(A) Purpose
This rule establishes procedures and standards
for certification of agency providers of supported living services, including
home and community-based services provided in accordance with section 5123.045
of the Revised Code.
(B) Definitions
For the purposes of this rule, the following
definitions apply:
(1) "Abuser
registry" has the same meaning as in rule 5123-17-03 of the Administrative
Code.
(2) "Accredited
college or university" means a college or university accredited by a
national or regional association recognized by the secretary of the United
States department of education or a foreign college or university of comparable
standing.
(3) "Agency
provider" means an entity that must be certified by the department to
provide supported living services in accordance with section 5123.161 of the
Revised Code and this rule.
(4) "Certificate of
high school equivalence" has the same meaning as in section 3301.80 of the
Revised Code and includes the equivalent of a certificate of high school
equivalence described in division (C) of that section.
(5) "County
board" means a county board of developmental disabilities.
(6) "Department" means the Ohio department of
developmental disabilities.
(7) "Direct support
assistant" means a person who is sixteen or seventeen years of age
employed by an agency provider to provide limited duties while in the company
of a direct support professional.
(8) "Direct support
professional" means a person who is at least eighteen years of age
employed in a "direct services position" as that term is defined in
section 5123.081 of the Revised Code.
(9) "Director of operations"
means a person employed by an agency provider who is responsible for, and who
is directly and actively involved in, the day-to-day operations of the agency
provider. For the purposes of conducting background investigations pursuant to
section 5123.081 of the Revised Code and rule 5123-2-02 of the Administrative
Code, "director of operations" has the same meaning as "chief
executive officer."
(10) "Health-related activities"
has the same meaning as in rule 5123-6-01 of the Administrative
Code.
(11) "Home and community-based
services" has the same meaning as in section 5123.01 of the Revised
Code.
(12) "Independent provider"
means a self-employed person who provides services for which the person is
certified in accordance with rule 5123-2-09 of the Administrative Code and does
not employ, either directly or through contract, anyone else to provide the
services.
(13) "Individual" means a person
with a developmental disability or for purposes of giving, refusing to give, or
withdrawing consent for services, the person's guardian in accordance with
section 5126.043 of the Revised Code or other person authorized to give
consent.
(14) "Individual service plan"
means the written description of services, supports, and activities to be
provided to an individual.
(15) "Major unusual incident"
has the same meaning as in rule 5123-17-02 of the Administrative
Code.
(16) "Provider network management
module" means a component of the Ohio medicaid enterprise system platform,
maintained by the Ohio department of medicaid at its website
(medicaid.ohio.gov), used by providers of services to initiate applications for
certification, access the provider services management system, and submit
required information and documents.
(17) "Provider services management
system" means the electronic portal, maintained by the department at its
website (dodd.ohio.gov), used by providers of services to apply for
certification and submit required information and documents.
(18) "Related party" has the
same meaning as in section 5123.16 of the Revised Code.
(19) "Service and support
administrator" means a person, regardless of title, employed by or under
contract with a county board to perform the functions of service and support
administration as set forth in section 5126.15 of the Revised Code and who
holds the appropriate certification in accordance with rule 5123-5-02 of the
Administrative Code.
(20) "Specialized services"
means any program or service designed and operated to serve primarily
individuals with developmental disabilities, including a program or service
provided by an entity licensed or certified by the department. If there is a
question as to whether an entity is providing specialized services, an agency
provider may request that the director of the department make a determination.
The director's determination is not subject to appeal. Programs or
services available to the general public are not specialized
services.
(21) "Supported living" has the
same meaning as in section 5126.01 of the Revised Code.
(22) "Unusual incident" has the
same meaning as in rule 5123-17-02 of the Administrative Code.
(23) "Volunteer" means a person
who donates time, effort, and/or talent to meet a need or advance the mission
of an agency provider and who is not paid or otherwise remunerated by the
agency provider. "Volunteer" does not include a family member,
guardian, friend, or other associate of an individual simply interacting with
that individual.
(C) General requirements for agency
providers
An agency provider will:
(1) Be in good standing
with the Ohio secretary of state as a for-profit corporation, nonprofit
corporation, limited liability company, or limited liability
partnership.
(2) Obtain and maintain a
medicaid provider agreement with the Ohio department of medicaid when the
agency provider intends to provide home and community-based
services.
(3) Comply with the
requirements of this rule and other standards and assurances established in
Chapter 5123. of the Revised Code and rules adopted pursuant to that
chapter.
(4) At the point of
application for certification and upon request by the department, provide proof
of a:
(a) Continuing line of credit in the agency provider's name
in an amount of at least ten thousand dollars; or
(b) Bank account in the agency provider's name with a daily
balance of at least ten thousand dollars for the most recent ninety
days.
(5) At the point of
application for certification and upon request by the department, provide a
certificate of a continuing policy of general liability insurance in an amount
of at least one million dollars which includes coverage for individuals'
losses due to theft or property damage.
(6) Provide and maintain
in the provider services management system and the provider network management
module, the agency provider's current physical address, telephone number,
and electronic mail address.
(7) Provide to the
department via the provider services management system, within fourteen
calendar days of occurrence, the name, date of birth, and social security
number for any person newly acquiring a financial interest of five per cent or
more in the agency provider (including a direct, indirect, security, or
mortgage financial interest).
(8) Notify the department
via the provider services management system, within seven calendar days of any
bankruptcy petition for which the agency provider is the subject and provide
related documents to the department upon request.
(9) Participate as
requested by the department in service delivery system data collection
initiatives.
(D) Management of the agency
provider
(1) An agency provider
will have written policies and procedures that address the agency
provider's management practices regarding:
(a) Person-centered planning and self-determination;
(b) Individuals' satisfaction with services
delivered;
(c) Internal monitoring and evaluation procedures to improve
services delivered;
(d) Supervision of staff;
(e) Training plan described in paragraph (F)(1) of this
rule;
(f) Service delivery;
(g) Background investigations for employment in accordance with
rule 5123-2-02 of the Administrative Code; and
(h) Volunteers (when the agency provider engages
volunteers).
(2) An agency provider
will demonstrate that the agency provider has an established internal
compliance program to ensure compliance with requirements for:
(a) Provider certification in accordance with this
rule;
(b) Background investigations and appropriate actions in
accordance with rule 5123-2-02 of the Administrative Code for its director of
operations, supervisors of direct support professionals, direct support
professionals, direct support assistants, and volunteers;
(c) Service delivery, service documentation, and billing for
services in accordance with Chapter 5123. of the Revised Code and rules adopted
pursuant to that chapter for supported living services and the specific home
and community-based services provided; and
(d) Management of individuals' funds.
(3) When an agency
provider is governed by a board of directors, board members will:
(a) Ensure the fiscal integrity of the agency provider by
reviewing and approving the agency provider's annual audit, if otherwise
required, or annual financial statements and by monitoring the agency
provider's financial status including trends and challenges;
(b) Review and evaluate all compliance review reports by the
department or a county board and the agency provider's response, including
the plan of correction;
(c) Monitor the effectiveness of the agency provider's
internal compliance program described in paragraph (D)(2) of this rule;
and
(d) Promote the delivery of high-quality services.
(E) Employment of staff
An agency provider will:
(1) In addition to
employing a director of operations who meets the requirements set forth in
paragraph (H) of this rule, employ at least one other person for the purpose of
providing services.
(2) Comply with
applicable federal, state, and local regulations, statutes, rules, codes, and
ordinances pertaining to employment of staff including, but not limited to,
wage and hour, workers' compensation, unemployment compensation, and
withholding taxes.
(3) Be current in payment
of payroll taxes, workers' compensation premiums, and unemployment
compensation premiums.
(4) Conduct background
investigations and take appropriate actions in accordance with rule 5123-2-02
of the Administrative Code.
(5) Annually notify in
writing, each of its staff members explaining the conduct for which the staff
member may be placed on the abuser registry and setting forth the requirement
for each staff member who is a supervisor of direct support professionals, a
direct support professional, or a direct support assistant to report in writing
to the agency provider, if the staff member is formally charged with, is
convicted of, pleads guilty to, or is found eligible for intervention in lieu
of conviction for any of the offenses listed or described in divisions
(A)(3)(a) to (A)(3)(e) of section 109.572 of the Revised Code within fourteen
calendar days after the date of such charge, conviction, guilty plea, or
finding.
(F) Staff training
documentation
An agency provider will:
(1) Develop and implement
a written training plan for its director of operations, supervisors of direct
support professionals, direct support professionals, direct support assistants,
and volunteers that:
(a) Is consistent with the needs of individuals served, best
practice, and the requirements set forth in appendix A and appendix C to this
rule.
(b) Describes the method (e.g., written test, skills
demonstration, or documented observation by supervisor) that will be used to
establish competency of supervisors of direct support professionals, direct
support professionals, and direct support assistants in areas of
training.
(c) Is updated at least once every twelve months and identifies
who is responsible for arranging or providing the training and projected
timelines for completion of the training.
(2) Maintain a written
record of training completed by its director of operations, supervisors of
direct support professionals, direct support professionals, direct support
assistants, and volunteers that includes a description of the training
completed, the date of training, the duration of training, and when applicable,
the instructor's name.
(G) Standards of service
provision
An agency provider will:
(1) Provide services only to individuals
whose needs the agency provider can meet.
(2) Communicate effectively with each
individual served by the agency provider.
(3) Ensure that direct support
professionals are knowledgeable in the individual service plan for each
individual served prior to providing services to the individual.
(4) Implement services in accordance with
the individual service plan and in a person-centered manner.
(5) Comply with the requirements of rule
5123-2-06 of the Administrative Code.
(6) Take all reasonable steps necessary
to prevent the occurrence or recurrence of major unusual incidents and unusual
incidents.
(7) Upon realization that the agency
provider may be unable to continue to effectively provide services to an
individual, immediately engage the individual and the individual's service
and support administrator to consider alternative strategies for serving the
individual that ensure the health and safety of the individual.
(8) Notify, in writing, an individual and
the individual's service and support administrator in the event that the
agency provider intends to cease providing services to the individual no less
than thirty calendar days prior to termination of services and convey documents
and records to the individual's service and support administrator as
requested.
(9) Ensure that a direct support
professional does not:
(a) Provide services to the direct support professional's
minor child except as permitted pursuant to rule 5160-44-32 of the
Administrative Code;
(b) Provide services to the direct support professional's
spouse except as permitted pursuant to rule 5160-44-32 of the Administrative
Code;
(c) Provide services to the minor child of an owner of the agency
provider;
(d) Provide services to the spouse of an owner of the agency
provider;
(e) Provide services to the minor child of the director of
operations;
(f) Provide services to the spouse of the director of
operations;
(g) Administer medication or perform health-related activities
for individuals who receive services unless the direct support professional
meets the applicable requirements of Chapters 4723., 5123., and 5126. of the
Revised Code and rules adopted pursuant to those chapters; or
(h) Use or be under the influence of the following while
providing services:
(i) Alcohol;
(ii) Illegal
drugs;
(iii) Illegal chemical
substances; or
(iv) Controlled
substances that may adversely affect the direct support professional's
ability to furnish services.
(H) Requirements for director of
operations
(1) An agency provider
will employ a director of operations who:
(a) Has a valid birth certificate.
(b) Is at least twenty-one years of age.
(c) Has a valid social security card and a valid
government-issued photo identification.
(d) Has at least:
(i) One year of full-time
(or equivalent part-time) paid work experience in the provision of specialized
services; or
(ii) Four years of
experience providing care to a family member (i.e., parent, child, or sibling)
with a developmental disability.
(e) Has at least one year of full-time (or equivalent part-time)
paid work experience in:
(i) Supervision of
employees;
(ii) Development,
oversight, and/or supervision of programs or services; and
(iii) Financial
management of an organization.
(f) Holds either:
(i) A bachelor's
degree from an accredited college or university; or
(ii) A high school
diploma or certificate of high school equivalence and has at
least:
(a) Four years of
full-time (or equivalent part-time) paid work experience as a supervisor of
specialized services; or
(b) Four years of
experience providing care to a family member (i.e., parent, child, or sibling)
with a developmental disability.
(g) Is able to read, write, and understand English at a level
sufficient to comply with all requirements set forth in administrative rules
governing the services provided by the agency provider.
(2) Prior to the agency
provider's application for initial certification, the director of
operations will successfully complete the training specified in appendix A to
this rule.
(3) On an annual basis,
the director of operations will successfully complete the training specified in
appendix A to this rule.
(4) The director of
operations will undergo a background investigation in accordance with rule
5123-2-02 of the Administrative Code and consent to be enrolled by the
department in the Ohio attorney general's retained applicant fingerprint
database (also known as "Rapback").
(5) A person may not
serve as the director of operations for an agency provider if the person
is:
(a) The parent of a minor child served by the agency provider;
or
(b) The spouse of an individual served by the agency
provider.
(I) Required actions and notifications
regarding director of operations
(1) An agency provider
will notify the department via the provider services management system, if the
director of operations is formally charged with, is convicted of, pleads guilty
to, or is found eligible for intervention in lieu of conviction for any of the
offenses listed or described in divisions (A)(3)(a) to (A)(3)(e) of section
109.572 of the Revised Code within fourteen calendar days after the date of
such charge, conviction, guilty plea, or finding.
(2) An agency provider
will notify the department via the provider services management system, within
fourteen calendar days of determining that the director of operations is or has
become a related party of a person or government entity for which the
department refused to issue or renew or revoked certification pursuant to
section 5123.166 of the Revised Code.
(3) An agency provider
will notify the department via the provider services management system, within
fourteen calendar days of determining that the director of operations has had a
professional registration, certification, or license (other than a
driver's license) suspended or revoked.
(4) An agency provider
will update its record in the provider services management system, within
fourteen calendar days when a director of operations leaves or joins the agency
provider's employ.
(5) When the director of
operations leaves an agency provider's employ, the agency provider will
report within fourteen calendar days via the provider services management
system, the agency provider's plan for identifying a new director of
operations and to whom executive authority has been delegated in the interim
period.
(6) A person newly
appointed or employed as director of operations of an agency provider will
complete the department-provided web-based orientation for directors of
operations described in appendix A to this rule within thirty calendar days of
appointment or hire.
(7) A director of
operations will inform the department via the provider services management
system, if the director of operations serves as director of operations for more
than one agency provider.
(8) A director of
operations will inform the department via the provider services management
system, if the director of operations is or was the director of operations of
an agency provider at a point in time within the last five years when the
agency provider had its provider certification revoked or not
renewed.
(9) A director of
operations will designate in writing a staff member to whom executive authority
has been delegated in the temporary absence of the director of
operations.
(J) Requirements for direct support
professionals
(1) An agency provider
will ensure that each direct support professional:
(a) Is at least eighteen years of age.
(b) Is able to read, write, and understand English at a
level sufficient to comply with all requirements set forth in administrative
rules governing the services provided by the direct support
professional.
(2) An agency provider
will ensure that each direct support professional, except for direct support
professionals exempted as specified in appendix B to this rule, holds and
maintains:
(a) Valid "American Red Cross" or equivalent
certification in first aid which included an in-person skills assessment
completed with an approved trainer; and
(b) Valid "American Red Cross" or equivalent
certification in cardiopulmonary resuscitation which included an in-person
skills assessment completed with an approved trainer.
(3) An agency provider
will ensure that each direct support professional, except for direct support
professionals exempted as specified in appendix B to this rule, successfully
completes the training specified in appendix C to this rule.
(K) Requirements for supervisory
staff
An agency provider will ensure that each staff
member who supervises direct support professionals:
(1) Meets the
requirements set forth in paragraphs (J)(1) to (J)(3) of this rule;
and
(2) Has successfully
completed training regarding all relevant duties and responsibilities of being
a supervisor for the agency provider within ninety calendar days of becoming a
supervisor.
(L) Requirements for direct support
assistants
(1) An agency provider
may employ persons who are sixteen or seventeen years of age to perform limited
duties as direct support assistants.
(2) A person employed as
a direct support assistant will, at all times, work in the company of an
employee of the agency provider who is:
(a) Physically present at the location where the direct
support assistant is providing services; and
(b) A direct support professional who meets the
requirements of paragraph (J) of this rule or a supervisor of direct support
professionals who meets the requirements of paragraph (K) of this
rule.
(3) An agency provider
will ensure that each direct support assistant:
(a) Undergoes a background investigation for employment in
accordance with rule 5123-2-02 of the Administrative Code.
(b) Meets the training requirements for direct support
professionals set forth in appendix C to this rule.
(c) Is able to read, write, and understand English at a
level sufficient to comply with all requirements set forth in administrative
rules governing the services provided by the direct support
assistant.
(4) A person employed as
a direct support assistant will not, under any circumstances:
(a) Provide intimate personal care such as dressing,
showering, bathing, toileting, or changing undergarments;
(b) Operate a vehicle to transport an individual receiving
services;
(c) Administer medication or perform health-related
activities;
(d) Provide any care or perform any task for an individual
expressly forbidden by the individual (e.g., provide assistance with eating);
or
(e) Implement any restrictive measure as defined in rule
5123-2-06 of the Administrative Code.
(5) An agency provider
will not assign a direct support assistant to provide services to an individual
who does not consent to having services provided by a direct support
assistant.
(M) Requirements for volunteers
(1) An agency provider
may engage volunteers to provide supplementary services. An agency provider
will not bill for services provided by volunteers.
(2) An agency provider
will ensure that volunteers are at all times under supervision of paid
supervisory staff of the agency provider.
(3) An agency provider
will ensure that volunteers do not provide intimate personal care (such as
dressing, showering, bathing, toileting, or changing undergarments), administer
medication, or perform health-related activities.
(4) An agency provider
will ensure that volunteers who provide more than forty hours of service
working directly with individuals served by the agency provider during a
calendar year:
(a) Receive training in:
(i) The role of a
volunteer in supporting individuals served by the agency provider including the
national alliance for direct support professionals code of ethics and the
rights of individuals set forth in section 5123.62 of the Revised
Code;
(ii) Recognizing and
reporting major unusual incidents and unusual incidents; and
(iii) An overview of
emergency procedures.
(b) Undergo background investigations.
(i) The background
investigation for a volunteer will include:
(a) Requiring the
volunteer to submit a statement to the agency provider with the
volunteer's signature attesting that the volunteer has not been convicted
of, pleaded guilty to, or been found eligible for intervention in lieu of
conviction for any of the offenses listed or described in divisions (A)(3)(a)
to (A)(3)(e) of section 109.572 of the Revised Code.
(b) Requiring the
volunteer to sign an agreement under which the volunteer agrees to notify the
agency provider within fourteen calendar days if the volunteer is formally
charged with, is convicted of, pleads guilty to, or is found eligible for
intervention in lieu of conviction for any of the offenses listed or described
in divisions (A)(3)(a) to (A)(3)(e) of section 109.572 of the Revised Code. The
agreement will provide that failure to make the notification may result in
termination of the volunteer's services.
(c) Checking each of the
databases described in paragraph (C)(2) of rule 5123-2-02 of the Administrative
Code to determine if the volunteer is included.
(d) Obtaining a criminal
records check conducted by the Ohio bureau of criminal identification and
investigation. If the volunteer does not present proof that the volunteer has
been a resident of Ohio for the five-year period immediately prior to the date
upon which the criminal records check is requested, the criminal records check
will include information from the federal bureau of investigation.
(ii) The agency provider
will, at a frequency of no less than once every five years, conduct a
background investigation in accordance with paragraph (M)(4)(b)(i) of this rule
for each volunteer.
(iii) The agency provider
will not engage or continue to engage a volunteer who:
(a) Is included in one or
more of the databases described in paragraphs (C)(2)(a) to (C)(2)(f) of rule
5123-2-02 of the Administrative Code; or
(b) Has a conviction for,
pleads guilty to, or is found eligible for intervention in lieu of conviction
for any of the offenses listed or described in divisions (A)(3)(a) to (A)(3)(e)
of section 109.572 of the Revised Code if the corresponding exclusionary period
as specified in paragraph (E) of rule 5123-2-02 of the Administrative Code has
not elapsed.
(N) Procedure for obtaining initial agency provider
certification
(1) An applicant for
initial agency provider certification will submit an application via the
provider services management system, for supported living services and the
specific home and community-based services the applicant seeks to provide in
accordance with procedures prescribed by the department. The application will
include required signatures and supporting documentation to demonstrate that
standards are met as required by this rule and rules in Chapter 5123-9 of the
Administrative Code for the specific home and community-based services the
applicant seeks to provide including, but not limited to:
(a) A certificate of good standing from the Ohio secretary of
state demonstrating the agency provider's status as a for-profit
corporation, nonprofit corporation, limited liability company, or limited
liability partnership.
(b) Proof of an unencumbered line of credit in the agency
provider's name in an amount of at least ten thousand dollars or proof of
a bank account in the agency provider's name with a daily balance of at
least ten thousand dollars during the past ninety days.
(c) A certificate of general liability insurance in an amount of
at least one million dollars which includes coverage for individuals'
losses due to theft or property damage.
(d) Proof that the agency provider employs a director of
operations who meets the requirements set forth in this rule.
(e) Proof that in addition to employing a director of operations,
the agency provider employs at least one other person for the purpose of
providing services.
(f) An employer identification number from the internal revenue
service.
(g) A certificate of policy from the Ohio bureau of workers'
compensation.
(h) The name, country of birth, date of birth, and social
security number for any person having a financial interest of five per cent or
more in the agency provider (including a direct, indirect, security, or
mortgage financial interest).
(i) Written policies and procedures that address the agency
provider's management practices regarding:
(i) Confidentiality of
individuals' records;
(ii) Management of
individuals' funds;
(iii) Reporting and
investigation of major unusual incidents and unusual incidents;
and
(iv) Documentation and
billing for services.
(j) The application fee specified in paragraph (R) of this rule
except when, based on the specific home and community-based services to be
provided, the applicant is exempted from paying an application fee in
accordance with appendix D to this rule.
(k) The criminal records check by the Ohio bureau of criminal
identification and investigation, and when applicable by the federal bureau of
investigation, for the director of operations.
(2) The department will
review an application within thirty calendar days of receipt of all required
components to determine if the applicant meets the standards for the requested
certification.
(a) If the department determines an applicant seeking to provide
home and community-based services meets the standards for the requested
certification, the department will initiate the process for the applicant to
obtain a medicaid provider agreement from the Ohio department of medicaid. The
applicant may be subject to an on-site visit by the Ohio department of medicaid
or its designee in accordance with rule 5160-1-17.8 of the Administrative Code;
successful completion of the on-site visit is required prior to issuance of the
medicaid provider agreement by the Ohio department of medicaid and
certification issued by the department.
(b) If, upon review of the application, the department determines
that supporting documentation does not demonstrate that the applicant meets the
standards for the requested certification, the department will notify the
applicant by electronic mail and advise that the applicant has thirty calendar
days to submit components needed to demonstrate that the applicant meets the
standards for the requested certification.
(i) When the department
receives components needed to demonstrate that the applicant meets the
standards for the requested certification within the specified thirty calendar
days, the application will be advanced for processing.
(ii) When an applicant
fails to submit components needed to demonstrate that the applicant meets the
standards for the requested certification within the specified thirty calendar
days, the department will take no further action with respect to the
application.
(3) When the department
has determined the applicant meets the standards for the requested
certification and, when applicable, after the Ohio department of medicaid has
issued a medicaid provider agreement to an applicant seeking to provide home
and community-based services, the department will notify the applicant by
electronic mail that certification is approved. The notification will specify
the effective date and expiration date of the certification and the specific
services for which the applicant is certified.
(4) The department's
review of an application may extend beyond thirty calendar days
when:
(a) One or more of the submitted documents requires verification;
or
(b) The director of operations:
(i) Has a conviction or
notation on the criminal records check by the Ohio bureau of criminal
identification and investigation or the federal bureau of
investigation;
(ii) Is included in one
or more of the databases described in paragraph (C)(2) of rule 5123-2-02 of the
Administrative Code;
(iii) Is the primary
person involved in a major unusual incident;
(iv) Is under
consideration for placement on the abuser registry; or
(v) Is a related party to
an agency provider or an independent provider whose certification has been
suspended or revoked or is proposed for revocation.
(5) When the department
determines an applicant does not meet the standards for the requested
certification, the department will notify the applicant in accordance with
paragraph (T)(3) of this rule that the certification is denied. The
notification will specify the reason for denial.
(O) Procedure for obtaining certification to provide
additional home and community-based services during the term of existing
department-issued certification
(1) A certified agency
provider seeking to provide additional home and community-based services will
submit an application via the provider services management system, for the
additional home and community-based services the agency provider seeks to
provide including:
(a) Required signatures and supporting documentation to
demonstrate that standards are met as required by this rule and rules in
Chapter 5123-9 of the Administrative Code for the specific home and
community-based services the applicant seeks to provide.
(b) The application fee specified in paragraph (R) of this rule
except when, based on the specific home and community-based services to be
provided, the applicant is exempted from paying an application fee in
accordance with appendix D to this rule.
(2) The department will
review an application within thirty calendar days of receipt of all required
components to determine if the applicant meets the standards for the requested
certification. If, upon review of the application, the department determines
that supporting documentation does not demonstrate that the applicant meets the
standards for the requested certification, the department will notify the
applicant by electronic mail and advise that the applicant has thirty calendar
days to submit components needed to demonstrate that the applicant meets the
standards for the requested certification.
(a) When the department receives components needed to demonstrate
that the applicant meets the standards for the requested certification within
the specified thirty calendar days, the application will be advanced for
processing.
(b) When an applicant fails to submit components needed to
demonstrate that the applicant meets the standards for the requested
certification within the specified thirty calendar days, the department will
take no further action with respect to the application.
(3) When the department
determines the applicant meets the standards for the requested certification,
the department will notify the applicant by electronic mail that certification
is approved. The notification will specify the effective date and expiration
date of the certification and the specific services for which the applicant is
certified.
(4) When the department
determines the applicant does not meet the standards for the requested
certification, the department will notify the applicant in accordance with
paragraph (T)(3) of this rule that the certification is denied. The
notification will specify the reason for denial.
(P) Procedure for obtaining renewal agency provider
certification
(1) The department will
notify an agency provider by electronic mail to the address in the provider
services management system, of required certification renewal no later than
ninety calendar days prior to the date the agency provider's certification
expires. The notification will describe the procedures for submitting the
certification renewal application in accordance with this rule.
(2) The agency provider
will submit the certification renewal application via the provider services
management system including:
(a) Required signatures and supporting documentation to
demonstrate that standards are met as required by this rule and rules in
Chapter 5123-9 of the Administrative Code for the specific home and
community-based services the applicant seeks to provide;
(b) The application fee specified in paragraph (R) of this rule
except when, based on the specific home and community-based services to be
provided, the applicant is exempted from paying an application fee in
accordance with appendix D to this rule; and
(c) The criminal records check by the Ohio bureau of criminal
identification and investigation, and when applicable by the federal bureau of
investigation, for the director of operations, unless the director of
operations has been enrolled without interruption in the Ohio attorney
general's retained applicant fingerprint database (also known as
"Rapback") for the entire previous certification term and has been a
resident of Ohio without interruption for the past five years.
(3) The department will
review an application within thirty calendar days of receipt of all required
components to determine if the applicant meets the standards for the requested
certification.
(a) If the department determines an applicant meets the standards
for the requested certification, the department will notify the applicant by
electronic mail that certification is approved. The notification will specify
the effective date and expiration date of the certification and the specific
services for which the applicant is certified.
(b) If, upon review of the application, the department determines
that supporting documentation does not demonstrate that the applicant meets the
standards for the requested certification, the department will notify the
applicant by electronic mail and advise that the applicant has thirty calendar
days to submit components needed to demonstrate that the applicant meets the
standards for the requested certification.
(i) When the department
receives components needed to demonstrate that the applicant meets the
standards for the requested certification within the specified thirty calendar
days, the application will be advanced for processing.
(ii) When an applicant
fails to submit components needed to demonstrate that the applicant meets the
standards for the requested certification within the specified thirty calendar
days, the department will take no further action with respect to the
application.
(4) The department's
review of an application may extend beyond thirty calendar days
when:
(a) One or more of the submitted documents requires verification;
or
(b) The director of operations:
(i) Has a conviction or
notation on the criminal records check by the Ohio bureau of criminal
identification and investigation or the federal bureau of
investigation;
(ii) Is included in one
or more of the databases described in paragraph (C)(2) of rule 5123-2-02 of the
Administrative Code;
(iii) Is the primary
person involved in a major unusual incident;
(iv) Is under
consideration for placement on the abuser registry; or
(v) Is a related party to
an agency provider or an independent provider whose certification has been
suspended or revoked or is proposed for revocation.
(5) When the department
determines an applicant does not meet the standards for the requested
certification, the department will notify the applicant in accordance with
paragraph (T)(3) of this rule that the certification is denied. The
notification will specify the reason for denial.
(6) When an agency
provider submits an application for renewal certification prior to
certification expiration that demonstrates the applicant meets the standards
for the requested renewal certification, the agency provider's
certification will be renewed without lapse.
(7) When an agency
provider submits an application for renewal certification fewer than forty-five
calendar days in advance of certification expiration that demonstrates the
applicant meets the standards for the requested renewal certification, the
agency provider may experience a gap in its ability to bill for services
provided between the date of certification expiration and the date the renewal
certification is approved. Once the renewal certification is approved, however,
the agency provider may bill for services provided during that
period.
(8) When an agency
provider submits an application for renewal certification after certification
expiration, there will be a lapse of certification from the date of
certification expiration to the date the department receives an application for
renewal certification that demonstrates the applicant meets the standards for
the requested renewal certification. The agency provider will not provide
services nor be reimbursed for provision of services during the
lapse.
(9) An agency provider
will not provide services nor submit claims for reimbursement for services
provided subsequent to expiration of the agency provider's
certification.
(Q) Application for certification subsequent to
expiration
(1) An applicant whose
certification has been expired for less than one year will be required to apply
for and meet the requirements for renewal certification.
(2) An applicant whose
certification has been expired for one year or more will be required to apply
for and meet the requirements for initial certification.
(R) Application fees
(1) Applicants seeking
certification to provide services, other than those exempted in accordance with
appendix D to this rule, will submit an application fee at the time of
application for initial certification, application for certification to provide
additional home and community-based services during the term of existing
department-issued certification, and application for renewal
certification.
(a) Application fees for initial certification and renewal
certification
(i) The application fee
for a small agency provider (i.e., one that serves or plans to serve fifty or
fewer individuals) seeking initial certification or renewal certification is
eight hundred dollars.
(ii) The application fee
for a large agency provider (i.e., one that serves or plans to serve fifty-one
or more individuals) seeking initial certification or renewal certification is
one thousand six hundred dollars.
(b) Application fees for certification to provide additional home
and community-based services during the term of existing department-issued
certification
(i) The application fee
for a small agency provider (i.e., one that serves or plans to serve fifty or
fewer individuals) seeking certification to provide additional home and
community-based services is seventy-five dollars.
(ii) The application fee
for a large agency provider (i.e., one that serves or plans to serve fifty-one
or more individuals) seeking certification to provide additional home and
community-based services is one hundred fifty dollars.
(2) Applicants will pay
application fees by electronic check or credit card.
(3) Application fees are
non-refundable.
(4) The department will
invalidate a certification issued to an applicant whose application fees cannot
be collected due to non-sufficient funds available or for any other reason. An
agency provider whose certification is invalidated in accordance with this
paragraph will be required to initiate and submit an entirely new application
via the provider services management system.
(S) Certification terms
(1) Initial certification
will be issued for a term of three years.
(2) Renewal certification
will be issued for a term of three years.
(3) Certification to
provide additional home and community-based services will be issued for the
remainder of the term of the applicant's existing
certification.
(T) Denial, suspension, or revocation of
certification
(1) Agency providers are
subject to monitoring and compliance reviews as set forth in rules promulgated
by the department. Failure to comply with this rule or other rules governing
services provided by the agency provider may result in corrective action by the
department, up to and including suspension, summary suspension, denial, or
revocation of certification.
(2) The department may
deny, suspend, or revoke an agency provider's certification for good cause
pursuant to section 5123.166 of the Revised Code.
(3) When denying,
suspending, or revoking certification pursuant to this rule, the department
will comply with the notice and hearing requirements of Chapter 119. of the
Revised Code and section 5123.166 of the Revised Code.
(4) When the department
denies an application for renewal certification, the agency provider will
comply with the department's adjudication order within thirty calendar
days of the date of the mailing of the order.
(U) Department's authority to waive provisions of this
rule
(1) For good cause, the
department may waive a provision of this rule. The department's decision
to waive a provision of this rule will not be contrary to the rights, health,
or safety of individuals served.
(2) An agency provider or
applicant for agency provider certification may initiate a request for the
department to waive a provision of this rule by submitting the request with
justification in writing.
(a) The department may ask for input regarding the request from
individuals served, individuals' guardians, or county boards.
(b) The department will grant or deny a request within fourteen
calendar days of receipt of the request or within such longer period of time as
the department deems necessary and may put whatever conditions on approval as
determined to be necessary.
(c) The department's decision regarding a request to waive a
provision of this rule is not subject to appeal.
