Okla. Stat. tit. 56 § 198.15

Current through Laws 2024, c. 453.

Section 198.15 - Self-Directed Care Option

1. The Oklahoma Health Care Authority and the Department of Human Services, hereinafter referred to as the Authority and the Department, respectively, are hereby directed to operate the Self-Directed Care Option for the citizens of the state who have disabilities and are currently served by a home- and community-based waiver with a Centers for Medicare and Medicaid Services approved self-directed option which shall be based on the principles of consumer choice and control.

2. The Department of Human Services shall implement the program upon federal approval.

3. The Authority and the Department shall further establish interagency cooperative agreements to implement and administer the program.

4. Persons enrolled in the Self-Directed Care Option shall be authorized to choose the providers of services and to direct the delivery of services to best meet their long-term care needs.

5. The Self-Directed Care Option shall operate within funds appropriated by the Legislature.

B. Any person currently receiving waiver services in a home-and community-based waiver program as amended to include the Self-Directed Care Option and who is determined through the Department's assessment process to be able to direct their own care or to designate an eligible representative to assist the person in directing care may choose to participate in the Self-Directed Care Option. For purposes of this section, a legal representative acts on behalf of the consumer.

1. A consumer enrolled in the program shall be given a budget allowance based on the results of the functional needs assessment for the consumer.

2. The Department of Human Services shall develop purchasing guidelines, approved by the Authority, to assist a consumer in using the budget allowance to purchase needed, cost-effective services.

D. A consumer shall use the budget allowance only to pay for home- and community-based services that meet the long-term needs of the consumer and are a cost-efficient use of funds including, but not limited to:

1. Ancillary services as defined in Section 198.14 of this title;

2. Basic services as defined in Section 198.14 of this title;

3. Homemaking and chores, including housework, meals, shopping and transportation;

4. Day care and respite care services provided by adult day care facilities;

5. Personal care and support services provided in an assisted living facility should the facilities be subsequently approved for reimbursement under the state Medicaid program;

6. Durable medical equipment and supplies; and

7. Adaptive equipment.

E. A consumer shall be allowed to choose providers of services, as well as when and how services will be provided. A qualified consumer-employed caregiver is a person who is not legally responsible for the consumer's care, who is eighteen (18) years of age or older, has passed a criminal background check and a registry check pursuant to Sections 1025.2 and 1025.3 of this title, and has the training necessary to meet the needs of the consumer. When the consumer is the employer of record, the consumer's roles and responsibilities include, but are not limited to, the following:

1. Developing a job description;

2. Selecting caregivers and submitting information for a criminal history background check;

3. Establishing and communicating needs, preferences and expectations about services being purchased;

4. Providing payments and tax requirements;

5. Being considered employer of record for purposes of the Workers' Compensation Act and paying premiums for workers' compensation insurance from the budget allowance or being self-insured pursuant to the Workers' Compensation Act;

6. Directing and supervising consumer-employed caregivers;

7. Ensuring the accuracy and timely submission of records required by the fiscal intermediary; and

8. Terminating the employment of an unsatisfactory caregiver.

F. The roles and responsibilities of the Department include, but are not limited to:

1. Assessing the functional needs of each consumer to determine eligibility, developing a service plan, and establishing a budget allowance based on the needs assessment;

2. Offering or contracting for services which shall provide training, technical assistance, and support to the consumer;

3. Approving fiscal intermediaries;

4. Establishing minimum qualifications and training for all caregivers and providers;

5. Serving as the final arbiter of the fitness of any individual to be a caregiver or provider; and

6. Developing and implementing a quality assurance plan.

G. The responsibilities of the fiscal intermediary include, but are not limited to:

1. Providing recordkeeping services;

2. Retaining the budget allowance;

3. Processing employment information;

4. Processing federal and state tax, unemployment and FICA;

5. Processing workers' compensation insurance premiums or payments for self-insurance pursuant to the Workers' Compensation Act;

6. Reviewing records to ensure correctness;

7. Writing paychecks to providers;

8. Completing criminal history background check and registry check for consumer-employed caregivers pursuant to Sections 1025.2 and 1025.3 of this title; and

9. Delivering paychecks to the consumer for distribution to providers and caregivers.

Okla. Stat. tit. 56, § 198.15

Added by Laws 2005 , HB 1015, c. 434, § 4, emerg. eff. 7/1/2005; Amended by Laws 2010 , HB 2777, c. 309, § 1, eff. 11/1/2010.