5101:3-51-05 HOME choice ("Helping Ohioans Move, Expanding Choice") demonstration program: process for enrolling service providers.

(A) All providers of HOME choice demonstration program services must meet the conditions of participation set forth in rule 5101:3-51-03 of the Administrative Code, as appropriate, and the provider requirements and specifications set forth in rule 5101:3-51-04 of the Administrative Code prior to furnishing services to a consumer.

(B) A prospective provider intending to furnish HOME choice demonstration program services to a participant enrolled on a home and community-based services (HCBS) waiver administered by ODJFS must meet the requirements set forth in this paragraph. The provider must submit a signed statement affirming that the provider received and read all rules of the Administrative Code governing the HOME choice demonstration program and the ODJFS-administered waiver on which the participant is enrolled.

(1) For qualified services, the provider shall:

(a) Be a provider as approved by ODJFS in accordance with rule 5101:3-45-04 of the Administrative Code, and the ODJFS-administered waiver service provider specifications set forth in rule 5101:3-46-04 , 5101:3-47-04 or 5101:3-50-04 of the Administrative Code, as appropriate, for the specific waiver service to be furnished.

(b) Be a medicaid state plan service provider as approved by ODJFS in accordance with division 5101:3 of the Administrative Code, as appropriate for the specific medicaid state plan service to be furnished.

(2) For demonstration services, the provider shall:

(a) Be a medicaid provider of nutritional consultation services as certified by the Ohio department of developmental disabilities (DODD) in accordance with rule 5123:2-2-01 of the Administrative Code, or an ODA-certified long term care provider of nutritional consultation services in accordance with rule 173-39-02.10 of the Administrative Code, if the provider is furnishing nutritional consultation as that service is set forth in rule 5101:3-51-04 of the Administrative Code.

(b) Be a medicaid provider of social work counseling services as certified by DODD in accordance with rule 5123:2-2-01 of the Administrative Code, or as certified by ODMH in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code, or be an ODA-certified long term care provider of social work counseling services in accordance with rule 173-39-02.12 of the Administrative Code, if the provider is furnishing social work counseling as that service is set forth in rule 5101:3-51-04 of the Administrative Code.

(c) Be a provider of community support coaching as approved by ODJFS in accordance with rule 5101:3-45-04 of the Administrative Code, or a community mental health center certified by ODMH in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code, if the provider is furnishing community support coaching as that service is set forth in rule 5101:3-51-04 of the Administrative Code.

(d) Be a provider of independent living skills training as approved by ODJFS in accordance with rule 5101:3-45-04 of the Administrative Code, or a community mental health center certified by ODMH in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code, if the provider is furnishing independent living skills training as that service is set forth in rule 5101:3-51-04 of the Administrative Code.

(3) For supplemental services, the provider shall:

(a) Be a:

(i) Medicaid provider of supplementary adaptive and assistive device services as approved by ODJFS in accordance with rule 5101:3-45-04 of the Administrative Code, and rule 5101:3-46-04 , 5101:3-47-04 or 5101:3-50-04 of the Administrative Code, as appropriate, if the provider is furnishing communication aid services as those services are set forth in rule 5101:3-51-04 of the Administrative Code; or

(ii) Provider of communication aid services as approved by ODJFS if the provider is furnishing communication aid services as those services are set forth in rule 5101:3-51-04 of the Administrative Code.

(b) Be a medicaid provider of adaptive and assistive equipment services as certified by DODD in accordance with rule 5123:2-2-01 of the Administrative Code, if the provider is furnishing service animal services as those services are set forth in rule 5101:3-51-04 of the Administrative Code.

(C) A prospective provider intending to furnish HOME choice demonstration program services to a participant enrolled on an HCBS waiver administered by ODA must meet the requirements set forth in this paragraph.

(1) For qualified services, the provider shall:

(a) Be an ODA-certified long term care provider in accordance with rule 173-39-02 of the Administrative Code.

(b) Be a medicaid state plan service provider as approved by ODJFS in accordance with division 5101:3 of the Administrative Code, as appropriate for the specific medicaid state plan service to be furnished.

(2) For demonstration services, the provider shall:

(a) Be a provider of HOME choice nursing services as approved by ODJFS in accordance with rule 5101:3-51-04 of the Administrative Code, if the provider is furnishing HOME choice nursing services as that service is set forth in rule 5101:3-51-04 of the Administrative Code.

(b) Be a provider of community support coaching as approved by ODJFS, or a community mental health center certified by ODMH in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code, if the provider is furnishing community support coaching as that service is set forth in rule 5101:3-51-04 of the Administrative Code.

(c) Be a provider of independent living skills training as approved by ODJFS, or a community mental health center certified by ODMH in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code, if the provider is furnishing independent living skills training as that service is set forth in rule 5101:3-51-04 of the Administrative Code.

(3) For supplemental services, the provider shall:

(a) Be:

(i) An ODA-certified long term care provider of specialized medical equipment and supplies in accordance with rule 173-39-02.7 of the Administrative Code, if the provider is furnishing communication aid services as those services are set forth in rule 5101:3-51-04 of the Administrative Code; or

(ii) A provider of communication aid services as approved by ODJFS if the provider is furnishing communication aid services as those services are set forth in rule 5101:3-51-04 of the Administrative Code.

(b) Be a medicaid provider of adaptive and assistive equipment services as certified by DODD in accordance with rule 5123:2-2-01 of the Administrative Code, if the provider is furnishing service animal services as those services are set forth in rule 5101:3-51-04 of the Administrative Code.

(D) A prospective provider intending to furnish HOME choice demonstration program services to a participant enrolled on an HCBS waiver administered by DODD must meet the requirements set forth in this paragraph. The provider must submit a signed statement affirming that the provider received and read all rules of the Administrative Code governing the HOME choice demonstration program.

(1) For qualified services, the provider shall:

(a) Be a medicaid provider as certified by DODD in accordance with rule 5123:2-2-01 of the Administrative Code for the specific waiver service to be furnished.

(b) Be a medicaid state plan service provider as approved by ODJFS in accordance with division 5101:3 of the Administrative Code, as appropriate for the specific medicaid state plan service to be furnished.

(2) For demonstration services, the provider shall:

(a) Be a medicaid provider of nutritional consultation services as certified by DODD in accordance with rule 5123:2-2-01 of the Administrative Code, or an ODA-certified long term care provider of nutritional consultation services in accordance with rule 173-39-02.10 of the Administrative Code, if the provider is furnishing nutritional consultation as that service is set forth in rule 5101:3-51-04 of the Administrative Code.

(b) Be a medicaid provider of social work counseling services as certified by DODD in accordance with rule 5123:2-2-01 of the Administrative Code, or as certified by ODMH in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code, or be an ODA-certified long term care provider of social work counseling services in accordance with rule 173-39-02.12 of the Administrative Code, if the provider is furnishing social work counseling as that service is set forth in rule 5101:3-51-04 of the Administrative Code.

(c) Be a provider of HOME choice nursing services as approved by ODJFS in accordance with rule 5101:3-51-04 of the Administrative Code, if the provider is furnishing HOME choice nursing services as that service is set forth in rule 5101:3-51-04 of the Administrative Code.

(d) Be a provider of community support coaching as approved by ODJFS, or a community mental health center certified by ODMH in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code, if the provider is furnishing community support coaching as that service is set forth in rule 5101:3-51-04 of the Administrative Code.

(3) For supplemental services, the provider shall be:

(a) A medicaid provider of adaptive and assistive equipment or specialized medical equipment as certified by DODD in accordance with rule 5123:2-2-01 of the Administrative Code, if the provider is furnishing communication aid services as those services are set forth in rule 5101:3-51-04 of the Administrative Code; or

(b) A provider of communication aid services as approved by ODJFS if the provider is furnishing communication aid services as those services are set forth in rule 5101:3-51-04 of the Administrative Code; and

(c) Be a medicaid provider of adaptive and assistive equipment services as certified by DODD in accordance with rule 5123:2-2-01 of the Administrative Code, if the provider is furnishing service animal services as those services are set forth in rule 5101:3-51-04 of the Administrative Code.

(E) A prospective provider intending to furnish HOME choice demonstration program services to a participant who is not enrolled on an HCBS waiver must meet the requirements set forth in this paragraph.

(1) For qualified medicaid state plan services, the provider shall be a medicaid state plan service provider as approved by ODJFS in accordance with division 5101:3 of the Administrative Code, as appropriate for the specific medicaid state plan service to be furnished.

(2) For demonstration services, the provider shall:

(a) Be a provider of HOME choice nursing services as approved by ODJFS in accordance with rule 5101:3-51-04 of the Administrative Code, if the provider is furnishing HOME choice nursing services as that service is set forth in rule 5101:3-51-04 of the Administrative Code.

(b) Be a medicaid provider of nutritional consultation services as certified by DODD in accordance with rule 5123:2-2-01 of the Administrative Code, or an ODA-certified long term care provider of nutritional consultation services in accordance with rule 173-39-02.10 of the Administrative Code, if the provider is furnishing nutritional consultation as that service is set forth in rule 5101:3-51-04 of the Administrative Code.

(c) Be a medicaid provider of social work counseling services as certified by DODD in accordance with rule 5123:2-2-01 of the Administrative Code, or as certified by ODMH in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code, or be an ODA-certified long term care provider of social work counseling services in accordance with rule 173-39-02.12 of the Administrative Code, if the provider is furnishing social work counseling as that service is set forth in rule 5101:3-51-04 of the Administrative Code.

(d) Be a provider of community support coaching as approved by ODJFS, or a community mental health center certified by ODMH in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code, if the provider is furnishing community support coaching as that service is set forth in rule 5101:3-51-04 of the Administrative Code.

(e) Be a provider of independent living skills training as approved by ODJFS, or a community mental health center certified by ODMH in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code, if the provider is furnishing independent living skills training as that service is set forth in rule 5101:3-51-04 of the Administrative Code.

(f) Be a provider of out-of-home respite services as approved by ODJFS in accordance with rule 5101:3-45-04 of the Administrative Code, or day camp respite as approved by ODJFS, if the provider is furnishing respite services as that service is set forth in rule 5101:3-51-04 of the Administrative Code.

(3) For supplemental services, the provider shall:

(a) Be:

(i) A medicaid provider of durable medical equipment as approved by ODJFS in accordance with rule 5101:3-10-01 of the Administrative Code, if the provider is furnishing communication aid services as those services are set forth in rule 5101:3-51-04 of the Administrative Code; or

(ii) A provider of communication aid services as approved by ODJFS if the provider is furnishing communication aid services as those services are set forth in rule 5101:3-51-04 of the Administrative Code.

(b) Be a medicaid provider of adaptive and assistive equipment services as certified by DODD in accordance with rule 5123:2-2-01 of the Administrative Code, if the provider is furnishing service animal services as those services are set forth in rule 5101:3-51-04 of the Administrative Code.

(F) ODJFS shall not process a service provider application packet for prospective providers of HOME choice nursing, community support coaching, independent living skills training, or communication aid services if the packet does not contain information necessary to complete the required verifications.

(1) ODJFS shall not process a service provider application packet for prospective providers of HOME choice nursing, community support coaching, independent living skills training or communication aid services if the provider does not submit the signed statement as required by paragraphs (B) and (D) of this rule.

(2) ODJFS shall notify the service provider in writing of any missing information, and shall provide the applicant thirty calendar days to submit the required documentation. If the provider does not submit the required documentation within thirty calendar days, the service provider application process shall be terminated.

(3) ODJFS shall review all information and make a determination regarding the prospective service provider's eligibility for enrollment. If ODJFS determines the provider is ineligible for enrollment as a provider of HOME choice demonstration program services, 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