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Library: Policy

340:100-3-27.5. Provider agency quality assurance and fiscal controls

Revised 9-15-15

(a) Each agency providing services funded through the Oklahoma Department of Human Services (DHS) or the Oklahoma Health Care Authority (OHCA), through Home and Community-Based Services (HCBS) Waivers, to six or more service recipients implements an internal quality assurance system.  The system identifies and corrects obstacles to agency compliance with rules governing its services or effectively addressing the needs and preferences of service recipients.  Implementation is assessed on the basis of outcomes for service recipients and services.

(b) Provider agencies must have adequate fiscal controls, including internal management controls, systems to ensure accuracy and authorization of claims, and mechanisms to detect and resolve a threat to solvency.

  • (1) A provider agency is a corporation, partnership, association, or individual proprietorship that contracts with DHS or OHCA, through HCBS Waivers, to provide residential, employment, or in-home paraprofessional supports to service recipients.

  • (2) Each provider agency receiving $100,000 or more per fiscal year for the delivery of supports funded through DHS or HCBS Waivers is required to conduct an independent financial audit.  When a financial audit is required:

    • (A) the audit is performed by a certified public accountant:

      • (i) with a valid and current permit to practice public accountancy in Oklahoma; and

      • (ii) approved by the Oklahoma Accountancy Board to perform audits in accordance with Government Auditing Standards;

    • (B) DHS reserves the right to approve the selection of the auditor or examine the work papers of the auditor; and

    • (C) the provider agency submits two copies of the audited financial statements, management letter, and plan to address all concerns noted by the auditor to the DHS Office of Inspector General (OIG).

      • (i) The audited financial statements are submitted within four months after the end of the provider agency's fiscal year.

      • (ii) An extension of up to four months may be authorized by DDS or OIG, following the provider agency's submission of a request and explanation for delay.

      • (iii) No extension is granted to an agency that has not submitted the previous year's audit.

      • (iv) Failure to submit the audited financial statements may result in sanctions per Oklahoma Administrative Code (OAC) 340:100-3-27.2.

  • (3) Audited financial statements are examined by DDS and OIG staff.  Problems noted in either the findings or substance of the audit may result in:

    • (A) acceptance of audited financial statements;

    • (B) correspondence with the provider agency or auditor to clarify and resolve issues in or with the audited financial statements;

    • (C) an administrative inquiry per OAC 340:100-3-27.1; or

    • (D) sanctions per OAC 340:100-3-27.2.

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