5101:3-51-04 HOME choice ("Helping Ohioans Move, Expanding Choice") demonstration program: definitions of the covered services and program service limitations, provider qualifications and specifications.

This rule sets forth the definitions of the covered services and some program service limitations available to a HOME choice demonstration program participant. This rule also sets forth the provider requirements and specifications for the delivery of HOME choice demonstration program services. The HOME choice demonstration program participant shall have choice and control over the selection of his or her provider of services, and the direction over the provision of the services. HOME choice demonstration program services are reimbursed in accordance with rule 5101:3-51-06 of the Administrative Code.

(A) "Independent living skills training" is information and educational supports and resources provided to a HOME choice demonstration program participant or group of HOME choice demonstration program participants for the purpose of developing or increasing skills, knowledge or abilities needed to live more independently. Independent living skills training services can be furnished individually, or in a group setting or classroom setting as those terms are defined in rule 5101:3-51-01 of the Administrative Code.

(1) Training focuses on:

(a) Financial management skills including, but not limited to:

(i) Finding a bank and establishing an account,

(ii) How to pay bills and taxes,

(iii) Personal budgeting,

(iv) How to manage entitlements and insurance,

(v) How to use a bank machine,

(vi) Understanding credit, and

(vii) Understanding contracts;

(b) Social skills development including, but not limited to:

(i) Communication skill building,

(ii) How to be a good neighbor/roommate,

(iii) How to work with providers, and

(iv) How to know when and how to ask for help;

(c) Health management skills including, but not limited to:

(i) How to efficiently manage nutrition and diet,

(ii) How to talk to the doctor,

(iii) Training service providers,

(iv) Managing and accessing medical supplies,

(v) Crisis care/recovery services,

(vi) Linking to medical/dental services,

(vii) Assessing the need for, and accessing, adaptive and assistive devices,

(viii) Continuing therapies,

(ix) Emergency preparedness, and

(x) Medication management;

(d) Home management skills including, but not limited to:

(i) Personal shopping,

(ii) Housekeeping and laundry,

(iii) Grocery shopping, cooking and meal planning,

(iv) How to request and/or complete simple repairs,

(v) Safety skills at home, and

(vi) Operating simple technology;

(e) Personal skills including, but not limited to:

(i) Daily functions such as hygiene, dressing and undressing,

(ii) Scheduling, and

(iii) Utilization of leisure/education/physical/emotional activities; and

(f) Community living skills including, but not limited to:

(i) Travel training,

(ii) How to negotiate transportation systems and arrange transportation,

(iii) Identifying and accessing existing community resources,

(iv) Job training and seeking employment opportunities,

(v) Linking to legal resources, and

(vi) Safety skills in the community.

(2) Independent living skills training shall not duplicate community support coaching services available through the HOME choice demonstration program. In addition, independent living skills training shall not duplicate similar waiver or administrative services available on a home and community-based services (HCBS) waiver on which the HOME choice demonstration program participant is enrolled.

(3) If the HOME choice demonstration program participant is enrolled on a DODD-administered waiver, the HOME choice demonstration program participant must access homemaker/personal care in lieu of independent living skills training.

(4) The independent living skills training provider shall, as a function of the service, provide the entity responsible for assisting the HOME choice demonstration program participant with the development of his or her all services plan, service plan or non-waiver HOME choice demonstration program service plan, as appropriate, with written status reports during the HOME choice demonstration program participant's transition, as prescribed by the plan.

(5) In order to provide and submit a claim for reimbursement of independent living skills training, the independent living skills training provider delivering the service:

(a) Must be either a community mental health center certified by the Ohio department of mental health (ODMH) in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code, or a non-profit agency provider,

(i) Whose staff with direct participant contact:

(a) May have either:

(i) A disability and lived in an institution and successfully transitioned to the community, and/or

(ii) Experience transitioning individuals from an institution to the community, and

(b) Must have knowledge and experience about:

(i) Local community resources,

(ii) Applicable disability laws and regulations, and

(c) Are age eighteen or older; and

(ii) Whose staff that provide transportation:

(a) Possess a valid Ohio driver's license, and

(b) Possess valid automobile liability insurance.

(b) Must meet the conditions of participation set forth in rule 5101:3-51-03 of the Administrative Code.

(c) Must meet the provider enrollment criteria set forth in paragraph (B), (C) or (E) of rule 5101:3-51-05 of the Administrative Code, as applicable.

(d) Must be identified as the provider, and have specified on the participant's all services plan, service plan or non-waiver HOME choice demonstration program service plan, as appropriate, the number of hours for which the provider is authorized to furnish independent living skills training services to the participant.

(e) Must be providing the service to one individual, or to two or three individuals in a group setting, or four or more individuals in a classroom setting, during the same face-to-face visit.

(B) "Community support coaching" is a service provided for the purpose of guiding, educating and empowering the HOME choice demonstration program participant, authorized representative and family members before, during and after the HOME choice demonstration program participant's transition from an institution into the community.

(1) The community support coach shall:

(a) Communicate with and educate the HOME choice demonstration program participant in vital aspects of the transition process;

(b) Assist the HOME choice demonstration program participant in:

(i) Making informed and independent choices,

(ii) Setting and achieving short and long-term goals,

(iii) Managing multiple tasks, and

(iv) Identifying options and problem solving;

(c) Provide one-on-one coaching;

(d) Provide follow-up coaching during and after the transition;

(e) Inform and advise the HOME choice demonstration program participant in such a manner that empowers, but protects, the participant from being taken advantage of in the community;

(f) Assist with the identification of community resources and linkages to be used by the HOME choice demonstration program participant;

(g) Assist the HOME choice demonstration program participant in connecting to potential employment opportunities before, during and after transition; and

(h) Provide the entity responsible for assisting the HOME choice demonstration program participant with the development of his or her all services plan, service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate, with written status reports during the HOME choice demonstration program participant's transition, as prescribed by the all services plan, service plan, ISP or non-waiver HOME choice demonstration program service plan.

(2) Community support coaching shall include assistance after normal business hours when the HOME choice demonstration program participant is not enrolled on an HCBS waiver and is only receiving medicaid state plan services.

(3) Community support coaching shall not duplicate independent living skills training available through the HOME choice demonstration program. In addition, community support coaching shall not duplicate similar waiver or administrative services available on an HCBS waiver on which the HOME choice demonstration program participant is enrolled.

(4) In order to provide and submit a claim for reimbursement of community support coaching, the community support coach provider delivering the service:

(a) Must be:

(i) A non-agency provider who:

(a) May have either:

(i) A disability and lived in an institution and successfully transitioned to the community, and/or

(ii) Experience transitioning individuals from an institution to the community; and

(b) Is age eighteen or older, and

(c) Possesses a valid Ohio driver's license, and

(d) Possesses valid automobile liability insurance, and

(e) Is not the participant's legally responsible family member as that term is defined in rule 5101:3-51-01 of the Administrative Code, and

(f) Is not the participant's case manager (CM) or service and support administrator (SSA), as those terms are defined in rule 5101:3-51-01 of the Administrative Code; or

(ii) Either a community mental health center certified by ODMH in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code, or a non-profit agency provider,

(a) Whose staff with direct participant contact:

(i) May have either:

(A) A disability and lived in an institution and successfully transitioned to the community; and/or

(B) Experience transitioning individuals from an institution to the community; and

(ii) Are age eighteen or older, and

(b) Whose staff that provide transportation:

(i) Possess a valid Ohio driver's license, and

(ii) Possess valid automobile liability insurance.

(b) Must not also be the transition coordination agency providing transition coordination services to the same participant during the pre-transition phase.

(c) Must meet the conditions of participation set forth in rule 5101:3-51-03 of the Administrative Code.

(d) Must meet the provider enrollment criteria set forth in paragraph (B), (C), (D) or (E) of rule 5101:3-51-05 of the Administrative Code, as applicable.

(e) Must be identified as the provider, and have specified on, the participant's all services plan, service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate, the number of hours for which the provider is authorized to furnish community support coaching services to the participant.

(C) "HOME choice nursing services" are intermittent services provided to HOME choice demonstration program participants that require the skills of a registered nurse (RN) or licensed practical nurse (LPN) at the direction of an RN. All nurses providing HOME choice nursing services shall provide services within the nurse's scope of practice as set forth in Chapter 4723. of the Revised Code and rules of the Administrative Code adopted thereunder, and shall possess a current, valid and unrestricted license with the Ohio board of nursing.

(1) HOME choice nursing services do not include:

(a) Services delegated in accordance with Chapter 4723. of the Revised Code and rules of the Administrative Code adopted thereunder and to be performed by individuals who are not licensed nurses in accordance with Chapter 4723. of the Revised Code;

(b) Services that require the skills of a psychiatric nurse;

(c) Visits performed for the sole purpose of conducting an "OASIS" (outcome and assessment information set) assessment or any other assessment; or

(d) Visits performed for the sole purpose of meeting the home care attendant service nurse consultation requirements set forth in rules 5101:3-46-04.1 and 5101:3-50-04.1 of the Administrative Code.

(e) Services performed in excess of the number of hours approved pursuant to the HOME choice demonstration program participant's service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate.

(2) HOME choice nursing services shall not duplicate similar waiver or administrative services available on the HCBS waiver on which the HOME choice demonstration program participant is enrolled, or medicaid state plan home health nursing and/or private duty nursing services.

(3) In order to provide and submit a claim for reimbursement of HOME choice nursing services, the RN, or LPN at the direction of an RN, delivering the service must meet all of the following requirements:

(a) Be employed by a medicare-certified, or otherwise-accredited home health agency, or be a non-agency home care nurse provider.

(b) Not be the participant's spouse, or in the case of a minor, the participant's birth or adoptive parent, unless the family member is employed by a medicare-certified, or otherwise-accredited home health agency.

(c) Not be the foster caregiver of the HOME choice demonstration program participant.

(d) Meet the conditions of participation set forth in rule 5101:3-51-03 of the Administrative Code.

(e) Meet the provider enrollment criteria set forth in paragraph (C), (D) or (E) of rule 5101:3-51-05 of the Administrative Code, as applicable.

(f) Be identified as the provider, and have specified on, the participant's service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate, the number of hours for which the provider is authorized to furnish HOME choice nursing services to the participant.

(g) Be identified as the provider on, and be performing HOME choice nursing services pursuant to the participant's plan of care, as that term is defined in rule 5101:3-51-01 of the Administrative Code. The plan of care must be signed and dated by the participant's treating physician.

(h) Be providing the service for one individual during a face-to-face visit, or for two or three individuals in a group setting during the same face-to-face visit.

(4) Non-agency LPNs, at the direction of an RN, must:

(a) Conduct a face-to-face visit with the directing RN at least every sixty days after the initial visit to evaluate the provision of HOME choice nursing services and LPN performance, and to assure that HOME choice nursing services are being provided in accordance with the approved plan of care; and

(b) Conduct a face-to-face visit with the participant and the directing RN prior to initiating services and at least once every one hundred twenty days for the purpose of evaluating the provision of HOME choice nursing services, the participant's satisfaction with care delivery, and LPN performance, and to assure that HOME choice nursing services are being provided in accordance with the approved plan of care.

(5) All HOME choice nursing service providers must maintain a clinical record for each participant served in a manner that protects the confidentiality of these records. Medicare-certified, or otherwise-accredited home health agencies, must maintain the clinical records at their place of business. Non-agency HOME choice nursing service providers must maintain the clinical records at their place of business, and maintain a copy in the participant's residence. For the purposes of this rule, the place of business must be a location other than the participant's residence. At a minimum, the clinical record must contain the information listed in paragraphs (C)(5)(a) to (C)(5)(l) of this rule.

(a) Participant identifying information, including but not limited to: name, address, age, date of birth, sex, race, marital status, significant phone numbers, and health insurance identification numbers.

(b) Participant medical history.

(c) Name of participant's treating physician.

(d) A copy of the initial and all subsequent service plans, ISPs or non-waiver HOME choice demonstration program service plans, as appropriate.

(e) A copy of the initial and all subsequent plans of care, specifying the type, frequency, scope and duration of the HOME choice nursing services being performed. When services are performed by an LPN at the direction of an RN, the clinical record shall include documentation that the RN has reviewed the plan of care with the LPN. The plan of care must be recertified by the treating physician every sixty days, or more frequently if there is a significant change in the participant's condition.

(f) In all instances when the treating physician gives verbal orders to the nurse, the nurse must document, in writing, the physician's orders, the date and time the orders were given, and sign the entry in the clinical record. The nurse must subsequently secure documentation of the verbal orders, signed and dated by the treating physician.

(g) In all instances when a non-agency LPN is providing HOME choice nursing services, the LPN must provide clinical notes, signed and dated by the LPN, documenting face-to-face visits between the LPN and the directing RN, and documenting the face-to-face visits between the LPN, the participant and the directing RN. Nothing shall prohibit the use of technology-based systems in collecting and maintaining the documentation required by this paragraph.

(h) Documentation of all drug and food interactions, allergies and dietary restrictions.

(i) A copy of any advanced directives including, but not limited to, "do not resuscitate order" or medical power of attorney, if they exist.

(j) Clinical notes and other documentation of tasks performed or not performed, arrival and departure times, and the dated signatures of the provider and the participant or authorized representative verifying the service delivery upon completion of service delivery. Nothing shall prohibit the use of technology-based systems in collecting and maintaining the documentation required by this paragraph. The participant or authorized representative's signature of choice shall be documented on the service plan, ISP or non-waiver HOME choice demonstration program service plan, and shall include, but not be limited to any of the following: a handwritten signature, initials, a stamp or mark, or an electronic signature.

(k) Clinical notes, signed and dated by the nurse, documenting all communications between the treating physician and other members of the multidisciplinary team. Nothing shall prohibit the use of technology-based systems in collecting and maintaining the documentation required by this paragraph.

(l) A discharge summary, signed and dated by the departing nurse at the conclusion of the three hundred sixty-five-day eligibility period, or at the point the nurse is no longer going to provide services to the participant, or when the participant no longer needs HOME choice nursing services. The summary should include documentation regarding progress made toward goal achievement and indicate any recommended follow-up or referrals.

(D) "Social work/counseling services" are transitional services provided to the HOME choice demonstration program participant, authorized representative, caregiver and/or family member on a short-term basis to promote the participant's physical, social and emotional well-being. Social work/counseling services promote the development and maintenance of a stable and supportive environment for the HOME choice demonstration program participant.

(1) Social work/counseling services can include crisis interventions, grief counseling and/or other social service interventions that support the HOME choice demonstration program participant's health and welfare.

(2) Social work/counseling services shall not:

(a) Take the place of case management services;

(b) Duplicate similar services available on an HCBS waiver on which the HOME choice demonstration program participant is enrolled; or

(c) Include services provided in excess of what is approved on the participant's all services plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate.

(3) In order to provide and submit a claim for reimbursement of social work/counseling services, the social work/counseling service provider delivering the service:

(a) Must be either:

(i) A non-agency provider who shall:

(a) Be a licensed professional clinical counselor (LPCC), licensed independent social worker (LISW), or independent marriage and family therapist (IMFT) who holds a current, valid and unrestricted license to practice issued by the counselor, social worker, and marriage and family therapist board in accordance with Chapter 4757. of the Revised Code, or a psychologist who holds a current, valid and unrestricted license to practice issued by the state board of psychology of Ohio in accordance with Chapter 4732. of the Revised Code, or an RN who holds a current, valid and unrestricted license to practice issued by the Ohio board of nursing in accordance with Chapter 4723. of the Revised Code and holds a masters degree in nursing (MSN) with a specialization or concentration in psychiatric or mental health nursing , and

(b) Maintain documentation of licensure by the applicable Ohio licensure board and have at least one year of social work/counseling experience, or

(ii) An agency provider who shall:

(a) Assure that direct care staff include an LPCC, licensed professional counselor (LPC), LISW, licensed social worker (LSW), marriage and family therapist (MFT), or IMFT who holds a current, valid and unrestricted license to practice issued by the counselor, social worker, and marriage and family therapist board in accordance with Chapter 4757. of the Revised Code, or a psychologist who holds a current, valid and unrestricted license to practice issued by the state board of psychology of Ohio in accordance with Chapter 4732. of the Revised Code, or an individual who holds a current, valid and unrestricted license as an RN from the Ohio board of nursing accordance to Chapter 4723. of the Revised Code, and holds an MSN with a specialization or concentration in psychiatric or mental health nursing,

(b) Assure that LSWs, LPCs and MFTs are supervised in accordance with Chapter 4757. of the Revised Code, and that the supervisor of an LSW, SPC or MFT co-signs all initial assessments and social work/counseling intervention plans prepared by the LSW, LPC, MFT or MSN, and

(c) Maintain documentation that all direct care social work/counseling staff are licensed by the applicable Ohio licensure board, and have at least one year of social work/counseling experience.

(b) Must conduct an individual assessment to evaluate the HOME choice demonstration program participant's psycho-social, financial and environmental status.

(c) Must develop and revise, as necessary, with the assistance of the participant, and/or the participant's authorized representative, caregiver(s) and the CM or SSA, as appropriate, a treatment plan that includes the recommended method of treatment and the recommended number of counseling sessions.

(d) Must assure the treatment plan is implemented.

(e) Must furnish to either the CM or SSA, a copy of the individual assessment report and the treatment plan no later than seven working days after completion of the individual assessment. The participant and/or the participant's authorized representative shall also be furnished with a copy of the individual assessment report and the treatment plan unless clinically indicated otherwise.

(f) Must meet the conditions of participation set forth in rule 5101:3-51-03 of the Administrative Code.

(g) Must meet the provider enrollment criteria set forth in paragraph (B), (D) or (E) of rule 5101:3-51-05 of the Administrative Code, as applicable.

(h) Must be identified as the provider, and have specified on the participant's all services plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate, the number of hours for which the provider is authorized to furnish social work/counseling services to the participant.

(4) Providers of social work/counseling services must maintain a clinical record for each participant served. At a minimum, the clinical record must contain the information listed in paragraphs (D)(4)(a) to (D)(4)(j) of this rule.

(a) Participant identifying information, including but not limited to name, address, age, date of birth, sex, race, marital status, significant phone numbers and health insurance identification information.

(b) Participant medical history.

(c) Name of participant's treating physician.

(d) A copy of the initial and all subsequent all service plans, ISPs or non-waiver HOME choice demonstration program service plans, as appropriate.

(e) A copy of the initial and all subsequent individual assessments.

(f) A copy of the initial and all revised treatment plans.

(g) A copy of any advanced directives including, but not limited to, "do not resuscitate order" or medical power of attorney, if they exist.

(h) Documentation of all drug and food interactions, allergies and dietary restrictions.

(i) Documentation that clearly shows the date of social work/counseling service delivery. Nothing shall prohibit the use of technology-based systems in collecting and maintaining the documentation required by this paragraph.

(j) A discharge summary, signed and dated by the departing social work/counseling service provider at the conclusion of the three hundred sixty-five-day eligibility period, or at the point the service provider is no longer going to provide social work/counseling services to the participant, or when the participant no longer needs social work/counseling services. The summary should include documentation regarding service outcomes and progress made toward goal achievement and indicate any recommended follow-ups and/or referrals.

(E) "Nutritional consultation services" are services that provide individualized guidance to a HOME choice demonstration program participant who has special dietary needs. Nutritional consultation takes into consideration the participant's health, cultural, religious, ethnic and socio-economic background and dietary preferences and/or restrictions.

(1) Nutritional consultation services shall not:

(a) Duplicate similar HCBS waiver services a HOME choice demonstration program participant is receiving; or

(b) Include services provided in excess of what is approved on the participant's all services plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate.

(2) In order to provide and submit a claim for reimbursement of nutritional consultation services, the nutritional consultation service provider delivering the service must meet all of the requirements set forth in paragraph (E)(2) of this rule.

(a) Be a dietitian who:

(i) Is registered by the commission on dietetic registration; and

(ii) Maintains a license in good standing with the Ohio board of dietetics.

(b) Be providing services pursuant to a plan of care for nutritional consultation services that is signed and dated by the treating physician. The plan of care for nutritional consultation services must be recertified by the treating physician every sixty days, or more frequently if there is a significant change in the participant's condition.

(c) Meet the conditions of participation set forth in rule 5101:3-51-03 of the Administrative Code.

(d) Meet the provider enrollment criteria set forth in paragraph (B), (D) or (E) of rule 5101:3-51-05 of the Administrative Code, as applicable.

(e) Be identified as the provider, and have specified on the participant's all services plan, ISP or non-waiver HOME choice demonstration program service plan, the number of hours for which the provider is authorized to furnish nutritional consultation services to the participant.

(3) All providers of nutritional consultation services must:

(a) Conduct an initial individual assessment of the participant's nutritional needs, and subsequent assessments when necessary, using a tool that identifies whether the participant is at nutritional risk or identifies a nutritional diagnosis that the dietitian will treat. The tool must include the following:

(i) An assessment of height and weight history;

(ii) An assessment of adequacy of nutrient intake;

(iii) A review of medications, medical diagnoses and diagnostic test results;

(iv) An assessment of verbal, physical and motor skills that could be attributable to, or affect, nutrient needs;

(v) An assessment of caregiver and participant interactions during feeding; and

(vi) An assessment of the need for additional adaptive equipment and/or other community resources and/or services.

(b) Develop, implement, evaluate and revise, as necessary, a nutrition intervention plan with the assistance of the participant and/or authorized representative, case manager and when applicable, the treating physician and other relevant service providers. The plan shall be used to prioritize and address the identified nutrition problems. It must include purposely planned actions designed to change nutrition-related behavior, risk factors, environmental conditions or health status, and at a minimum, it must address the following:

(i) Appropriate dietary restrictions and modifications;

(ii) Specific nutrients that may be required or limited;

(iii) Feeding modality;

(iv) Nutrition education and counseling; and

(v) Expected measurable indicators and outcomes related to the participant's nutrition goals.

(c) Furnish the CM or SSA, as appropriate, the participant and/or the participant's authorized representative with a copy of the assessment and the nutrition intervention plan no later than seven working days after completion of the assessment.

(d) Furnish evidence, upon request, that the nutrition intervention plan was developed and services were delivered in accordance with professional licensure requirements.

(4) Providers of nutritional consultation services must maintain a clinical record for each HOME choice demonstration program participant served. Nothing shall prohibit the use of technology-based systems in the collection and maintenance of the documentation required by this paragraph. At a minimum, the clinical record must contain all of the information listed in paragraphs (E)(4)(a) to (E)(4)(k) of this rule.

(a) Participant identifying information, including but not limited to name, address, age, date of birth, sex, race, marital status, significant phone numbers and health insurance identification numbers.

(b) Participant medical history.

(c) Name of participant's treating physician.

(d) Treating physician's authorization for a nutritional assessment.

(e) A copy of the initial and all subsequent all service plans, ISPs or non-waiver HOME choice demonstration program service plans, as appropriate.

(f) A copy of the initial and all subsequent individual assessments of the participant's nutritional needs.

(g) A copy of the initial and all subsequent plans of care for nutritional consultation services specifying the type, frequency, scope and duration of the services being performed.

(h) A copy of the initial and all subsequent nutrition intervention plans developed and implemented.

(i) Documentation of all drug and food interactions, allergies and dietary restrictions.

(j) Documentation that clearly shows the date of nutritional consultation service delivery, including copies of all nutritional assessments conducted and all nutrition intervention plans developed and implemented. Nothing shall prohibit the use of technology-based systems in collecting and maintaining the documentation required by this paragraph.

(k) A discharge summary, signed and dated by the departing nutritional consultation service provider at the conclusion of the three hundred sixty-five-day eligibility period, at the point the dietitian is no longer going to provide services to the participant, or when the participant no longer needs nutritional consultation services. The summary shall include progress made to date toward goal achievement and nutritional outcomes, and any recommended follow-ups and/or referrals that have been made.

(F) "Communication aids" are devices, systems or services necessary to assist the HOME choice demonstration program participant with hearing, speech or vision impairments to effectively communicate with service providers, family, friends and the general public.

(1) Communication aids include, but are not limited to:

(a) Augmentative communication devices or systems that transmit or produce a message or symbols in a manner that compensates for the HOME choice demonstration program participant's communication impairment;

(b) Computers and computer equipment;

(c) Other mechanical and electronic devices;

(d) Cable and internet access; and

(e) The cost of installation, repair, maintenance and support of any covered communication aid.

(2) Communication aids may also include:

(a) Interpreter services that support the HOME choice demonstration program participant's integration into the community. Interpreter services refer to the process by which the interpreter conveys one person's message to another by incorporating both the message and the attitude of the communicator.

(b) New technologies and any other devices so long as the technologies and devices achieve the objective of the service.

(3) Reimbursement for communication aids shall not exceed a total of five thousand dollars within the three hundred sixty-five day HOME choice demonstration program eligibility period per participant. The CM or SSA, as appropriate, shall not approve the same type of communication aid equipment for the same HOME choice demonstration program participant more than once unless there is a documented need for ongoing communication aid services or a change in the HOME choice demonstration program participant's medical and/or physical condition requiring the replacement.

(4) If the HOME choice demonstration program participant is enrolled on an HCBS waiver, then the participant must exhaust similar waiver services that are available to the participant before utilizing communication aid services. Communication aid service costs are not included in the cost of HCBS waiver services.

(5) In order to provide and submit a claim for reimbursement of communication aid services, the communication aid service provider delivering the service:

(a) Must be an agency provider.

(b) Must meet the conditions of participation set forth in rule 5101:3-51-03 of the Administrative Code.

(c) Must meet the provider enrollment criteria set forth in paragraph (B), (C), (D) or (E) of rule 5101:3-51-05 of the Administrative Code, as applicable.

(d) Must be identified as the provider, and have specified on the participant's all services plan, service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate, the number of hours for which the provider is authorized to furnish communication aid services to the participant.

(G) "Service animals" are animals that are individually trained to perform tasks for HOME choice demonstration program participants that the participants are unable to perform for themselves. They also assist people with disabilities in their day-to-day activities.

(1) Tasks performed by service animals include, but are not limited to:

(a) Guiding people who are blind;

(b) Alerting people who are deaf;

(c) Pulling wheelchairs;

(d) Alerting and protecting participants who are having a seizure;

(e) Carrying and picking up things for participants with mobility impairments; and

(f) Assisting participants with mobility impairments with balance.

(2) Service animals may include, but are not limited to:

(a) Seeing eye dogs;

(b) Hearing dogs; and

(c) Service monkeys.

(3) Activities related to the use of service animals include, but are not limited to:

(a) First-year costs associated with the raising of the animal;

(b) Housing, feeding, upkeep and medical care of the animal during training;

(c) Actual training of the animal, student training and related transportation, room/board and administrative activities;

(d) Equipment and supplies;

(e) Home care, including cooking/food, housekeeping, laundry for students in training;

(f) Animal health insurance; and

(g) Transportation to the veterinarian.

(4) Reimbursement for service animals shall not exceed a total of eight thousand dollars within the three hundred sixty-five day HOME choice demonstration program eligibility period per participant. The CM or SSA, as appropriate, shall not approve the same type of service animal services for the same HOME choice demonstration program participant more than once unless there is a documented need for ongoing service animal services or a change in the HOME choice demonstration program participant's medical and/or physical condition requiring the replacement.

(5) If the HOME choice demonstration program participant is enrolled on a DODD-administered waiver, then the participant must exhaust similar waiver services that are available to the participant before utilizing the service animal service. Service animal costs are not included in the cost of waiver services.

(6) In order to provide and submit a claim for reimbursement of service animal services, the service animal service provider delivering the service:

(a) Must be an agency provider.

(b) Must meet the conditions of participation set forth in rule 5101:3-51-03 of the Administrative Code.

(c) Must meet the provider enrollment criteria set forth in paragraph (B), (C), (D) or (E) of rule 5101:3-51-05 of the Administrative Code, as applicable.

(d) Must be identified as the provider, and have specified on, the participant's all services plan, service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate, the number of hours for which the provider is authorized to furnish service animal services to the participant.

(H) "Community transition services" are services providing goods, services and support for the purpose of addressing an identified need in the HOME choice demonstration program participant's all services plan, service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate, including improving and maintaining the HOME choice demonstration program participant's opportunities for membership in the community.

(1) Community transition services are intended to meet the following criteria:

(a) The goods and services will decrease the need for formal support services and other medicaid services;

(b) The goods and services will take into consideration the appropriateness and availability of a lower cost alternative for comparable services that meet the HOME choice demonstration program participant's needs;

(c) The goods and services will promote community inclusion and family involvement;

(d) The goods and services will improve the HOME choice demonstration program participant's health and welfare in the home and/or community;

(e) The HOME choice demonstration program participant does not have the funds to purchase the goods and services, or the goods and services are not available through another source;

(f) The goods and services will assist the HOME choice demonstration program participant in developing and maintaining personal, social, physical or work-related skills; and

(g) The goods and services will assist the HOME choice demonstration program participant in living independently in the home and community.

(2) Allowable community transition expense and service limitations are as follows:

(a) A maximum of five hundred dollars for pre-transition (i.e., up to, but not including, the actual date of transition) transportation expenses that may include, but are not limited to, visits to potential housing, and to local agencies for the purpose of establishing benefits; and

(b) A maximum of two thousand dollars for pre- and post-transition expenses including, but not limited to, the following, and except as limited by paragraph (H)(3) of this rule:

(i) Post-transition (i.e., on or after the actual date of transition) transportation expenses,

(ii) Security deposits that are required to obtain a lease on an apartment or home ,

(iii) Essential household furnishings, including furniture, window coverings, food preparation items, and bed/bath linens ,

(iv) Set-up fees or deposits for utility or service access, including telephone, electricity, heating and water ,

(v) Services necessary for the participant's health and welfare, such as pest control and one-time cleaning prior to moving in to the residence ,

(vi) Moving expenses ,

(vii) Necessary home accessibility adaptations , and

(viii) Start-up groceries, i.e., food and household supplies.

(3) Community transition services do not include:

(a) Experimental or prohibited treatments;

(b) The ongoing cost of room and board;

(c) Regular utility charges;

(d) Ongoing grocery expenses;

(e) Cigarettes and alcohol;

(f) Uniforms and memberships;

(g) Electronics and other household appliances or items that are used for entertainment or recreational purposes; and

(h) Cable/internet access.

(4) Reimbursement for community transition services shall not exceed a cumulative maximum of two thousand five hundred dollars for the items set forth in paragraph (H)(2) of this rule. The CM or SSA, as appropriate, shall not approve the same type of community transition services for the same HOME choice demonstration program participant unless there is a documented need for ongoing community transition services or a change in the HOME choice demonstration program participant's medical and/or physical condition requiring the replacement.

(5) Except as provided for in paragraph (H)(6) of this rule, community transition services shall not duplicate similar waiver or administrative services available on an HCBS waiver on which the HOME choice demonstration program participant is enrolled.

(6) When the HOME choice demonstration program participant is enrolling on an ODA-administered waiver, the participant may use HOME choice community transition services in lieu of, but not in addition to, the community transition service available through the ODA-administered waiver.

(7) In order for a provider to provide and submit a claim for reimbursement of community transition services,

(a) The specific goods and services to be purchased shall be:

(i) Determined by the HOME choice demonstration program participant in conjunction with his or her CM or SSA, as appropriate,

(ii) Based upon the HOME choice demonstration program participant's established need, and

(iii) Specified on the participant's all service plan, service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate.

(b) During the HOME choice demonstration period, the purchase of community transition services shall be coordinated by the participant's CM or SSA, as appropriate, in conjunction with the ODJFS-designated HOME choice financial management service (FMS) provider.

(c) Community transition services shall be reimbursed in accordance with rule 5101:3-51-06 of the Administrative Code, the requirements set forth in the FMS contract and established HOME choice demonstration program policies and procedures. At ODJFS's discretion, community transition services may also be reimbursed through a debit card, an electronic benefit transfer (EBT) card or another similar financial instrument.

(I) "Respite services" are services provided on a short-term basis to a HOME choice demonstration program participant who is not enrolled on an HCBS waiver, and who is unable to care for himself or herself, and because of the absence of, or the temporary or periodic relief for, the primary caregiver. Respite services include all of the necessary care that the primary caregiver would normally provide during that period. Respite services may be provided in an in-home, out-of-home or day camp setting in accordance with the participant's non-waiver HOME choice demonstration program service plan.

(1) In-home respite services are services provided in the HOME choice demonstration program participant's place of residence during the day or overnight.

(a) In-home respite services shall include, but not be limited to:

(i) General supervision of the participant;

(ii) Homemaker services to assist with housekeeping chores, meal preparation and shopping;

(iii) Personal care services to assist with bathing, dressing and exercise;

(iv) Skilled nursing services to assist with medical needs;

(v) Accompanying the participant to community outings; and

(vi) Other related services.

(b) Nothing shall preclude a non-legally responsible family member from being an in-home respite service provider if the family member meets the requirements set forth in paragraph (I) (4) of this rule.

(2) Out-of-home respite services are services provided in an approved out-of-home setting that require an overnight stay. Out-of-home respite services shall:

(a) Include, but not be limited to:

(i) Personal care services;

(ii) Skilled nursing services; and

(iii) Three meals per day that meet the participant's dietary needs; and

(b) Not be provided in the HOME choice demonstration program participant's place of residence.

(3) Day camp respite services are services provided by a day camp that is licensed or certified by a recognized, accredited entity. Day camp respite services shall:

(a) Be provided for the purpose of therapeutic interventions that will meet the emotional and behavioral needs of the HOME choice demonstration program participant;

(b) Include, but not be limited to:

(i) Personal care services;

(ii) Skilled nursing services; and

(iii) Meal services commensurate with the camp respite setting that meet the participant's dietary needs; and

(c) Not be provided in the HOME choice demonstration program participant's place of residence.

(4) In order to provide and submit a claim for reimbursement of respite services,

(a) The provider must:

(i) Be an in-home respite provider who is:

(a) A homemaker/personal care provider certified by DODD in accordance with rule 5123:2-13-04 , 5123:2-8-03 or 5123:2-8-10 of the Administrative Code; or

(b) An approved ODJFS-administered waiver personal care aide service provider or nursing service provider in accordance with rule 5101:3-46-04 , 5101:3-47-04 or 5101:3-50-04 of the Administrative Code; or

(ii) Be an out-of-home respite provider that is:

(a) An ICF-MR facility licensed in accordance with rules 5101:3-3-02 and 5101:3-3-02.3 of the Administrative Code; or

(b) A non-ICF-MR entity (i.e., a group home) licensed by DODD in accordance with rule 5123:2-3-02 of the Administrative Code; or

(c) A nursing facility (NF) licensed in accordance with rules 5101:3-3-02 and 5101:3-3-02.3 of the Administrative Code; or

(d) Another licensed setting approved by ODJFS or its designated CMA, including, but not limited to, a hospice or hospital; or

(iii) Be a camp respite provider that is licensed or certified by a recognized, accredited entity that includes, but is not limited to, the American camping association.

(b) Meet the conditions of participation set forth in rule 5101:3-51-03 of the Administrative Code.

(c) Must meet the provider enrollment criteria set forth in paragraph (E) of rule 5101:3-51-05 of the Administrative Code.

(d) Must be identified as the provider, and have specified on the participant's non-waiver HOME choice demonstration program service plan the number of hours for which the provider is authorized to furnish respite services to the participant. Respite services shall not exceed the service and cost limitations specified on the participant's non-waiver HOME choice demonstration program service plan.

(e) All providers of in-home respite services must:

(i) Maintain evidence of the completion of twelve hours of in-service training within a twelve-month period, excluding agency and program-specific orientation. Agency providers must maintain evidence of non-licensed direct care staff's completion of the same requirements. In-service training must be initiated immediately after the non-licensed direct care staff's first anniversary of employment with the provider, and must be completed annually thereafter.

(ii) Assure that any skilled nursing services provided are within the nurse's scope of practice as set forth in Chapter 4723. of the Revised Code.

(iii) Receive task-based instruction regarding the provision of personal care services. Agency providers must provide such task-based instruction to direct care staff providing personal care services.

(f) All providers of out-of-home respite services must:

(i) Comply with federal nondiscrimination regulations as set forth in 42 C.F.R. 80 (as in effect on the effective date of this rule).

(ii) Provide for coverage of a participant's loss due to theft, property damage or personal injury, and maintain a written procedure identifying the steps a participant takes to file a liability claim. Additionally, upon request, provide documentation to the designated CMA verifying the coverage.

(iii) Maintain evidence of non-licensed direct care staff's completion of twelve hours of in-service training within a twelve-month period, excluding agency and program-specific orientation. In-service training must be initiated immediately after the non-licensed direct care staff's first anniversary of employment with the provider, and must be completed annually thereafter.

(iv) Assure that any skilled nursing services provided are within the nurse's scope of practice as set forth in Chapter 4723. of the Revised Code.

(v) Provide task-based instruction to direct care staff providing personal care services.

(5) Respite service providers must maintain a record for each participant served in a manner that protects the confidentiality of the records. Providers of in-home respite must assure the record contains the information set forth in paragraphs (I)(5)(a) to (I)(5)(g) of this rule. At a minimum, providers of out-of-home respite must assure the record contains the information set forth in paragraphs (I)(5)(a) to (I)(5)(h) of this rule.

(a) Participant's identifying information including, but not limited to, name, address, age, date of birth, sex, race, marital status, significant phone numbers and health insurance identification number.

(b) Participant medical history.

(c) A copy of the initial and all subsequent non-waiver HOME choice demonstration program service plans.

(d) A copy of any advance directives including, but not limited to, "do not resuscitate order" or "medical power of attorney," if they exist.

(e) Documentation of all drug and food interactions, allergies and dietary restrictions.

(f) Documentation including, but not limited to, case notes clearly show the date and outcome of respite service delivery, including tasks performed or not performed. Nothing shall prohibit the use of technology-based systems in collecting and maintaining the documentation required by this paragraph.

(g) Documentation required for providers of ODJFS-administered waiver nursing services as set forth in rule 5101:3-46-04 , 5101:3-47-04 or 5101:3-50-04 of the Administrative Code when skilled nursing services are provided during respite services.

(h) A discharge summary, signed and dated by the departing respite service provider, at the point the provider is no longer going to furnish respite services to the participant, or when the participant no longer needs respite services. The summary should indicate any recommended follow-ups or referrals.

Effective: 08/01/2011
R.C. 119.032 review dates: 07/01/2013
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.02 , Section 309.33.80 of Am. Sub. H.B. 153 of the 129th G.A.
Prior Effective Dates: 07/01/2008, 06/01/2009, 09/09/2010