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Rule 173-39-01 | ODA provider certification: introduction and definitions.
(A) Introduction: (1) This chapter
establishes the requirements for providers to become, and to remain, certified
by ODA, compliance reviews of ODA-certified providers, and disciplinary actions
that may be imposed upon ODA-certified providers. (2) Rule 5160-58-04 of
the Administrative Code requires providers to comply with many of the
requirements for providing services in this chapter when the provider provides
those services to individuals in the mycare Ohio program. (B) Definitions for this
chapter: "Activity of daily living" (ADL) has
the same meaning as in rule 5160-3-05 of the Administrative Code. "Activity plan" means a description of
interventions and the schedule for when to provide those interventions. "ADS" has the same meaning as in rule
173-39-02.1 of the Administrative Code. "Assistance with self-administration of
medication" has the same meaning as in paragraph (C) of rule 4723-13-02 of
the Administrative Code when an unlicensed person provides the
assistance. "Business site" includes any location
at which the provider retains records or provides services. "Business
site" does not include the home of an individual receiving services unless
the individual employs a participant-directed provider. "Caregiver" means a relative, friend,
or significant other who voluntarily provides assistance to the individual and
is responsible for the individual's care on a continuing basis. "Case manager" means the registered
nurse, licensed social worker, or licensed independent social worker that
ODA's designee employs to plan, coordinate, monitor, evaluate, and
authorize services for ODA-administered programs that require provider
certification under this chapter. "CDJFS" means county department of job
and family services. "Certification" means ODA's
approval of a provider to provide one or more of the services that this chapter
regulates. "CMS" means centers for medicare and
medicaid services. "Competency evaluation" includes both
standardized testing (whether written or electronic) and skills testing by
return demonstration to ensure an applicant or employee is able to address the
care needs of the individual to be served. "Complete application" means the
application and all records required by rule 173-39-03, 173-39-03.1,
173-39-03.2, 173-39-03.3, or 173-39-03.4 of the Administrative Code. Although
ODA cannot approve an application to become an ODA-certified assisted living
provider unless the RCF is licensed, the application is a complete application
if the provider indicates in its application that it applied for a RCF license
and the provider submits the required RCF licensure information to ODA as soon
as it is available. "Continuing care retirement
communities" has the same meaning as in rule 5160:1-6-02.3 of the
Administrative Code. "Current owner" means a person with an
ownership interest in an ODA-certified provider whose interest in the provider
is being sold or transferred. "Electronic record" has the same
meaning a sin section 1306.01 of the Revised Code. For a health care record,
"electronic record" has the same meaning as in section 3701.75 of the
Revised Code. "Electronic signature" has the same
meaning as in section 1306.01 of the Revised Code. If attached to, or
associated with, a health care record, "electronic signature" has the
same meaning as in section 3701.75 of the Revised Code. "Electronic visit verification" (EVV)
means using the ODM-approved EVV system to verify the provision of any service
required by ODM, pursuant to rule 5160-1-40 of the Administrative Code. "Emergency contact person" means a
person the individual or caregiver wants the provider to contact in the event
of an emergency to inform the person about the nature of the emergency. "HCBS" means home and community-based
services. "Health care record" has the same
meaning as in section 3701.75 of the Revised Code. Examples of a health care
record are a plan of treatment or diet order received from a licensed
healthcare professional. "HHS" means the United States
department of health and human services. "Incident" means any event or situation
that is not consistent with providing routine care or a service to an
individual that may result in injury to a person or damage to property or
equipment. Examples of an incident are abuse, neglect, abandonment, accidents,
and exploitation. An incident may involve an individual, a caregiver (to the
extent the event or situation impacts the individual), a provider, a facility,
or a staff member of a provider, facility, ODA, ODA's designee, or another
administrative authority. "Individual" has the same meaning in
rule 5160-31-02 of the Administrative Code. "Instrumental activity of daily living"
(IADL) has the same meaning as in rule 5160-3-05 of the Administrative
Code. "Licensed healthcare professional"
includes a physician with an "expedited license," as defined in
section 4731.11 of the Revised Code; or a licensed audiologist, occupational
therapist, occupational therapy assistant, physical therapist, physical therapy
assistant, or speech-language pathologist from another state with "compact
privilege," as defined in section 4753.17, 4755.14, or 4755.57 of the
Revised Code. Beginning on January 1, 2023, "licensed healthcare
professional" also includes an RN or LPN with a "multistate
license" from another state with "multistate licensure
privilege," as those terms are defined in section 4723.11 of the Revised
Code. "Licensed practical nurse" (LPN) has
the same meaning as in section 4723.01 of the Revised Code. Beginning on
January 1, 2023, "licensed practical nurse" also includes a licensed
practical nurse with a "multistate license" from another state with
"multistate licensure privilege," as those terms are defined in
section 4723.11 of the Revised Code. "Medicaid-provider agreement" means an
agreement between ODM and the provider. "Medicaid provider number" means a
number ODM issued to a provider with whom ODM has entered into a
medicaid-provider agreement. "National provider identifier" (NPI)
means a number issued to a provider by HHS. "Nursing facility" has the same meaning
as in section 5165.01 of the Revised Code. "ODA" means the Ohio department of
aging. "ODA-certified provider" means a
provider certified by ODA according to this chapter. "ODA's designee" means an entity
to which ODA delegates one or more of its administrative duties. ODA's
current designees include the area agencies on aging that ODA lists in rule
173-2-04 of the Administrative Code and "Catholic Social Services of the
Miami Valley." When "its designee" occurs after "ODA,"
it means "ODA's designee." "ODH" means the Ohio department of
health. "ODM" means the Ohio department of
medicaid. "Ownership interest" means interest
totaling five per cent or more in the provider, indirect ownership interest
equal to five percent or more in the provider, a combination of direct and
indirect ownership interest equal to five per cent or more in the provider; or
an interest of five per cent or more in any mortgage, deed of trust, note, or
other obligation if that interest equals at least five per cent of the value of
the property or assets of the provider. "PCA" means "personal care
aide." "Plan of treatment" means the orders of
a licensed healthcare professional whose scope of practice includes making
plans of treatment. "Provider" has the same meaning as in
section 173.39 of the Revised Code. ODA certifies the following categories of
providers: agency providers, assisted living providers, non-agency providers,
and participant-directed providers. "Agency provider" means a
legally-organized entity that employs staff. "Assisted living
provider" means a licensed residential care facility. "Non-agency
provider" (i.e., "self-employed provider") means a
legally-organized entity that is owned and controlled by one self-employed
person who does not employ, either directly or through a contract, anyone else
to provide services, and who is unsupervised. "Participant-directed
provider" means a person that an individual (participant) directly employs
and supervises to provide a service. "Provider agreement" means an agreement
between ODA's designee and the provider. "Region" means a distinct geographic
area in which ODA's designee administers the PASSPORT and assisted living
programs. Each region consists of the counties assigned to similarly-numbered
planning and service areas (PSAs) in rule 173-2-02 of the Administrative Code,
except for "PSA2." In that PSA, Clark, Greene, and Montgomery
counties comprise "Region 2" and Champaign, Darke, Logan, Miami,
Preble, and Shelby counties comprise "Region CSS." "Registered nurse" (RN) has the same
meaning as in section 4723.01 of the Revised Code. Beginning on January 1,
2023, "registered nurse" also includes a registered nurse with a
"multistate license" from another state with "multistate
licensure privilege," as those terms are defined in section 4723.11 of the
Revised Code. "Residential care facility" (RCF) has
the same meaning as in section 3721.01 of the Revised Code. "Service plan" means the outline of the
services that a case manager authorizes a provider to provide to an individual,
regardless of the funding source for those services. "Service plan"
includes the person-centered planning in rule 5160-44-02 of the Administrative
Code. "Services" has the same meaning as
"community-based long-term care services" in section 173.39 of the
Revised Code. "Significant change" means a variation
in the health, care, or needs of an individual that warrants further evaluation
to determine if changes to the type, amount, or scope of services are needed.
Significant changes include differences in health status, caregiver status,
residence, service location, service delivery, hospitalization, and emergency
department visits that result in the individual not receiving services for
thirty days. "Unique identifier" means an item
belonging to a specific individual, caregiver, driver (in the case of rule
173-39-02.13 of the Administrative Code), participant-directed provider (in the
cases of rules 173-39-02.4 and 173-39-02.11 of the Administrative Code), aide
(in the case of rule 173-39-02.8 of the Administrative Code), or PCA (in the
case of rule 173-39-02.20 of the Administrative Code) that identifies only that
individual or caregiver. Examples of a unique identifier are a handwritten or
electronic signature or initials, fingerprint, mark, stamp, password, barcode,
or swipe card. An individual, caregiver, driver, participant-directed provider,
aide, or PCA offers their unique identifier as an attestation that the
provider, or the provider's staff, completed an activity or unit of
service. "Vocational program" means a planned
series, or a sequence of courses or modules, that incorporate challenging,
academic education and rigorous, performance-based training to prepare
participants for success in a particular health care career or
occupation.
Last updated March 27, 2024 at 9:16 AM
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Rule 173-39-02 | ODA provider certification: requirements for providers to become, and to remain, certified.
Introduction: This rule presents requirements for
every type of provider to become, and to remain, certified. For agency and
assisted living providers, the requirements in this rule include requirements
for each provider's employees. (A) Requirements for every type of
provider to become certified: (1) Qualifications: The
provider shall meet all of the following: (a) Any qualification (e.g., licensure, training requirements,
staffing levels) required by this chapter. (b) Any qualification (e.g., licensure, certification,
registration) required by applicable federal, state, and local laws, including
the requirement under 45 C.F.R. Part 162 to have a national provider identifier
(NPI), if applicable. (2) Criminal records checks and database
reviews: Sections 173.38 and 173.381 of the Revised Code and Chapter 173-9 of
the Administrative Code establish the requirements for criminal records checks
and database reviews. Rule 173-9-02 of the Administrative Code lists exceptions
to the applicability of those requirements. Rule 5160-1-17.8 of the
Administrative Code establishes additional provider screening requirements for
participation in a medicaid-funded program. (3) Business site: (a) The provider shall maintain a business site(s) from which to
conduct business, unless the provider is a participant-directed
provider. (b) The provider's business site(s) for providing services
are subject to the HCBS setting requirements in rule 5160-44-01 of the
Administrative Code. Additionally, any such business site used for providing
ADS or assisted living services may be subject to federal heightened scrutiny
under 42 C.F.R. 441.301(c)(5)(v) and rules 173-39-03 and 173-39-03.1 of the
Administrative Code. (c) Each business site in which the provider retains records
(e.g., headquarters, regional offices) shall have a designated, locked storage
space for retaining records that is accessible to ODA and its designee, HHS,
the state auditor's office, and ODM. (4) Contact information: The provider
shall have a valid email address and telephone number. (5) Insurance: The provider shall have
the following, unless the provider is a participant-directed
provider: (a) A minimum of one million dollars in commercial liability
insurance, which includes coverage for individuals' losses due to theft or
property damage. In lieu of commercial liability insurance, a non-agency
provider may have a minimum of one million dollars in professional liability
insurance, which includes coverage for individuals' losses due to theft or
property damage. (b) Written instructions any individual may use to obtain payment
for loss due to theft or property damage caused by the provider, or if
applicable, the provider's employee. (6) Provider agreements: The provider
shall enter into, comply with, and maintain an active status with the
following: (a) A medicaid provider agreement under rules 5160-1-17.2 and
5160-1-17.4 of the Administrative Code. (b) A provider agreement with ODA's designee for the region
in which the provider seeks certification to provide services pursuant to rule
173-39-03 of the Administrative Code. (7) Incident reporting: The provider
shall have a written or electronic policy on documenting incidents which
complies with paragraph (B)(3)(b) of this rule. (8) Electronic visit verification (EVV):
Rule 5160-1-40 of the Administrative Code establishes the requirements for
certain providers to have an ODM-approved EVV system in place. (B) Requirements for every type of
provider to remain certified: (1) Continuation: The
provider shall remain in compliance with all requirements under paragraph (A)
of this rule. (2) Service-related: For
any service ODA certified the provider to furnish, the provider shall report
all mandatory reporting items to verify the service to ODA or its designee and
comply with any rule in this chapter regulating the provision of the
service. (3) Reporting: (a) APS: Section 5101.63 of the Revised Code, as applicable,
establishes a requirement for the provider to report any reasonable cause to
believe an individual suffered abuse, neglect, or exploitation to the local
adult protective services program. The provider shall also notify ODA or its
designee within one business day after becoming aware of the reasonable
cause. (b) Significant changes: The provider shall notify ODA or
its designee no later than one business day after the provider is aware of any
significant change that may affect the individual's service needs or
safety, including one or more of the following: (i) The provider does not
provide an authorized service at the time, or for the period of time,
authorized by ODA's designee. (ii) The individual moves
to another address. (iii) The
individual's repeated refusal of services. (iv) Any incident that is subject to the incident-reporting
requirements in rule 5160-44-05 of the Administrative Code. (v) Any other significant change in the individual's
physical, mental, or emotional status or the individual's environment that
affects the individual's service needs or safety. (c) Contact information: The provider shall notify ODA or
its designee of any change in the provider's telephone number, mailing
address, or email address within seven days after the change. (d) Last day of service: Unless the provider is an assisted
living provider, the provider shall notify the individual and ODA's
designee in writing at least thirty days before the last day the provider
provides services to the individual, unless one or more of the following
occurs: (i) The individual has
been hospitalized, placed in a long-term care facility, or is
deceased. (ii) The health or safety
of the individual or provider is at serious, imminent risk. (iii) The individual
chooses to no longer receive services from the provider. (4) Confidentiality: The provider is
subject to all state and federal laws and regulations governing individual
confidentiality including sections 5160.45 to 5160.481 of the Revised Code, 42
C.F.R. 431.300 to 431.307, and 45 C.F.R. parts 160, 162, and 164. (5) Legally-responsible family members:
The provider shall not provide a service to an individual if the provider is
the individual's spouse, parent, step-parent, legal guardian, power of
attorney, or authorized representative. During a state of emergency declared by
the governor or a federal public health emergency, a provider may provide a
service to an individual if the provider is the individual's spouse,
parent, or step-parent. The period in which a spouse, parent, or step-parent is
qualified to provide a service to an individual during a state of emergency
declared by the governor or a federal public health emergency ends when the
provider's medicaid provider agreement is terminated. (6) Volunteers: The provider shall
supervise the provider's volunteers. (7) Person-centered planning: The
provider is subject to the person-centered planning requirements in rule
5160-44-02 of the Administrative Code. (8) Ethical, professional, respectful,
and legal service standards: The provider shall not engage in any unethical,
unprofessional, disrespectful, or illegal behavior including the
following: (a) Consuming alcohol while providing services to the
individual. (b) Consuming medicine, drugs, or other chemical substances in a
way that is illegal, unprescribed, or impairs the provider from providing
services to the individual. (c) Accepting, obtaining, or attempting to obtain money, or
anything of value, including gifts or tips, from the individual or his or her
household or family members. (d) Engaging the individual in sexual conduct, or in conduct a
reasonable person would interpret as sexual in nature, even if the conduct is
consensual. (e) Leaving the individual's home when scheduled to provide
a service for a purpose not related to providing the service without notifying
the agency supervisor, the individual's emergency contact person, any
identified caregiver, or ODA's designee. (f) Failing to cooperate with or treating ODA or its designee
respectfully. (g) Engaging in any activity while providing a service that may
distract the provider from providing the service as authorized, including the
following: (i) Watching television,
movies, videos, or playing games on computers, personal phones, or other
electronic devices whether owned by the individual, provider, or the
provider's staff. (ii) Non-care-related
socialization with a person other than the individual (e.g., a visit from a
person who is not providing care to the individual; making or receiving a
personal telephone call; or, sending or receiving a personal text message,
email, or video). (iii) Providing care to a
person other than the individual. (iv) Smoking tobacco or
any other material in any type of smoking equipment, including cigarettes,
electronic cigarettes, vaporizers, hookahs, cigars, or pipes. (v) Sleeping. (vi) Bringing a child,
friend, relative, or anyone else, or a pet, to the individual's place of
residence. (vii) Discussing religion
or politics with the individual and others. (viii) Discussing
personal issues with the individual or any other person. (h) Engaging in behavior that causes, or may cause, physical,
verbal, mental, or emotional distress or abuse to the individual including
publishing photos of the individual on social media without the
individual's written or electronic consent. (i) Engaging in behavior a reasonable person would interpret as
inappropriate involvement in the individual's personal
relationships. (j) Making decisions, or being designated to make decisions, for
the individual in any capacity involving a declaration for mental health
treatment, power of attorney, durable power of attorney, guardianship, or
authorized representative. (k) Selling to, or purchasing from, the individual products or
personal items, unless the provider is the individual's family member who
does so only when not providing services. (l) Consuming the individual's food or drink, or using the
individual's personal property without his or her consent. (m) Taking the individual to the provider's business site,
unless the business site is an ADS center, RCF, or (if the provider is a
participant-directed provider) the individual's home. (n) Engaging in behavior constituting a conflict of interest, or
taking advantage of, or manipulating services resulting in an unintended
advantage for personal gain that has detrimental results to the individual, the
individual's family or caregivers, or another provider. (9) Training: The provider shall
participate in ODA's or its designee's mandatory free provider
training sessions. (10) Records and monitoring: (a) Records retention: (i) Service records: The
provider shall retain all records necessary (including activity plans,
assessments (if required), permits (if required), and all mandatory reporting
items to verify an episode of service), and in such form, so as to fully
disclose the extent of the services the provider provided, and significant
business transactions, until all of the following periods of time have
passed: (a) Six years after the date the provider receives payment for
the service. (b) The date on which ODA, its designee, ODM, or a
duly-authorized law enforcement official concludes a review of the records and
any findings are resolved. (c) The date on which the auditor of the state of Ohio, the
inspector general, or a duly-authorized law enforcement official concludes an
audit of the records and any findings are resolved. (ii) Qualification
records: Each provider shall retain all records regarding the provider's
or an employee's qualifications to provide a service for the duration of
the provider's certification or the duration of the employee's
employment and for six years after the provider is no longer certified or no
longer retains the employee. Qualification records include records on
background checks, initial qualifications, orientation, and
training. (iii) Electronic records:
The provider may use an electronic system to collect or retain
records. (b) Compliance reviews: The provider shall participate in good
faith in any compliance reviews under rule 173-39-04 of the Administrative Code
and assist ODA and its designee with scheduling those reviews. (c) Access: The provider shall, upon request, immediately provide
representatives of ODA, its designee, HHS, the state auditor's office, and
ODM with access to its business site(s) during the provider's normal
business hours, a place to work in its business site(s), and access to
policies, procedures, and records for each unit of service billed. (11) Payment: (a) The provider may bill for a service only if the provider
complies with the requirements under all applicable laws, rules, and
regulations, including service-verification requirements. (b) ODA's obligation to pay the provider for the costs of
services provided as a certified provider is subject to the hold and review
process described in rule 5160-1-27.2 of the Administrative Code. (c) The provider shall accept the payment rates established in
its provider agreement with ODA's designee as payment in full for the
services it provides, and not seek any additional payment for services from the
individual or any other person. (d) The provider may provide a service not authorized by the
individual's person-centered services plan, but ODA (or its designee) pays
a provider only for providing services authorized by the individual's
person-centered services plan. (12) Other laws: The provider is subject
to all applicable federal, state, and local laws, rules, and regulations and is
responsible for ensuring all subcontractors comply with all applicable federal,
state, and local laws, rules, and regulations. (13) Rules updates: The
provider shall subscribe to receive email updates on ODAs rules on
https://aging.ohio.gov. (C) Requirements for specific types of
providers to become certified: (1) Agency
providers: (a) Disclosures: The provider shall disclose the
following: (i) The name of any
person with an ownership interest in the provider. (ii) The name of any
person with an ownership interest in the provider who was convicted of a felony
under a state or federal law. (iii) A table of
organization clearly identifying lines of administrative, advisory,
contractual, and supervisory responsibilities. (iv) The active
registration as a business entity with the Ohio secretary of
state. (b) Statements: The provider shall provide ODA or its
designee with statements on the following: (i) The purpose of the
provider's business. (ii) The provider's
compliance with 45 C.F.R. 80.4 regarding the provision of
services. (iii) The provider's
compliance with the Equal Employment Opportunity Act of 1972, federal
wage-and-hour laws, and workers' compensation laws regarding the
recruitment and employment of persons. (iv) The provider's
payment of all applicable federal, state, and local income and employment taxes
for the most recent year. (c) Policies: The provider shall have written policies,
bylaws, or articles of incorporation (or an electronic record of policies,
bylaws, or articles of incorporation) that include requirements for its
employees to provide services in a manner compliant with paragraph (B)(8) of
this rule. (2) Non-agency providers:
The provider shall provide a statement to ODA or its designee certifying that
he or she paid all applicable federal, state, and local income and employment
taxes. (3) Participant-directed
providers: A person may qualify to become a participant-directed provider only
if the person meets the requirements in rule 173-39-02.4 of the Administrative
Code. (4) Assisted living
providers: (a) Preemption: The provider shall acknowledge that any statute
governing, or rule regulating, the assisted living program supersedes any
clause in the RCF's resident agreement. (b) License: The provider shall have an RCF license issued under
Chapter 3701-16 of the Administrative Code and comply with section 3721.121 of
the Revised Code. (c) Identifying key persons: The provider shall disclose the
following: (i) The name of any
person with an ownership interest in the provider. (ii) The name of any
person with an ownership interest in the provider who was convicted of a felony
under a state or federal law. (iii) A table of
organization clearly identifying lines of administrative, advisory,
contractual, and supervisory responsibilities. (d) Statements: The provider shall provide ODA or its designee
with statements on the following: (i) The provider's
compliance with 45 C.F.R. 80.4 regarding the provision of
services. (ii) The provider's
compliance with the Equal Employment Opportunity Act of 1972, federal
wage-and-hour laws, and workers' compensation laws regarding the
recruitment and employment of persons. (e) Policies: The provider shall have written policies, bylaws,
or articles of incorporation (or an electronic record of policies, bylaws, or
articles of incorporation) that include the following: (i) A requirement for the
residents' rights policy that the provider adopts under section 3721.12 of
the Revised Code to apply the prohibition against unethical, unprofessional,
disrespectful, or illegal behavior under paragraph (B)(8) of this rule to its
employees. (ii) A requirement for
the policy that the provider adopts under rule 3701-64-02 of the Administrative
Code on reporting abuse, neglect, or exploitation to ODH to apply the
requirement under paragraph (B)(3)(a) of this rule to report abuse, neglect, or
exploitation to ODA or its designee to its employees. (iii) A requirement for
the policy that the provider adopts under paragraph (B) of rule 3701-16-12 of
the Administrative Code to apply the requirement under paragraph (B)(3)(b) of
this rule to report incidents to ODA or its designee to its
employees. (D) Requirements for specific types of
providers to remain an ODA-certified provider: (1) Agency providers: The
provider shall remain in compliance with all requirements under paragraphs (B)
and (C)(1) of this rule. (2) Non-agency providers:
The provider shall remain in compliance with all requirements under paragraphs
(B) and (C)(2) of this rule. (3) Participant-directed
providers: (a) Continuation: The provider shall remain in compliance with
all requirements under paragraphs (B) and (C)(3) of this rule. (b) Records retention: In addition to the records-retention
requirements under paragraph (B)(10)(a) of this rule, the provider shall store
the individual's records in the home of the individual in a physical
location or an electronic device that is accessible to the provider,
individual, and ODA or its designee. (4) Assisted living
providers: (a) Continuation: The provider shall remain in compliance with
all requirements under paragraphs (B) and (C)(4) of this rule. (b) Payment: (i) The assisted living
program does not pay for any service the provider provides to an individual
before ODA's designee enrolls the individual into the program and before
ODA's designee authorizes the service in the individual's
person-centered services plan. (ii) If an individual is
absent from the RCF, the provider shall not accept a payment for the service
under rules 173-39-02.16 and 5160-33-07 of the Administrative Code or charge
the individual an additional fee for the service or to hold the unit during the
individual's absence. (c) Transfers/discharges: Section 3721.16 of the Revised Code
establishes the terms for transferring or discharging an
individual. (d) Last day of service: If the provider terminates its
medicaid-provider agreement, pursuant to section 3721.19 of the Revised Code,
it shall provide written notification to the individual and to ODA's
designee at least ninety days before terminating the provision of services to
the individual.
Last updated April 12, 2024 at 11:08 AM
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Rule 173-39-02.1 | ODA provider certification: adult day service.
Effective:
December 1, 2023
(A) "Adult day service" ("ADS") means a regularly-scheduled service provided at an adult day center (center) in a non-institutional, community-based setting and consisting of the activities authorized in an individual's person-centered services plan. ADS includes recreational and educational programming to support an individual's health and independence goals; at least one, but no more than two, meals per day; and, sometimes, health status monitoring, skilled therapy services, and transportation to and from the center. Table 1 to this rule defines the levels and activities of ADS. | ENHANCED ADS | INTENSIVE ADS | | Structured activity programming | Yes | Yes | | Health assessments | Yes | Yes | | Supervision of ADLs | All ADLs | All ADLs | | Hands-on assistance with ADLs | Yes, one or more ADL (bathing excluded) | Yes, minimum of two ADLs (bathing included) | | Hands-on assistance with medication administration | Yes | Yes | | Comprehensive therapeutic activities | Yes | Yes | | Monitoring of health status | Intermittent | Regular, with intervention | | Hands-on assistance with personal hygiene activities | Yes | Yes | | Social work services | No | Yes | | Skilled nursing services and rehabilitative nursing services | No | Yes | | Rehabilitative and restorative services | No | Yes |
(B) Requirements to become, and to remain, an ODA-certified provider of ADS: (1) General requirements: The provider is subject to rule 173-39-02 of the Administrative Code. (2) Service requirements: (a) Transportation: The provider shall transport each individual to and from the center by performing transportation that complies with rule 173-39-02.18 of the Administrative Code, unless the provider subcontracts with another provider that complies with rule 173-39-02.18 of the Administrative Code, or unless the caregiver transports or designates another person, other than the center's provider, to transport the individual to and from the center. (b) Provider's initial assessment: (i) The provider shall assess the individual before the end of the individual's second day of attendance at the center. The provider may substitute a copy of the case manager's assessment of the individual if the case manager assessed the individual no more than thirty days before the individual's first day of attendance at the center. (ii) The initial assessment shall include both of the following components: (a) The individual's functional, cognitive, and social needs. (b) A social profile including social activity patterns, major life events, community services, caregiver data, formal and informal support systems, and behavior patterns. (c) Health assessment: No later than thirty days after the individual's initial attendance at the center or before the individual receives the first ten units of service at the center, whichever comes first, the provider shall obtain a health assessment of each individual from a licensed healthcare professional whose scope of practice includes health assessments or an employee who is such a licensed healthcare professional to perform a health assessment of each individual. The health assessment shall include the individual's psychosocial profile and identify the individual's risk factors, diet, and medications. If the licensed healthcare professional who performs the health assessment is not an employee of the provider, the provider shall retain a record of the professional's name and phone number. (d) Activity plan: No later than thirty days after the individual's initial attendance at the center or before the individual receives the first ten units of service at the center, whichever comes first, the provider shall obtain the services of a licensed healthcare professional whose scope of practice includes developing activity plans to draft an activity plan for each individual or an employee who is such a licensed healthcare professional to draft an activity plan for each individual. The plan shall do all of the following: (i) Identify the individual's strengths, needs, problems or difficulties, and objectives. (ii) Describe the individual's interest, preferences, and social rehabilitative needs. (iii) Describe the individual's health needs. (iv) Describe the individual's specific goals, objectives, and planned interventions of ADS that meet the goals. (v) Describe the individual's level of involvement in the drafting of the plan, and, if the individual has a caregiver, the caregiver's level of involvement in the drafting of the plan. (vi) Describe the individual's ability to provide a unique identifier as an attestation that the provider, or the provider's staff, completed an activity or unit of service. (e) Plan of treatment: Before administering medication or meals with a therapeutic diet, and before providing a nursing service, nutrition consultation, physical therapy, or speech therapy, the provider shall obtain a plan of treatment from a licensed healthcare professional whose scope of practice includes making plans of treatment. The provider shall obtain the plan of treatment at least every ninety days for each individual that receives medication, a nursing service, nutrition consultation, physical therapy, or speech therapy. For diet orders that may be part of a plan of treatment, a new diet order is not required every ninety days. Instead, the provider is subject to the diet-order requirements for therapeutic diets under rule 5160-44-11 of the Administrative Code. (f) Interdisciplinary care conference (conference): (i) Frequency: The provider shall conduct a conference for each individual at least once every six months. (ii) Participants: The provider shall conduct the conference between the provider's staff and invitees who choose to participate. At least seven days before the conference begins, the provider shall invite the following persons to participate in the conference and provide those persons with the date and time of the conference: (a) The individual's case manager. (b) Any licensed healthcare profession who does not work for the provider, but who provided the provider with a health assessment of the individual or an activity plan for the individual. (c) The individual's caregiver, if the individual has a caregiver. (iii) Revise activity plan: If the conference participants identify changes in the individual's health needs, condition, preferences, or responses to the service, the provider shall obtain the services of a licensed healthcare professional whose scope of practice includes developing activity plans to revise the activity plan accordingly or an employee who is such a licensed healthcare professional to revise the activity plan accordingly. (g) Activities: The provider shall announce daily and monthly planned activities through two or more of the following media: (i) Posters in prominent locations throughout the center. (ii) An electronic display (e.g., a television) in a prominent location in the center. (iii) The center's website. (iv) Email sent to individuals (and others) who agree to receive the email. (v) Monthly newsletters distributed to individuals by mail, email, or at the center. (h) Lunch and snacks: (i) The provider shall provide lunch and snacks to each individual who is present during lunchtime or snack time. (ii) Each meal the provider provides shall comply with all the requirements for home-delivered meals under rules 173-39-02.14 and 5160-44-11 of the Administrative Code, except for the requirements in those rules pertaining to the delivery of the meal. (3) Center requirements: A provider qualifies to be an ODA-certified ADS provider only if the provider's center has the following specifications: (a) If the center is housed in a building with other services or programs other than ADS, the provider uses a separate, identifiable space and staff for ADS during all hours that the provider provides ADS in the center. (b) The center complies with the "ADA Accessibility Guidelines for Buildings and Facilities" in appendix A to 28 C.F.R. part 36. (c) The center has at least sixty square feet per individual that it serves (not just individuals who are enrolled in an ODA-administered program), excluding hallways, offices, rest rooms, and storage areas. (d) The provider stores individuals' medications in a locked area the provider maintains at a temperature complying with the storage requirements of the medications. (e) The provider stores toxic substances in an area which is inaccessible to individuals. (f) The center has at least one working toilet for every ten individuals present that the center serves (not just individuals who are enrolled in an ODA-administered program) and at least one wheelchair-accessible toilet. (g) If the center seeks certification to provide intensive ADS, the center has bathing facilities suitable to the needs of individuals who need intensive ADS. (4) Staffing levels: (a) The provider shall have at least two staff members present, with at least one of those staff members having a certification in CPR, when more than one individual is present in the center. (b) The provider shall maintain a staff-to-individual ratio of at least one staff member to six individuals at all times. (c) The provider shall have an RN, or LPN under the direction of an RN, available to provide nursing services that need the skills of an RN, or LPN under the direction of an RN, and that are based on the needs of the individuals and within the nurse's scope of practice. (d) The provider shall employ an activity director to direct activities. (5) Provider qualifications: (a) Type of provider: (i) Only an agency provider qualifies for ODA's certification to provide ADS. (ii) For each provider that ODA certifies, ODA shall certify the provider as an enhanced or intensive provider. If ODA certifies a provider to provide an intensive service level, the provider may also directly provide, or arrange for, the enhanced service level. (b) Staff qualifications: (i) Every person who is an RN, LPN under the direction of an RN, social worker, physical therapist, physical therapy assistant, speech therapist, licensed dietitian, occupational therapist, occupational therapy assistant, or other licensed professional qualifies to practice in the center only if the person has a current, valid license to practice in their profession. (ii) A person qualifies to be an activity director only if the person has at least one of the following: (a) A baccalaureate or associate degree in recreational therapy or a related degree. (b) At least two years of experience as an activity director, activity coordinator, or a related position. (c) Compliance with the qualifications under rule 3701-17-07 of the Administrative Code for directing resident activities in a nursing home. (d) A certification from the national certification council for activity professionals (NCCAP). (iii) A person qualifies to be an activity assistant only if the person has at least one of the following: (a) A high school diploma. (b) A high school equivalence diploma as defined in section 5107.40 of the Revised Code. (c) At least two years of employment in a supervised position to provide personal care, to provide activities, or to assist with activities. (iv) A person qualifies to be a PCA only if the person has at least one of the following: (a) A high school diploma. (b) A high school equivalence diploma as defined in section 5107.40 of the Revised Code. (c) At least two years of employment in a supervised position to provide personal care, to provide activities, or to assist with activities. (d) The successfully completion of a vocational program in a health or human services field. (v) A person qualifies to transport individuals for the provider only if the person meets the qualifications for drivers under rule 173-39-02.18 of the Administrative Code. (c) Staff training: (i) Orientation: The provider shall comply with the requirements for the orientation of PCAs in rule 173-39-02.11 of the Administrative Code. (ii) Task-based training: Before each new PCA provides ADS, the provider shall provide task-based training. (iii) Continuing education and in-service training: Each PCA, activity director, and activity assistant shall successfully complete at least eight hours of continuing education or in-service training each calendar year. Any hour of continuing education or in-service training successfully completed during a calendar year to comply with the requirements for certification as an activity director or activity assistant counts towards the eight-hour requirement in this paragraph. (iv) Verification of compliance: The provider shall comply with paragraph (C)(3)(f) of rule 173-39-02.11 of the Administrative Code regarding records of each PCA's successful completion of any training and competency evaluation program, orientation, and in-service training. (6) Service verification: The following are the mandatory reporting items that a provider retains for each ADS session to comply with the requirements under paragraph (B)(10)(a)(i) of rule 173-39-02 of the Administrative Code: (a) Individual's name. (b) Service date. (c) Individual's arrival time. (d) Individual's departure time. (e) Individual's mode of transportation. (f) Unique identifier of the individual to attest to receiving the service. (C) Units and rates: (1) For the PASSPORT program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the following: (a) The units of ADS attendance. (b) The units of ADS transportation. (c) The maximum rates allowable per unit of ADS attendance or ADS transportation. (2) For the PASSPORT program, the rate-setting methodology is established in rule 5160-31-07 of the Administrative Code and in the following paragraphs: (a) Attendance: (i) Units of ADS attendance are calculated as follows: (a) One-half day unit is less than four hours of ADS per day. (b) One day unit is four to eight hours of ADS per day. (c) A fifteen-minute unit is each fifteen-minute period of time over eight hours up to, and including, a maximum of twelve hours of ADS per day. (ii) A unit of ADS attendance does not include transportation time. (b) Transportation: If the service is provided to an individual enrolled in the PASSPORT program, a unit of ADS transportation is a round trip, a one-way trip, or one mile with the trip cost based on a case manager's pre-determined calculation of distance between the individual's home and the center multiplied by an established ADS mileage rate. If the provider provides the transportation simultaneously to more than one PASSPORT-enrolled individual who resides in the same household in the same vehicle to the same destination, the provider's payment rate for that trip is seventy-five per cent of the per-unit rate.
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Rule 173-39-02.2 | ODA provider certification: alternative meals.
(A) "Alternative meals" means a
participant-directed service for sustaining an individual's health by
enabling the individual to procure up to two meals per day from a
non-traditional provider, such as a restaurant, but not an adult day
center. (B) Every ODA-certified provider of
alternative meals shall comply with the following requirements: (1) General
requirements: (a) The provider shall comply with the requirements for
every ODA-certified provider in rule 173-39-02 of the Administrative
Code. (b) The provider shall comply with all the requirements for
home-delivered meals in rule 173-39-02.14 of the Administrative Code except the
rule's delivery requirements. (2) Provider
qualifications: Only an ODA-certified agency provider shall provide alternative
meals. (C) Unit and rate: (1) A unit of an
alternative meals equals one meal provided according to this rule. (2) The maximum rate
allowable for one unit of an alternative meals is listed in appendix A to rule
5160-1-06.1 of the Administrative Code. (3) The rates are subject
to the rate-setting methodology in rule 5160-31-07 of the Administrative
Code.
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Rule 173-39-02.4 | ODA provider certification: choices home care attendant service.
(A) "Choices home care attendant
service" (service) means a service that provides one or more of the
following activities to support the needs of an individual with impaired
physical or cognitive functioning: (1) Assisting the
individual with money management and correspondence as directed by the
individual, managing the home, handling personal affairs, and providing
assistance with self-administration of medications, as defined in rule
173-39-01 of the Administrative Code. (2) Assisting the
individual with ADLs and IADLs. (3) Homemaker activities
listed in rule 173-39-02.8 of the Administrative Code when those activities are
specified in the individual's service plan and are incidental to the
activities in paragraphs (A)(1) and (A)(2) of this rule or are essential to the
health and welfare of the individual instead of other persons living with the
individual. (4) Providing respite
services to the individual's caregiver. (5) Escort and
transportation. (6) Providing an errand
outside of the presence of the individual that is needed by the individual to
maintain the individual's health and safety (e.g., picking up a
prescription or groceries for the individual). (7) The activities
included in home maintenance and chores under rule 5160-44-12 of the
Administrative Code, including seasonal yard care and snow
removal. (B) Requirements for an ODA-certified
provider of the choices home care attendant service: (1) The provider is
subject to rule 173-39-02 of the Administrative Code. (2) Availability and
scheduling: (a) The provider shall maintain availability to provide
this service as agreed upon with the individual and as authorized in the
individual's person-centered services plan. (b) No participant-directed provider may provide this
service in excess of the following limits: (i) To more than five
individuals per week. (ii) For more than forty
hours per week for any individual who employs the provider, unless the
individual's case manager authorizes working more than forty hours per
week due to an emergency that cannot be resolved by allowing another provider
to provide the service after the fortieth hour. (iii) For more than a
total of fifty-six hours per week regardless of the number of individuals who
employ the provider. (3) Oversight: The individual who
receives this service is the employer of record. As used in this paragraph,
"employer of record" means the individual who employs the provider;
supervises the provider; pays the appropriate state, federal, and local taxes;
and pays premiums for worker's compensation and unemployment compensation
insurance. A financial management service (FMS) acts as the agent of the
common-law employer with the participant-directed provider the individual
employs. (4) Provider qualifications: (a) Initial qualifications: A person may qualify to provide
this service only if the person meets all the following
qualifications: (i) The person is an ODA-certified participant-directed
provider or an ODA-certified agency provider. (ii) The person is at least eighteen years of
age. (iii) The person has a valid social security number and at
least one of the following current, valid, government-issued, photographic
identification cards: (a) Driver's license. (b) State of Ohio identification card. (c) United States of America permanent residence
card. (iv) The person reads, writes, and understands English at a
level which enables the person to comply with this rule and rule 173-39-02 of
the Administrative Code. (v) The person is able to effectively communicate with the
individual. (b) Qualifications to transport the
individual: (i) If the provider
intends to transport the individual, before providing the first episode of
transportation, the provider shall show ODA's designee a valid
driver's license and valid insurance identification card to show that the
provider has liability insurance for driving a vehicle which complies with the
financial responsibility requirements in Chapter 4501:1-02 of the
Administrative Code. A provider may transport an individual in a vehicle only
if ODAs designee has verified that the vehicle is insured. (ii) If the provider does
not intend to transport the individual, the provider shall provide a written or
electronic attestation to ODA's designee declaring the provider will not
transport the individual unless the provider complies with paragraph (B)(4)(b)
of this rule before the first episode of transportation. (c) Initial training: The provider shall successfully
complete any training that the individual determined the provider needs to meet
the individual's specific needs by the deadline the individual
establishes. (d) Continuing education: The provider shall successfully
complete eight units of training that the individual determined the provider
needs to meet the individual's specific needs by the deadline the
individual establishes, but no later than the provider's anniversary
certification date. A unit of training includes a course or training activity
lasting up to an hour. (5) Service verification: (a) Until rule 5160-1-40 of the Administrative Code
requires a provider of this service to use EVV, the following are the mandatory
reporting items that a provider retains on a time sheet that the individual
provides through the FMS for each episode of service to comply with the
requirements under paragraph (B)(10)(a)(i) of rule 173-39-02 of the
Administrative Code: (i) Individual's
name. (ii) Service
date. (iii) Provider's
name. (iv) Provider's
arrival time. (v) Provider's
departure time. (vi) Unique identifier of
the individual to attest to receiving the service. (vii) Unique identifier
of the provider to attest to providing the service. (b) The following are the mandatory reporting items that a
provider retains on a task sheet that the individual provides through the FMS
for each episode of service to comply with the requirements under paragraph
(B)(10)(a)(i) of rule 173-39-02 of the Administrative Code: (i) Description of the
activities provided. (ii) Unique identifier of
the provider to attest to providing the service. (iii) Unique identifier
of the individual to attest to receiving the service. (C) Unit and rates: (1) For the PASSPORT
program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the
following for the choices home care attendant service: (a) The unit as fifteen minutes. (b) The maximum rate allowable for a unit. (2) For the PASSPORT
program, rule 5160-31-07 of the Administrative Code establishes the
rate-setting methodology for the choices home care attendant
service.
Last updated April 12, 2024 at 11:33 AM
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Rule 173-39-02.5 | ODA provider certification: home maintenance and chores.
(A) "Home maintenance and
chores" means the service defined in rule 5160-44-12 of the Administrative
Code. (B) Every ODA-certified provider of home
maintenance and chores shall comply with the following
requirements: (1) General requirements:
The provider shall comply with the requirements for every ODA-certified agency
provider in rule 173-39-02 of the Administrative Code. (2) Requirements specific
to home maintenance and chores: The provider shall comply with the requirements
in rule 5160-44-12 of the Administrative Code. (3) If a conflict exists
between a requirement in rule 173-39-02 of the Administrative Code and a
requirement in rule 5160-44-12 of the Administrative Code, the provider shall
comply with the requirement in rule 173-39-02 of the Administrative
Code. (C) Units and rates: (1) One unit of home
maintenance and chores is one job. (2) Appendix A to rule
5160-1-06.1 of the Administrative Code establishes the maximum-allowable rate
per job. (3) Rule 5160-31-07 of
the Administrative Code requires the unit rate to be negotiated between the
provider and ODA's designee. The negotiated rate shall include all
administrative, labor, and material costs for a specific job. The provider
shall not bill ODA's designee for any amount in excess of the negotiated
rate, unless ODA's designee revises the negotiated rate in one of the
following situations: (a) ODA's designee revises the rate before the
provider begins the job. (b) ODA's designee revises the rate to coincide with
authorizing the provider to address an unforeseen issue as part of the original
job.
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Rule 173-39-02.6 | ODA provider certification: personal emergency response system.
Effective:
January 1, 2019
(A) "Personal emergency response
system" ("PERS") means the service defined in rule 5160-44-16 of
the Administrative Code. (B) Every ODA-certified provider of PERS
shall comply with the following requirements: (1) General requirements:
The provider shall comply with the requirements for every ODA-certified agency
provider in rule 173-39-02 of the Administrative Code. (2) PERS-specific
requirements: The provider shall comply with the requirements in rule
5160-44-16 of the Administrative Code. (3) If a conflict exists
between a requirement in rule 173-39-02 of the Administrative Code and a
requirement in rule 5160-44-16 of the Administrative Code, the provider shall
comply with the requirement in rule 173-39-02 of the Administrative
Code. (C) Units and rates: (1) Two types of PERS units: (a) Monthly PERS: One
unit of monthly PERS is one or more days of PERS in a month. (b) PERS installation:
The one-time cost for installing PERS equipment, the initial training of the
individual on how to use the PERS equipment, the initial response plan, the
initial training of responders, and verifying the success of the
individuals return demonstration. (2) Appendix A to rule
5160-1-06.1 of the Administrative Code establishes the rates for PERS
units. (3) Rule 5160-31-07 of
the Administrative Code establishes rate-setting methodology for PERS
units.
Last updated April 12, 2024 at 11:33 AM
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Rule 173-39-02.7 | ODA provider certification: home medical equipment and supplies.
(A) "Home medical equipment and
supplies" (HME) means a service providing rented or purchased home medical
equipment and supplies to individuals to enable those individuals to function
safely in their homes with greater independence, thereby eliminating the need
for placement in a nursing facility. HME is limited to equipment and supplies allowed
under Chapter 5160-10 of the Administrative Code, miscellaneous equipment and
supplies, equipment repairs, and equipment and supplies not paid (in full or in
part) by medicare, state plan medicaid, or another third-party payer. (B) Requirements for ODA-certified providers of home medical
equipment and supplies: (1) General requirements:
The agency provider shall comply with the requirements for every ODA-certified
agency provider in rule 173-39-02 of the Administrative Code and the non-agency
provider shall comply with the requirements for every ODA-certified agency
provider in rule 173-39-02 of the Administrative Code. (2) Ongoing assistance:
The provider shall provide professional, ongoing assistance when needed to
evaluate and adjust equipment and supplies delivered, and/or to instruct the
individual or the individuals caregiver in the use of equipment and
supplies. (3) Repairs and
replacements: The provider shall assume liability for equipment warranties and
shall install, maintain, and/or replace any defective parts or items specified
in those warranties. Replacement items or parts for HME are not payable as
rental equipment. (4) Billing: (a) Before ODA's designee may authorize equipment or
supplies, the provider shall document the equipment and supplies to be
purchased were not covered (in full or in part) by medicare, state plan
medicaid, and any other third-party payer. (b) The provider shall, in collaboration with the ODA's
designee, ascertain and recoup any third-party resource(s) available to the
individual before billing ODA or its designee. ODA or its designee may then pay
the unpaid balance up to the lesser of the provider's billed charge or the
maximum allowable payment established in the appendix to rule 5160-1-06.1 of
the Administrative Code. (c) The provider shall provide the price for an item to be
purchased or rented to the ODA's designee no more than two business days
after the ODA's designee's request. The provider shall purchase,
deliver, and install (as appropriate) the authorized item(s) before billing
ODA's designee. The billed amount for each item shall not exceed the item
rate authorized by ODA's designee. (5) Delivery and
verification: (a) The provider shall verify the successful completion of each
activity (i.e., delivery, installation, or education) it provides using either
an electronic or manual system and shall retain records verifying the delivery
of HME. Regardless of the system used, the verification shall include the
individuals name, date of delivery, installation, or education, and
itemization of each activity completed. (b) Delivery verification methods: The provider shall verify the
delivery of HME by one of the following methods: (i) A unique identifier
of the individual. (ii) If a provider uses a
common carrier to deliver HME, the provider shall verify the success of the
delivery by using the method in paragraph (B)(5)(b)(i) of this rule or by
retaining the common carrier's tracking statement or returned postage-paid
delivery invoice. (c) If a provider leaves an HME item outside the door of an
individual's home, the provider shall contact the individual by telephone
at least once per month to alert them to any delivery left outside the door to
their home. (d) The provider shall replace (at no cost to the individual,
ODA, or ODA's designee) any HME item lost or stolen between the time of
delivery and receipt by the individual. (e) If a single visit by the provider includes more than one HME
activity, the provider may verify the success of all the activities it provides
by obtaining only one verification. (f) The provider shall not verify an HME activity was
successfully provided with the signature of the provider, an employee of the
provider, or any other person with a financial interest in the
HME. (C) Units and rates: (1) A unit of HME is the
item purchased or rented, and the unit rate is the purchase, installation,
and/or rental price authorized for the item by ODAs
designee. (2) The appendix to rule
5160-1-06.1 of the Administrative Code establishes the maximum rate allowable
for one unit of HME. (3) Rule 5160-31-07 of
the Administrative Code establishes rate-setting methodology for units of
HME.
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Rule 173-39-02.8 | ODA provider certification: homemaker.
(A) Definitions for this
rule: (1) "Homemaker" means a service
enabling individuals to achieve and maintain clean, safe and healthy
environments, assisting individuals to manage their personal appointments and
day-to-day household activities, and ensuring individuals maintain their
current living arrangements. The service consists of general household
activities, such as meal preparation and routine household care when persons
regularly responsible for these activities are temporarily absent or unable to
manage the home. Homemaker staff may act as travel attendants for individuals.
Homemaker activities include the following when authorized in the
person-centered services plan: (a) Assistance with meal planning. (b) Meal preparation, grocery purchase planning, and
assisting individuals with shopping and other errands. (c) Laundry, including folding, ironing, and putting away
laundry. (d) House cleaning including dusting furniture, sweeping,
vacuuming, and mopping floors; kitchen care including dishes, appliances, and
counters; bathroom care; emptying and cleaning bedside commodes; changing bed
linens; washing inside windows within reach from the floor; and removing
trash. (e) Errands outside of the presence of the individual which
are needed by the individual to maintain the individual's health and
safety (e.g., picking up a prescription or groceries for the
individual). (2) "Aide"
means the person who provides homemaker activities. (B) Requirements for ODA-certified providers of
homemaker: (1) General requirements:
The provider shall comply with the requirements for every ODA-certified agency
provider in rule 173-39-02 of the Administrative Code. (2) Eligible providers of homemaker are
ODA-certified agency providers. (3) Availability: The provider shall
maintain adequate staffing levels to provide the service at least five days per
week and shall possess a back-up plan to ensure the service is provided during
staff absences. (4) Provider policies: The provider shall
develop written or electronic personnel requirements, including all the
following: (a) Job descriptions for each position. (b) Documentation of each employee's qualifications for the
homemaker activities to be provided. (c) Performance appraisals for all staff. (5) Staff qualifications: (a) Aides: (i) Initial qualifications: The provider shall only allow a
person to serve as an aide if the person meets at least one of the following
qualifications: (a) The person meets at
least one of the qualifications to be a PCA under paragraph (C)(3)(a) of rule
173-39-02.11 of the Administrative Code. (b) The person successfully completed a training and
competency evaluation program with all the following
characteristics: (i) The training lasted
at least twenty hours. (ii) All the following
subjects were included in the program's training and its competency
evaluation: (A) Universal precautions for infection control, including
hand washing and the disposal of bodily waste. (B) Meal preparation/nutrition that includes special diet
preparation, grocery purchase planning and shopping; and other errands, such as
picking up prescriptions. (C) Laundry, including folding, ironing, and putting away
laundry. (D) Basic home safety. (E) House cleaning skills that include dusting furniture;
sweeping, vacuuming and washing floors, kitchen care (including washing dishes,
appliances and counters), bathroom care, emptying and cleaning bedside
commodes, changing bed linens, washing inside windows within reach from the
floor, and removing trash. (F) Body mechanics. (G) Communication skills. (H) Emergency protocols. (I) Record-keeping skills. (ii) Before providing activities to an individual, the provider
shall conduct a competency evaluation of all aides not listed on ODH's
nurse aide registry for all subject areas listed under paragraph
(B)(5)(a)(i)(b)(ii) of this rule. The provider shall retain records for the
name of the school or training organization, name of the course, training
dates, and training hours successfully completed. (b) Supervisors: The provider shall only allow a person to serve
as an aide supervisor if the person meets one or more of the following
qualifications: (i) The person has a
bachelors or associates degree in a health and human services
area. (ii) The person is an RN
or an LPN under the direction of an RN. (iii) The person
completed at least two years of work as an aide, as defined by this
rule. (c) All staff: (i) Orientation: Before allowing any staff member to provide
homemaker activities to an individual, the provider shall train the staff
member on all the following: (a) The provider's
expectations of homemaker staff. (b) The provider's
ethical standards, as required under rule 173-39-02 of the Administrative
Code. (c) An overview of the
provider's personnel policies. (d) The organization and lines of communication of the
provider's agency. (e) Incident-reporting
procedures. (f) Emergency
procedures. (g) Person-centered
planning process. (ii) In-service training: The provider shall retain records to
show that each aide successfully completes a minimum of eight hours of
in-service training every twelve months on topics listed under paragraph
(B)(5)(a)(i)(b)(ii) of this rule. (6) Supervisory
requirements: (a) Initial: The supervisor shall complete an initial visit,
which may occur at the aide's initial homemaker visit to the individual to
define the expected activities of the homemaker aide and prepare a written or
electronic activities plan consistent with the case manager authorized plan
that has been completed by the case manager and the individual before the
individual's first episode of service. During a state of emergency
declared by the governor or federal public health emergency, the supervisor may
conduct the visit by telephone, video conference, or in person at the
individual's home. (b) Subsequent: The supervisor shall complete an evaluation of
the aide's compliance with the activities plan, the individual's
satisfaction, and job performance during a home visit with the individual at
least every ninety days to evaluate the aides compliance with the plan.
The supervisor may conduct each visit with or without the presence of the aide
being evaluated. The supervisor may conduct the visit by telephone, video
conference, or in person. (c) Verification: The supervisor shall retain a record of the
initial visit and each subsequent visit in the individual's activity plan,
including the date of the visit, individual's name, the supervisor's
name, and the supervisor's handwritten or electronic signature, and a
unique identifier of the individual. During a state of emergency declared by
the governor or a federal public health emergency, the provider may verify that
the PCA supervisor provided the initial or subsequent visit without collecting
a unique identifier of the individual or the individual's
caregiver. (7) Service verification:
The provider shall verify each episode of homemaker activities provided to each
individual by using the provider's choice of either an electronic or
manual system which collects all the following information: the
individual's name, the date of service, a description of the activities
provided, the name of the aide providing the activities, the aide's
arrival and departure times, the unique identifier of the aide, and the unique
identifier of the individual to attest to the accuracy of the
record. (C) Units and rates: (1) One unit of homemaker
service is fifteen minutes. (2) The appendix to rule
5160-1-06.1 of the Administrative Code establishes the maximum rate allowable
for a unit of homemaker activities. (3) The rates are subject
to the rate-setting methodology in rule 5160-31-07 of the Administrative Code.
Last updated April 12, 2024 at 11:08 AM
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Rule 173-39-02.9 | ODA provider certification: home modification.
(A) "Home modification" has the
same meaning as "home modifications" in rule 5160-44-13 of the
Administrative Code. (B) Requirements for ODA-certified providers of home
modification: (1) General requirements:
The provider shall comply with the requirements for every ODA-certified
provider in rule 173-39-02 of the Administrative Code. (2) Requirements specific
to home modification: The provider shall comply with the requirements in rule
5160-44-13 of the Administrative Code. (3) If a conflict exists
between a requirement in rule 173-39-02 of the Administrative Code and a
requirement in rule 5160-44-13 of the Administrative Code, the provider shall
comply with the requirement in rule 173-39-02 of the Administrative
Code. (C) Units and rates: (1) A unit of home
modification is one completed job. (2) The rate per job is
subject to the maximum-allowable rate established in appendix A to rule
5160-1-06.1 of the Administrative Code and the limitations in paragraph (A) of
rule 5160-44-13 of the Administrative Code. (3) Rule 5160-31-07 of
the Administrative Code requires the unit rate to be negotiated between the
provider and ODA's designee. The negotiated rate shall include all
administrative, labor, and material costs for a specific job. The provider
shall not bill ODA's designee for any amount in excess of the negotiated
rate, unless ODA's designee approves a revised rate.
Last updated April 12, 2024 at 11:33 AM
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Rule 173-39-02.10 | ODA provider certification: nutritional consultations.
(A) Definitions for this
rule: (1) "Nutritional
consultation" (consultation) means individualized guidance to an
individual who has special dietary needs. Consultations take into consideration
the individual's health; cultural, religious, ethnic, socio-economic
background; and dietary preferences and restrictions. Consultations are also
known as medical nutrition therapy. "Nutritional consultation" does
not include either of the following: (a) A consultation provided to an individual's authorized
representative or caregiver to improve the individual's
well-being. (b) A consultation provided to an individual if the individual
receives a similar service paid (in full or in part) by medicare state plan
medicaid, or another third-party payer. (2) "Nutritional
assessment" (assessment) has the same meaning as in rule 4759-2-01 of the
Administrative Code. (B) Every ODA-certified provider of
nutritional consultations shall comply with the following
requirements: (1) General requirements:
The provider shall comply with the requirements for every ODA-certified
provider in rule 173-39-02 of the Administrative Code. (2) Dietitian: Only a
licensed dietitian (dietitian) working for an ODA-certified agency provider, or
a licensed dietitian working as an ODA-certified non-agency provider shall
provide consultations to individuals. (3) Orders: Before the provider provides
a consultation to an individual or to the individual's authorized
representative or caregiver, the provider shall obtain an order for the
consultation from a licensed healthcare professional whose scope of practice
includes ordering consultations. (4) Venue: (a) The dietitian may conduct the initial consultation by
telephone, video conference, or in person in the individual's
home. (b) The dietitian may conduct subsequent consultations by
telephone, video conference, or in person in the individual's
home. (5) Nutritional assessment: (a) The provider shall conduct an initial, individualized
assessment of the individual's nutritional needs and, when necessary,
subsequent assessments, using a tool that identifies whether the individual is
at nutritional risk or identifies a nutritional diagnosis that the dietitian
will treat. The tool shall include the following: (i) An assessment of
height and weight history. (ii) An assessment of the
adequacy of nutrient intake. (iii) A review of
medications, medical diagnoses, and diagnostic test results. (iv) An assessment of
verbal, physical, and motor skills that may affect, or contribute to, nutrient
needs. (v) An assessment of
interactions with the caregiver during feeding. (vi) An assessment of the
need for adaptive equipment, other community resources, or other
services. (b) The provider shall provide the case manager, the individual,
and the individual's authorized representative (if the individual has
authorized a representative) with a copy of the assessment no later than seven
business days after the provider completes the assessment. (c) The provider may use an electronic system to develop and
retain an assessment. (6) Nutrition intervention
plan: (a) The provider shall develop, evaluate, and revise, as
necessary, a nutrition intervention plan with the individual's and case
manager's assistance and, when applicable, the assistance of the licensed
healthcare professional who authorized the consultations. In the plan, the
provider shall outline the purposely-planned actions for changing
nutrition-related behavior, risk factors, environmental conditions, or health
status, which, at a minimum, shall include the following information about the
individual: (i) Food and diet
modifications. (ii) Specific nutrients
to require or limit. (iii) Feeding
modality. (iv) Nutrition education
and consultations. (v) Expected measurable
indicators and outcomes related to the individual's nutritional
goals. (b) The provider shall use the nutrition intervention plan to
prioritize and address the identified nutrition problems. (c) The provider shall provide the case manager, the individual,
and the licensed healthcare professional who ordered the consultations with a
copy of the nutrition intervention plan no later than seven business days after
the provider develops or revises the plan. (d) The provider may use an electronic system to develop and
retain the nutrition intervention plan. (7) Service verification: By one of the
following two methods, the provider shall verify that each consultation for
which it bills was provided: (a) The provider may use an electronic system if the system does
all of the following: (i) Collects the
individual's name, date of consultation, time of day each consultation
begins and ends, name of licensed dietitian providing consultation, and a
unique identifier of the individual. (ii) Retains the
information it collects. (iii) Produces reports,
upon request, that ODA (or its designee) can monitor for
compliance. (b) The provider may use a manual system if the provider records
the date of service, time of day that each consultation begins and ends, name
of the person providing the consultation, and collects the handwritten
signature of the person providing the consultation and a unique identifier of
the individual. (C) Unit and rate: (1) A unit of a
nutritional consultation is fifteen minutes of session time with the
individual. (2) The maximum rate
allowable for a unit of nutritional consultations is listed in the appendix to
rule 5160-1-06.1 of the Administrative Code. (3) The rate is subject
to the rate-setting methodology in rule 5160-31-07 of the Administrative
Code.
Last updated April 12, 2024 at 11:08 AM
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Rule 173-39-02.11 | ODA provider certification: personal care.
(A) "Personal care" means hands-on assistance with ADLs
and IADLs (when incidental to providing ADLs) in the individual's home and
community. Personal care activities include the following when authorized in a
person-centered services plan: (1) Assisting the individual with
managing the home, handling personal affairs, and providing assistance with
self-administration of medications, as defined in rule 173-39-01 of the
Administrative Code. (2) Assisting the individual with ADLs
and IADLs. (3) Homemaker activities listed in rule
173-39-02.8 of the Administrative Code when those activities are specified in
the individual's service plan and are incidental to the activities in
paragraphs (A)(1) and (A)(2) of this rule or are essential to the health and
welfare of the individual rather than the individual's
family. (4) Providing respite services to the
individual's caregiver. (5) Providing an errand outside of the
presence of the individual that is needed by the individual to maintain the
individual's health and safety (e.g., picking up a prescription or
groceries for the individual). (B) Qualifying provider types: Eligible
providers of personal care are ODA-certified agency providers and ODA-certified
participant-directed personal care providers. (C) Requirements for ODA-certified agency
providers of personal care: (1) General requirements:
The provider is subject to rule 173-39-02 of the Administrative
Code. (2) Availability and
staffing: (a) The provider may accept a referral to provide personal
care to an individual only if the provider has adequate staffing levels of PCAs
and PCA supervisors to provide the number of hours ODA's designee
authorized for each individual. (b) The PCA receives supervision from an RN or LPN under
the direction of an RN during all hours that PCAs are scheduled to
work. (c) The provider shall maintain a back-up plan for
providing personal care when the provider has no PCA or PCA supervisor
available. (3) PCA
requirements: (a) Initial qualifications: The provider may allow a person to
serve as a PCA only if the person meets at least one of the following
qualifications, the training and competency evaluation comply with paragraph
(C)(3)(e) of this rule, and the provider meets the verification requirements
under paragraph (C)(3)(f) of this rule: (i) STNA: The person
successfully completed a nurse aide training and competency evaluation program
approved by ODH under section 3721.31 of the Revised Code. (ii) Medicare: The person
met the qualifications to be a medicare-certified home health aide according to
one of the following sets of standards: (a) The standards in 42
C.F.R. 484.4 and 484.36, if the person met those standards on or before January
12, 2018. (b) The standards in 42
C.F.R. 484.80 and 484.115, if the person met those standards on or after
January 13, 2018. (iii) Previous
experience: The person has at least one year of supervised employment
experience as a home health aide or nurse aide, and has successfully completed
a competency evaluation covering the topics listed under paragraph
(C)(3)(a)(v)(b) of this rule. (iv) Vocational programs:
The person successfully completed the COALA home health training program or a
certified vocational training and competency evaluation program in a health
care field covering the topics listed under paragraph (C)(3)(a)(v)(b) of this
rule. (v) Other programs: The
person successfully completed a training and competency evaluation program with
the following characteristics: (a) The training lasted
at least sixty hours. (b) All the following
subjects were included in the program's training and its competency
evaluation: (i) Communication skills,
including the ability to read, write, and make brief and accurate reports
(oral, written, or electronic). (ii) Observation,
reporting, and retaining records of an individual's status and activities
provided to the individual. (iii) Reading and
recording an individual's temperature, pulse, and
respiration. (iv) Basic infection
control. (v) Basic elements of body functioning and changes in body
function that should be reported to a PCA supervisor. (vi) Maintaining a clean,
safe, and healthy environment, including house cleaning and laundry, dusting
furniture, sweeping, vacuuming, and washing floors; kitchen care (including
dishes, appliances, and counters), bathroom care, emptying and cleaning beside
commodes and urinary catheter bags, changing bed linens, washing inside window
within reach from the floor, removing trash, and folding, ironing, and putting
away laundry. (vii) Recognition of emergencies, knowledge of emergency
procedures, and basic home safety. (viii) The physical,
emotional, and developmental needs of individuals, including privacy and
respect for personal property. (ix) Appropriate and safe
techniques in personal hygiene and grooming including bed, tub, shower, and
partial bath techniques; shampoo in sink, tub, or bed; nail and skin care; oral
hygiene; toileting and elimination; safe transfer and ambulation; normal range
of motion and positioning; and adequate nutrition and fluid
intake. (x) Meal preparation and nutrition planning, including special
diet preparation; grocery purchase, planning, and shopping; and errands such as
picking up prescriptions. (b) Orientation: Before allowing a PCA or other employee to have
direct, in-person contact with an individual, the provider shall ensure the PCA
or other employee successfully completed orientation, which, at a minimum,
addressed the following topics: (i) The provider's
expectations of employees. (ii) The provider's
ethical standards under rule 173-39-02 of the Administrative Code. (iii) An overview of the
provider's personnel policies. (iv) The organization and
lines of communication of the provider's agency. (v) Incident-reporting
procedures. (vi) Emergency
procedures. (vii) Universal
precautions for infection control. (c) Additional training: The provider shall ensure each PCA
successfully completes additional training and competency evaluation if the PCA
is expected to perform activities for which the PCA did not receive training or
undergo competency evaluation under paragraph (C)(3)(a) of this
rule. (d) In-service training: The provider shall ensure that each PCA
successfully completes eight hours of in-service training every twelve months.
Agency- and program-specific orientation do not count toward the eight
hours. (e) Training sources: (i) An organization other
than the provider may provide the orientation and training under paragraphs
(C)(3)(b) to (C)(3)(d) of this rule. The training completed through
https://mylearning.dodd.ohio.gov/ is free of charge. (ii) The portion of
training that is not competency evaluation may occur online. (iii) The portion of
competency evaluation that involves return demonstration only qualifies as
competency evaluation under paragraph (C)(3)(a) of this rule if it is conducted
in person. (f) Verification of compliance with PCA
requirements: (i) The provider shall
either retain copies of certificates of completion earned by each PCA after the
PCA meets requirements under paragraph (C)(3) of this rule for successfully
completing any training and competency evaluation program, orientation,
additional training, and in-service training under paragraph (C)(3) of this
rule or record the following information for each PCA, and retain it, if it
does not appear on the PCA's certificate of completion (or if the PCA did
not receive a certificate of completion): name of the school or training
organization, name of the course, training dates, and training hours
successfully completed. (ii) If a person meets
the initial qualifications to be a PCA under paragraph (C)(3)(a) of this rule
by successfully completing a nurse aide training and competency evaluation
program described in paragraph (C)(3)(a)(i) of this rule, the provider shall
retain a copy of the search results from ODH's nurse aide registry
(https://nurseaideregistry.odh.ohio.gov/Public/PublicNurseAideSearch) to verify
that the registry listed the person as "active," "in good
standing," or "expired." (iii) If a person meets
the initial qualifications to be a PCA under paragraph (C)(3)(a) of this rule
only by the previous employment experience described in paragraph
(C)(3)(a)(iii) of this rule, the provider shall also retain records to verify
the former employer's name and contact information, the former PCA
supervisor's name, the date the person began working for the former
employer, and the date the person stopped working for the former
employer. (4) PCA
supervisors: (a) Qualifications: Only an RN or LPN under the direction of an
RN qualifies to be a PCA supervisor. (b) PCA supervisor visits: (i) Initial: The PCA
supervisor shall visit each individual in person at the individual's home
to define the expected activities of the PCA and develop a written or
electronic activity plan with the individual either before allowing a PCA to
provide an episode of service to the individual or during the PCA's
initial episode of service to the individual. During a state of emergency
declared by the governor or a federal public health emergency, the PCA
supervisor may conduct the initial visit by telephone, video conference, or in
person at the individual's home. (ii) Subsequent: (a) The PCA supervisor shall visit the individual at least
once every sixty days after the PCA's initial episode of service with the
individual to evaluate compliance with the activities plan, the
individual's satisfaction, and the PCA's performance. The PCA
supervisor may conduct subsequent visits with or without the presence of the
PCA being evaluated. (b) If the PCA supervisor
conducts at least two in-person visits per year, the PCA supervisor may conduct
the remainder of the subsequent visits during the same year by telephone, video
conference, or in person based upon the individual's needs. To comply, the
PCA supervisor may conduct two subsequent in-person visits in the same year or
the combination of an initial in-person visit and an in-person subsequent visit
in the same year. (iii) Verification: In
the individual's record, the PCA supervisor shall retain a record of the
initial visit and each subsequent visit that includes the date of the visit;
whether the visit occurred by telephone, video conference, or in person at the
individual's home; the PCA supervisor's name and signature; the
individual's name; and a unique identifier of the individual or the
individual's caregiver. During a state of emergency declared by the
governor or a federal public health emergency, the provider may verify that the
PCA supervisor provided the initial or subsequent visit without collecting a
unique identifier of the individual or the individual's
caregiver. (5) Provider policies:
The provider shall develop, implement, comply with, and maintain written or
electronic policies on all the following topics: (a) Job descriptions for each position. (b) Retaining records on how each PCA meets the qualifications in
paragraph (C)(3) of this rule. (6) Service
verification: (a) The following are the mandatory reporting items that a
provider retains for each episode of personal care to comply with the
requirements under paragraph (B)(10)(a)(i) of rule 173-39-02 of the
Administrative Code: (i) Service
date. (ii) PCA's arrival
time. (iii) PCA's
departure time. (iv) Description of the
activities provided. (v) Name of each PCA in
contact with the individual. (vi) Unique identifier of
each PCA in contact with the individual to attest to the accuracy of the
record. (b) The provider is subject to rule 5160-1-40 of the
Administrative Code regarding EVV. (c) The provider is subject to section 121.36 of the
Revised Code. (D) Every ODA-certified
participant-directed provider of personal care shall comply with the
requirements under paragraph (B) of rule 173-39-02.4 of the Administrative
Code. (E) Units and rates: (1) For the PASSPORT
program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the
following: (a) One unit of personal care as fifteen
minutes. (b) The maximum rate allowable for one unit of personal
care. (2) For the PASSPORT program, rule
5160-31-07 of the Administrative Code establishes the rate-setting methodology
for personal care. According to that rule, if the same provider provides
personal care during the same visit to more than one but fewer than four
PASSPORT individuals in the same home, as identified in the individuals'
person-centered services plans, the provider's payment rate for personal
care provided to one person in the home is one hundred per cent of the per-unit
rate listed in the provider agreement and seventy-five per cent of the per-unit
rate for each subsequent PASSPORT individual in the home receiving services
during the visit. As used in this paragraph, "in the same home" does
not refer to a PASSPORT individual who resides alone in an apartment building
where another individual may reside alone in a separate apartment.
Last updated April 12, 2024 at 11:08 AM
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Rule 173-39-02.12 | ODA provider certification: social work or counseling.
Effective:
April 17, 2022
(A) Definitions for this
rule: (1) "Social work or counseling"
(service) means a service to an individual or to an individual's caregiver
to promote the individual's physical, social, or emotional well-being; and
the development and maintenance of a stable and supportive environment for the
individual. (a) "Social work or counseling" includes crisis
interventions, grief counseling, and other social work and counseling
interventions that support the individual's health and
welfare. (b) "Social work or counseling" does not include
any of the following: (i) A service provided in place of case
management. (ii) A service provided to the individual's authorized
representative or caregiver that is unrelated to the individual's
well-being. (iii) A service provided if the individual receives a similar
service paid (in full or in part) by medicare, state plan medicaid, or another
third-party payer. (2) "E.passport" has the same
meaning as in section 4732.40 of the Revised Code. (B) Requirements for a provider of social
work or counseling: (1) General requirements:
The provider is subject to rule 173-39-02 of the Administrative
Code. (2) Venue: The provider
shall provide this service in the individual's home, or by telephone or
video conference as permitted by the licensing board for the licensed
healthcare professional providing this service or the state medical board if
the licensed healthcare professional is an advanced practice RN designated as a
clinical nurse practitioner (CNP) or clinical nurse specialist (CNS) and
certified as a psychiatric-mental health CNP or CNS by the American nurses
credentialing center. (3) Assessment: (a) The provider shall assess each individual, including the
individual's psycho-social, financial, and environmental
statuses. (b) The provider shall provide the case manager with the
assessment report no later than fourteen days after the provider completes the
assessment. (4) Treatment
plan: (a) With the assistance of the individual, caregiver, and case
manager, the provider shall develop and revise, as necessary, a treatment plan
that recommends a method of treatment and number of sessions. (b) The provider shall provide the case manager with the
treatment plan no later than fourteen days after the provider completes the
assessment. (c) The provider shall offer the individual the treatment plan no
later than fourteen days after the provider completes the assessment, unless
there are clinical indications against providing the individual with the
treatment plan. If the individual declines to receive the treatment plan, the
provider shall retain a record that the provider offered to provide the
individual with the treatment plan, but that the individual
declined. (d) The provider shall implement the treatment plan. (5) Provider qualifications: No person
shall provide the service unless the person is employed by a provider that ODA
certifies as an agency provider, or unless ODA certifies the person as a
non-agency provider. (a) Agency provider: (i) An agency provider shall assure that the agency's
direct-care staff includes a licensed professional clinical counselor (LPCC), a
licensed professional counselor (LPC), a licensed psychologist or a licensed
psychologist with an e.passport, an independent marriage and family therapist
(IMFT), a marriage and family therapist (MFT), a licensed independent social
worker (LISW), or a licensed social worker (LSW). (ii) No employee shall provide the service under the
employment of the agency provider unless the individual is a LPCC, LPC, a
licensed psychologist or a licensed psychologist with an e.passport, IMFT, MFT,
LISW, LSW, or an advanced practice RN designated as a CNP or CNS and certified
as a psychiatric-mental health CNP or CNS by he American nurses credentialing
center. (iii) The provider shall retain records to show that each
social work or counseling staff member holds a license in good standing with
their respective Ohio professional licensure board or an e.passport, and has at
least one year of social work or counseling experience. (b) Non-agency provider: (i) No person shall
provide the service as a non-agency provider unless the person is an IMFT,
LPCC, licensed psychologist or a licensed psychologist with an e.passport,
LISW, or an advanced practice RN designated as a CNP or CNS and certified as a
psychiatric-mental health CNP or CNS by the American nurses credentialing
center. (ii) The provider shall
retain records to show that the provider holds a license in good standing with
their Ohio professional licensure board or an e.passport, and has at least one
year of social work or counseling experience. (6) Service verification: (a) For each session, the provider shall retain a record of all
the following: (i) Individual's
name. (ii) Date of
service. (iii) Time of day each
session begins and ends. (iv) Name of staff member
providing social work or counseling to the individual or the individual's
caregiver (if an agency provider). (v) A unique identifier
of the individual. (b) The provider may use an electronic system to collect or
retain the records required under this rule. (C) Unit and rate: (1) A unit of a social
work or counseling is fifteen minutes of session time with the
individual. (2) The appendix to rule
5160-1-06.1 of the Administrative Code establishes the maximum rate allowed for
a unit of social work or counseling provided through the PASSPORT
program. (3) Rule 5160-31-07 of
the Administrative Code establishes the rate-setting methodology for social
work or counseling provided through the PASSPORT program.
Last updated April 12, 2024 at 11:08 AM
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Rule 173-39-02.14 | ODA provider certification: home-delivered meals.
Effective:
January 1, 2019
(A) "Home-delivered meal" means
a meal regulated by rule 5160-44-11 of the Administrative Code. (B) Every ODA-certified provider of
home-delivered meals shall comply with the following requirements: (1) General requirements:
The provider shall comply with the requirements for every ODA-certified agency
provider in rule 173-39-02 of the Administrative Code. (2) Requirements specific
to home-delivered meals: (a) For all meals, the provider shall comply with the
requirements in rule 5160-44-11 of the Administrative Code. (b) If ODA's designee authorizes home-delivered meals
for an individual, the provider shall provide the individual with
home-delivered meals that are kosher if the individual requests a kosher
diet. (3) If a conflict exists
between a requirement in rule 173-39-02 of the Administrative Code and a
requirement in rule 5160-44-11 of the Administrative Code, the provider shall
comply with the requirement in rule 173-39-02 of the Administrative
Code. (C) Units and rates: (1) A unit of regular
home-delivered meals is one home-delivered meal. (2) A unit of
home-delivered meals with a therapeutic diet is one home-delivered meal with a
therapeutic diet. (3) Appendix A to rule
5160-1-06.1 of the Administrative Code establishes the maximum rates allowable
for units of home-delivered meals. (4) Rule 5160-31-07 of
the Administrative Code establishes rate-setting methodology for units of
home-delivered meals. (5) Section 173.524 of the Revised Code authorizes the
PASSPORT program to pay for home-delivered meals with a kosher diet at the same
rate as a therapeutic diet.
Last updated April 12, 2024 at 11:33 AM
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Rule 173-39-02.15 | ODA provider certification: community integration.
(A) "Community integration"
means the service defined in rule 5160-44-14 of the Administrative
Code. (B) Requirements for an ODA-certified
provider of community integration: (1) General requirements:
The provider shall comply with the requirements for every ODA-certified agency
provider in rule 173-39-02 of the Administrative Code. (2) Requirements specific
to community integration: The provider shall comply with the requirements in
rule 5160-44-14 of the Administrative Code. (3) If a conflict exists
between a requirement in rule 173-39-02 of the Administrative Code and a
requirement in rule 5160-44-14 of the Administrative Code, the provider shall
comply with the requirement in rule 173-39-02 of the Administrative
Code. (C) Units and rates: (1) One unit of community
integration is fifteen minutes. (2) Appendix A to rule
5160-1-06.1 of the Administrative Code establishes the maximum-allowable rate
per unit. (3) Rule 5160-31-07 of
the Administrative Code establishes the rate-setting methodology for a unit of
community integration.
Last updated April 12, 2024 at 11:33 AM
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Rule 173-39-02.16 | ODA provider certification: assisted living service.
Effective:
January 1, 2024
(A) Definitions for this
rule: (1) "Assisted living
service" means all of the following: (a) A service promoting aging in place by supporting the
individual's independence, choice, and privacy. (b) A service that includes the following
activities: (i) Hands-on assistance,
supervision, and/or cuing of ADLs, IADLs, and other supportive
activities. (ii) Nursing activities,
including the following: (a) The initial and
subsequent health assessments under rule 3701-16-08 of the Administrative
Code. (b) Monitoring the
individual according to the standards of practice for the individual's
condition. (c) Medication management
according to rule 3701-16-09 of the Administrative Code. (d) The part-time
intermittent skilled nursing care described in rule 3701-16-09.1 of the
Administrative Code when not available to the individual through a third-party
payer. (iii) Coordinating three
meals per day and snacks according to rule 3701-16-10 of the Administrative
Code with access to food according to rule 5160-44-01 of the Administrative
Code. (iv) Coordinating the
social, recreational, and leisure activities under rule 3701-16-11 of the
Administrative Code to promote community participation and integration,
including non-medical transportation to services and resources in the
community. (c) A service that does not include the following: (i) Housing. (ii) Meals. (iii) Twenty-four-hour
skilled nursing care. (iv) One-on-one
supervision of an individual. (2) "Medication
management" includes knowing what medications an individual is
self-managing, assistance with self-administration of medication, ordering
medication, medication reminders, and medication administration. (3) "Memory
care" means a service that a provider provides in compliance with
paragraph (D) of this rule to an individual with a documented diagnosis of any
form of dementia. (4) "Resident call system" has
the same meaning as in rule 3701-16-01 of the Administrative Code. (5) "Staff member" and
"staff" have the same meanings as in rule 3701-16-01 of the
Administrative Code. (B) Certification types: ODA certifies
each provider for the basic assisted living service, memory care, or both the
basic service and memory care. (C) Requirements for an ODA-certified provider of the basic
assisted living service: (1) General requirements:
The provider is subject to rule 173-39-02 of the Administrative
Code. (2) RCF
qualifications: (a) Licensure: Only a provider who maintains a current, valid RCF
license from ODH and maintains compliance with Chapter 3721. of the Revised
Code and Chapters 3701-13 and 3701-16 of the Administrative Code qualifies to
provide this service. (b) Public information: The provider shall display the following
on its website: (i) Whether the provider
is currently certified by ODA to provide the basic assisted living service,
memory care, or both the basic service and memory care. (ii) Whether the provider
is currently accepting individuals who are enrolling in the assisted living
program or mycare Ohio. (c) Resident units: A resident unit qualifies for this service
only if the unit meets all the following standards: (i) Occupancy: (a) The resident unit is
a single-occupancy resident unit designated solely for the individual, except
as permitted under paragraph (C)(2)(c)(i)(b) of this rule. (b) The provider may
allow an individual to share a single-occupancy resident unit only if all of
the following conditions exist: (i) The individual
requests to share the individual's unit. (ii) The individual
shares the individual's unit with a person with whom the individual has an
existing relationship. (iii) ODA's designee
verifies that the conditions of paragraphs (C)(2)(c)(i)(b)(i) and
(C)(2)(c)(i)(b)(ii) of this rule are met and authorizes sharing the unit in the
individual's person-centered services plan. (ii) Lock: The resident
unit has a lock that allows the individual to control access to the resident
unit at all times, unless the individual's person-centered services plan
indicates otherwise. (iii) Bathroom: The
resident unit includes a bathroom with a toilet, a sink, and a shower or
bathtub, all of which are in working order. (iv) Social space: The
resident unit includes identifiable space, separate from the sleeping area,
that provides seating for the individual and one or more visitors for
socialization. (d) Common areas: The provider shall provide common areas
accessible to the individual, including a dining area (or areas) and an
activity center (or centers). A multi-purpose common area may serve as both a
dining area and an activity center. (3) Availability: The
provider shall maintain adequate staffing levels to comply with rule 3701-16-05
of the Administrative Code and to provide hands-on assistance, supervision,
and/or cuing of ADLs in a timely manner in response to individual's
unpredictable care needs, supervisory needs, emotional needs, and reasonable
requests for services through the resident call system twenty-four hours per
day. (4) Minors: Staff members
under eighteen years of age do not qualify to do any of the
following: (a) Assist with medication management. (b) Provide transportation. (c) Provide personal care without on-site supervision, in
accordance with rule 3701-16-06 of the Administrative Code. (5) Initial staff
qualifications: Only a staff member who successfully completes training in the
following subject areas qualifies to provide this service: (a) Principles and philosophy of assisted living. (b) The aging process. (c) Cuing, prompting, and other means of effective
communication. (d) Common behaviors for cognitively-impaired individuals,
behaviorally-impaired individuals, or other individuals and strategies to
redirect or de-escalate those behaviors. (e) Confidentiality. (f) The person-centered planning process in rule 5160-44-02 of
the Administrative Code, which includes supporting individuals' full
access to the greater community. (g) The individual's right to assume responsibility for
decisions related to the individual's care. (6) In-service training:
The provider shall ensure that each employee providing this service
successfully completes any training requirements in rule 3701-16-06 of the
Administrative Code and makes verification of successful completion of those
requirements available to ODA or its designee upon request. (7) Quarterly
assessments: The provider's RN or LPN shall contact the individual at
least quarterly to assess, and retain a record of, all of the
following: (a) The individual's satisfaction with the individual's
activity plan and whether the activity plan continues to meet the
individual's needs. (b) Whether the individual's records demonstrate that the
individual is receiving activities as ODA or its designee authorized them in
the individual's person-centered service plan. (c) Whether staff are providing personal care services to the
individual in a manner that complies with rule 3701-16-09 of the Administrative
Code. (8) Subcontracting: The
provider may subcontract to provide one or more, but not all, of the activities
listed under paragraph (A)(1)(b) of this rule that ODA or its designee
authorizes for the individual. The provider is responsible to assure that any
activity provided by a sub-contractor complies with this chapter. (D) Requirements for an ODA-certified provider of memory
care: (1) The provider is
subject to the standards in paragraphs (C) of this rule. (2) The provider
qualifies for certification to provide memory care only if the provider meets
all of the following standards: (a) The provider displays a purpose statement on its
website that explains the difference between the provider's basic assisted
living service and its memory care, or if the provider provides only memory
care, a purpose statement on its website that explains the memory care that the
provider provides. (b) The provider
designates the single-occupancy resident unit in paragraph (C)(2)(c) of this
rule to be a stand-alone memory care unit, a memory care unit in a memory care
section of the RCF, or a memory care unit in an RCF of a provider that provides
only memory care. (c) The provider provides or arranges for at least three
therapeutic, social, or recreational activities listed in rule 3701-16-11 of
the Administrative Code per day with consideration given to individuals'
preferences and designed to meet individuals' needs. (d) The provider ensures safe access to outdoor space for
individuals. (e) The provider assists each individual who makes a call
through the resident call system in person in fewer than ten minutes after the
individual initiates the call. (3) Availability: The
provider qualifies for certification to provide memory care only if the
provider meets all of the following standards in addition to the requirements
in paragraph (C)(3) of this rule: (a) The provider has a sufficient number of RNs, or LPNs
under the direction of an RN, on call or on site at all times for individuals
receiving memory care. (b) The provider maintains the appropriate direct-care
staff-to-resident ratio below for its memory care: (i) If providing both
memory care and the basic service, a ratio that is at least twenty per cent
higher than the provider's ratio for its basic service. (ii) If providing only
memory care and the average ratio for the basic service provided by a
representative sample of providers participating in the medicaid-funded
component of the assisted living program is readily available to the provider,
then a ratio that is at least twenty per cent higher than that average
ratio. (iii) If providing only
memory care and the average ratio for the basic service provided by a
representative sample of providers participating in the medicaid-funded
component of the assisted living program is not readily available to the
provider, then a ratio of at least one staff member who provides personal care
services for every ten individuals receiving memory care with at least one
staff member who provides personal care services on each floor of the RCF if
the RCF provides memory care on multiple floors. (4) Initial staff
qualifications: A staff member qualifies to provide memory care without
in-person supervision only if the staff member successfully completes training
all of the following topics in addition to the topics listed under paragraph
(C)(5) of this rule: (a) Overview of dementia: symptoms, treatment approaches,
and progression. (b) Foundations of effective communication in dementia
care. (c) Common behavior challenges and recommended behavior
management techniques. (d) Current best practices in dementia care. (e) Missing resident prevention and response. (5) In-service training:
A staff member continues to qualify to provide memory care only if the staff
member successfully completes dementia care training when complying with
paragraph (C)(6) of this rule. (E) Units and rates: (1) For the assisted
living program, the appendix to rule 5160-1-06.5 of the Administrative Code
lists the following: (a) The unit of service as one day. (b) The maximum-allowable rates for a unit of a unit of
basic assisted living service and a unit of memory care. (2) For the assisted living program, rule
5160-33-07 of the Administrative Code establishes the rate-setting methodology
for a unit of service.
Last updated April 15, 2024 at 11:47 AM
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Rule 173-39-02.17 | ODA provider certification: community transition.
(A) "Community transition"
means the service defined in rule 5160-44-26 of the Administrative
Code. (B) Requirements for an ODA-certified
provider of community transition: (1) General requirements:
The provider shall comply with the requirements for every ODA-certified agency
provider in rule 173-39-02 of the Administrative Code. (2) Requirements specific
to community transition: The provider shall comply with the requirements in
rule 5160-44-26 of the Administrative Code. (3) If a conflict exists
between a requirement in rule 173-39-02 of the Administrative Code and a
requirement in rule 5160-44-26 of the Administrative Code, the provider shall
comply with the requirement in rule 173-39-02 of the Administrative
Code. (C) Units and rates: (1) One unit of community
transition is one completed job per individual per enrollment in the PASSPORT
program or the assisted living program and includes includes any of the
expenses listed under paragraph (A)(1) of rule 5160-44-26 of the Administrative
Code. (2) The rate per job is
subject to the maximum-allowable rate established in appendix A to rule
5160-1-06.1 of the Administrative Code, appendix A to rule 5160-1-06.5 of the
Administrative Code, and paragraph (C)(2) of rule 5160-44-26 of the
Administrative Code. (3) Rules 5160-31-07 and
5160-33-07 of the Administrative Code require the unit rate to be negotiated
between the provider and ODA's designee. The negotiated rate shall include
any expenses listed under paragraph (A)(1) of rule 5160-44-26 of the
Administrative Code. The provider shall not bill ODA's designee for any
amount in excess of the negotiated rate, unless ODA's designee approves a
revised rate.
Last updated April 12, 2024 at 11:33 AM
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Rule 173-39-02.18 | ODA provider certification: non-medical transportation.
(A) Definitions for this
rule: (1) "Non-medical
transportation" (transportation) means using a provider's vehicle and
driver to transport individuals from one place to another for a non-medical
purpose. "Non-medical transportation" does not include the
following: (a) Transportation otherwise available, or funded by,
Ohio's medicaid program or another source. (b) Transportation for a non-emergency medical
purpose. (c) Transportation being provided through a similar service
in this chapter. (d) Transportation that the individual's family,
neighbors, friends, or community agencies are willing or legally responsible to
provide to the individual free of charge. (e) Escort or transportation by a participant-directed
provider. (See rule 173-39-02.4 of the Administrative Code.) (2) "Board of
EMFTS" means the state board of emergency medical, fire, and
transportation services created under section 4765.02 of the Revised
Code. (3) "Bus" has
the same meaning as in section 4513.50 of the Revised Code. (4) "CLIA-certified
laboratory" means a laboratory that ODH lists as a "CLIA Lab" in
active status on the "Long-Term Care, Non Long-Term Care, & CLIA
Health Care Provider Search"
(http://publicapps.odh.ohio.gov/eid/Provider_Search.aspx). (5) "EMT" means
any of the emergency medical technicians defined in division (A), (B), or (C)
of section 4765.01 of the Revised Code. (6) "First
responder" has the same meaning as in division (A) of section 4765.01 of
the Revised Code. (B) Requirements for ODA-certified
providers of non-medical transportation: (1) General
requirements: (a) The provider is subject to the requirements for every
ODA-certified provider in rule 173-39-02 of the Administrative
Code. (b) Availability: The provider shall possess a back-up plan
for transporting individuals when an agency provider's driver or vehicle
is unavailable or when a non-agency provider or the provider's vehicle is
unavailable. (c) Transferring: As part of each trip, the driver shall
help the individual safely transfer between the pick-up point and the vehicle,
safely enter and exit the vehicle, and safely transfer between the vehicle and
the destination point. (d) Provider types: ODA certifies only agency and
non-agency providers to provide the transportation under this
rule. (2) Vehicle
requirements: (a) Maintenance: The provider shall maintain vehicles
according to the manufacturer's maintenance schedule for each vehicle used
to transport individuals. If the vehicle includes a wheelchair lift, the
provider shall maintain the wheelchair lift according to the
manufacturer's maintenance schedule for the wheelchair lift. (b) Inspections: The provider shall conduct the following
inspections on each vehicle used to transport individuals. If the vehicle
includes a wheelchair lift, the provider's inspection shall include
inspecting the wheelchair lift: (i) An annual vehicle
inspection on an ODA-approved form. The provider may use a vehicle for
transporting individuals only if a mechanic who is certified by the national
institute for automotive service excellence (i.e., "ASE-certified")
or another mechanic approved by ODA's designee, inspected the vehicle no
more than twelve months before and answers all questions on the form in the
affirmative. (ii) A daily vehicle
inspection on an ODA-approved form. The provider may use a vehicle only if the
provider answers all questions on the form in the affirmative. (c) Exemptions: (i) A vehicle possessing
a current, valid ambulette license is deemed to comply with paragraph
(B)(2)(b)(i) of this rule by providing ODA or its designee with evidence of the
vehicle's current, valid ambulette license. (ii) A bus displaying a
current, valid safety-inspection decal issued by the state highway patrol under
Chapter 4501-52 of the Administrative Code is deemed to comply with paragraph
(B)(2)(b)(i) of this rule. (3) Driver
requirements: (a) Statutory requirements to hire: The provider may hire a
person to be a driver only if the person meets all the requirements for drivers
under divisions (A)(3) and (B) of section 4766.14 of the Revised Code, as
amplified in paragraph (A) (8) of rule 4766-3-13 of the Administrative Code,
subject to the following conditions: (i) The applicant's
first-aid training and cardiopulmonary-resuscitation training came from a
training organization approved by the board of EMFTS
(http://www.ems.ohio.gov/medical-transportation-faq.aspx). (ii) The applicant's
drug test results came from a CLIA-certified laboratory that declared the
applicant to be free of alcohol, amphetamines, cannabinoids (THC), cocaine,
opiates, or phencyclidine (PCP). (iii) The provider
complies with the background-check requirements in Chapter 173-9 of the
Administrative Code. (b) Additional requirements to hire: The provider may hire
a person to be a driver only if the person meets all the following
requirements: (i) The applicant has
held a current, valid driver's license for at least two
years. (ii) The applicant holds
any driver's license endorsement necessary to operate the type of vehicle
the applicant would drive. (iii) The applicant
understands written and oral instructions. (iv) The applicant has
the ability to comply with paragraph (B)(1)(c) of this rule. (v) The applicant has the
ability to conduct the daily vehicle inspection in paragraph (B)(2)(b)(ii) of
this rule. (vi) The applicant has
the ability to collect the mandatory reporting items under paragraph (B)(4) of
this rule. (c) Passenger-assistance training: The provider may retain
a driver only if the driver successfully completes a passenger-assistance
training course approved by the board of EMFTS
(http://www.ems.ohio.gov/medical-transportation-faq.aspx) no later than six
months after the provider hires the driver. (d) Exempted professionals: Providers hiring an applicant
with a current, valid license or certificate to be one or more of the following
professionals may demonstrate compliance with paragraphs (B)(3)(a), (B)(3)(b),
and (B)(3)(c) of this rule by providing ODA or its designee with evidence the
applicant possesses a current, valid license or certificate as one of the
following professionals: (i) An ambulette
driver. (ii) An EMT or first
responder who passed the board of EMFTS' curriculum for an EMT or first
responder, but does not necessarily hold a current, valid certification for
either profession. (iii) A driver for a
county transit system, regional transit authority, or regional transit
commission. (4) Trip verification:
The following are the mandatory reporting items for each trip provided to
comply with the requirements under paragraph (B)(10)(a)(i) of rule 173-39-02 of
the Administrative Code: (a) Individual's name. (b) Date of trip. (c) Pick-up point and time of the pick up. (d) Destination point and time of the drop
off. (e) Driver's name. (f) Unique identifier of the driver to attest to providing
the trip. (g) Unique identifier of the individual to attest to
receiving the trip. (C) Jobs and rates: (1) For the PASSPORT
program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the
following for a job of non-medical transportation: (a) The job as one trip, whether a one-way or round
trip. (b) The maximum rate allowable for a job. (2) For the PASSPORT program, rule
5160-31-07 of the Administrative Code establishes the rate-setting methodology
for non-medical transportation.
Last updated April 12, 2024 at 11:08 AM
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Rule 173-39-02.20 | ODA provider certification: enhanced community living.
(A) Definitions for this
rule: (1) "Enhanced community living"
(ECL) means a service promoting aging in place, in multi-family affordable
housing, through access to on-site, individually-tailored, health-related, and
supportive interventions for individuals who have functional deficits resulting
from one or more chronic health conditions. (a) ECL includes the following activities: (i) The establishment of measurable health goals. (ii) The identification of modifiable healthcare
risks. (iii) The provision of regular health-status monitoring
interventions. "Health-status monitoring interventions" mean taking
and recording vital signs, weight, nutrition, and hydration
statuses. (iv) Assistance with accessing additional allied health
services. (v) The provision of, or arrangement for, education on
self-managing chronic diseases or chronic health conditions. (vi) Daily wellness checks. "Daily wellness check" means
an activity of ECL through which a PCA observes any changes in the
individual's level of functioning and determine what, if any,
modifications to the activity plan are needed. (vii) Access to planned and intermittent personal care under rule
173-39-02.11 of the Administrative Code, excluding respite care. (viii) Activities to assist an individual who is returning home
following a hospital or nursing facility stay. (b) ECL does not include activities provided while the individual
is receiving a similar service under this chapter. (2) "Chronic health
condition" means a condition that lasts twelve months or longer and meets
one or both of the following tests: (a) It places limitation on self-care, independent living, and
social interactions. (b) It results in the need for ongoing intervention with medical
services, products, and equipment. (3) "Intermittent" means stopping and starting at
intervals; pausing from time to time; periodic, not pre-determined designated
time periods (e.g., ten a.m. to eleven a.m.) or for designated lengths of time
(e.g., fifteen minutes or two hours). (4) "Multi-family
affordable housing" means a housing site meeting all of the following
requirements: (a) The housing site uses a landlord-tenant rental agreement that
complies with Chapter 5321. of the Revised Code. (b) The housing site provides a minimum of six units of housing
under one roof. (c) The housing site receives assistance through one of the
following programs: (i) Federally-assisted
housing program under 24 C.F.R. Part 5. (ii) Project-based
voucher program under 24 C.F.R. Part 983. (iii) Low-income housing
tax credit program based on Section 42 of the Internal Revenue
Code. (5) "Person-centered activity"
means an activity directed by the individual's informed choices that is
offered at the time and place most preferable to the individual, in a safe and
unhurried manner, and in a way that honors the individual's individuality
and preferences. (B) Every ODA-certified ECL provider
shall comply with the following requirements: (1) General requirements: The provider
shall comply with the requirements for every ODA-certified provider in rule
173-39-02 of the Administrative Code. (2) Person-centered activity
plan: (a) Development: Before the provider provides the initial episode
of ECL to an individual, the PCA supervisor shall: (i) Assess the
individual's health goals, modifiable health risks, and planned and
anticipated intermittent personal care needs; and, (ii) Develop a
person-centered activity plan with the individual that describes the
interventions the individual has chosen to reach his or her identified health
goals, to minimize his or her modifiable health risks, and to meet his or her
planned and anticipated intermittent personal care needs. The provider shall
obtain a unique identifier of the individual to verify that the individual was
involved in the development of his or her person-centered activity
plan. (b) Regular monitoring: After the individual begins to receive
ECL, the PCA supervisor shall do both of the following: (i) Revise the
person-centered activity plan in fewer than five days after each hospital or
nursing facility stay, and as otherwise needed to reflect changes in the
individual's status, condition, preferences, and response to
ECL. (ii) Facilitate an
in-person review of the person-centered activity plan with the individual, the
primary team, the individual's case manager, the individual's
caregiver (if the individual has a caregiver), and the housing site's
service coordinator (if the housing site has a service coordinator) every sixty
days to evaluate the effectiveness of the plan in addressing the
individual's health goals, reducing modifiable risks, and meeting planned
and anticipated intermittent personal care needs. (c) Records-retention: The provider shall retain a record of the
person-centered activity plan, including any revisions to the person-centered
activity plan and the in-person review of the person-centered activity
plan: (3) Staffing
levels: (a) The provider shall maintain adequate staffing levels to
provide each ECL activity. (b) The PCA supervisor shall maintain accessibility to respond to
individuals' emergencies in the housing site during any time that a PCA is
providing ECL to an individual in the housing site. (c) The provider shall maintain adequate staffing levels to
provide person-centered ECL seven days a week for a minimum of six hours a
day. (d) During each hour the provider has a PCA providing ECL
to an individual in a housing site, the provider shall ensure that any other
individual has a mechanism to contact a PCA to request assistance with
intermittent and unplanned personal care needs related to the measurable health
goals and modifiable healthcare risks described in the individual's
activity plan. (e) Each day, the provider shall provide adequate staffing
levels of on-site PCAs for no fewer than six hours (or, twenty-four units) to
meet the individuals' assessed, intermittent, and unscheduled healthcare
needs. (f) The PCA supervisor or another RN (or LPN under the
direction of an RN) shall monitor the health status of individuals for no fewer
than three hours (or, twelve units) each week. (4) Provider
qualifications: (a) Type of provider: A provider shall only provide ECL if both
of the following conditions are met: (i) ODA certifies the provider as an agency provider of both
personal care and ECL. (ii) The provider is a legal entity distinct from the housing site
owner and property manager so the site is not subject to licensure, as defined
in Chapters 3721. and 5119. of the Revised Code, and safeguards are in place to
prevent any unremedied conflicts of interest. (b) Staff designations and minimum staff
qualifications: (i) PCA supervisor: The
provider shall only employ a person as a PCA supervisor if the person if the
person meets the qualifications in paragraph (C)(4)(a) of rule 173-39-02.11 of
the Administrative Code. (ii) PCAs: The provider
shall only employ a person to serve as a PCA if the person meets at least one
of the qualifications under paragraph (C)(3)(a) of rule 173-39-02.11 of the
Administrative Code, the training and competency evaluation meet the standards
under paragraph (C)(3)(e) of rule 173-39-02.11 of the Administrative Code, and
the provider meets the verification requirements under paragraph (C)(3)(f) of
rule 173-39-02.11 of the Administrative Code. (iii) Primary team: The
provider shall provide person-centered activities to individuals through a
primary team that consists of PCAs and PCA supervisors who regularly provide
activities within a given housing site and, as a result, are familiar with the
individuals in the housing site. The provider shall replace any PCA on the
primary team who is absent with a back-up PCA who is familiar with the housing
site and the individuals residing in the housing site. A PCA supervisor shall
supervise the primary team and also any back-up PCAs. (c) Staff training: (i) Before allowing any PCA to have direct, in-person
contact with an individual, the provider shall comply with the orientation
requirements in paragraphs (C)(3)(b), (C)(3)(e), and (C)(3)(f) of rule
173-39-02.11 of the Administrative Code. (ii) In-service training:
Each PCA shall comply with the in-service training requirements in paragraphs
(C)(3)(d), (C)(3)(e), and (C)(3)(f) of rule 173-39-02.11 of the Administrative
Code. (5) Service verification: (a) The provider shall develop and retain a daily activity record
for each individual that includes all of the following: (i) Individual's
name. (ii) Date of
service. (iii) Activities provided
as authorized in the person-centered activity plan. (iv) Activities provided
in response to daily, intermittent needs. (v) Description of the
individual's status and response to the activities provided. (vi) Total number of
units provided to the individual. (vii) Name and signature
of the provider's staff person who provided the activities. (viii) Unique identifier
of the individual, which by offering the individual attests to receiving the
activities. (b) The provider may use an electronic system to collect or
retain the records required under this rule. (C) Unit and rates: (1) One unit of ECL is
fifteen minutes. (2) The appendix to rule
5160-1-06.1 of the Administrative Code establishes the maximum rate allowable
for one unit of ECL. (3) Rule 5160-31-07 of
the Administrative Code establishes the rate-setting methodology for the ECL
provided through the PASSPORT program.
Last updated April 12, 2024 at 11:08 AM
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Rule 173-39-02.22 | ODA provider certification: waiver nursing service.
Effective:
January 1, 2019
(A) "Waiver nursing service"
means the service defined in rule 5160-44-22 of the Administrative
Code. (B) Every ODA-certified provider of a
waiver nursing service shall comply with the following
requirements: (1) General requirements:
The provider shall comply with the requirements for every ODA-certified agency
provider in rule 173-39-02 of the Administrative Code. (2) Requirements specific
to a waiver nursing service: The provider shall comply with the requirements in
rule 5160-44-22 of the Administrative Code. (3) If a conflict exists
between a requirement in rule 173-39-02 of the Administrative Code and a
requirement in rule 5160-44-22 of the Administrative Code, the provider shall
comply with the requirement in rule 173-39-02 of the Administrative
Code. (C) Units and rates: (1) A unit of a waiver
nursing service under the PASSPORT program equals a unit of a waiver nursing
service that rule 5160-46-06 of the Administrative Code establishes for the
Ohio home care waiver program. (2) Rule 5160-46-06 of
the Administrative Code establishes the maximum rate allowable for a unit of a
waiver nursing service. (3) Rule 5160-31-07 of
the Administrative Code establishes rate-setting methodology for units of a
waiver nursing service.
Last updated April 12, 2024 at 11:33 AM
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Rule 173-39-02.23 | ODA provider certification: out-of-home respite.
Effective:
October 10, 2020
(A) "Out-of-home respite" means
the service defined in rule 5160-44-17 of the Administrative Code. (B) Every ODA-certified provider of
out-of-home respite shall comply with the following requirements: (1) General requirements:
The provider shall comply with the requirements for every ODA-certified agency
provider in rule 173-39-02 of the Administrative Code. (2) Requirements specific
to out-of-home respite: The provider shall comply with the requirements in rule
5160-44-17 of the Administrative Code. (3) If a conflict exists
between a requirement in rule 173-39-02 of the Administrative Code and a
requirement in rule 5160-44-17 of the Administrative Code, the provider shall
comply with the requirement in rule 173-39-02 of the Administrative
Code. (C) Units and rates: (1) A unit of out-of-home
respite under the PASSPORT program equals a unit of out-of-home respite that
rule 5160-46-06 of the Administrative Code establishes for the Ohio home care
waiver program. (2) Rule 5160-46-06 of
the Administrative Code establishes the maximum rate allowable for a unit of
out-of-home respite. (3) Rule 5160-31-07 of
the Administrative Code establishes rate-setting methodology for units
out-of-home respite.
Last updated April 12, 2024 at 11:33 AM
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Rule 173-39-02.24 | ODA provider certification: home care attendant service.
Effective:
January 1, 2019
(A) "Home care attendant
service" means the service defined in rule 5160-44-27 of the
Administrative Code. (B) Every ODA-certified provider of a
home care attendant service shall comply with the following
requirements: (1) General requirements:
The provider shall comply with the requirements for every ODA-certified agency
provider in rule 173-39-02 of the Administrative Code. (2) Requirements specific
to a home care attendant service: The provider shall comply with the
requirements in rule 5160-44-27 of the Administrative Code. (3) If a conflict exists
between a requirement in rule 173-39-02 of the Administrative Code and a
requirement in rule 5160-44-27 of the Administrative Code, the provider shall
comply with the requirement in rule 173-39-02 of the Administrative
Code. (C) Units and rates: (1) A unit of a home care
attendant service under the PASSPORT program equals a unit of a home care
attendant service that rule 5160-46-06 of the Administrative Code establishes
for the Ohio home care waiver program. (2) Rule 5160-46-06.1 of
the Administrative Code establishes the maximum rate allowable for a unit of a
home care attendant service. (3) Rule 5160-31-07 of
the Administrative Code establishes rate-setting methodology for units a home
care attendant service.
Last updated April 12, 2024 at 11:33 AM
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Rule 173-39-03 | ODA provider certification: applying for certification.
(A) Initial steps: (1) To apply for
certification, a provider shall complete an application in the provider
management system, which includes electronic submission of all supporting
records required as part of the application. If the provider does not complete
the application within ninety days, the application expires. (2) ODA shall review an
application to determine if the application meets the requirements for the
certification the provider is seeking. (a) ODA shall initiate the process for a pre-certification
review if ODA determines that a provider submitted a complete
application. (b) If ODA determines that the supporting records do not
demonstrate that the provider submitted a complete application, then ODA shall
email the provider to give the provider a deadline to submit supporting records
that demonstrate that the provider meets the requirements for certification
that is the earlier of thirty days after the email or the deadline in paragraph
(A)(1) of this rule. (B) Voluntary withdrawal of application
for certification: (1) A provider may
withdraw its application at any time before enrollment with ODM unless ODA
issued a notice of denial of certification. (2) A provider that
withdrew its application may later reapply for certification. (C) Pre-certification review: (1) For all providers
except providers of community transition provided through the home choice
program under rule 5160-51-10 of the Administrative Code and
participant-directed providers: (a) ODA's designee shall visit the provider's
business site to determine if the provider meets the applicable requirements in
rule 173-39-02 of the Administrative Code and any additional requirements in
this chapter regulating a service the provider is seeking certification to
provide. During a state of emergency declared by the governor, a federal public
health emergency, or during another time if authorized by ODA, ODA's
designee may conduct a desk review of the provider's business site in lieu
of a visit. (b) ODA's designee shall complete the review and
notify ODA of its recommendation within sixty days after receiving a complete
application to become any other type of provider, unless ODA approves an
extended deadline. (c) ODA's designee shall recommend approval of the
provider's application if a provider other than an ADS or assisted living
provider complies with all applicable requirements. (d) Paragraph (D) of this rule applies if ODA's
designee determines that an ADS or assisted living provider complies with all
applicable requirements. (e) ODA's designee shall recommend denial of the
application if the provider does not comply with all applicable
requirements. (2) For providers of
community transition provided through the home choice program under rule
5160-51-10 of the Administrative Code: (a) ODA may direct its designee to conduct the
pre-certification review to determine if the provider meets the applicable
requirements in rules 173-39-02 and 173-39-02.17 of the Administrative
Code. (b) ODA or its designee shall determine whether the
provider complies with all applicable requirements and either approve or deny
the provider's application pursuant to this rule. (3) For
participant-directed providers, ODA's designee shall conduct a
pre-certification review within thirty days after receiving a complete
application to determine whether the provider meets the applicable requirements
in rule 173-39-02 of the Administrative Code and any additional requirements in
this chapter regulating a service the provider is seeking certification to
provide, unless ODA approves an extended deadline. (D) HCBS settings requirements: A provider may qualify for
certification only if the provider provides its services in the
individual's home or another setting meeting the HCBS settings
requirements in 42 C.F.R. 441.301 and rule 5160-44-01 of the Administrative
Code as determined by ODA on form ODM10172 (revised, June 2021), which is
entitled, "Home and Community Based Services (HCBS) Settings Evaluation
Tool." (1) ODA may certify the
provider if ODA determines the setting is presumed to have the qualities of a
HCBS setting and the setting is not subject to the heightened scrutiny
described in rule 173-39-03.1 of the Administrative Code. (2) The setting is
subject to the heightened scrutiny described in rule 173-39-03.1 of the
Administrative Code if ODA determines the setting is presumed to have the
qualities of an institution. ODA defers action on the application for
certification until the conclusion of the heightened scrutiny. ODA shall notify
the provider that action on the provider's application is
deferred. (E) Final determination: ODA bases its final determination
of whether to certify a provider on the review of the application materials and
the recommendation of ODA's designee. (F) Approved application: (1) Applications for all
services except community transition provided through the home choice program
under rule 5160-51-10 of the Administrative Code: (a) When ODA approves an application, ODA notifies
ODA's designee for the region in which the provider is being certified to
provide services. (b) ODA's designee shall enter into an agreement with
each provider specifying, at a minimum, the following: (i) The time period
during which the agreement is in effect. (ii) The region for which
the provider is certified. (iii) The rate of payment per unit the provider is willing to
accept subject to any limits ODM established in rule 5160-31-07 of the
Administrative Code and the appendix to rule 5160-1-06.1 of the Administrative
Code for the PASSPORT program, and rule 5160-33-07 of the Administrative Code
and the appendix to rule 5160-1-06.5 of the Administrative Code for the
assisted living program. (2) Applications for
community transition provided through the home choice program under rule
5160-51-10 of the Administrative Code: After ODA approves an application to be
a provider of community transition through the home choice program, ODA's
designee shall enter into an agreement with the provider specifying the items
under paragraph (F)(1) of this rule. (G) Deemed providers: ODA may deem any provider certified
by ODM or the department of developmental disabilities to provide one or more
services through a medicaid-waiver program as having satisfied the requirements
for certification by ODA for the same or similar services under this chapter,
as determined by ODA. The effective period for a provider to be deemed an
ODA-certified provider under this paragraph begins when the provider completes
the deeming application process and has a provider agreement with ODA's
designee, and ends if the provider cannot comply with all the requirements of
Chapter 173-9 of the Administrative Code and this chapter within sixty days
after initial deeming or a medicaid provider agreement is terminated, whichever
occurs first. (H) Denied application: (1) ODA may deny a
providers application for any of the following reasons: (a) The provider made false representations, by omission or
commission, on the provider's application. (b) The provider made false statements, provided false
information, or altered records or documents. (c) The provider is disqualified under section 173.38 or
173.381 of the Revised Code or under Chapter 173-9 of the Administrative
Code. (d) The provider does not meet the applicable requirements
in rule 173-39-02 of the Administrative Code or any requirements in this
chapter regulating a service that the provider is seeking certification to
provide. (e) ODA previously revoked the provider's
certification. (f) Any reason permitted or required by state or federal
law. (2) When ODA denies a provider's
application, ODA notifies the provider of its final determination and any
applicable hearing rights established in section 173.391 of the Revised
Code. (3) When ODA denies a provider's
application, the provider is ineligible to reapply for certification for one
year after the mailing date of ODA's final adjudication
order.
Last updated March 26, 2024 at 11:18 AM
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Rule 173-39-03.1 | ODA provider certification: federal heightened scrutiny of provider settings with institutional characteristics.
Introduction: In 42 C.F.R. 441.301(c)(5)(v), HHS
requires heightened scrutiny by HHS's secretary to determine if a setting
presumed to have the qualities of an institution meets HCBS settings
requirements. This rule applies to settings subject to heightened scrutiny to
become or remain an ODA-certified provider. (A) Scope: A setting presumed to have the
qualities of an institution requires heightened scrutiny by HHSs
secretary, based on information presented by the state or other parties, to
determine whether the setting has the qualities of an institution or has the
qualities of a HCBS setting. A setting is presumed to have the qualities of an
institution if it has any of the following characteristics: (1) The entire setting is
located in a building that is also a publicly or privately-operated facility
that provides inpatient institutional treatment. (2) The setting is in a
building on the grounds of, or immediately adjacent to, a public
institution. (3) The setting has the
effect of isolating individuals receiving medicaid HCBS from the broader
community of individuals not receiving medicaid HCBS. (B) Process: ODA shall determine if a
setting requires heightened scrutiny by HHS's secretary. If ODA determines
a setting requires heightened scrutiny under paragraph (A) of this rule, ODA
shall review information submitted by the provider, conduct an on-site visit of
the setting, and complete form ODM10204, "Heightened Scrutiny Evidence
Package" (February 2017). ODA may recommend the provider undertake
remediation of any possible deficiencies in its compliance with HCBS settings
requirements and may establish deadlines for completion of any remediation. If
the provider fails to complete requested remediation or provide evidence of the
same to ODA, ODA may withhold submission of the provider's application for
heightened scrutiny. (C) Public-comment periods: Before
providing an application for heightened scrutiny to the HHS secretary, ODA
shall offer the public a thirty-day opportunity to comment on the application.
ODM, on behalf of ODA, shall offer public-comment periods four times per
year. (D) Request for heightened scrutiny:
Following the completion of the public-comment period, ODM, on behalf of ODA,
shall provide form ODM 10204 and any supplemental material, if requested, to
HHS's secretary for heightened scrutiny of the setting. (E) HHS heightened scrutiny
determination: (1) For providers seeking
ODA certification: (a) If HHS's secretary determines the setting meets HCBS
settings requirements, ODA may approve the provider's application for
certification. (b) If HHS's secretary determines the provider's
setting does not meet HCBS settings requirements, ODA shall notify the provider
of the final determination and any applicable hearing rights established in
section 173.391 of the Revised Code. If ODA denies a providers
certification, the provider is ineligible to reapply for certification for one
year after the mailing date of ODA's final determination. (2) For certified
providers: (a) If HHS's secretary determines the provider's
setting meets HCBS settings requirements, the provider shall retain its
certification so long as it continues to comply with this chapter. (b) If HHS's secretary determines the provider's
setting does not meet HCBS settings requirements, ODA may impose discipline
against the provider and notify the provider of any applicable hearing rights
established in section 173.391 of the Revised Code.
Last updated March 26, 2024 at 11:18 AM
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Rule 173-39-03.2 | ODA provider certification: changes of ownership interest or organizational structure.
Introduction: Section 173.39 of the Revised Code
prohibits ODA from paying a provider for services provided to individuals
enrolled in the PASSPORT or assisted living programs unless the provider is an
ODA-certified provider. ODA-certification is assigned to a provider's
federal taxpayer identification number (TIN) and is not transferable. This rule
shall apply in all instances where there is a change of ownership interest
involving an ODA-certified provider obtaining a new TIN according to any rule
adopted by the internal revenue service (IRS) or any change in organizational
structure of an ODA-certified provider involving a person with an ownership or
management interest, including non-profit providers. ODA will be unable to process a change of ownership
interest or organizational structure while ODA and ODM develop a new electronic
infrastructure for processing applications. (A) Requirements: (1) Notification: The
providers current owner(s) shall notify ODA in writing of a change of
ownership interest or change of organizational structure (change) no later than
forty-five days before the change, unless this chapter requires notifying ODA
sooner. The current owner(s) shall email their written notice to ODA at
"provider_enrollment@age.ohio.gov." In the notice, the current
owner(s) shall include a notarized statement including all of the following
information, as applicable and to the extent it is available to the current
owner(s) at the time the notice is provided to ODA. In the event information is
not available at the time written notice is required, the current owner(s)
shall supplement the written notice until all the following information is
provided: (a) Name of the provider undergoing the change. (b) Name of each current owner, and, if any, the name of each
current owner's authorized agent. (c) Medicaid provider number and NPI of the provider after the
change, if known. ODA considers the notice to be complete if the notice is
complete except for indicating the provider's number if ODM has not yet
granted the provider a number, so long as the provider provides the number to
ODA as soon as it is available. (d) The following information about each new
owner(s): (i) Name. (ii) Date of
birth. (iii) Social security
number. (iv) Percentage of
ownership or control in the provider. (v) Whether each new
owner has been a resident of Ohio for the five-year period immediately
preceding the date of the change of ownership interest. (e) Date the change takes effect, as evidence by a bill of sale
or purchase contract executed by both parties. (f) Statement indicating whether the provider intends to seek
payment from ODA for services it provides after the change. (g) Names and addresses of the persons to whom ODA and its
designee should send correspondence regarding the change. (h) Any information required to show the ongoing compliance
required by paragraph (B) of this rule. (i) Signatures of the current and new owner(s). (2) Current certification
ends: If IRS rules require a provider to obtain a new TIN, the provider's
certification ends on the date the change is finalized. The relinquishment of
the provider's certification means a provider shall not bill ODA after the
date the change is finalized. (3) New certification
required: If a provider with a new TIN intends to seek payment from ODA for
services it provides after a change, the provider shall apply to become an
ODA-certified provider according to the application process in rule 173-39-03
of the Administrative Code. (4) Payment for
authorized services: If ODA approves an application to become an ODA-certified
provider, ODA may pay for authorized services provided during a change back to
the first date on which both of the following have occurred: (a) The provider provided evidence the change was finalized to
ODA, such as a bill of sale or an executed purchase. (b) The new owner(s) provided a complete application, as defined
in rule 173-39-01 of the Administrative Code, to become an ODA-certified
provider. (5) Discharging
residents: After an assisted-living provider has applied for new certification
from ODA during a change, neither the current nor the new owner(s) shall
discharge residents from the RCF for non-payment until ODA makes a final
determination regarding certification of the provider. (B) Compliance with HCBS settings requirements: (1) Every provider is
subject to the HCBS settings requirements in state and federal law, including
rule 5160-44-01 of the Administrative Code and 42 C.F.R. Part 441, as indicated
in rule 173-39-02 of the Administrative Code. Every provider shall maintain
compliance with those requirements from the effective date of ODA certification
and thereafter to maintain ODA certification. (2) For a provider
subject to federal heightened scrutiny under rule 173-39-03.1 of the
Administrative Code, the new owner(s) shall, at a minimum, implement policies,
procedures, to maintain compliance with the HCBS settings requirements under
rules 173-39-02 and 5160-44-01 of the Administrative Code, and any other
requirements under 42 C.F.R. Part 441 at the time of the change of ownership
interest and thereafter. When applying for ODA certification, the new owner(s)
shall email a notarized statement demonstrating compliance with this
requirement to ODA at
"provider_enrollment@age.ohio.gov."
Last updated April 12, 2024 at 11:33 AM
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Rule 173-39-03.3 | ODA provider certification: applying to be certified to provide additional services.
Introduction: After ODA initially certifies a
provider in a region, the provider may apply to become certified to provide an
additional service in that region. (A) Application: The provider shall
provide a complete application to become certified to provide an additional
service in a region in which it is already certified. Only complete
applications shall be processed. If the provider does not complete the
application within ninety days of the date the application is requested, the
application shall expire. (B) Pre-certification review: ODA's
designee shall visit the providers business site to conduct an on-site
pre-certification review to determine if the provider meets the requirements of
this chapter to be certified to provide the additional service. For agency
providers, this includes compliance with paragraph (C)(1)(a) of rule 173-39-02
of the Administrative Code. During a state of emergency declared by the
governor, a federal public health emergency, or during another time if
authorized by ODA, ODA's designee may conduct a desk review of the
provider's business site in lieu of a visit. (C) Approved application: ODA and its
designee shall follow the process under paragraph (E) of rule 173-39-03 of the
Administrative Code for an approved application for certification to provide an
additional service in a region for which it is already certified. (D) Denied application: ODA and its
designee shall follow the process under paragraph (G) of rule 173-39-03 of the
Administrative Code for a denied application to become certified to provide an
additional service in a region for which it is already certified.
Last updated March 27, 2024 at 9:16 AM
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Rule 173-39-03.4 | ODA provider certification: applying to be certified in additional regions or to certify additional business sites.
Introduction: After ODA initially certifies a
provider in a region, the provider may apply to become certified to provide the
service for which it is already certified in an additional region or additional
business site within the same region. An assisted-living provider certified by ODA for
one RCF shall obtain a new certification for each additional RCF pursuant to
rule 173-39-03 of the Administrative Code. This rule would not apply. (A) Application: The provider shall
provide a complete application to become certified to provide the service for
which it is already certified in an additional region or additional business
site within the same region. Only complete applications shall be processed. If
the provider does not complete the application within ninety days of the date
the application is requested, the application shall expire. (B) Pre-certification review: ODA's
designee shall visit the provider's business site to conduct an on-site
pre-certification review to determine if the provider meets the requirements of
this chapter to provide the service for which it is already certified in the
additional region or additional business site within the same region. For
agency providers seeking certification in an additional region, this includes
compliance with paragraph (C)(1)(a) of rule 173-39-02 of the Administrative
Code. During a state of emergency declared by the governor, a federal public
health emergency, or during another time if authorized by ODA, ODA's
designee may conduct a desk review of the provider's business site in lieu
of a visit. (C) Approved application: ODA and its
designee shall follow the process under paragraph (E) of rule 173-39-03 of the
Administrative Code for an approved application for certification to provide
the service for which it is already certified in an additional region or
additional business site within the same region. (D) Denied application: ODA and its
designee shall follow the process under paragraph (G) of rule 173-39-03 of the
Administrative Code for a denied application to become certified to provide the
service for which it is already certified in an additional region or additional
business site within the same region.
Last updated April 12, 2024 at 11:14 AM
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Rule 173-39-03.5 | ODA provider certification: military provisions.
Effective:
October 1, 2020
(A) Applications: Persons who submit with
their applications for ODA provider certification proof that they are a service
member or veteran, as section 5903.01 of the Revised Code defines those terms,
or the spouse or surviving spouse of a service member or veteran, shall receive
priority processing of their applications. (1) If an applicant
answers affirmatively that he or she is a service member, veteran, or the
spouse or surviving spouse of a service member or veteran, the applicant shall
submit supporting documents along with their application. Acceptable forms of
documentation include: (a) A copy of a document issued by the armed forces, such as an
identification card or military discharge certificate; and (b) A marriage certificate or other document showing the
applicant and service member or veteran are spouses. (2) ODA or its designee
shall track and monitor the total number of applications submitted by service
members, veterans, or their spouse or surviving spouse, and the average number
of business days it takes to process the applications. (B) Training: Pursuant to section 5903.03
of the Revised Code, a person subject to the training requirements in this
chapter may request that ODA or its designee consider their successfully
completed military training to satisfy the training requirements in this
chapter. The person shall provide ODA or its designee with supporting documents
demonstrating that the military training was successfully completed and is
substantially equivalent to or exceeds the training requirements in this
chapter.
Last updated March 26, 2024 at 11:18 AM
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Rule 173-39-04 | ODA provider certification: structural compliance reviews.
Introduction: Each ODA-certified provider is
subject to a regular structural compliance review (review) to ascertain if it
complies with this chapter. (A) Deadline for ODA's designee to conduct the first
review: The one-year anniversary of the provider's certification
date. (B) Deadlines for ODA's designee to conduct subsequent
reviews: (1) The one-year anniversary of the
previous review if the provider is one of the following: (a) A provider of an adult day service. (b) A provider of an assisted living service. (c) An agency provider of personal care that is neither
certified by medicare nor accredited by the accreditation commission for health
care, the community health accreditation partner, the joint commission, or
another national accreditation organization that is approved by CMS and
ODH. (2) The three-year anniversary of the
previous review if the provider is not listed under paragraph (B)(1) of this
rule. (C) Deadline extensions: ODA may extend a deadline for
ODA's designee under paragraph (A) or (B) of this rule if both of the
following occur: (1) ODA's designee
provides ODA with a request for an extension that includes the rationale for a
delay and a forecast on the time needed to complete the review. (2) ODA's designee
retains the request for an extension in the provider's file and makes a
note in the provider contact section of the PASSPORT information management
system (PIMS). (D) ODA or its designee may conduct an
unannounced review of a provider at any time to review compliance with this
chapter. (E) ODA's designee may review a
provider at any time without waiting for a deadline in paragraph (A), (B), or
(C) of this rule to near. (F) Responsible designees, type of reviews to conduct, and
scope of reviews: (1) Based on the provider type and
situation, Appendix A to this rule establishes when a designee is responsible
for conducting a review, the type of review it is responsible to conduct, and
the scope of that review. (2) ODA may authorize a
designee to conduct a desk review even if Appendix A to this rule establishes a
requirement for an on-site review. (G) Review components: For each review, ODA's designee
shall do the following: (1) Inform the provider of the review
before beginning the review and before conducting an introductory conference
with the provider, unless the review is an unannounced review under paragraph
(D) of this rule. (2) Conduct an
introductory conference with the provider to explain the purpose and scope of
the review. (3) Review compliance with each
applicable requirement in rule 173-39-02 of the Administrative Code other than
the records and monitoring requirements in that rule, unless appendix A to this
rule determines that this paragraph is not a component of the
review. (4) Review compliance with each
applicable requirement in rules 173-39-02.1 to 173-39-02.24 of the
Administrative Code and the records and monitoring requirements in rule
173-39-02 of the Administrative Code. (5) Verify that a sample of paid service
units were provided according to the applicable requirements in rules
173-39-02.1 to 173-39-02.24 of the Administrative Code and the records and
monitoring requirements in rule 173-39-02 of the Administrative
Code. (6) Review a sample of paid service units
for ten per cent of the individuals that the provider served since being
certified (if an initial review) or since the previous review (if a subsequent
review) so long as the ten-per-cent sample contains no fewer than three
individuals and no more than thirty individuals, with the following
exceptions: (a) If non-compliance is identified, ODA or its designee
may review a larger sample size or order an independent audit at the
provider's expense. (b) If the provider operates from multiple business sites,
ODA's designee shall review a sample of paid service units for ten per
cent of the individuals that the provider served from each business
site. (c) If the provider did not bill ODA for providing a
service to any individual during the period in paragraph (G)(6) of this rule,
ODA or its designee shall indicate in the review record that ODA did not pay
the provider for providing a service to any individual during the review
period, then complete the remaining elements of the review under this
rule. (d) If the provider is a participant-directed provider, ODA
or its designee shall review records for each individual served during the
review period in paragraph (G)(6) of this rule. If the provider did not bill
ODA for providing any units of service during the review period in paragraph
(G)(6) of this rule, ODA or its designee shall indicate in the review record
that ODA did not pay the provider to provide any units of service during the
review period, then complete the remaining elements of the review under this
rule. (e) If the provider is certified to provide both personal
care and homemaker, ODA or its designee shall combine the review for each
service so that the aggregate sample size for the combined services equals the
sample size in paragraph (G)(6) of this rule. (f) During a state of emergency declared by the governor or
a federal public health emergency, ODA may determine a lesser review sample and
issue this determination by notice. (7) Review the qualifications of the
employees who provided services to individuals in the sample in paragraph
(G)(6) of this rule according to the following standards: (a) The sample size of employees corresponds to the sample
size of individuals in appendix B to this rule. (b) If the provider hired or subcontracted with RNs or LPNs
under the direction of RNs, the number of RNs or LPNs in the sample corresponds
to the sample size of individuals in appendix B to this rule. (c) The sample of employees includes any employees
providing services to individuals in the sample in paragraph (G)(6) of this
rule that the provider hired since the previous review. (d) The sample of employees does not need to include an
employee providing services to individuals in the sample in paragraph (G)(6) of
this rule if one or more of ODA's designees already reviewed the
employee's qualifications when conducting a review of the same provider at
a different business site within the past three hundred sixty-five
days. (e) For a provider that provides only home-delivered meals
or a personal emergency response system, the maximum sample size is ten
employees. (H) At the conclusion of the review: (1) If ODA's
designee determines a provider engaged in conduct determined injurious or
posing a threat to the health or safety of an individual, ODA's designee
shall ensure all of the following occur: (a) ODA's designee notifies the provider at the exit
interview or, if the provider is unavailable for the exit interview, with a
detailed email within one day after the review. (b) ODA's designee records the method of notification
in paragraph (H)(1)(a) of this rule in PIMS. (c) ODA's designee notifies ODA within one
day. (d) The provider demonstrates compliance within five days
after receiving notification from ODA's designee. (e) ODA or its designee determine whether to impose an
immediate disciplinary action under rule 173-39-05 of the Administrative
Code. (2) Within sixty days
after the review, ODA's designee shall issue a written or electronic
structural compliance review report to the provider, including a summary of all
areas of non-compliance and disciplinary action imposed by ODA or its
designee. (3) Within sixty days
after the date ODA's designee issues the written or electronic structural
compliance review report to the provider, the provider shall provide evidence
of compliance with the laws, rules, or regulations determined to have been
violated during the review which were not subject to disciplinary action under
rule 173-39-05 of the Administrative Code. (4) If a unit-of-service
error is detected during unit-of-service verification, the provider shall
return the overpayment of funds to ODA or its designee using appropriate
auditing procedures. (I) ODA may suspend any review during a state of emergency
declared by the governor or a federal public health emergency. (J) If any deadline in this rule occurs on a Saturday,
Sunday, or legal holiday under section 1.14 of the Revised Code, the deadline
is extended to the next day that is not a Saturday, Sunday, or legal holiday
under section 1.14 of the Revised Code.
View Appendix
Last updated April 17, 2024 at 12:28 PM
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Rule 173-39-05 | ODA provider certification: disciplinary actions.
(A) Introduction: Pursuant to section 173.391 of the Revised Code, ODA or its designee may impose disciplinary action against an ODA-certified provider (provider) for good cause, including misfeasance, malfeasance, nonfeasance, confirmed abuse or neglect, financial irresponsibility, or other conduct ODA determines is injurious, or poses a threat, to the health or safety of individuals being served. (B) Disciplinary actions by ODA's designee: (1) Disciplinary actions imposed by ODA's designee may include any one or more of the following: (a) Plan of correction: ODA's designee may require the provider to provide a plan of correction with all areas of non-compliance within seven days after the disciplinary action is imposed. (b) Evidence of compliance: ODA's designee may require the provider to provide evidence of compliance according to the following deadlines: (i) Health or safety: If the non-compliance is injurious or poses a threat to the health or safety of individuals being served, the provider shall provide evidence of compliance within five days after the disciplinary action is imposed. (ii) Non health or safety: If the non-compliance is not injurious or poses no threat to the health or safety of individuals being served, the provider shall provide evidence of compliance within sixty days after the disciplinary action is imposed. (c) Suspending referrals: ODA's designee may cease to refer individuals to the provider until ODA's designee determines the provider complies with all requirements in this chapter. (2) When ODA's designee imposes a disciplinary action, it shall do the following: (a) Notify the provider of the disciplinary action via encrypted email or mail. (b) Notify ODA of the disciplinary action via an ODA-approved method. (c) Complete the required fields in ODA's provider information management system related to the disciplinary action. (d) Indicate in ODA's provider information management system anytime it grants an extension to the deadlines in paragraph (B)(1)(a) or (B)(1)(b) of this rule. (3) ODA's designee does not have authority to impose more than one disciplinary action against a provider for the same episode of non-compliance. (4) ODA may require ODA's designee to rescind or modify any pending disciplinary action. (C) Disciplinary actions imposed by ODA: (1) ODA may impose any discipline authorized in section 173.391 of the Revised Code, including the following: (a) Plan of correction. (b) Evidence of compliance. (c) Suspension of referrals. (d) Removal of clients. (e) Fiscal sanctions, including a civil monetary penalty or an order that unearned funds be repaid. (f) Suspension of certification. (g) Permanent revocation of certification. (h) Another disciplinary action. (2) ODA may consider any one or more of the following when imposing disciplinary action: (a) Whether the conduct is injurious or poses a threat to the health or safety of individuals being served. (b) The provider's previous disciplinary history. (c) Any other factors ODA may consider relevant. (D) A provider may appeal a disciplinary action listed in column B of table 1 to this rule unless the reason for the disciplinary action is listed under division (E) of section 173.391 of the Revised Code. As used in table 1 to this rule, "another sanction" does not include any of the disciplinary actions listed in column A of the table. | COLUMN A | COLUMN B | | Written warning | Fiscal sanction such as a civil monetary penalty or an order to repay unearned funds | | Requirement to submit a plan of correction or provide evidence of compliance | Suspended certification | | Suspended referrals | Revoked certification | | Removal of clients | Another sanction |
(E) The provider may request a hearing under Chapter 119. of the Revised Code only if it does so within thirty days after the mailing date of the notice. (F) If any deadline in this rule occurs on a Saturday, Sunday, or legal holiday under section 1.14 of the Revised Code, the deadline is extended to the next day that is not a Saturday, Sunday, or legal holiday under section 1.14 of the Revised Code.
Last updated March 26, 2024 at 11:18 AM
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