Chapter 173-39 Certification of Community-Based Long-Term Care Service Providers

173-39-01 Introduction and definitions.

(A) The rules in Chapter 173-39. of the Administrative Code establish criteria for the certification of persons and governmental entities to provide community-based long-term care services under programs administered by the Ohio department of aging.

(B) As used in this chapter:

(1) “ADL” means activities of daily living, including: bathing; grooming; toileting; dressing; eating; and mobility, which refers to bed mobility, transfer, and locomotion.

(2) “Assessment” means an in-depth information about an individual’s current situation and ability to function. It is comprehensive and identifies the individual’s strengths, problems, and care needs in the following major functional areas: physical health, medical care utilization, activities of daily living, instrumental activities of daily living, mental and social functioning, financial resources, physical environment, and utilization of services and support.

(3) “Assistance with self-administration of medication” means an unlicensed person assisting with self-administration of medications may do only the following:

(a) Remind a consumer when to take the medication and observe to ensure that the consumer follows the directions on the container; and,

(b) Assist a consumer in the self-administration of medication by taking the medication in its container from the area where it is stored and handing the container with the medication in it to the consumer. If the consumer is physically unable to open the container, the unlicensed person may open the container for the consumer.

(4) “Assisted living provider” means a licensed residential care facility certified by ODA to furnish assisted living and community transition services.

(5) “Assisted living care plan” means a written plan identifying the extent and types of services, as described in rules 173-39-02.16 and 173-39-02.17 of the Administrative Code, to be provided to the consumer by an assisted living provider.

(6) “Authorized representative” means an adult eighteen years of age or older who is designated to act on behalf of the consumer.

(7) “Caregiver” means a relative, friend, and/or significant other who voluntarily provides assistance to the consumer and is responsible for the consumer’s care on a continuing basis.

(8) “Case management” means coordinating and monitoring the delivery of all services identified on the service plan; periodic re-evaluation of the consumer’s goals and objectives for long-term care services; periodic re-determination of program eligibility; authorization of the amount, scope, and duration of long-term care services; and assisting the consumer to access needed waiver and other medical and social services regardless of funding source.

(9) “Case manager” means the registered nurse or licensed social worker employed by a regional area agency on aging who is responsible for the planning, coordinating, monitoring, evaluation and authorization of ODA-certified long-term care services.

(10) “CDJFS” means county department of job and family services.

(11) “Certification” means the approval of a provider to furnish one or more of the long-term care services described in rules 173-39-02.1 to 173-39-02.16 of the Administrative Code.

(12) “Certified health care professional” means an individual with a professional license or certificate to provide a health care service.

(13) “COALA program” means the home health aide training program developed and copyrighted by the council on aging of southwestern Ohio.

(14) “Consumer” means an individual who has been accepted for enrollment and is receiving ODA-certified long-term care services.

(15) “Consumer-directed individual provider” means a provider who is certified to furnish consumer-directed long-term care services to a consumer. The consumer-directed individual provider may not be a spouse, parent, or stepparent of the consumer, or serve as the consumer’s legal guardian.

(16) “Consumer signature” means the signature or mark of the consumer or the consumer’s caregiver.

(17) “Denial” means that a provider applying for certification as a long-term care service provider has been refused or not accepted.

(18) “Department” means the Ohio Department of Aging.

(19) “DRI” means dietary reference intakes as established by the food and nutrition board of the institute of medicine of the national academy of sciences.

(20) “Emergency Contact” means an individual identified by a consumer and/or caregiver to be contacted in the event of an emergency and informed about the nature of the emergency.

(21) “Incident” means any event that is not consistent with the routine care and service delivery for a consumer. Incidents include, but are not limited to: abuse, neglect, abandonment, accidents, unusual events or situations which might result in injury to a person or damage to property or equipment. Incidents may involve consumers, caregivers (to the extent the event impacts on the consumer), providers, facilities, provider or facility staff, staff from ODA’s regional designee, ODA staff and other administrative authorities.

(22) “Instrumental activity of daily living” and “IADL” means any of the following activities: shopping; meal preparation; laundry; community access activities including telephoning, transportation, legal or financial services; and environmental activities including house cleaning, heavy chores, yard work or maintenance.

(23) “Level of care” (LOC) means that designation describing a person’s functional levels and nursing needs pursuant to the requirements in rules 5101:3-3-05 to 5101:3-3-08 of the Administrative Code.

(24) “Licensed practical nurse” and “LPN” mean an individual who holds a current, valid license issued pursuant to Chapter 4723. of the Revised Code.

(25) “Long-term care agency provider” means a legally organized entity that is certified by ODA to furnish certified long-term care services and employs staff.

(26) “Long-term care non-agency provider” means a provider entity that is owned and controlled by one person who is certified by ODA to furnish certified long-term care services and does not employ staff.

(27) “Mailing date” means the date that has been metered or postmarked by the United States post office.

(28) “ODA” means the Ohio department of aging.

(29) “ODA’s Designee” means the regional area agency on aging, or other entity, designated by the Ohio department of aging to administer certified long-term care services funded by the department.

(30) “ODJFS” means the Ohio department of job and family services.

(31) “Nursing facility” means a facility, or a distinct part of a facility, that is certified as a nursing facility by the director of the Ohio department of health (ODH) in accordance with Title XIX of the “Social Security Act,” 79 Stat. 286 (1965), 42 U.S.C. 1396, as amended, and is not an intermediate care facility for the mentally retarded. “Nursing facility” includes a facility, or a distinct part of a facility, that is certified as a nursing facility by the director of ODH in accordance with Title XIX of the “Social Security Act,” 79 Stat. 286 (1965), 42 U.S.C. 1396, as amended, and is certified as a skilled nursing facility by the director in accordance with Title XVIII of the “Social Security Act,” 79 Stat. 286 (1965), 42 U.S.C. 1396, as amended.

(32) “Payroll agent” means the entity operating under contract with ODA’s regional designee to facilitate payment of individual providers on behalf of the consumer for the provision of consumer-directed services.

(33) “Plan of treatment” means a physician’s orders.

(34) “Region” means the geographic area of Ohio in which ODA’s designee administers ODA-certified long-term care services.

(35) “Registered nurse” and “RN” mean an individual who holds a current, valid license issued pursuant to Chapter 4723. of the Revised Code.

(36) “Service plan” means the written outline of the consumer’s services, including certified long term care services and all other services regardless of funding source.

(37) “Significant change” means a remarkable change in a consumer’s health status, mood, behavior, and/or demeanor that may indicate the need for a re-assessment of the consumer’s needs.

(38) “Special review” means a non-electronic review of documentation submitted for payment of services compared with authorization and service provision documentation.

(39) “Sub-region” means a geographic area located within a region for the purpose of establishing unit rates as set forth in rule 5101:3-31-11 of the Administrative Code.

(40) “Vocational program” means a planned series or sequence of courses or modules that incorporate challenging academic education and rigorous, performance-based Skills training to prepare participants for success in a particular health care career field or occupation.

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

173-39-02 Conditions of participation.

(A) There are four types of ODA-certified long-term care service providers:

(1) Long-term care agency providers;

(2) Long-term care non-agency providers;

(3) Consumer-directed individual providers; and,

(4) Assisted living providers.

(B) In order to be an ODA-certified long-term care agency, or non-agency service provider, a provider shall:

(1) Comply with any service specification under rules 173-39-02.1 to 173-39-02.18 of the Administrative Code for any service regulated under those rules that the provider provides.

(2) Accept as payment in full the reimbursement levels negotiated for each service by the provider and ODA’s designee and, except as otherwise required in this rule, not seek any additional payment for those services from the consumer or any other person.

(3) Provide for a consumer only a service that is specified in the consumer’s care plan.

(4) Bill only for a service for which the provider has documentation that complies with the documentation requirements for the service under the rule of Chapter 173-39 of the Administrative Code that regulates the service.

(a) At ODA’s (or ODA’s designee’s) request, the provider shall submit written documentation for each unit of service billed so ODA (or ODA’s designee) may review the evidence to see if the provider is in compliance with all requirements before paying the provider.

(b) The provider shall give ODA (or ODA’s designee) access at any time to the provider’s fiscal and consumer records that are related to the provision of the authorized service to ensure compliance with this requirement.

(5) Have a written procedure for documenting consumer incidents with evidence of notification to ODA or its designee.

(6) Assure ODA and its designee that none of the provider’s staff persons will be a spouse, parent, or stepparent to a consumer for whom they provide services.

(7) Comply with the criminal records check requirements under rule 173-9-01 of the Administrative Code.

(8) Immediately provide representatives of ODA or its designee with access to the provider facility or place of work, and to policies, procedures, records, and other documents related to the provision of services.

(9) Not use or disclose any information concerning a long-term care consumer for any purpose without the documented consent of the consumer or the consumer’s authorized representative. Even with the consumer’s consent, the information shall not be used or disclosed for any purpose not directly associated with the provision of services.

(10) Comply with all applicable federal and state privacy laws, including the medicaid confidentiality regulations set forth in 42 C.F.R. 421.300 to 421.306 and the Health Insurance Portability and Accountability Act (HIPAA) regulations set forth in 45 C.F.R. parts 160, 162, and 164.

(11) Maintain and retain all records relating to costs, work performed, and supporting documentation for payment of work performed, along with copies of all deliverables for audit by the state of Ohio (including, but not limited to, ODJFS, ODA, the auditor of the state of Ohio, the inspector general, and duly authorized law enforcement officials) and agencies of the United States government for three years, or until an audit is concluded and all issues are resolved, whichever occurs later.

(12) Report any suspicions of abuse, neglect, or exploitation to the CDJFS or its designee according to section 5101.61 of the Revised Code, and notify ODA or its designee of any such suspicions.

(13) Provide evidence of a minimum of one million dollars in commercial liability insurance and insurance coverage for consumer loss due to theft or property damage, and a written procedure describing the step-by-step instructions a consumer shall follow to file a claim.

(14) Notify ODA or its designee within one business day when the provider is aware of significant changes that may affect the service needs of the consumer. Significant changes that may affect service needs of the consumer include, but are not limited to:

(a) The consumer refuses services repeatedly;

(b) The consumer moves to another address; and,

(c) There are changes in the physical, mental, and/or emotional status of the consumer, changes in environmental conditions and/or other health and safety issues.

(15) Provide written notification to the consumer and ODA’s designee at least thirty business days before the anticipated last date of service if the provider is terminating the provision of ODA-certified services to the consumer. Exceptions to this requirement include:

(a) The consumer has been hospitalized, placed in a long-term care facility, or has expired;

(b) The health and/or safety of the consumer or provider is at serious, imminent risk; and,

(16) Assure ODA or its designee that volunteers will not be authorized to provide any aspect of certified long-term care services for consumers without supervision by the provider’s supervisory staff.

(17) )Disclose the identity and offense of any person who is an owner and/or has control over the agency who has been convicted of a felony under state or federal law.

(18) Adopt and implement an employee code of ethics that ensures ethical standards of care by requiring workers to deliver services professionally, respectfully, legally, and during the provision of authorized services shall prohibit unprofessional, disrespectful, or illegal behavior, including, but not limited to:

(a) Consuming the consumer’s food and/or drink, or using the consumers’ personal property without the consumer’s consent.

(b) Bringing children, pets, friends, relatives, or anyone else to the consumer’s place of residence.

(d) Consuming alcohol, medicine, drugs, or other chemical substances not in accordance with the legal, valid, prescribed use, and/or in any way that impairs the provider in the delivery of services to the consumer.

(e) Discussing religion or politics with the consumer and others in the care setting.

(f) Discussing personal issues with the consumer and others in the care setting.

(g) Accepting, obtaining or attempting to obtain money, or anything of value, including gifts or tips from the consumer, household members, and family members of the consumer.

(h) Engaging with the consumer in sexual conduct or in conduct that may reasonably be interpreted as sexual in nature, regardless of whether or not the contact is consensual.

(i) Leaving the home for a purpose not related to the provision of services without notifying the agency supervisor, the consumer’s emergency contact person, any identified caregiver, and/or the consumer’s case manager; or, for consumer-directed service providers, leaving the home without the consent and/or knowledge of the consumer.

(j) Engaging in activities that may distract the provider from service delivery, including, but not limited to:

(i) Watching television or playing computer or video games;

(ii) Making or receiving personal telephone calls;

(iii) Engaging in non-care related socialization with individuals other than the consumer;

(iv) Providing care to individuals other than the consumer;

(v) Smoking without the consent of the consumer; and,

(vi) Sleeping.

(k) Engaging in behavior that causes or may cause physical, verbal, mental, or emotional distress or abuse to the consumer.

(l) Engaging in behavior that may reasonably be interpreted as inappropriate involvement in the consumer’s personal relationships.

(m) Being designated to make decisions for the consumer in any capacity involving a declaration for mental health treatment, power of attorney, durable power of attorney, or guardianship.

(n) Selling or purchasing from the consumer products or personal items. The only exception to this prohibition occurs when the consumer is a family member and the provider is not delivering services.

(o) Engaging in behavior that constitutes a conflict of interest or takes advantage of or manipulates ODA-certified services resulting in an unintended advantage for personal gain that has detrimental results for the consumer, the consumer’s family or caregivers, or another provider.

(1) Be a formally organized formally-organized business or service agency registered with the Ohio secretary of state that has been operating, providing, and being paid for the same services for which certification is being applied for at least two adults in the community for a minimum of three months at the point of application and shall:

(a) Disclose all entities that own at least five per cent of the business;

(b) Have a written statement defining the purpose of the business or service agency;

(d) Have a written table of organization that clearly identifies lines of administrative, advisory, contractual, and supervisory authority, unless the business consists of a self-employed individual;

(e) Operate the business in compliance with all applicable federal, state, and local laws; and,

(f) Have a written statement supporting compliance with nondiscrimination laws, federal wage and hour laws, and workers’ compensation laws in the recruitment and employment of individuals and in service delivery.

(2) Maintain a physical facility from which to conduct business that has all of the following:

(a) A primary business telephone listed under the name of the business locally and/or a toll-free number available through directory assistance that allows for reliable, dependable, and accessible communication.

(b) A designated locked storage space for consumer records.

(D) An ODA-certified long-term care consumer-directed individual provider shall meet the following requirements:

(1) Be at least eighteen years of age, possess a valid social security number, and have proof of automobile liability insurance when proof insurance is appropriate.

(2) Complete an application to become an ODA-certified long-term care consumer-directed individual provider.

(3) Notify ODA or its designee of any “incident” involving a consumer, as defined in rule 173-39-01 of the Administrative Code.

(4) Comply with the criminal records check requirements under rule 173-9-01 of the Administrative Code.

(5) Comply with any service specification under rules 173-39-02.1 to 173-39-02.18 of the Administrative Code for any service regulated under those rules that the provider provides.

(6) At the consumer’s request, participate in an interview with the consumer before initiating any service.

(7) Enter into and abide by a written agreement with the consumer specifying the agreed-upon arrangements for service provision.

(8) Accept as payment in full the reimbursement levels negotiated for each service by the provider, consumer, and ODA’s designee and, except as otherwise required in this rule, not seek any additional payment for those services from the consumer or any other person.

(9) Immediately provide access to representatives of ODA or its designee to the provider’s place of work and to any records and other documents related to the provision of services.

(10) Cooperate in ODA’s and ODA’s designee’s quality assurance activities, including:

(a) Provide space for on-site reviews of consumer records;

(b) Make all requested information available to ODA or its designee at the time quality assurance reviews are conducted; and,

(11) Not use or disclose any information concerning a long-term care consumer for any purpose without the documented consent of the consumer. Even with the consumer’s consent, the provider shall not use or disclose the information for any purpose not directly associated with the provision of services. This includes maintaining compliance with all applicable federal and state privacy laws, including the medicaid confidentiality requirements found in 42 C.F.R. parts 421.300 to 421.306 and the Health Insurance Portability and Accountability Act (HIPAA) regulations as set forth in 45 C.F.R. parts 160, 162, and 164.

(12) Report any suspicions of abuse or neglect to the CDJFS or its designee in accordance with section 5101.61 of the Revised Code, and notify ODA or its designee of any such suspicions.

(13) Notify ODA or its designee within one business day when the provider is aware of significant changes that may affect the service needs of the consumer. Examples of significant changes that may affect the service needs of the consumer include, but are not limited to:

(a) The consumer repeatedly refuses services;

(b) The consumer moves to another address; and,

(c) There are changes in the physical, mental, and/or emotional status of the consumer, documented changes in environmental conditions, and/or other health and safety issues.

(14) Provide written notification to the consumer and ODA’s designee at least thirty business days before the anticipated last date of service if the provider is terminating the provision of ODA-certified services to the consumer. Exceptions to this requirement include:

(a) The consumer has been hospitalized, placed in a long-term care facility, or has expired;

(b) The consumer is terminating services with the provider; and,

(15) During the provision of authorized services, a consumer-directed individual provider shall provide services in a professional, respectful, and legal manner and shall not engage in any unprofessional, disrespectful or illegal behavior including, but not limited to the following:

(a) Consuming alcohol, medicine, drugs, or other chemical substances not in accordance with the legal, valid, prescribed use, and/or in any way that impairs the provider in the delivery of services to the consumer;

(b) Accepting, obtaining, or attempting to obtain money or anything of value from the consumer, household members and family members of the consumer in accordance with paragraph (C)(8) of this rule. Consumer-directed individual providers who are family members with their consumers, however, may accept gifts for birthdays and holidays;

(c) Engaging with the consumer in sexual conduct, or in conduct that may reasonably be interpreted as sexual in nature, regardless of whether or not the contact is consensual;

(d) Leaving the home for a purpose not related to the provision of services without the consent and/or knowledge of the consumer;

(e) Engaging in activities that may distract from service delivery including, but not limited to:

(i) Watching television or playing computer or video games;

(ii) Making or receiving personal calls;

(iii) Engaging in non-care related socialization with individuals other than the consumer;

(iv) Providing care to individuals other than the consumer;

(v) Smoking without the consent of the consumer; or,

(vi) Sleeping.

(f) Engaging in behavior that causes or may cause physical, verbal, mental, or emotional distress or abuse to the consumer;

(g) Engaging in behavior that may reasonably be interpreted as inappropriate involvement in the consumer’s personal relationships;

(h) Serve as the authorized representative for the ODA-certified consumer directed long-term care program;

(i) Be designated or serve to make decisions for the consumer in any capacity involving a declaration for mental health treatment, durable power of attorney, or guardianship pursuant to court order; or,

(j) Sell to or purchase from the consumer products or personal items. The only exception to this would be family members when not delivering services.

(16) Assure ODA and its designee that provider staff will not be related as a spouse, parent, stepparent, or legal guardian to a consumer for whom the staff provide services.

(E) In order to be an ODA-certified long-term care assisted living provider, a provider shall:

(1) Be licensed as a residential care facility by the Ohio department of health in accordance with rules 3701-17-50 to 3701-17-68 of the Administrative Code, and shall:

(a) Have a written statement of policies and directives, and bylaws or articles of incorporation.

(b) Have a written table of organization that clearly identifies lines of administrative, advisory, contractual, and supervisory authority, unless the business consists of a self-employed individual.

(c) Have a written statement supporting compliance with nondiscrimination law in hiring and service delivery, federal wage and hour laws, and worker’ compensation laws.

(d) Comply with all applicable federal and state privacy laws, including the medicaid confidentiality regulations set forth in 42 C.F.R. 421.300 to 421.306, and the Health Insurance Portability and Accountability Act (HIPAA) regulations set forth in 45 C.F.R. parts 160, 162, and 164.

(e) Provide evidence of commercial liability insurance and insurance coverage for consumer loss due to theft or property damage, and a written procedure describing the process a consumer must follow to report a loss.

(f) Maintain and retain all records relating to costs, work performed, and supporting documentation for payment of work performed, along with copies of all deliverables for audit by the state of Ohio (including, but not limited to, ODJFS, ODA, the auditor of the state of Ohio, the inspector general, and duly authorized law enforcement officials) and agencies of the United States government for three years, or until the audit is concluded and all issues are resolved, whichever occurs later.

(g) Provide, upon request, representatives of ODA or its designee with a place to work in the provider facility and access to policies, procedures, records, and other documents related to the provision of services.

(h) Operate the business in compliance with all applicable federal, state, and local laws.

(2) The provider shall comply with any service specification under rules 173-39-02.16 and 173-39-02.17 of the Administrative Code and shall:

(a) Comply with the criminal records check requirements under rule 173-9-01 of the Administrative Code.

(b) Assure ODA and its designee that no facility staff person is the spouse, parent, or stepparent of the consumer for whom the staff person provides personal care services ordered on an assisted living care plan.

(c) Assure ODA and its designee that volunteers will not be authorized to provide any aspect of assisted living services as defined in rule 173-39-02.16 of the Administrative Code for consumers without supervision by the provider’s supervisory staff.

(d) Adopt and implement an employee code of ethics that ensures ethical standards of care by requiring facility staff to deliver services in accordance with the residents’ rights policies and procedures described in section 3721.12 of the Revised Code, and in accordance with the provider’s policies and procedures.

(3) The provider shall implement the following practices:

(a) Notify ODA or its designee within one business day when the provider is aware of a significant adverse change in the consumer’s status that may affect the service needs of the consumer.

(b) Have a written procedure for documenting consumer incidents, in accordance with paragraph (B) of rule 3701-17-62 of the Administrative Code, that includes evidence of notification to ODA or its designee.

(c) Report any suspicions of abuse, neglect, and/or exploitation of a consumer receiving assisted living services in accordance with rule 3701-64-02 of the Administrative Code, and notify ODA or its designee of any such suspicions.

(d) Provide written notification to the consumer and ODA’s designee at least thirty business days before the anticipated last date of service if the provider is terminating the provision of assisted living services to the consumer. Exceptions to this requirement include:

(i) The health and/or safety of the consumer or provider is at serious, imminent risk;

(ii) The consumer is terminating services with the provider; and,

(iii) The consumer has been hospitalized, placed in a long-term care facility, or has expired.

(4) The provider shall only provide for a consumer a service that is authorized by ODA’s designee.

(5) The provider shall bill only for a service for which the provider has documentation that complies with the documentation requirements for the service under rule 173-39-02.16 or 173-39-02.17 of the Administrative Code.

(6) Accept as payment in full the reimbursement levels negotiated for each service by the provider and ODA’s designee and, except as otherwise required in this rule, not seek any additional payment for those services from the consumer or any other person.

(F) In addition to paragraphs (B)(1) to (B)(17) of this rule, ODA-certified long-term care non-agency providers shall pay all applicable federal, state, and local income and employment taxes. On an annual basis, each certified long-term care non-agency provider must submit to ODA an approved affidavit stating that the provider has paid all applicable federal, state, and local income and employment taxes.

(G) In accordance with rule 173-39-06 of the Administrative Code, a provider’s failure to meet any of the required conditions of participation set forth in this rule may result in sanctions including, but not limited to, the denial or revocation of the provider’s certification.

Effective: 04/26/2009

R.C. 119.032 review dates: 11/14/2008 and 04/25/2013

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

Prior Effective Dates: 3/31/2006

173-39-02.1 Adult day service.

(A) Adult Day Service (ADS) is a non-residential, community-based service designed to meet the needs of functionally and/or cognitively impaired older adults through an individualized care plan that encourages optimal capacity for self-care and/or maximizes functional abilities. ADS consists of structured, comprehensive and continually supervised components that are provided in a protective setting. Consumers who receive ADS attend on a planned basis during specified hours.

(B) Eligible providers of ADS are ODA-certified long term care agency providers.

(C) There are two levels of ADS: enhanced and intensive. The case manager must assess the consumers’ needs and preferences and must specify which level of ADS will be approved for each consumer.

(1) Enhanced ADS providers must be capable of providing:

(a) Supervision of all activities of daily living (ADLs), supervision of medication administration, hands-on assistance with ADL activities (except bathing) and hands-on assistance with medication administration;

(b) Comprehensive therapeutic activities;

(d) Hands-on assistance with personal hygiene activities (except bathing).

(2) Intensive ADS providers must be capable of providing:

(a) The service described in paragraph (C)(1) of this rule;

(b) Hands-on assistance with two or more ADLs;

(d) Health assessments;

(e) Regular monitoring of and intervention with health status;

(f) Skilled nursing services (e.g., dressing changes and other treatments), and rehabilitative nursing procedures;

(g) Rehabilitative and restorative services, including physical therapy, speech therapy, and occupational therapy; and,

(h) Social work services.

(D) Adult day service centers must be certified as enhanced or intensive providers.

(1) A center that is certified to provide intensive ADS meets the certification requirements for the enhanced level.

(2) A center that is certified to provide the intensive level may arrange for or directly furnish those components described in paragraphs (C)(2)(f) to (C)(2)(h) of this rule.

(E) A unit of ADS attendance does not include transportation time. A unit of ADS attendance is measured in time according to the following:

(1) One-half unit is less than four hours ADS per day;

(2) One unit is four through eight hours ADS per day; and,

(3) 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.

(F) ADS transportation must be furnished by the provider, either directly or by contract. The transportation provider must meet the transportation requirements found in rule 173-39-02.13 of the Administrative Code. A “unit of transportation” is not included in the ADS unit of service described in paragraph (E) of this rule. A unit of ADS transportation is a round trip, a one-way trip, or a mileage rate with the trip cost based on a case manager’s predetermined distance between the consumer’s residence and the ADS center multiplied by an established ADS mileage rate.

(G) Provider agency and center requirements:

(1) If the ADS center is housed in a building with other services or programs, the provider must assure that a separate, identifiable space and staff is available for ADS during operational hours.

(2) The ADS facility must meet American With Disabilities Act Accessibility Guidelines (28 CFR Part 36) issued by the Department of Justice.

(3) The center must have at least sixty square feet per ADS participant excluding hallways, offices, rest rooms and storage areas.

(4) The provider must keep participant medications in locked storage and at appropriate temperatures.

(5) The provider must keep toxic substances stored in an area inaccessible to participants.

(6) The provider must develop and annually review a fire inspection and emergency safety plan. The provider must post evacuation procedures in conspicuous areas throughout the center.

(7) The provider must conduct and document periodic inspection (at least annually) and provide routine maintenance of fire extinguishers, smoke alarms, and conduct quarterly evacuation drills.

(8) The center must have at least one working toilet for every ten ADS participants, of which one toilet must be wheelchair accessible.

(9) A center that is certified to provide intensive ADS services must have appropriate bathing facilities for participants.

(10) At least two staff must be present in the ADS center when more than one participant is in attendance. At least one of the two staff must be a paid direct care staff and at least one staff person present must be certified in CPR.

(11) The staff to participant ratio must be at least one staff to six participants at all times.

(12) A RN or LPN under the direction of a RN must be on-site at the ADS center to provide nursing services that require the skills of a RN or a LPN under the direction of an RN, and that are within the nurse’s scope of practice.

(13) The daily attendance roster must include documentation of arrival and departure times of each consumer, the consumer’s mode of transportation, the consumer’s signature and the signature of the ADS staff person. If the consumer is unable to sign, this must be noted in the care plan and the consumer may use initials or other mark.

(14) An activity director must supervise consumer activities.

(15) Daily and monthly planned activities must be posted in conspicuous locations throughout the center.

(16) A noon meal and snacks must be procured or prepared by the provider.

(a) The menu for meals and snacks must be approved by a licensed dietitian.

(b) Each meal must provide one-third of the daily Dietary Guidelines for Americans and Recommended Dietary Allowance (RDA) Dietary Reference Intakes (DRI) reference values unless a special meal is approved by a licensed dietitian.

(c) The provider must adopt a consumer choice plan that offers the consumer an opportunity to make a choice about the food served by using one or more of the following methods:

(i) Offer consumer choices from two or more of the following groups of food: milk; bread; fruit; vegetable; meat; and dessert.

(ii) Offer consumers the opportunity to provide suggestions for menu planning at least annually.

(iii) Implement an alternative choice plan approved by ODA’s designee.

(d) The provider must develop a system that offers consumer access to the ingredient content of meals. This system must receive prior approval from ODA’s designee.

(e) The provider must document that all meals are prepared in compliance with Chapter 3117. of the Ohio Revised Code and Chapter 3717-1 (Ohio Uniform Food Safety Code) of the Administrative Code or, for a provider in another state, in compliance with equivalent laws. The provider must maintain a copy of a current food service licenses, issued by the state, for the preparer and/or subcontractor.

(f) The provider must maintain appropriate licenses for the food preparer and demonstrate the food preparer is in compliance with local health department inspections and Ohio Department of Agriculture inspections, or for a provider in another state, demonstrate compliance with equivalent state and local requirements and inspections.

(g) The provider must report all citations to ODA or its designee within five working days of receipt of a report following local department of health and Ohio department of agriculture inspections or, for a provider in another state, equivalent state and local inspections, of food preparer and plans for corrective action and follow-up.

(H) Consumer Service Management

(1) The provider must conduct an initial intake assessment of the consumer within the first two days of attendance. The center may substitute a copy of the case manager’s assessment of the consumer if the assessment occurred no more than thirty days prior to the consumer’s attendance at the center.

(2) The provider initial intake assessment must include the following components:

(a) (a)Functional and cognitive profiles which also identify ADLs and instrumental activities of daily living (IADLS) which require attention or assistance by ADS center staff;

(b) A social profile including social activity patterns, life events, community services, caregiver data, formal and informal support systems, and behavior patterns; and,

(c) A health assessment must be completed for each consumer within thirty calendar days of first attendance, conducted by a RN or a physician, or a licensed practical nurse (LPN) under the direction of a RN that includes, but is not limited to, a health profile including risk factors, psychosocial profile, diet, medications, and the name and phone number of attending physician.

(3) A care plan must be developed by a RN, LPN or physician for each consumer within the consumer’s first thirty days of attendance or ten units of service, whichever comes first. The care plan must identify the consumer’s strengths, needs, problems or difficulties, goals, and objectives. The care plan must document the following elements:

(a) interests, preferences and social rehabilitative needs;

(b) health needs;

(d) a description of the consumer and/or caregiver involvement in development of the care plan.

(4) The provider must document physician authorization prior to administering medications or providing nursing services, therapeutic meals, nutrition consultation, or therapeutic service(s). The provider must obtain physician authorization for the plan of treatment at least every ninety days for each consumer that receives medications, nursing services, nutrition consultation, and/or therapeutic services.

(5) Document and maintain a consumer record of each service delivered, including date of contact, type of contact and name(s) of person(s) having contact with the consumer.

(6) The provider’s documentation must identify that the consumer’s needs and the corresponding level of ADS service authorized by the case manager are being provided at the ADS center.

(7) An interdisciplinary care conference with the ADS staff that may include the consumer and/or caregiver must be conducted and documented for each consumer at least every six months, and the plan must be revised in accordance with changes in consumer status, condition, preferences and response to service, when applicable. The case manager must be invited to participate in the interdisciplinary care conference and be notified of the date and time in advance.

(I) The provider must document compliance with the following personnel requirements:

(1) The provider must document that all ADS staff participate in at least eight hours of in-service or continuing education on appropriate topics each calendar year.

(2) Prior to providing personal care activities, the provider must provide and document task-based instruction to ADS direct care staff.

(3) Evidence of task-based instruction and continuing education programs provided to ADS direct care staff must list the instructor’s title, qualifications and signature, date and time of instruction, content of the instruction and name and signature of ADS direct care staff completing the instruction or continuing education program.

(4) The provider must document and retain evidence that ADS staff possess the following qualifications:

(a) Appropriate, current and valid licensure for all registered nurses, licensed practical nurses, social workers, physical therapists, physical therapy assistants, speech therapists, dietitians, occupational therapists and occupational therapy assistants or other licensed professionals.

(b) Activity director/coordinator must have a baccalaureate or associate degree in recreational therapy or a related degree; or must demonstrate proof of successful completion of the national certification council of activities professionals; or two years experience as an activity director or coordinator related position.

(c) Activity program staff must be high school graduates, or must have successfully completed a GED, or have a minimum of two years of work experience providing personal care activities and/or social/recreational services under the direction of a licensed or certified health care professional.

(d) Staff that provide personal care assistance to enrollees must be high school graduates, or must have successfully completed a GED or vocational program in a health or human service field, or have a minimum of two years employment experience in providing and/or assisting with personal care or social activities.

(e) Transportation staff must meet all transportation requirements set forth in rule 173-39-03-13 the Administrative Code.

(f) Assure all employees who have direct, face-to-face contact with consumers complete required orientation training prior to working with consumers. The training must cover the following topics:

(i) Expectations of employees;

(ii) The employee code of conduct;

(iii) An overview of personnel policies;

(iv) Incident reporting procedures;

(v) Agency organization and lines of communication; and,

(vi) Emergency procedures.

(J) The provider must maintain evidence of compliance with personnel requirements, including but not limited to:

(1) Job descriptions for each position;

(2) Documentation of each employee’s qualifications for the service(s) to be provided;

(3) Performance appraisals for all workers;

(4) Documentation of compliance with required staff orientation training;

(5) Continuing education requirements;

(6) Current licensure; and,

(7) Expectations of employees as described in rule 173-39-03 of the Administrative Code.

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

173-39-02.2 Alternative meals service.

(A) Alternative meals service is a service designed to sustain a consumer’s health by enabling the consumer to procure up to two meals per day from non-traditional providers, such as restaurants.

(B) A unit of service is one meal.

(C) An eligible provider of alternative meals services is a certified long-term care consumer-directed individual provider.

(D) A certified provider of alternative meals services must:

(1) Maintain all appropriate vendor licenses; and

(2) Prepare meals in compliance with all applicable federal, state, county, and local laws and regulations governing the preparation, handling and delivery of food.

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

173-39-02.3 Pest control service.

(A) Pest control is a service designed to improve, restore, or maintain a clean, sanitary, and safe living environment through the performance of tasks in the home that are beyond the consumer’s capability and the removal of pests posing a threat to the consumer’s health and welfare.

(B) Pest control services are provided only in cases where:

(1) Neither the individual, nor anyone else in the household, is capable of performing or financially providing for the services;

(2) No other relative, caregiver, community/volunteer agency, or third-party payer is capable of, or responsible for, their provision; and,

(3) In the case of rental property, the responsibilities of the landlord under the lease agreement have been examined prior to any authorization of service.

(C) Eligible providers of pest control service are ODA-certified long-term care consumer-directed individual providers and ODA-certified long-term care agency providers.

(D) A unit of pest control service is one job order, with the unit rate being the price quoted by a qualified provider and accepted by the consumer.

(E) An ODA-certified pest control service provider must:

(1) Maintain a consumer record that documents service delivery, indicates that service tasks were performed as specified in the job order, and is signed by the consumer or the consumer’s caregiver upon completion of the job order;

(2) Maintain a current and valid commercial pesticide applicator license and a pesticide application business license from the Ohio department of agriculture;

(3) Maintain, and furnish to the consumer and/or ODA’s designee, upon request, a list of the chemical(s) or substance(s) used for each job order;

(4) Comply with any applicable local codes or ordinances in the performance of each job order;

(5) Inform the consumer and ODA’s designee of any specific health or safety risks expected during the job project, and assist the case manager to coordinate times and dates of service to insure minimal risk of hazard to the consumer as applicable to each job;

(6) Furnish to the consumer and ODA’s designee a warranty covering workmanship and materials used for job orders;

(7) Furnish the consumer and/or ODA’s designee with a verbal estimate of the services cost, to be followed by a written price quote within seven days of the consumer’s initial request for services or within an alternative time period acceptable to the consumer; and,

(8) Not charge more than the amount of the original price quote submitted to, and approved by, the consumer and/or ODA’s designee.

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

173-39-02.4 Home care attendant service.

(A) Home care attendant service (HCAS) is a service designed to provide supportive services specific to the needs of an individual consumer with impaired physical or cognitive functioning. Allowable home care attendant services include, but are not limited to:

(1) Personal assistance with bathing, dressing, grooming, caring for nail, hair and oral hygiene, shaving, deodorant application, skin care, foot care, ear care, feeding, toileting, ambulation, changing position in bed, assistance with transfers, normal range of motion, and nutrition and fluid intake;

(2) General household assistance with the planning, preparation and clean-up of meals, laundry, bed-making, dusting, vacuuming, shopping and other errands, the replacement of furnace filters, waste disposal, seasonal yard care and snow removal;

(3) Heavy household chores including, but not limited to, washing floors, windows and walls, tacking down loose rugs and tiles, moving heavy items of furniture to provide safe access and egress;

(4) Assistance with money management and correspondence as directed by the consumer; and,

(5) Escort services and transportation to community services, activities and resources. This activity is offered in addition to medical transportation available under the Medicaid state plan, and may not replace it. Whenever possible, other sources, which can provide this service without charge, must be utilized.

(B) Eligible providers of HCAS are ODA-certified consumer-directed individual longterm care service providers and ODA-certified long-term care agency providers.

(D) Certified providers who transport a consumer for any reason must ensure that the driver has a valid drivers license, and proof of collision and liability insurance for each vehicle used.

(E) Prior to service initiation, the HCAS worker must complete training provided by the consumer or his designee, and must demonstrate competency in skills appropriate to the consumer’s needs.

(F) At the request of a consumer, the HCAS worker must participate in an interview with the consumer prior to service initiation.

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

173-39-02.5 Chore service.

(A) Chore is a service designed to improve, restore, or maintain a clean, sanitary and safe living environment through the performance of tasks in the home that are beyond the consumer’s capability, and the removal of hazards posing a threat to the consumer’s health and welfare. Chore services are provided only in cases where neither the consumer, nor anyone else in the household, is capable of performing or financially providing for the services, and where no relative, caregiver, landlord, community/volunteer agency, or third party payer is capable of or responsible for their provision.

(B) Chore services are limited to those activities that are not the legal or contractual responsibility of a landlord. In the case of rental property, the responsibility of the landlord, pursuant to the lease agreement, will be examined prior to any authorization of service.

(D) Eligible providers of chore service are ODA certified long term care agency and non-agency providers.

(E) A certified chore service provider may furnish one or more chore services, including, but not limited to:

(1) Heavy household cleaning, including, but not limited to:

(a) Washing walls and ceilings;

(b) Washing outside windows and inside of hard to reach windows;

(d) Shampooing carpets or furniture.

(2) Simple household repair, including, but not limited to:

(a) Repairing water faucets;

(b) Unclogging drains;

(d) Replacing furnace filters;

(3) Pest control; and,

(4) Disposal of garbage.

(F) ODA-certified chore service providers must:

(1) Maintain a consumer record that documents each episode of service delivery and indicates that service tasks were performed as specified in the job order, lists the date(s) of contact(s), describes the type of contact(s), identifies by name the person(s) having contact with the consumer, and includes the signature of the consumer/caregiver and the service provider upon completion of a specific job order;

(2) Maintain, and furnish to ODA’s designee, upon request, a list of the chemicals or substances used for each job order;

(3) Comply with any applicable local codes or ordinances in the performance of each job order;

(4) Inform the consumer and ODA’s designee of any specific health or safety risks expected during the job project, and assist the case manager to coordinate times and dates of service to insure minimal risk of hazard to the consumer as applicable to each job;

(5) Assure all workmanship and materials are warranted;

(6) Furnish ODA’s designee with a verbal estimate of the costs of the service to be provided, followed by a written price quote within seven days of the case manager’s initial request for the quote or within an alternate time period acceptable to the case manager;

(7) Submit an invoice to ODA’s designee for not more than the amount of the original price quote submitted to and approved by the ODA’s designee, unless a cost revision has been previously authorized by the ODA’s designee; and,

(8) Submit the invoice to ODA’s designee only after completion of the job and any final inspection mandated by local requirements.

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

173-39-02.6 Emergency response system service.

(A) As used in this rule,

(1)

(a) “Emergency response system” (“ERS”) means an emergency intervention service comprised of telecommunications equipment (“ERS equipment”), an emergency response center, and a medium for two-way communication between the consumer and the emergency response center. Personnel at the emergency response center intervene in an emergency once the center receives an alarm signal from the ERS equipment.

(b) “Emergency response system” (“ERS”) does not mean equipment such as a boundary alarm, a medication dispenser, a medication reminder, or any other equipment or home medical equipment, regardless of whether such equipment is approved under rule 173-39-02.7 of the Administrative Code and regardless of whether such equipment is connected to ERS equipment.

(2) “Alarm signal” means a signal transmitted from the ERS equipment to the emergency response center indicating that a consumer is facing imminent danger.

(3)

(a) “Alternative ERS device” means equipment that is used in conjunction with ERS equipment to facilitate the provision of the ERS service described in paragraph (A)(1)(a) of this rule.

(b) “Alternative ERS device” does not mean equipment such as a boundary alarm, a medication dispenser, a medication reminder, or any other equipment or home medical equipment, regardless of whether such equipment is approved under rule 173-39-02.7 of the Administrative Code and regardless of whether such equipment is connected to ERS equipment.

(4) “Center staff member” means an employee of a provider or an employee of a subcontractor of a provider who responds to each alarm signal appropriately and immediately.

(5) “ERS equipment” means in-home two-way communications equipment that sends an alarm signal to the emergency response center. ERS equipment includes a portable device activated by the consumer that either sends an alarm signal to a console device that, in turn, provides the services described in paragraph (A)(1)(a) of this rule, or this device provides the service described in paragraph (A)(1)(a) of this rule with no need to relay the signal through a console device.

(6) “Imminent danger” means an immediate, real threat to a person’s safety.

(7) “Public service personnel” means a staff member of a sheriff’s department, police department, emergency medical service, or a fire department.

(8) “Responder” means a person designated by a consumer to respond to an alarm signal by going to the consumer’s home after an alarm signal has been sent to the emergency response center. The responder responds to the emergency with appropriate action, which sometimes includes contacting public service personnel. A responder may be a relative, a neighbor, or a volunteer.

(B) There are three types of units of ERS:

(1) Unit of ERS service: One unit is sixteen or more days in a month of the service described in paragraph (A)(1)(a) of this rule. One-half unit is fifteen services days or less in a month of the service described in paragraph (A)(1)(a) of this rule.

(2) Unit of ERS installation: The one-time cost for delivery and installation of the ERS equipment into the home of the consumer and the initial education to the consumer on the operation of the equipment. No additional installation fee shall be charged for installation of additional devices mentioned in paragraph (B)(3) of this rule unless authorized in writing by ODA.

(3) Unit of ERS device: The negotiated cost of an alternative ERS device that is approved by ODA.

(a) This does not include a smoke detector or any other device that is not integrated into the ERS described in paragraph (A)(1)(a) of this rule.

(b) This does not include any device described by paragraph (A)(1)(b) of this rule.

(D) General requirements:

(1) Each ERS service shall include a way for the consumer to activate an alarm signal by activating a device that is wearable by the consumer. This device shall either act as a remote activation device that sends a signal to a console device that shall, in turn, provide the services described in paragraph (A)(1)(a) of this rule, or this device shall provide the service described in paragraph (A)(1)(a) of this rule with no need to relay the signal through a console device.

(2) Whenever ERS equipment malfunctions, the provider shall replace it at no additional cost to the consumer, ODA, or ODA’s designee within twenty-four hours of notification.

(3) Except for an alternative ERS device, all ERS equipment shall be tested to meet the published underwriters laboratories (UL) standard for home health care signaling equipment. Providers shall provide evidence of compliance with this paragraph upon request by ODA or ODA’s designee.

(4) Every alternative ERS device shall be tested to meet applicable published industry standards for quality assurance and quality control. Providers shall provide evidence of compliance with this paragraph upon request by ODA or ODA’s designee.

(5) Except for consumers who are unable to hear or speak, all ERS equipment shall provide effective, two-way, hands-free voice-to-voice communication with an emergency response center.

(6) In the event that the two-way, hands-free voice-to-voice communication provided by standard ERS equipment is not appropriate for a consumer with a particular disability or disabilities, ERS equipment that is more appropriate shall be offered to that consumer at no additional cost.

(a) For a consumer who cannot hear, the ERS equipment shall give a visual indication of alarm activation at no additional cost.

(b) For a consumer who cannot see, the ERS equipment shall give an audible indication of alarm activation at no additional cost.

(7) The provider shall provide each ERS service without interruption.

(8) All ERS equipment that is wearable by the consumer shall be waterproof.

(9) Because many consumers use ERS equipment that communicates with an emergency response center over telephone lines, the provider shall operate all of its emergency response telephone lines as toll-free telephone lines.

(10) In the event that ERS equipment does not successfully transmit an alarm signal to the emergency response center during the first attempt to do so, it shall continuously attempt to transmit an alarm signal until communication is established.

(11) Whenever a remote activation device is lost, the provider shall replace it within twenty-four hours of notification of the loss. Additionally, the provider shall notify ODA’s designee of the loss thereby giving the case manager the opportunity to help the consumer find the lost device. If the lost device is found, then, it may be returned to the provider for reimbursement. Any request for a replacement occurring less than one year from the time of the initial delivery or the most recent replacement of the remote activation device, whichever is more recent, shall receive the authorization of ODA’s designee before such a replacement is made.

(12) In accordance with Chapter 1301:7-7 of the Administrative Code, a smoke detector or a heat detector that is part of an ERS shall only be installed by an individual who is certified by the state fire marshal.

(E) Responder requirements:

(1) The provider shall attempt to secure the names of at least two responders from each consumer on or before the date that ERS is initiated.

(a) If the provider is able to secure the name of only one responder from a consumer, the provider shall:

(i) Designate public service personnel in place of the consumer’s second responder; and,

(ii) Document the reason the provider could secure the name of only one responder.

(b) If the provider is unable to secure the names of any responders from a consumer, the provider shall:

(i) Designate public service personnel in place of the individual’s responders; and,

(ii) Send written notification to the case manager of the inability to secure the names of any responders within fourteen days after initiating services.

(2) Before a responder is asked to respond to an alarm signal, the provider shall provide an orientation for that responder. The orientation shall:

(a) Be performed in-person, by telephone, or in writing;

(b) Educate the responder about the responsibility of a responder to respond to an alarm signal by going to the consumer’s home after an alarm signal has been sent to the emergency response center and how to respond to the emergency with appropriate action, which sometimes includes contacting public service personnel;

(c) Include leaving written educational materials with the responder that outline the procedures on how to respond to an alarm signal. If the orientation is performed by telephone or in writing, these materials may be mailed to the responder; and,

(d) Be documented by the provider; including documentation of the following:

(i) Name of the consumer;

(ii) Name of the responder;

(iii) Telephone number of the responder;

(iv) Date the responder was secured;

(v) Date of the orientation;

(vi) Method of the orientation (in person, by telephone, or in writing);

(vii) Topics covered in the orientation; and,

(viii) Date that written educational materials were given to the responder or mailed to the responder.

(3) The provider shall secure a replacement responder when a consumer’s responder ceases to participate.

(a) If a consumer has two responders, the provider shall secure a second responder within seven days after becoming aware that the consumer will no longer have two responders.

(b) If a consumer has one responder, a provider shall secure a replacement responder within four days after becoming aware that the individual’s sole responder will no longer participate.

(i) Designate public service personnel in place of the replacement responders; and,

(ii) Provide the case manager with written notification within fourteen days after the provider determines it cannot secure a replacement responder.

(d) The provider shall document the following:

(i) The date the provider becomes aware that a responder will no longer participate; and,

(ii) The date the provider secured a replacement responder.

(4) In the event that a consumer sends an alarm signal but a listed responder cannot be reached, the provider shall contact public service personnel.

(F) Emergency response center requirements:

(1) Each center shall be staffed and ready to receive and to respond to alarm signals from consumers twenty-four hours per day, three hundred sixty-five days per year.

(2) Each center shall maintain the capacity to respond to all alarm signals.

(3) In case the primary system cannot respond to alarm signals, each center shall maintain a secondary capacity to respond to all incoming alarm signals.

(4) Each center shall respond to each alarm signal within sixty seconds.

(5) A center staff member shall notify ODA’s designee of all emergencies of each consumer within twenty four hours of receiving the alarm signal.

(6) Each center shall perform a monthly check of the ERS equipment of each consumer;

(7) Before a center staff member responds to an alarm signal, the provider shall have assurance that the member can perform the following:

(a) Communicate with the consumer and the responder;

(b) Respond to an alarm signal as described in paragraphs (F)(1) to (F)(5) of this rule;

(d) Conduct and document a monthly check of the ERS equipment; and,

(e) Identify a consumer’s health history and functioning levels.

(G) Documentation requirements:

(1) The provider shall document each service-related consumer contact, including the date and time of contact, the service delivered (including the service of responding to a false alarm), and the name of each person having contact with the consumer.

(2) The provider shall maintain records concerning the installation and maintenance of ERS equipment that includes the following:

(a) The delivery date and installation of ERS equipment;

(b) The signature of the consumer or caregiver verifying receipt of ERS equipment;

(d) Updating responder contact information at least every six months.

(H) Education requirements:

(1) The provider shall furnish each ERS consumer with an initial face-to-face demonstration to educate the consumer about the ERS and the proper use of the ERS equipment.

(2) The provider shall provide any consumer, caregiver, or responder with further education about the ERS and the proper use of the ERS equipment whenever requested by the consumer, caregiver, responder, or ODA’s designee.

Replaces: 173-39-02.6

Effective: 07/01/2007

R.C. 119.032 review dates: 06/30/2011

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391, 173.40

Rule Amplifies: 173.391

Prior Effective Dates: 3/31/2006

173-39-02.7 Home medical equipment and supplies.

(A) Home medical equipment and supplies (HME) is a service designed to promote functional independence and safe, effective, in-home care through the provision of health-related equipment and supplies. The equipment items and/or supplies eligible to be purchased, installed and/or rented through this service are those items that enable the consumer to function with greater independence in the home and help prevent the consumer’s placement in a nursing facility.

(B) HME items are limited to only those medicaid items in rule 5101:3-10-03 of the Administrative Code, other items and repairs as applicable in rules 5101:3-10-02 to 5101:3-10-26 of the Administrative Code, and miscellaneous items that include, but are not limited to: walker baskets or trays; room monitors; eating, dressing and vision assistive devices; incontinent bath wipes; and medication dispensers. HME items are also limited to those items that and are not covered by other payers (third-party payers, medicare, state plan medicaid, etc.). A HME provider must have documentation that items to be purchased cannot be paid for by medicare, state plan medicaid, or other sources prior to authorization by ODA’s designee.

(D) A unit of HME service is the item purchased or rented, and the unit rate is the purchase, installation and/or rental price authorized for the item by ODA’s designee.

(1) The provider must furnish professional, ongoing assistance when needed to evaluate and adjust products delivered and/or to instruct the consumer or the consumer’s caregiver in the use of an item furnished.

(2) The provider must have the prior approval of the case manager for any HME item(s) purchased and delivered.

(E) The provider must assume liability for equipment warranties and must install, maintain, and/or replace any defective parts or items specified in those warranties. Replacement items or parts for HME are not reimbursable as rental equipment.

(F) The provider must, in collaboration with the case manager, ascertain and recoup any third-party resource(s) available to the consumer prior to billing ODA or its designee. ODA or its designee will then pay any unpaid balance up to the lesser of the provider’s billed charge or the maximum allowable reimbursement set forth in division-level designation 5101:3 of the Administrative Code.

(G) The provider must submit the price for an item to be purchased or rented within two business days of the case manager’s request. The provider must purchase, deliver and install (as appropriate) the authorized item(s) prior to submitting a bill to ODA’s designee. The billed amount for each item may not exceed the preauthorized amount.

(H) The provider must maintain a record for each consumer. The record must document the delivery, installation of the item(s) purchased or rented, any education and/or instructions for the use of equipment and/or supplies provided to the consumer, and must include documentation of delivery of item(s) to the consumer. The documentation must consist of:

(1) The consumer’s signature, the signature of the consumer’s caregiver or electronic verification of delivery; and,

(2) The date on which the equipment and/or supplies were delivered.

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

173-39-02.8 Homemaker service.

(A) Homemaker (HMK) is a service designed to enable a consumer to achieve and maintain a clean, safe and healthy environment, assist the consumer to manage personal appointments and day-to-day household activities as authorized by the case manager, and ensure that the consumer maintains the consumer’s current living arrangement. HMK service consists of general household activities, such as meal preparation and routine household care when the individual regularly responsible for these activities is temporarily absent or unable to manage the home. HMK staff may act as travel attendants for a consumer.

(B) One unit of homemaker service is fifteen minutes.

(1) Assistance with meal planning;

(2) Meal preparation, grocery purchase planning, and assisting consumers with shopping and other errands;

(3) Laundry, including folding, ironing, and putting away laundry; and,

(4) House cleaning, including, but not limited to, 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.

(D) Eligible providers of homemaker services are certified long-term care agency providers.

(E) HMK providers must maintain a consumer record documenting each episode of service delivery. The record must include the date of service delivery, a description of the service tasks performed, the name of the aide providing the service(s), the aide’s arrival and departure time, and the aide’s written or electronic signature to verify the accuracy of the record. A provider that does not utilize an electronic verification system to document services and keep records must also obtain the consumer’s signature for each episode of service.

(F) HMK providers must demonstrate that they:

(1) Have the capacity to deliver services at least five days per week;

(2) Have a service back-up plan to ensure services are delivered during staff absence;

(3) Comply with and maintain written policies and procedures, as applicable, supporting the operation of the business and the provision of services. These policies and procedures must address:

(a) Reporting and documenting consumer incidents;

(b) Obtaining written permission from consumers to share information and/or release information to anyone;

(d) Personnel matters, including:

(i) Job descriptions for each position;

(ii) The documentation of each employee’s qualifications for the service(s) to be provided;

(iii) Performance appraisals for all workers;

(iv) Documentation of compliance with required staff orientation training; and,

(v) The employee code of ethics described in rule 173-39-02 of the Administrative Code.

(G) HMK providers must demonstrate evidence of compliance with the following personnel requirements:

(1) HMK aides must meet one or more of the following minimum personnel requirements:

(a) Successful completion of the nurse aide competency evaluation program conducted by the Ohio department of health under section 3721.31 of the Revised Code within the last twenty-four months;

(b) One year of supervised employment experience in a health or human services field, and successful written and skill testing by return demonstration;

(c) Successful completion of the medicare competency evaluation program for home health aides required under 42 C.F.R. Part 484, without a twenty-four month lapse in employment as a nurse aide or home health aide;

(d) Successful completion of a certified vocational program in a health-related field and successful written and skill testing by return demonstration;

(e) Successful completion of at least twenty hours of training and skill testing by return demonstration that includes, but is not limited to:

(i) Universal precautions for infection control, including hand washing and the disposal of bodily waste;

(ii) Meal preparation/nutrition that includes special diet preparation, grocery purchase planning and shopping; and other errands, such as picking up prescriptions;

(iii) Laundry, including folding, ironing, and putting away laundry;

(iv) Basic home safety;

(v) 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;

(vi) Body mechanics;

(vii) Communication skills;

(viii) Emergency protocols; and,

(ix) Documentation skills.

(f) Prior to the provision of services to a consumer, the provider must conduct written testing, and skill testing by return demonstration, of all HMK staff that are not listed on the Ohio department of health’s nurse aide registry for all subject areas listed in paragraph (G)(1)(e) of this rule. The training and testing must be documented by the provider, and the documentation must include training site information, the date of training, the number of hours of training, a list of instruction materials and the subject areas covered, the qualifications of the trainer and the tester, the signatures of the trainer and tester verifying the accuracy of the record, and all testing results.

(2) The HMK supervisor must have a bachelor’s or associate’s degree in a health or human services area or have a minimum of two years of work experience as a HMK.

(3) Prior to working with consumers, all employees who have face-to-face contact with consumers must receive orientation and training that addresses, at a minimum:

(a) The expectations of employees;

(b) The employee code of conduct;

(d) Incident reporting procedures;

(e) The organization of the provider’s agency and the lines of communication; and,

(f) Emergency procedures.

(4) The provider must assure and document a minimum of eight hours of continuing education for each HMK staff every twelve months.

(H) Supervisory Requirements

(1) The supervisor must complete and document a consumer home visit, which may occur at the initial HMK visit to the consumer to define the expected activities of the HMK and prepare a written activities plan consistent with the case manager authorized plan that has been completed by the case manager and the consumer prior to consumer service initiation.

(2) The supervisor must evaluate HMK compliance with the plan, consumer satisfaction, and job performance during a home visit with the consumer at least every ninety three days to evaluate the HMK aide’s compliance with the plan. The HMK aide need not be present during the visit. The visit must be documented, including the date of the visit, the name of the HMK supervisor, name of the consumer, and must include the signature of the consumer and the HMK supervisor or the electronic signature of the HMK supervisor.

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

173-39-02.9 Minor home modification, maintenance, and repair services.

(A) Minor home modification, maintenance and repair service (MHM) provides environmental accessibility adaptations to the structural elements of the interior or exterior of a consumer’s place of residence that enable the consumer to function with greater independence in the home and remain in the community. Modifications, maintenance and repairs that are excluded from this service are those adaptations or improvements to the home that are of general utility and not of direct medical or remedial benefit to the consumer, such as carpeting, roof replacement, central air conditioning, and adaptations which add to the total square footage of the home, etc.

MHM services are limited to those that cannot be accomplished through existing informal or formal supports, and those that are not the legal or contractual responsibility of a landlord or a home owner other than the consumer.

All MHM services must be provided in accordance with applicable building codes and must be authorized by the consumer’s plan of care.

(B) A unit of MHM service is one completed job order. The unit rate is the rate negotiated by ODA’s designee and must include a formal estimate of materials and labor. The provider cannot bill in excess of the estimate, unless a cost revision is authorized by the case manager prior to the initiation of the MHM service.

(1) Minor home modification includes, but is not limited to:

(a) The installation of safety devices, such as smoke alarms and/or carbon monoxide detectors;

(b) The installation of devices to improve the consumer’s ability to perform activities of daily living, if not provided under home medical equipment and supplies service;

(d) Enhanced accessibility modifications, such as ramps and doorways.

(2) Minor home maintenance includes, but is not limited to:

(a) The inspection of furnaces and water heaters;

(b) Plumbing and electrical repairs; and,

(3) Minor household repair includes, but is not limited to:

(a) The repair or replacement of screens, broken window panes; and,

(b) The replacement and/or installation of electrical fuses.

(D) Eligible providers of MHM services are certified long-term care agency and non-agency providers. Providers must have appropriate licensure, as required, or other appropriate credentials to perform jobs requiring specialized skills, including but not limited to:

(1) Electrical work;

(2) Heating and ventilation; and,

(3) Plumbing work.

(E) Except as otherwise provided below, MHM providers must obtain and furnish evidence of compliance with:

(1) The written consent of the property owner to modify the property. When appropriate, the provider must ensure that the owner understands that the property will be left in the modified state after the consumer vacates the premises.

(2) All permits required by law, including building permits, prior to commencing work on each job order.

(3) Any necessary inspections, inspection reports, and permits required by federal, state and local laws upon completion of each job to verify that the repair, modification or installation was completed. The provider must obtain these inspections, inspection reports, and permits prior to prior to billing for the completed job.

(4) A signed and dated authorization from the consumer’s case manager, or case manager’s designee, for each job order prior to commencing work.

(F) The provider must:

(1) Inform the consumer and ODA or its designee of any health and/or safety risks expected during the job; and assist the consumer and case manager to coordinate dates and times of work to assure minimal risk of hazard to the consumer.

(2) Furnish a warranty covering workmanship and materials with the final invoice submitted to ODA’s designee. ODA and ODA’s designee will not pay any invoice that is not accompanied by a warranty.

(3) Assure that any smoke and/or heat detectors authorized to be installed by the provider will be installed only by individuals certified by the state fire marshal in accordance with Chapter 1301:7-7 of the Administrative Code.

(4) Obtain the consumer’s or caregiver’s signature and date at the close of the job order to certify that the work authorized has been completed, the consumer’s property has been left in satisfactory condition, and any incidental damages have been repaired.

(G) In cases where a provider is already in a consumer’s home and identifies additional problems that should be fixed immediately, should be fixed in conjunction with the original repair, or could easily be fixed while in the consumer’s home, the provider may address the additional problems only if the provider contacts the consumer’s case manager or the case manager’s designee to explain what the problem is, how it will be fixed, the cost of the additional repair, and obtains authorization to complete the additional work.

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

173-39-02.10 Nutritional consultation service.

(A) Nutritional consultation, also known as medical nutrition therapy, is a service designed to provide individualized guidance on appropriate food and nutrient intakes for consumers with special needs. Nutritional consultation takes into consideration the consumer’s desires, health, cultural and socioeconomic background, and any functional and psychological factors, including home and caregiver resources. Unless authorized by the consumer/caregiver and the case manager, the provider must deliver this service in the consumer’s residence.

(B) A unit of nutritional consultation services is fifteen minutes of face-to-face services for the consumer and/or caregiver.

(C) Unless authorized by the consumer/caregiver and the case manager, the provider must deliver this service in the consumer’s residence.

(D) Eligible providers of nutritional consultation services are long-term care agency and non-agency providers.

(E) The provider must provide services pursuant to a plan of care or a plan of treatment for nutrition consultation long-term care services that are signed and dated by the physician. The plan of care must be recertified by the physician every sixty days, or more frequently if there is a significant change in the consumer’s condition.

(F) Certified providers of nutritional consultation services must ensure all of the following requirements are met:

(1) Prior to the delivery of services, the provider must obtain documentation that a case manager has authorized the provision of nutritional consultation services to the consumer.

(2) The provider must document and maintain a record of each episode of service including the date and duration of the service, the name and signature of the dietitian, the name and signature of the consumer or informal caregiver, and a description of the service provided.

(3) The provider must furnish evidence that staff who deliver services are registered by the commission on dietetic registration and licensed by the state board of dietetics.

(4) The provider must conduct an initial individualized assessment of the consumer’s nutritional needs and subsequent assessments when necessary, using a nutrition screening tool that identifies whether the consumer is at nutritional risk. The assessments must include:

(a) Demographic data;

(b) An assessment of height and weight;

(d) A review of medications, diagnoses, and any diagnostic test results;

(e) An assessment of verbal and motor skills that could be attributable to nutrient needs;

(f) Clinical and behavioral goals and care plan;

(g) Interventions planned;

(h) Adherence potential; and,

(i) Scheduling of follow-up appointments.

(5) The provider must develop, implement, evaluate and revise a nutrition intervention plan based on consumer status and response. The plan must include the nutrients required, feeding modality and method of nutrition education and counseling with expected, measurable outcomes.

(6) The provider must furnish the case manager and consumer with a copy of the report of assessment outcome and nutrition intervention plan within seven business days following the nutritional assessment.

(7) The nutrition intervention planning process must include the consumer, the consumer’s caregiver, case manager, physician and, when applicable, any relevant service providers.

(8) The provider must furnish documentation of the plan implementation and outcomes to the case manager.

(9) The provider must plan and document termination of nutrition consultation services and provide follow up plans for the consumer as appropriate.

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

173-39-02.11 Personal care service.

(A) Personal care is a service designed to enable a consumer to achieve optimal functioning with ADLS and IADLS, and includes personal care services and homemaking tasks appropriate to a consumer’s needs. Personal care services must be provided in the consumer’s place of residence. Personal care activities may include, but are not limited to:

(1) Assisting the consumer with managing the household, 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 consumer with eating, bathing, dressing, personal hygiene, grooming and other activities of daily living and instrumental activities of daily living described in rule 5101:3-3-08 of the Administrative Code;

(3) The preparation of the consumer’s meals;

(4) Housekeeping chores, as defined in rule 173-39-02.8 of the Administrativ Code, when they are specified in the consumer’s care plan and are incidental to the care furnished, or are essential to the health and welfare of the individual, rather than the individual’s family; and,

(5) The provision of respite services to the consumer’s caregiver.

(B) One unit of personal care service is equal to fifteen minutes.

(D) A certified provider of personal care services must maintain evidence that it:

(1) Has the capacity to deliver services seven days a week;

(2) Has a system in place to ensure that the provider nurse supervisor is accessible to respond to emergencies during those times when the provider’s employees are scheduled to work;

(3) Maintains a back-up plan for service delivery in the event of a staff person’s absence;

(4) Maintains a consumer record documenting each episode of service delivery. The record must include the date of service delivery, a description of the service tasks performed, the name of the personal care aide (PCA) providing services, the PCA’s arrival and departure time, and the PCA’s written or electronic signature to verify the accuracy of the record. A provider that does not utilize an electronic verification system to document services and keep records must also obtain the consumer’s signature for each episode of service.

(5) Offers to provide consumers and case managers with monthly reports of services delivered that include the date of service delivery, the service tasks performed, the name of the personal care aide (PCA) providing services, the PCA’s arrival and departure time, if the provider has an electronic verification system.

(6) Requires all employees who will have direct, face-to-face contact with consumers to complete an orientation and training prior to working with the consumers that cover, but are not limited to:

(a) Expectations of employees;

(b) The employee code of conduct;

(d) Incident reporting procedures;

(e) A description of the provider agency’s organization and lines of communication; and,

(f) Emergency procedures.

(7) Has developed and complies with written policies and procedures, as applicable, that support the operation of the business and the provision of services. At a minimum, the policies and procedures must address:

(a) Reporting and documenting consumer incidents;

(b) Obtaining a consumer’s written permission to share information and/or release information to anyone and compliance with the requirements described in rule 173-39-02 of the Administrative Code;

(d) Personnel requirements including:

(i) Job descriptions for each position;

(ii) The documentation of each employee’s qualifications for the service(s) to be provided;

(iii) Performance appraisals for all workers;

(iv) The documentation of compliance with required staff orientation training; and,

(v) Compliance with the code of conduct described in rule 173-39-02 of the Administrative Code.

(E) Certified providers of personal care must maintain evidence of compliance with the following personnel requirements:

(1) Each PCA must, at a minimum, meet at least one of the following requirements:

(a) Be listed on the Ohio department of health’s nurse aide registry;

(b) Successfully complete the medicare competency evaluation program for home health aides set forth in 42 C.F.R. Part 484., as a direct care health care worker without a twenty-four month lapse in employment as a home health aide or nurse aide;

(c) Have at least one year employment experience as a supervised home health aide or nurse aide, and have successfully completed written testing and skills testing by return demonstration prior to initiation of service provision;

(d) Successfully complete the COALA home health training program, or a certified vocational program in a health care field, and successfully complete written testing and skills testing by return demonstration prior to initiation of service provision; or,

(e) Successfully complete sixty hours of training, including, but not limited to instruction on:

(i) Communication skills, including the ability to read, write and make brief and accurate oral or written reports;

(ii) Observation, reporting and documentation of consumer status and services provided;

(iii) Reading and recording temperature, pulse and respiration;

(iv) Universal precautions for infection control procedures;

(v) Basic elements of body functioning and changes in body function that should be reported to a supervisor;

(vi) The maintenance of a clean, safe and healthy environment, including but not limited to house cleaning and laundry, dusting furniture, sweeping, vacuuming, and washing floors; kitchen care

(including dishes, appliances, and counters), bathroom care, emptying and cleaning bedside commodes and urinary catheter bags, changing bed linens, washing inside windows 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 consumers, including the need for privacy and respect for consumers and their property;

(ix) Appropriate and safe techniques in personal hygiene and grooming that include: 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; and

(x) Meal preparation and nutrition planning, including special diet preparation, grocery purchase, planning, and shopping, and errands for the sole purpose of picking up prescriptions.

(f) The provider must document training and testing for PCA staff, including training site information, the date of training, the number of hours of training, a list of the instruction materials, a description of the subject areas covered, the qualifications of the trainer and tester, the signatures of the trainer and tester to verify the accuracy of the documentation, and all testing results.

(2) Prior to the provision of services for a consumer, the provider must conduct written testing and skill testing by return demonstration for all PCA staff that are qualified as a PCA by meeting the requirements of paragraph (E)(1)(e) of this rule, and tests must cover all subject areas listed in paragraphs (E)(1)(e)(i) to (E)(1)(e)(x) of this rule.

(3) The provider must conduct additional training and skill testing by return demonstration for PCA staff expected to provide services not included in the training subjects listed in this rule.

(4) The provider must maintain evidence that each PCA has successfully completed eight hours of in-service continuing education, excluding agency and program specific orientation, every twelve months.

(5) The PCA supervisor trainer and tester may only be a RN or a LPN under the direction of a RN.

(F) The provider must maintain evidence of compliance with the following supervisory requirements:

(1) Prior to consumer service initiation, the supervisor must complete and document a consumer home visit, which may occur at the initial PCA visit to the consumer, to define the expected activities of the PCA and prepare a written PCA activity plan;

(2) After the consumer service initiation, the supervisor must conduct and document a visit to the consumer at least once every sixty-two days to evaluate compliance with the activity plan, consumer satisfaction, and PCA performance. The supervisor must discuss recommended modifications with the case manager and PCA. The PCA need not be present during this visit. The visit must be documented. The documentation must include the date of the visit, the name of the PCA supervisor, name of the consumer, and must include the signature of the consumer and the PCA supervisor or the electronic signature of the PCA supervisor;

(3) The provider must have a mechanism to verify:

(a) Whether the PCA is present at the location where the services are to be provided and at the time the services are to be provided;

(b) At the end of each working day, whether the provider’s employees have provided the services at the proper location and time;

(c) A protocol to be followed in scheduling a substitute employee when the monitoring system identifies that an employee has failed to provide home care services at the proper location and time, including standards for determining the length of time that may elapse without jeopardizing the health and safety of the consumer;

(d) Procedures for maintaining records of the information obtained through the monitoring system;

(e) Procedures for compiling annual reports of the information obtained through the monitoring system, including statistics on the rate at which home care services were provided at the proper location and time; and,

(f) Procedures for conducting random checks of the accuracy of the monitoring system. For purposes of conducting these checks, a random check is considered to be a check of not more than five per cent of the home care visits each PCA makes to different consumers.

Effective: 04/16/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

173-39-02.12 Social work counseling service.

(A) Social work counseling is a service designed to facilitate consumer adjustment when the consumer’s physical, social and emotional well being is threatened. Services may be provided for caregiver/family members, in conjunction with the consumer, when the purpose of the service is to enable the caregiver/family members to function better together with the consumer or the purpose is related to the consumer’s care.

(B) A unit of service is fifteen minutes.

(1) An eligible individual provider may be a licensed professional clinical counselor (LPCC), licensed professional counselor (LPC), licensed psychologist (MA or PHD), a licensed independent social worker (LISW), or have a master of science in social administration (MSSA).

(2) An eligible agency provider may be an agency, partnership or group practice utilizing one or more LPCCs, LPCs, LISWs, licensed psychologists (MA or PHD), MSSAs, and/or licensed social workers (LSW).

(3) The provider must maintain documentation that social work counseling staff are licensed by the applicable Ohio licensure board, and have at least one year of counseling service.

(D) The provider must assure consumer plans are developed and services are delivered in accordance with professional licensure requirements.

(E) Unless authorized by the consumer/caregiver and the case manager, the provider must deliver this service in the consumer’s residence.

(F) The provider must document and maintain a record of each service-related consumer contact and each service delivered, including the date of contact, the type of contact, the social worker’s name, and the signatures of the counselor and the consumer.

(G) The provider must conduct an individualized assessment for each consumer that includes an evaluation of the consumer’s psychosocial, financial and environmental status. In addition, the provider must:

(1) Develop and revise the social work counseling plan based on the consumer’s status and response, and must include the treatment modality and the recommended number of counseling sessions;

(2) Include the consumer and/or caregiver, as available, and the case manager in the treatment planning process;

(3) Furnish the case manager and consumer a copy of the report of the assessment outcome and intervention plan within seven working days following the individualized assessment;

(4) Plan and document social work counseling service termination in consideration of goal achievement and in communication with the case manager, and must provide follow-up or referral for the consumer as indicated.

(H) At the conclusion of services, or as requested by the case manager, the provider must furnish documentation of the consumer plan implementation and the outcomes.

(I) The provider must practice in accordance with the licensing and supervision requirements appropriate to the provider’s licensing board.

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

173-39-02.13 Non-emergency medical transportation service.

(A) “Non-emergency medical transportation service” means a service that transports a consumer from one place to another for a non-emergency medical purpose through the use of a provider’s vehicle and driver. Examples of places to which the service may transport a consumer are a doctor’s office or a pharmacy. (This service is different than the non-medical transportation service defined in rule 173-39-02.18 of the Administrative Code, which transports a consumer from one place to another for a non-medical purpose.)

(B) Eligibility criteria: A consumer is eligible for a non-emergency medical transportation service if:

(1) The consumer is enrolled in the PASSPORT program;

(2) A case manager authorizes the service;

(3) The service is not otherwise available or funded by Ohio’s medicaid program (i.e., the “Medicaid card”) or another source; and,

(4) The consumer’s family, neighbors, friends, or community agencies are unwilling or not required to provide the service to the consumer free of charge.

(1) In general:

(b) Availability: The agency provider shall possess a back-up plan for providing the service when a driver or vehicle is unavailable. A non-agency provider shall possess a back-up plan for providing the service when he/she or his/her vehicle is unavailable.

(c) To and from vehicle: As part of each service provided, the driver shall help the consumer to safely transfer between the pick-up point and the vehicle, to safely enter and exit the vehicle, and to safely transfer between the vehicle and the destination point.

(d) Records: As part of each service provided, the driver shall document the consumer’s name; the pick-up point and the date and time of the pick up; the destination point and the date and time of the drop off; the consumer’s signature, the driver’s name, and the driver’s signature.

(2) Vehicle inspections:

(a) The provider shall create a written plan for preventive maintenance and inspection of each vehicle and wheelchair lift used for this service which shall include the recommended preventive-maintenance schedule of the vehicle or wheelchair lift and the:

(i) “Annual Vehicle Inspection” on form ODA0004 (http://www.aging.ohio.gov/information/rules/forms.aspx): The provide shall only use a vehicle for the service if the inspection was conducted no more than twelve months beforehand and the answers to all questions on the form were “yes.” Only a certified mechanic, the Ohio highway patrol safety inspection unit, or the Ohio medical transportation board may perform the inspection; and,

(ii) “Pre-Trip Vehicle Inspection” on form ODA0008 (http://www.aging.ohio.gov/information/rules/forms.aspx): The provider shall only use a vehicle if, before providing the first service of the day, the driver conducted the inspection and the answers to all questions required by the form were “yes.”

(b) The provider shall deem that a vehicle that holds a current, valid license from the Ohio medical transportation board to operate as an ambulette is a vehicle that complies with paragraph (C)(2)(a)(i) of this rule.

(3) Driver qualifications:

(a) Before providing the first service, the driver shall:

(i) Hold a current, valid driver’s license for at least two years, hold any driver’s license endorsement that is necessary to operate the type of vehicle used for the service, and have fewer than six points issued under Chapter 4506. or 4507. of the Revised Code (or have points issued under statutes of the driver’s home state that are substantially equivalent to six points issued under Chapter 4506. or 4507. of the Revised Code if the driver is a resident of another state);

(ii) Obtain a signed statement from a licensed physician acting within the scope of the physician’s practice that states that the driver has no medical or physical condition, including an incurable vision impairment, that may impair safe driving, passenger assistance, emergency treatment, or the health and welfare of a consumer or the general public;

(iii) Pass drug and alcohol tests. The drug tests check for the use or abuse of amphetamines, cannabinoids (THC), cocaine, opiates, and phencyclidine (PCP). The driver receives a passing score if the drug tests do not find the drugs in his/her blood, breath, or urine. The alcohol tests check blood-alcohol content. The driver receives a passing score if the alcohol tests do not find a blood-alcohol content in the driver’s blood that is higher than Ohio’s maximum blood-alcohol content. The driver shall obtain the drug and alcohol tests from a hospital or another entity that the Ohio department of health permits to conduct the tests;

(iv) Pass a training course in first aid and CPR offered by the American red cross, the American heart association, the national safety council, medic first aid international, American safety and health institute, or an equivalent organization approved by ODA;

(v) Possess the ability to understand written and oral instructions;

(vi) Possess the ability to comply with paragraph (C)(1)(c) of this rule; and,

(vii) Possess the ability to comply with the documentation requirement and the “Pre-Trip Vehicle Inspection” requirement under paragraphs (C)(1)(d) and (C)(2)(a)(ii) of this rule.

(b) No later than six months after a driver provides his/her service or no later than six months after the effective date of this rule, whichever occurs later, the driver shall:

(i) Complete a defensive-driving course sponsored or endorsed by the national safety council or the Ohio department of transportation. The driver shall also complete a defensive-driving course every three years thereafter; and,

(ii) Complete an introductory course approved by ODA on passenger-assistance training that includes the following topics:

(a) Sensitivity to aging;

(b) Overview of diseases and functional factors commonly affecting older adults;

(c) Environmental considerations affecting consumers;

(d) Consumer assistance and transfer techniques;

(e) Management of a wheelchair, including the proper methods for securing a wheelchair;

(f) Inspection and operation of a wheelchair lift and other types of assistive equipment; and,

(g) Emergency procedures.

(i) Any driver for an urban or rural transit system is deemed to comply with paragraph (C)(3)(a) of this rule.

(ii) Any driver who successfully passed the defensive-driving course required under paragraph (C)(3)(b)(i) of this rule no more than three years before the effective date of this rule is deemed to comply with paragraph (C)(3)(b)(i) of this rule. (For example, a driver for an urban or rural transit system may have recently completed a defensive-driving course in order to qualify for his/her job. Therefore, he/she is not required to take another defensive-driving course before transporting a consumer under this rule. He/she is only required to complete a defensive-driving course every three years after the date he/she most recently passed a defensive-driving course.)

(iii) Any driver who successfully passed the introductory course required under paragraph (C)(3)(b)(ii) of this rule no more than three years before the effective date of this rule is deemed to comply with paragraph (C)(3)(b)(ii) of this rule. (For example, a driver for an urban or rural transit system may have recently completed the introductory course in order to qualify for his/her job. Therefore, he/she is not required to take another introductory course on transporting older persons and people with disabilities before transporting a consumer under this rule. He/she is only required to complete the refresher course every three years after the date he/she most recently passed the introductory course.)

(d) The provider shall maintain documentation on the compliance of each driver (or the non-agency provider shall maintain documentation on his/her compliance) with the driver qualifications in paragraph (C)(3) of this rule.

(D) Rates:

(1) One trip, whether a one-way trip or a round trip, constitutes one job of non-emergency medical transportation service.

(2) The per-job rate for a service is negotiable, but is finalized by the consumer’s case manager before the provision of the service. A finalized rate is renegotiable if the case manager revises the rate before the service is provided.

(3) The maximum rates allowable for a one-way trip and a round trip are listed in rule 5101:3-1-06.1 of the Administrative Code.

Replaces: 173-39-02.13

Effective: 02/15/2009

R.C. 119.032 review dates: 09/30/2013

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

Prior Effective Dates: 03/31/2006

173-39-02.14 Home-delivered meal service.

(A) Home-delivered meal is a service designed to provide consumers with one to two safe and nutritious meals per day that meet the current dietary guidelines for Americans and the recommended dietary allowances (RDA) and dietary reference intakes (DRI).

(B) A unit of service is one meal prepared and delivered to a consumer’s residence.

(D) Providers must document and maintain a record of each service-related consumer contact and each service delivered, including the date and time of the contact, a description of the type of contact, and the name(s) of person(s) having contact with the consumer.

(E) Nutritional Adequacy:

The provider must ensure that:

(1) Each meal complies with one-third of the current dietary guidelines for Americans as published by the United States department of health and human services and the United States department of agriculture, and meets the current recommended dietary allowance (RDA)/dietary reference intakes (DRI) established by the food and nutrition board of the institute of medicine of the national academy of sciences, unless the meal was prepared in accordance with a diet prescription ordered by a physician or licensed dietitian.

(2) All meals provided follow meal pattern or are verified with nutrition computer analysis to meet dietary guidelines for Americans and RDA/DRI.

(3) All menus have been approved by a licensed dietitian. The provider must have access to a licensed dietitian for consultation.

(4) Each meal will consist of: two ounces of edible cooked meat, fish, fowl, eggs or meat alternate; three servings of vegetables and/or fruits; two servings of starches/grains; one cup low-fat milk or equivalent; fat serving; and optional items to complement the meal such as a dessert, condiments, etc. The provider must also ensure that serving sizes are based on dietary guidelines for Americans and my food pyramid.

(5) Meals are prepared in compliance with all applicable federal, state, county, and local laws and regulations governing the preparation, handling, and transportation of food.

(F) Food Safety

(1) The provider must maintain documentation that demonstrates that all meals are prepared by the provider or a subcontractor that is in compliance with Chapter 3117. of the Revised Code and Chapter 3717-1. of the Administrative Code (the Ohio uniform food safety code).

(2) The provider must maintain appropriate licenses and demonstrate compliance with local health department inspections and Ohio department of agriculture meat and poultry inspections.

(3) The provider must report all local health department and Ohio department of agriculture inspection citations to ODA’s designee within five working days of the provider’s receipt thereof, together with a corrective action and follow-up plans.

(4) Food preparers must develop and implement a time/temperature monitoring system for food preparation, food handling, and food delivery.

(G) Meal

(1) The provider must adopt a consumer choice plan that offers the consumer an opportunity to make a choice about the food served by using one or more of the following methods:

(a) Offer consumer choices from two or more of the following groups of food: milk; bread; fruit; vegetable; meat; and dessert.

(b) Offer consumers the opportunity to provide suggestions for menu planning at least annually.

(2) The provider must develop a system that offers consumer access to ingredient content of meals. This system must receive prior approval from ODA’s designee.

(3) All meals must be labeled with a production date.

(4) The provider may be authorized by the case manager to furnish a therapeutic diet for a consumer. A therapeutic diet must be authorized by a physician or licensed dietitian as part of a treatment of a disease or a clinical condition to eliminate, decrease, or increase certain substances in the diet. It is a food regimen requiring a daily minimum or maximum amount of one or more specific nutrients or a specific distribution of one or more nutrients.

(a) A consumer may be authorized to receive a therapeutic diet for up to thirty days prior to authorization by a physician or a licensed dietitian.

(b) Physician or dietitian authorization must be documented every ninety days.

(H) Meal Delivery

(1) The provider must document:

(a) That the provider’s meal delivery systems ensure quality and safe meals:

(i) Custom-built, temperature-controlled food delivery vehicles must maintain verification of testing meal temperatures at least monthly;

(ii) All other delivery systems must test meal temperatures at least weekly;

(iii) Newly established food delivery routes must have meal temperatures taken daily for one week or longer as needed to ensure constant safe temperature and quality meals, followed by routine checks.

(b) The number of meals delivered at each consumer residence.

(d) A consumer’s receipt of meals by obtaining the signature of the consumer or the consumer’s caregiver.

(2) The provider must assure delivery of meals as authorized by ODA’s designee. The provider must notify the consumer if delivery of the meal will be delayed more than one hour past established delivery time. The provider must furnish written instructions to driver as related to the meal delivery.

(3) The provider must provide evidence of documentation that the home-delivered meal transport staff possess a current and valid driver’s license and appropriate personal insurance, if not covered by provider’s insurance.

(I) Training

(1) The provider must assure a training plan, continuous education events and documentation of trainings each year. Each staff must have a minimum of four hours of continuous education each year in an area described in paragraph (I)(2) of this rule or on another relevant subject.

(2) All personnel (including volunteers) who participate in food preparation, food handling and/or food delivery must demonstrate competency, to the satisfaction of a licensed dietitian or a person certified in a food safety education program, the following skills and abilities as relevant for the individual’s job duties:

(a) Sensitivity training to the needs of older adults and/or disabled;

(b) Handling emergencies;

(d) Meal service and meal delivery;

(e) Food safety and sanitation; and,

(f) Handling hazardous materials.

(J) The provider must develop, implement and evaluate the effectiveness of an annual internal quality control plan (IQCP) to assure the preparation and delivery of safe meals. The IQCP must reflect the required components defined in the Ohio uniform food safety code found in Chapter 3717-1 of the Administrative Code. The provider must furnish documentation of self-inspection outcome, problems identified and corrective action taken.

Effective: 04/16/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

173-39-02.15 Independent living assistance service.

(A) Independent living assistance (ILA) is a service that consists of activities that assist consumers to manage their households, handle their personal affairs, self-administer medications, and help ensure that consumers retain their community living arrangements and avoid institutionalization due to loss of shelter or other essential environmental services. There are three types of ILA: telephone support, in-person support activities and travel attendant activities.

(1) Telephone support includes:

(a) Calling consumers according to a preset schedule to remind them to take prescribed and over-the-counter medications at specified times; and,

(b) Calling consumers at times that no other in-home services are being provided to confirm that consumers are functioning safely in the home environment.

(2) In-person support includes one or more of the following:

(a) Assisting consumers with banking to include making routine deposits and withdrawals;

(b) Cashing a consumer’s benefit checks;

(d) Writing personal checks for consumers;

(e) Paying bills in person or by mail on behalf of a consumer;

(f) Balancing a consumer’s checkbooks and reconciling the consumer’s monthly checking account statements;

(g) Organizing and coordinating health insurance records for consumers;

(h) Assisting or acting as a consumer’s authorized representative in order to obtain and/or maintain public benefits;

(i) Applying for programs such as homestead exemption, home energy assistance program (heap) and subsidized housing on behalf of a consumer;

(j) Monitoring and replenishing a consumer’s stock of needed groceries; and,

(k) Assisting a consumer with business and personal correspondence including writing letters, purchasing postage stamps and delivering correspondence to the post office.

(3) Travel attendant activities include:

(a) Accompanying consumers to medical and other appointments; and,

(b) Accompanying consumers on errands and to other activities outside the home.

(B) A unit of service is fifteen minutes of direct consumer service or one completed phone call.

(D) The provider must maintain a consumer record documenting each episode of service delivery, including the date of service, service tasks performed, name of the staff person providing services, the beginning and ending times of services provided, and the provider staff’s signature or electronic signature. Providers who do not utilize an electronic verification system to document services and keep records must also obtain the consumer’s signature for each episode of in-person and travel attendant service.

(E) Certified ILA providers must be able to document that they:

(1) Have the capacity to deliver services five days per week; and,

(2) Have a service back-up plan to ensure services are delivered during staff absence.

(F) Providers must demonstrate evidence of compliance with the following personnel requirements:

(1) ILA staff must meet all of the following minimum requirements prior to working with consumers:

(a) Have a high school diploma, have successfully completed a GED, or have a minimum of one year of relevant, supervised work experience with a public health, human services or other community service agency;

(b) Have the ability to understand written activity plans, execute instructions, document services delivered, and, for staff providing ILA in-person services, the ability to perform basic mathematical operations;

(d) Have the ability to access emergency service systems; and,

(e) Have the ability to access transportation services required as appropriate.

(2) Eligible supervisors of ILA services must have at least one of the following:

(a) A current and valid license to practice in the state of Ohio as an RN, LPN, LISW, or LSW;

(b) A bachelor’s degree or an associate degree in: home economics/nutrition or dietetics, counseling, gerontology, social work, nursing, public health, health education, other related field; or,

(3) The provider must document a minimum of eight hours of continuing education for each ILA staff providing in-person services every twelve months.

(G) The provider must demonstrate evidence of compliance with the following supervisory requirements:

(1) Prior to service initiation of ILA in-person and/or ILA travel attendant services, the supervisor must complete and document a home visit to define the expected ILA activities. The supervisor must develop and document a specific activities plan consistent with the case manager’s authorized plan.

(2) Prior to service initiation of ILA telephone support services, the supervisor must conduct a conference call with the consumer or a home visit with the consumer to define the expected ILA telephone support activities. The supervisor must develop and document a specific activities plan consistent with the case manager’s authorized plan.

(3) The supervisor must evaluate the ILA staff compliance with the plan, consumer satisfaction and job performance during a home visit with the consumer receiving in-person and travel attendant ILA services at least every ninety days. The ILA staff need not be present during the visit. The supervisor must evaluate the ILA telephone support staff compliance with the plan, consumer satisfaction and job performance during a home visit or a telephone conference with the consumer receiving ILA telephone support services.

(H) The provider must demonstrate evidence of compliance with the following:

(1) All employees who have contact with consumers must complete orientation and training prior to working with consumers. The orientation and training must include, but need not be limited to, the following:

(a) Expectations of employees;

(b) The employee code of conduct;

(d) Incident reporting procedures;

(e) Agency organization and lines of communication; and,

(f) Emergency procedures.

(2) Comply with and maintain written policies and procedures as applicable supporting the operation of the business and provision of service that include, at a minimum:

(a) Reporting and documenting consumer incidents;

(b) Obtaining consumer’s written permission to share information and/or release information to anyone;

(d) Personnel requirements including:

(i) Job descriptions for each position;

(ii) Documentation of each employee’s qualifications for the service(s) to be provided;

(iii) Performance appraisals for all workers;

(iv) Documentation of compliance with required staff orientation training; and,

(v) The employee code of conduct as described in rule 173-39-02 of the Administrative Code.

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 1273.39, 173.391

173-39-02.16 Assisted living service.

(A) As used in this rule, “assisted living service” (“AL”) means a service that promotes aging in place by supporting individual independence, choice, and privacy through the provision of the following services, as authorized in a consumer’s assisted living care plan:

(1) A personal care service, as defined in rule 3701-17-50 of the Administrative Code;

(2) A supportive service, such as housekeeping, personal and other laundry, or maintenance;

(3) Twenty-four-hours-per-day, on-site response capability to meet scheduled and/or unscheduled consumer needs;

(4) The co-ordination of the provision of three meals per day, as described in paragraph (B) of rule 3701-17-60 of the Administrative Code;

(5) Social and recreational programming;

(6) Non-medical scheduled transportation, as agreed upon by the consumer and the provider and ordered in the assisted living care plan; and,

(7) A nursing service that includes the following:

(a) Health assessments and monitoring;

(b) Medication oversight, to the extent permitted under state law;

(c) Part-time, intermittent skilled nursing care, as described in rule 3701-17-59.1 of the Administrative Code, when not available to the consumer through a third-party payor; and,

(d) Part-time, intermittent skilled nursing care, including supervision of special diets, administration of medication, and the application of dressings, as described in rule 3701-17-59 of the Administrative Code.

(B) One unit of assisted living service is equal to one day.

(C) Only a certified assisted living provider licensed as a residential care facility by the Ohio department of health, in accordance with rules 3701-50 to 3701-17-68 of the Administrative Code, may provide an assisted living service.

(D) An assisted living provider may contract with an outside provider to furnish some, but not all, of the assisted living services that a consumer is authorized to receive.

(E) Each provider of assisted living service, as described in paragraph (A) of this rule, shall also provide a community transition service, as described in rule 173-39-02.17 of the Administrative Code, to any consumer who also qualifies for both an assisted living service and a community transition service.

(F) The provider’s facility shall have common areas accessible to the consumer, including a dining area (or areas) and an activity center (or centers) that may also serve as a living or dining area (or areas).

(G) The provider shall provide each consumer with a personal residential living unit. The living unit shall:

(1) Be a single-occupancy unit, unless otherwise requested by the consumer;

(2) Be able to be locked by the consumer, unless contra-indicated in writing by the consumer’s physician;

(3) Include a bathroom with a working toilet, a sink, and a shower or bathtub; and,

(4) Include identifiable space for socialization.

(H) The provider shall retain, either directly or through the use of a subcontractor, the services of a registered nurse or a licensed practical nurse pursuant to Chapter 4723. of the Revised Code.

(I) The provider shall furnish sufficient on-duty staff, as defined in paragraph (Y) of rule 3701-17-50 of the Administrative Code, on a twenty-four-hours-per-day basis to meet, in a timely manner, the consumer’s unpredictable care, supervisory needs, emotional needs, reasonable requests for services, and to adequately assist the consumer in performing all activities of daily living.

(J) The provider shall document that, prior to service delivery, each facility staff member, as defined in paragraph (KK) of rule 3701-17-50 of the Administrative Code, received orientation in the following subject areas:

(1) Principles and philosophy of assisted living;

(2) The aging process;

(3) Intermittent cuing, redirecting, and environmental cues for cognitively-impaired consumers and/or behaviorally-impaired consumers;

(4) Confidentiality;

(5) The consumer care plan process; and,

(6) The consumer’s right to assume responsibility for decisions related to his/her care.

(K) The provider shall assure and document that facility staff members, as defined in paragraph (KK) of rule 3701-12-50 of the Administrative Code, who provide an assisted living service and are under eighteen years of age, shall not perform the following:

(1) Assist with medication supervision, medication administration, or delegated nursing tasks;

(2) Provide transportation; or,

(3) Provide hands-on assistance with bathing, toileting, or transferring without on-site supervision.

(L) The provider shall assure and document that each staff member who provides a personal care service in an assisted living facility (with the exception of a licensed health professional whose scope of practice includes the provision of a personal care service) has annually completed a minimum of eight hours of continuing education, as described in paragraph (E)(4) of rule 3701-17-55 of the Administrative Code.

(M) The provider’s registered nurse or licensed practical nurse shall do the following:

(1) Document quarterly contact with the consumer to assess consumer satisfaction with the assisted living care plan and the appropriateness of the assisted living care plan;

(2) Review service delivery records at least quarterly to assure implementation of the assisted living care plan as ordered; and,

(3) Document, at least quarterly, that the facility staff are providing personal care in accordance with paragraph (D) of rule 3701-17-59 of the Administrative Code.

Replaces: 173-39-02.16

Effective: 03/22/2008

R.C. 119.032 review dates: 03/21/2012

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

Prior Effective Dates: 3/31/2006

173-39-02.17 Community transition service.

(A) “Community transition service” means a service that covers one or more one-time expenses for setting-up a consumer in a residential care facility, house, or apartment. Examples of these expenses are the purchase of essential household furnishings, window coverings, household supplies, food-preparation items, bed linens, or bath linens; fees or deposits to initiate utility services; or moving expenses.

(B) Eligibility criteria:

(1) A case manager may authorize one or more community transition service expenses for:

(a) A consumer who is enrolled in the assisted living program and is in transition from a nursing facility to a residential care facility; or,

(b) A consumer who is enrolled into the PASSPORT program and is in transition from a nursing facility to a house or apartment.

(2) A case manager may only authorize a community transition service expense in a consumer’s care plan (or service plan) if the consumer’s family, neighbors, friends, or community agencies are unwilling or not required to provide the service to the consumer free of charge; or, if no other person (e.g., a landlord) has a legal or contractual responsibility to cover the expense.

(1) Only an agency provider, non-agency provider, or assisted living provider who is certified under rule 173-39-02 of the Administrative Code may provide a community transition service.

(2) Each provider of a community transition service shall:

(a) Only make an expense that is authorized in a consumer’s care plan (or service plan);

(b) Provide the service no later than ninety days after the date the consumer enrolls in the assisted living program or the PASSPORT program;

(d) Maintain a record of each service that includes:

(i) The date of service;

(ii) An accurate description of each expense;

(iii) A receipt for any item purchased;

(iv) The signature (or initials) of the consumer (or authorized representative) to verify that the consumer (or authorized representative) was involved in the selection of any item purchased on the consumer’s behalf; and,

(v) The signature (or initials) of the consumer (or authorized representative) to verify that the service was provided.

(D) Rates:

(1) The sum of the community transition service expenses authorized in a consumer’s care plan (or service plan) constitutes one job of community transition service.

(2) The per-job rate for a service is negotiable, but is finalized by the PAA.

(3) The maximum rate allowable for the service is established in the appendix to rule 5101:3-1-06.5 for the assisted living program and in the appendix to rule 5101:3-1-06.1 of the Administrative Code for the PASSPORT program.

Replaces: 173-39-02.17

Effective: 07/03/2008

R.C. 119.032 review dates: 06/30/2013

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

Prior Effective Dates: 03/31/2006, 03/22/2008

173-39-02.18 Non-medical transportation service.

(A) “Non-medical transportation service” means a service that transports a consumer from one place to another for a non-medical purpose through the use of a provider’s vehicle and driver. Examples of places to which the service may transport a consumer are a grocery store, a senior center, or a government office. (This service is different than the non-emergency medical transportation service defined in rule 173-39-02.13 of the Administrative Code, which transports a consumer from one place to another for a non-emergency medical purpose.)

(B) Eligibility criteria: A consumer is eligible for a non-medical transportation service if:

(1) The consumer is enrolled in the PASSPORT program;

(2) A case manager authorizes the service;

(3) The service is not otherwise available or funded by Ohio’s medicaid program (i.e., the “Medicaid card”) or another source; and,

(4) The consumer’s family, neighbors, friends, or community agencies are unwilling or not required to provide the service to the consumer free of charge.

(1) In general:

(a) Type of provider: Only an agency provider or non-agency provider who is certified under rule 173-39-02 of the Administrative Code may provide the service. A consumer-directed individual provider shall not provide the service. (See rule 173-39-02.4 of the Administrative Code regarding a escort service or transportation to community service, activity, or resource provided by a consumer-directed individual provider as part of a home-care attendant service.)

(b) Availability: The agency provider shall possess a back-up plan for providing the service when a driver or vehicle is unavailable. The non-agency provider shall possess a back-up plan for providing the service when he/she or his/her vehicle is unavailable.

(2) Vehicle inspections:

(i) The “Annual Vehicle Inspection” on form ODA0004 (http://www.aging.ohio.gov/information/rules/forms.aspx): The provide shall only use a vehicle for the service if the inspection was conducted no more than twelve months beforehand and the answers to all questions on the form were “yes.” Only a certified mechanic, the Ohio highway patrol safety inspection unit, or the Ohio medical transportation board may perform the inspection; and,

(ii) The “Pre-Trip Vehicle Inspection” on form ODA0008 (http://www.aging.ohio.gov/information/rules/forms.aspx): The provider shall only use a vehicle if, before providing the first service of the day, the driver conducted the inspection and the answers to all questions required by the form were “yes.”

(3) Driver qualifications:

(a) Before providing the first service, the driver shall:

(v) Possess the ability to understand written and oral instructions;

(vi) Possess the ability to comply with paragraph (C)(1)(c) of this rule; and,

(vii) Possess the ability to comply with the documentation requirement and the “Pre-Trip Vehicle Inspection” requirement under paragraphs (C)(1)(d) and (C)(2)(a)(ii) of this rule.

(b) No later than six months after a driver provides his/her service or no later than six months after the effective date of this rule, whichever occurs later, the driver shall:

(ii) Complete an introductory course approved by ODA on passenger-assistance training that includes the following topics:

(a) Sensitivity to aging;

(b) Overview of diseases and functional factors commonly affecting older adults;

(c) Environmental considerations affecting consumers;

(d) Consumer assistance and transfer techniques;

(e) Management of a wheelchair, including the proper methods for securing a wheelchair;

(f) Inspection and operation of a wheelchair lift and other types of assistive equipment; and,

(g) Emergency procedures.

(i) Any driver for an urban or rural transit system is deemed to comply with paragraph (C)(3)(a) of this rule.

(D) Rates:

(1) One trip, whether a one-way trip or a round trip, constitutes one job of non-medical transportation service.

(3) The maximum rates allowable for a one-way trip and a round trip are listed in rule 5101:3-1-06.1 of the Administrative Code.

Replaces: 173-39-02.18

Effective: 02/15/2009

R.C. 119.032 review dates: 09/30/2013

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

Prior Effective Dates: 7/3/2008

173-39-03 Provider certification.

(A) Application materials for applicants seeking ODA long-term care certification as a consumer-directed individual provider include:

(1) A signed and completed application form prescribed by ODA; and,

(2) A completed W-9 form.

(B) Application materials for applicants seeking ODA long-term care certification as an agency provider, a non-agency provider, or an assisted living provider include:

(1) A signed and completed application form prescribed by ODA.

(a) Incomplete applications will be returned to the applicant by ODA’s designee with an explanation of the information needed and a statement specifying that the complete application must be resubmitted within thirty business days.

(b) ODA’s designee must send a written acknowledgment of receipt for each complete application received and schedule an on-site pre-certification review within fifteen business days of receipt.

(2) A completed W-9 form.

(3) In addition to those materials described in paragraphs (B)(1) and (B)(2) of this rule, applicants seeking certification as an assisted living provider must also provide evidence that provider’s facility is a residential care facility licensed by the Ohio department of health.

(C) Applicants also seeking to obtain medicaid provider agreements for ODA-administered long-term care services must complete those application materials required by ODJFS, and must submit those materials to ODA’s designee at the same time as they submit ODA certification materials.

(D) The process to become an ODA-certified long-term care consumer-directed individual provider is:

(1) Obtain application materials from the consumer for whom the applicant will serve.

(2) Application materials must be reviewed by the consumer.

(3) The applicant may be interviewed by the consumer.

(4) If the consumer wishes to employ an applicant as a consumer-directed individual provider, the consumer must recommend the applicant for certification to ODA’s designee.

(5) ODA or ODA’s designee must review the application materials and the consumer’s recommendation to determine whether the applicant meets the requirements set forth in Chapter 173-39. of the Administrative Code.

(a) If the applicant demonstrates compliance with all requirements, within ten business days, ODA’s designee must recommend to ODA that certification be granted.

(b) If the applicant does not demonstrate compliance with all requirements, within ten business days, ODA’s designee must recommend to ODA that certification be denied.

(6) ODA must make the final determination of provider certification based upon a review of the application and the documentation presented by ODA’s designee.

(7) ODA must notify its designee in writing of the determination within twenty business days of receipt of the designee’s recommendation.

(8) Within ten business days following receipt of ODA’s written determination, ODA’s designee must notify the consumer in writing about the status of certification.

(a) If certification is granted, the consumer must enter into a contract with the certified provider to furnish specific services.

(b) If certification is denied, the applicant:

(i) May not reapply for certification for at least one year after the mailing date on which ODA’s designee’s notified the consumer of ODA’s final determination of denial; and,

(ii) Any applicant denied certification as a consumer-directed individual provider may appeal ODA’s decision in accordance with the appeal provisions outlined in rules 173-39-07 and 173-39-08 of the Administrative Code.

(E) The process to become an ODA-certified long-term care agency, non-agency and assisted living provider is:

(1) An applicant must request application materials and instructions from ODA’s designee.

(2) Within forty-five business days after receipt of a signed and complete application, ODA’s designee must complete an on-site pre-certification review to ascertain whether the applicant meets the requirements set forth in Chapter 173-39. of the Administrative Code.

(3) Within thirty business days of the on-site certification review, ODA’s designee must determine whether the applicant meets the requirements set forth in Chapter 173-39. of the Administrative Code.

(a) If the applicant demonstrates compliance with all requirements, ODA’s designee may recommend to ODA that certification be granted.

(b) If the applicant does not demonstrate compliance with all requirements, ODA’s designee must provide written notification to the applicant specifying the areas of noncompliance.

(i) The applicant has twenty business days from the date of notification to demonstrate full compliance with all requirements.

(ii) ODA’s designee must recommend to ODA within ten business days that certification be granted if the applicant complies with all requirements within the allotted time.

(iii) ODA’s designee must recommend to ODA within ten business days that certification be denied if the applicant fails to comply with all requirements within the allotted time.

(4) ODA must make the final determination of provider certification based upon a review of the application and the documentation presented by ODA’s designee.

(5) ODA must notify the ODA designee in writing of the determination within forty-five business days of receipt of ODA’s designee’s recommendation.

(6) Within ten business days following receipt of ODA’s written determination to the ODA designee about certification, ODA’s designee must notify the applicant in writing about the status of certification. The notice provided to the applicant must comply with rule 173-39-06 of the Administrative Code.

(a) If certification is granted, ODA’s designee must notify the applicant in writing and must send a two-party contract for the applicant’s signature. The contract must specify:

(i) Billing requirements;

(ii) The certified service(s) approved for payment;

(iii) The rate(s) of payment for each certified service;

(iv) The geographic area to be served;

(v) Termination notice requirements;

(vi) Record retention requirements; and

(vii) The time period covered by agreement.

(b) If certification is denied, the applicant:

(i) May not reapply for certification for at least one year after the mailing date of ODA’s designee’s final determination of denial;

(ii) May appeal the denial of certification in accordance with rules 173-39-07 and 173-39-08 of the Administrative Code.

(F) To maintain certification, each provider must:

(1) Maintain signed assurances contained in the ODA-specified application form;

(2) Meet the conditions of participation set forth in rule 173-39-02 of the Administrative Code;

(3) Meet the applicable requirements for long-term care services set forth in rules 173-39-02.1 to 173-39-02.17 of the Administrative Code; and,

(G) Providers currently certified as long-term care agency, non-agency and assisted living service providers may submit a request to ODA’s designee at any time to provide additional services within the geographic region of the state in which the provider is currently certified and/or to expand the delivery of services into other geographic regions.

(1) An applicant must notify ODA’s designee in the geographic region in which additional and/or expanded services are to be provided to request application materials and instructions.

(2) Within twenty business days after receipt of a signed and complete application, ODA’s designee must schedule an on-site certification review to ascertain whether the applicant meets the conditions of participation set forth in rule 173-39-02 of the Administrative Code or schedule a desk review. On-site pre-certification reviews must be scheduled to occur within thirty business days of the phone call and must be completed within twenty business days of the actual review. Desk reviews must be completed within thirty business days of receipt of the complete application.

(3) Within thirty business days of the on-site or desk review, ODA’s designee must inform the applicant in writing of any unmet requirements and specify that the applicant must demonstrate compliance with all requirements within thirty business days of the notification.

(4) If the applicant does not demonstrate compliance with all requirements within thirty business days following the mailing of the written notice to the applicant, ODA’s designee must recommend to ODA within ten business days that certification expansion and/or service addition be denied.

(5) If the applicant demonstrates compliance with all requirements within thirty business days following the mailing of the written notice to the applicant, ODA’s designee may recommend to ODA within ten business days that certification expansion or certified service addition be granted.

(6) Within sixty calendar days of receipt of the designee’s recommendation, ODA must provide written notice of its determination to its designee. If certification expansion or certified service addition is denied, ODA or its designee must issue a denial letter to the applicant in compliance with rule 173-39-06 of the Administrative Code.

(H) A provider is ineligible to be certified, or may have its certification terminated immediately, if the provider:

(1) Has had its certification and/or provider agreements terminated by a state, federal or nationally recognized accrediting body.

(2) Has falsified its application for certification as a community-based long-term care provider.

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173, 39, 173.391

173-39-04 Provider structural compliance review.

(A) Certified long-term care agencies, long-term care non-agencies and assisted living service providers must undergo regular structural compliance reviews to ascertain whether they continue to meet the conditions of participation and service specifications set forth in Chapter 173-39. of the Administrative Code. The reviews will be conducted by the entity designated by ODA to administer programs within the geographic region of the state in which the provider’s administrative offices are located, and must include verification of a sample of paid service units. Service providers that deliver services in two or more geographic regions of the state may be monitored by the ODA-designees operating in those geographic regions where the providers’ consumers reside. Business sites located outside the geographic region of the state in which the provider’s administrative offices are located, including those with business sites outside of Ohio, must undergo a desk review or an on-site review as determined by ODA or it’s designee.

(B) On-site provider structural compliance reviews:

(1) Must occur at least annually, from the first date of service delivery as a certified provider through the second year of service delivery;

(2) Must occur at least once every two years beginning the third year of service delivery for those providers certified to provide emergency response services, chore services, home medical equipment services, minor home maintenance services and transportation services;

(3) Must occur at least annually for those providers of services not listed in paragraph (B)(2) of this rule; and,

(4) May be conducted on an as needed basis to ascertain whether the provider meets the conditions of participation set forth in rule 173-39-02 of the Administrative Code, and the applicable service requirements listed in rules 173-39-02.1 to 173-39-02.17 of the Administrative Code.

(5) Must be announced by ODA’s designee by placing a telephone call, or sending a written announcement, to the provider prior to the visit and on-site introductory conference with the provider;

(6) Must include an evaluation of compliance with each applicable condition of participation set forth in rule 173-39-02 of the Administrative Code, and each applicable service specification listed in rules 173-39-02.1 to 173-39-02.17 of the Administrative Code.

(7) Must include verification that a sample of paid service units were delivered according to the requirements set forth in rules 173-39-02 and 173-39-02.1 to 173-39-02.17 of the Administrative Code, as appropriate; and,

(8) Must include an exit conference with the provider.

(C) The evaluation described in paragraph (B)(6) of this rule must be based on a review of a ten per cent sample of the provider’s current certified service delivery records for each service delivered, with a minimum of three and a maximum of thirty records reviewed for each certified service delivered by the provider during the quarter preceding the date of the on-site structural compliance review. If problems are identified, ODA’s designee may expand the sample or may require that an outside audit be conducted at the provider’s expense.

(D) The structural compliance review for certified providers that provide both personal care and homemaker services must be a combined review and the total sample must equal the sample size required in paragraph (C) of this rule.

(E) ODA’s designee must notify ODA within one business day when the health and/or safety of one or more consumers is at imminent risk.

(1) If a provider is determined to be out of compliance in an area that poses a serious threat to the health and/or safety of one or more consumers, the provider must demonstrate compliance within five business days.

(2) If ODA’s designee determines an imminent risk to the health and/or safety of one or more consumers, ODA may impose immediate sanctions as set forth in rule 173-39-05 of the Administrative Code.

(F) Within forty-five business days of the on-site review, ODA’s designee must issue to the provider a written structural compliance review report, including a summary of areas of non-compliance.

(G) Within forty-five business days from the date the structural compliance review report is mailed by ODA’s designee, the provider must submit evidence of compliance with the regulations that were determined to have been violated during the on-site structural compliance review.

(H) If unit of service errors are detected during a unit of service verification, providers must return the overpayment of funds to ODA or its designee. The repayment must be completed using acceptable state auditing procedures.

(I) ODA’s designee may conduct a follow-up on-site review to evaluate the provider’s compliance.

(J) ODA and/or its designee may exercise the right to conduct an unannounced on-site review of a provider at any time to evaluate any consumer complaint or concern, and/or to determine whether the health and/or safety of one or more consumers is at imminent risk.

(K) A provider has the right to challenge structural compliance review findings by ODA’s designee and to request a review by ODA.

(L) As specified in rule 173-39-03 of the Administrative Code, all certified long-term care providers are required to keep records for each episode of service delivery. Certified providers are required to provide such records and documentation to ODA, the secretary of the United States department of health and human services, the auditor of state, and the Ohio department of job and family services upon request. Various methods of audit and review will be utilized in all cases of suspected waste and abuse. If waste and abuse are apparent, the department will take action to gain compliance and recoup inappropriate payments. The provider must maintain all records as stipulated in this rule and rule 173-39-03 of the Administrative Code.

(1) The provider must maintain all records as stipulated in this rule and rule 173-39-03 of the Administrative Code.

(2) Records, documentation and information must be available regarding any services for which payment has been or will be claimed to determine that payment has been or will be made in accordance with applicable federal and state requirements. For purposes of this rule, an invoice constitutes a business transaction but does not constitute a record which is documentation of a medical service.

(3) All records, documentation and/or information requested in accordance with paragraph (B) of this rule shall be submitted to the department of its designee, in an appropriate manner as determined by the department. Records subject to audit and review must be produced at no cost to the department.

(a) Records subject to audit and review must be made available for examination in the time period determined by the department of its designee. Failure to supply the requested records, documentation and/or information as indicated in this rule will result in no payment for outstanding services.

(b) In all situations the department has the authority to conduct an on-site visit with the provider at the provider’s location for the examination or collection of records, and/or for compliance verification. Upon such occasions, as deemed necessary by the department of its designee, a member of the provider’s staff is to be assigned to assist in collecting the information. Upon request from the department, the provider will photocopy or make the applicable records available for photocopying.

(c) Services billed to and reimbursed by the department, which are not validated in the consumer record, are subject to recoupment through the audit and review process described in this rule.

(d) For purposes of this rule, the following definitions apply:

(i) “Audit” means a formal post-payment examination, made in accordance with generally accepted auditing standards, of a certified provider’s records and documentation to determine program compliance, the extent and validity of services paid for and to identify any inappropriate payments. ODA must have the authority to use statistical methods to conduct audits and to determine the amount of overpayment. An audit may result in a final adjudication order by ODA.

(ii) “Review” means an informal, prepayment or post-payment, limited scope investigation, special project and/or special analysis, examination or monitoring of a certified provider’s records, claims and/or supporting documentation to determine quality of care, compliance with accepted standards of care, program compliance and/or validity of services rendered, billed or paid for. A review may result in an educational letter, the denial of invalid services or claims, a corrective action plan subject to ODA approval, and/or the collection of overpayments.

(iii) “Notice of operational deficiency” means a formal written notice issued by ODA, pursuant to an audit and review, that identifies provider conduct, treatment or practices that are determined by ODA not to be in the best interests of the consumer or the long term care service program and/or are noncompliant with the regulations governing the long term care service program that must be corrected. The notice states the nature of the deficiency, the time period that the provider has to correct the deficiency and the person within ODA the provider is to contact to verify that the deficiency has been corrected

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

173-39-05 Sanctions for non-compliance.

Pursuant to section 173.39 of the Revised Code, the department of aging or its designee may take disciplinary action against a certified long-term care provider for good cause including, but not limited to: misfeasance, malfeasance, nonfeasance, confirmed abuse or neglect, financial irresponsibility, or any conduct the department determines is injurious to the health, safety and welfare of individuals receiving long-term care services.

(A) ODA or its designee may impose the following sanctions/penalties upon certified long-term care providers that fail to comply with the long-term care certification requirements outlined in Chapter 173-39. of the Administrative Code:

(1) ODA or its designee may impose a level one sanction against a certified provider that violates any condition of participation listed in rule 173-39-02 of the Administrative Code and/or any service specification listed in rules 173-39-02.1 to 173-39-02.17 of the Administrative Code. A level one sanction may include a written warning to, and/or a written mandate for documentation demonstrating compliance with regulations against, the provider.

(2) ODA may impose a level two sanction against any certified provider that:

(a) Fails to correct any deficiency for which a level one sanction was applied, or fails to comply with a mandate for documentation demonstrating compliance with regulations imposed upon the provider as a level one sanction; and/or,

(b) Commits any second violation of any condition of participation listed in rule 173-39-02 of the Administrative Code and/or any service specification listed in rules 173-39-02.1 to 173-39-02.17 of the Administrative Code; or,

A level two sanction may include a written warning to, and/or the written mandate for documentation demonstrating compliance with regulations against, the provider; the provisional certification of the provider until the problems serving as the basis for the decision to sanction have been resolved; the denial of reimbursement for undocumented services; and/or an order that unearned funds be repaid to the department.

For purposes of this rule, when a provider is provisionally certified, the provider retains its certification to provide long-term care services, but the department may order the removal of the provider’s existing clients, and/or temporarily suspend any new referrals to the provider until the problems that are the basis for the department’s decision to sanction the provider have been resolved.

(3) ODA may impose a level three sanction against any certified provider that:

(a) Fails to correct the deficiency(ies) for which a level two sanction was applied, or fails to document evidence of compliance with certification requirements imposed upon the provider as a level two sanction;

(b) Engages in a pattern of recurring or continuing non-compliance with the conditions of participation listed in rule 173-39-02 of the Administrative Code, or the service specifications listed in rules 173-39-02.1 to 173-39-02.17 of the Administrative Code;

(d) Is convicted, employs or is associated with a principal that has been convicted, of medicaid or medicare fraud; and/or,

(e) Endangers the health, safety or welfare of a recipient of long-term care services.

A level three sanction involves the decertification of the certified long-term care provider.

(B) ODA or its designee may propose that a sanction be assessed against a provider, but the department may not impose a level two or a level three sanction against a provider until the department has given the provider written notice of the Department’s intent to discipline and offered the provider an opportunity to appeal the proposed disciplinary action in accordance with rules 173-39-06, 173-39-07, and 173-39-08 of the Administrative Code.

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: 173.39, 173.391

173-39-06 Notice of denial of certification and proposed sanctions.

Whenever ODA proposes to deny an individual or government entity certification as a community-based long-term care service provider or to sanction a certified provider pursuant to rule 173-39-05 of the Administrative Code, ODA will send the provider written notice of the intended action via registered mail, return receipt requested.

(A) At a minimum, the notice will include:

(1) Notice of the specific sanction(s) the department intends to take.

(2) A list of the charges or reasons for the proposed action(s).

(3) A citation to the statute(s) or rule(s) directly involved.

(4) A statement that the provider is entitled to a prior hearing if it is requested within thirty days from the date of mailing the notice.

(5) A statement that the provider may appear at a hearing in person or through an attorney.

(6) A statement that the provider may present positions entirely in writing, may examine evidence and adverse witnesses at the hearing, and may introduce evidence and bring forth witnesses on behalf of the provider.

(7) A statement that rules governing the provider’s hearing before the department may be found in Chapter 173-39. of the Administrative Code.

(B) ODA will mail a copy of the notice to the provider’s attorney or other representative of record. To qualify as an attorney or representative of record, the provider or the attorney or representative must notify the department, in writing, that the attorney or representative is to be designated the attorney or representative of record. The notification must include the address where the department should mail the notice to the attorney or representative of record. The mailing of notice to the provider’s attorney or representative is not deemed to perfect service of the notice. Failure to mail a copy of the notice to the attorney or representative of record will not result in failure of otherwise perfected service upon the provider. In those instances where a provider is a corporation doing business in Ohio or is incorporated in Ohio, the mailing of notice to the corporation’s statutory agent pursuant to sections 1701.07 and 1703.19 of the Revised Code will perfect service provided that all the requirements of paragraph (A) of this rule have been complied with.

(C) Whenever the notice required by paragraph (A) of this rule is returned because of inability to deliver, ODA may either have its employee or designee make personal delivery of the notice or cause the notice to be published once a week for three consecutive weeks in a newspaper of general circulation in the county where the last known place of residence or business of the provider is located. The department will mail, first class mail, a copy of the first publication of the notice in a newspaper to the provider at the provider’s last known place of residence or business. The notice is deemed received as of the date of last publication.

(D) Nothing in this rule is to be construed to limit or otherwise prohibit the department’s utilization of sections 1701.07 and 1703.19 of the Revised Code to perfect service of process.

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: Chapter 119., 173.39, 173.391

173-39-07 Appeal of denial of certification and proposed sanctions.

(A) Any request for a hearing made as the result of notice issued pursuant to rule 173-39-06 of the Administrative Code must be made in writing, must clearly identify both the provider involved and the proposed action that is being contested, and must be mailed or delivered to the Ohio department of aging within thirty calendar days of the mailing of the notice.

(1) If a request for a hearing is mailed to ODA, the request is deemed to have been made as follows:

(a) If the request is mailed by certified mail, the request is deemed to have been made as of the date stamped by the United States postal service on its receipt form.

(b) If the request is mailed by regular United States mail, the request is deemed to have been made as of the date of the postmark appearing upon the envelope containing the request.

(c) In those cases where a postmark is illegible or fails to appear on the envelope, the request is deemed to have been made as of the date of its receipt by ODA as evidenced by the agency’s time stamp.

(2) If a request for a hearing is mailed or personally delivered to a party or address other than ODA, the request is deemed to have been made as of the date of its receipt by ODA as evidenced by ODA’s time stamp.

(3) If a request for a hearing is personally delivered to the department, the request is deemed to have been made as of the date of its receipt as evidenced by ODA’s time stamp.

(4) If a request for a hearing is made by facsimile transmission or by electronic mail, the request is deemed to have been made as of the date of its receipt as evidenced by the receipt date generated by the facsimile transmission or as shown on the electronic mail received by ODA.

(B) If a provider that has been proposed for sanction fails to request a hearing, or if the request is not timely, ODA will issue a final and binding order of adjudication adopting and ratifying the allegations contained in the original notice.

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: Chapter 119., 173.39, 173.391

173-39-08 Appeal hearings and adjudication orders.

(A) ODA will conduct all appeal hearings resulting from a proposal to deny certification as a community-based long-term care provider or to sanction a provider in accordance with Chapter 119. of the Revised Code.

(1) ODA will employ a hearing examiner to conduct all hearings initiated under rule 173-39-07 of the Administrative Code.

(2) The date, time, and place of any hearing is set by ODA. ODA will provide written or electronic notice prior to the date of the hearing to all participants in the hearing and file a copy of the written notice in the record of the hearing.

(3) Subject to the prior approval of the hearing examiner, any appellant may choose to present the case entirely in writing provided that a written request is made by the appellant no later than fourteen business days prior to the date scheduled for the hearing. Any request to present the case entirely in writing must be filed with the hearing examiner. Any appellant who elects to present the case entirely in writing must do so in accordance with procedures ordered by the hearing examiner. The hearing examiner’s order must be in writing and filed in the record of the hearing. In the event that the appellant elects to present its case in writing, the department may elect to present its case entirely in writing. Nothing in this rule is to be construed as preventing the department from compelling the attendance of the appellant or other witnesses at the hearing and questioning the appellant or other witnesses as if on cross-examination. Nothing in this rule is to be construed as preventing any appellant from examining any witnesses or evidence presented by the department at the hearing.

(4) During the course of any hearing, the participants to the proceeding may enter into oral stipulations of fact, procedure, or the authenticity of documents which will be incorporated into the record and will bind the conduct of the participants. The hearing examiner conducting the case may require oral stipulations to be reduced to writing and submitted to the hearing examiner. The hearing examiner assigned to conduct a hearing has the power to rule on the admissibility of evidence or testimony, but a participant may make objections to the rulings thereon. If the hearing examiner refuses to admit evidence or testimony, the participant seeking admission of same must make a proffer thereof and such proffer will be made a part of the record of the hearing. The hearing examiner may refer to the guidelines contained in the “Ohio Rules of Evidence” in making decisions on admissibility.

(B)

(1) Upon the conclusion of any hearing, the hearing examiner will prepare a written report of findings of fact, conclusions of law, and recommendations of departmental action to be taken in disposition of the hearing. Within five days of its completion, ODA will send by certified mail, return receipt requested, to the appellant or the appellant’s attorney, a copy of the hearing examiner’s report. The report will be considered to have been mailed as of the date appearing on United States postal service form 3800.

(2) An appellant may file written objections to the hearing examiner’s report. Any such objections must be received by ODA no later than ten days after the appellant receives the report. ODA may grant an extension of time to file objections if the appellant’s written request for an extension is received by ODA no later than ten days after the appellant’s receipt of the report. The date the appellant receives the hearing examiner’s report is the date indicated on the United States postal service form 3800. The director of ODA will consider timely written objections before approving, modifying, or disapproving the recommendations of the hearing examiner.

(C)

(1) Recommendations of the hearing examiner may be approved, modified, or disapproved by the director of ODA. The director of ODA may order additional testimony to be taken and permit the introduction of further documentary evidence. In those instances where the director of ODA modifies or disapproves the recommendations of the hearing examiner, the director of ODA will include the reasons therefore and incorporate said reasons into the final order of adjudication.

(2) After ODA’s director has entered an order approving, modifying, or disapproving the hearing examiner’s recommendation on the department’s journal of proceedings, ODA’s director will mail to the appellant and any attorney of record by certified mail, return receipt requested, a copy of the order and a statement of the time and method by which an appeal may be perfected.

(D)

(1) Any appellant other than a licensee against whom a final order of adjudication is entered, pursuant to this rule, may appeal that order to the Franklin County court of common pleas. Any licensee against whom a final order of adjudication is entered, pursuant to the this rule, may appeal that order to the court of common pleas of the county in which the place of business of the licensee is located or the county in which the licensee is a resident.

(2) Any party desiring an appeal pursuant to this rule must file an original notice of appeal with the department setting forth the order appealed from and the grounds of the party’s appeal. In order to be determined filed with ODA, the notice of appeal must be received by ODA, as evidenced by an ODA date and time stamp, no later than fifteen days after the mailing to the affected party, as evidenced by United States postal service form 3800, of the order to be appealed from. Appellant shall also file a copy of the notice of appeal with the court of common pleas no later that fifteen days after the mailing to the affected party, as evidenced by United States postal service form 3800, of the order to be appealed from.

Effective: 03/31/2006

R.C. 119.032 review dates: 10/15/2010

Promulgated Under: 119.03

Statutory Authority: 173.02, 173.391

Rule Amplifies: Chapter 119., 173.39, 173.391