5101:3-51-03 HOME choice ("Helping Ohioans Move, Expanding Choice") demonstration program: conditions of participation for providers.

This rule sets forth the conditions of participation for providers furnishing demonstration, supplemental and qualified services to HOME choice demonstration program participants.

(A) Demonstration and supplemental services.

(1) All providers of demonstration and supplemental services to participants enrolled on the HOME choice demonstration program shall:

(a) Meet all requirements in the applicable provider service specifications set forth in rule 5101:3-51-04 of the Administrative Code, and provider enrollment criteria set forth in rule 5101:3-51-05 of the Administrative Code.

(b) As applicable, comply with the criminal records check requirements set forth in:

(i) Rules 5101:3-45-07 and 5101:3-45-08 of the Administrative Code if the provider is approved by ODJFS;

(ii) Rule 173-41-01 of the Administrative Code if the provider is certified by the Ohio department of aging(ODA);

(iii) Rule 5123:2-1-05 or 5123:2-1-05.1 of the Administrative Code, as applicable, if the provider is certified by the Ohio department of developmental disabilities (DODD); or

(iv) Rules 5122-30-03 and 5122-30-04 of the Administrative Code, or rule 5122-26-06 of the Administrative Code, as applicable, if the provider is certified by the Ohio department of mental health(ODMH).

(c) Attend ODJFS-sponsored HOME choice demonstration program provider training sessions.

(d) Assure participants receive HOME choice demonstration program services in accordance with their all services plan, service plan, individual service plan (ISP) or non-waiver HOME choice demonstration service plan, as appropriate.

(e) Upon request and within the timeframe prescribed in the request, provide all information to the state agency administering the HCBS waiver on which the HOME choice demonstration program participant is enrolled, or ODJFS if the HOME choice demonstration program participant is not enrolled on an HCBS waiver, and to CMS and the entity under contract with ODJFS to provide HOME choice financial management services (FMS).

(f) Comply with all federal and state privacy laws, including the health insurance portability and accountability act (HIPAA) regulations set forth in 45 C.F.R. parts 160, 162 and 164 (as in effect on the effective date of this rule), and the medicaid confidentiality regulations as set forth in 42 C.F.R. 421.300 to 42 C.F.R. 306 (as in effect on the effective date of this rule), and sections 5101.26 to 5101.28 of the Revised Code.

(g) Maintain and retain all required documentation, including but not limited to, documentation of tasks performed or not performed, arrival and departure times, and the dated signatures of the provider and the HOME choice participant or authorized representative verifying the service delivery upon completion of service delivery. Nothing shall prohibit the collection and maintenance of documentation through technology-based systems. The participant's or authorized representative's signature of choice shall be documented on the all services plan, service plan, ISP or non-waiver HOME choice demonstration service plan, as appropriate. It shall include, but not be limited to, any of the following: a handwritten signature, initials, a stamp or mark, or an electronic signature.

(h) Retain all records of service delivery and billing for a period of six years after the date of receipt of the payment based upon those records, or until any initiated audit is completed, whichever is longer.

(i) Cooperate with ODJFS and the FMS provider under contract with ODJFS during all provider monitoring activities by being available to answer questions during reviews, and by assuring the availability and confidentiality of participant information and other documents that may be requested as part of provider monitoring activities.

(j) Notify the case manager (CM) or the service and support administrator (SSA) , as appropriate, within twenty-four hours and provide written documentation within five calendar days when the provider is aware of issues that may affect service delivery to the participant. Issues may include, but are not limited to the following:

(i) The participant consistently declines services.

(ii) The participant moves to another residential address.

(iii) There are changes in the physical, mental and/or emotional status of the participant.

(iv) There are changes in environmental conditions affecting the participant.

(v) The participant's caregiver status has changed.

(vi) The participant no longer requires medically necessary services as defined in rule 5101:3-1-01 of the Administrative Code.

(vii) A referral has been made to a protective service agency on the participant's behalf, or an active case is pending.

(viii) The participant is behaving inappropriately toward the provider.

(ix) The participant is consistently noncompliant with physician orders, or is noncompliant with physician orders in a manner that may jeopardize the participant's health and welfare.

(x) The participant's requests consistently conflict with the participant's approved all services plan, service plan, ISP or non-waiver HOME choice demonstration service plan.

(xi) The participant has been hospitalized or visited the emergency room.

(xii) The participant has been placed in an institutional setting.

(xiii) Abuse or neglect of the participant is suspected.

(xiv) The participant is experiencing other health and welfare issues.

(k) Make arrangements to accept all mail sent by ODJFS, ODA or DODD, as appropriate, or its designee, or the FMS, including but not limited to certified mail.

(l) Submit written notification to the participant and the FMS provider under contract with ODJFS, and the CM, SSA or ODJFS HOME choice demonstration program care coordinator, as appropriate, at least thirty calendar days prior to the anticipated last date of the service if the provider is terminating the provision of HOME choice demonstration program services to the participant. Exceptions to the thirty-day advance notification requirement are set forth in paragraphs (A)(1)(l)(i) to (A)(1)(l)(iii) of this rule, and are subject to oral notification within twenty-four hours of the last date of service, and written notification within five calendar days of the last date of service.

(i) Thirty-day advance notification is not required when the participant:

(a)Has been hospitalized for at least three days;

(b)Has been placed in an institutional setting;

(c)Has been incarcerated;

(d)Has died;

(e)Is terminating the services of the provider; or

(f)Is no longer eligible for medicaid.

(ii) Thirty-day advance notification is not required when the provider is furnishing services in an environment that places the provider in imminent danger.

(iii) The thirty-day advance notification may be waived for the provider by the CM, SSA or ODJFS HOME choice demonstration program care coordinator, as appropriate, on a case-by-case basis.

(iv) Advanced notification of service termination is not required if the participant is terminating the services of the provider.

(2) Providers furnishing HOME choice demonstration program services to participants enrolled on an ODA-administered waiver, providers shall comply with the consumer incident reporting requirements set forth in rule 173-39-02 of the Administrative Code.

(3) Providers furnishing HOME choice demonstration program services to participants enrolled on a DODD-administered waiver, or who are not enrolled on an HCBS waiver but are eligible for services through a county board of developmental disabilities (CBDD), providers shall comply with the major unusual incident requirements set forth in rule 5123:2-17-02 of the Administrative Code.

(4) Providers furnishing HOME choice demonstration program services to participants enrolled on an ODJFS-administered waiver, providers shall comply with the consumer incident reporting requirements set forth in rule 5101:3-45-05 of the Administrative Code.

(5) Providers furnishing HOME choice demonstration program services to participants who are not enrolled on an HCBS waiver, or who are not eligible for services through a CBDD, providers shall comply with the consumer incident reporting requirements set forth in rule 5101:3-45-05 of the Administrative Code.

(6) Agency providers shall pay applicable federal, state and local income and employment taxes in compliance with federal, state and local requirements.

(7) Non-agency providers shall pay applicable federal, state and local income and employment taxes in compliance with federal, state and local requirements. On an annual basis, non-agency providers must also submit an ODJFS-approved affidavit stating that they paid the applicable federal, state and local income and employment taxes.

(8) All providers shall deliver services professionally, respectfully, and legally, and shall not:

(a) Consume the participant's food and/or drink without the participant's offer and consent.

(b) Bring children, pets, friends, relatives, other HOME choice participants or anyone else to the participant's place of residence.

(c) Take the participant to the provider's place of residence.

(d) Use illegal drugs or chemical substances.

(e) Consume alcohol or take medications that may in any way impair the provider in the delivery of services to the participant.

(f) Provide services to the participant when the provider is medically, physically or emotionally unfit.

(g) Discuss religion or politics with the participant and others present in the care setting.

(h) Discuss personal issues with the participant and others in the care setting.

(i) Accept, obtain or attempt to obtain money or anything of value, including gifts or tips from the participant, household members and family members of the participant.

(j) Borrow money, credit cards or other items from the participant, household members and family members of the participant.

(k) Be designated on a financial account or credit card held by the participant, household members and family members of the participant.

(l) Use the property of the participant, household members and family members for personal gain.

(m) Lend or give the participant, household members and family members money or other personal items.

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

(o) Engage in behavior that causes or may cause physical, verbal, mental or emotional distress or abuse to the participant.

(p) Engage in behavior that may reasonably be interpreted as inappropriate involvement in the participant's personal relationships.

(q) Leave the home for a purpose not related to the provision of services without notifying the agency supervisor, the participant's emergency contact person, identified caregiver and/or CM, SSA or ODJFS HOME choice demonstration program care coordinator, as appropriate.

(r) Use the participant's motor vehicle, unless solely for the benefit of the participant.

(s) Engage 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 communications.

(iii) Engaging in non-care-related socialization with individuals other than the participant.

(iv) Providing care to individuals other than the participant.

(v) Smoking without the consent of the participant.

(vi) Sleeping.

(t) Sell to, or purchase from the participant, products or personal items unless the provider is a family member and the transaction occurs when the provider is not furnishing HOME choice services.

(u) Engage in behavior that takes advantage of or manipulates the participant, the participant's authorized representative or family, or the HOME choice demonstration program rules set forth in Chapter 5101:3-51 of the Administrative Code resulting in an advantage for personal gain.

(v) Use information about the participant or the participant's family for personal gain.

(9) HOME choice demonstration program providers shall not be designated to serve or make decisions for the participant in any capacity involving a declaration for mental health, durable power of attorney, financial power of attorney or guardianship pursuant to court order, or a representative payee. For the purpose of this rule, "representative payee" means a parent or spouse who the participant designates to receive and manage payments that would otherwise be made directly to the participant.

(B) Qualified services.

(1) Providers furnishing qualified services to HOME choice demonstration program participants enrolled on an HCBS waiver administered by DODD shall meet the assurances set forth in rules 5123:2-9-08 and 5123:2-2-01 of the Administrative Code.

(2) Providers furnishing qualified services to HOME choice demonstration program participants enrolled on an HCBS waiver administered by ODA shall meet the conditions of participation established for ODA-administered waivers set forth in rule 173-39-02 of the Administrative Code.

(3) Providers furnishing qualified services to HOME choice demonstration program participants enrolled on an HCBS waiver administered by ODJFS shall meet the conditions of participation established for ODJFS-administered waivers as set forth in rule 5101:3-45-10 of the Administrative Code.

(4) Providers furnishing qualified services to HOME choice demonstration program participants who are not enrolled on an HCBS waiver shall meet the same conditions of participation set forth for ODJFS-administered waiver service providers as described in rule 5101:3-45-10 of the Administrative Code.

(C) Failure to meet the requirements set forth in this rule may result in termination of the HOME choice demonstration program provider's provider agreement in accordance with rule 5101:3-1-17.6 of the Administrative Code. The provider shall be entitled to a hearing under Chapter 119. of the Revised Code in accordance with Chapter 5101:6-50 of the Administrative Code.

Effective: 09/09/2010
R.C. 119.032 review dates: 07/01/2013
Promulgated Under: 119.03
Statutory Authority: 5111.02 , 5111.85
Rule Amplifies: 5111.01 , 5111.02 , 5111.85 , Section 309.30.90 of Am. Sub. H.B. 1, 128th G.A.
Prior Effective Dates: 7/1/2008