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 must:

(1) Meet the service specifications outlined in rules 173-39-02.1 to 173-39-02.17 of the Administrative Code for each of the services for which the provider wishes to be certified.

(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 and bill for only those services specified in the consumer’s care plan that are provided and documented in accordance with the requirements set forth in Chapter 173-39. of the Administrative Code.

(a) At ODA’s request, the provider must submit written documentation for each unit of service billed.

(b) The provider must agree to give ODA access to the provider’s fiscal records at any time to ensure compliance with this requirement.

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

(5) 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.

(6) Comply with criminal background investigation requirements set forth in rule 173-41-01 of the Administrative Code.

(7) 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.

(8) 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 may not be used or disclosed for any purpose not directly associated with the provision of services.

(9) 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.

(10) 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.

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

(12) 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 must follow to file a claim.

(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. 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.

(14) Provide written notification to the consumer and ODA’s designee at least thirty business days prior to 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 risk; and,

(15) 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.

(16) )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.

(17) 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 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 with a five per cent or more ownership;

(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 must 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 criminal background investigation requirements set forth in rule 173-41-01 of the Administrative Code.

(5) Meet the service specifications outlined in rules 173-39-02.1 to 173-39-02.17 of the Administrative Code for each of the services for which the provider wishes to be certified.

(6) At the consumer’s request, participate in an interview with the consumer prior to service initiation.

(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 information may not be used or disclosed 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 through 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 it’s 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.

(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;

(15) During the provision of authorized services, consumer-directed individual providers may 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;

(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;

(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 to whom the staff provide services.

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

(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 must:

(a) Have a written statement of policies and directives, or 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 for three years 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 or until the audit is concluded and all issues are resolved.

(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 must meet the service specifications outlined in rules 173-39-02.16 and 173-39-02.17 of the Administrative Code and must.

(a) Comply with the criminal background investigation requirements set forth in rule 173-41-01 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 must 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 prior to 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 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 must deliver and bill for only those services authorized by ODA’s designee and documented in accordance with the requirements set forth in rules 173-39-02.16 and 173-39-02.17 of the Administrative Code.

(a) At ODA’s request, the provider must submit written documentation for each unit of service billed.

(b) The provider must agree to give ODA access to the provider’s fiscal records that are related to the provision of the authorized service to ensure compliance with this requirement.

(5) 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) through (B)(17) of this rule, ODA-certified long-term care non-agency providers must 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: 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

173-39-02.1 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 Transportation service.

(A) Transportation is a service designed to enable a consumer to gain access to medical appointments specified by the consumer’s plan of care, when medical transportation is not otherwise available or funded by state plan medicaid or any other source. Whenever possible, consumers must use family, neighbors, friends, or community agencies to provide this service without charge.

(B) A unit of transportation service is a one-way trip or a round trip. The unit rate is the price quoted by the provider and approved by the consumer’s case manager prior to the provision of the service. The provider must bill for the original price quote submitted to and approved by the case manager unless a cost revision is authorized by the case manager prior to delivering the service.

(1) The provider must be either an ODA-certified long-term care agency or an ODA-certified long-term care non-agency provider.

(2) The provider must furnish evidence of a service back-up plan to provide service when a vehicle becomes disabled.

(3) All vehicle operators and owners must maintain proof of financial responsibility as required in section 4509.101 of the Revised Code.

(4) A copy of the certificate of insurance and the vehicle registration must be maintained in each vehicle.

(5) The provider must have a written plan for regularly scheduled maintenance and safety inspection for the vehicles in service and must document compliance with the plan.

(6) The provider must assure that each vehicle is inspected every twelve months by a certified mechanic, the highway patrol safety inspection unit, or the Ohio medical transportation board, and is certified to be safe. The inspections must include the elements listed in appendix A of this rule.

(7) Vehicles equipped for transporting a passenger who remains in a wheelchair must be equipped with permanently installed floor wheelchair restraints for each wheelchair position used. Providers must inspect their vehicles for compliance with the items listed in appendix B on a daily basis.

(8) The provider must document and maintain a record of each service related consumer contact and each service delivered, including date of contact, type of contact and name(s) of person(s) having contact with the consumer. The provider must maintain documentation for each episode of service that includes a description of the service provided, the date and time of consumer pick-up and delivery, the name and signature of the driver, and name and signature of the consumer to whom transportation services were provided.

(D) Providers must assure that drivers:

(1) Maintain a safety checklist that includes items listed in appendix C of this rule that must be completed by the driver prior to transporting consumer(s) and/or travel attendant(s);

(2) Maintain service logs or trip sheets daily that include the date of service, the consumer’s name, the pick-up point and destination point for each consumer, and the driver’s and consumer’s signatures. An exception to the requirement for consumer signature is allowed for ADS transportation providers who may use the consumer’s signature for attendance in ADS services that includes transportation to and from ADS; and,

(3) Assist in transfer of the consumer, as necessary, safely from the consumer’s door to the vehicle and from the vehicle to the entrance of the destination point. The provider must perform the same transfer assist service when transporting the consumer back to the consumer’s residence;

(E) The provider must assure and document that prior to transporting consumers, each driver meets all of the following requirements:

(1) A current and valid driver’s license with fewer than six points against the driver issued under Chapters 4506. or 4507. of the Revised Code, or their equivalent, if the operator is a resident of another state;

(2) A valid copy of a signed statement from a licensed physician acting within the scope of the physician’s practice declaring that the applicant does not have a medical or physical condition, including vision impairment, that cannot be corrected and could interfere with safe driving, passenger assistance, and emergency treatment activity, or could jeopardize the health and welfare of a client or the general public.

(3) The results of a chemical test or tests of the driver’s blood, breath, or urine conducted at a hospital or other laboratory licensed by the Ohio Department of Health for the purpose of determining the alcohol or drug content of the applicant’s blood, breath and/or urine;

(4) A certificate of completion of a training course in first aid and cardio-pulmonary resuscitation (CPR) offered by the American red cross, the American heart association, the national safety council, or an equivalent course approved by the Ohio department of aging;

(5) A course of instruction in consumer assistance and transfer techniques, lift operation and how to properly secure a wheelchair, if applicable, prior to transporting consumers;

(6) At least two years of licensed driving experience; and,

(7) The driver has the ability to understand written and oral instructions and document services delivered.

(F)

(1) The provider must assure and document that each driver obtains the following:

(a) A certificate of completion of an introductory defensive driving course sponsored or endorsed by the national safety council or the Ohio department of transportation, and completion of a four hour refresher course every three years thereafter.

(b) A certificate of completion of an introductory training course approved by ODA, addressing the transport of older persons and people with disabilities, and a refresher course every three years thereafter, both of which must include:

(i) Sensitivity to aging training;

(ii) An overview of diseases and functional factors commonly affecting older adults;

(iii) Environmental considerations affecting passengers;

(iv) Instruction in consumer assistance and transfer techniques;

(v) Training on the management of wheelchairs, and how to properly secure a wheelchair;

(vi) The inspection and operation of wheelchair lifts and other assistive equipment; and,

(vii) Emergency procedures.

(2) The certificates of completion to which this rule applies must be received as follows:

(a) For all new drivers, the certificates of completion must be for training received by the driver within the first six months following the date on which the driver is hired or retained by the provider.

(b) For all drivers hired or retained by a provider prior to the effective date of this rule, the certificates of completion must be obtained for training received in the first six months following the effective date of this rule, unless the provider can verify that the driver successfully completed the required training at some time within the three year period immediately preceding the adoption of this rule. Drivers who successfully completed one or both of the introductory training courses required by this rule within the three years immediately preceding the adoption of this rule shall be deemed to have complied with the requirement for the introductory training course(s) for which the training was received, and will only be required to complete the required refresher course(s) every three years after the date the certificate(s) of completion was received.

(G) ODA and its designee must deem those vehicles licensed as ambulettes by the Ohio medical transportation board as complying with paragraph (C) of this rule.

(H) ODA and its designee must deem those drivers employed as drivers of urban or rural transit systems as meeting the requirements in paragraph (E) of this rule.

APPENDIX A

Required Annual Inspection Elements for vehicles equipped to concurrently transport five or more participants.

A. Seating

1. All seats must be securely fastened to the floor.

2. No broken tubing or protruding pieces of metal should be around seats.

B. Defrosters & Heaters

1. Must operate as designed.

2. Heater cores must be clean and free of leaks and obstructions to the flow of air.

3. Hoses must not have cracks or leaks and must otherwise be in good condition.

4. Fan guards must be metal or plastic.

C. Windshield Wipers/Washers

1. Must operate as designed.

2. Wiper blades in the vehicle operator’s field of vision must be clean.

3. Wiper blades must not be brittle or badly worn.

D. The Floor Must Be Metal and Intact Without Holes

E. Mirrors

1. Must have at least one rear view interior mirror that is properly secured and in proper placement.

2. Must have at least one mirror on each side of the vehicle that is properly secured and in proper placement.

3.Prismatic lens must be properly installed.

4. All mirrors must enable vehicle operators to see a clean image (i.e., without cloudiness, cracks, or other obstacles on the mirror to interfere with reflection).

F. Emergency Equipment

1. Three red reflectors must be stored in the vehicle.

2. The vehicle must have a five pound dry chemical fire extinguisher with the minimum rating outlined in section 20.b.c. of the Ohio fire code and based on section 10 of the National Fire Protection Association. The fire extinguishers must be securely mounted near the vehicle operator for easy access.

3. The vehicle must be equipped with a first aid kit.

G. Brakes

1. Properly located and free of crimps, rust, breaks in integrity, and not in contact with inappropriate vehicle components.

2. Tail exhaust pipes are properly secured to prevent dropping on brake lines.

3. Vehicles using vacuum-assisted brakes: wheel cylinders, master cylinders, hydrovac, and hose connections must be free of fluid leaks.

4. Vehicles using air brakes: reservoirs, chambers, valves, connections, and lines must be