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340:100-5-26. Health and wellness
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Revised 5-15-09
(a) Purpose. Services and supports promote health and well-being.
(b) Scope and applicability. OAC 340:100-5-26 applies to service recipients receiving services funded by Developmental Disabilities Services Division (DDSD) or Home and Community-Based Services (HCBS) Waivers.
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(1) Oklahoma State Department of Health (OSDH) guidelines for universal precautions, and infection control practices are used to prevent the transmission of communicable diseases.
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(2) DDSD staff and contract providers implement procedures to promote the health and wellness of each service recipient, including procedures related to:
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(A) accessing emergency medical intervention;
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(B) initiating first aid and cardio pulmonary resuscitation (CPR);
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(C) promoting disease prevention;
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(D) addressing issues associated with aging;
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(G) assisting the service recipient to access medical and dental services when needed; and
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(c) Service recipient responsibilities.
(d) Assessment of needs. The DDSD case manager ensures an individual assessment is completed for each service recipient per OAC 340:100-5-51.
(e) Planning and implementation requirements.
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(2) For a service recipient who receives minimal services to maintain residence in his or her own home, family home, or to maintain employment, the service recipient and his or her Team determines the appropriate roles for members of the Team per applicable policy.
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(3) For a service recipient who receives residential, group home or extensive health supports to remain in their own home, family home, or maintain employment, the team will identify specific roles and protocols necessary to provide support as listed in (A) – (H) of this paragraph.
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(A) The Team identifies desired health care outcomes through the Team process.
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(B) 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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(C) Health care services are addressed in terms of individual outcomes, not units of clinically specific service.
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(D) When assessing health care services or implementation strategies involving discipline-specific services, a representative from that discipline participates in at least a consulting role.
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(E) Any invasive or intensive professional service or procedure is reviewed by the Team, including participation from any other service provider as appropriate. Consent is assessed per OAC 340:100-3-5.
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(i) 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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(ii) Invasive procedures reviewed by the Team comprise both scheduled and emergency procedures, that include but are not limited to:
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(iii) An invasive or intensive professional service or procedure implemented on an emergency basis must be reviewed by the Team as soon as possible, but within five working days. Emergency procedures subject to review include, but are not limited to emergency:
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(F) The residential or group home provider has an obligation to assure health coordination activities are implemented.
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(G) The Team identifies a health care coordinator (HCC) to ensure implementation and coordination of health care services for the service recipient. The HCC:
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(i) is a person who has an understanding 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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(ii) receives DDSD required training;
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(iii) documents that health concerns are addressed, monitored, and communicated;
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(iv) supports the person to directly communicate to the physician the reason for the medical consultation whenever possible, or communicate on the service recipient's behalf;
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(v) keeps the physician advised of medical status and data regarding any target symptoms;
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(vi) communicates physician orders to core Team members and other service providers as appropriate;
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(vii) presents Form 06HM005E, Referral Form for Examination or Treatment, for HCBS Waiver recipients to the physician at the time of the visit.
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(viii) When 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; and
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(ix) completes health status and medication reviews each month using Form 06HM006E.
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(H) For HCBS Waiver service recipients, the DDSD case manager makes a referral for a clinical pharmacy review by a clinical pharmacist or physician:
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(i) upon request of a Team member or clinician participating with the Team;
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(ii) when a 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 submits a clinical pharmacy review annually or as needed when the service recipient:
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(I) receives five or more medications;
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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;
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(III) uses a p.r.n. medication routinely for more than three months with an average use of three per week or ten per month;
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(V) takes three or more anticonvulsant medications used for a seizure disorder.
(f) Implementation procedures for HCBS waiver skilled nursing services.
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(2) Community service workers are trained and carry out implementation strategies addressing health care outcomes.
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(3) Accurate and current medical and program information is maintained in the home record by the residential provider and available for review by authorized OKDHS staff.
(g) Case management monitoring responsibilities for HCBS Waiver service recipients.
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(2) For the purpose of monitoring and evaluation, designated DDSD staff have access at all times to the service recipient's medical and programmatic information.
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(3) The case manager monitors the service recipient's access to medical and dental services.
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(4) The case manager may assist the service recipient in locating health care providers.
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