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Part 41      FAMILY SUPPORT SERVICES

317:30-5-410.Home and Community-Based Services Waivers for persons with an intellectual disability or certain persons with related conditions
[Revised 06-25-12]
(a) The Oklahoma Health Care Authority (OHCA) administers Home and Community-Based Services (HCBS) Waivers for persons with an intellectual disability and certain persons with related conditions that are operated by the Oklahoma Department of Human Services (OKDHS) Developmental Disabilities Services Division (DDSD).   Each waiver allows payment for family support services as defined in the waiver approved by the Centers for Medicare and Medicaid Services (CMS). Waiver services:
(1) when utilized with services normally covered by SoonerCare, other generic services, and natural supports provide for health and developmental needs of members who otherwise would not be able to live in a home or community setting;
(2) are provided with the goal of promoting independence through strengthening the member's capacity for self-care and self-sufficiency;
(3) are centered on the needs and preferences of the member and support the integration of the member within his/her community; and
(4) do not include room and board. The costs associated with room and board must be met by the member.
(b) The DDSD case manager develops the Individual Plan (IP) and Plan of Care (Plan) per OAC 340:100-5-53. The IP contains descriptions of the services provided, documentation of the amount, frequency and duration of the services, and types of service providers.
(1) Services:
(A) are authorized per OAC 340:100-3-33 and 100-3-33.1.
(B) provided prior to the development of the IP or not included in the IP are not compensable. The Plan may not be backdated;
(C) may be provided on an emergency basis when approved by the area manager or designee. The plan must be revised to reflect the additional services; and
(D) are provided by qualified provider entities contracted with the OHCA.(2) Members have freedom of choice of providers and in the selection of HCBS or institutional services.
317:30-5-411.Coverage
[Revised 5-11-07]
All family support services will be included in the member's Individual Plan (IP). Arrangements for care under this program must be made with the member's case manager.

317:30-5-412.Description of services
[Revised 09-01-15]

Family support services include services identified in (1) through (6) of this section.  Providers of any family support service must have an applicable SoonerCare Provider Agreement for Home and Community Based Services (HCBS) Waiver Providers for persons with developmental disabilities.

(1) Transportation services.  Transportation services are provided per Oklahoma Administrative Code (OAC) 317:40-5-103.

(2) Assistive technology (AT) devices and services.  AT devices and services are provided per OAC 317:40-5-100.

(3) Architectural modification.  Architectural modification services are provided per OAC 317:40-5-101.

(4) Family training.

(A) Minimum qualifications.

(i) Individual providers must have a Developmental Disabilities Services (DDS) Family Training application and training curriculum approved by DDS staff.  Individual providers must hold current licensure, certification or a Bachelor's Degree in a human service field related to the approved training curriculum, or other Bachelor's Degree combined with a minimum of five years' experience in the intellectual disabilities field. Only individuals named on the SoonerCare Provider Agreement to provide Family Training services may provide service to members.

(ii) Agency or business providers must have a (DDS) Family Training application and training curriculum approved by DDS staff.  Agency or business provider training staff must hold current licensure, certification, or a Bachelor's Degree in a human service field related to the approved training curriculum or other Bachelor's Degree combined with a minimum of five years experience in the intellectual disabilities field.  The credentials of new training staff hired by an approved DDS HCBS Family Training agency or business provider must be submitted to and approved by the DDS programs manager for Family Training prior to new staff training members or members' families.

(B) Description of services.  Family Training services include instruction in skills and knowledge pertaining to the support and assistance of members.  Services are:

(i) intended to allow families to become more proficient in meeting the needs of members who are eligible;

(ii) provided in any community setting;

(iii) provided in either group, consisting of two to 15 persons, or individual formats; and

(iv) for members served through DDS HCBS Waivers and their families. For the purpose of this service, family is defined as any person who lives with, or provides care to a member served on the Waiver;

(v) included in the member's Individual Plan (Plan) and arranged through the member's case manager; and

(vi) intended to yield outcomes as defined in the member's Plan.

(C) Coverage limitations.  Coverage limitations for family training are:

(i) individual family training; Limitation: $5,500 per Plan of Care year;

(ii) group family training; Limitation: $5,500 per Plan of Care year;

(iii) session rates for individual and group sessions do not exceed a range comparable to rates charged by persons with similar credentials providing similar services; and

(iv) rates must be justified based on costs incurred to deliver the service and are evaluated to determine if costs are reasonable.

(D) Documentation requirements.  Providers must maintain documentation fully disclosing the extent of services furnished that specifies:

(i) the service date;

(ii) the start and stop time for each session;

(iii) the signature of the trainer;

(iv) the credentials of the trainer;

(v) the specific issues addressed;

(vi) the methods used to address issues;

(vii) the progress made toward outcomes;

(viii) the member's response to the session or intervention; and

(ix) any new issues identified during the session.

(x) progress reports for each member served must be submitted to the DDS case manager per OAC 340:100-5-52; and

(xi) an annual report of the provider's overall Family Training program, including statistical information about members served, their satisfaction with services, trends observed, changes made in the program and program, recommendations must be submitted to the DDS programs manager for Family Training on an annual basis.

(5) Family counseling.

(A) Minimum qualifications.  Counseling providers must hold current licensure as clinical social workers, psychologists, licensed professional counselors (LPC), or licensed marriage and family therapists (LMFT).

(B) Description of services.  Family counseling offered to members and his or her natural, adoptive, or foster family members, helps to develop and maintain healthy, stable relationships among all family members.

(i) Emphasis is placed on the acquisition of coping skills by building upon family strengths.

(ii) Knowledge and skills gained through family counseling services increase the likelihood the member remains in or returns to his or her own home.

(iii) All family counseling needs are documented in the member's Plan.

(iv) Services are rendered in any confidential setting where the member/family resides or the provider conducts business.

(C) Coverage limitations.  Coverage limitations for family counseling are:

(i) individual family counseling; unit: 15  minutes;

limitation: 400 units per Plan of Care year; and

(ii) group, six person maximum, family counseling;

unit: 30  minutes; limitation: 225 units per Plan of

Care year.

(D) Documentation requirements.  Providers must maintain documentation fully disclosing the extent of services furnished that specifies:

(i) the service date;

(ii) the start and stop time for each session;

(iii) the signature of the therapist;

(iv) the credentials of the therapist;

(v) the specific issues addressed;

(vi) the methods used to address issues;

(vii) the progress made toward resolving issues and outcomes;

(viii) the member's response to the session or intervention; and

(ix) any new issue identified during the session.  

(E) Reporting requirements.  Progress reports for each member served must be submitted to the DDS case manager per OAC 340:100-5-52. 

   (6) Specialized medical supplies.  Specialized medical supplies are provided per OAC 317:40-5-104.
317:30-5-413.Diagnosis codes [REVOKED]

[Revoked 07-01-13]

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.