(A) The following definitions are
applicable to this rule:
(1) "Adult"
means an individual at least eighteen years of age.
(2) "Authorizing
health care professional" means a health care professional who, pursuant
to section 5166.307 of the Revised Code, authorizes a home care attendant to
assist an individual enrolled on a nursing facility (NF)-based level of care
waiver with self-administration of medication, nursing tasks, or
both.
(3) "Controlled
substance" has the same meaning as in section 3719.01 of the Revised
Code.
(4) "Custodian"
has the same meaning as in section 2151.011 of the Revised Code.
(5) "Gastrostomy
tube" means a percutaneously inserted catheter that terminates in the
stomach.
(6) "Group
setting" means a situation in which a home care attendant service provider
furnishes home care attendant services in accordance with this rule and as
authorized by the Ohio department of medicaid (ODM), or certified by the Ohio
department of aging (ODA), to two or three individuals who reside at the same
address.
(7) "Guardian"
has the same meaning as in section 2111.01 of the Revised Code.
(8) "Health care
professional" means a physician or registered nurse who holds a current,
valid unrestricted license.
(9) "Home care
attendant" means a provider, holding a valid medicaid provider agreement
in accordance with section 5166.301 of the Revised Code and paragraph (G) of
this rule, who is authorized to provide home care attendant services to a
specific individual enrolled on a NF-based level of care waiver.
(10) "Individual
enrolled on a NF-based level of care waiver" and "individual"
mean the same as "consumer" as defined in section 5166.30 of the
Revised Code.
(11) "Jejunostomy
tube" means a percutaneously inserted catheter that terminates in the
jejunum.
(12)
"Medication" means a drug as defined in section 4729.01 of the
Revised Code.
(13) "Minor"
means an individual under eighteen years of age.
(14) "Nursing
facility (NF) -based level of care waiver" and "waiver" mean the
MyCare Ohio and Ohio home care waivers administered by ODM and the PASSPORT
waiver administered by ODA.
(15) "Nursing tasks" means
skilled tasks that would otherwise be performed by a registered nurse (RN), or
a licensed practical nurse (LPN) at the direction of an RN.
(16) "Oral medication" means any
medication that can be administered through the mouth, through a gastrostomy
tube or jejunostomy tube if through a pre-programmed pump, or through a
syringe. Oral medication may include medication administered through a metered
dose inhaler.
(17) "Physician" means an
individual authorized under Chapter 4731. of the Revised Code to practice
medicine and surgery or osteopathic medicine and surgery.
(18) "Practice of nursing as a
registered nurse," "practice of nursing as a licensed practical nurse
(LPN)", and "registered nurse (RN)" have the same meanings as in
section 4723.01 of the Revised Code. "Registered nurse" includes an
advance practice nurse as defined in section 4723.01 of the Revised
Code.
(19) "RN home care attendant service
visit" means the visit every ninety days between the RN and the individual
receiving home care attendant services as required by paragraph (G)(8) of this
rule. The visit may be conducted by via telehealth, unless the
individual's needs necessitate in-person visit.
(20) "Schedule II, "
"schedule III," "schedule IV" and "schedule V"
have the same meaning as in section 3719.01 of the Revised Code.
(21) "Topical medication" means
any medication applied to the outer skin, including transdermal medications and
eye, ear and nose drops. Topical medication may also include vaginal or rectal
suppositories.
(B) Home care attendant services are
services provided to an individual enrolled on a waiver by an unlicensed
non-agency provider in accordance with this rule. Home care attendant services
are tasks that would otherwise be performed by an RN or an LPN at the direction
of an RN. Home care attendant services include:
(1) Assistance with
self-administration of medications as set forth in paragraph (E) of this
rule.
(2) Assistance with the
performance of nursing tasks as set forth in paragraph (F) of this
rule.
(3) Tasks performed as
part of personal care aide services as described in rule 5160-46-04 or
173-39-02.11 of the Administrative Code when performed during a home care
attendant service visit. Personal care aide tasks are not reimbursable
separately as personal care aide services when they are performed during a home
care attendant service visit.
(C) Home care attendant services may be
provided:
(1) In the
individual's home or in the community; and
(2) To assist an
individual to function in the workplace without duplicating workplace
accommodations.
(D) If the individual has an authorized representative as
5166.3010 of the Revised Code, the authorized representative will be present
and awake during the delivery of home care attendant services.
(E) Assistance with self-administration of
medication.
(1) A home care attendant
will only assist an individual enrolled on a waiver with the
self-administration of the following medication:
(a) Oral medications;
(b) Topical medications;
(c) Subcutaneous injections only for routine doses of
insulin;
(d) Programming of a pump only used to deliver a routine dose of
insulin;
(e) Medication administered via stable, labeled gastrostomy or
jejunostomy tubes using pre-programmed pumps; and
(f) Doses of schedule II, schedule III, schedule IV and schedule
V drugs only when administered orally or topically.
(2) Medication will be
maintained in its original container and the attached label will match the
dosage and means of administration set forth on the ODM 02389 "Home Care
Attendant Medication Authorization" form. The label on the container will
display all of the following information for the individual enrolled on a
waiver:
(a) The individual's full name;
(b) A dispensing date within the prior twelve months;
and
(c) The exact dosage and means of administration.
(3) For schedule II,
schedule III, schedule IV and schedule V drugs, all of the following
apply:
(a) Medication(s) will have a warning label on the
bottle;
(b) During the first visit, the home care attendant will count
the medication(s) in the presence of the individual enrolled on a waiver or the
authorized representative and will record the count on a log located in the
individual's clinical record.
(c) The medication(s) will be recounted by the home care
attendant in the presence of the individual enrolled on a waiver or the
authorized representative at least monthly, and the count will be reconciled on
a log located in the individual's clinical record. The home care attendant
will notify the authorizing health care professional, in writing, within
twenty-four hours if:
(i) Medication is
missing; or
(ii) The count of
medication(s) cannot be reconciled.
(d) The medication(s) will be stored separately from all other
medications, and secured and locked at all times when not being administered in
order to prevent access by unauthorized persons.
(F) Assistance with the performance of nursing
tasks.
(1) A home care attendant
may assist with the performance of nursing tasks not expressly excluded in
accordance with paragraph (F)(2) of this rule.
(2) A home care attendant
may not assist an individual who is receiving home care attendant services with
the performance of any of the following nursing tasks:
(a) Intravenous (IV) insertion, removal or
discontinuation;
(b) Intramuscular injections;
(c) IV medication administration;
(d) Subcutaneous injections, except for routine doses of insulin
pursuant to paragraph (E)(1)(c) of this rule;
(e) Programming of a pump used to deliver medications (including,
but not limited to epidural, subcutaneous and IV), except for routine doses of
insulin pursuant to paragraph (E)(1)(d) of this rule;
(f) Insertion or initiation of infusion therapies;
and
(g) Central line dressing changes.
(3) Performance of
nursing tasks will be summarized and submitted on the ODM 02390 "Home Care
Attendant Skilled Task Authorization" form.
(G) In order to provide services to an individual enrolled on a
waiver and to submit a claim for reimbursement, home care attendants will meet
all of the following requirements:
(1) As part of the medicaid provider
agreement application process, provide ODM, ODA or their designee with evidence
to its satisfaction of the following:
(a) Submission of the ODM 02389 "Home Care Attendant
Medication Authorization" form and/or ODM 02390 "Home Care Attendant
Skilled Task Authorization" form as prescribed by paragraph (H) of this
rule.
(b) Successful completion of at least one of the
following:
(i) A competency
evaluation program or training and competency evaluation program approved or
conducted by the director of health under section 3721.31 of the Revised Code,
and registration as active or in good standing on the Ohio nurse aide registry
maintained by the director of health under section 3721.32 of the Revised Code;
or
(ii) A training program
and competency evaluation program for home health aides as specified in 42
C.F.R. 484.4 and 484.36, if the person met those standards as they existed on
or before January 12, 2018, or 42 C.F.R. 484.80 and 484.115, if the person met
those standards since they were adopted on January 13, 2018. A person is not
considered to have completed a training and competency evaluation program, or a
competency evaluation program if, since the person's most recent
completion of this program(s), there has been a continuous period of
twenty-four consecutive months during none of which the person furnished
services described in 42 C.F.R. 409.40 (as in effect on October 1, 2023);
or
(iii) A certified
vocational program in a health care field, and written testing and skills
testing by return demonstration; or
(iv) A written
attestation of training, instruction, and as appropriate, skills testing by
return demonstration prior to initiation of service provision on:
(a) Appropriate and safe
techniques in personal hygiene and grooming that include: bed, tub, shower and
partial bath techniques, shampoo in sink, tub or bed, nail and skin care, oral
hygiene, toileting and elimination, safe transfer and ambulation, normal range
of motion and positioning, and adequate nutrition and fluid
intake.
(b) The maintenance of a
clean, safe and healthy environment, including but not limited to, house
cleaning and laundry, dusting furniture, sweeping, vacuuming and washing
floors, kitchen care (including dishes, appliances and counters), bathroom
care, emptying and cleaning bedside commodes and urinary catheter bags,
changing bed linens, washing inside windows within reach from the floor,
removing trash and folding, ironing and putting away laundry.
(c) Meal preparation,
including special diet preparation, grocery purchase, planning and shopping,
and running errands.
(d) The physical,
emotional and developmental needs of individuals, including the need for
privacy and respect for individuals and their property.
(e) Universal precautions
for the prevention of disease transmission, including hand-washing and proper
disposal of bodily waste and medical instruments that are sharp or may produce
sharp pieces if broken.
(f) Basic elements of
body functioning and changes in body function that should be reported to a
supervisor.
(g) Basic safety
requirements and knowledge of emergency procedures.
(h) Reading and recording
temperature, pulse and respiration.
(i) Observation,
reporting and documentation of individual status and services
provided.
(j) Communication skills,
including the ability to read, write and make brief and accurate oral or
written reports.
(c) Completion of training and instruction, prior to the
provision of home care attendant services, regarding the delivery of the home
care attendant services authorized by the individual's authorizing health
care professional. The training will be specific to the individual enrolled on
a waiver and may be provided by the individual's authorizing health care
professional, the individual receiving services or the authorized
representative in cooperation with the individual's health care
professional as indicated on the ODM 02389 "Home Care Attendant Medication
Authorization" form and/or ODM 02390 "Home Care Attendant Skilled
Task Authorization" form, as appropriate.
(d) Performance of a successful return demonstration of the home
care attendant service to be provided if requested by the individual enrolled
on a waiver or the authorizing health care professional.
(e) Completion and maintenance of first aid certification from a
class that is not solely internet-based and that includes hands-on training by
a certified first aid instructor and a successful return demonstration of what
was learned in the course, and certification that education was received from
the authorizing health care professional about health and welfare
considerations appropriate for an individual or group setting.
(f) Completion and maintenance of cardiopulmonary resuscitation
(CPR) certification from a class that is not solely internet-based and that
includes hands-on training by a certified CPR instructor and a successful
return demonstration of what was learned in the course. Current providers and
those provider-applicants whose applications are pending as of the effective
date of this rule shall have one hundred and eighty days from the effective
date of this rule to meet this requirement.
(2) Be a non-agency provider who holds an
active medicaid provider agreement as a home care attendant and who maintains
compliance with sections 5166.30 to 5166.3010 of the Revised Code and
applicable rules set forth in Chapters 173-39, 5160-44, 5160-45 and 5160-46 of
the Administrative Code.
(3) Request reimbursement for the
provision of home care attendant services in accordance with rule 5160-1-06.1
of the Administrative Code for Ohio department of aging certified providers or
5160-46-06.1 of the Administrative Code for providers of Ohio department of
medicaid administrated waiver programs.
(4) Not be the authorizing health care
professional of the individual receiving services.
(5) Not be an authorized
representative of the individual receiving services.
(6) Not be the legally
responsible family member as that term is defined in rule 5160-45-01 of the
Administrative Code of the individual receiving services.
(7) Not be the legal
guardian or foster caregiver of the individual receiving services.
(8) In collaboration with the individual
receiving services, secure the services of an RN and participate in an
in-person visit with the individual receiving services, the authorized
representative, and the RN for the purpose of answering any questions the home
care attendant and/or individual receiving services, or authorized
representative have about meeting care needs, medications and other issues.
(a) At least twice per year, the RN will conduct RN home
care attendant service visits in-person.
All other RN home care attendant service visits may be
conducted via telehealth, unless the individual's needs necessitate an
in-person visit.
(b) The RN performing an RN home care attendant service
visit will:
(i) Possess a current, valid and unrestricted license with the
Ohio board of nursing;
(ii) Possess an active Ohio medicaid provider
agreement;
(iii) Comply with the conditions of participation as set forth in
rule 5160-44-31 of the Administrative Code.
(c) The RN will be present at the first visit between the
home care attendant and individual upon the initiation of home care attendant
services. ODM, ODA, or their designee will also be present at the first
visit.
(d) The home care attendant and the RN will document the
activities of each visit in the clinical record of the individual receiving
services.
(e) The home care attendant will discuss the results of the
RN visit with ODM, ODA or their designee, the individual receiving services
and/or the authorized representative.
(f) When the RN performs an RN home care attendant service
visit, the RN may bill the state plan nursing assessment code set forth in
appendix A to rule 5160-12-08 of the Administrative Code.
(H) If authorized on the person-centered
services plan, a home care attendant may provide services to two or three
individuals enrolled on a waiver in a group setting.
(I) The ODM 02389 "Home Care Attendant Medication
Authorization" form and/or the ODM 02390 "Home Care Attendant Skilled
Task Authorization" form, as appropriate, will contain all of the
following:
(1) Written consent from
the individual enrolled on a waiver or the authorized representative, as
applicable, allowing the home care attendant to provide home care attendant
services, and assuming responsibility for directing the home care
attendant.
(2) A written statement
from the authorizing health care professional attesting that the individual
enrolled on a waiver or the authorized representative has demonstrated the
ability to direct the home care attendant. The written statement will also
indicate whether the home care attendant has demonstrated the ability to
furnish the home care attendant service to the individual enrolled on a waiver.
The statement will include all of the following:
(a) The name and address of the individual receiving home care
attendant services;
(b) A description of the specific nursing task or
self-administration of medication that the home care attendant will assist
with, including, in the case of assistance with self-administration of
medication, the name, dosage, and route of administration of the
medication;
(c) The times or intervals when the home care attendant is to
assist the individual receiving services with the self-administration of each
dosage of the medication or with the performance of nursing tasks;
(d) The dates on which the home care attendant is to begin and
cease providing assistance;
(e) A list of severe adverse reactions that the home care
attendant will report to the individual's health care professional should
the individual experience one or more reactions;
(f) At least one telephone number at which the home care
attendant can reach the individual's health care professional in an
emergency for consultation after contacting emergency personnel;
(g) At least one contact number at which the home care attendant
can reach the authorizing health care professional when the home care attendant
observes that scheduled medication(s) is missing or cannot be reconciled;
and
(h) Instructions the home care attendant will follow when
assisting the individual receiving services with the performance of a nursing
task or the self-administration of medications, including, instructions for
maintaining sterile conditions and for the storage of task-related equipment
and supplies.
(J) The individual enrolled on a waiver will participate
with ODM, ODA, or their designee in the development and maintenance of a
written back-up plan prior to initiation of services. The authorizing health
care professional and/or the home care attendant may also participate in the
development and maintenance of the back-up plan.
(1) The back-up plan will meet the needs
of the individual enrolled on a waiver in the event:
(a) The regularly scheduled home care attendant cannot or does
not meet his or her obligation to provide services to the individual receiving
services; or
(b) The individual receiving services and/or the authorized
representative is not able to direct home care attendant services.
(2) As authorized by ODM, ODA, or their
designee,
(a) Waiver nursing as set forth in rule 5160-44-22 of the
Administrative Code, and/or private duty nursing or home health nursing as set
forth in Chapter 5160-12 of the Administrative Code, may be used as back-up to
assist with self-administration of medications and the performance of nursing
tasks;
(b) Personal care aide services as set forth in rule 5160-46-04
of the Administrative Code may be used as back-up for personal care aide tasks
in an ODM-administered waiver;
(c) Personal care services as set forth in rule 173-39-02.11 of
the Administrative Code may be used as back-up for personal care tasks in the
PASSPORT waiver; and
(d) Back-up may include informal caregivers.
(K) All home care attendants service providers will
maintain a clinical record for each individual served in accordance with the
requirements set forth in rule 5160-44-31 of the Administrative
Code.
(1) Storage of the
clinical record will be in a manner that protects the confidentiality of these
records and will be in a secure location that may be the individual's
residence or primary location where the individual receives
services.
(2) Each clinical record will
include:
(a) Identifying information including name, address, date of
birth, gender/gender identity, race, significant phone numbers and health
identification numbers of the individual.
(b) Information regarding the individual's medical
diagnoses, treatment and preferences.
(c) The individual's medication profile, as
applicable.
(d) The individual's treatment administration record, as
applicable.
(e) The name and contact information for all of the licensed
health care professionals serving the individual.
(f) The name of and current contact information for the
individual's parent/guardian/authorized representative and/or emergency
contact.
(g) A copy of the initial and all subsequent person-centered
services plans.
(h) All known drug and food interactions, allergies and dietary
needs, preferences and/or restrictions.
(i) A copy of any advance directives including, but not limited
to, a "do not resuscitate order" (DNR) or a "medical power of
attorney," if they exist.
(j) The ODM 02389 "Home Care Attendant Medication
Authorization" form and/or the ODM 02390 "Home Care Attendant Skilled
Task Authorization" form, as appropriate. The ODM 02389 "Home Care
Attendant Medication Authorization" form and/or the ODM 02390 "Home
Care Attendant Skilled Task Authorization" form will be updated and
reflected in the clinical record should any changes in home care attendant
service provisions be needed.
(k) Documentation of home care attendant services performed or
not performed, arrival and departure times, and the dated signature of the
provider, and individual receiving services or the authorized representative,
verifying the service delivery upon its completion and arrival and departure
times. The signature method of choice for the individual receiving services or
the authorized representative will be documented on the person-centered
services plan, and will include, but not be limited to, any of the following: a
handwritten signature, initials, a stamp or mark, or an electronic signature.
If the individual is unable to provide the signature at the time of service,
the individual is to submit an electronic signature or standard signature via
regular mail, or otherwise provide a signature in no instance any later than
within three business days of the completion of the service delivery that
requires signature.
(l) A copy of the log detailing the count and reconciliation of
schedule II, schedule III, schedule IV and schedule V drugs for which
assistance with self-administration is provided.
(m) Service notes, signed and dated by the home care attendant,
documenting all communications with ODM, ODA or their designee, health care
professionals including the authorizing health care professional, and other
members of the individual's team, and documenting the general condition of
the individual, any unusual events occurring during the visit, and the service
tasks performed.
(n) Documentation of the RN home care attendant service visits
every ninety days between the home care attendant, individual enrolled on a
waiver and RN, and of any resulting activities, in accordance with paragraph
(G)(8) of this rule.
(L) Unless the clinical record described
in paragraph (K) of this rule is maintained in the home of the individual and
accessible to team members, the home care attendant will maintain another
record which:
(1) Includes
communication logs going back no less than sixty calendar days in a format
agreed upon by the individual and provider for the purpose of promoting
communication between team members.
(2) Any other
documentation required by the individual.
(3) Is maintained in a
place and manner that is accessible to the individual and other team members
chosen by the individual at the individual's residence or primary service
location.
(4) Is maintained in a
manner that protects the confidentiality of the individual.
(M) If ODM, ODA, or their designee determines that the
individual enrolled on a waiver cannot meet the requirements of this rule, or
the health and welfare of the individual receiving home care attendant services
cannot be ensured, then ODM, ODA, or their designee, at its discretion, may
prohibit the individual from receiving home care attendant services. The
individual will be afforded notice and hearing rights in accordance with
division 5101:6 of the Administrative Code.
