C), the DDSD case manager and nurse annually, or more frequently if necessary, complete a review of the service recipient's condition. If a pharmacological review is clinically indicated, the case manager requests a pharmacological review in conjunction with the annual Plan.
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(4) For the purpose of monitoring and evaluation, designated DDSD staff has access at all times to the service recipient's medical and programmatic information.
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(5) If the service recipient receives DDSD services but has no DDSD case manager, the provider contacts the DDSD area manager or designee for assistance in requesting an independent pharmacological review.
Revised 5-15-08
1. Pharmacological reviews. Developmental Disabilities Services Division (DDSD) has a contract through which pharmacological reviews are provided.
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