Okla. Admin. Code § 317:40-5-100

Current through Vol. 42, No. 4, November 1, 2024

Section 317:40-5-100 - Assistive technology (AT) devices and services

(a)Applicability. This Section applies to AT services and devices authorized by Oklahoma Human Services (OKDHS) Developmental Disabilities Services (DDS) through Home and Community-Based Services (HCBS) Waivers.

(b)General information.

(1) AT devices include the purchase, rental, customization, maintenance, and repair of devices, controls, and appliances. AT devices include:

(A) Visual alarms;

(B) Telecommunication devices;

(C) Telephone amplifying devices;

(D) Devices for the protection of health and safety of members who are deaf or hard of hearing;

(E) Tape recorders;

(F) Talking calculators;

(G) Specialized lamps;

(H) Magnifiers;

(I) Braille writers;

(J) Braille paper;

(K) Talking computerized devices;

(L) Devices for the protection of health and safety of members who are blind or visually impaired;

(M) Augmentative and alternative communication devices including language board and electronic communication devices;

(N) Competence-based cause and effect systems, such as switches;

(O) Mobility and positioning devices including:

(i) Wheelchairs;

(ii) Travel chairs;

(iii) Walkers;

(iv) Positioning systems;

(v) Ramps;

(vi) Seating systems;

(vii) Standers;

(viii) Lifts;

(ix) Bathing equipment;

(x) Specialized beds;

(xi) Specialized chairs; and

(P) Orthotic and prosthetic devices, including:

(i) Braces;

(ii) Precribed modified shoes;

(iii) Splints; and

(Q) Environmental controls or devices;

(R) Items necessary for life support, and devices necessary for the proper functioning of such items, including durable and non-durable medical equipment not available through SoonerCare (Medicaid);

(S) Enabling technology devices to protect the member's health and safety or support increased independence in the home, employment site or community can include, but are not limited to:

(i) Motion sensors;

(ii) Smoke and carbon monoxide alarms;

(iii) Bed or chair sensors;

(iv) Door and window sensors;

(v) Pressure sensors in mats on the floor;

(vi) Stove guards or oven shut off systems;

(vii) Live web-based remote supports;

(viii) Cameras;

(ix) Medication dispenser systems;

(x) Software to operate accessories included for environmental control;

(xi) Software applications;

(xii) Personal Emergency Response Systems or mobile;

(xiii) Emergency Response Systems;

(xiv) Global positioning system monitoring devices;

(xv) Radio frequency identification;

(xvi) Computers, smart watches and tablets; and

(xvii) Any other device approved by the DDS director or designee;

(T) Eye glasses lenses, frames or visual aids.

(2) AT services include:

(A) Sign language interpreter services for members who are deaf;

(B) Reader services;

(C) Auxiliary aids;

(D) Training the member and provider in the use and maintenance of equipment and auxiliary aids;

(E) Repair of AT devices;

(F) Evaluation of the member's AT needs; and

(G) Eye examinations.

(3) AT devices and services must be included in the member's Individual Plan (Plan), prescribed by a physician, or appropriate medical professional with a SoonerCare (Medicaid) contract, and arrangements for this HCBS service must be made through the member's case manager.

(4) AT devices are provided by vendors with a durable medical equipment or other appropriate contract with the Oklahoma Health Care Authority (OHCA).

(5) AT devices and services are authorized per requirements of the Oklahoma Central Purchasing Act, other applicable statutory provisions, Oklahoma Administrative Code (OAC) 580:15 and OKDHS-approved purchasing procedures.

(6) AT services are provided by an appropriate professional services provider with a current HCBS contract with OHCA and current, unrestricted licensure and certification with their professional board, when applicable.

(7) AT devices or services may be authorized when the device or service:

(A) Has no utility apart from the needs of the person receiving services;

(B) Is not otherwise available through SoonerCare (Medicaid) an AT retrieval program, the Oklahoma Rehabilitation Services, or any other third party or known community resource;

(C) Has no less expensive equivalent that meets the member's needs;

(D) Is not solely for family or staff convenience or preference;

(E) Is based on the assessment and Personal Support Team (Team) consideration of the member's unique needs;

(F) Is of direct medical or remedial benefit to the member;

(G) Enables the member to maintain, increase, or improve functional capabilities;

(H) Is supported by objective documentation included in a professional assessment, except as specified, per OAC 317:40-5-100;

(I) Is within the scope of AT, per OAC 317:40-5-100;

(J) Is the most appropriate and cost effective bid, when applicable; or

(K) Exceeds a cost of seventy-five dollars ($75) AT devices or services with a cost of seventy-five dollars ($75) or less, are not authorized through DDS HCBS Waivers.

(8) The homeowner must sign a written agreement for any AT equipment that attaches to the home or property.

(c)Assessments. Recommendations for enabling technology devices are completed by the DDS programs manager for remote supports or their designee. Assessments for AT devices or services are performed by a licensed, professional service provider and reviewed by other providers whose services may be affected by the device selected. A licensed, professional service provider must:

(1) Determine if the member's identified outcome can be accomplished through the creative use of other resources, such as:

(A) Household items or toys;

(B) Equipment loan programs;

(C) Low-technology devices or other less intrusive options; or

(D) A similar, more cost-effective device; and

(2) Recommend the most appropriate AT based on the member's:

(A) Present and future needs, especially for members with degenerative conditions;

(B) History of use of similar AT, and his or her current ability to use the device; and

(C) Outcomes; and

(3) Complete an assessment, including a decision making review and device trial that provides supporting documentation for purchase, rental, customization, or fabrication of an AT device. Supporting documentation must include:

(A) A device review;

(B) Availability of the device rental with discussion of advantages and disadvantages;

(C) How frequently and in what situations the device is used in daily activities and routines;

(D) How the member and caregiver(s) are trained to safely use the AT device; and

(E) The features and specifications of the device necessary for the member, including rationale for why other alternatives are not available to meet the member's needs; and

(4) Upon DDS staff's request, provide a current, unedited video or photographs of the member using the device, including recorded trial time frames.

(d)Repairs and placement part authorization. AT device repairs or parts replacements, do not require a professional assessment or recommendation. DDS resource development staff with AT experience may authorize repairs and replacement of parts for previously recommended AT.

(e)AT device retrieval. When a member no longer needs an AT device, OKDHS DDS staff may retrieve the device.

(f)Team decision-making process. The member's Team reviews the licensed professional's assessment and decision-making review. The Team ensures the recommended AT:

(1) Is needed by the member to achieve a specific, identified functional outcome.

(A) A functional outcome, in this Section, means the activity is meaningful to the member, occurs on a frequent basis, and would require assistance from others, if the member could not perform the activity independently, such as self-care, assistance with eating, or transfers.

(B) Functional outcomes must be reasonable and necessary given a member's age, diagnosis, and abilities; and

(2) Allows the member receiving services to:

(A) Improve or maintain health and safety;

(B) Participate in community life;

(C) Express choices; or

(D) Participate in vocational training or employment; and

(3) Is used frequently or in a variety of situations;

(4) Is easily fit into the member's lifestyle and work place;

(5) Is specific to the member's unique needs; and

(6) Is not authorized solely for family or staff convenience.

(g)Requirements and standards for AT devices and service providers.

(1) Providers guarantee devices, work, and materials for one (1) calendar year, and supply necessary follow-up evaluation to ensure optimum usability.

(2) Providers ensure a licensed occupational therapist, physical therapist, speech therapist, or rehabilitation engineer evaluates the need for AT, and individually customizes AT devices.

(h)Services not covered through AT devices and services. AT devices and services do not include:

(1) Trampolines;

(2) Hot tubs;

(3) Bean bag chairs;

(4) Recliners with lift capabilities;

(5) Computers, except as adapted for individual needs as a primary means of oral communication, and approved, per OAC 317:40-5-100;

(6) Massage tables;

(7) Educational games and toys; or

(8) Generators.

(i)AT approval or denial. DDS approval, conditional approval for pre-determined trial use, or denial of the purchase, rental, or lease or purchase of the AT is determined, per OAC 317:40-5-100.

(1) The DDS case manager sends the AT request to designated DDS AT-experienced resource development staff. The request must include:

(A) The licensed professional's assessment and decision making review;

(B) A copy of the Plan of Care;

(C) Documentation of the current Team consensus, including consideration of issues, per OAC 317:40-5-100; and

(D) All additional documentation to support the AT device or service need.

(2) The designated AT-experienced resource development staff approves or denies the AT request when the device costs less than $5000.

(3) The State Office programs manager for AT approves or denies the AT request when the device has a cost of $5000 or more. When authorization of an AT device of $5000 or more is requested:

(A) The AT-experienced resource development staff:

(i) Solicits three (3) AT bids; and

(ii) Submits the AT request, bids, and other relevant information identified in (1) of this subsection to the State Office DDS AT programs manager or designee within five (5) business days of receipt of the required bids; and

(B) The State Office DDS AT programs manager or designee issues a letter of authorization, a written denial, or a request for additional information within five (5) business days of receipt of all required AT documentation.

(4) Authorization for purchase or a written denial is provided within ten (10) business days of receipt of a complete request.

(A) If the AT is approved, a letter of authorization is issued.

(B) If additional documentation is required by the AT-experienced resource development staff, to authorize the recommended AT, the request packet is returned to the case manager for completion.

(C) When necessary, the case manager contacts the licensed professional to request the additional documentation.

(j)Vehicle approval adaptations. Vehicle adaptations are assessed and approved, per OAC 317:40-5-100. In addition, the requirements in (1) through (3) of this subsection must be met.

(1) The vehicle must be owned or in the process of being purchased by the member receiving services or his or her family in order to be adapted.

(2) The AT request must include a certified mechanic's statement that the vehicle and adaptations are mechanically sound.

(3) Vehicle adaptations are limited to one vehicle in a ten (10) year period per member. Authorization for more than one vehicle adaptation in a ten (10) year period must be approved by the DDS director or designee.

(k)Eye glasses and eye exams. Routine eye examination or the purchase of corrective lenses for members twenty-one (21) years of age and older, not covered by SoonerCare (Medicaid), may be authorized for the purpose of prescribing glasses or visual aids, determination of refractive state, treatment of refractive errors, or purchase of lenses, frames, or visual aids. Payment can be made to a licensed optometrist who has a current contract on file with OHCA for services within the scope of Optometric practice as defined by the appropriate State law; provided, however, that services performed by out-of-state providers are only compensable to the extent that they are covered services.

(l)AT denial. Procedures for denial of an AT device or service are described in (1) through (3) of this subsection.

(1) The person denying the AT request provides a written denial to the case manager citing the reason for denial, per OAC 317:40-5-100.

(2) The case manager sends OKDHS Form 06MP004E, Notice of Action, to the member and his or her family or guardian.

(3) AT service denials may be appealed through the OKDHS hearing process, per OAC 340:2-5.

(m)AT device returns. When, during a trial use period or rental of a device, the therapist or Team including the licensed professional who recommended the AT and, when available, determines the device is not appropriate, the licensed professional sends a brief report describing the change of device recommendation to the DDS case manager. The DDS case manager forwards the report to the designated resource development staff, who arranges for the equipment return to the vendor or manufacturer.

(n)AT device rental. AT devices are rented when the licensed professional or AT-experienced resource development staff determines rental of the device is more cost effective than purchasing the device or the licensed professional recommends a trial period to determine if the device meets the member's needs.

(1) The rental period begins on the date the manufacturer or vendor delivers the equipment to the member, unless otherwise stated in advance by the manufacturer or vendor.

(2) AT-experienced resource development staff monitor use of equipment during the rental agreement for:

(A) Rental time frame cost effectiveness;

(B) Renewal conditions; and

(C) The Team's, including the licensed professional's re-evaluation of the member's need for the device, per OAC 317:40-5-100.

(3) Rental costs are applied toward the purchase price of the device when the option is available from the manufacturer or vendor.

(4) When a device is rented for a trial-use period, the Team including the licensed professional, decides within ninety (90) calendar days whether the device:

(A) Meets the member's needs; and

(B) Needs to be purchased or returned.

(o)AT committee. The AT committee reviews equipment requests when deemed necessary by the OKDHS DDS State Office AT programs manager.

(1) The AT committee is comprised of:

(A) DDS professional staff members of the appropriate therapy;

(B) DDS State Office AT programs manager;

(C) The DDS area field administrator or designee; and

(D) An AT expert, not employed by OKDHS.

(2) The AT committee performs a paper review, providing technical guidance, oversight, and consultation.

(3) The AT committee may endorse or recommend denial of a device or service, based on criteria provided in this Section. Any endorsement or denial includes a written rationale for the decision and, when necessary, an alternative solution, directed to the case manager within twenty (20) business days of the receipt of the request. Requests reviewed by the AT committee result in suspension of time frames specified, per OAC 317:40-5-100.

Okla. Admin. Code § 317:40-5-100

Added at 18 Ok Reg 288, eff 11-21-00 (emergency); Added at 18 Ok Reg 1168, eff 5-11-01; Amended at 26 Ok Reg 2151, eff 6-25-09; Amended at 28 Ok Reg 1550, eff 6-25-11

Amended by Oklahoma Register, Volume 32, Issue 23, August 17, 2015, eff. 8/27/2015

Amended by Oklahoma Register, Volume 38, Issue 23, August 16, 2021, eff. 9/1/2021

Amended by Oklahoma Register, Volume 40, Issue 24, September 1, 2023, eff. 9/11/2023