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This website publishes administrative rules on their effective dates, as designated by the adopting state agencies, colleges, and universities.

Chapter 173-4 | Older Americans Act Nutrition Program

 
 
 
Rule
Rule 173-4-01 | Older Americans Act nutrition program: introduction and definitions.
 

(A) Introduction: This chapter governs nutrition projects paid, in whole or in part, with Older Americans Act funds.

(B) Definitions: The definitions in rule 173-3-01 of the Administrative Code and the following definitions apply to this chapter:

"Congregate dining project" means a nutrition project that complies with rule 173-4-05.1 of the Administrative Code.

"Congregate dining project based in restaurants and supermarkets" means a nutrition project that complies with rule 173-4-05.3 of the Administrative Code.

"Dietary Guidelines for Americans" (2020-2025) means the guidelines published by the United States departments of agriculture and health and human services on https://www.dietaryguidelines.gov/.

"Dietitian" and "licensed dietitian" mean a person with a current, valid license to practice dietetics under section 4759.06 of the Revised Code.

"Groceries" mean foods for a household to eat, such as breads and cereals; fruits and vegetables; meats, fish, and poultry; and dairy products.

"Grocery store" has the same meaning as "retail food establishment" in rule 3717-1-01 of the Administrative Code.

"Home-delivered meals project" means a nutrition project that complies with rule 173-4-05.2 of the Administrative Code.

"Nutrition project" means a congregate dining project, home-delivered meals project, or a congregate dining project based in restaurants and supermarkets.

"Older Americans Act nutrition program" means the program created under 42 U.S.C. 3030d-21 to 3030g-23 (2020).

"Restaurant" has the same meaning as "food service operation" in rule 3717-1-01 of the Administrative Code.

"Shelf-stable meal" means a meal that is non-perishable, ready-to-eat, stored at room temperature, and eaten without heating.

Last updated December 23, 2024 at 8:06 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11, 1321.17
Amplifies: 173.39, 173.392; 42 U.S.C. 3025, 3030e, 3030f, 3030g-21; 45 C.F.R. 1321.11, 1321.17
Five Year Review Date: 11/30/2029
Prior Effective Dates: 9/1/2016
Rule 173-4-02 | Older Americans Act nutrition program: meals eligible for payment.
 

(A) Congregate dining: Meals provided at a congregate dining location are eligible for payment with Older Americans Act funds if they meet the requirements for meals in this chapter and if the recipient is one of the following:

(1) A consumer who is sixty years of age or older.

(2) The spouse of the consumer in paragraph (A)(1) of this rule, if the spouse accompanies that consumer to the congregate dining location.

(3) A volunteer who provides volunteer services to the consumer in paragraph (A)(1) of this rule, if the volunteer services are provided to the consumer at the congregate dining location during the mealtime.

(4) A person with disabilities who resides in the home of the consumer in paragraph (A)(1) of this rule, if the person with disabilities accompanies that consumer to the congregate dining location.

(5) A person with disabilities who resides in a non-institutional residential building, but only if the building's residents are primarily sixty years of age or older and the meal is provided at a congregate dining location located in the person's building.

(B) Home-delivered meals: Meals delivered to a home are eligible for payment with Older Americans Act funds if they meet the requirements for meals in this chapter and if the recipient is one of the following:

(1) A consumer who is sixty years of age or older and meets the following requirements: unable to prepare his or her own meals, unable to consume meals at a congregate dining location due to physical or emotional difficulties, and lacking another meal support service in the home or community.

(2) The spouse of the consumer in paragraph (B)(1) of this rule.

(3) A volunteer who provides volunteer services to the consumer in paragraph (B)(1) of this rule.

(4) A person with disabilities who resides in the home of the consumer in paragraph (B)(1) of this rule.

Last updated January 30, 2022 at 10:01 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11, 1321.17
Amplifies: 173.39, 173.392; 42 U.S.C. 3025, 3030e, 3030f, 3030g-21; 45 C.F.R. 1321.11, 1321.17, 1321.69
Five Year Review Date: 11/30/2026
Prior Effective Dates: 4/22/2010
Rule 173-4-03 | Older Americans Act nutrition program: consumer enrollment.
 

(A) Congregate dining:

(1) Initial verification: Before enrolling the consumer into a congregate dining project or congregate dining project based in restaurants or supermarkets, the provider shall verify that a consumer's congregate meals are eligible for payment, in whole or in part, with Older Americans Act funds according to rule 173-4-02 of the Administrative Code.

(2) Annual verification: The provider may keep a consumer enrolled in a congregate dining project or congregate dining project based in restaurants or supermarkets project for more than one year only if, at least once every calendar year, the provider verifies that the consumer's congregate meals continue to be eligible for payment, in whole or in part, with Older Americans Act funds according to rule 173-4-02 of the Administrative Code.

(B) Home-delivered meals:

(1) Initial verification: Before enrolling a consumer into a home-delivered meals project, the provider shall verify that the consumer's home-delivered meals are eligible for payment, in whole or in part, with Older Americans Act funds according to rule 173-4-02 of the Administrative Code.

(2) Annual verification: The provider may keep a consumer enrolled in a home-delivered meals project for more than one year only if, at least once every calendar year, the provider verifies that the consumer's home-delivered meals continue to be eligible for payment, in whole or in part, with Older Americans Act funds according to rule 173-4-02 of the Administrative Code.

(3) Temporary verification: A provider may deem a discharge order to be adequate verification to authorize temporary payment for home-delivered meals, in whole or in part, with Older Americans Act funds until the provider conducts its own verification of eligibility, but only if the following conditions are met:

(a) The consumer requires meals before the provider can verify that the consumer's home-delivered meals are eligible for payment, in whole or in part, with Older Americans Act funds.

(b) The consumer is sixty years of age or older.

(c) The discharge order indicates the consumer is unable to prepare his or her own meals, unable to consume meals at a congregate dining location due to physical or emotional difficulties, and lacking another meal support service in the home or community.

(d) The provider begins providing home-delivered meals no later than seven days after the discharge.

(e) The provider conducts the initial verification no later than thirty consecutive days after the discharge.

(C) Waiting lists: If a waiting list exists for enrolling into a congregate dining project, congregate dining project based in restaurants or supermarkets, or a home-delivered meals project, the provider or the AAA shall develop a prioritization system that distributes meals equitably by prioritizing consumers who have the highest nutritional risk, as determined by the following:

(1) The result of a nutritional health screening of the consumer conducted according to rule 173-4-09 of the Administrative Code.

(2) The nutritional risk status of the spouse (if any), if the spouse is determined to have a higher nutritional risk than the consumer.

Last updated January 3, 2023 at 8:38 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11, 1321.17
Amplifies: 173.39, 173.392; 42 U.S.C. 3025, 3030e, 3030f; 45 C.F.R. 1321.11, 1321.17, 1321.69
Five Year Review Date: 11/30/2027
Prior Effective Dates: 12/31/2020
Rule 173-4-04 | Older Americans Act nutrition program: procuring for person direction.
 

(A) When an AAA procures for congregate dining project(s) or home-delivered meals project(s), the AAA is subject to rules 173-3-04, 173-3-05, 173-3-05.1, and 173-3-06 of the Administrative Code and this rule.

(B) When an AAA procures for congregate dining project(s) or home-delivered meal project(s), the AAA shall procure for person direction by one of the following competitive procurement methods:

(1) Procurement by the competitive-proposal method defined in 45 C.F.R. 75.329:

(a) Allow the highest level(s) of person direction that providers offer in bid(s) to determine what are responsive level(s) of person direction for its PSA.

(b) Indicate in the request for proposal (RFP) that a responsive bid is a bid in which the provider explains how it proposes to offer person direction.

(c) Award the AAA-provider agreement(s) to the provider(s) offering the most-responsive bid(s) that is based on a score on the level of person direction that each provider's bid offers in the score determining the responsiveness of a bid.

(2) Procurement by the sealed-bid, small-purchase, and micro-purchase methods defined in 45 C.F.R. 75.329:

(a) Determine the level of person direction that providers in the PSA are capable of offering without basing the AAA's calculations of this level solely on the willingness of providers who are currently in AAA-provider agreements with the AAA.

(b) Indicate in the RFP that a responsive bid is a bid in which the provider explains how it proposes to meet or exceed the level of person direction that the AAA determined providers in the PSA are capable of offering.

(c) Award the AAA-provider agreement(s) to the provider(s) offering the most-responsive bid(s) that is based on a score on the level of person direction that each provider's bid offers in the score determining the responsiveness of a bid.

(C) During a state of emergency declared by the governor or a federal public health emergency, paragraph (B) of this rule does not apply with regard to dining formats, location, delivery methods, times, and frequencies.

(D) Definition for this rule: "Person direction" means a subset of person-centered methodology. While person-centered methodology requires providers to work with consumers to determine what is best for the consumers, person direction allows consumers to decide what is best for themselves from a range of viable options. Person direction over congregate and home-delivered meals allows consumers to control the direction of their meals.

Giving consumers options between dining formats, locations, and times; allowing consumers to enjoy multi-generational dining; giving consumers options between entrées at each mealtime; and giving consumers options between one entrée and the sides that accompany it and at least one other entrée and the sides that accompany it (even if consumers exchange entrées or sides between two or more complete meal options) are examples of possible ways to offer person direction to consumers through congregate nutrition projects.

Giving consumers options between delivery formats (e.g., warm, frozen, chilled), options between delivery times (e.g., morning, afternoon), and options between delivery frequencies (e.g., per-meal delivery, periodic delivery); options between entrées at each mealtime; and options between one entrée and the sides that accompany it and at least one other entrée and the sides that accompany it (even if consumers exchange entrées or sides between two or more complete meal options) are examples of possible ways to offer person direction to consumers through home-delivered meals programs.

Last updated January 3, 2023 at 8:38 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11, 1321.17
Amplifies: 173.39, 173.392; 42 U.S.C. 3025, 3030e, 3030f; 45 C.F.R. 1321.11, 1321.17
Five Year Review Date: 11/30/2027
Prior Effective Dates: 1/29/2022
Rule 173-4-05 | Older Americans Act nutrition program: nutrition projects.
 

(A) Requirements, flexibilities, and recommendations to include in every AAA-provider agreement for a nutrition project paid, in whole or in part, with Older Americans Act funds:

(1) Every AAA-provider agreement paid, in whole or in part, with Older Americans Act funds is subject to rule 173-3-06 of the Administrative Code.

(2) Project types:

(a) An AAA-provider agreement for a congregate dining project, is subject to rule 173-4-05.1 of the Administrative Code.

(b) An AAA-provider agreement for a home-delivered meals project, is subject to rule 173-4-05.2 of the Administrative Code.

(c) An AAA-provider agreement for a congregate dining project based in restaurants and grocery stores, is subject to rule 173-4-05.3 of the Administrative Code.

(3) Separate project components: If the AAA procured for components of a nutrition project separately, the AAA shall identify in each provider's AAA-provider agreement, which requirements in Chapters 173-3 and 173-4 of the Administrative Code each provider is required to provide.

(4) Nutrition services in addition to providing meals:

(a) The AAA shall include a requirement for the provider to provide nutrition health screening to consumers at least every calendar year and strongly encourage providers to provide the nutrition health screening in person.

(b) The AAA shall indicate whether the provider is offering nutrition assessment, nutrition counseling, or nutrition education to consumers.

(c) The AAA shall indicate whether the provider is providing grocery shopping assistance or grocery ordering and delivery to consumers, and if so, include the requirements in rules 173-4-10 and 173-4-11 of the Administrative Code in the AAA-provider agreement.

(5) Eligibility verification: The provider shall determine the eligibility of each consumer before paying for their meals, in whole or in part, with Older Americans Act funds and do so in person whenever possible.

(6) Consumer contributions: The provider is subject to rule 173-3-07 of the Administrative Code.

(7) Person direction:

(a) The provider shall implement the person direction the provider pledged to provide when the provider bid for the AAA-provider agreement. During a state of emergency declared by the governor or a federal public health emergency, the provider is only responsible for providing the person direction that the provider pledged to provide to the extent practicable during the state of emergency or federal public health emergency.

(b) The provider shall offer consumers opportunities to give feedback on current and future menus.

(8) Menus:

(a) The provider shall only offer menus approved by a dietitian.

(b) The AAA shall indicate the method by which the provider offers ingredient information on the meals provided to consumers.

(c) The provider shall list the serving size for each food item on each production menu.

(9) Nutritional adequacy:

(a) The provider shall offer meals that satisfy at least one-third of the dietary reference intakes (DRIs) for each mealtime by targeting nutrient levels on the predominant population and health characteristics of the consumers in the PSA. The federal government makes the DRIs available to the general public free of charge on https://www.nal.usda.gov/fnic/dietary-reference-intakes.

(b) For each mealtime, the provider shall offer meals that follow the "Dietary Guidelines for Americans."

(c) For each meal time, the provider shall offer meals that, to the maximum extent practicable, are adjusted to meet any special dietary needs of consumers, including meals adjusted for cultural considerations, and preferences, and medically-tailored meals.

(d) The provider has flexibility in designing meals that are appealing to consumers.

(e) The provider has flexibility to use either nutrient analysis or menu patterns to determine nutritional adequacy.

(f) The AAA shall encourage providers to use, where feasible, locally-grown foods and identify potential partnerships and contracts with local producers and providers of locally-grown foods.

(10) Diet orders: If the AAA-provider agreement requires the provider to offer consumers therapeutic diets, then the provider is subject to the additional requirements in rule 173-4-06 of the Administrative Code unless it is the consumer's preference to choose a therapeutic diet.

(11) Dietary supplements: The provider shall not pay for supplements, in whole or in part, with Older Americans Act funds unless the supplement is part of a meal with a therapeutic diet.

(12) Food safety:

(a) The AAA shall indicate whether the United States department of agriculture, Ohio department of agriculture, another state's department of agriculture, or a local health district has jurisdiction to monitor the provider's compliance with food-safety laws, including sanitation, food temperatures, thermometers, food-borne illnesses, packaging, and dating meals.

(b) The AAA shall state that the AAA is responsible for reporting any reasonable cause to believe a provider is out of compliance with food-safety laws to the government authority identified in the AAA-provider agreement to comply with paragraph (A)(12)(a) of this rule.

(13) Training:

(a) The provider shall develop a training plan that includes orientation and annual in-service training.

(i) Orientation: The provider shall ensure that each employee, including each volunteer, who participates in meal preparation, handling, storage, or delivery successfully completes orientation on topics relevant to the employee's job duties before the employee performs those duties.

(ii) In-service training: The provider shall ensure that each employee, including a volunteer, who participates in meal preparation, handling, storage, or delivery successfully completes in-service training every twelve months on topics relevant to the employee's job duties.

(b) During a state of emergency declared by the governor or a federal public health emergency, the provider is not responsible for complying with paragraph (A)(13)(a)(i) or (A)(13)(a)(ii) of this rule.

(B) Units:

(1) Congregate dining project: A unit is one meal provided in compliance with this rule and rule 173-4-05.1 of the Administrative Code.

(2) Home-delivered meals project: A unit is one meal provided in compliance with this rule and rule 173-4-05.2 of the Administrative Code.

(3) Congregate dining project based in restaurants or grocery stores: A unit is one meal provided in compliance with this rule and rule 173-4-05.3 of the Administrative Code.

Last updated December 1, 2023 at 9:30 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11, 1321.17
Amplifies: 173.39, 173.392; 2 U.S.C. 3025, 3030c-2, 3030e, 3030f, 3030g-21; 45 C.F.R. 1321.11, 1321.17, 1321.67
Five Year Review Date: 11/30/2028
Prior Effective Dates: 1/29/2022
Rule 173-4-05.1 | Older Americans Act nutrition program: congregate dining projects.
 

The following are the requirements for every AAA-provider agreement for a congregate dining project paid, in whole or in part, with Older Americans Act funds:

(A) The AAA-provider agreement is subject to rules 173-3-06 and 173-4-05 of the Administrative Code.

(B) Availability:

(1) The provider shall keep at least one congregate dining location in its nutrition project open for business to provide meals for at least one mealtime (i.e., a breakfast, lunch, or dinner) per day to consumers on five or more days per week, within a reasonable distance to older adult target populations. An AAA may obtain ODA's approval to enter into an AAA-provider agreement that allows fewer days per week or during a state of emergency declared by the governor or a federal public health emergency.

(2) The provider has flexibility to offer meals in different congregate dining locations on different days rather than have every congregate dining location open for at least five days per week.

(C) Carry-out meals: Older Americans Act Title III-C1 funds do not pay, in whole or in part, for regularly-provided carry-out meals (also known as "grab-and-go meals") provided at congregate dining locations, but may pay for occasional carry-out meals, including meals sent home with consumers to prepare for an anticipated closing of congregate dining locations for weather-related emergencies or a state of emergency declared by the governor or a federal public health emergency.

(D) Emergency closings:

(1) The provider shall give those consumers enrolled in its congregate dining project reasonable notice, to the extent practicable, before a scheduled mealtime when a congregate dining location will be closed due to weather-related emergencies, loss of power, kitchen malfunctions, natural disasters, a state of emergency declared by the governor, or a federal public health emergency by using broadcast media, its website, telephone, or by any combination of the three.

(2) The provider shall distribute information to consumers on how to stock an emergency food shelf to prepare for emergency closings.

(E) Quality assurance: Each year, the provider shall implement a plan to evaluate and improve the effectiveness of the project's operations and services to ensure continuous improvement by reviewing the existing project and the changing needs or interests of consumers, staff, or volunteers.

(F) Meal verification:

(1) The following are the mandatory reporting items for each meal provided that a provider retains to comply with the requirements under paragraph (B)(9) of rule 173-3-06 of the Administrative Code:

(a) Consumer's name.

(b) Date of meal provision.

(c) Unique identifier of the consumer or the consumer's caregiver to attest to receiving the meal.

(2) During a state of emergency declared by the governor or a federal public health emergency, the provider may verify each meal provided without collecting a unique identifier of the consumer or the consumer's caregiver.

Last updated November 8, 2023 at 8:20 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11, 1321.17
Amplifies: 173.39, 173.392; 42 U.S.C. 3025, 3030e, 3030g-21; 45 C.F.R. 1321.11, 1321.17
Five Year Review Date: 11/30/2027
Prior Effective Dates: 12/31/2020
Rule 173-4-05.2 | Older Americans Act nutrition program: home-delivered meals projects.
 

The following are the requirements to include in every AAA-provider agreement for a home-delivered meals project paid, in whole or in part, with Older Americans Act funds:

(A) The AAA-provider agreement is subject to rules 173-3-06 and 173-4-05 of the Administrative Code.

(B) Delivery:

(1) Availability:

(a) Per-meal delivery:

(i) To a consumer who chooses to receive per-meal deliveries and needs meals on five or more days per week, the provider shall deliver at least one meal per day for five or more days per week.

(ii) To a consumer who chooses to receive per-meal deliveries, but does not need meals on five or more days per week, the provider shall deliver at least one meal per day on days that the consumer needs meals.

(b) Periodic delivery: The provider has flexibility to deliver meals to cover multiple mealtimes in one delivery to consumers who choose periodic deliveries.

(c) State of emergency: During a state of emergency declared by the governor or a federal public health emergency, the provider has flexibility to, in one delivery, deliver meals to cover multiple mealtimes for consumers who received meals before the state of emergency (or federal public health emergency) by per-meal delivery or periodic delivery.

(2) Successful deliveries: The provider may deliver meals to the consumer's home only when the consumer or the consumer's caregiver is home, unless otherwise authorized by the AAA.

(C) Emergency closings: The provider shall develop and implement emergency preparedness plans for emergency closings due to short-term weather-related emergencies, loss of power, kitchen malfunctions, natural disasters, a state of emergency declared by the governor (or a federal public health emergency), etc. that include both of the following:

(1) Providing timely notification of emergency situations to consumers.

(2) Distributing either of the following:

(a) Information to consumers on how to stock an emergency food shelf.

(b) Shelf-stable meals to consumers for an emergency food shelf.

(D) Quality assurance: Each year, the provider shall implement a plan to evaluate and improve the effectiveness of the project's operations and services to ensure continuous improvement by reviewing the existing project and the needs or interest of consumers, staff, or volunteers.

(E) Delivery verification: The following are the mandatory reporting items for each meal delivery that a provider retains to comply with the requirements under paragraph (B)(9) of rule 173-3-06 of the Administrative Code:

(1) Consumer's name.

(2) Delivery date.

(3) Number of meals delivered.

(4) A unique identifier of the consumer, the consumer's caregiver, or the delivery person to attest to the delivery.

Last updated November 8, 2023 at 8:20 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11, 1321.17
Amplifies: 173.39, 173.392; 42 U.S.C. 3025, 3030e, 3030g-21; 45 C.F.R. 1321.11, 1321.17
Five Year Review Date: 11/30/2027
Prior Effective Dates: 8/24/2017, 12/31/2020
Rule 173-4-05.3 | Older Americans Act nutrition program: congregate dining projects based in restaurants or grocery stores.
 

The following are the requirements to include in every AAA-provider agreement for a congregate dining project based in restaurants or grocery stores paid, in whole or in part, with Older Americans Act funds:

(A) The AAA-provider agreement is subject to rules 173-3-06 and 173-4-05 of the Administrative Code.

(B) Eligibility verification: The provider shall use one of the following three methods to verify consumers' eligibility when complying with the eligibility-verification requirements in rule 173-4-03 of the Administrative Code:

(1) Identification card method (whether or not electronically verified): The provider that uses this method registers each consumer that it serves and issues the consumer an identification card. When the consumer visits the restaurant or grocery store, the consumer provides the identification card to the designated staff person at the restaurant or grocery store to receive a prepared meal. The provider may use an electronic verification system to validate the identification card.

(2) Voucher method (whether or not electronically verified): The provider that uses this method registers each consumer that it serves and issues the consumer a voucher. When the consumer visits the restaurant or grocery store, the consumer provides a voucher to the designated staff person at the restaurant or grocery store to receive a prepared meal. The provider may use an electronic verification system to validate the voucher.

(3) Handwritten verification method: Before providing a consumer the first meal, the provider that uses this method collects information required by the AAA and obtains a unique identifier from the consumer.

(C) Consumer contributions: The provider shall use one of the following two methods for soliciting consumer contributions when complying with the consumer-contribution requirements in rule 173-3-07 of the Administrative Code:

(1) The provider that uses the consumer identification method in paragraph (B)(1) or (B)(3) of this rule solicits the consumer to voluntarily contribute to the cost of the meals when the provider provides the meals.

(2) The provider that uses the method in paragraph (B)(2) of this rule solicits the consumer to voluntarily contribute to the cost of the meals when the provider provides the vouchers.

(D) Emergency closings: The provider shall distribute information to consumers on how to stock an emergency food shelf.

(E) Quality assurance: The provider shall elicit consumer's comments on dining environments, food appearance, type of food, food temperatures, and staff professionalism.

(F) Meal verification:

(1) The following are the mandatory reporting items for each meal provided that a provider retains to comply with the requirements under paragraph (B)(9) of rule 173-3-06 of the Administrative Code:

(a) Consumer's name.

(b) Date of meal provision.

(c) Unique identifier of the consumer or the consumer's caregiver to attest to receiving the meal.

(2) During a state of emergency declared by the governor or a federal public health emergency, the provider may verify each meal provided without collecting a unique identifier of the consumer or the consumer's caregiver.

Last updated November 8, 2023 at 8:20 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11, 1321.17
Amplifies: 173.39, 173.392; 42 U.S.C. 3025, 3030e, 3030g-21; 45 C.F.R. 1321.11, 1321.17, 1321.67
Five Year Review Date: 11/30/2027
Prior Effective Dates: 9/1/2016, 6/11/2020 (Emer.)
Rule 173-4-06 | Older Americans Act nutrition program: diet orders.
 

(A) Definitions for this rule:

(1) "Diet order" means an order for a therapeutic diet from a licensed healthcare professional whose scope of practice includes ordering a therapeutic diet.

(2) "Therapeutic diet" means a calculated nutritive regimen including, the following regimens:

(a) Diabetic and other nutritive regimens requiring a daily specific calorie level.

(b) Renal nutritive regimens.

(c) Dysphagia nutritive regimens, excluding simple textural modifications.

(d) Any other nutritive regimen requiring a daily minimum or maximum level of one or more specific nutrients or a specific distribution of one or more nutrients.

(B) Requirements for every AAA-provider agreement for therapeutic diets paid, in whole or in part, with Older Americans Act funds:

(1) The AAA-provider agreement is subject to the requirements in rule 173-3-06 of the Administrative Code.

(2) Diet orders:

(a) The provider may provide a therapeutic diet to a consumer only if the provider received a diet order for the consumer or if it is the consumer's preference to choose a therapeutic diet. If a therapeutic diet is a dysphagia nutritive regimen, the provider may provide the therapeutic diet only if the diet order indicates whether the consumer requires texture-modified foods and/or thickened liquids.

(b) The provider shall provide a therapeutic dietto the consumer identified in a diet order for the shorter of the following two durations:

(i) The length of time authorized by the diet order.

(ii) One year from the date the diet order indicates the diet should begin.

(c) The provider shall provide the therapeutic diet according to any updated diet order if the updated diet order is received before the expiration of the current diet order.

(d) The provider may use either nutrient analysis or a meal-pattern plan approved by a dietitian to assure that the therapeutic diet contains nutrients consistent with the diet order.

(e) The provider may provide a therapeutic diet only if the provider (or, if the consumer is in a care-coordination program, the AAA) retains a copy of the diet order unless it is the consumer's preference to choose a therapeutic diet.

(3) Dietitians:

(a) The provider shall determine the need, feasibility, and cost-effectiveness of offering a therapeutic diet by consulting with a licensed dietitian.

(b) A provider may provide a therapeutic diet only if the provider relies upon the oversight of a dietitian when providing the therapeutic diet.

Last updated December 1, 2023 at 9:30 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11, 1321.17
Amplifies: 173.39, 173.392; 42 U.S.C. 3025, 3030g-21; 45 C.F.R. 1321.11, 1321.17
Five Year Review Date: 11/30/2028
Prior Effective Dates: 9/1/2016
Rule 173-4-07 | Older Americans Act nutrition program: nutrition counseling.
 

(A) Definitions for this rule:

"Nutrition counseling" ("counseling") has the same meaning as "medical nutrition therapy" in rule 4759-2-01 of the Administrative Code.

"Nutritional assessment" ("assessment") has the same meaning as in rule 4759-2-01 of the Administrative Code.

(B) Requirements for every AAA-provider agreement for nutrition counseling paid, in whole or in part, with Older Americans Act funds:

(1) The AAA-provider agreement is subject to the rule 173-3-06 of the Administrative Code.

(2) Dietitian: Only a licensed dietitian ("dietitian") working for an agency provider, or a licensed dietitian working as a self-employed provider may provide counseling to consumers.

(3) Orders and limits:

(a) The provider may provide counseling to a consumer only if the provider obtains an order for the consumer's counseling from a licensed healthcare professional whose scope of practice includes ordering counseling before providing the counseling.

(b) The provider may only provide counseling up to the amount the licensed healthcare professional ordered.

(c) The provider may provide counseling to a consumer's caregiver only if the licensed healthcare professional also ordered counseling for the consumer's caregiver to improve the caregiver's care to the consumer.

(4) Venue: The provider may conduct sessions by telephone, video conference, or in person in the consumer's home.

(5) Nutritional assessment:

(a) The provider shall conduct an assessment of the consumer's nutritional intake, anthropometic measurements, biochemical values, physical and metabolic parameters, socio-economic factors, current medical diagnosis and medications, pathophysiological processes, and access to food and food-assistance programs.

(b) No later than seven days after the initial assessment, the dietitian forwards the results of the initial assessment to the licensed healthcare professional who ordered the counseling and, if the consumer is in a care-coordination program, to the consumer's case manager.

(6) Nutrition intervention plan: The provider shall perform all of the following activities concerning a nutrition intervention plan:

(a) Base the plan on the initial assessment and subsequent assessments (if conducted).

(b) Include all of the following in the plan:

(i) Clinical and behavioral goals and a care plan.

(ii) Intervention planning, including nutrients required, feeding modality, and method of nutrition education and counseling, with expected measurable outcomes.

(iii) Consideration for input from the consumer, licensed healthcare professional who ordered the counseling, case manager (if any), consumer's caregiver (if any), and relevant service provider (if any).

(iv) The scheduling of any follow-up counseling sessions.

(c) Forward, no more than seven days after the provider sends the assessment to the licensed healthcare professional who ordered the counseling, the plan to the same professional and, if the consumer is in a care-coordination program, to the consumer's case manager.

(d) Provide reports on the plan's implementation and the consumer's outcomes to the licensed healthcare professional who ordered the counseling and, if the consumer is in a care-coordination program, to the consumer's case manager.

(7) Service verification:

(a) The following are the mandatory reporting items for each counseling/assessment session that a provider retains to comply with the requirements under paragraph (B)(9) of rule 173-3-06 of the Administrative Code:

(i) Date of session.

(ii) Time of day when the session begins and ends.

(iii) Name of the dietitian providing the session.

(iv) Unique identifier of the dietitian to attest to providing the session.

(v) Unique identifier of the consumer or the consumer's caregiver to attest to receiving the session.

(b) During a state of emergency declared by the governor or a federal public health emergency, the provider may verify each episode of service provided without collecting a unique identifier of the consumer or the consumer's caregiver.

(C) Units:

(1) A unit of nutrition counseling is fifteen minutes of counseling.

(2) A unit of nutrition assessment is one nutrition assessment session per consumer.

Last updated January 3, 2023 at 8:40 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11, 1321.17
Amplifies: 173.39, 173.392; 42 U.S.C. 3025, 3030e, 3030f, 3030g-21; 45 C.F.R. 1321.11, 1321.17
Five Year Review Date: 11/30/2027
Prior Effective Dates: 3/5/2009, 12/31/2020
Rule 173-4-08 | Older Americans Act nutrition program: nutrition education.
 

(A) "Nutrition education" means an intervention targeting consumers and caregivers that uses information dissemination, instruction, and training with the intent to support food, nutrition, and physical activity choices and behaviors (related to nutritional status) in order to maintain or improve health and address nutrition-related conditions.

(B) Requirements for every AAA-provider agreement for nutrition education paid, in whole or in part, with Older Americans Act funds:

(1) The AAA-provider agreement is subject to rule 173-3-06 of the Administrative Code.

(2) Approved content: The provider shall provide education content that meets the following requirements:

(a) A licensed dietitian approved it as promoting better health.

(b) It is consistent with the "Dietary Guidelines for Americans."

(c) It is accurate, culturally sensitive, regionally appropriate, and considerate of personal preferences, including a consumer's needs interests and abilities (including literacy level).

(d) It supports food, nutrition, and physical activity choices and behaviors in order to maintain or improve health and address nutrition-related conditions.

(3) Education format: The provider may provide education in person, through remote formats (including video, audio, or online), or through the distribution of materials. The provider shall use a format that is culturally sensitive, regionally appropriate, and considers personal preferences, including a consumer's needs and abilities.

(4) Approved evaluation methodology: The provider shall implement a methodology for evaluating the effectiveness of its nutrition education that has the AAA's approval before the provider implements it.

(5) Frequency: The AAA-provider agreement shall obligate the provider to provide nutrition education according to one of the following three options:

(a) The provider offers nutrition education at least two times per year.

(b) The provider offers nutrition counseling according to rule 173-4-07 of the Administrative Code instead of nutrition education within a particular county.

(c) A combination of paragraphs (B)(5)(a) and (B)(5)(b) of this rule.

(6) Special requirements for congregate dining projects: If the AAA-provider agreement obligates the provider to offer nutrition education through a congregate dining project, the provider shall comply with the following requirements:

(a) Offer nutrition education in group sessions.

(b) Report the following mandatory reporting items for each session to comply with the requirements under paragraph (B)(9) of rule 173-3-06 of the Administrative Code:

(i) Each consumer's name (e.g., in a list).

(ii) Session date.

(iii) Duration of session.

(iv) Educational topic.

(v) Instructor's name.

(vi) Unique identifier of the instructor to attest to providing the session.

(7) Special requirements for home-delivered meal projects and congregate dining projects based in restaurants and supermarkets: If the AAA-provider agreement obligates the provider to offer nutrition education through a home-delivered meal project or congregate dining project based in restaurants or supermarkets, the following are the mandatory reporting items for the service that a provider retains to comply with the requirements under paragraph (B)(9) of rule 173-3-06 of the Administrative Code:

(a) Number of consumers who received the approved content.

(b) Service date.

(c) Topic of approved content.

(d) Unique identifier of the provider to attest to providing the approved content.

(C) Units: A unit of nutrition education is one nutrition education session per consumer whether provided in person, through remote formats (including video, audio, or online), or through the distribution of materials.

Last updated January 3, 2023 at 8:40 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11, 1321.17
Amplifies: 173.39, 173.392; 42 U.S.C. 3020e, 3025, 3030e, 3030f, 3030g-21; 45 C.F.R. 1321.11, 1321.17
Five Year Review Date: 11/30/2027
Prior Effective Dates: 7/12/2012, 1/29/2022
Rule 173-4-09 | Older Americans Act nutrition program: nutrition health screening.
 

(A) Definitions for this rule:

"High nutritional risk" means the status of a consumer whose score on the ODA form labeled "Determine Your Own Nutritional Health" (ODA0010, rev. May, 2009) is a six or above.

"Nutrition health screening" ("screening") means using the ODA form labeled "Determine Your Own Nutritional Health" (ODA0010, rev. May, 2009) to screen a consumer for nutritional risks and, if the screening determines the consumer to be at high nutritional risk, referring consumer to home and community-based services with potential for reducing the risk.

(B) Requirements for every AAA-provider agreement for nutrition health screening paid, in whole or in part, with Older Americans Act funds:

(1) The AAA-provider agreement is subject to rule 173-3-06 of the Administrative Code.

(2) Stand-alone or part: The provider may screen consumers as a stand-alone service or as part of a nutrition project or nutrition counseling.

(3) Venue: The provider may screen consumers by telephone, video conference, or in person, but is strongly encouraged to screen consumers in person.

(4) Checklist: The provider shall use an ODA form labeled "Determine Your Own Nutritional Health" (ODA0010, rev. May, 2009) to screen consumers for nutritional risks at least once every calendar year.

(5) Referrals: If a screening determines a consumer to be at high nutritional risk, the provider shall refer the consumer to home and community-based services with potential for reducing the risk.

(6) Service verification: The following are the mandatory reporting items for each screening that a provider retains to comply with the requirements under paragraph (B)(9) of rule 173-3-06 of the Administrative Code:

(a) Consumer's name.

(b) Date of screening.

(c) Provider's name.

(d) An indication of whether the consumer is at high nutritional risk.

(C) Units:

(1) One unit of nutrition health screening provided as a stand-alone service is a single instance of screening one consumer.

(2) When a provider provides nutrition health screening as part of another service paid, in whole or in part, with Older Americans Act funds, the screening is part of the cost of providing a unit of a meal through the other service.

Last updated January 3, 2023 at 8:40 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11, 1321.17
Amplifies: 173.39, 173.392; 42 U.S.C. 3025, 3030e, 3030f, 3030g-21; 45 C.F.R. 1321.11, 1321.17
Five Year Review Date: 11/30/2027
Prior Effective Dates: 7/5/2012
Rule 173-4-10 | Older Americans Act nutrition program: grocery shopping assistance.
 

(A) "Grocery shopping assistance" means a service that assists consumers with the act of shopping for groceries.

(B) Requirements for every AAA-provider agreement for grocery shopping assistance paid, in whole or in part, with Older Americans Act funds:

(1) The AAA-provider agreement is subject to rule 173-3-06 of the Administrative Code.

(2) Introductory information: The provider shall provide a consumer with a packet of introductory information that explains how grocery shopping assistance works on the consumer's enrollment into the grocery shopping assistance service.

(3) Transferring groceries: The AAA shall indicate the extent to which it requires the provider to transfer the groceries that the consumer purchases or receives.

(4) Payment:

(a) No Older Americans Act funds, other than funds from Title III-B or III-E of the Older Americans Act, may pay for grocery shopping assistance.

(b) No Older Americans Act funds, other than funds from Title III-B or III-E of the Older Americans Act, may pay for consumable supplies or material aid to meet basic needs, such as groceries. Providers may accept other funds (e.g., private pay, SNAP) for consumable supplies or material aid to meet basic needs.

(5) Service verification:

(a) The following are the mandatory reporting items for each episode of assistance that a provider retains to comply with the requirements under paragraph (B)(9) of rule 173-3-06 of the Administrative Code:

(i) Consumer's name.

(ii) Service date.

(iii) Pick-up time and location.

(iv) Drop-off time and location.

(v) Service units.

(vi) Unique identifier of the consumer or the consumer's caregiver to attest to receiving the service.

(b) During a state of emergency declared by the governor or a federal public health emergency, the provider may verify each episode of service provided without collecting the unique identifier of the consumer or the consumer's caregiver.

(C) Units: One unit of grocery shopping assistance is one-way transportation to or from a retail food establishment or non-profit food establishment.

Last updated January 3, 2023 at 8:40 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11, 1321.17
Amplifies: 173.39, 173.392; 42 U.S.C. 3025, 3030e, 3030f; 45 C.F.R. 1321.11, 1321.17
Five Year Review Date: 11/30/2027
Rule 173-4-11 | Older Americans Act nutrition program: grocery ordering and delivery.
 

(A) "Grocery ordering and delivery" means a service for a consumer who needs assistance shopping for groceries that allows consumers to order groceries, then delivers the ordered groceries to the consumer's home or vehicle (e.g., at a drive-thru pick-up window).

(B) Requirements for every AAA-provider agreement for grocery ordering and delivery paid, in whole or in part, with Older Americans Act funds:

(1) The AAA-provider agreement is subject to rule 173-3-06 of the Administrative Code.

(2) Procedures: The provider shall develop and implement procedures for the safe delivery of groceries.

(3) Payment:

(a) No Older Americans Act funds, other than funds from Title III-B or III-E of the Older Americans Act, may pay for grocery ordering and delivery.

(b) No Older Americans Act funds, other than funds from Title III-B or III-E of the Older Americans Act, may pay for consumable supplies or material aid to meet basic needs, such as groceries. Providers may accept other funds (e.g., private pay, SNAP) for consumable supplies or material aid to meet basic needs.

(4) Service verification:

(a) The following are the mandatory reporting items for each episode of service that a provider retains to comply with the requirements under paragraph (B)(9) of rule 173-3-06 of the Administrative Code:

(i) Consumer's name.

(ii) Service date.

(iii) Unique identifier of the consumer or the consumer's caregiver to attest to receiving the service.

(b) During a state of emergency declared by the governor or a federal public health emergency, the provider may verify each episode of service provided without collecting the unique identifier of the consumer or the consumer's caregiver.

(C) Units: One unit of grocery ordering and delivery is one episode of grocery ordering and delivery.

Last updated January 3, 2023 at 8:40 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11, 1321.17
Amplifies: 173.39, 173.392; 42 U.S.C. 3025, 3030e, 3030f; 45 C.F.R. 1321.11, 1321.17
Five Year Review Date: 11/30/2027
Prior Effective Dates: 6/11/2020 (Emer.)