Chapter 173-45 Long Term Care Consumer Guide

173-45-01 Introduction and definitions.

(A) Introduction: This chapter governs the Ohio long-term care consumer guide that ODA electronically publishes to provide the public with detailed information on long-term care facilities, including nursing homes, residential care facilities, skilled nursing facility units of hospitals, and county homes certified to receive medicare and medicaid reimbursement. The information includes a facility's size, location, services offered, customer satisfaction data, regulatory compliance performance data, and, in the case of nursing facilities, quality measures. The guide's information allows the public to compare two or more facilities. The guide may also include detailed information about other types of long-term care providers.

(B) Definitions for this chapter:

(1) "CMS" means "centers for medicare and medicaid services."

(2) "Facility" means a nursing facility or a residential care facility.

(3) "Guide" means the "Ohio long-term care consumer guide," which was created by ODA in accordance with section 173.46 of the Revised Code.

(4) "Medicaid" has the same meaning as in section 5111.01 of the Revised Code.

(5) "Medicare" means the program operated pursuant to Title XVIII of the "Social Security Act," 49 Stat. 620 (1936), 42 U.S.C. 301, as amended.

(6) "Nursing facility" means either:

(a) A facility, or a distinct part of a facility, that is certified a nursing facility or a skilled nursing facility for purposes of the medicare or medicaid program; or,

(b) A nursing home licensed under section 3721.02 of the Revised Code that is not certified as a nursing facility or skilled nursing facility.

(7) "ODA" means "the Ohio department of aging."

(8) "ODH" means "the Ohio department of health."

(9) "Quality measure" means an aspect of the physical or mental conditions of the residents of a nursing facility that is derived from the resident assessment instruments submitted by nursing facilities to CMS for the purposes of the medicare and medicaid programs.

(10) "Residential care facility" has the same meaning as in section 3721.01 of the Revised Code.

Replaces: 173-45-01

Effective: 08/30/2010
R.C. 119.032 review dates: 08/30/2015
Promulgated Under: 119.03
Statutory Authority: 173.02, 173.49
Rule Amplifies: 173.44 to 173.49
Prior Effective Dates: 09/07/2006

**173-45-02 [Rescinded] Consumer guide advisory council.**

Effective: 09/10/2012
R.C. 119.032 review dates: 06/15/2012
Promulgated Under: 119.03
Statutory Authority: 173.01, 173.02, 173.49
Rule Amplifies: 173.49
Prior Effective Dates: 09/07/2006, 08/30/2010

173-45-03 Consumer guide content.

(A) General information: ODA shall include the following information in the guide:

(1) A description of the guide;

(2) Disclaimers stating the limitations of the data included in the guide;

(3) A recommendation for each individual who is considering an admission into a long-term care facility to visit any facility that he or she is considering; and,

(4) Electronic links to other information on the internet about selecting long-term care facilities and long-term care service providers, including information maintained by pertinent government agencies and private organizations and the telephone numbers for those agencies and organizations.

(B) Facility-specific information: ODA shall include the following information in the guide to help the public compare and select long-term care providers:

(1) Each nursing facility's consumer satisfaction survey data, quality measures, and regulatory survey data;

(2) Each residential care facility's consumer satisfaction survey data and regulatory survey data; and,

(3) Other publicly-available information to help the public compare and select long-term care service providers, including, but not limited to, nursing home staffing information published by CMS.

Replaces: 173-45-03

Effective: 08/30/2010
R.C. 119.032 review dates: 08/30/2015
Promulgated Under: 119.03
Statutory Authority: 173.02, 173.49
Rule Amplifies: 173.46, 173.47, 173.49
Prior Effective Dates: 09/07/2006

173-45-04 Search queries.

(A) Nursing facilities: The search query page allows the public to search for nursing facilities using the following criteria:

(1) Geographic location by city, county, ZIP code, or radius;

(2) Source of payment accepted in addition to private sources:

(a) Medicaid;

(b) Medicare; and,

(3) Special care services:

(a) Alzheimer's disease/dementia care (secured or unsecured);

(b) Bariatric care;

(d) Dialysis;

(e) Formalized wellness programs;

(f) Hospice care;

(g) Pediatric care;

(h) Short-term stay for respite;

(i) Skin and wound care;

(j) Spinal cord injury care;

(k) Traumatic brain injury care; and,

(l) Ventilator care.

(4) A keyword search of nursing facility page information; and,

(5) Nursing facility name.

(B) Residential care facilities: The search query page allows the public to search for residential care facilities using the following criteria:

(1) Geographic location by city, county, ZIP code, or radius;

(2) Source of payment accepted in addition to private sources:

(a) Medicaid waiver for services; and,

(b) Residential state supplement.

(3) Services beyond basic personal care:

(a) Twenty-four hour licensed nursing;

(b) Advanced skin care;

(d) Assistance with self-administration of medication;

(e) Formalized wellness programs;

(f) Hospice care;

(g) Medication administration;

(h) Rehabilitative therapy (occupational, physical, speech);

(i) Short-term stay for respite;

(j) Special diets;

(k) Total incontinence care;

(l) Transfer assistance (e.g., bed to chair); and,

(m) Transportation (e.g., to appointments, outings).

(4) A keyword search of residential care facility page information; and,

(5) Residential care facility name.

Replaces: 173-45-04

Effective: 08/30/2010
R.C. 119.032 review dates: 08/30/2015
Promulgated Under: 119.03
Statutory Authority: 173.02, 173.49
Rule Amplifies: 173.46
Prior Effective Dates: 09/07/2006

173-45-05 Display of comparative information following the execution of a search query.

(A) Following a search query for long-term care providers, the guide shall present a list of all providers that meet the criteria specified in the search.

(B) For each provider listed, the guide shall present all comparative measures, electronic links to definitions and descriptions of the measures, and to further detailed information about the measure to the extent it is available to ODA. For each provider, the guide shall include the following information:

(1) The aggregate responses made by a facility's residents/consumers or their family members to all measures of customer satisfaction;

(2) In the case of nursing facilities, the facility's scores on the quality measures described in rule 173-45-07 of the Administrative Code;

(3) The date of the facility's most recent ODH survey, if applicable;

(4) The survey data provided pursuant to rule 173-45-08 of the Administrative Code;

(5) An electronic link for each provider on the list allowing the public to gain access to information on the provider maintained in accordance with rule 173-45-06 of the Administrative Code; and,

(6) Other comparative measures derived from data specified in Chapter 173-45 of the Administrative Code.

Replaces: 173-45-05

Effective: 08/30/2010
R.C. 119.032 review dates: 08/30/2015
Promulgated Under: 119.03
Statutory Authority: 173.02, 173.49
Rule Amplifies: 173.46
Prior Effective Dates: 09/07/2006

173-45-06 Facility page.

(A) Facility page content: The guide includes an individual facility page for each facility that presents the following specific comparative information, if available:

(1) The facility's name; the facility's telephone number, mailing address, county in which the facility is located, electronic mail address, web site address, photograph of the facility, and electronic link to a mapping feature that allows an individual to pinpoint the facility's location.

(2) The name of the facility's owner and operator (if different from the owner), and the telephone number and mailing address of the facility's owner and operator (if different from the owner).

(3) If a nursing facility, the facility's certification status regarding medicare and medicaid.

(4) The facility's private accreditation, with a link to the accrediting body's website.

(5) The number of beds in the facility; the number of single-occupancy and multiple-occupancy rooms in the facility; and, if a nursing facility, the number of beds in the facility that are certified for medicare or medicaid.

(6) Any waivers of space and occupancy requirements ODH allowed for the facility.

(7) A checklist describing the services available through the facility, as provided in rule 173-45-06.1 of the Administrative Code.

(8) The sources of payment the facility accepts and is eligible to receive.

(9) Any religious or fraternal affiliation.

(10) The facility's policies with regard to smoking, alcohol, pets, do not resuscitate orders, and advanced directives regarding nutrition, hydration, and life sustaining care.

(11) Specific information concerning staffing at the facility, as described in rule 173-45-06.2 of the Administrative Code.

(12) The facility's private pay rate with a link to facility-provided information that describes what that rate includes.

(13) The facility's occupancy rate with a link to facility-provided information describing specific bed availability.

(B) Updating content:

(1) Each facility shall provide the information under paragraph (A) of this rule to ODA, except as otherwise provided in this chapter.

(2) ODA shall provide each facility with access to its facility page and allow the facility to update the information on that page at any time. An automated date-stamping mechanism shall reflect the date of the most recent update.

(3) ODA may update a facility page with publicly-available information about the facility (e.g., bed count, website address, payment sources, etc.).

(C) Disclaimer: ODA shall include a disclaimer on the facility page that explains that the information appearing on each facility's facility page is provided and updated by the facility described on the page, and that the accuracy of the information appearing on a facility page is not routinely verified by ODA.

Replaces: 173-45-06

Effective: 08/30/2010
R.C. 119.032 review dates: 08/30/2015
Promulgated Under: 119.03
Statutory Authority: 173.02, 173.49
Rule Amplifies: 173.46
Prior Effective Dates: 09/07/2006

173-45-06.1 Information on services provided by facilities.

(A) Checklist items: ODA shall include a checklist in the guide that describes the services provided by, or in affiliation with, each facility listed in the guide.

(1) Services for nursing facility residents: The checklist of services in which a nursing facility may specialize includes:

(a) Alzheimer's disease/dementia care (secured or unsecured);

(b) Bariatric care;

(d) Formalized wellness programs;

(e) Hospice care;

(f) Intensive rehabilitation services;

(g) Pediatric care;

(h) Short-term stay for respite;

(i) Skin and wound care;

(j) Spinal cord injury care;

(k) Traumatic brain injury care; and,

(l) Ventilator care.

(2) Services for residential care facility residents: The checklist of services in which a residential care facility may specialize that is beyond basic personal care includes:

(a) Twenty-four hour licensed nursing;

(b) Advanced skin care;

(d) Assistance with self-administration of medication;

(e) Formalized wellness programs;

(f) Hospice care;

(g) Medication administration;

(h) Rehabilitative therapy (occupational, physical, speech);

(i) Short-term stay for respite;

(j) Special diets;

(k) Total incontinence care;

(l) Transfer assistance (e.g., bed to chair); and,

(m) Transportation (e.g., to appointments, outings).

(3) Services for nursing facility non-residents: The checklist of services available to non-residents in affiliation with the nursing facility includes:

(a) Adult day care;

(b) Assisted living on site;

(d) Home health care;

(e) Hospice services;

(f) Independent living housing on site;

(g) Outpatient therapy; and,

(h) Short-term stay for respite;

(i) Transportation (e.g., from homes to appointments); and,

(j) Any other community service the facility provides to non-residents that it specifically identifies.

(4) Services for residential care facility non-residents: The checklist of services available to non-residents in affiliation with the residential care facility includes:

(a) Adult day care;

(b) Home health care;

(d) Independent living housing on site;

(e) Outpatient therapies (occupational, physical, speech);

(f) Short-term stay for respite;

(g) Skilled nursing facility on site;

(h) Transportation (e.g., from homes to appointments); and,

(i) Any other community service the facility provides to non-residents that it specifically identifies.

(B) Check-off boxes: For the facility services specified in paragraphs (A)(1) and (A)(2) of this rule, ODA shall include check-off boxes to see if a facility provides specific services, and if the facility provides the services within a specific unit of the facility.

(C) Updating content: ODA shall obtain information regarding the services listed in paragraph (A) of this rule from the facilities themselves and may also obtain information from publicly-available sources, in accordance with paragraph (B) of rule 173-45-06 of the Administrative Code. Each facility may supplement the information required under paragraphs (A)(1) and (A)(2) of this rule in order to ensure an accurate description of services provided through the special care unit.

(D) Definition: As used in this rule, "affiliation" means a connection between a facility and a provider that are operated by the same entity, or that have entered into a contract whereby the provider provides services on the property of the facility or in close proximity to the facility.

Replaces: 173-45- 06.1

Effective: 08/30/2010
R.C. 119.032 review dates: 08/30/2015
Promulgated Under: 119.03
Statutory Authority: 173.02, 173.49
Rule Amplifies: 173.46
Prior Effective Dates: 09/07/2006

173-45-06.2 Facility staffing information.

(A) Nursing facilities: To the extent each facility provides the relevant information to ODA, the facility page for each nursing facility shall:

(1) Identify the medical director, the licensed nursing home administrator, and the director of nursing; and a narrative description of their qualifications. For the medical director, the licensed nursing home administrator, and the director of nursing, the narrative field shall include, at a minimum, the person's:

(a) Title (i.e., "medical director," "licensed nursing home administrator," or "director of nursing");

(b) Name;

(d) Board certifications or other professional affiliations;

(e) Years employed in the long-term care field; and,

(f) Years employed by the facility.

(2) List the number of hours of care per resident day for all registered nurses, licensed practical nurses, and state-tested nurse aides, expressed individually, along with the statewide average and range for facilities. ODA may obtain this information from a publicly-available source;

(3) List the number of hours per resident day for all activity staff, social workers, and therapy personnel along with the statewide average and range for facilities. ODA may obtain this information from a publicly-available source;

(4) List the percentage of agency pool staff used in providing care at the facility. ODA shall calculate the percentage as a percentage of the total care hours provided by the staff listed in paragraph (A)(2) of this rule;

(5) Indicate if the nursing facility makes permanent staff-to-unit/resident assignments; and,

(6) Display data showing staff retention.

(B) Residential care facilities: To the extent each facility provides the relevant information to ODA, the facility page for each residential care facility shall:

(1) Identify the administrator and director of clinical services, if applicable, and provide the facility with an opportunity to provide a narrative description of their qualifications. For the administrator and director of clinical services, the narrative field shall include, at a minimum, the person's:

(a) Title (i.e., "administrator" or "director of clinical services");

(b) Name;

(d) Board certifications or other professional affiliations;

(e) Years employed in the long-term care field; and, (f) Years employed by the facility.

(2) List the number of licensed nurses, direct care staff, and other staff typically on duty on day, evening, and night shifts, displayed separately for weekdays and weekends; and,

(3) Display a narrative description of the facility's staffing information.

(1) ODA shall provide each facility with an opportunity to submit the information that paragraphs (A) and (B) of this rule require. ODA shall collect the information in accordance with paragraph (B) of rule 173-45-06 of the Administrative Code. ODA shall use an automatic date-stamp mechanism to reflect the date of the facility's most recent update.

(2) ODA shall recalculate the statewide averages and ranges that paragraph (A) of this rule requires at least quarterly.

Replaces: 173-45- 06.2

Effective: 08/30/2010
R.C. 119.032 review dates: 08/30/2015
Promulgated Under: 119.03
Statutory Authority: 173.02, 173.49
Rule Amplifies: 173.46
Prior Effective Dates: 09/07/2006

173-45-07 Quality measures for nursing facilities.

(A) Definitions: ODA shall define each quality measure in the guide and indicate which quality measures are risk adjusted and which quality measures constitute sentinel health events.

(B) Quality measures: For each nursing facility for which data is available, ODA shall include in the guide the nursing facility's scores on each quality measure, as calculated by CMS, and the statewide average score on each quality measure, as calculated by CMS. ODA shall present the scores as percentages. This allows the public to compare scores between facilities and to statewide averages.

(C) Disclaimers: ODA shall include in the guide a disclaimer indicating that lower scores may not indicate that a nursing facility provides inadequate care. A nursing facility's scores on the quality measures serve as a flag to prompt further inquiry about the care and services the nursing facility provides. Therefore ODA shall also include in the guide an automatic link to the nursing facility's related survey findings and to a list of issues to consider when choosing a nursing facility.

(D) Updates: ODA shall update quarterly the quality measure data displayed in the guide by using the most recent CMS data.

Replaces: 173-45-07

Effective: 08/30/2010
R.C. 119.032 review dates: 08/30/2015
Promulgated Under: 119.03
Statutory Authority: 173.02, 173.49
Rule Amplifies: 173.46
Prior Effective Dates: 09/07/2006

173-45-08 Regulatory survey data.

(A) Data to incorporate: ODA shall incorporate data derived from ODH's most recent survey of each facility in Ohio into the guide to allow the public to compare a facility to other facilities and to the statewide average. In doing so, ODA shall incorporate the following data into the guide:

(1) The date of the facility's most recent survey;

(2) Any non-compliance with regulatory requirements related to a facility's provision of care and services that ODH cites on all surveys at least ten or more times in the previous calendar year;

(3) The number of the survey data tags ODH cited in the facility's most recent survey;

(4) The statewide average number of survey data tags ODH cited on a survey;

(5) The percentage of regulatory requirements each facility meets;

(6) The statewide average percentage of the survey data tags for which all facilities were found to be in compliance during the most recent surveys;

(7) The date each nursing facility achieved substantial compliance with medicare and medicaid certification requirements;

(8) A notation if ODH determined, at any time during the previous eighteen months, that a nursing facility provided substandard care to its residents;

(9) A notation if ODH determined, at any time during the previous eighteen months, that the care provided by a nursing facility placed its residents in immediate jeopardy or the care provided by the residential care facility placed its residents in real or present danger; and,

(10) The date ownership or management of the facility changed, if at all, since ODH's last survey of the facility.

(B) Links: ODA shall include the following links in the guide:

(1) A link that allows the public to view an explanation submitted to ODA by a facility whose ownership or management has changed since ODH's last survey of the significance of that change to its current survey results;

(2) A link that allows the public to view a current survey report, if available to ODA, and any plan of correction a nursing facility has filed with ODH that ODH has provided to ODA or that the facilities include in the guide;

(3) A link that allows the public to view the report of the most recent licensure inspection conducted by the department of heath for any facility that is licensed by ODH, but not certified for either medicare or medicaid, if the report is available to ODA; and,

(4) A link that provides facility visitation guidelines and suggestions.

(C) Peer grouping: In the guide, ODA shall group facilities by peer groups that correspond ODH's health districts. For each peer group, ODA shall display a peer-group average.

(D) Updates: ODA shall update, on a weekly basis, the data derived from ODH's surveys of nursing facilities and residential care facilities in Ohio, including licensure inspection reports for facilities not certified by medicare or medicaid, to the extent the updated information is available to ODA, and except as otherwise provided in this rule.

(E) Data retention: ODA shall retain four years of regulatory data for each facility in the guide.

(F) Disclaimer: ODA shall display the following disclaimer in the guide along with the display of data derived from surveys accompanied by ODH: "Surveys of facilities are conducted at periodic intervals. Conditions at a facility can change significantly between surveys and consumers considering admission are encouraged to visit any facility they are considering."

(G) Definitions: As used in this rule, "deficiency," "immediate jeopardy," "standard survey," and "substandard care" have the same meanings as in section 5111.35 of the Revised Code.

Replaces: 173-45-08

Effective: 08/30/2010
R.C. 119.032 review dates: 08/30/2015
Promulgated Under: 119.03
Statutory Authority: 173.02, 173.49
Rule Amplifies: 173.46
Prior Effective Dates: 09/07/2006

173-45-09 Fees.

(A) Consumer guide fee:

(1) ODA shall collect an annual consumer guide fee of six hundred fifty dollars from each nursing facility, and three hundred dollars from each residential care facility in Ohio, for the publication of the guide.

(2) Each facility shall pay the consumer guide fee in full to ODA in fewer than thirty days after the date on which ODA mailed the billing statement to the facility.

(3) ODA shall certify to the Ohio attorney general the amount of any payment it does not receive from a facility in fewer than forty-five days after the date on which ODA mailed the billing statement to the facility.

(B) Billing statement: One time, every year, ODA shall bill each facility for the consumer guide fee. In each billing statement, ODA shall include:

(1) A description of the time period covered by the billing statement;

(2) A statement indicating that the facility shall pay ODA in fewer than thirty days after the date on which ODA mailed the billing statement to the facility;

(3) A statement indicating that the facility shall make the payment in the form of a check or money order payable to the "Long-Term Care Consumer Guide Fund";

(4) The address to which the facility shall mail the payment; and,

(5) A statement indicating that ODA may certify to the office of the attorney general for collection any fee that is not paid in fewer than forty-five days after the date on which ODA mailed the billing statement to the facility.

Effective: 09/29/2011
R.C. 119.032 review dates: 07/13/2011 and 09/29/2016
Promulgated Under: 119.03
Statutory Authority: 173.01, 173.02, 173.49
Rule Amplifies: 173.48
Prior Effective Dates: 09/07/2006, 08/30/2010

173-45-10 Consumer satisfaction surveys.

(A) Definitions for this rule:

(1) "Consumer satisfaction survey" means the customer satisfaction survey required under section 173.47 of the Revised Code.

(2) "Domain" means a subset of a survey question identified by the survey administrator as an area of interest to long-term care facility consumers.

(3) "Survey administrator" means a designee of ODA responsible for implementing a consumer satisfaction survey.

(B) Survey information: The guide shall include the following information that is derived each year from an annual consumer satisfaction survey of each long-term care facility conducted by ODA or a survey administrator pursuant to section 173.47 of the Revised Code:

(1) A description of the survey and of the calculation methods used;

(2) Item scores for each facility, which are calculated by averaging the numerical response for each item on all returned surveys pertaining to a particular facility. Each survey administrator shall:

(a) Determine an item score by assigning a number in the range of 0 to 100;

(b) Exclude a response from the calculation of an item score whenever the respondent did not respond to an item or when the respondent believes the item is not applicable, which is indicated by responses such as "I don't know" or "This does not apply to me" ; and,

(3) Statewide item scores for all items of the survey, calculated by averaging all item scores for all facilities for which enough surveys were returned to be within a ten per cent margin of error;

(4) Domain scores for each facility, which are calculated by averaging the facility item scores in a domain for all returned surveys with responses to at least all but two items in that domain;

(5) Statewide domain scores, which are calculated as the average of all facility domain scores;

(6) Facility response rate for a satisfaction survey of a sample of consumers conducted by mail, which is calculated by dividing the number of surveys returned by the number of surveys issued to consumers.

(a) The number of surveys issued to facility consumers should reflect:

(i) A generally accepted response rate for similar surveys; and,

(ii) The most recent available estimate of the occupancy of that facility.

(b) A survey audit form will be used to confirm the occupancy of a facility and the number of surveys that were distributed to the consumers of that facility.

(7) A facility response rate for a satisfaction survey of a whole population of a facility's consumers is calculated by dividing the number of surveys returned by the number of consumers surveyed.

(8) A statewide response rate, which is calculated as the average of all facility response rates;

(9) An overall facility satisfaction score, which is calculated by averaging all item scores on all returned surveys pertaining to a particular facility. If the survey administrator determines that there are not enough returned surveys from that facility to be within a ten per cent margin of error, then no overall satisfaction survey score will be displayed;

(10) A statewide satisfaction score, which is calculated by averaging all overall facility satisfaction scores for facilities for which enough surveys were returned to be within a ten per cent margin of error;

(11) The total number of surveys returned statewide;

(12) Statewide high and low item scores, which are obtained by identifying the highest and lowest item score among all facilities that have enough returned surveys to be within a ten per cent margin of error; and,

(13) Statewide high and low domain scores, which are obtained by identifying the highest and lowest domain score among all facilities that have enough returned surveys to be within a ten per cent margin of error.

(C) Confidentiality: To protect the privacy of the survey's respondents, the long-term care consumer guide shall not report the results from any facility for which no more than two surveys were returned.

(D) Invalid surveys: An invalid survey includes a survey that is completed by a person other than a consumer (e.g., completed by a member of the facility's staff) or involves surveying the wrong population (e.g., surveying the resident instead of the family or vice versa). If ODA's review of any survey indicates that the survey is invalid, ODA may take the following actions:

(1) Remove invalid scores from the calculation of the overall satisfaction scores;

(2) Remove the facility's scores from the long-term care consumer guide and any published reports of the survey results; or,

(3) Refer the facility with invalid scores to the appropriate investigatory agency.

(E) Margin of error: The number of completed surveys considered necessary for a facility to not exceed a ten per cent margin of error is based on the size of the facility and shall be governed by table 1 to this rule.

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(F) Quality assurance: Any survey administrator conducting a consumer satisfaction survey on behalf of ODA shall take quality-assurance measures such as inter-rater reliability testing.

Effective: 08/30/2010
R.C. 119.032 review dates: 06/15/2010 and 08/30/2015
Promulgated Under: 119.03
Statutory Authority: 173.02, 173.49
Rule Amplifies: 173.46
Prior Effective Dates: 7/1/2007, 12/13/2009