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Library: Policy

317:40-1-4. Remote support (RS)

Revised 9-15-23

(a) General Information.  RS services are intended to promote a member's independence.  RS services are provided in the member's home, family home, or employment site to reduce reliance on in person support while ensuring the member's health and safety.  RS services are included in the member's Individual Plan (Plan) and arrangements for this service are made through the case manager.  Authorization to provide RS must be obtained from the Developmental Disabilities Services (DDS) division director or designee.

(1) RS services are:

(A) based on the member's needs as documented and supported by the Plan and Person-Centered Assessment;

(B) the least-restrictive option and the member's preferred method to meet an assessed need;

(C) provided when all adult members of the household; his or her guardians, when applicable; and Personal Support Team (Team) agree to the provision of RS services as documented in the Plan; and

(D) reviewed by the Team after 60-calendar days of initial installation to determine continued appropriateness and approval of services.

(2) RS services are not a system to provide surveillance or for staff convenience.

(b) Service description.  RS is monitoring of an adult member; allowing for live, two-way communication with him or her in his or her residence or employment site, by monitoring staff using one or more of the systems in one (1) through eight (8) of this subsection.

(1) Live-video feed.

(2) Live-audio feed.

(3) Motion-sensing monitoring.

(4) Radio-frequency identification.

(5) Web-based monitoring.

(6) Personal Emergency Response System.

(7) Global positioning system monitoring devices.

(8) Any other device approved by the DDS director or designee.

(c) General provider requirements.  RS service providers must have a valid Oklahoma Health Care Authority (OHCA) SoonerCare (Medicaid) provider agreement to provide agency-based RS services to Oklahoma Human Services (OKDHS) DDS Home and Community-Based Services (HCBS) Waiver members.  Requests for applications to provide RS are made to and approved by OKDHS DDS State Office. 

(1) An Assessment for RS services is completed:

(A) annually;

(B) prior to RS implementation; and

(C) as required by ongoing progress and needs assessments.

(2) Each member is required to identify at least two emergency response staff.  The member's emergency response staff are documented in his or her Plan.

(3) RS observation sites are not located in a member's residence.

(4) The use of camera or video equipment in the member's bedroom or other private area is prohibited.

(5) RS services are provided in real time by awake staff at a monitoring base using the appropriate connection, not by a recording.  While RS is provided the RS staff does not have duties other than RS.

(6) RS equipment used in the member's residence includes a visual indicator to the member that the system is on and operating.

(7) RS provider agencies must immediately notify in writing, the member's residential provider agency, vocational provider agency, assigned DDS case manager, or guardian of activity in the household that could potentially compromise the member's health or safety.

(8) Emergency response provider agency staff records are maintained, per Oklahoma Administrative Code (OAC) 340:100-3-40.

(9) RS provider records are maintained for seven-calendar years or until any pending litigation involving the service recipient is completed, whichever occurs last and include at a minimum:

(A) the member's name;

(B) the staff's name who delivered the service;

(C) service dates;

(D) service begin and end times;

(E) provider's location;

(F) description of services provided or observation note;

(G) method of contact with member; and

(H) the member's current photograph.

(10) RS providers must have:

(A) safeguards in place including, but not limited to:

(i) a battery or generator to insure continued coverage during an electrical outage at the member's home and monitoring facility;

(ii) back-up procedures at the member's home and monitoring site for:

(I) prolonged power outage;

(II) fire;

(III) severe weather; and

(IV) the member's personal emergency; and

(iii) the ability to receive alarm notifications, such as home security, smoke, or carbon monoxide at each residence monitored, as assessed by the Team as necessary for health and safety; and

(B) two-way audio communication allowing staff monitors to effectively interact with, and address the member's needs in each residence;

(C) a secure Health Insurance Portability and Accountability Act (HIPAA)-compliant network system requiring data authentication, authorization, and encryption to ensure access to computer vision, audio, sensor, or written information is limited to authorized staff or Team members per the Plan;

(D) a current file for each member receiving RS services including:

(i) the member's photograph;

(ii) the member's Plan;

(iii) the member's demographics; and

(iv) any other pertinent data to ensure the member's safety; and

(E) capability to maintain all video and make it available to OKDHS staff upon request for a minimum of 12-calendar months.  OKDHS may require an extended timeframe when necessary.

(d) RS staff requirements.  RS staff:

(1) may not have any assigned duties other than oversight and member support at the time they are monitoring;

(2) receives member specific training per the member's Plan prior to providing support to a member;

(3) assesses urgent situations at a member's home or employment site and call 911 first when deemed necessary; then contact the member's residential provider agency or employment provider agency designated emergency response staff; or the member's natural support designated emergency response person while maintaining contact with the member until persons contacted or emergency response personnel arrive on site;

(4) implements the member's Plan as written by the Team and document the member's status at least hourly;

(5) completes and submits incident reports, per OAC 340:100-3-34, unless emergency backup staff is engaged;

(6) provides simultaneous support to no more than 30 members;

(7) is 18 years of age and older; and

(8) is employed by an approved RS agency.

(e) Emergency response requirement.

(1) Emergency response staff is employed by a provider agency with a valid OHCA SoonerCare (Medicaid) provider agreement to provide residential services, vocational services or habilitation training specialist (HTS) services to OKDHS DDS HCBS Waiver members and:

(A) may not have any assigned duties other than oversight and support of members at the time they are assigned as response staff;

(B) receives all trainings required, per OAC 340:100-3-38.1, for members in residential settings; OAC 340:100-3-38.2 for members in employment settings; or OAC 340:100-3-38.3, for members in non-residential settings per the Plan prior to providing support;

(C) provides a response on site at the member's residence or employment site within twenty minutes when contacted by RS staff unless a shorter timeframe is indicated in the member's Plan;

(D) has an on-call back-up person who responds when the primary response staff engaged at another home or employment site is unable to respond within the specified time frame;

(E) provides written or verbal acknowledgement of a request for assistance from the RS staff;

(F) completes and document emergency drills with the member quarterly when services are provided in the member's home;

(G) implements the Plan as written and document each time they are contacted to respond, including the nature of the intervention and the duration;

(H) completes incident reports, per OAC 340:100-3-34; and

(I) is 18 years of age and older.

(2) Natural emergency response persons:

(A) Are unpaid family members or other interested parties who agree to become, and are approved as, an emergency response person by the member's Team;

(B) Are available to respond in the case of an emergency within 20 minutes from the time they are contacted by RS staff, unless a shorter response time is indicated in the Plan;

(C) Have an on-call back-up person who responds when the primary response staff is unable to respond within the specified time frame;

(D) Provide written or verbal acknowledgement of a request for assistance from RS staff; and

(E) Are 18 years of age and older.

(f) Service limitations.  RS is limited to 24 hours per day.  RS is not provided simultaneously with HTS, homemaker, respite, intensive personal supports, daily living supports, per OAC 340:100-5-22.1, or employment services, per OAC 340:100-17.  RS may not be provided to members receiving specialized foster care or agency companion services, per OAC 340:100-5.22.1, or group home services, per OAC 340:100-6.

 (1) Services not covered include, but are not limited to:

(A) direct care staff monitoring;

(B) services to persons under the age of 18; or

(C) services provided in any setting other than the member's primary residence or employment site.

(2) RS services are shared among OKDHS DDS Waiver members of the same household in a residential setting.  RS provider agencies may only bill for one member of a household at a time.  Only one RS provider per household.

(3) Assistive technology purchases are authorized, per OAC 317:40-5-100.

(g) RS Discontinuation.  RS services can be discontinued:

(1) when the member and member's Team determine it is appropriate to discontinue RS services.  When RS services are terminated, the RS provider agency coordinates termination of service with the member's residential or vocational provider agency and Team to ensure a safe transition.  When a member requests the termination of RS services while RS is being provided, the RS staff:

(A) notifies the provider to request an emergency response staff;

(B) leaves the system operating until the emergency response staff arrives; and

(C) turns off the system once relieved by the emergency response staff; or

(2) at the discretion of the RS provider when services do not meet the health or behavioral needs of the individual.

(A) A 30-calendar days termination notice must be provided to the member and the Team prior to discontinuing services so alternative services can be arranged.

(B) Services must continue to be provided to the service recipient until the Team confirms all essential services are in place.