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Library: Policy

340:100-1-2. Definitions

Revised 9-15-22

The following words and terms, when used in this Chapter, shall have the following meanings, unless the context clearly indicates otherwise:

    "Active treatment" means aggressive and consistent implementation of a program of specialized and generic training, treatment, and health services directed toward the service recipient's acquisition of skills necessary, in order to function as independently as possible.

    "Advisory Committee on Services to Persons with Developmental Disabilities" means the committee appointed by the Director of Human Services (Director) to review and make recommendations on Developmental Disabilities Services (DDS) rules and programs.

    "Advocate" means a person who speaks for or on behalf of a service recipient, especially when individual rights or interests are at risk.

    "Alternative appropriate setting" means a setting, other than a nursing facility, where needed habilitation services are provided, including an intermediate care facility for individuals with intellectual disabilities (ICF/IID) or Home and Community-Based Services (HCBS).

    "Assessment" means one or more processes used to obtain information about a service recipient, including his or her condition, personal goals and preferences, functional limitations, health status, or other factors relevant to service authorization or provision.  Assessment information supports the determination that an individual requires services and is used to develop the Individual Plan (Plan).

    "Back-up-plan" means provision for alternative service delivery arrangements for critical to the service recipient's well-being in the event the service provider fails, is unable to deliver the services, or the home where the person lives is no longer available.

    "Capacity to give informed consent" means an individual's ability to make and express voluntary decisions, given correct and sufficient information about the nature, purpose, risks, and benefits of a proposed service or action, when the individual is not adjudicated incapacitated by a court for purposes of the decision.

    "Case manager" means an Oklahoma Department of Human Services (OKDHS) DDS professional who is responsible for assisting a service recipient in gaining access to needed medical, social, educational, or other services per Oklahoma Administrative Code (OAC) 317:30-5-1010.1.  Case management activities may include assessment, plan development, plan implementation and monitoring, as well as assistance in accessing services and other resources.

    "Challenging behavior" means a behavior that, by its frequency or degree of intensity:

(A) places a service recipient's physical safety, environment, relationships, or participation in the community at risk; or

(B) creates a risk of involvement in civil or criminal processes.

    "Client Contact Manager (CCM)" means a computer software system used by DDS case managers to collect and monitor case management data for service recipients.

    "Community Integrated Employment (CIE)" means a service program that provides placement, job training, and short-term or long-term supports to assist service recipients in achieving and maintaining employment within the community.

    "Confidential information" means:

(A) information related to a service recipient generated by OKDHS or contract providers; and

(B) observations of and discussions concerning service recipients, their families, guardians, or friends.

    "Consumer" means a person who is a direct recipient or beneficiary of service planning and delivery and is synonymous with client, service recipient, individual, and member in Oklahoma Health Care Authority (OHCA) policy.

    "Contract provider or agency" means an agency rendering services to persons with developmental disabilities under a contractual agreement with OKDHS or OHCA.

    "Convalescent care" means nursing facility care:

(A) following a person's release from an acute care hospital that is part of a medically prescribed recovery period; and

(B) not expected to exceed an established number of days.

    "DDS" means OKDHS Developmental Disabilities Services.

    "Developmental disability" means a person's severe chronic disability that:

(A) is attributable to a mental or physical impairment or combination of mental and physical impairments;

(B) is manifested before the person is 22 years of age;

(C) is likely to continue indefinitely;

(D) results in substantial functional limitations in three or more major life activity areas:

(i) self-care;

(ii) receptive and expressive language;

(iii) learning;

(iv) mobility;

(v) self-direction;

(vi) capacity for independent living; and

(vii) economic self-sufficiency; and

(E) reflects the person's need for a combination and sequence of special, interdisciplinary, or generic care, treatment, or other services that are of lifelong or extended duration and are individually planned and coordinated.

    "Enabling technology" means equipment, product systems, engineered solutions, devices, or items that support a service recipient's increased independence in the home, employment site, or the community.  These items address a service recipient's needs and outcomes identified in his or her Plan.

    "Family homes" means residences maintained by persons related by biology, adoption, marriage or common law, to a service recipient.

    "Family training" means activities designed to equip family members, significant others, and persons with developmental disabilities with knowledge and skills that allow a family member with developmental disabilities to remain in, or return to, his or her home.

    "Goals" means long-term categorical statements that describe what the service recipient is expected to achieve in a given time frame and are used synonymously with outcomes.

    "Guardian" means a person appointed by a court as general or limited guardian of the person, general or limited guardian of property, special guardian, or temporary guardian as provided by state statutes.  A guardian ensures the essential requirements for the ward's health and safety are met and manages the ward's estate, financial resources, or both.

    "Guardian ad litem" means a person appointed by a court to represent the interests of a person in a legal action.

    "Habilitation services" means goal-directed services and therapy activities:

(A) designed to assist a service recipient in acquiring a variety of skills, including self-help, socialization, adaptive skills, and prevention of loss of skills; and

(B) based on the service recipient's capacity to increase his or her own level of physical, mental, and social functioning.

    "Human Rights Committee" means the committee charged with the responsibility for external monitoring and advocacy to address protection of individual rights.

    "ICF/IID" means an intermediate care facility for individuals with intellectual disabilities (ID) that is:

(A) a residential facility licensed in accordance with Oklahoma law; and

(B) certified by the federal government as a Medicaid services provider to persons who have ID or related conditions.

    "Incapacitated" means a court determination that a person is unable to provide for and make decisions for his or her own needs and safety.

    "Individual Plan (Plan)" means a written document developed by the Personal Support Team (Team) based on a need assessment.  The Plan:

(A) specifies outcomes pursued on the service recipient's behalf, steps taken to achieve outcomes; and

(B) is a single, comprehensive plan that encompasses all relevant components of the service recipient's life.  Various aspects of the Plan are assigned to those persons or agencies designated by the Team to provide services.

    "Individual provider" means a person rendering services to persons with ID under a contractual agreement with OKDHS or OHCA.

    "Intake" means the process a person goes through to gain access to DDS services.  Intake staff:

(A) provides answers to specific service inquiries;

(B) assists in the identification of needs in times of crisis;

(C) supplies information regarding the range and means of accessing available services;

(D) provides assistance as necessary in service application; and

(E) facilitates eligibility determination.

    "Intellectual Disability (ID)" means a person, per Section 1408 of Title 10 of the Oklahoma Statutes who:

(A) has significantly sub average functioning, an intelligence quotient (IQ) of less than 70 that manifests before 18 years of age; and

(B) exists concurrently with related limitations in two or more of the applicable adaptive skill areas that are:

(i) communication;

(ii) self-care;

(iii) home living;

(iv) social skills;

(v) use of community resources;

(vi) self-direction;

(vii) health and safety;

(viii) functional academics;

(ix) leisure; and

(x) work.

    "Integrated employment site" means a location or activity that provides service recipients with regular interaction with persons without disabilities, excluding service providers, to the same extent that a worker without disabilities, in a comparable position, interacts with others.

    "Intrusive procedure" means a procedure that impinges upon the service recipient's bodily integrity, per OAC 340:100-5-57 and OAC 340:100-5-58.  Intrusive procedures include, but are not limited to:

(A) p.r.n. psychotropic medications used for behavioral control;

(B) physical management or physical restraint; and

(C) mechanical restraints for behavioral reasons.

    "Job coach" means a person who holds an OKDHS approved job coach certification and provides ongoing support services to service recipients in supported employment placements.  Services directly support the service recipient's work activity, including:

(A) marketing and job development;

(B) job and work site assessment;

(C) training and assessment;

(D) job matching procedures;

(E) developing co-worker supports; and

(F) teaching job skills.

    "Least restrictive" means services and supports that maximize the service recipient's independence and freedom and are provided in a manner that is the least restrictive and intrusive possible to meet the service recipient's needs.

    "Long-term resident" means a nursing facility resident with ID or related conditions who has continuously resided in a nursing facility for at least 30-consecutive months prior to the date of the first preadmission screening and resident review (PASRR) disposition.

    "Mechanical restraint" means any device used to hinder, forcibly confine, or control an individual's freedom of bodily movement.

    "Monitoring" means the ongoing service provision observation and analysis to determine whether the services are furnished per the Plan and effectively meet the service recipient's needs, including whether services adequately protect his or her health and welfare.  Monitoring activities may include, but are not limited to, telephone contact, observations, and interviewing the service recipient, family, or service provider.

    "Natural supports" means assistance provided by a person, such as a service recipient's family, friend, co-worker, neighbor, or member of a service recipient's club, church, or interest group, or others in the service recipient's community, who:

(A) are not paid specifically to provide assistance to the service recipient; and

(B) provide voluntary assistance.

    "Non-prescription medication" means a pharmacological drug sold without a prescription, prepackaged for the service recipient's use, and labeled per state and federal statutes and regulations.

    "Nursing facility" means an Oklahoma Medicaid-certified institution providing skilled nursing and related services, excluding a facility certified as ICF/IID.

    "Personal Support Team (Team)" means the participants in the service recipient's assessment and planning process and includes:

(A) the service recipient; and

(B) service recipient's:

(i) case manager;

(ii) legal guardian; and

(iii) when applicable, advocate, who may be a parent, family member, friend, or other person who knows the service recipient well; and

(C) others, including service providers, whose participation is necessary to achieve the service recipient's desired outcomes.

    "Physical management" means an intrusive procedure involving any physical guidance of a service recipient to overcome his or her resistance, or a brief upper body hold to ensure safety per OAC 340:100-5-57.

    "Physical restraint" means an intrusive procedure where the service recipient is physically held to restrict movement.

    "Plan of Care (POC)" means a summary listing of services requested as a result of needs identified within the Plan that indicates the amount, duration, and cost of each service recommended for funding through DDS HCBS Waivers.

    "Preadmission screening and resident review (PASRR)" means the process of evaluating, reviewing, and establishing the need for nursing facility services in contrast to other services for persons with ID and related conditions.

    "Prescription medication" means any drug ordered by a health care provider, who is licensed by law to prescribe a drug, intended to be filled, compounded, or dispensed by a pharmacist.

    "p.r.n." means to take or administer a medication as needed.

    "Program coordinator" means a person employed by a DDS residential or group home contract provider agency who supervises, coordinates, and monitors the contract agency's service provision to a service recipient.

    "Program manager" means a person employed by a DDS employment contract provider agency who supervises, coordinates, and monitors the contract agency's service provision to a service recipient.

    "Psychotropic medication" means a pharmacological drug used to treat a mental disorder, or any drug prescribed to stabilize or improve mood, mental status, or behavior.

    "Punishment" means the intentional application of something undesirable or unpleasant, or the removal of something desirable or pleasant, in response to a behavior deemed unacceptable.

    "Punitive" means inflicting or involving punishment.

    "QIDP" means a qualified ID professional who meets ICF/IID regulations per Section 483.430 of Title 42 of the Code of Federal Regulations (42 C.F.R. § 483.430).  A QIDP must have a baccalaureate degree in a human services field, in addition to one year of experience serving persons with ID.

    "Related condition" means a severe chronic disability, per 42 C.F.R. § 435.1010 that:

(A) is attributable to:

(i) cerebral palsy;

(ii) epilepsy; or

(iii) other condition except mental illness (MI) that is closely related to ID as it results in impairment of general intellectual functioning or adaptive behavior similar to that of persons with ID and requires treatment or services similar to those required for persons with ID;

(B) is manifested before the person reaches 22 years of age;

(C) is likely to continue indefinitely; and

(D) results in substantial functional limitations in three or more major life activity areas, including:

(i) self-care;

(ii) understanding and use of language;

(iii) learning;

(iv) mobility;

(v) self-direction; and

(vi) independent living.

    “Response cost procedure” means the removal of a reinforcer the individual values as a consequence of a behavior with the intent of reducing the frequency of the behavior.

    "Restrictive procedure" or "restriction" means a procedure that results in limiting the service recipient's rights, per OAC 340:100-5-57 and OAC 340:100-5-58 and includes:

(A) limiting communication or association with others;

(B) any limitation of access to:

(i) leisure activities;

(ii) the service recipient's own money, personal property, or items purchased with the individual's money; and

(iii) food or beverages;

(C) any movement limitation at home or in the community;

(D) visual or electronic supervision during times or places that would otherwise be considered private; or

(E) the use of a response cost procedure.

    "Sheltered employment" means a service that:

(A) assists service recipients toward achieving their vocational potential through a controlled work environment;

(B) provides worker reimbursement in accordance with individual production and Fair Labor Standards Act (FLSA); and

(C) includes assessment, training, and transitional programming leading to community job placements.

    "Sheltered workshop" means a facility that contracts with DDS to provide employment training and sheltered employment services for workers with disabilities.

    "Short-term resident" means any resident with ID or related conditions who resided in a nursing facility for less than 30 months prior to the first PASRR disposition date.

    "Specialized services" means individualized services specified in PASRR evaluations DDS completes that, combined with services the nursing facility or other service providers provide, results in a treatment regimen leading to continued and ongoing independence enhancement.

    "Supplemental Security Income (SSI)" means a federal income subsidy program administered by the Social Security Administration.

    "Supported employment" means competitive work in an integrated work setting with ongoing support services for service recipients with severe disabilities for whom competitive employment has not traditionally occurred or has been interrupted or intermittent as a result of severe disabilities.

    "Terminal illness" means, as certified by a physician, a person with a medical prognosis of life expectancy of six months or less, when the illness runs its natural course.

    "Transition" means a service recipient's planned movement from one service setting to another, occurring as a result of a Team recommendation and the service recipient's informed consent.

    "Treatment team for specialized services" means the team whose purpose is to develop a prescribed plan of specialized services for each service recipient.  The team:

(A) is composed of the service recipient, guardian or advocate, nursing home representative, and other professionals and paraprofessionals as needed to develop a comprehensive service plan; and

(B) may include a psychologist, physical therapist, speech pathologist, physician, and nurse's aide among others.

    "Vocational assessment" means the employment service evaluation, whether standardized procedures are employed, that:

(A) identifies the service recipient's unique preferences, strengths, and needs;

(B) evaluates work skills and work behaviors;

(C) is supplemented by personal interviews and behavioral observations; and

(D) incorporates information that addresses the service recipient's:

(i) medical;

(ii) physical;

(iii) psychological;

(iv) social;

(v) cultural;

(vi) educational goals and objectives; and

(vii) present and future employment options.

    "Volunteer guardian" means a person unrelated to the service recipient who:

(A) serves as guardian for the service recipient and is trained and certified by the volunteer guardianship agency; and

(B) is appointed by and responsible to the court to ensure essential requirements for the health and safety of the service recipient are met.

    "Ward" means a person who has a court-appointed guardian.

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