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Library: Policy

340:100-3-16. Provider enrollment

Revised 9-17-18

(a) Eligible providers.The SoonerCare Home and Community-Based Services (HCBS) Waiver programs are authorized per Section 1915(c) of the Social Security Act.All providers must have current provider agreements with the Oklahoma Health Care Authority (OHCA) to provide HCBS for persons with intellectual disabilities or related conditions.

(b) Application.Requests for applications to provide daily living supports, agency companion, supported living, group home, habilitation training services (HTS), homemaker, and employment services are made to the Oklahoma Department of Human Service (DHS) Developmental Disabilities Services (DDS) State Office.Applications must include a narrative describing the applicant's:

(1) existing program, when applicable;

(2) service and support philosophies for persons with intellectual disabilities;

(3) proposed plan for providing HCBS, in compliance with Oklahoma Administrative Code (OAC) 317:40-1-3;

(4) quality assurance program, commitment to DDS quality assurance processes, and OAC 340:100-3-27, et. seq. compliance; and

(5) organizational summary and operational plan, including:

(A) the anticipated number of persons served in the first three months, first six months, and the first year of operation;

(B) the counties served;

(C) an organizational chart and a key personnel roster; and

(D) evidence of the applicant's plan for compliance with the United States (U.S.) Internal Revenue Service, U.S. Worker's Compensation, U.S. Department of Labor, U.S. Occupational Safety and Health Administration, U.S. Drug-Free Workplace, and Health Insurance Portability and Accountability Act (HIPAA) requirements.

(c) Policies and procedures.All applications must include the provider's internal policies for:

(1) protection of individual rights per OAC 340:100-3-1.2;

(2) a statement of rights and responsibilities developed and submitted by the group home provider per OAC 340:100-6-95;

(3) service recipient admission and discharge procedures;

(4) client confidentiality;

(5) emergencies and disasters per OAC 340:100-3-32 including, but not limited to:

(A) fire;

(B) severe weather;

(C) missing persons;

(D) evacuations;

(E) a plan for continuity of services in the event of an emergency; and

(F) provisions for practice drills per OAC 340:100-5-22.1, and OAC 340-100-6-45, as applicable;

(6) identifying and avoiding conflicts of interest and nepotism including, but not limited to:

(A) renting and leasing;

(B) staffing;

(C) board membership;

(D) contracted services;

(E) real property and equipment acquisition;

(F) board membership and relationships with agency staff and/or contractors;

(G) auditing;

(H) client-staff relationships including the prohibition of services to individuals for whom agency staff are guardian; unless the ward is the guardian's spouse, mother, father, sibling, aunt, uncle, grandparent, adult child, adult grandchild, niece, nephew, or cousin; and

(I) any other situation with the potential to result in a conflict of interest;

(7) a means to establish and collect fees for services not covered by OHCA or DDS per OAC 317:30-3-5.1;

(8) a grievance process that is reviewed and approved by the Office of Client Advocacy per OAC 340:2-3-2 and OAC 340:2-3-45;

(9) suspected maltreatment reporting per  Section 1025.1 of Title 56 of the Oklahoma Statutes and OAC 340:2-3-33;

(10) personnel policies that comply with federal and state employment laws and DHS training requirements per OAC 340:100-3-38 through OAC 340:100-3-38.13;

(11) protection of the service recipient's personal funds per OAC 340:100-3-4 and for those providing residential supports per OAC 340:100-5-22.1, and non-residential services per OAC 340:100-5-35;

(12) records maintenance per OAC 340:100-3-40;

(13) health and wellness maintenance per OAC 340:100-5-26; and

(14) medication administration per OAC 340:100-5-32 and OAC 340:100-5-33.

(d) Financial solvency and service capacity.All applications must include evidence supported by an operational plan demonstrating the applicant's capacity to provide services in a financially solvent manner by:

(1) a description of experience and capacity to operate a business in a fiscally-responsible manner;

(2) management and financial strategies ensuring SoonerCare compliance per OAC 317:30, Subchapters One and Three, per the OHCA provider manual;

(3) a description of the proposed record-keeping system and the methods used to maintain and retain documentation to successfully complete the annual financial audit;

(4) evidence of sufficient liquid assets or lines-of-credit in the name of the provider agency or business indicating the greater of $100,000 or three times the average monthly-budgeted expenses;

(5) a line-item budget, accompanied by a description justifying an expense estimate for the first full-year of operations;

(6) a written quote for proposed insurance coverage identifying all policy types and limitations.Insurance requirements are:

(A) a $250,000 professional liability minimum, when the provider agency receives $50,000 or less per fiscal year for the delivery of supports funded through DHS or HCBS Waivers or $1,000,000 when the provider agency receives more than $50,000;

(B) a $100,000 general liability minimum, when the provider agency receives $50,000 or less per fiscal year for the delivery of supports funded through DHS or HCBS Waivers or $1,000,000 when the provider agency receives more than $50,000;

(C) a $100,000 commercial automobile liability minimum per occurrence;

(D) a $25,000 minimum employee dishonesty coverage; and

(E) upon coverage commencement, a copy of the certificate of insurance with a 30-calendar day cancellation notice is required and, is sent to DDS by the carrier showing DHS as the certificate of insurance holder;

(7) a State of Oklahoma certificate of incorporation and the applicant's federal tax identification number; and

(8) the most recent, audited-financial statement, when applicable or the most recent tax return.

(e) Qualified personnel.All applications must include key personnel's qualifications and appropriate background searches, including:

(1) administrative and executive position descriptors and resumes including three references for each;

(2) documentation of an Oklahoma State Bureau of Investigation (OSBI) background search and Community Services Worker Registry search for the executive director, program coordinator, program manager, key business office staff, and management staff who supervise service delivery;

(3) documentation that the executive director or program director has a Bachelor's degree from an accredited college or university and a minimum of two-years supervisory or management experience;

(4) board of director meeting minutes listing the authorized individual by name, who conducts business and has the provider agency's signature authority;

(5) documentation that the program coordinator meets minimum qualifications per OAC 340:100-5-22.1, when residential, group home, HTS, or homemaker services are provided;

(6) documentation that the provider agency's program manager meets minimum qualifications when employment services are provided per OAC 317:40-7-20; and

(7) an attestation that staff meet training requirements per OAC 340:100-3-38 through OAC 340:100-3-38.13 and that community service workers meet pre-employment screening requirements per OAC 340:100-3-39.

(f) Disclosures.Disclosure of ownership and control by an organization, institution, business, fiscal agent, or agency requesting a provider agreement is a federal requirement for any SoonerCare program.The SoonerCare provider is the disclosing entity and the person(s) making application for a provider agreement with OHCA to provide HCBS.

(1) SoonerCare providers, other than an individual practitioner, group of practitioners, or a fiscal agent must disclose per Section 455.104 of Title 42 of the Code of Federal Regulations (42C.F.R. § 455.104):

(A) the name and address of any person, individual, or corporation, with an ownership or controlling interest in the disclosing entity.Corporate entities must include the primary business address, all business locations, and PO Box addresses, as applicable;

(B) the date of birth and Social Security number, for an individual;

(C) other tax identification numbers for a corporation with an ownership or controlling interest in the disclosing entity or in any subcontractor in which the disclosing entity has a five percent or more interest; and

(D) if the person, individual, or corporation with an ownership or controlling interest in the disclosing entity is related to an individual, such as a spouse, parent, child, or sibling with ownership or controlling interest in the disclosing entity, or if the person, individual or corporation, with an ownership or controlling interest in any subcontractor in which the disclosing entity has a five percent or more interest is related to another person with ownership or controlling interests in the disclosing entity as a spouse, parent, child, or sibling; and

(E) the name of any other disclosing entity in which a person with an ownership or controlling interest in the disclosing entity has an ownership or controlling interest; and

(F) the name, address, date of birth, and Social Security number of any managing employee of the disclosing entity.

(2) SoonerCare providers, or the person making application, must disclose per 42 C.F.R. § 455.106 the identity of any person convicted of crimes prior to OHCA issuing or renewing a provider agreement or when OHCA submits a written request, who:

(A) has ownership or controlling interest in the provider, is an agent, or is a managing employee of the provider; and

(B) was convicted of a criminal offense related to his or her involvement in any program under Medicare, SoonerCare, or the Title XIX services program since the inception of those programs.

(g) Provider orientation.DDS area office staff conducts provider orientation and OHCA conducts provider-billing training.

(h) Ownership transfers.Providers provide DDS with a 30-calendar day notice of intent to transfer ownership.Services cannot be provided by a new owner until there is a valid provider agreement contract, with OHCA.

(i) Provider agreement termination.DDS may recommend a provider agreement termination to OHCA, when the:

(1) owners, officers, managers, or other persons with substantial contractual relationships are convicted of certain crimes or received certain sanctions per Section 1128 of the Social Security Act;

(2) provider fails to maintain required licensure or certification;

(3) provider fails to timely correct program deficiencies per OAC 340:100-3-27.1;

(4) provider is unable to provide the services per the agreement; or

(5) provider becomes insolvent.

(j) Exceptions.Employment providers requesting a provider agreement to provide services through the Contracts with Industry program contact the DDS State Office employment services program supervisor.The provider submits copies of the Oklahoma State Bureau of Investigation (OSBI) background searches and of the Community Services Worker Registry checks for assigned job coaches.

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