The purpose of this rule is to set forth the provisions for claiming to receive reimbursement for the provision of services by home visiting contractors in the help me grow (HMG) home visiting program.
(A) If home visiting services are reimbursable as targeted case management, TCM services shall be reimbursed in accordance with rules adopted by the department of job and family services.
(B) Covered services provided by home visiting contractors are reimbursable when completed by an eligible family's assigned home visitor. The reimbursable services include:
(1) Preparing materials and information for a completed home visit.
(2) Conducting comprehensive assessment, including the administration of screening and assessment tools, and monitoring and follow-up, with families during a home visit, in accordance with Appendix 6.1 - A to rule 3701-8-06.1 of the Administrative Code.
(3) Developing and managing a family plan during home visits, when goals on the family plan are related to the program goals, in accordance with rule 3701-8-06 of the Administrative Code.
(4) Parenting education provided to families during home visits.
(5) Referrals made by home visitors to link families to services that address identified goals or needs in the family plan or record. Following-up by home visitors for referrals made on behalf of families with the entities who received the referrals in order to determine and document a referral outcome.
(6) Traveling to and from the home visit, when the home visit is successfully completed.
(7) Documenting related to the services provided during a completed home visit.
(8) Data entry into the statewide data system for HMG related services provided.
(C) The rate for reimbursement for home visiting activities shall be thirteen dollars and fifty cents per unit when services are delivered by a licensed registered nurse or licensed social worker who is credentialed as HMG home visitors and eleven dollars and fifty cents per unit when services are delivered by non-licensed, credentialed HMG home visitors.
(D) Contractors may be reimbursed for up to two hundred fifty-one units of covered services to an eligible individual over a one year period of time. Reimbursement exceeding two hundred fifty-one units of covered services provided to a eligible individual over a one year period of time must be prior approved by the department. In addition, the following must be prior approved by the department:
(1) Preparation time covered in paragraph (B)(1) of this rule that exceeds two units for a home visit of a eligible individual.
(2) Travel time covered in paragraph (B)(6) of this rule that exceed six units for a home visit of a eligible individual.
(3) Documentation time covered in paragraph (B)(7) of this rule for a home visit that exceeds three units for a eligible individual.
(4) Data entry time covered in paragraph (B)(8) of this rule for a home visit that exceeds three units for a eligible individual.
(E) Contractors may be reimbursed for up to eight units of time spent on activities in paragraph (B)(1), (B)(2), (B)(6), (B)(7), or (B)(8) of this rule for a home visit that that was conducted which did not result in an individual being eligible for HMG home visiting.
(F) Activities which are not reimbursable in HMG home visiting include, but are not limited to:
(1) Time spent in training.
(2) Time spent in supervision.
(3) Time spent on activities for a home visit that was not successfully completed.
(4) Time spent on administrative duties including completing payroll.
(5) Vacation leave, sick leave or other related benefits.
(G) Documentation for the provision of each service shall be maintained for purposes of supporting the payment, delivery of the service, and to provide an audit trail. Documentation shall include:
(1) The activity that was provided;
(2) The date inclusive of day, month, and year that the activity was provided;
(3) The first and last name of the individual for whom the activity was provided;
(4) The duration in minutes or time in and time out of the activity provided; and
(5) The signature or initials of the person delivering the service on each entry of service delivery.
(H) Home visiting contractors who meet the following criteria shall be reimbursed for home visiting services:
(1) Contractors shall be reimbursed for home visiting services in units of fifteen minutes. Minutes of service provided to an eligible individual will be aggregated by covered services in accordance with paragraph (B) of this rule, within each calendar day. The number of units of covered services is the total minutes divided by fifteen plus one additional unit if the remaining number of minutes is at least eight minutes, for each covered service.
(2) The contractor is a qualified home visiting contractor in accordance with rule 3701-8-02 of the Administrative Code.
(3) The home visitor shall meet all of the requirements for education and training, and be credentialed as a HMG home visitor in accordance with rule 3701-8-03 of the Administrative Code before serving an eligible individual in HMG home visiting.
(4) The data listed in paragraph (D) of this rule are entered into the statewide data system for HMG and are approved by the contractor.
(5) The service for which reimbursement is sought is allowable under paragraph (B) of this rule and is identified in the family plan or record.
(6) Contractor shall accept reimbursement for all reimbursable services as payment in full for the services provided.
(I) Records necessary to fully disclose the extent of services provided and costs associated with these services shall be maintained for a period of six years from the date of receipt of payment based upon those records or until any initiated audit, review, investigation or other activities are completed and appropriately resolved, whichever is longer. Records shall be made available upon request to the Ohio department of health or designee. Failure to supply requested records, documentation and/or information may result in no payment for outstanding services or other legal recourse.
(J) The Ohio department of health, or a designee, may conduct audits, reviews, investigations, or any other activities necessary to assure a home visiting contractor, its sub grantee or subcontractor are compliant with federal and state requirements. Based on the results of an audit, review, investigation or other activities, the Ohio department of health may seek legal recourse, including but not limited to, recoupment of funding related to over payments, misuse, fraud waste or abuse or noncompliance with federal or state requirements from the home visiting contractor.