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Rule 173-39-01 | ODA provider certification: introduction and definitions.
(A) Introduction: (1) This chapter
establishes the requirements for providers to become, and to remain, certified
by ODA, compliance reviews of ODA-certified providers, and disciplinary actions
that may be imposed upon ODA-certified providers. (2) Rule 5160-58-04 of
the Administrative Code establishes requirements for providers of services to
individuals in the mycare Ohio program to comply with many of the requirements
in this chapter. (B) Definitions for this
chapter: "Activity of daily living" (ADL) has
the same meaning as in rule 5160-3-05 of the Administrative Code. "Activity plan" means a description of
interventions and the schedule for when to provide those interventions. "ADS" has the same meaning as in rule
173-39-02.1 of the Administrative Code. "Agency provider" means a
legally-organized entity that employs staff, with the exception of an assisted
living provider. "Assistance with self-administration of
medication" has the same meaning as in paragraph (C) of rule 4723-13-02 of
the Administrative Code when an unlicensed person provides the
assistance. "Assisted living provider" means a
licensed residential care facility. "Business day" means any day that is
not a Saturday, Sunday, or legal holiday under section 1.14 of the Revised
Code. "Business site" includes any location
at which the provider retains records or provides services. "Business
site" does not include the home of an individual receiving services unless
the individual employs a participant-directed provider. "Caregiver" means a relative, friend,
or significant other who voluntarily provides assistance to the individual and
is responsible for the individual's care on a continuing basis. "Case manager" means a registered or
licensed person that ODA's designee employs to plan, coordinate, monitor,
evaluate, and authorize services for individuals enrolled in ODA-administered
programs. "Certification" means ODA's
approval of a provider to provide one or more of the services that this chapter
regulates. "CMS" means centers for medicare and
medicaid services. "Competency evaluation" includes both
standardized testing (whether written or electronic) and skills testing by
return demonstration to ensure an applicant or employee is able to address the
care needs of the individual to be served. "Complete application" means the
application and all records necessary to comply with rule 173-39-03 of the
Administrative Code, and if applicable, rule 173-39-03.1, 173-39-03.2,
173-39-03.3, or 173-39-03.4 of the Administrative Code. Although ODA cannot
approve an application to become an ODA-certified assisted living provider
unless the RCF is licensed, the application is a complete application if the
provider indicates in its application that it applied for a RCF license and the
provider provides the necessary RCF licensure information to ODA as soon as it
is available. "Current owner" means a person with an
ownership interest in an ODA-certified provider whose interest in the provider
is being sold or transferred. "Electronic record" has the same
meaning a sin section 1306.01 of the Revised Code. For a health care record,
"electronic record" has the same meaning as in section 3701.75 of the
Revised Code. "Electronic signature" has the same
meaning as in section 1306.01 of the Revised Code. If attached to, or
associated with, a health care record, "electronic signature" has the
same meaning as in section 3701.75 of the Revised Code. "Electronic visit verification" (EVV)
means using an ODM-approved EVV system to verify the provision of a service
pursuant to rule 5160-1-40 of the Administrative Code (until July 1, 2024) or
Chapter 5160-32 of the Administrative Code (on or after July 1, 2024). "Emergency contact person" means a
person the individual or caregiver wants the provider to contact in the event
of an emergency to inform the person about the nature of the emergency. "HCBS" means home and community-based
services. "Health care record" has the same
meaning as in section 3701.75 of the Revised Code. Examples of a health care
record are a plan of treatment or diet order received from a licensed
healthcare professional. "HHS" means the United States
department of health and human services. "Individual" has the same meaning in
rule 5160-31-02 of the Administrative Code. "Instrumental activity of daily living"
(IADL) has the same meaning as in rule 5160-3-05 of the Administrative
Code. "Licensed healthcare professional"
includes a physician with an "expedited license," as defined in
section 4731.11 of the Revised Code; or a licensed audiologist, occupational
therapist, occupational therapy assistant, physical therapist, physical therapy
assistant, or speech-language pathologist from another state with "compact
privilege," as defined in section 4753.17, 4755.14, or 4755.57 of the
Revised Code, or an RN or LPN with a "multistate license" from
another state with "multistate licensure privilege," as those terms
are defined in section 4723.11 of the Revised Code. "Licensed practical nurse" (LPN) has
the same meaning as in divisions (E) and (F) of section 4723.01 of the Revised
Code and includes a licensed practical nurse with a "multistate
license" from another state with "multistate licensure
privilege," as those terms are defined in section 4723.11 of the Revised
Code. "Medicaid-provider agreement" means an
agreement between ODM and the provider. "Medicaid provider number" means a
number ODM issued to a provider with whom ODM has entered into a
medicaid-provider agreement. "National provider identifier" (NPI)
means a number issued to a provider by HHS. "Non-agency provider" (i.e.,
"self-employed provider") means a legally-organized entity that is
owned and controlled by one self-employed person who does not employ, either
directly or through a contract, anyone else to provide services, and who is
unsupervised. A non-agency provider is not a participant-directed provider.
(See the definition of "participant-directed provider" in this
rule.) "Nursing facility" has the same meaning
as in section 5165.01 of the Revised Code. "ODA" means the Ohio department of
aging. "ODA-certified provider" means a
provider certified by ODA according to this chapter. "ODA's designee" means an entity
to which ODA delegates one or more of its administrative duties. ODA's
current designees include the area agencies on aging that ODA lists in rule
173-2-04 of the Administrative Code and "Catholic Social Services of the
Miami Valley." When "its designee" occurs after "ODA,"
it means "ODA's designee." "ODH" means the Ohio department of
health. "ODM" means the Ohio department of
medicaid. "Ownership interest" means direct
ownership interest totaling five per cent or more in the provider, indirect
ownership interest equal to five percent or more in the provider, a combination
of direct and indirect ownership interest equal to five per cent or more in the
provider; or an interest of five per cent or more in any mortgage, deed of
trust, note, or other obligation if that interest equals at least five per cent
of the value of the property or assets of the provider. "Participant-directed provider" means a
person that an individual (participant) directly employs and supervises to
provide a service. "PCA" means "personal care
aide." "Person-centered services plan" means
the person-centered planning in rule 5160-44-02 of the Administrative
Code. "PIMS" means "PASSPORT Information
Management System" or the system that replaces PIMS. "Plan of treatment" means the orders of
a licensed healthcare professional whose scope of practice includes making
plans of treatment. "Provider" has the same meaning as in
section 173.39 of the Revised Code. ODA certifies the following categories:
agency provider, assisted living provider, non-agency provider, and
participant-directed provider. "Provider agreement" means an agreement
between ODA's designee and the provider. "Region" means a distinct geographic
area in which ODA's designee provides administrative functions for this
chapter and the PASSPORT and assisted living programs. Each region consists of
the counties assigned to similarly-numbered planning and service areas (PSAs)
in rule 173-2-02 of the Administrative Code, except for "PSA2." In
that PSA, Clark, Greene, and Montgomery counties comprise "Region 2"
and Champaign, Darke, Logan, Miami, Preble, and Shelby counties comprise
"Region CSS." "Registered nurse" (RN) has the same
meaning as in section 4723.01 of the Revised Code and includes a registered
nurse with a "multistate license" from another state with
"multistate licensure privilege," as those terms are defined in
section 4723.11 of the Revised Code. "Residential care facility" (RCF) has
the same meaning as in section 3721.01 of the Revised Code. "Services" has the same meaning as
"community-based long-term care services" in section 173.39 of the
Revised Code. "Significant change" means a variation
in the health, care, or needs of an individual that warrants further evaluation
to determine if changes to the type, amount, or scope of services are needed.
Significant changes include differences in health status, caregiver status,
residence, service location, service delivery, hospitalization, and emergency
department visits that result in the individual not receiving services for
thirty days. "Unique identifier" means an item
belonging to a specific individual, caregiver, driver (in the case of rule
173-39-02.18 of the Administrative Code), participant-directed provider (in the
case of rule 173-39-02.4 of the Administrative Code), aide (in the case of rule
173-39-02.8 of the Administrative Code), or PCA (in the case of rule
173-39-02.11 or 173-39-02.20 of the Administrative Code) that identifies only
that individual, caregiver, driver, provider, aide, or PCA. Examples of a
unique identifier are a handwritten or electronic signature or initials,
fingerprint, mark, stamp, password, barcode, or swipe card. An individual,
caregiver, driver, participant-directed provider, aide, or PCA offers their
unique identifier as an attestation that the provider, or the provider's
staff, completed an activity or unit of service. "Vocational program" means a planned
series, or a sequence of courses or modules, that incorporate challenging,
academic education and rigorous, performance-based training to prepare
participants for success in a particular health care career or
occupation.
Last updated July 2, 2024 at 9:53 AM
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Rule 173-39-02 | ODA provider certification: requirements for providers to become, and to remain, certified.
Introduction: This rule presents requirements for
every type of provider to become, and to remain, certified. For agency and
assisted living providers, the requirements in this rule include requirements
for each provider's employees. (A) Requirements for every type of
provider to become certified: (1) Qualifications: The
provider shall meet all of the following: (a) Any qualification (e.g., licensure, training requirements,
staffing levels) required by this chapter. (b) Any qualification (e.g., licensure, certification,
registration) required by applicable federal, state, and local laws, including
the requirement under 45 C.F.R. Part 162 to have a national provider identifier
(NPI), if applicable. (2) Criminal records checks and database
reviews: Sections 173.38 and 173.381 of the Revised Code and Chapter 173-9 of
the Administrative Code establish the requirements for criminal records checks
and database reviews. Rule 173-9-02 of the Administrative Code lists exceptions
to the applicability of those requirements. Rule 5160-1-17.8 of the
Administrative Code establishes additional provider screening requirements for
participation in a medicaid-funded program. (3) Business site: (a) The provider shall maintain a business site(s) from which to
conduct business, unless the provider is a participant-directed
provider. (b) The provider's business site(s) for providing services
are subject to the HCBS setting requirements in rule 5160-44-01 of the
Administrative Code. Additionally, any such business site used for providing
ADS or assisted living services may be subject to federal heightened scrutiny
under 42 C.F.R. 441.301(c)(5)(v) and rules 173-39-03 and 173-39-03.1 of the
Administrative Code. (c) Each business site in which the provider retains records
(e.g., headquarters, regional offices) shall have a designated, locked storage
space for retaining records that is accessible to ODA and its designee, HHS,
the state auditor's office, and ODM. (4) Contact information: The provider
shall have a valid email address and telephone number. (5) Insurance: The provider shall have
the following, unless the provider is a participant-directed
provider: (a) A minimum of one million dollars in commercial liability
insurance, which includes coverage for individuals' losses due to theft or
property damage. In lieu of commercial liability insurance, a non-agency
provider may have a minimum of one million dollars in professional liability
insurance, which includes coverage for individuals' losses due to theft or
property damage. (b) Written instructions any individual may use to obtain payment
for loss due to theft or property damage caused by the provider, or if
applicable, the provider's employee. (6) Provider agreements: The provider
shall enter into, comply with, and maintain an active status with the
following: (a) A medicaid provider agreement under rules 5160-1-17.2 and
5160-1-17.4 of the Administrative Code. (b) A provider agreement, with ODA's designee for the region
in which the provider seeks certification to provide services pursuant to rule
173-39-03 of the Administrative Code (7) Incident reporting: The provider
shall have a written or electronic policy on documenting incidents which
complies with paragraph (B)(3)(b) of this rule. (8) Electronic visit verification (EVV):
Rule 5160-1-40 of the Administrative Code (until July 1, 2024) or Chapter
5160-32 of the Administrative Code (on or after July 1, 2024) establishes the
requirements for certain providers to have an ODM-approved EVV system in
place. (B) Requirements for every type of
provider to remain certified: (1) Continuation: The
provider shall remain in compliance with all requirements under paragraph (A)
of this rule. (2) Service-related: For
any service ODA certified the provider to furnish, the provider shall report
all mandatory reporting items to verify the service to ODA or its designee and
comply with any rule in this chapter regulating the provision of the
service. (3) Reporting: (a) APS: Section 5101.63 of the Revised Code, as applicable,
establishes a requirement for the provider to report any reasonable cause to
believe an individual suffered abuse, neglect, or exploitation to the local
adult protective services program. The provider shall also notify ODA or its
designee within one business day after becoming aware of the reasonable
cause. (b) Significant changes: The provider shall notify ODA or its
designee no later than one business day after the provider is aware of any
significant change that may affect the individual's service needs or
safety, including one or more of the following: (i) The provider does not
provide an authorized service at the time, or for the period of time,
authorized by ODA's designee. (ii) The individual moves
to another address. (iii) The
individual's repeated refusal of services. (iv) Any incident that is
subject to the incident-reporting requirements in rule 5160-44-05 of the
Administrative Code. (v) Any other significant change in the individual's
physical, mental, or emotional status or the individual's environment that
affects the individual's service needs or safety. (c) Contact information: The provider shall notify ODA or its
designee of any change in the provider's telephone number, mailing
address, or email address within seven days after the change. (d) Last day of service: The provider shall notify the individual
and ODA's designee in writing at least thirty days before the last day the
provider provides services to the individual, unless one or more of the
following occurs: (i) The individual has
been hospitalized, placed in a long-term care facility, or is
deceased. (ii) The health or safety
of the individual or provider is at serious, imminent risk. (iii) The individual
chooses to no longer receive services from the provider. (iv) The provider is an
assisted living provider, in which case paragraph (D)(4)(d) of this rule
applies. (4) Confidentiality: The provider is
subject to all state and federal laws and regulations governing individual
confidentiality including sections 5160.45 to 5160.481 of the Revised Code, 42
C.F.R. 431.300 to 431.307, and 45 C.F.R. parts 160, 162, and 164. (5) Direct-care worker
relationships: Rule 5160-44-32 of the Administrative Code establishes standards
for which relationships are eligible for payment for providing
services. (6) Volunteers: The provider shall
supervise the provider's volunteers. (7) Person-centered planning: The
provider is subject to the person-centered planning requirements in rule
5160-44-02 of the Administrative Code. (8) Ethical, professional, respectful,
and legal service standards: The provider shall not engage in any unethical,
unprofessional, disrespectful, or illegal behavior including the
following: (a) Consuming alcohol while providing services to the
individual. (b) Consuming medicine, drugs, or other chemical substances in a
way that is illegal, unprescribed, or impairs the provider from providing
services to the individual. (c) Accepting, obtaining, or attempting to obtain money, or
anything of value, including gifts or tips, from the individual or his or her
household or family members. (d) Engaging the individual in sexual conduct, or in conduct a
reasonable person would interpret as sexual in nature, even if the conduct is
consensual. (e) Leaving the individual's home when scheduled to provide
a service for a purpose not related to providing the service without notifying
the agency supervisor, the individual's emergency contact person, any
identified caregiver, or ODA's designee. (f) Failing to cooperate with or treating ODA or its designee
respectfully. (g) Engaging in any activity while providing a service that may
distract the provider from providing the service as authorized, including the
following: (i) Watching television,
movies, videos, or playing games on computers, personal phones, or other
electronic devices whether owned by the individual, provider, or the
provider's staff. (ii) Non-care-related
socialization with a person other than the individual (e.g., a visit from a
person who is not providing care to the individual; making or receiving a
personal telephone call; or, sending or receiving a personal text message,
email, or video). (iii) Providing care to a
person other than the individual. (iv) Smoking tobacco or
any other material in any type of smoking equipment, including cigarettes,
electronic cigarettes, vaporizers, hookahs, cigars, or pipes. (v) Sleeping. (vi) Bringing a child,
friend, relative, or anyone else, or a pet, to the individual's place of
residence. (vii) Discussing religion
or politics with the individual and others. (viii) Discussing
personal issues with the individual or any other person. (h) Engaging in behavior that causes, or may cause, physical,
verbal, mental, or emotional distress or abuse to the individual including
publishing photos of the individual on social media without the
individual's written or electronic consent. (i) Engaging in behavior a reasonable person would interpret as
inappropriate involvement in the individual's personal
relationships. (j) Making decisions, or being designated to make decisions, for
the individual in any capacity involving a declaration for mental health
treatment, power of attorney, durable power of attorney, guardianship, or
authorized representative. (k) Selling to, or purchasing from, the individual products or
personal items, unless the provider is the individual's family member who
does so only when not providing services. (l) Consuming the individual's food or drink, or using the
individual's personal property without his or her consent. (m) Taking the individual to the provider's business site,
unless the business site is an ADS center, RCF, or (if the provider is a
participant-directed provider) the individual's home. (n) Engaging in behavior constituting a conflict of interest, or
taking advantage of, or manipulating services resulting in an unintended
advantage for personal gain that has detrimental results to the individual, the
individual's family or caregivers, or another provider. (9) Training: The provider shall
participate in ODA's or its designee's mandatory free provider
training sessions. (10) Records and monitoring: (a) Records retention: (i) Service records: The
provider shall retain all records necessary (including activity plans,
assessments (if required), permits (if required), and all mandatory reporting
items to verify an episode of service), and in such form, so as to fully
disclose the extent of the services the provider provided, and significant
business transactions, until all of the following periods of time have
passed: (a) Six years after the date the provider receives payment for
the service. (b) The date on which ODA, its designee, ODM, or a
duly-authorized law enforcement official concludes a review of the records and
any findings are resolved. (c) The date on which the auditor of the state of Ohio, the
inspector general, or a duly-authorized law enforcement official concludes an
audit of the records and any findings are resolved. (ii) Qualification
records: Each provider shall retain all records regarding the provider's
or an employee's qualifications to provide a service for the duration of
the provider's certification or the duration of the employee's
employment and for six years after the provider is no longer certified or no
longer retains the employee. Qualification records include records on
background checks, initial qualifications, orientation, and
training. (iii) Electronic records:
The provider may use an electronic system to collect or retain
records. (b) Compliance reviews: The provider shall participate in good
faith in any compliance reviews under rule 173-39-04 of the Administrative Code
and assist ODA and its designee with scheduling those reviews. (c) Access: The provider shall, upon request, immediately provide
representatives of ODA, its designee, HHS, the state auditor's office, and
ODM with access to its business site(s) during the provider's normal
business hours, a place to work in its business site(s), and access to
policies, procedures, and records for each unit of service billed. (11) Payment: (a) The provider may bill for a service only if the provider
complies with the requirements under all applicable laws, rules, and
regulations, including service-verification requirements. (b) ODA's obligation to pay the provider for the costs of
services provided as a certified provider is subject to the hold and review
process described in rule 5160-1-27.2 of the Administrative Code. (c) The provider shall accept the payment rates established in
its provider agreement with ODA's designee as payment in full for the
services it provides, and not seek any additional payment for services from the
individual or any other person. (d) The provider may provide a service not authorized by the
individual's person-centered services plan, but ODA (or its designee) pays
a provider only for providing services authorized by the individual's
person-centered services plan. (12) Other laws: The provider is subject
to all applicable federal, state, and local laws, rules, and regulations and is
responsible for ensuring all subcontractors comply with all applicable federal,
state, and local laws, rules, and regulations. (13) Rules updates: The
provider shall subscribe to receive email updates on ODAs rules through
https://aging.ohio.gov. (C) Requirements for specific types of
providers to become certified: (1) Agency
providers: (a) Disclosures: The provider shall disclose the
following: (i) The name of any
person with an ownership interest in the provider. (ii) The name of any
person with an ownership interest in the provider who was convicted of a felony
under a state or federal law. (iii) A table of
organization clearly identifying lines of administrative, advisory,
contractual, and supervisory responsibilities. (iv) The active
registration as a business entity with the Ohio secretary of
state. (b) Attestations: The provider shall provide ODA or its designee
with written or electronic attestations on the following: (i) The provider's compliance with 45 C.F.R. 80.4
regarding the provision of services. (ii) The provider's compliance with the Equal
Employment Opportunity Act of 1972, federal wage-and-hour laws, and
workers' compensation laws regarding the recruitment and employment of
persons. (iii) The provider's payment of all applicable federal,
state, and local income and employment taxes for the most recent
year. (c) Policies: The provider shall have written policies, bylaws,
or articles of incorporation (or an electronic record of policies, bylaws, or
articles of incorporation) that include requirements for its employees to
provide services in a manner compliant with paragraph (B)(8) of this
rule. (2) Non-agency providers:
The provider shall provide a written or electronic attestation to ODA or its
designee that the provider paid all applicable federal, state, and local income
and employment taxes. (3) Participant-directed
providers: A person may qualify to become a participant-directed provider only
if the person meets the requirements in rule 173-39-02.4 of the Administrative
Code. (4) Assisted living
providers: (a) Preemption: The provider shall acknowledge that any statute
governing, or rule regulating, the assisted living program supersedes any
clause in the RCF's resident agreement. (b) License: The provider shall have an RCF license issued under
Chapter 3701-16 of the Administrative Code and comply with section 3721.121 of
the Revised Code. (c) Identifying key persons: The provider shall disclose the
following: (i) The name of any
person with an ownership interest in the provider. (ii) The name of any
person with an ownership interest in the provider who was convicted of a felony
under a state or federal law. (iii) A table of
organization clearly identifying lines of administrative, advisory,
contractual, and supervisory responsibilities. (d) Attestations: The provider shall provide ODA or its designee
with written or electronic attestations on the following: (i) The provider's
compliance with 45 C.F.R. 80.4 regarding the provision of
services. (ii) The provider's
compliance with the Equal Employment Opportunity Act of 1972, federal
wage-and-hour laws, and workers' compensation laws regarding the
recruitment and employment of persons. (e) Policies: The provider shall have written policies, bylaws,
or articles of incorporation (or an electronic record of policies, bylaws, or
articles of incorporation) that include the following: (i) A requirement for the
residents' rights policy that the provider adopts under section 3721.12 of
the Revised Code to apply the prohibition against unethical, unprofessional,
disrespectful, or illegal behavior under paragraph (B)(8) of this rule to its
employees. (ii) A requirement for
the policy that the provider adopts under rule 3701-64-02 of the Administrative
Code on reporting abuse, neglect, or exploitation to ODH to apply the
requirement under paragraph (B)(3)(a) of this rule to report abuse, neglect, or
exploitation to ODA or its designee to its employees. (iii) A requirement for
the policy that the provider adopts under paragraph (B) of rule 3701-16-12 of
the Administrative Code to apply the requirement under paragraph (B)(3)(b) of
this rule to report incidents to ODA or its designee to its
employees. (D) Requirements for specific types of
providers to remain an ODA-certified provider: (1) Agency providers: The
provider shall remain in compliance with all requirements under paragraphs (B)
and (C)(1) of this rule. (2) Non-agency providers:
The provider shall remain in compliance with all requirements under paragraphs
(B) and (C)(2) of this rule. (3) Participant-directed
providers: (a) Continuation: The provider shall remain in compliance with
all requirements under paragraphs (B) and (C)(3) of this rule. (b) Records retention: In addition to the records-retention
requirements under paragraph (B)(10)(a) of this rule, the provider shall store
the individual's records in the home of the individual in a physical
location or an electronic device that is accessible to the provider,
individual, and ODA or its designee. (4) Assisted living
providers: (a) Continuation: The provider shall remain in compliance with
all requirements under paragraphs (B) and (C)(4) of this rule. (b) Payment: (i) The assisted living
program does not pay for any service the provider provides to an individual
before ODA's designee enrolls the individual into the program and before
ODA's designee authorizes the service in the individual's
person-centered services plan. (ii) If an individual is
absent from the RCF, the provider shall not accept a payment for the service
under rules 173-39-02.16 and 5160-33-07 of the Administrative Code or charge
the individual an additional fee for the service or to hold the unit during the
individual's absence. (c) Transfers/discharges: Section 3721.16 of the Revised Code
establishes the terms for transferring or discharging an
individual. (d) Last day of service: If the provider terminates its medicaid
provider agreement, pursuant to section 3721.19 of the Revised Code, or if the
provider plans to stop providing services to an individual, then it shall
provide written notification to the individual and to ODA's designee at
least ninety days before terminating the medicaid provider agreement or
provision of services to the individual.
Last updated July 2, 2024 at 9:54 AM
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Rule 173-39-02.1 | ODA provider certification: adult day service.
Effective:
December 1, 2023
(A) "Adult day service" ("ADS") means a regularly-scheduled service provided at an adult day center (center) in a non-institutional, community-based setting and consisting of the activities authorized in an individual's person-centered services plan. ADS includes recreational and educational programming to support an individual's health and independence goals; at least one, but no more than two, meals per day; and, sometimes, health status monitoring, skilled therapy services, and transportation to and from the center. Table 1 to this rule defines the levels and activities of ADS. | ENHANCED ADS | INTENSIVE ADS | | Structured activity programming | Yes | Yes | | Health assessments | Yes | Yes | | Supervision of ADLs | All ADLs | All ADLs | | Hands-on assistance with ADLs | Yes, one or more ADL (bathing excluded) | Yes, minimum of two ADLs (bathing included) | | Hands-on assistance with medication administration | Yes | Yes | | Comprehensive therapeutic activities | Yes | Yes | | Monitoring of health status | Intermittent | Regular, with intervention | | Hands-on assistance with personal hygiene activities | Yes | Yes | | Social work services | No | Yes | | Skilled nursing services and rehabilitative nursing services | No | Yes | | Rehabilitative and restorative services | No | Yes |
(B) Requirements to become, and to remain, an ODA-certified provider of ADS: (1) General requirements: The provider is subject to rule 173-39-02 of the Administrative Code. (2) Service requirements: (a) Transportation: The provider shall transport each individual to and from the center by performing transportation that complies with rule 173-39-02.18 of the Administrative Code, unless the provider subcontracts with another provider that complies with rule 173-39-02.18 of the Administrative Code, or unless the caregiver transports or designates another person, other than the center's provider, to transport the individual to and from the center. (b) Provider's initial assessment: (i) The provider shall assess the individual before the end of the individual's second day of attendance at the center. The provider may substitute a copy of the case manager's assessment of the individual if the case manager assessed the individual no more than thirty days before the individual's first day of attendance at the center. (ii) The initial assessment shall include both of the following components: (a) The individual's functional, cognitive, and social needs. (b) A social profile including social activity patterns, major life events, community services, caregiver data, formal and informal support systems, and behavior patterns. (c) Health assessment: No later than thirty days after the individual's initial attendance at the center or before the individual receives the first ten units of service at the center, whichever comes first, the provider shall obtain a health assessment of each individual from a licensed healthcare professional whose scope of practice includes health assessments or an employee who is such a licensed healthcare professional to perform a health assessment of each individual. The health assessment shall include the individual's psychosocial profile and identify the individual's risk factors, diet, and medications. If the licensed healthcare professional who performs the health assessment is not an employee of the provider, the provider shall retain a record of the professional's name and phone number. (d) Activity plan: No later than thirty days after the individual's initial attendance at the center or before the individual receives the first ten units of service at the center, whichever comes first, the provider shall obtain the services of a licensed healthcare professional whose scope of practice includes developing activity plans to draft an activity plan for each individual or an employee who is such a licensed healthcare professional to draft an activity plan for each individual. The plan shall do all of the following: (i) Identify the individual's strengths, needs, problems or difficulties, and objectives. (ii) Describe the individual's interest, preferences, and social rehabilitative needs. (iii) Describe the individual's health needs. (iv) Describe the individual's specific goals, objectives, and planned interventions of ADS that meet the goals. (v) Describe the individual's level of involvement in the drafting of the plan, and, if the individual has a caregiver, the caregiver's level of involvement in the drafting of the plan. (vi) Describe the individual's ability to provide a unique identifier as an attestation that the provider, or the provider's staff, completed an activity or unit of service. (e) Plan of treatment: Before administering medication or meals with a therapeutic diet, and before providing a nursing service, nutrition consultation, physical therapy, or speech therapy, the provider shall obtain a plan of treatment from a licensed healthcare professional whose scope of practice includes making plans of treatment. The provider shall obtain the plan of treatment at least every ninety days for each individual that receives medication, a nursing service, nutrition consultation, physical therapy, or speech therapy. For diet orders that may be part of a plan of treatment, a new diet order is not required every ninety days. Instead, the provider is subject to the diet-order requirements for therapeutic diets under rule 5160-44-11 of the Administrative Code. (f) Interdisciplinary care conference (conference): (i) Frequency: The provider shall conduct a conference for each individual at least once every six months. (ii) Participants: The provider shall conduct the conference between the provider's staff and invitees who choose to participate. At least seven days before the conference begins, the provider shall invite the following persons to participate in the conference and provide those persons with the date and time of the conference: (a) The individual's case manager. (b) Any licensed healthcare profession who does not work for the provider, but who provided the provider with a health assessment of the individual or an activity plan for the individual. (c) The individual's caregiver, if the individual has a caregiver. (iii) Revise activity plan: If the conference participants identify changes in the individual's health needs, condition, preferences, or responses to the service, the provider shall obtain the services of a licensed healthcare professional whose scope of practice includes developing activity plans to revise the activity plan accordingly or an employee who is such a licensed healthcare professional to revise the activity plan accordingly. (g) Activities: The provider shall announce daily and monthly planned activities through two or more of the following media: (i) Posters in prominent locations throughout the center. (ii) An electronic display (e.g., a television) in a prominent location in the center. (iii) The center's website. (iv) Email sent to individuals (and others) who agree to receive the email. (v) Monthly newsletters distributed to individuals by mail, email, or at the center. (h) Lunch and snacks: (i) The provider shall provide lunch and snacks to each individual who is present during lunchtime or snack time. (ii) Each meal the provider provides shall comply with all the requirements for home-delivered meals under rules 173-39-02.14 and 5160-44-11 of the Administrative Code, except for the requirements in those rules pertaining to the delivery of the meal. (3) Center requirements: A provider qualifies to be an ODA-certified ADS provider only if the provider's center has the following specifications: (a) If the center is housed in a building with other services or programs other than ADS, the provider uses a separate, identifiable space and staff for ADS during all hours that the provider provides ADS in the center. (b) The center complies with the "ADA Accessibility Guidelines for Buildings and Facilities" in appendix A to 28 C.F.R. part 36. (c) The center has at least sixty square feet per individual that it serves (not just individuals who are enrolled in an ODA-administered program), excluding hallways, offices, rest rooms, and storage areas. (d) The provider stores individuals' medications in a locked area the provider maintains at a temperature complying with the storage requirements of the medications. (e) The provider stores toxic substances in an area which is inaccessible to individuals. (f) The center has at least one working toilet for every ten individuals present that the center serves (not just individuals who are enrolled in an ODA-administered program) and at least one wheelchair-accessible toilet. (g) If the center seeks certification to provide intensive ADS, the center has bathing facilities suitable to the needs of individuals who need intensive ADS. (4) Staffing levels: (a) The provider shall have at least two staff members present, with at least one of those staff members having a certification in CPR, when more than one individual is present in the center. (b) The provider shall maintain a staff-to-individual ratio of at least one staff member to six individuals at all times. (c) The provider shall have an RN, or LPN under the direction of an RN, available to provide nursing services that need the skills of an RN, or LPN under the direction of an RN, and that are based on the needs of the individuals and within the nurse's scope of practice. (d) The provider shall employ an activity director to direct activities. (5) Provider qualifications: (a) Type of provider: (i) Only an agency provider qualifies for ODA's certification to provide ADS. (ii) For each provider that ODA certifies, ODA shall certify the provider as an enhanced or intensive provider. If ODA certifies a provider to provide an intensive service level, the provider may also directly provide, or arrange for, the enhanced service level. (b) Staff qualifications: (i) Every person who is an RN, LPN under the direction of an RN, social worker, physical therapist, physical therapy assistant, speech therapist, licensed dietitian, occupational therapist, occupational therapy assistant, or other licensed professional qualifies to practice in the center only if the person has a current, valid license to practice in their profession. (ii) A person qualifies to be an activity director only if the person has at least one of the following: (a) A baccalaureate or associate degree in recreational therapy or a related degree. (b) At least two years of experience as an activity director, activity coordinator, or a related position. (c) Compliance with the qualifications under rule 3701-17-07 of the Administrative Code for directing resident activities in a nursing home. (d) A certification from the national certification council for activity professionals (NCCAP). (iii) A person qualifies to be an activity assistant only if the person has at least one of the following: (a) A high school diploma. (b) A high school equivalence diploma as defined in section 5107.40 of the Revised Code. (c) At least two years of employment in a supervised position to provide personal care, to provide activities, or to assist with activities. (iv) A person qualifies to be a PCA only if the person has at least one of the following: (a) A high school diploma. (b) A high school equivalence diploma as defined in section 5107.40 of the Revised Code. (c) At least two years of employment in a supervised position to provide personal care, to provide activities, or to assist with activities. (d) The successfully completion of a vocational program in a health or human services field. (v) A person qualifies to transport individuals for the provider only if the person meets the qualifications for drivers under rule 173-39-02.18 of the Administrative Code. (c) Staff training: (i) Orientation: The provider shall comply with the requirements for the orientation of PCAs in rule 173-39-02.11 of the Administrative Code. (ii) Task-based training: Before each new PCA provides ADS, the provider shall provide task-based training. (iii) Continuing education and in-service training: Each PCA, activity director, and activity assistant shall successfully complete at least eight hours of continuing education or in-service training each calendar year. Any hour of continuing education or in-service training successfully completed during a calendar year to comply with the requirements for certification as an activity director or activity assistant counts towards the eight-hour requirement in this paragraph. (iv) Verification of compliance: The provider shall comply with paragraph (C)(3)(f) of rule 173-39-02.11 of the Administrative Code regarding records of each PCA's successful completion of any training and competency evaluation program, orientation, and in-service training. (6) Service verification: The following are the mandatory reporting items that a provider retains for each ADS session to comply with the requirements under paragraph (B)(10)(a)(i) of rule 173-39-02 of the Administrative Code: (a) Individual's name. (b) Service date. (c) Individual's arrival time. (d) Individual's departure time. (e) Individual's mode of transportation. (f) Unique identifier of the individual to attest to receiving the service. (C) Units and rates: (1) For the PASSPORT program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the following: (a) The units of ADS attendance. (b) The units of ADS transportation. (c) The maximum rates allowable per unit of ADS attendance or ADS transportation. (2) For the PASSPORT program, the rate-setting methodology is established in rule 5160-31-07 of the Administrative Code and in the following paragraphs: (a) Attendance: (i) Units of ADS attendance are calculated as follows: (a) One-half day unit is less than four hours of ADS per day. (b) One day unit is four to eight hours of ADS per day. (c) A fifteen-minute unit is each fifteen-minute period of time over eight hours up to, and including, a maximum of twelve hours of ADS per day. (ii) A unit of ADS attendance does not include transportation time. (b) Transportation: If the service is provided to an individual enrolled in the PASSPORT program, a unit of ADS transportation is a round trip, a one-way trip, or one mile with the trip cost based on a case manager's pre-determined calculation of distance between the individual's home and the center multiplied by an established ADS mileage rate. If the provider provides the transportation simultaneously to more than one PASSPORT-enrolled individual who resides in the same household in the same vehicle to the same destination, the provider's payment rate for that trip is seventy-five per cent of the per-unit rate.
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Rule 173-39-02.2 | ODA provider certification: alternative meals.
(A) "Alternative meals" means a
participant-directed service for sustaining an individual's health by
enabling the individual to procure up to two meals per day from a
non-traditional provider, such as a restaurant, but not an adult day
center. (B) Requirements for ODA-certified
provider of alternative meals: (1) General requirements: The provider is
subject to rule 173-39-02 of the Administrative Code. (2) Requirements specific to meals: The
provider is subject to all the requirements for ODA-certified providers of
home-delivered meals in rule 173-39-02.14 of the Administrative Code except
delivery requirements. (3) Provider qualifications: Only an
agency provider qualifies for ODA's certification to provide alternative
meals. (C) Unit and rates: (1) For the PASSPORT
program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the
following: (a) A unit of alternative meals as one meal provided
according to this rule. (b) The maximum-allowable rate for one unit of alternative
meals. (2) For the PASSPORT
program, rule 5160-31-07 of the Administrative Code establishes the
rate-setting methodology for alternative meals.
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Rule 173-39-02.4 | ODA provider certification: choices home care attendant service.
(A) "Choices home care attendant
service" (service) means a service that provides one or more of the
following activities to support the needs of an individual with impaired
physical or cognitive functioning: (1) Assisting the
individual with money management and correspondence as directed by the
individual, managing the home, handling personal affairs, and providing
assistance with self-administration of medications, as defined in rule
173-39-01 of the Administrative Code. (2) Assisting the
individual with ADLs and IADLs. (3) Homemaker activities
listed in rule 173-39-02.8 of the Administrative Code when those activities are
specified in the individual's service plan and are incidental to the
activities in paragraphs (A)(1) and (A)(2) of this rule or are essential to the
health and welfare of the individual instead of other persons living with the
individual. (4) Escort and
transportation. (5) Providing an errand outside of the
presence of the individual that is needed by the individual to maintain the
individual's health and safety (e.g., picking up a prescription or
groceries for the individual). (6) The activities included in home
maintenance and chores under rule 5160-44-12 of the Administrative Code,
including seasonal yard care and snow removal. (B) Requirements for an ODA-certified
provider of the choices home care attendant service: (1) The provider is
subject to rule 173-39-02 of the Administrative Code. (2) Availability and
scheduling: (a) The provider shall maintain availability to provide
this service as agreed upon with the individual and as authorized in the
individual's person-centered services plan. (b) No participant-directed provider may provide this
service in excess of the following limits: (i) To more than five
individuals per week. (ii) For more than forty
hours per week for any individual who employs the provider, unless the
individual's case manager authorizes working more than forty hours per
week due to an emergency that cannot be resolved by allowing another provider
to provide the service after the fortieth hour. (iii) For more than a
total of fifty-six hours per week regardless of the number of individuals who
employ the provider. (3) Oversight: The
individual who receives this service is the employer of record. As used in this
paragraph, "employer of record" means the individual who employs the
provider; supervises the provider; pays the appropriate state, federal, and
local taxes; and pays premiums for worker's compensation and unemployment
compensation insurance. A financial management service (FMS) acts as the agent
of the common-law employer with the participant-directed provider the
individual employs. (4) Provider
qualifications: (a) Initial qualifications: A person may qualify to provide
this service only if the person meets all the following
qualifications: (i) The person is an
ODA-certified participant-directed provider or an ODA-certified agency
provider. (ii) The person is at
least eighteen years of age. (iii) The person has a
valid social security number and at least one of the following current, valid,
government-issued, photographic identification cards: (a) Driver's license. (b) State of Ohio identification card. (c) United States of America permanent residence
card. (iv) The person reads,
writes, and understands English at a level which enables the person to comply
with this rule and rule 173-39-02 of the Administrative Code. (v) The person is able to
effectively communicate with the individual. (b) Qualifications to transport the
individual: (i) If the provider
intends to transport the individual, before providing the first episode of
transportation, the provider shall show ODA's designee a valid
driver's license and valid insurance identification card to show that the
provider has liability insurance for driving a vehicle which complies with the
financial responsibility requirements in Chapter 4501:1-02 of the
Administrative Code. A provider may transport an individual in a vehicle only
if ODAs designee has verified that the vehicle is insured. (ii) If the provider does
not intend to transport the individual, the provider shall provide a written or
electronic attestation to ODA's designee declaring the provider will not
transport the individual unless the provider complies with paragraph
(B)(4)(b)(i) of this rule before the first episode of
transportation. (c) Initial training: The provider shall successfully
complete any training that the individual determined the provider needs to meet
the individual's specific needs by the deadline the individual
establishes. (d) Continuing education: The provider shall successfully
complete eight units of training that the individual determined the provider
needs to meet the individual's specific needs by the deadline the
individual establishes, but no later than the provider's anniversary
certification date. A unit of training includes a course or training activity
lasting up to an hour. (5) Service
verification: (a) Until rule 5160-1-40 of the Administrative Code
requires a provider of this service to use EVV, the following are the mandatory
reporting items that a provider retains on a time sheet that the individual
provides through the FMS for each episode of service to comply with the
requirements under paragraph (B)(10)(a)(i) of rule 173-39-02 of the
Administrative Code: (i) Individual's
name. (ii) Service
date. (iii) Provider's
name. (iv) Provider's
arrival time. (v) Provider's
departure time. (vi) Unique identifier of
the individual to attest to receiving the service. (vii) Unique identifier
of the provider to attest to providing the service. (b) The following are the mandatory reporting items that a
provider retains on a task sheet that the individual provides through the FMS
for each episode of service to comply with the requirements under paragraph
(B)(10)(a)(i) of rule 173-39-02 of the Administrative Code: (i) Description of the
activities provided. (ii) Unique identifier of
the provider to attest to providing the service. (iii) Unique identifier
of the individual to attest to receiving the service. (C) Unit and rates: (1) For the PASSPORT
program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the
following for the choices home care attendant service: (a) The unit as fifteen minutes. (b) The maximum rate allowable for a unit. (2) For the PASSPORT
program, rule 5160-31-07 of the Administrative Code establishes the
rate-setting methodology for the choices home care attendant
service.
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Rule 173-39-02.5 | ODA provider certification: home maintenance and chores.
(A) "Home maintenance and
chores" means the service defined in rule 5160-44-12 of the Administrative
Code. (B) Requirements for every ODA-certified
provider of home maintenance and chores: (1) The provider is
subject to rule 173-39-02 of the Administrative Code. (2) The provider is
subject to rule 5160-44-12 of the Administrative Code. (3) If a conflict exists
between a requirement in rule 173-39-02 of the Administrative Code and a
requirement in rule 5160-44-12 of the Administrative Code, the provider shall
comply with the requirement in rule 173-39-02 of the Administrative Code
instead of the conflicting requirement in rule 5160-44-12 of the Administrative
Code. (C) Units and rates: (1) For the PASSPORT
program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the
following: (a) One unit of home maintenance and chores as one
job. (b) The maximum-allowable rate per job. (2) For the PASSPORT program, rule
5160-31-07 of the Administrative Code establishes the rate-setting methodology
for home maintenance and chores provided through the PASSPORT program, which
requires the unit rate to be negotiated between the provider and ODA's
designee. The negotiated rate includes all administrative, labor, and material
costs for a specific job. The PASSPORT program does not pay for any amount in
excess of the negotiated rate, unless ODA's designee revises the
negotiated rate in one of the following situations: (a) ODA's designee revises the rate before the provider
begins the job. (b) ODA's designee revises the rate to coincide with
authorizing the provider to address an unforeseen issue as part of the original
job.
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Rule 173-39-02.6 | ODA provider certification: personal emergency response system.
(A) "Personal emergency response
system" (PERS) means the service defined in rule 5160-44-16 of the
Administrative Code. (B) Requirements for every ODA-certified
provider of PERS: (1) The provider is
subject to rule 173-39-02 of the Administrative Code. (2) The provider is
subject to rule 5160-44-16 of the Administrative Code. (3) If a conflict exists
between a requirement in rule 173-39-02 of the Administrative Code and a
requirement in rule 5160-44-16 of the Administrative Code, the provider shall
comply with the requirement in rule 173-39-02 of the Administrative Code
instead of the conflicting requirement in rule 5160-44-16 of the Administrative
Code. (C) Units and rates: (1) For the PASSPORT
program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the
following: (a) One unit of ongoing PERS as one monthly rental for one or
more days of PERS in a month. (b) One unit of PERS installation as one completed installation,
which includes the one-time cost for installing PERS equipment, the initial
training of the individual on how to use the PERS equipment, the initial
response plan, the initial training of responders, and verifying the success of
the individuals return demonstration. (c) The maximum-allowable rates for PERS
units. (2) For the PASSPORT program, rule
5160-31-07 of the Administrative Code establishes rate-setting methodology for
PERS.
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Rule 173-39-02.7 | ODA provider certification: home medical equipment and supplies.
(A) "Home medical equipment and
supplies" (HME) means a service providing rented or purchased home medical
equipment and supplies to individuals to enable those individuals to function
safely in their homes with greater independence, thereby eliminating the need
for placement in a nursing facility. HME is limited to equipment and supplies allowed
under Chapter 5160-10 of the Administrative Code, miscellaneous equipment and
supplies, equipment repairs, and equipment and supplies not paid (in full or in
part) by medicare, state plan medicaid, or another third-party payer. (B) Requirements for ODA-certified providers of home medical
equipment and supplies: (1) General requirements:
The agency provider shall comply with the requirements for every ODA-certified
agency provider in rule 173-39-02 of the Administrative Code and the non-agency
provider shall comply with the requirements for every ODA-certified agency
provider in rule 173-39-02 of the Administrative Code. (2) Ongoing assistance:
The provider shall provide professional, ongoing assistance when needed to
evaluate and adjust equipment and supplies delivered, and/or to instruct the
individual or the individuals caregiver in the use of equipment and
supplies. (3) Repairs and
replacements: The provider shall assume liability for equipment warranties and
shall install, maintain, and/or replace any defective parts or items specified
in those warranties. Replacement items or parts for HME are not payable as
rental equipment. (4) Billing: (a) Before ODA's designee may authorize equipment or
supplies, the provider shall document the equipment and supplies to be
purchased were not covered (in full or in part) by medicare, state plan
medicaid, and any other third-party payer. (b) The provider shall, in collaboration with the ODA's
designee, ascertain and recoup any third-party resource(s) available to the
individual before billing ODA or its designee. ODA or its designee may then pay
the unpaid balance up to the lesser of the provider's billed charge or the
maximum allowable payment established in the appendix to rule 5160-1-06.1 of
the Administrative Code. (c) The provider shall provide the price for an item to be
purchased or rented to the ODA's designee no more than two business days
after the ODA's designee's request. The provider shall purchase,
deliver, and install (as appropriate) the authorized item(s) before billing
ODA's designee. The billed amount for each item shall not exceed the item
rate authorized by ODA's designee. (5) Delivery and
verification: (a) The provider shall verify the successful completion of each
activity (i.e., delivery, installation, or education) it provides using either
an electronic or manual system and shall retain records verifying the delivery
of HME. Regardless of the system used, the verification shall include the
individuals name, date of delivery, installation, or education, and
itemization of each activity completed. (b) Delivery verification methods: The provider shall verify the
delivery of HME by one of the following methods: (i) A unique identifier
of the individual. (ii) If a provider uses a
common carrier to deliver HME, the provider shall verify the success of the
delivery by using the method in paragraph (B)(5)(b)(i) of this rule or by
retaining the common carrier's tracking statement or returned postage-paid
delivery invoice. (c) If a provider leaves an HME item outside the door of an
individual's home, the provider shall contact the individual by telephone
at least once per month to alert them to any delivery left outside the door to
their home. (d) The provider shall replace (at no cost to the individual,
ODA, or ODA's designee) any HME item lost or stolen between the time of
delivery and receipt by the individual. (e) If a single visit by the provider includes more than one HME
activity, the provider may verify the success of all the activities it provides
by obtaining only one verification. (f) The provider shall not verify an HME activity was
successfully provided with the signature of the provider, an employee of the
provider, or any other person with a financial interest in the
HME. (C) Units and rates: (1) A unit of HME is the
item purchased or rented, and the unit rate is the purchase, installation,
and/or rental price authorized for the item by ODAs
designee. (2) The appendix to rule
5160-1-06.1 of the Administrative Code establishes the maximum rate allowable
for one unit of HME. (3) Rule 5160-31-07 of
the Administrative Code establishes rate-setting methodology for units of
HME.
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Rule 173-39-02.8 | ODA provider certification: homemaker.
(A) Definitions for this
rule: (1) "Homemaker" means a service
enabling individuals to achieve and maintain clean, safe and healthy
environments, assisting individuals to manage their personal appointments and
day-to-day household activities, and ensuring individuals maintain their
current living arrangements. Homemaker activities include the following when
authorized in the person-centered services plan: (a) Assistance with meal planning. (b) Meal preparation, grocery purchase planning, and assisting
individuals with shopping and other errands. (c) Laundry, including washing, drying, folding, ironing, and
putting away laundry in the individual's home and washing and drying at a
laundromat if the individual does not have a working washer and
dryer. (d) House cleaning including dusting furniture, sweeping,
vacuuming, and mopping floors; kitchen care including dishes, appliances, and
counters; bathroom care; emptying and cleaning bedside commodes; changing bed
linens; washing inside windows within reach from the floor; and removing
trash. (e) Errands outside of the presence of the individual which are
needed by the individual to maintain the individual's health and safety
(e.g., picking up a prescription or groceries for the individual). (f) Acting as a travel attendant for
individuals. (2) "Aide"
means the person who provides homemaker activities. (B) Requirements for ODA-certified providers of
homemaker: (1) General requirements:
The provider is subject to rule 173-39-02 of the Administrative
Code. (2) Eligible providers of homemaker are
ODA-certified agency providers. (3) Availability: The provider shall
maintain adequate staffing levels to provide the service at least five days per
week, including having a back-up plan for providing the service when the
provider has no aide or aide supervisor available. (4) Provider policies: The provider shall
develop written or electronic personnel requirements, including all the
following: (a) Job descriptions for each position. (b) Documentation of each employee's qualifications for the
homemaker activities to be provided. (5) Staff qualifications: (a) Aides: (i) General standard: No aide may provide an activity under
paragraph (A)(1) of this rule unless the aide successfully completes training
and competency evaluation on that activity. (ii) Initial qualifications: A person qualifies to serve as
an aide only if the person meets at least one of the following
qualifications: (a) The person meets at
least one of the qualifications to be a PCA under paragraph (C)(3)(a) of rule
173-39-02.11 of the Administrative Code, the training and competency evaluation
comply with paragraph (C)(3)(e) of rule 173-39-02.11 of the Administrative
Code, and the provider meets the verification requirements under paragraph
(C)(3)(f) of rule 173-39-02.11 of the Administrative Code. (b) The person successfully completed training and competency
evaluation on any activity listed under paragraph (A)(1) of this rule that the
person would provide as an aide. For example, a person who would provide only
laundry activities as an aide would qualify to be an aide by successfully
completing training and competency evaluation on laundry
activities. (iii) Before providing activities to individuals, the
provider shall conduct a competency evaluation of any aide not listed on
ODH's nurse aide registry as "active," "in good
standing," or "expired" for any activity the aide is expected to
provide to individuals. (b) Supervisors: A person qualifies to serve as an aide
supervisor only if the person meets one or more of the following
qualifications: (i) The person has a
bachelors or associates degree in a health and human services
area. (ii) The person is an RN
or LPN. (iii) The person is a licensed independent social worker
(LISW) or licensed social worker (LSW). (iv) The person completed at least two years of work as an
aide, as defined by this rule. (c) All staff: (i) Orientation: Before allowing any staff member to provide
homemaker activities to an individual, the provider shall ensure that the aide
successfully completes orientation on all the following topics: (a) The provider's
expectations of homemaker staff. (b) The provider's
ethical standards under rule 173-39-02 of the Administrative Code. (c) An overview of the
provider's personnel policies. (d) The organization and lines of communication of the
provider's agency. (e) Person-centered
planning process. (f) Incident-reporting procedures. (g) Emergency procedures. (h) Standard precautions
for infection control, including hand washing and the disposal of bodily
waste. (ii) In-service training: The provider shall ensure that each aide
successfully completes a minimum of six hours of ODA-approved in-service
training every twelve months on a topic related to an activity that the aide
provides or may provide after successfully completing training with competency
evaluation. (6) Supervisory
requirements: (a) Initial: The supervisor shall complete an initial visit,
which may occur at the aide's initial homemaker visit to the individual to
define the expected activities of the homemaker aide and prepare a written or
electronic activities plan consistent with the individual's
person-centered services plan. During a state of emergency declared by the
governor or federal public health emergency, the supervisor may conduct the
visit by telephone, video conference, or in person at the individual's
home. (b) Subsequent: The supervisor shall complete an evaluation of
the aide's compliance with the activities plan, the individual's
satisfaction, and job performance during a home visit with the individual at
least every ninety days. The supervisor may conduct each visit with or without
the presence of the aide being evaluated. The supervisor may conduct the visit
by telephone, video conference, or in person. (c) Verification: In the individual's activity plan, the
supervisor shall retain a record of the initial visit and each subsequent visit
that includes either of the following: (i) For an in-person
visit, the date of the visit, an indication that the visit occurred in person
at the individual's home, the supervisor's name, the
supervisor's unique identifier, the individual's name, and a unique
identifier of the individual or the individual's caregiver. During a state
of emergency declared by the governor or a federal public health emergency, the
provider may verify that the supervisor provided the initial or subsequent
visit without collecting a unique identifier of the individual or the
individual's caregiver. (ii) For a visit by
telephone or video conference, the date of the visit, an indication of whether
the visit was provided by telephone or video conference, the supervisor's
name, the individual's name, and evidence that a visit occurred by
telephone or video conference (e.g., a record automatically generated by
telehealth software, a record showing that the supervisor's phone called
the individual's phone, or clinical notes from the
supervisor). (7) Service verification:
The following are the mandatory reporting items for each episode of service:
the individual's name, the date of service, a description of the
activities provided, the name of the aide providing the activities, the
aide's arrival and departure times, the unique identifier of the aide, and
the unique identifier of the individual to attest to receiving the
service. (C) Units and rates: (1) For the PASSPORT
program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the
following: (a) One unit of homemaker service as fifteen
minutes. (b) The maximum rate allowable for a unit of homemaker
activities. (2) For the PASSPORT program, rule
5160-31-07 of the Administrative Code establishes the rate-setting methodology.
Last updated July 2, 2024 at 9:55 AM
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Rule 173-39-02.9 | ODA provider certification: home modification.
(A) "Home modification" has the
same meaning as "home modifications" in rule 5160-44-13 of the
Administrative Code. (B) Requirements for ODA-certified providers of home
modification: (1) The provider is
subject to rule 173-39-02 of the Administrative Code. (2) The provider is
subject to rule 5160-44-13 of the Administrative Code. (3) If a conflict exists
between a requirement in rule 173-39-02 of the Administrative Code and a
requirement in rule 5160-44-13 of the Administrative Code, the provider shall
comply with the requirement in rule 173-39-02 of the Administrative Code
instead of the conflicting requirement in rule 5160-44-13 of the Administrative
Code. (C) Unit and rates: (1) For the PASSPORT
program: (a) The appendix to rule 5160-1-06.1 of the Administrative
Code establishes one unit of home modification as one completed
job. (b) The appendix to rule 5160-1-06.1 of the Administrative
Code and rule 5160-44-13 of the Administrative Code establish the
maximum-allowable rate for a unit of home modification.. (2) For the PASSPORT
program, rule 5160-31-07 of the Administrative Code establishes the
rate-setting methodology for home modification, which requires the unit rate to
be negotiated between the provider and ODA's designee. The negotiated rate
includes all administrative, labor, and material costs for a specific job. The
PASSPORT program does not pay for any amount in excess of the negotiated rate,
unless ODA's designee approves a revised rate that does not exceed the
maximum-allowable rate in paragraph (C)(1)(b) of this rule.
Last updated May 17, 2024 at 12:08 PM
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Rule 173-39-02.10 | ODA provider certification: nutritional consultations.
(A) Definitions for this
rule: (1) "Nutritional
consultation" (consultation) means individualized guidance to an
individual who has special dietary needs. Consultations take into consideration
the individual's health; cultural, religious, ethnic, socio-economic
background; and dietary preferences and restrictions. Consultations are also
known as medical nutrition therapy. "Nutritional consultation" does
not include either of the following: (a) A consultation provided to an individual's authorized
representative or caregiver to improve the individual's
well-being. (b) A consultation provided to an individual if the individual
receives a similar service paid (in full or in part) by medicare state plan
medicaid, or another third-party payer. (2) "Nutritional
assessment" (assessment) has the same meaning as in rule 4759-2-01 of the
Administrative Code. (B) Every ODA-certified provider of
nutritional consultations shall comply with the following
requirements: (1) General requirements:
The provider shall comply with the requirements for every ODA-certified
provider in rule 173-39-02 of the Administrative Code. (2) Dietitian: Only a
licensed dietitian (dietitian) working for an ODA-certified agency provider, or
a licensed dietitian working as an ODA-certified non-agency provider shall
provide consultations to individuals. (3) Orders: Before the provider provides
a consultation to an individual or to the individual's authorized
representative or caregiver, the provider shall obtain an order for the
consultation from a licensed healthcare professional whose scope of practice
includes ordering consultations. (4) Venue: (a) The dietitian may conduct the initial consultation by
telephone, video conference, or in person in the individual's
home. (b) The dietitian may conduct subsequent consultations by
telephone, video conference, or in person in the individual's
home. (5) Nutritional assessment: (a) The provider shall conduct an initial, individualized
assessment of the individual's nutritional needs and, when necessary,
subsequent assessments, using a tool that identifies whether the individual is
at nutritional risk or identifies a nutritional diagnosis that the dietitian
will treat. The tool shall include the following: (i) An assessment of
height and weight history. (ii) An assessment of the
adequacy of nutrient intake. (iii) A review of
medications, medical diagnoses, and diagnostic test results. (iv) An assessment of
verbal, physical, and motor skills that may affect, or contribute to, nutrient
needs. (v) An assessment of
interactions with the caregiver during feeding. (vi) An assessment of the
need for adaptive equipment, other community resources, or other
services. (b) The provider shall provide the case manager, the individual,
and the individual's authorized representative (if the individual has
authorized a representative) with a copy of the assessment no later than seven
business days after the provider completes the assessment. (c) The provider may use an electronic system to develop and
retain an assessment. (6) Nutrition intervention
plan: (a) The provider shall develop, evaluate, and revise, as
necessary, a nutrition intervention plan with the individual's and case
manager's assistance and, when applicable, the assistance of the licensed
healthcare professional who authorized the consultations. In the plan, the
provider shall outline the purposely-planned actions for changing
nutrition-related behavior, risk factors, environmental conditions, or health
status, which, at a minimum, shall include the following information about the
individual: (i) Food and diet
modifications. (ii) Specific nutrients
to require or limit. (iii) Feeding
modality. (iv) Nutrition education
and consultations. (v) Expected measurable
indicators and outcomes related to the individual's nutritional
goals. (b) The provider shall use the nutrition intervention plan to
prioritize and address the identified nutrition problems. (c) The provider shall provide the case manager, the individual,
and the licensed healthcare professional who ordered the consultations with a
copy of the nutrition intervention plan no later than seven business days after
the provider develops or revises the plan. (d) The provider may use an electronic system to develop and
retain the nutrition intervention plan. (7) Service verification: By one of the
following two methods, the provider shall verify that each consultation for
which it bills was provided: (a) The provider may use an electronic system if the system does
all of the following: (i) Collects the
individual's name, date of consultation, time of day each consultation
begins and ends, name of licensed dietitian providing consultation, and a
unique identifier of the individual. (ii) Retains the
information it collects. (iii) Produces reports,
upon request, that ODA (or its designee) can monitor for
compliance. (b) The provider may use a manual system if the provider records
the date of service, time of day that each consultation begins and ends, name
of the person providing the consultation, and collects the handwritten
signature of the person providing the consultation and a unique identifier of
the individual. (C) Unit and rate: (1) A unit of a
nutritional consultation is fifteen minutes of session time with the
individual. (2) The maximum rate
allowable for a unit of nutritional consultations is listed in the appendix to
rule 5160-1-06.1 of the Administrative Code. (3) The rate is subject
to the rate-setting methodology in rule 5160-31-07 of the Administrative
Code.
Last updated May 17, 2024 at 12:08 PM
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Rule 173-39-02.11 | ODA provider certification: personal care.
(A) "Personal care" means
hands-on assistance with ADLs and IADLs (when incidental to providing ADLs) in
the individual's home and community. (1) Personal care
activities include the following when authorized in a person-centered services
plan: (a) Assisting the individual with managing the home,
handling personal affairs, and providing assistance with self-administration of
medications, as defined in rule 173-39-01 of the Administrative
Code. (b) Assisting the individual with ADLs and
IADLs. (c) Homemaker activities listed in rule 173-39-02.8 of the
Administrative Code when those activities are specified in the
individual's service plan and are incidental to the activities in
paragraphs (A)(1) and (A)(2) of this rule or are essential to the health and
welfare of the individual rather than the individual's
family. (d) Providing an errand outside of the presence of the
individual that is needed by the individual to maintain the individual's
health and safety (e.g., picking up a prescription or groceries for the
individual). (2) Personal care
activities do not include providing respite to the individuals
caregiver. (B) Qualifying provider types: Eligible
providers of personal care are ODA-certified agency providers and ODA-certified
participant-directed personal care providers. (C) Requirements for ODA-certified agency
providers of personal care: (1) General requirements:
The provider is subject to rule 173-39-02 of the Administrative
Code. (2) Availability and
staffing: (a) The provider may accept a referral to provide personal
care to an individual only if the provider has adequate staffing levels of PCAs
and PCA supervisors to provide the number of hours ODA's designee
authorized for each individual. (b) The PCA receives supervision from an RN or LPN under
the direction of an RN during all hours that PCAs are scheduled to
work. (c) The provider shall maintain a back-up plan for
providing personal care when the provider has no PCA or PCA supervisor
available. (3) PCA qualifications
and requirements: (a) Initial qualifications: The provider may allow a person
to serve as a PCA only if the person meets at least one of the following
qualifications, the training and competency evaluation comply with paragraph
(C)(3)(e) of this rule, and the provider meets the verification requirements
under paragraph (C)(3)(f) of this rule: (i) STNA: The person
successfully completed a nurse aide training and competency evaluation program
approved by ODH under section 3721.31 of the Revised Code. (ii) Medicare: The person
met the qualifications to be a medicare-certified home health aide according to
one of the following sets of standards: (a) The standards in 42 C.F.R. 484.4 and 484.36, if the
person met those standards on or before January 12, 2018. (b) The standards in 42 C.F.R. 484.80 and 484.115, if the
person met those standards on or after January 13, 2018. (iii) Previous
experience: The person has at least one year of supervised employment
experience as a home health aide or nurse aide, and has successfully completed
a competency evaluation covering the topics listed under paragraph
(C)(3)(a)(v)(b) of this rule. (iv) Vocational programs:
The person successfully completed the COALA home health training program or a
certified vocational training and competency evaluation program in a health
care field covering the topics listed under paragraph (C)(3)(a)(v)(b) of this
rule. (v) Other programs: The
person successfully completed a training and competency evaluation program with
the following characteristics: (a) The training lasted at least thirty hours. (b) All the following subjects were included in the
program's training and its competency evaluation: (i) Communication skills,
including the ability to read, write, and make brief and accurate reports
(oral, written, or electronic). (ii) Observation,
reporting, and retaining records of an individual's status and activities
provided to the individual. (iii) Reading and
recording an individual's temperature, pulse, and
respiration. (iv) Basic infection
control. (v) Basic elements of
body functioning and changes in body function that should be reported to a PCA
supervisor. (vi) Maintaining a clean,
safe, and healthy environment, including house cleaning and laundry, dusting
furniture, sweeping, vacuuming, and washing floors; kitchen care (including
dishes, appliances, and counters), bathroom care, emptying and cleaning beside
commodes and urinary catheter bags, changing bed linens, washing inside window
within reach from the floor, removing trash, and folding, ironing, and putting
away laundry. (vii) Recognition of
emergencies, knowledge of emergency procedures, and basic home
safety. (viii) The physical,
emotional, and developmental needs of individuals, including privacy and
respect for personal property. (ix) Appropriate and safe
techniques in personal hygiene and grooming including bed, tub, shower, and
partial bath techniques; shampoo in sink, tub, or bed; nail and skin care; oral
hygiene; toileting and elimination; safe transfer and ambulation; normal range
of motion and positioning; and adequate nutrition and fluid
intake. (x) Meal preparation and
nutrition planning, including special diet preparation; grocery purchase,
planning, and shopping; and errands such as picking up
prescriptions. (b) Orientation: Before allowing a PCA or other employee to
have direct, in-person contact with an individual, the provider shall ensure
the PCA or other employee successfully completed orientation, which, at a
minimum, addressed the following topics: (i) The provider's
expectations of employees. (ii) The provider's
ethical standards under rule 173-39-02 of the Administrative Code. (iii) An overview of the
provider's personnel policies. (iv) The organization and
lines of communication of the provider's agency. (v) Incident-reporting
procedures. (vi) Emergency
procedures. (vii) Standard
precautions for infection control, including hand washing and the disposal of
bodily waste. (c) Additional training: The provider shall ensure each PCA
successfully completes additional training and competency evaluation if the PCA
is expected to perform activities for which the PCA did not receive training or
undergo competency evaluation under paragraph (C)(3)(a) of this
rule. (d) In-service training: The provider shall ensure that
each PCA complies with the requirement in section 173.525 of the Revised Code
to successfully complete six hours of ODA-approved in-service training every
twelve months. Agency- and program-specific orientation do not count toward the
six hours. (e) Acceptable training, orientation, and competency
evaluation: (i) An organization other
than the provider may provide the orientation and training under paragraphs
(C)(3)(b) to (C)(3)(d) of this rule. The training completed through
https://mylearning.dodd.ohio.gov/ is free of charge. (ii) The portion of
training that is not competency evaluation may occur online. (iii) The portion of
competency evaluation that involves return demonstration only qualifies as
competency evaluation under paragraph (C)(3)(a) of this rule if it is conducted
in person. (iv) ODA considers any
person who meets one of the qualifications to be a PCA under paragraph
(C)(3)(a) of this rule to meet the requirement under section 173.525 of the
Revised Code for each PCA to successfully complete thirty hours of
ODA-acceptable pre-service training even if the qualification did not involve
thirty hours of training. (f) Verification of compliance with PCA qualifications and
requirements: (i) The provider shall
either retain copies of certificates of completion earned by each PCA after the
PCA meets qualifications/requirements under paragraph (C)(3) of this rule for
successfully completing any training and competency evaluation program,
orientation, additional training, and in-service training under paragraph
(C)(3) of this rule or record the following information for each PCA, and
retain it, if it does not appear on the PCA's certificate of completion
(or if the PCA did not receive a certificate of completion): name of the school
or training organization, name of the course, training dates, and training
hours successfully completed. (ii) If a person meets
the initial qualifications to be a PCA under paragraph (C)(3)(a) of this rule
by successfully completing a nurse aide training and competency evaluation
program described in paragraph (C)(3)(a)(i) of this rule, the provider shall
retain a copy of the search results from ODH's nurse aide registry
(https://nurseaideregistry.odh.ohio.gov/Public/PublicNurseAideSearch) to verify
that the registry listed the person as "active," "in good
standing," or "expired." (iii) If a person meets
the initial qualifications to be a PCA under paragraph (C)(3)(a) of this rule
only by the previous employment experience described in paragraph
(C)(3)(a)(iii) of this rule, the provider shall also retain records to verify
the former employer's name and contact information, the former PCA
supervisor's name, the date the person began working for the former
employer, and the date the person stopped working for the former
employer. (4) PCA
supervisors: (a) Qualifications: Section 173.525 of the Revised Code
allows only an RN or LPN under the direction of an RN to qualify as a PCA
supervisor. (b) PCA supervisor visits: (i) Initial: The PCA
supervisor shall visit each individual in person at the individual's home
to define the expected activities of the PCA and develop a written or
electronic activity plan with the individual either before allowing a PCA to
provide an episode of service to the individual or during the PCA's
initial episode of service to the individual. During a state of emergency
declared by the governor or a federal public health emergency, the PCA
supervisor may conduct the initial visit by telephone, video conference, or in
person at the individual's home. (ii) Subsequent: (a) The PCA supervisor shall visit the individual at least
once every sixty days after the PCA's initial episode of service with the
individual to evaluate compliance with the activities plan, the
individual's satisfaction, and the PCA's performance. The PCA
supervisor may conduct subsequent visits with or without the presence of the
PCA being evaluated. (b) If the PCA supervisor conducts at least two in-person
visits per year, the PCA supervisor may conduct the remainder of the subsequent
visits during the same year by telephone, video conference, or in person based
upon the individual's needs. To comply, the PCA supervisor may conduct two
subsequent in-person visits in the same year or the combination of an initial
in-person visit and an in-person subsequent visit in the same
year. (iii) Verification: In
the individual's record, the PCA supervisor shall retain a record of the
initial visit and each subsequent visit that includes either of the
following: (a) For an in-person
visit, the date of the visit, an indication that the visit occurred in person
at the individual's home, the PCA supervisor's name, the PCA
supervisor's unique identifier, the individual's name, and a unique
identifier of the individual or the individual's caregiver. During a state
of emergency declared by the governor or a federal public health emergency, the
provider may verify that the PCA supervisor provided the initial or subsequent
visit without collecting a unique identifier of the individual or the
individual's caregiver. (b) For a visit by
telephone or video conference, the date of the visit, an indication of whether
the visit was provided by telephone or video conference, the PCA
supervisor's name, the individual's name, and evidence that a visit
occurred by telephone or video conference (e.g., a record automatically
generated by telehealth software, a record showing that the PCA
supervisor's phone called the individual's phone, or clinical notes
from the PCA supervisor). (5) Provider policies:
The provider shall develop, implement, comply with, and maintain written or
electronic policies on all the following topics: (a) Job descriptions for each position. (b) Retaining records on how each PCA meets the
qualifications in paragraph (C)(3) of this rule. (6) Service
verification: (a) The following are the mandatory reporting items that a
provider retains for each episode of personal care to comply with the
requirements under paragraph (B)(10)(a)(i) of rule 173-39-02 of the
Administrative Code: (i) Service
date. (ii) PCA's arrival
time. (iii) PCA's
departure time. (iv) Description of the
activities provided. (v) Name of each PCA in
contact with the individual. (vi) Unique identifier of
each PCA in contact with the individual to attest to the accuracy of the
record. (vii) Unique identifier of the individual. (b) The provider is subject to Chapter 5160-32 of the
Administrative Code regarding EVV. (c) The provider is subject to section 121.36 of the
Revised Code. (D) Every ODA-certified
participant-directed provider of personal care shall comply with the
requirements under paragraph (B) of rule 173-39-02.4 of the Administrative
Code. (E) Units and rates: (1) For the PASSPORT
program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the
following: (a) One unit of personal care as fifteen
minutes. (b) The maximum rate allowable for one unit of personal
care. (2) For the PASSPORT
program, rule 5160-31-07 of the Administrative Code establishes the
rate-setting methodology for personal care. According to that rule, if the same
provider provides personal care during the same visit to more than one but
fewer than four PASSPORT individuals in the same home, as identified in the
individuals' person-centered services plans, the provider's payment
rate for personal care provided to one person in the home is one hundred per
cent of the per-unit rate listed in the provider agreement and seventy-five per
cent of the per-unit rate for each subsequent PASSPORT individual in the home
receiving services during the visit. As used in this paragraph, "in the
same home" does not refer to a PASSPORT individual who resides alone in an
apartment building where another individual may reside alone in a separate
apartment.
Last updated July 2, 2024 at 8:39 AM
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Rule 173-39-02.12 | ODA provider certification: social work or counseling.
(A) Definitions for this
rule: (1) "Social work or counseling"
(service) means a service to an individual or to an individual's caregiver
to promote the individual's physical, social, or emotional well-being; and
the development and maintenance of a stable and supportive environment for the
individual. (a) "Social work or counseling" includes crisis
interventions, grief counseling, and other social work and counseling
interventions that support the individual's health and
welfare. (b) "Social work or counseling" does not include
any of the following: (i) A service provided in place of case
management. (ii) A service provided to the individual's authorized
representative or caregiver that is unrelated to the individual's
well-being. (iii) A service provided if the individual receives a similar
service paid (in full or in part) by medicare, state plan medicaid, or another
third-party payer. (2) "E.passport" has the same
meaning as in section 4732.40 of the Revised Code. (B) Requirements for an ODA-certified
provider of social work or counseling: (1) General requirements:
The provider is subject to rule 173-39-02 of the Administrative
Code. (2) Venue: The provider
shall provide this service in the individual's home, in another
community-based setting agreed upon by the individual and the provider, or by
telephone or video conference as permitted by the licensing board for the
licensed professional providing this service. (3) Assessment: The
provider shall assess each individual, including the individual's
psycho-social, financial, and environmental statuses. (4) Treatment
plan: (a) The provider shall develop a treatment plan that
includes a method of treatment and number of sessions and share the plan with
the individual and the individual's case manager within ten business days
after the provider completes the assessment. (b) The provider shall implement the treatment
plan. (5) Provider qualifications: No person
may provide the service, whether as a non-agency provider or as an employee or
subcontractor of an agency provider, unless the person meets the following
qualifications. (a) The person has a current, valid license in good
standing with the provider's state licensing board to be one of the
following: (i) Licensed psychologist
or licensed psychologist with an e.passport. (ii) Licensed
professional clinical counselor (LPCC), including an LPCC from a member state
with an unencumbered multistate license under section 4757.51 of the Revised
Code. (iii) Licensed
professional counselor (LPC), including an LPC from a member state with an
unencumbered multistate license under section 4757.51 of the Revised
Code. (iv) Independent marriage
and family therapist (IMFT). (v) Marriage and family
therapist (MFT). (vi) Licensed independent
social worker (LISW) including, beginning on August 9, 2024, an LISW from a
member state with an unencumbered multistate license under section 4757.52 of
the Revised Code. (vii) Licensed social
worker (LSW) including, beginning on August 9, 2024, an LSW from a member state
with an unencumbered multistate license under section 4757.52 of the Revised
Code. (viii) An advanced
practice RN designated as a CNP or CNS and certified as a psychiatric-mental
health CNP or CNS by the American nurses credentialing center. (b) The person has at least one year of social work or
counseling experience. (6) Service verification:
The following are the mandatory reporting items for each session: (a) Individual's name. (b) Date of session. (c) Time of day each session begins and ends. (d) Name of staff member providing social work or
counseling to the individual or the individual's caregiver (if an agency
provider). (e) A unique identifier of the individual to attest to
participating in the session. (C) Unit and rate: (1) For the PASSPORT
program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the
following: (a) A unit of a social work or counseling as fifteen
minutes of session time with the individual. (b) The maximum-allowable rate for a unit of social work or
counseling. (2) For the PASSPORT
program, rule 5160-31-07 of the Administrative Code establishes the
rate-setting methodology for social work or counseling.
Last updated July 2, 2024 at 8:40 AM
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Rule 173-39-02.14 | ODA provider certification: home-delivered meals.
(A) "Home-delivered meal" means
a meal regulated by rule 5160-44-11 of the Administrative Code. (B) Requirements for every ODA-certified
provider of home-delivered meals: (1) The provider is
subject to rule 173-39-02 of the Administrative Code. (2) Requirements specific
to home-delivered meals: (a) For all meals, the provider is subject to rule 5160-44-11 of
the Administrative Code. (b) If ODA's designee authorizes home-delivered meals for an
individual, the provider shall provide the individual with home-delivered meals
that are kosher if the individual requests a kosher diet. (3) If a conflict exists
between a requirement in this rule or rule 173-39-02 of the Administrative Code
and a requirement in rule 5160-44-11 of the Administrative Code, the provider
shall comply with the requirement in this rule or rule 173-39-02 of the
Administrative Code instead of the conflicting requirement in rule 5160-44-11
of the Administrative Code. (C) Units and rates: (1) For the PASSPORT
program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the
following: (a) A unit of regular home-delivered meals as one
home-delivered meal. (b) A unit of home-delivered meals with a therapeutic diet
as one home-delivered meal with a therapeutic diet. (c) The maximum-allowable rate for a unit of home-delivered
meals. (2) For the PASSPORT program, rule
5160-31-07 of the Administrative Code establishes rate-setting methodology for
units of home-delivered meals. (3) For the PASSPORT program, section
173.524 of the Revised Code authorizes paying for home-delivered meals with a
kosher diet at the same rate as a therapeutic diet.
Last updated May 17, 2024 at 12:08 PM
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Rule 173-39-02.15 | ODA provider certification: community integration.
(A) "Community integration"
means the service defined in rule 5160-44-14 of the Administrative
Code. (B) Requirements for an ODA-certified
provider of community integration: (1) The provider is
subject to rule 173-39-02 of the Administrative Code. (2) The provider is
subject to rule 5160-44-14 of the Administrative Code. (3) If a conflict exists
between a requirement in rule 173-39-02 of the Administrative Code and a
requirement in rule 5160-44-14 of the Administrative Code, the provider is
subject to the requirement in rule 173-39-02 of the Administrative Code instead
of the conflicting requirement in rule 5160-44-14 of the Administrative
Code. (C) Unit and rates: (1) For the PASSPORT
program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the
following: (a) One unit of community integration as fifteen
minutes. (b) The maximum-allowable rate for a unit of community
integration. (2) For the PASSPORT
program, rule 5160-31-07 of the Administrative Code establishes the
rate-setting methodology for community integration.
Last updated May 17, 2024 at 12:08 PM
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Rule 173-39-02.16 | ODA provider certification: assisted living service.
(A) Definitions for this
rule: (1) "Assisted living
service" means either a basic service or memory care that promotes aging
in an RCF by supporting the individual's independence, choice, and
privacy. (2) "Basic service" means all
of the following: (a) A service that includes the following: (i) Personal care under
rule 3701-16-09 of the Administrative Code, which includes hands-on assistance,
supervision, and/or cuing of ADLs, and IADLs. (ii) Nursing, including
the following: (a) The initial and
subsequent health assessments under rule 3701-16-08 of the Administrative
Code. (b) Other activities
included in rules 3701-16-09 and 3701-16-09.1 of the Administrative
Code. (iii) Coordinating three
meals per day and snacks according to rule 3701-16-10 of the Administrative
Code with access to food according to rule 5160-44-01 of the Administrative
Code. (iv) Coordinating the
social, recreational, and leisure activities under rule 3701-16-11 of the
Administrative Code to promote community participation and integration,
including non-medical transportation to services and resources in the
community. (b) A service that does not include the
following: (i) Housing. (ii) Meals. (iii) Twenty-four-hour
skilled nursing care. (iv) One-on-one
supervision of an individual. (3) "Census"
means the total number of residents in an RCF on a given day and includes any
resident who is temporarily absent from the RCF without being
discharged. (4) "Memory care" means a
service that a provider provides in compliance with paragraph (D) of this rule
to an individual that a practitioner assessed, then issued a documented
diagnosis of any form of dementia. (5) "Practitioner" means a
health care provider engaging in activities authorized by the provider's
license, certification, or registration. (6) "Resident call system" has
the same meaning as in rule 3701-16-01 of the Administrative Code. (7) "Staff member" and
"staff" have the same meanings as in rule 3701-16-01 of the
Administrative Code. (B) Certification types: ODA certifies
each provider for either of the following: (1) The basic
service. (2) The basic service and
memory care. (C) Requirements for an ODA-certified provider of the basic
service: (1) General requirements:
The provider is subject to rule 173-39-02 of the Administrative
Code. (2) RCF
qualifications: (a) Licensure: Only a provider who maintains a current, valid RCF
license from ODH and maintains compliance with Chapter 3721. of the Revised
Code and Chapters 3701-13 and 3701-16 of the Administrative Code qualifies to
provide this service. (b) Public information: The provider shall display the following
on its website: (i) Whether the provider
is currently certified by ODA to provide the basic service or both the basic
service and memory care. (ii) Whether the provider
is currently accepting individuals who are enrolling in the assisted living
program or mycare Ohio. (c) Resident units: A resident unit qualifies for this service
only if the unit meets all the following standards: (i) Occupancy: (a) The resident unit is
a single-occupancy resident unit designated solely for the individual, except
as permitted under paragraph (C)(2)(c)(i)(b) of this rule. (b) The provider may
allow an individual to share a single-occupancy resident unit only if all of
the following conditions exist: (i) The individual
requests to share the individual's unit. (ii) The individual
shares the individual's unit with a person with whom the individual has an
existing relationship. (iii) ODA's designee
verifies that the conditions of paragraphs (C)(2)(c)(i)(b)(i) and
(C)(2)(c)(i)(b)(ii) of this rule are met and authorizes sharing the unit in the
individual's person-centered services plan. (ii) Lock: The resident
unit has a lock that allows the individual to control access to the resident
unit at all times, unless the individual's person-centered services plan
indicates otherwise. (iii) Bathroom: The
resident unit includes a bathroom with a toilet, a sink, and a shower or
bathtub, all of which are in working order. (iv) Social space: The
resident unit includes identifiable space, separate from the sleeping area,
that provides seating for the individual and one or more visitors for
socialization. (d) Common areas: The provider shall provide common areas
accessible to the individual, including a dining area (or areas) and an
activity center (or centers). A multi-purpose common area may serve as both a
dining area and an activity center. (3) Staff availability:
The provider shall maintain adequate staffing levels to comply with rule
3701-16-05 of the Administrative Code in a timely manner in response to
individual's unpredictable care needs, supervisory needs, emotional needs,
and reasonable requests for services through the resident call system
twenty-four hours per day. (4) Minors: No staff
member under eighteen years of age qualifies to do any of the
following: (a) Assist with medication administration. (b) Provide transportation. (c) Provide personal care without on-site supervision, in
accordance with rule 3701-16-06 of the Administrative Code. (5) Initial staff
qualifications: Only a staff member who successfully completes training in the
following subject areas qualifies to provide this service: (a) Principles and philosophy of assisted living. (b) The aging process. (c) Cuing, prompting, and other means of effective
communication. (d) Common behaviors for cognitively-impaired individuals,
behaviorally-impaired individuals, or other individuals and strategies to
redirect or de-escalate those behaviors. (e) Confidentiality. (f) The person-centered planning process in rule 5160-44-02 of
the Administrative Code, which includes supporting individuals' full
access to the greater community. (g) The individual's right to assume responsibility for
decisions related to the individual's care. (6) In-service training:
The provider shall ensure that each staff member providing this service
successfully completes any training requirements in rule 3701-16-06 of the
Administrative Code and makes verification of successful completion of those
requirements available to ODA or its designee upon request. (7) Quarterly
assessments: The provider's RN or LPN shall contact the individual at
least quarterly to assess, and retain a record of, all of the
following: (a) The individual's satisfaction with the individual's
activity plan and whether the activity plan continues to meet the
individual's needs. (b) Whether the individual's records demonstrate that the
individual is receiving activities as ODA or its designee authorized them in
the individual's person-centered service plan. (c) Whether staff are providing personal care services to the
individual in a manner that complies with rule 3701-16-09 of the Administrative
Code. (8) Subcontracting: The
provider may subcontract to provide one or more, but not all, of the activities
listed under paragraph (A)(2)(a) of this rule that ODA or its designee
authorizes for the individual. The provider is responsible to assure that any
activity provided by a sub-contractor complies with this chapter. (D) Requirements for an ODA-certified provider of the basic
service and memory care: (1) The provider is
subject to the standards in paragraph (C) of this rule. (2) The provider
qualifies for certification to provide memory care only if the provider meets
all of the following standards: (a) The provider displays a purpose statement on its website that
explains the difference between the provider's basic service and its
memory care, or only a memory care purpose statement if that is the exclusive
service the provider offers. (b) The provider designates each single-occupancy resident unit
in paragraph (C)(2)(c) of this rule in which it plans to provide memory care as
one of the following: (i) A resident unit in a
memory care section of the RCF. The provider may add a single-occupancy
resident unit to an existing memory care section even if the resident unit is
not next door to the existing section. (ii) A resident unit in
an RCF that provides only memory care. (c) A staff member who successfully completed the training
requirement in paragraph (D)(3) of rule 3701-16-06 of the Administrative Code
provides or arranges for at least three therapeutic, social, or recreational
activities listed in rule 3701-16-11 of the Administrative Code per day with
consideration given to individuals' preferences and designed to meet
individuals' needs. (d) The provider ensures safe access to outdoor space for
individuals. (e) The provider assists each individual who makes a call through
the resident call system in person in fewer than ten minutes after the
individual initiates the call. (3) Staff availability:
The provider qualifies for certification to provide memory care only if the
provider meets all of the following standards in addition to the requirements
in paragraph (C)(3) of this rule: (a) The provider has a sufficient number of RNs or LPNs on call
or on site at all times for individuals receiving memory care. (b) The provider maintains the appropriate direct-care
staff-to-resident ratio below for its memory care: (i) If providing memory
care and the basic service at the same time, a ratio for the provider's
memory care that is at least twenty per cent higher than the provider's
ratio for its basic service. (ii) If providing only
memory care and the average ratio for the basic service provided by a
representative sample of providers participating in the medicaid-funded
component of the assisted living program is readily available to the provider,
then a ratio that is at least twenty per cent higher than that average
ratio. (iii) If providing only
memory care and the average ratio for the basic service provided by a
representative sample of providers participating in the medicaid-funded
component of the assisted living program is not readily available to the
provider, then a ratio of at least one direct-care staff member for every ten
individuals receiving memory care with at least one direct-care staff member on
each floor of the RCF if the RCF provides memory care on multiple
floors. (4) Initial staff
qualifications: A staff member qualifies to provide memory care without
in-person supervision only if the staff member successfully completes training
all of the following topics in addition to the topics listed under paragraph
(C)(5) of this rule: (a) Overview of dementia: symptoms, treatment approaches, and
progression. (b) Foundations of effective communication in dementia
care. (c) Common behavior challenges specific to dementia and
recommended behavior management techniques. (d) Current best practices in dementia care. (e) Missing resident prevention and response. (5) In-service training:
A staff member continues to qualify to provide memory care only if the staff
member successfully completes dementia care training when complying with
paragraph (C)(6) of this rule. (E) Units and rates: (1) For the assisted
living program, the appendix to rule 5160-1-06.5 of the Administrative Code
lists the following: (a) The unit of service as one day. (b) The maximum-allowable rates for a unit of a unit of the basic
service and a unit of memory care. (c) Critical access rates. (2) For the assisted living program, rule
5160-33-07 of the Administrative Code establishes the rate-setting methodology
for a unit of service. (3) Requirements to
obtain the critical access rate for certified assisted living
providers: (a) A certified provider of the service, whether the basic
service or memory care, that provided the service for one or more state fiscal
years qualifies for the critical access rate by meeting all of the
following: (i) At least an average
of fifty per cent of the residents in the RCF were enrolled in medicaid during
the preceding state fiscal year, whether through the assisted living program,
mycare Ohio, or PACE. (ii) The provider
responds to ODA's annual June survey by providing, and attesting to the
veracity of, all of the following information based on the current state fiscal
year: (a) The average daily
census of the RCF. (b) The average daily
number of residents in paragraph (E)(3)(a)(ii)(a) of this rule who are enrolled
in medicaid. (c) The average daily
percentage of residents in paragraph (E)(3)(a)(ii)(a) of this rule who are
enrolled in medicaid. (d) The medicaid
identification numbers of all residents in paragraph (E)(3)(a)(ii)(a) of this
rule who are enrolled in medicaid. (e) For each resident in
paragraph (E)(3)(a)(ii)(a) of this rule who is enrolled in mycare Ohio, the
name of the mycare Ohio plan into which the resident enrolled. (f) Any other information
required in the survey. (b) A certified provider of the assisted living service,
whether the basic service or memory care, that has not provided the service for
one or more state fiscal years and intends to provide the service for the
duration of the state fiscal year in which the provider was initially
certified, qualifies for the critical access rate by meeting all of the
following: (i) The provider projects
and attests that at least an average of fifty percent of the residents in the
RCF will be enrolled in medicaid during the state fiscal year, whether through
the assisted living program, mycare Ohio, or PACE. (ii) The provider
responds to ODA's annual June survey by providing, and attesting to the
veracity of, all of the following information for the period beginning with the
provider's attestation date in paragraph (E)(3)(b)(i) of this rule through
the remainder of the current state fiscal year: (a) The average daily
census of the RCF. (b) The average daily
number of residents in paragraph (E)(3)(a)(ii)(a) of this rule who are enrolled
in medicaid. (c) The average daily
percentage of residents in paragraph (E)(3)(a)(ii)(a) of this rule who are
enrolled in medicaid. (d) The medicaid
identification numbers of all residents in paragraph (E)(3)(a)(ii)(a) of this
rule who are enrolled in medicaid. (e) For each resident in
paragraph (E)(3)(a)(ii)(a) of this rule who is enrolled in mycare Ohio, the
name of the mycare Ohio plan into which the resident enrolled. (f) Any other information
required in the survey. (c) A certified provider who fails to meet all requirements
under paragraph (E)(3)(a) or (E)(3)(b) of this rule at the end of the fiscal
year may requalify for the critical access rate by meeting the requirement in
paragraph (E)(3)(a)(i) of this rule and satisfying the requirements in
paragraph (E)(3)(a) of this rule. (d) The critical access rate is payable for a qualifying
provider for a resident receiving the basic service for the duration of the
state fiscal year without adjustment. This rate is not payable for a resident
also receiving memory care.
Last updated July 2, 2024 at 8:40 AM
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Rule 173-39-02.17 | ODA provider certification: community transition.
(A) "Community transition"
means the service defined in rule 5160-44-26 of the Administrative
Code. (B) Requirements for an ODA-certified
provider of community transition: (1) The provider is
subject to rule 173-39-02 of the Administrative Code. (2) The provider is
subject to rule 5160-44-26 of the Administrative Code. (3) If a conflict exists
between a requirement in rule 173-39-02 of the Administrative Code and a
requirement in rule 5160-44-26 of the Administrative Code, the provider is
subject to the requirement in rule 173-39-02 of the Administrative Code rather
than the conflicting requirement in rule 5160-44-26 of the Administrative
Code. (C) Units and rates: (1) For the assisted
living program: (a) The appendix to rule 5160-1-06.5 of the Administrative
Code lists the unit of community transition as one completed job per individual
per enrollment in the assisted living program and includes any of the expenses
listed under paragraph (A)(1) of rule 5160-44-26 of the Administrative
Code. (b) The rate per job is subject to the maximum-allowable
rate established in the appendix to rule 5160-1-06.5 of the Administrative Code
and the per-individual-per-enrollment limit in paragraph (C)(2) of rule
5160-44-26 of the Administrative Code. (c) Rule 5160-33-07 of the Administrative Code establishes
the unit rate as a rate that is negotiated between the provider and ODA's
designee. The negotiated rate includes any of the expenses listed under
paragraph (A)(1) of rule 5160-44-26 of the Administrative Code. The provider is
ineligible to receive a payment for a unit of community transition that exceeds
the negotiated rate, unless ODA's designee approves a revised
rate. (2) For the PASSPORT
program: (a) The appendix to rule 5160-1-06.1 of the Administrative
Code lists the unit of community transition as one completed job per individual
per enrollment in the PASSPORT program and includes any of the expenses listed
under paragraph (A)(1) of rule 5160-44-26 of the Administrative
Code. (b) The rate per job is subject to the maximum-allowable
rate established in the appendix to rule 5160 1 06.1 of the Administrative Code
and the per-individual-per-enrollment limit in paragraph (C)(2) of rule
5160-44-26 of the Administrative Code. (c) Rule 5160-31-07 of the Administrative Code establishes
the unit rate as a rate that is negotiated between the provider and ODA's
designee. The negotiated rate includes any of the expenses listed under
paragraph (A)(1) of rule 5160-44-26 of the Administrative Code. The provider is
ineligible to receive a payment for a unit of community transition that exceeds
the negotiated rate, unless ODA's designee approves a revised
rate.
Last updated May 17, 2024 at 12:08 PM
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Rule 173-39-02.18 | ODA provider certification: non-medical transportation.
(A) Definitions for this
rule: (1) "Non-medical
transportation" (transportation) means using a provider's vehicle and
driver to transport individuals from one place to another for a non-medical
purpose. "Non-medical transportation" does not include the
following: (a) Transportation otherwise available, or funded by,
Ohio's medicaid program or another source. (b) Transportation for a non-emergency medical
purpose. (c) Transportation being provided through a similar service
in this chapter. (d) Transportation that the individual's family,
neighbors, friends, or community agencies are willing or legally responsible to
provide to the individual free of charge. (e) Escort or transportation by a participant-directed
provider. (See rule 173-39-02.4 of the Administrative Code.) (2) "Board of
EMFTS" means the state board of emergency medical, fire, and
transportation services created under section 4765.02 of the Revised
Code. (3) "Bus" has
the same meaning as in section 4513.50 of the Revised Code. (4) "CLIA-certified
laboratory" means a laboratory that ODH lists as a "CLIA Lab" in
active status on the "Long-Term Care, Non Long-Term Care, & CLIA
Health Care Provider Search"
(http://publicapps.odh.ohio.gov/eid/Provider_Search.aspx). (5) "EMT" means
any of the emergency medical technicians defined in division (A), (B), or (C)
of section 4765.01 of the Revised Code. (6) "First
responder" has the same meaning as in division (A) of section 4765.01 of
the Revised Code. (B) Requirements for ODA-certified
providers of non-medical transportation: (1) General
requirements: (a) The provider is subject to the requirements for every
ODA-certified provider in rule 173-39-02 of the Administrative
Code. (b) Availability: The provider shall possess a back-up plan
for transporting individuals when an agency provider's driver or vehicle
is unavailable or when a non-agency provider or the provider's vehicle is
unavailable. (c) Transferring: As part of each trip, the driver shall
help the individual safely transfer between the pick-up point and the vehicle,
safely enter and exit the vehicle, and safely transfer between the vehicle and
the destination point. (d) Provider types: ODA certifies only agency and
non-agency providers to provide the transportation under this
rule. (2) Vehicle
requirements: (a) Maintenance: The provider shall maintain vehicles
according to the manufacturer's maintenance schedule for each vehicle used
to transport individuals. If the vehicle includes a wheelchair lift, the
provider shall maintain the wheelchair lift according to the
manufacturer's maintenance schedule for the wheelchair lift. (b) Inspections: The provider shall conduct the following
inspections on each vehicle used to transport individuals. If the vehicle
includes a wheelchair lift, the provider's inspection shall include
inspecting the wheelchair lift: (i) An annual vehicle
inspection on an ODA-approved form. The provider may use a vehicle for
transporting individuals only if a mechanic who is certified by the national
institute for automotive service excellence (i.e., "ASE-certified")
or another mechanic approved by ODA's designee, inspected the vehicle no
more than twelve months before and answers all questions on the form in the
affirmative. (ii) A daily vehicle
inspection on an ODA-approved form. The provider may use a vehicle only if the
provider answers all questions on the form in the affirmative. (c) Exemptions: (i) A vehicle possessing
a current, valid ambulette license is deemed to comply with paragraph
(B)(2)(b)(i) of this rule by providing ODA or its designee with evidence of the
vehicle's current, valid ambulette license. (ii) A bus displaying a
current, valid safety-inspection decal issued by the state highway patrol under
Chapter 4501-52 of the Administrative Code is deemed to comply with paragraph
(B)(2)(b)(i) of this rule. (3) Driver
requirements: (a) Statutory requirements to hire: The provider may hire a
person to be a driver only if the person meets all the requirements for drivers
under divisions (A)(3) and (B) of section 4766.14 of the Revised Code, as
amplified in paragraph (A) (8) of rule 4766-3-13 of the Administrative Code,
subject to the following conditions: (i) The applicant's
first-aid training and cardiopulmonary-resuscitation training came from a
training organization approved by the board of EMFTS
(http://www.ems.ohio.gov/medical-transportation-faq.aspx). (ii) The applicant's
drug test results came from a CLIA-certified laboratory that declared the
applicant to be free of alcohol, amphetamines, cannabinoids (THC), cocaine,
opiates, or phencyclidine (PCP). (iii) The provider
complies with the background-check requirements in Chapter 173-9 of the
Administrative Code. (b) Additional requirements to hire: The provider may hire
a person to be a driver only if the person meets all the following
requirements: (i) The applicant has
held a current, valid driver's license for at least two
years. (ii) The applicant holds
any driver's license endorsement necessary to operate the type of vehicle
the applicant would drive. (iii) The applicant
understands written and oral instructions. (iv) The applicant has
the ability to comply with paragraph (B)(1)(c) of this rule. (v) The applicant has the
ability to conduct the daily vehicle inspection in paragraph (B)(2)(b)(ii) of
this rule. (vi) The applicant has
the ability to collect the mandatory reporting items under paragraph (B)(4) of
this rule. (c) Passenger-assistance training: The provider may retain
a driver only if the driver successfully completes a passenger-assistance
training course approved by the board of EMFTS
(http://www.ems.ohio.gov/medical-transportation-faq.aspx) no later than six
months after the provider hires the driver. (d) Exempted professionals: Providers hiring an applicant
with a current, valid license or certificate to be one or more of the following
professionals may demonstrate compliance with paragraphs (B)(3)(a), (B)(3)(b),
and (B)(3)(c) of this rule by providing ODA or its designee with evidence the
applicant possesses a current, valid license or certificate as one of the
following professionals: (i) An ambulette
driver. (ii) An EMT or first
responder who passed the board of EMFTS' curriculum for an EMT or first
responder, but does not necessarily hold a current, valid certification for
either profession. (iii) A driver for a
county transit system, regional transit authority, or regional transit
commission. (4) Trip verification:
The following are the mandatory reporting items for each trip provided to
comply with the requirements under paragraph (B)(10)(a)(i) of rule 173-39-02 of
the Administrative Code: (a) Individual's name. (b) Date of trip. (c) Pick-up point and time of the pick up. (d) Destination point and time of the drop
off. (e) Driver's name. (f) Unique identifier of the driver to attest to providing
the trip. (g) Unique identifier of the individual to attest to
receiving the trip. (C) Jobs and rates: (1) For the PASSPORT
program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the
following for a job of non-medical transportation: (a) The job as one trip, whether a one-way or round
trip. (b) The maximum rate allowable for a job. (2) For the PASSPORT program, rule
5160-31-07 of the Administrative Code establishes the rate-setting methodology
for non-medical transportation.
Last updated May 17, 2024 at 12:08 PM
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Rule 173-39-02.20 | ODA provider certification: enhanced community living.
(A) Definitions for this
rule: (1) "Enhanced community living"
(ECL) means a service promoting aging in place, in multi-family affordable
housing, through access to on-site, individually-tailored, health-related, and
supportive interventions for individuals who have functional deficits resulting
from one or more chronic health conditions. (a) ECL includes the following activities: (i) The establishment of measurable health goals. (ii) The identification of modifiable healthcare
risks. (iii) The provision of regular health-status monitoring
interventions. "Health-status monitoring interventions" mean taking
and recording vital signs, weight, nutrition, and hydration
statuses. (iv) Assistance with accessing additional allied health
services. (v) The provision of, or arrangement for, education on
self-managing chronic diseases or chronic health conditions. (vi) Daily wellness checks. "Daily wellness check" means
an activity of ECL through which a PCA observes any changes in the
individual's level of functioning and determine what, if any,
modifications to the activity plan are needed. (vii) Access to planned and intermittent personal care under rule
173-39-02.11 of the Administrative Code. (viii) Activities to assist an individual who is returning home
following a hospital or nursing facility stay. (b) ECL does not include activities provided while the individual
is receiving a similar service under this chapter. (2) "Chronic health
condition" means a condition that lasts twelve months or longer and meets
one or both of the following tests: (a) It places limitation on self-care, independent living, and
social interactions. (b) It results in the need for ongoing intervention with medical
services, products, and equipment. (3) "Intermittent" means stopping and starting at
intervals; pausing from time to time; periodic, not pre-determined designated
time periods (e.g., ten a.m. to eleven a.m.) or for designated lengths of time
(e.g., fifteen minutes or two hours). (4) "Multi-family
affordable housing" means a housing site meeting all of the following
requirements: (a) The housing site uses a landlord-tenant rental agreement that
complies with Chapter 5321. of the Revised Code. (b) The housing site provides a minimum of six units of housing
under one roof. (c) The housing site receives assistance through one of the
following programs: (i) Federally-assisted
housing program under 24 C.F.R. Part 5. (ii) Project-based
voucher program under 24 C.F.R. Part 983. (iii) Low-income housing
tax credit program based on Section 42 of the Internal Revenue
Code. (5) "Person-centered activity"
means an activity directed by the individual's informed choices that is
offered at the time and place most preferable to the individual, in a safe and
unhurried manner, and in a way that honors the individual's individuality
and preferences. (B) Requirements for ODA-certified
providers of ECL: (1) General requirements: The provider is
subject to rule 173-39-02 of the Administrative Code. (2) Person-centered activity
plan: (a) Development: Before the provider provides the initial episode
of ECL to an individual, the PCA supervisor shall do both of the
following: (i) Assess the
individual's health goals, modifiable health risks, and planned and
anticipated intermittent personal care needs. (ii) Develop a
person-centered activity plan with the individual that describes the
interventions the individual has chosen to reach the individual's
identified health goals, to minimize the individual's modifiable health
risks, and to meet the individual's planned and anticipated intermittent
personal care needs. The provider shall obtain a unique identifier of the
individual to attest that the individual was involved in the development of the
person-centered activity plan. (b) Regular monitoring: After the individual begins to receive
ECL, the PCA supervisor shall do both of the following: (i) Revise the
person-centered activity plan in fewer than five days after each hospital or
nursing facility stay, and as otherwise needed to reflect changes in the
individual's status, condition, preferences, and response to
ECL. (ii) Facilitate an
in-person review of the person-centered activity plan with the individual, the
primary team, the individual's case manager, the individual's
caregiver (if the individual has a caregiver), and the housing site's
service coordinator (if the housing site has a service coordinator) every sixty
days to evaluate the effectiveness of the plan in addressing the
individual's health goals, reducing modifiable risks, and meeting planned
and anticipated intermittent personal care needs. (3) Primary team: The
provider shall provide person-centered activities to individuals through a
primary team that consists of PCAs and PCA supervisors who regularly provide
activities within a given housing site and, as a result, are familiar with the
individuals in the housing site. (4) Staffing levels: (a) The provider shall maintain adequate staffing levels to
provide each ECL activity. (b) The PCA supervisor shall maintain accessibility to respond to
individuals' emergencies in the housing site during any time that a PCA is
providing ECL to an individual in the housing site. (c) The provider shall maintain adequate staffing levels to
provide person-centered ECL seven days a week for a minimum of six hours a
day. (d) During each hour the provider has a PCA providing ECL to an
individual in a housing site, the provider shall ensure that any other
individual has a mechanism to contact a PCA to request assistance with
intermittent and unplanned personal care needs related to the measurable health
goals and modifiable healthcare risks described in the individual's
activity plan. (e) Each day, the provider shall provide adequate staffing levels
of on-site PCAs for no fewer than six hours (or, twenty-four units) to meet the
individuals' assessed, intermittent, and unscheduled healthcare
needs. (f) The PCA supervisor or another RN (or LPN under the direction
of an RN) shall monitor the health status of individuals for no fewer than
three hours (or, twelve units) each week. (g) The provider shall
replace any PCA on the primary team who is absent with a back-up PCA who is
familiar with the housing site and the individuals residing in the housing
site. A PCA supervisor shall supervise the primary team and any back-up
PCAs. (5) Provider qualifications: (a) Type of provider: A provider qualifies to provide ECL only if
both of the following conditions are met: (i) ODA certifies the provider as an agency provider of both
personal care and ECL. (ii) The provider is a legal entity distinct from the housing site
owner and property manager so the site is not subject to licensure, as defined
in Chapters 3721. and 5119. of the Revised Code, and safeguards are in place to
prevent any unremedied conflicts of interest. (b) Staff qualifications: (i) PCA supervisor: A
person qualifies to be a PCA supervisor only if the person meets the
qualifications in paragraph (C)(4)(a) of rule 173-39-02.11 of the
Administrative Code. (ii) PCAs: A person
qualifies to serve as a PCA only if the person meets at least one of the
qualifications under paragraph (C)(3)(a) of rule 173-39-02.11 of the
Administrative Code. (c) Staff training: (i) A PCA qualifies to have direct, in-person contact with an
individual only after the PCA complies with the orientation requirements in
paragraphs (C)(3)(b), (C)(3)(e), and (C)(3)(f) of rule 173-39-02.11 of the
Administrative Code. (ii) In-service training:
Each PCA is subject to the in-service training requirements in paragraphs
(C)(3)(d), (C)(3)(e), and (C)(3)(f) of rule 173-39-02.11 of the Administrative
Code. (6) Service verification: The following
are the mandatory reporting items to include in each individual's daily
activity record: (a) Individual's name. (b) Date of service. (c) Activities provided as authorized in the
person-centered activity plan. (d) Activities provided in response to daily, intermittent
needs. (e) Description of the individual's status and
response to the activities provided. (f) Total number of units provided to the
individual. (g) Name and unique identifier of the provider's staff
person who provided the activities to attest to providing the
activities. (h) Unique identifier of the individual, to attest to
receiving the activities. (C) Unit and rates: (1) For the PASSPORT
program, rule 5160-1-06.1 of the Administrative Code lists the
following: (a) One unit of ECL as fifteen minutes. (b) The maximum rate allowable for one unit of
ECL. (2) For the PASSPORT program, rule
5160-31-07 of the Administrative Code establishes the rate-setting methodology
for ECL.
Last updated July 2, 2024 at 9:55 AM
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Rule 173-39-02.22 | ODA provider certification: waiver nursing service.
(A) "Waiver nursing" means the
service defined in rule 5160-44-22 of the Administrative Code. (B) Requirements for every ODA-certified
provider of waiver nursing: (1) The provider is
subject to rule 173-39-02 of the Administrative Code. (2) The provider is
subject to rule 5160-44-22 of the Administrative Code. (3) If a conflict exists
between a requirement in rule 173-39-02 of the Administrative Code and a
requirement in rule 5160-44-22 of the Administrative Code, the provider shall
comply with the requirement in rule 173-39-02 of the Administrative Code
instead of the conflicting requirement in rule 5160-44-22 of the Administrative
Code. (C) Units and rates: (1) For the PASSPORT
program, a unit of waiver nursing equals a unit of waiver nursing that rule
5160-46-06 of the Administrative Code establishes for the Ohio home care waiver
program. (2) For the PASSPORT
program, rule 5160-46-06 of the Administrative Code establishes the
maximum-allowable rate for a unit of a waiver nursing. (3) For the PASSPORT
program, rule 5160-31-07 of the Administrative Code establishes rate-setting
methodology for waiver nursing.
Last updated May 17, 2024 at 12:08 PM
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Rule 173-39-02.23 | ODA provider certification: out-of-home respite.
(A) "Out-of-home respite" means
the service defined in rule 5160-44-17 of the Administrative Code. (B) Requirements for every ODA-certified
provider of out-of-home respite: (1) The provider is
subject to rule 173-39-02 of the Administrative Code. (2) The provider is
subject to rule 5160-44-17 of the Administrative Code. (3) If a conflict exists
between a requirement in rule 173-39-02 of the Administrative Code and a
requirement in rule 5160-44-17 of the Administrative Code, the provider shall
comply with the requirement in rule 173-39-02 of the Administrative Code
instead of the conflicting requirement in rule 5160-44-17 of the Administrative
Code. (C) Units and rates: (1) For the PASSPORT
program, a unit of out-of-home respite equals a unit of out-of-home respite
that rule 5160-46-06 of the Administrative Code establishes for the Ohio home
care waiver program. (2) For the PASSPORT
program, rule 5160-46-06 of the Administrative Code establishes the
maximum-allowable rate for a unit of out-of-home respite. (3) For the PASSPORT
program, rule 5160-31-07 of the Administrative Code establishes rate-setting
methodology for out-of-home respite.
Last updated May 17, 2024 at 12:08 PM
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Rule 173-39-02.24 | ODA provider certification: home care attendant service.
(A) "Home care attendant
service" means the service defined in rule 5160-44-27 of the
Administrative Code. (B) Requirements for every ODA-certified
provider of a home care attendant service: (1) The provider is
subject to rule 173-39-02 of the Administrative Code. (2) The provider is
subject to rule 5160-44-27 of the Administrative Code. (3) If a conflict exists
between a requirement in rule 173-39-02 of the Administrative Code and a
requirement in rule 5160-44-27 of the Administrative Code, the provider shall
comply with the requirement in rule 173-39-02 of the Administrative Code
instead of the conflicting requirement in rule 5160-44-27 of the Administrative
Code. (C) Units and rates: (1) For the PASSPORT
program, a unit of a home care attendant service equals a unit of a home care
attendant service that rule 5160-46-06 of the Administrative Code establishes
for the Ohio home care waiver program. (2) For the PASSPORT
program, rule 5160-46-06.1 of the Administrative Code establishes the
maximum-allowable rate for a unit of a home care attendant
service. (3) For the PASSPORT
program, rule 5160-31-07 of the Administrative Code establishes rate-setting
methodology for a home care attendant service.
Last updated May 17, 2024 at 12:08 PM
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Rule 173-39-03 | ODA provider certification: applying for certification.
(A) Initial steps: (1) To apply for
certification, a provider shall complete an application in the provider
management system, which includes electronic submission of all supporting
records required as part of the application. If the provider does not complete
the application within ninety days, the application expires. (2) ODA shall review an
application to determine if the application meets the requirements for the
certification the provider is seeking. (a) ODA shall initiate the process for a pre-certification
review if ODA determines that a provider submitted a complete
application. (b) If ODA determines that the supporting records do not
demonstrate that the provider submitted a complete application, then ODA shall
email the provider to give the provider a deadline to submit supporting records
that demonstrate that the provider meets the requirements for certification
that is the earlier of thirty days after the email or the deadline in paragraph
(A)(1) of this rule. (B) Voluntary withdrawal of application
for certification: (1) A provider may
withdraw its application at any time before enrollment with ODM unless ODA
issued a notice of denial of certification. (2) A provider that
withdrew its application may later reapply for certification. (C) Pre-certification review: (1) For all providers
except providers of community transition provided through the home choice
program under rule 5160-51-10 of the Administrative Code and
participant-directed providers: (a) ODA's designee shall visit the provider's
business site to determine if the provider meets the applicable requirements in
rule 173-39-02 of the Administrative Code and any additional requirements in
this chapter regulating a service the provider is seeking certification to
provide. During a state of emergency declared by the governor, a federal public
health emergency, or during another time if authorized by ODA, ODA's
designee may conduct a desk review of the provider's business site in lieu
of a visit. (b) ODA's designee shall complete the review and
notify ODA of its recommendation within sixty days after receiving a complete
application to become any other type of provider, unless ODA approves an
extended deadline. (c) ODA's designee shall recommend approval of the
provider's application if a provider other than an ADS or assisted living
provider complies with all applicable requirements. (d) Paragraph (D) of this rule applies if ODA's
designee determines that an ADS or assisted living provider complies with all
applicable requirements. (e) ODA's designee shall recommend denial of the
application if the provider does not comply with all applicable
requirements. (2) For providers of
community transition provided through the home choice program under rule
5160-51-10 of the Administrative Code: (a) ODA may direct its designee to conduct the
pre-certification review to determine if the provider meets the applicable
requirements in rules 173-39-02 and 173-39-02.17 of the Administrative
Code. (b) ODA or its designee shall determine whether the
provider complies with all applicable requirements and either approve or deny
the provider's application pursuant to this rule. (3) For
participant-directed providers, ODA's designee shall conduct a
pre-certification review within thirty days after receiving a complete
application to determine whether the provider meets the applicable requirements
in rule 173-39-02 of the Administrative Code and any additional requirements in
this chapter regulating a service the provider is seeking certification to
provide, unless ODA approves an extended deadline. (D) HCBS settings requirements: A provider may qualify for
certification only if the provider provides its services in the
individual's home or another setting meeting the HCBS settings
requirements in 42 C.F.R. 441.301 and rule 5160-44-01 of the Administrative
Code as determined by ODA on form ODM10172 (revised, June 2021), which is
entitled, "Home and Community Based Services (HCBS) Settings Evaluation
Tool." (1) ODA may certify the
provider if ODA determines the setting is presumed to have the qualities of a
HCBS setting and the setting is not subject to the heightened scrutiny
described in rule 173-39-03.1 of the Administrative Code. (2) The setting is
subject to the heightened scrutiny described in rule 173-39-03.1 of the
Administrative Code if ODA determines the setting is presumed to have the
qualities of an institution. ODA defers action on the application for
certification until the conclusion of the heightened scrutiny. ODA shall notify
the provider that action on the provider's application is
deferred. (E) Final determination: ODA bases its final determination
of whether to certify a provider on the review of the application materials and
the recommendation of ODA's designee. (F) Approved application: (1) Applications for all
services except community transition provided through the home choice program
under rule 5160-51-10 of the Administrative Code: (a) When ODA approves an application, ODA notifies
ODA's designee for the region in which the provider is being certified to
provide services. (b) ODA's designee shall enter into an agreement with
each provider specifying, at a minimum, the following: (i) The time period
during which the agreement is in effect. (ii) The region for which
the provider is certified. (iii) The rate of payment per unit the provider is willing to
accept subject to any limits ODM established in rule 5160-31-07 of the
Administrative Code and the appendix to rule 5160-1-06.1 of the Administrative
Code for the PASSPORT program, and rule 5160-33-07 of the Administrative Code
and the appendix to rule 5160-1-06.5 of the Administrative Code for the
assisted living program. (2) Applications for
community transition provided through the home choice program under rule
5160-51-10 of the Administrative Code: After ODA approves an application to be
a provider of community transition through the home choice program, ODA's
designee shall enter into an agreement with the provider specifying the items
under paragraph (F)(1) of this rule. (G) Deemed providers: ODA may deem any provider certified
by ODM or the department of developmental disabilities to provide one or more
services through a medicaid-waiver program as having satisfied the requirements
for certification by ODA for the same or similar services under this chapter,
as determined by ODA. The effective period for a provider to be deemed an
ODA-certified provider under this paragraph begins when the provider completes
the deeming application process and has a provider agreement with ODA's
designee, and ends if the provider cannot comply with all the requirements of
Chapter 173-9 of the Administrative Code and this chapter within sixty days
after initial deeming or a medicaid provider agreement is terminated, whichever
occurs first. (H) Denied application: (1) ODA may deny a
providers application for any of the following reasons: (a) The provider made false representations, by omission or
commission, on the provider's application. (b) The provider made false statements, provided false
information, or altered records or documents. (c) The provider is disqualified under section 173.38 or
173.381 of the Revised Code or under Chapter 173-9 of the Administrative
Code. (d) The provider does not meet the applicable requirements
in rule 173-39-02 of the Administrative Code or any requirements in this
chapter regulating a service that the provider is seeking certification to
provide. (e) ODA previously revoked the provider's
certification. (f) Any reason permitted or required by state or federal
law. (2) When ODA denies a provider's
application, ODA notifies the provider of its final determination and any
applicable hearing rights established in section 173.391 of the Revised
Code. (3) When ODA denies a provider's
application, the provider is ineligible to reapply for certification for one
year after the mailing date of ODA's final adjudication
order.
Last updated June 10, 2024 at 8:01 AM
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Rule 173-39-03.1 | ODA provider certification: federal heightened scrutiny of provider settings with institutional characteristics.
Introduction: In 42 C.F.R. 441.301(c)(5)(v), HHS
requires heightened scrutiny by HHS's secretary to determine if a setting
presumed to have the qualities of an institution meets HCBS settings
requirements. This rule applies to settings subject to heightened scrutiny to
become or remain an ODA-certified provider. (A) Scope: A setting presumed to have the
qualities of an institution requires heightened scrutiny by HHSs
secretary, based on information presented by the state or other parties, to
determine whether the setting has the qualities of an institution or has the
qualities of a HCBS setting. A setting is presumed to have the qualities of an
institution if it has any of the following characteristics: (1) The entire setting is
located in a building that is also a publicly or privately-operated facility
that provides inpatient institutional treatment. (2) The setting is in a
building on the grounds of, or immediately adjacent to, a public
institution. (3) The setting has the
effect of isolating individuals receiving medicaid HCBS from the broader
community of individuals not receiving medicaid HCBS. (B) Process: ODA shall determine if a
setting requires heightened scrutiny by HHS's secretary. If ODA determines
a setting requires heightened scrutiny under paragraph (A) of this rule, ODA
shall review information submitted by the provider, conduct an on-site visit of
the setting, and complete form ODM10204, "Heightened Scrutiny Evidence
Package" (February 2017). ODA may recommend the provider undertake
remediation of any possible deficiencies in its compliance with HCBS settings
requirements and may establish deadlines for completion of any remediation. If
the provider fails to complete requested remediation or provide evidence of the
same to ODA, ODA may withhold submission of the provider's application for
heightened scrutiny. (C) Public-comment periods: Before
providing an application for heightened scrutiny to the HHS secretary, ODA
shall offer the public a thirty-day opportunity to comment on the application.
ODM, on behalf of ODA, shall offer public-comment periods four times per
year. (D) Request for heightened scrutiny:
Following the completion of the public-comment period, ODM, on behalf of ODA,
shall provide form ODM 10204 and any supplemental material, if requested, to
HHS's secretary for heightened scrutiny of the setting. (E) HHS heightened scrutiny
determination: (1) For providers seeking
ODA certification: (a) If HHS's secretary determines the setting meets HCBS
settings requirements, ODA may approve the provider's application for
certification. (b) If HHS's secretary determines the provider's
setting does not meet HCBS settings requirements, ODA shall notify the provider
of the final determination and any applicable hearing rights established in
section 173.391 of the Revised Code. If ODA denies a providers
certification, the provider is ineligible to reapply for certification for one
year after the mailing date of ODA's final determination. (2) For certified
providers: (a) If HHS's secretary determines the provider's
setting meets HCBS settings requirements, the provider shall retain its
certification so long as it continues to comply with this chapter. (b) If HHS's secretary determines the provider's
setting does not meet HCBS settings requirements, ODA may impose discipline
against the provider and notify the provider of any applicable hearing rights
established in section 173.391 of the Revised Code.
Last updated June 10, 2024 at 8:01 AM
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Rule 173-39-03.2 | ODA provider certification: changes of ownership interest or organizational structure.
Introduction: Section 173.39 of the Revised Code
prohibits ODA from paying a provider for services provided to individuals
enrolled in the PASSPORT or assisted living programs unless the provider is an
ODA-certified provider. ODA-certification is assigned to a provider's
federal taxpayer identification number (TIN) and is not transferable. This rule
applies in all instances where there is a change of ownership interest
involving an ODA-certified provider obtaining a new TIN according to any rule
adopted by the internal revenue service (IRS) or any change in organizational
structure of an ODA-certified provider involving a person with an ownership or
management interest, including a non-profit provider. (A) Requirements: (1) Notification: The
providers current owner(s) shall email ODA at
provider_enrollment@age.ohio.gov with an original signed statement that
includes all the following information to announce a change of ownership
interest or change of organizational structure (change) no later than
forty-five days before the change, unless this chapter requires notifying ODA
sooner. By sending the statement, the owner is certifying that the following
information is accurate, truthful, and complete: (a) Name of the provider undergoing the change. (b) Name of each current owner, and, if any, the name of each
current owner's authorized agent. (c) Medicaid provider number and NPI of the provider after the
change, if known. ODA considers the notice to be complete if the notice is
complete except for indicating the provider's number if ODM has not yet
granted the provider a number, so long as the provider provides the number to
ODA as soon as it is available. (d) The following information about each new
owner(s): (i) Name. (ii) Date of
birth. (iii) Social security
number. (iv) Percentage of
ownership or control in the provider. (v) Whether each new
owner has been a resident of Ohio for the five-year period immediately
preceding the date of the change. (e) Date the change takes effect, as evidence by a bill of sale
or purchase contract executed by both parties. (f) Statement indicating whether the provider intends to seek
payment from ODA for services it provides after the change. (g) Names and addresses of the persons to whom ODA and its
designee should send correspondence regarding the change. (h) Any information required to show the ongoing compliance
required by paragraph (B) of this rule. (i) Signatures of the current and new owner(s). (2) Supplemental
notification: If the provider's current owner(s) are unable to provide all
the information under paragraph (A)(1) of this rule forty-five days before the
change, the current owner(s) may provide as much information as possible in the
notice no later than forty-five days before the change, then provide the
remaining information to ODA as soon as it is available. (3) Current certification ends: If IRS
rules mandate a provider to obtain a new TIN, the provider's certification
ends on the date the change is finalized. The relinquishment of the
provider's certification means a provider is ineligible to bill ODA after
the date the change is finalized. (4) New certification required: A
provider with a new TIN may apply to become an ODA-certified provider according
to the application process in rule 173-39-03 of the Administrative Code to seek
payment from ODA for services that it provides after a change. (5) Payment for authorized services: If
ODA approves an application to become an ODA-certified provider, ODA may pay
for authorized services provided during a change back to the first date on
which both of the following have occurred: (a) The provider provided evidence that the change was finalized
to ODA, such as a bill of sale or an executed purchase. (b) The new owner(s) provided a complete application, as defined
in rule 173-39-01 of the Administrative Code, to become an ODA-certified
provider. (6) Discharging residents: After an
assisted-living provider has applied for new certification from ODA during a
change, neither the current nor the new owner(s) may discharge residents from
the RCF for non-payment until ODA submits the request to HHS for its review
under 42 C.F.R. 441.301(c)(5)(v). (B) Compliance with HCBS settings requirements: (1) Every provider is
subject to the HCBS settings requirements in state and federal law, including
rule 5160-44-01 of the Administrative Code and 42 C.F.R. Part 441, as as a
requirement to become and to remain certified in rule 173-39-02 of the
Administrative Code, from the effective date of ODA certification and
thereafter. (2) For a provider that
is subject to federal heightened scrutiny under rule 173-39-03.1 of the
Administrative Code, the new owner(s) shall, at a minimum, implement policies
and procedures to maintain compliance with the HCBS settings requirements under
rules 173-39-02 and 5160-44-01 of the Administrative Code and 42 C.F.R. Part
441 at the time of the change and thereafter and email a signed statement
demonstrating compliance with this requirement to ODA at
"provider_enrollment@age.ohio.gov."
Last updated June 10, 2024 at 8:01 AM
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Rule 173-39-03.4 | ODA provider certification: applying to be certified in additional regions or to certify additional business sites.
. (A) Introduction: (1) This rule applies to
the following scenarios: (a) A provider certified to provide a service in a region
wants to be certified to provide the same service in another
region. (b) A provider certified to provide a service in a region
wants to be certified to provide the same service from an additional business
site in the same region. (c) A certified assisted living provider wants confirmation
that more designated resident units in its RCF qualify as resident units under
paragraph (C)(2)(c) of rule 173-39-02.16 of the Administrative Code than
ODAs designee previously confirmed. (2) This rule does not
apply to the following scenarios: (a) A certified assisted living provider wants to operate a
separately-licensed RCF, because each certification applies to only one
licensed RCF. (b) A certified assisted living provider wants to operate
from an additional building and ODH allows the provider to operate out of the
existing and new buildings under one RCF license. (B) Application: A certified provider may apply for
certification in an additional region or from an additional business site in
the same region, or for confirmation that more designated resident units in its
RCF qualify as resident units under paragraph (C)(2)(c) of rule 173-39-02.16 of
the Administrative Code than ODA's designee previously confirmed. An
incomplete application expires if the provider does not complete the
application within ninety days. (C) Review: ODA's designee shall visit the
provider's business site to conduct an on-site review to determine if the
provider meets the requirements of this chapter to provide the service for
which it is already certified in the additional region or from an additional
business site in the same region, or to confirm that more designated resident
units in its RCF qualify as resident units under paragraph (C)(2)(c) of rule
173-39-02.16 of the Administrative Code than ODA's designee previously
confirmed. During a state of emergency declared by the governor, a federal
public health emergency, or during another time if authorized by ODA,
ODA's designee may conduct a desk review of the provider's business
site in lieu of an on-site review. ODA's designee may conduct a desk
review of the provider's business site instead of an on-site review if the
provider's business site is outside of the designee's
region. (D) Approved application: ODA and its designee shall follow
the process under paragraph (F) of rule 173-39-03 of the Administrative Code
for an approved application or confirmation of designated resident units under
paragraph (C)(2)(c) of rule 173-39-02.16 of the Administrative
Code. (E) Denied application: ODA and its designee shall follow
the process under paragraph (H) of rule 173-39-03 of the Administrative Code
for a denied application.
Last updated July 2, 2024 at 8:40 AM
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Rule 173-39-03.5 | ODA provider certification: military provisions.
Effective:
October 1, 2020
(A) Applications: Persons who submit with
their applications for ODA provider certification proof that they are a service
member or veteran, as section 5903.01 of the Revised Code defines those terms,
or the spouse or surviving spouse of a service member or veteran, shall receive
priority processing of their applications. (1) If an applicant
answers affirmatively that he or she is a service member, veteran, or the
spouse or surviving spouse of a service member or veteran, the applicant shall
submit supporting documents along with their application. Acceptable forms of
documentation include: (a) A copy of a document issued by the armed forces, such as an
identification card or military discharge certificate; and (b) A marriage certificate or other document showing the
applicant and service member or veteran are spouses. (2) ODA or its designee
shall track and monitor the total number of applications submitted by service
members, veterans, or their spouse or surviving spouse, and the average number
of business days it takes to process the applications. (B) Training: Pursuant to section 5903.03
of the Revised Code, a person subject to the training requirements in this
chapter may request that ODA or its designee consider their successfully
completed military training to satisfy the training requirements in this
chapter. The person shall provide ODA or its designee with supporting documents
demonstrating that the military training was successfully completed and is
substantially equivalent to or exceeds the training requirements in this
chapter.
Last updated June 10, 2024 at 8:01 AM
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Rule 173-39-04 | ODA provider certification: structural compliance reviews.
Introduction: Each ODA-certified provider is
subject to a regular structural compliance review (review) to ascertain if it
complies with this chapter. (A) Deadline for ODA's designee to
conduct the first review: The one-year anniversary of the provider's
certification date. (B) Deadlines for ODA's designee to
conduct subsequent reviews: (1) The one-year
anniversary of the previous review if the provider is one of the
following: (a) A provider of an adult day service. (b) A provider of an assisted living service. (c) A provider of personal care, enhanced community living,
or waiver nursing that is neither certified by medicare nor accredited by the
accreditation commission for health care, the community health accreditation
partner, the joint commission, or another national accreditation organization
that is approved by CMS and ODH. (d) A provider of the choices home care attendant
service. (e) A provider of the home care attendant
service. (2) The three-year
anniversary of the previous review if the provider is not listed under
paragraph (B)(1) of this rule. (C) Deadline extensions: ODA may extend a
deadline for ODA's designee under paragraph (A) or (B) of this rule if
ODA's designee provides ODA with a request for an extension that includes
the rationale for a delay and a forecast on the time needed to complete the
review. (D) ODA or its designee may conduct an
unannounced review of a provider at any time to review compliance with this
chapter. (E) ODA's designee may review a
provider at any time without waiting for a deadline in paragraph (A), (B), or
(C) of this rule to near. (F) Responsible designees, type of
reviews to conduct, and scope of reviews: (1) Based on the provider
type and situation, Appendix A to this rule establishes when a designee is
responsible for conducting a review, the type of review it is responsible to
conduct, and the scope of that review. (2) ODA may authorize a
designee to conduct a desk review even if Appendix A to this rule establishes a
requirement for an on-site review. (G) Review components: For each review,
ODA's designee shall do the following: (1) Inform the provider
of the review in writing before beginning the review and before conducting an
introductory conference with the provider, unless the review is an unannounced
review under paragraph (D) of this rule. (2) Conduct an
introductory conference with the provider to explain the purpose and scope of
the review. (3) Review compliance
with each applicable requirement in rule 173-39-02 of the Administrative Code
other than the records and monitoring requirements in that rule, unless
Appendix A to this rule determines that this paragraph is not a component of
the review. (4) Review compliance
with each applicable requirement in rules 173-39-02.1 to 173-39-02.24 of the
Administrative Code and the records and monitoring requirements in rule
173-39-02 of the Administrative Code. (5) Verify that a sample
of paid service units were provided according to the applicable requirements in
rules 173-39-02.1 to 173-39-02.24 of the Administrative Code and the records
and monitoring requirements in rule 173-39-02 of the Administrative
Code. (6) Review a sample of
paid service units for ten per cent of the individuals that the provider served
during the previous three months (if a subsequent review of a provider listed
under paragraph (B)(1) of this rule) or the previous six months (if a
subsequent review of a provider listed under paragraph (B)(2) of this rule), so
long as the ten-per-cent sample contains no fewer than three individuals and no
more than thirty individuals, with the following exceptions: (a) If non-compliance is identified, ODA or its designee
may review a larger sample size or order an independent audit at the
provider's expense. (b) If the provider operates from multiple business sites,
ODA's designee shall review a sample of paid service units for ten per
cent of the individuals that the provider served from each business
site. (c) If the provider did not bill ODA for providing a
service to any individual during the period in paragraph (G)(6) of this rule,
ODA or its designee shall indicate in the review record that ODA did not pay
the provider for providing a service to any individual during the review
period, then complete the remaining elements of the review under this
rule. (d) If the provider is a participant-directed provider, ODA
or its designee shall review records for each individual served during the
review period in paragraph (G)(6) of this rule. If the provider did not bill
ODA for providing any units of service during the review period in paragraph
(G)(6) of this rule, ODA or its designee shall indicate in the review record
that ODA did not pay the provider to provide any units of service during the
review period, then complete the remaining elements of the review under this
rule. (e) If the provider is certified to provide both personal
care and homemaker, ODA or its designee shall combine the review for each
service so that the aggregate sample size for the combined services equals the
sample size in paragraph (G)(6) of this rule. (f) During a state of emergency declared by the governor or
a federal public health emergency, ODA may determine a lesser review sample and
issue this determination by notice. (7) Review the
qualifications of the employees who provided services to individuals in the
sample in paragraph (G)(6) of this rule according to the following
standards: (a) The sample size of employees corresponds to the sample
size of individuals in Appendix B to this rule. (b) If the provider hired or subcontracted with RNs or LPNs
under the direction of RNs, the number of RNs or LPNs in the sample corresponds
to the sample size of individuals in Appendix B to this rule. (c) The sample of employees includes any employees
providing services to individuals in the sample in paragraph (G)(6) of this
rule that the provider hired since the previous review. (d) The sample of employees does not need to include an
employee providing services to individuals in the sample in paragraph (G)(6) of
this rule if one or more of ODA's designees already reviewed the
employee's qualifications when conducting a review of the same provider at
a different business site within the past three hundred sixty-five
days. (e) For a provider that provides only home-delivered meals
or a personal emergency response system, the maximum sample size is ten
employees. (H) At the conclusion of the
review: (1) If ODA's
designee determines a provider is out of compliance, then ODA's designee
shall ensure all of the following occur: (a) ODA's designee notifies the provider at the exit
interview or, if the provider is unavailable for the exit interview, with a
detailed communication within one business day after the review. (b) ODA's designee records the method of notification
in paragraph (H)(1)(a) of this rule in PIMS. (c) ODA or its designee determine whether to impose an
immediate disciplinary action under rule 173-39-05 of the Administrative
Code. (2) Within ten business
days after the review, ODA's designee shall issue a summary letter to the
provider, including a summary of all areas of non-compliance, request for a
plan of correction or evidence of compliance, and disciplinary action if
imposed by ODA or its designee. (3) Within ten business
days after the date ODA's designee issues the summary letter to the
provider, the provider shall provide a plan of correction or evidence of
compliance with the laws, rules, or regulations determined to have been
violated during the review which were not subject to disciplinary action under
rule 173-39-05 of the Administrative Code. (4) ODA or its designee
may impose a disciplinary action under rule 173-39-05 of the Administrative
Code if either of the following occur: (a) The provider did not provide ODA or its designee with a
plan of correction or evidence of compliance. (b) The provider remains out of compliance after ODA or its
designee receives a plan of correction or evidence of compliance from the
provider. (5) If a unit-of-service error is
detected during unit-of-service verification, the provider shall return the
overpayment of funds to ODA or its designee using appropriate auditing
procedures. (I) ODA may suspend any review during a
state of emergency declared by the governor or a federal public health
emergency. (J) ODA's designee or the provider may email any plan
of correction, evidence of compliance, notice, communication, or summary letter
required in this rule.
View AppendixView Appendix
Last updated July 2, 2024 at 9:56 AM
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Rule 173-39-05 | ODA provider certification: disciplinary actions.
(A) Introduction: Pursuant to section 173.391 of the Revised Code, ODA or its designee may impose disciplinary action against an ODA-certified provider (provider) for good cause, including misfeasance, malfeasance, nonfeasance, confirmed abuse or neglect, financial irresponsibility, or other conduct ODA determines is injurious, or poses a threat, to the health or safety of individuals being served. (B) Disciplinary actions by ODA's designee: (1) Disciplinary actions imposed by ODA's designee may include any one or more of the following: (a) Plan of correction or evidence of compliance: ODA's designee may require the provider to provide a plan of correction or evidence of compliance with all areas of non-compliance within seven business days after the disciplinary action is imposed. (b) Suspending referrals: ODA's designee may cease to refer individuals to the provider until ODA's designee determines the provider complies with all requirements in this chapter. (c) Remove clients: ODA's designee may revise the person-centered services plans for individuals to stop authorizing the non-compliant provider as a provider for those individuals. (2) When ODA's designee imposes a disciplinary action, it shall do the following: (a) Notify the provider of the disciplinary action via encrypted email or mail. (b) Notify ODA of the disciplinary action via an ODA-approved method. (c) Complete the required fields in PIMS related to the disciplinary action. (d) Indicate in PIMS anytime it grants an extension to the deadlines in paragraph (B)(1)(a) or (B)(1)(b) of this rule. (3) ODA's designee does not have authority to impose more than one disciplinary action against a provider for the same episode of non-compliance. (4) ODA's designee may follow-up with the provider to verify compliance in the area of non-compliance. Follow-up may include site visits, requesting supplemental information, or reviewing records. (5) ODA may require ODA's designee to rescind or modify any pending disciplinary action. (C) Disciplinary actions imposed by ODA: (1) ODA may impose any discipline authorized under division (A)(2) of section 173.391 of the Revised Code. (2) ODA may consider any one or more of the following when imposing disciplinary action: (a) Whether the conduct is injurious or poses a threat to the health or safety of individuals being served. (b) The provider's previous disciplinary history. (c) Any other factors ODA may consider relevant. (D) A provider may appeal a disciplinary action listed in column B of table 1 to this rule unless the reason for the disciplinary action is listed under division (E) of section 173.391 of the Revised Code. As used in table 1 to this rule, "another sanction" does not include any of the disciplinary actions listed in column A of the table. | COLUMN A | COLUMN B | | Written warning | Fiscal sanction such as a civil monetary penalty or an order to repay unearned funds | | Requirement to submit a plan of correction or provide evidence of compliance | Suspended certification | | Suspended referrals | Revoked certification | | Removal of clients | Another sanction |
(E) The provider may request a hearing under Chapter 119. of the Revised Code only if it does before the deadline in that chapter.
Last updated July 2, 2024 at 9:57 AM
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