Lawriter - OAC - 5160-51-04 Helping Ohioans move, expanding choice (HOME choice) program definitions of covered services and provider qualifications.

5160-51-04 Helping Ohioans move, expanding choice (HOME choice) program definitions of covered services and provider qualifications.

(A) This rule sets forth the covered services available to a helping Ohioans move, expanding choice (hereafter referred to as HOME choice) program participant as well as provider requirements for those services.

(B) "Communication aid services" include devices, systems or services necessary to assist a HOME choice participant with hearing, speech or vision impairments to effectively communicate with others.

(1) Communication aid services 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 participant's communication impairment;

(b) Computers and computer equipment;

(c) Other mechanical and electronic devices;

(d) Cable and internet access;

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

(f) Interpreter services that support the HOME choice participant's integration into the community. Interpreter services refers 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; and

(g) New technologies and any other devices that achieve the objective of the service.

(2) If the HOME choice participant is enrolled on a home and community based services (HCBS) waiver, the participant must exhaust similar waiver services that are available before utilizing communication aid services through HOME choice.

(3) A provider of communication aid services must be an agency provider who is:

(a) An Ohio department of medicaid (ODM)-approved provider of supplemental adaptive and assistive device services in accordance with rule 5160-46-04 or rule 5160-50-04 of the Administrative Code, as appropriate; or

(b) An Ohio department of developmental disabilities (DODD)-certified provider of adaptive and assistive equipment services in accordance with rule 5123:2-2-01 of the Administrative Code; or

(c) An Ohio department of aging (ODA)-certified long term care provider of home medical equipment and supplies in accordance with rule 173-39-03 of the Administrative Code.

(4) Reimbursement for communication aid services shall not exceed a total of five thousand dollars during the participant's demonstration period. The same type of communication aid equipment may be approved by ODM for the HOME choice participant when there is a documented need.

(5) In order to submit a claim and be reimbursed for communication aid services, the provider delivering the service must:

(a) Meet the conditions of participation and enrollment criteria set forth in rule 5160-51-03 of the Administrative Code, as well as all applicable provider qualifications set forth in this rule; and

(b) Be identified as the communication aid service provider on the participant's HOME choice service plan as authorized by ODM. The authorized service plan will indicate the service begin date and the number of units/hours for which the provider is authorized to furnish services to the participant. The provider will not be reimbursed for unauthorized services including services provided in excess of what is documented on the participant's service plan for that provider.

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

(1) The community support coach shall:

(a) Communicate with and educate the participant about vital aspects of the transition process;

(b) Assist the HOME choice participant in:

(i) Making informed and independent choices,

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

(iii) Managing multiple tasks,

(iv) Identifying options and problem solving,

(v) Identifying community resources available to the participant, and

(vi) Connecting to potential employment opportunities before, during and after transition.

(c) Provide the case manager, service and support administrator, or HOME choice case manager, as appropriate, with written status reports during the participant's demonstration period, as prescribed by the HOME choice service plan.

(2) A provider of community support coaching services shall not be the same staff person, of a transition coordination agency, who provided transition coordination services to the same participant during their pre-transition period.

(3) Community support coaching shall not duplicate independent living skills training available through HOME choice, similar waiver services available to participants enrolled on an HCBS waiver, or services available through the medicaid state plan.

(4) A provider of community support coaching must:

(a) Be a non-agency provider, or

(b) Be an agency provider that is either:

(i) A community mental health provider certified by the Ohio department of mental health and addiction services (OhioMHAS) in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code, or

(ii) A non-profit agency provider.

(5) Non-agency providers of community support coaching services, and all staff members of agency providers of community support coaching services with direct participant contact must:

(a) Have either:

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

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

(b) Be age eighteen or older;

(c) Possess a valid Ohio driver license and automobile liability insurance when providing transportation;

(d) Not be the participant's legally responsible family member; and

(e) Not be the participant's case manager or service and support administrator, as those terms are defined in rule 5160-51-01 of the Administrative Code.

(6) In order to a submit claim and be reimbursed for community support coaching, the provider delivering the service must:

(a) Meet the conditions of participation and enrollment criteria set forth in rule 5160-51-03 of the Administrative Code, as well as all applicable provider qualifications set forth in this rule; and

(b) Be identified as the community support coach provider on the participant's HOME choice service plan as authorized by ODM. The authorized service plan will indicate the service begin date and the number of units/hours for which the provider is authorized to furnish services to the participant. The provider will not be reimbursed for unauthorized services including services provided in excess of what is documented on the participant's service plan for that provider.

(D) "Community transition services" are goods, services and support for the purpose of addressing an identified need in a participant's HOME choice service plan, including improving and maintaining the participant's opportunities for inclusion in the community.

(1) Community transition services are intended to:

(a) Decrease the need for formal support services and other medicaid services;

(b) Take into consideration the appropriateness and availability of a lower cost alternative for comparable services that meet the participant's needs;

(c) Promote community inclusion and family involvement;

(d) Improve the participant's health and welfare in the home and community;

(e) Be provided when the participant does not have the funds to purchase the services, or the services are not available through another source;

(f) Assist the participant in developing and maintaining personal, social, physical or work-related skills; and

(g) Assist the participant in living independently in the home and community.

(2) Community transition services include:

(a) Transportation expenses up to a maximum of five hundred dollars during the participant's pre-transition period and for thirty days after transitioning to the community;

(b) Initial transition expenses up to a maximum of two thousand dollars including, but not limited to the following:

(i) Security deposit and rent required to lease a qualified residence;

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

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

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

(v) Moving expenses;

(vi) Necessary home accessibility adaptations; and

(vii) Initial grocery purchase, i.e., food and household supplies.

(3) Community transition services do not include:

(a) Experimental or prohibited treatments;

(b) The ongoing cost of rent;

(c) Ongoing utility charges;

(d) Ongoing grocery expenses;

(e) Cigarettes and alcohol;

(f) Electronics and other household appliances or items that are intended to be used for entertainment or recreational purposes; and

(g) Cable and/or internet access.

(4) Community transition services shall not duplicate similar services available to a participant who is enrolled on an HCBS waiver except when the participant is enrolled on an ODA-administered waiver or ODM-administered waiver. Participants enrolled on an ODA-administered waiver or ODM-administered waiver shall use HOME choice community transition services in lieu of, but not in addition to, the community transition services available through the waiver.

(5) Reimbursement for community transition services shall not exceed a cumulative maximum of two thousand five hundred dollars for the items set forth in paragraph (D)(2) of this rule.

(6) In order to submit a claim and be reimbursed for community transition services:

(a) The specific goods and services purchased shall have been based upon the participant's needs; and

(b) The goods and/or services must have been identified on the participant's HOME choice service plan as authorized by ODM. The authorized service plan will indicate the service begin date for which the provider is authorized to furnish community transition services to the participant. The provider will not be reimbursed for unauthorized community transition services including community transition services provided in excess of what is documented on the participant's service plan for that provider.

(7) During the HOME choice participant's demonstration period, the purchase of community transition services shall be coordinated by the participant's case manager, service and support administrator and/or HOME choice case manager as appropriate and as approved by ODM prior to submission for reimbursement to the ODM-designated HOME choice financial management service (FMS) provider.

(E) "HOME choice nursing services" are intermittent services provided to a HOME choice participant 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 providers who are not licensed nurses;

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

(c) Visits performed for the purpose of conducting an RN assessment, including but not limited to an outcome and assessment information set (OASIS) assessment or any other assessment;

(d) Visits or communication performed by an RN either for the purpose of RN consultation or for the purpose of meeting supervisory requirements;

(e) Visits performed for the purpose of meeting the home care attendant service RN visit requirements set forth in rules 5160-46-04.1 and 5160-50- 04.1 of the Administrative Code.

(2) HOME choice nursing services shall not duplicate similar waiver services available to participants enrolled on an HCBS waiver or available through medicaid state plan home health nursing or private duty nursing services.

(3) HOME choice nursing services may be provided on the same day as, but not concurrently with an RN assessment or an RN consultation.

(4) A provider of HOME choice nursing services must be a medicaid provider who is either:

(a) Employed by a medicare-certified, or otherwise-accredited home health agency; or

(b) An approved ODM-administered waiver non-agency nursing service provider in accordance with rule 5160-46-04 or 5160-50-04 of the Administrative Code.

(5) A provider of HOME Choice nursing services must not be:

(a) The participant's legally responsible family member unless the family member is employed by a medicare-certified, or otherwise-accredited home health agency; or

(b) The foster caregiver of the participant.

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

(a) Meet with the directing RN at least every sixty days after the initial visit to evaluate the provision of HOME choice nursing services and the LPN's performance of those services, and to ensure that services are being provided in accordance with the approved plan of care and within the LPN's scope of practice; and

(b) Conduct an in-person visit with the participant and the directing RN before 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 the LPN's performance, and to ensure that services are being provided in accordance with the approved plan of care and within the LPN's scope of practice

(7) 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 include:

(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) The participant's medical history;

(c) Name of the participant's treating physician;

(d) A copy of the HOME choice service plan approved by ODM;

(e) A copy of the initial and all subsequent plans of care, specifying the type, frequency, scope and duration of the 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) Documentation of verbal orders given by the treating physician to the nurse. The nurse must document, in writing, the physician's verbal 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) Clinical notes, signed and dated by the non-agency LPN, in all instances when a non-agency LPN is providing HOME choice nursing services. The LPN must maintain documentation of all consultations between the LPN and the directing RN, and the in-person visits between the LPN, the participant and the directing RN;

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

(i) A copy of any existing advanced directives including, but not limited to, do not resuscitate orders or medical powers of attorney;

(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 their guardian verifying the service delivery upon completion of service delivery. The participant or their guardian's signature of choice shall be documented on the HOME choice 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; and

(l) A discharge summary, signed and dated by the nurse at the conclusion of the participant's demonstration 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.

(8) In order to submit a claim and be reimbursed for HOME choice nursing services, the provider delivering the service must:

(a) Meet the conditions of participation and enrollment criteria set forth in rule 5160-51-03 of the Administrative Code, as well as all applicable provider qualifications set forth in this rule; and

(b) Be identified as the HOME choice nursing services provider on the participant's HOME choice service plan as authorized by ODM. The authorized service plan will indicate the service begin date and the number of units/hours for which the provider is authorized to furnish services to the participant. The provider will not be reimbursed for unauthorized services including services provided in excess of what is documented on the participant's service plan for that provider;

(c) 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 5160-51-01 of the Administrative Code. The plan of care must be signed and dated by the participant's treating physician; and

(d) Have provided the services for one participant during an in-person visit, or for two or three participants in a group setting during an in-person visit.

(F) "Independent living skills training" is information, educational supports and resources provided to a HOME choice participant for the purpose of developing skills, knowledge or abilities needed to live more independently.

(1) Independent living skills training focuses on:

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

(i) Identifying and accessing existing community resources,

(ii) Job training and seeking employment opportunities,

(iii) Linking to legal resources,

(iv) Negotiating transportation systems and arranging transportation,

(v) Safety in the community, and

(vi) Travel training.

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

(i) Budgeting,

(ii) Finding a bank and establishing an account,

(iii) Managing entitlements and insurance,

(iv) Paying bills and taxes,

(v) Understanding credit,

(vi) Understanding contracts,

(vii) Using a bank machine,

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

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

(ii) Crisis care/recovery services,

(iii) Efficiently managing nutrition and diet,

(iv) Ensuring emergency preparedness,

(v) Linking to medical/dental services,

(vi) Managing and accessing medical supplies,

(vii) Managing medication,

(viii) Talking to the doctor, and

(ix) Training service providers;

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

(i) Grocery shopping, cooking and meal planning,

(ii) Housekeeping and laundry,

(iii) Operating simple technology,

(iv) Personal shopping,

(v) Requesting and/or completing simple repairs, and

(vi) Safety at home;

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

(i) Building communication skills,

(ii) Knowing when and how to ask for help,

(iii) Learning how to be a good neighbor/roommate, and

(iv) Learning how to work with providers.

(2) Independent living skills training shall not duplicate community support coaching services available through HOME choice, similar waiver services available to participants enrolled on an HCBS waiver, or services available through the medicaid state plan.

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

(4) The independent living skills training provider shall provide the case manager, service and support administrator, or HOME choice case manager, as appropriate, with written status reports as directed during the participant's demonstration period.

(5) A provider of independent living skills training must be either:

(a) A community mental health provider certified by OhioMHAS in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code; or

(b) A non-profit agency provider whose staff with direct participant contact:

(i) Have either:

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

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

(ii) Must have knowledge and experience about:

(a) Local community resources,

(b) Applicable disability laws and regulations, and

(iii) Are age eighteen or older; and

(iv) Possess a valid Ohio driver license and automobile liability insurance when providing transportation.

(6) In order to submit a claim and be reimbursed for independent living skills training, the provider delivering the service must:

(a) Meet the conditions of participation and enrollment criteria set forth in rule 5160-51-03 of the Administrative Code, as well as all applicable provider qualifications set forth in this rule;

(b) Be identified as the independent living skills training provider on the participant's HOME choice service plan as authorized by ODM. The authorized service plan will indicate the service begin date and the number of units/hours for which the provider is authorized to furnish services to the participant. The provider will not be reimbursed for unauthorized services including services provided in excess of what is documented on the participant's service plan for that provider; and

(c) Have provided the service to one participant, or to two or three participants in a group setting, or four or more participants in a classroom setting, during the same in-person visit.

(G) "Nutritional consultation services" are services that provide individualized guidance to a HOME choice 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 duplicate similar waiver services available to participants enrolled on an HCBS waiver or services available through the medicaid state plan.

(2) A provider of nutritional consultation services must be:

(a) 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; and,

(b) 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;

(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 an assessment tool that identifies whether the participant is at nutritional risk or identifies a nutritional diagnosis that the dietitian will treat. The assessment must include:

(i) A history of the participant's height and weight;

(ii) An assessment of the participant's nutrient intake adequacy;

(iii) A review of the participant's medications, medical diagnoses and diagnostic test results;

(iv) An assessment of the participant's 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 for the participant.

(b) Develop, implement, evaluate and revise, as necessary, a nutrition intervention plan with the assistance of the participant and/or their guardian, 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) Provide 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 re certified by the treating physician every sixty days, or more frequently if there is a significant change in the participant's condition.

(d) Furnish the case manager, service support administrator, or HOME choice case manager, as appropriate, as well as the participant and/or the participant's guardian with a copy of the assessment and the nutrition intervention plan no later than seven working days after completion of the assessment.

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

(f) Maintain a clinical record for each participant served. At a minimum, the clinical record must include:

(i) 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;

(ii) The participant's medical history;

(iii) Name of the participant's treating physician;

(iv) Treating physician's authorization for a nutritional assessment;

(v) A copy of the HOME choice service plan approved by ODM;

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

(vii) 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;

(viii) A copy of the initial and all subsequent nutrition intervention plans developed and implemented;

(ix) Documentation of all drug and food interactions, allergies and dietary restrictions;

(x) 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; and

(xi) A discharge summary, signed and dated by the nutritional consultation provider at the conclusion of the participant's demonstration period, or 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.

(4) In order to submit a claim and be reimbursed for nutritional consultation services, the provider delivering the service must:

(a) Meet the conditions of participation and enrollment criteria set forth in rule 5160-51-03 of the Administrative Code, as well as all applicable provider qualifications set forth in this rule; and

(b) Be identified as the nutritional consultation services provider on the participant's HOME choice service plan as authorized by ODM. The authorized service plan will indicate the service begin date and the number of units/hours for which the provider is authorized to furnish services to the participant. The provider will not be reimbursed for unauthorized services including services provided in excess of what is documented on the participant's service plan for that provider.

(H) "Respite services" are services provided on a short-term basis to a HOME choice participant who is not enrolled on an HCBS waiver, and who is unable to care for himself or herself, due to the temporary absence of 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-home, out-of-home or in a day camp setting in accordance with the participant's HOME choice service plan.

(1) In-home respite services are services provided in the participant's place of residence and shall include, but not be limited to:

(a) General supervision of the participant;

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

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

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

(e) Accompanying the participant to community outings; and

(f) Other related services.

(2) Out-of-home respite services are services provided in an out-of-home setting that meets the requirements set forth in paragraph (H)(4)(b) of this rule, and that require an overnight stay. Out-of-home respite services shall include, but not be limited to:

(a) Personal care services;

(b) Skilled nursing services; and

(c) Three meals per day that meet the participant's dietary needs.

(3) Day camp respite services are 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 intervention that will meet the emotional and behavioral needs of the HOME choice 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 participant's place of residence.

(4) A provider of respite services must be one of the following:

(a) An in-home respite provider who is:

(i) A homemaker/personal care provider certified by DODD in accordance with rules 5123:2-9-30 and 5123:2-2-01 or rule 5123:2-3-19 of the Administrative Code, as applicable; or

(ii) An approved ODM-administered waiver personal care aide service provider or nursing service provider in accordance with rule 5160-46-04 or 5160-50-04 of the Administrative Code; or

(b) An out-of-home respite provider that is:

(i) Approved by ODM in accordance with rule 5160-45-04 of the Administrative Code; or

(ii) An intermediate care facility for individuals with intellectual disabilities (ICF-IID) that meets the requirements set forth in rules 5160-3-02 and 5160-3-02.3 of the Administrative Code; or

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

(iv) A nursing facility that meets the requirements set forth in rules 5160-3-02 and 5160-3-02.3 of the Administrative Code; or

(v) Another licensed setting approved by ODM or its designee, including but not limited to, a hospice or hospital; or

(c) 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.

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

(a) 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 order to maintain ongoing provider status, 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;

(b) Not be the participant's legally responsible family member;

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

(d) Provide care as specified by task-based instruction for the provision of personal care services. Agency providers must provide such task-based instruction to direct care staff providing personal care services. Non-agency providers will receive instruction regarding their necessary care from the participant and/or their guardian and as documented in their plan of care.

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

(a) Provide insurance 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. Documentation verifying the coverage shall be provided to ODM upon request;

(b) 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 order to maintain ongoing provider status, 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;

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

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

(7) All 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 ensure at a minimum the record contains the information set forth in paragraphs (H)(7)(a) to (H)(7)(g) of this rule. At a minimum, providers of out-of-home respite must ensure the record contains the information set forth in paragraphs (H)(7)(a) to (H)(7)(h) 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 number;

(b) The participant's medical history;

(c) A copy of the initial and all subsequent HOME choice service plans;

(d) A copy of any existing advance directives including, but not limited to, do not resuscitate orders or medical powers of attorney;

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

(f) Documentation including, but not limited to, case notes clearly showing the date and outcome of respite service delivery, including tasks performed or not performed;

(g) Documentation required for providers of ODM administered waiver nursing services as set forth in rule 5160-46-04 or 5160-50-04 of the Administrative Code when skilled nursing services are provided during respite services;

(h) A discharge summary, signed and dated by the 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.

(8) In order to submit a claim and be reimbursed for respite services the provider must:

(a) Meet the conditions of participation and enrollment criteria set forth in rule 5160-51-03 of the Administrative Code, as well as all applicable provider qualifications set forth in this rule; and

(b) Be identified as the respite services provider on the participant's HOME choice service plan as approved by ODM. The authorized service plan will indicate the service begin date and the number of units/hours for which the provider is authorized to furnish services to the participant. The provider will not be reimbursed for unauthorized services including services provided in excess of what is documented on the participant's service plan for that provider.

(I) "Service animals" are animals that are trained to perform tasks for HOME choice participants that the participants are unable to perform for themselves.

(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) Expenses 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, participant orientation and related transportation, room/board and administrative activities;

(d) Equipment and supplies;

(e) Animal health insurance; and

(f) Transportation to the veterinarian.

(4) If the HOME choice participant is enrolled on a DODD-administered waiver, the participant must exhaust similar waiver services that are available before utilizing the service animal service through HOME choice.

(5) A provider of service animal services must be an agency provider of adaptive and assistive equipment services as certified by DODD in accordance with rule 5123:2-2-01 of the Administrative Code.

(6) Reimbursement for service animal expenses shall not exceed a total of eight thousand dollars during the participant's demonstration period.

(7) In order to submit a claim and be reimbursed for service animal services, the provider delivering the service must:

(a) Meet the conditions of participation and enrollment criteria set forth in rule 5160-51-03 of the Administrative Code, as well as all applicable provider qualifications set forth in this rule; and

(b) Be identified as the service animal service provider on the participant's HOME choice service plan as authorized by ODM. The authorized service plan will indicate the service begin date and the number of units/hours for which the provider is authorized to furnish services to the participant. The provider will not be reimbursed for unauthorized services including services provided in excess of what is documented on the participant's service plan for that provider.

(J) "Social work/counseling services" are transitional services provided to a HOME choice participant, their guardian, 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 participant.

(1) Social work/counseling services can include, but are not limited to, crisis interventions, grief counseling and/or other social service interventions that support the participant's health and welfare.

(2) Social work/counseling services shall not:

(a) Take the place of case management services; or

(b) Duplicate similar waiver services available to participants enrolled on an HCBS waiver or through the medicaid state plan.

(3) A provider of social work/counseling services must be either:

(a) A non-agency provider who shall maintain documentation of licensure by the applicable Ohio licensure board and have at least one year of social work/counseling experience, and is:

(i) 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

(ii) 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

(iii) 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; or

(b) An agency provider who shall 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, and:

(i) Is 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 OhioMHAS in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code, or is an ODA-certified long term care provider of social work counseling services in accordance with rule 173-39- 02.12 of the Administrative Code; and

(ii) Ensures that staff providing direct care is one of the following:

(a) 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;

(b) 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

(c) 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; and

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

(4) A provider of social work/counseling services must:

(a) Conduct individual assessments in order to evaluate the HOME choice participant's psycho-social, financial and environmental status;

(b) Develop and revise, as necessary, with the assistance of the participant, and/or the participant's guardian, caregiver(s) and the case manager or service and support administrator, as appropriate, a treatment plan that includes the recommended method of treatment and the recommended number of counseling sessions;

(c) Ensure that the treatment plan is implemented; and

(d) Furnish to the case manager, service and support administrator, or HOME choice case manager, 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 guardian shall also be furnished with a copy of the individual assessment report and the treatment plan unless otherwise specified by the treatment plan.

(e) Maintain a clinical record for each participant served. At a minimum, the clinical record must include:

(i) 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;

(ii) The participant's medical history;

(iii) Name of the participant's treating physician;

(iv) A copy of the HOME choice service plan approved by ODM;

(v) A copy of the initial and all subsequent individual assessments;

(vi) A copy of the initial and all revised treatment plans;

(vii) A copy of any existing advanced directives including, but not limited to, do not resuscitate orders or medical powers of attorney;

(viii) Documentation of all drug and food interactions, allergies and dietary restrictions;

(ix) Documentation that clearly shows the date of social work/counseling service delivery;

(x) A discharge summary, signed and dated by the social work/counseling service provider at the conclusion of the participant's demonstration period, or at the point the provider is no longer going to provide 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.

(5) In order to submit a claim and be reimbursed for social work/counseling services, the provider delivering the service must:

(a) Meet the conditions of participation and enrollment criteria set forth in rule 5160-51-03 of the Administrative Code, as well as all applicable provider qualifications set forth in this rule; and

(b) Be identified as the social work/counseling services provider on the participant's HOME choice service plan as approved by ODM. The authorized service plan will indicate the service begin date and the number of units/hours for which the provider is authorized to furnish services to the participant. The provider will not be reimbursed for unauthorized services including services provided in excess of what is documented on the participant's service plan for that provider.

Replaces: 5160-51-04, 5160-51-05


Effective: 2/1/2015
Five Year Review (FYR) Dates: 02/01/2020
Promulgated Under: 119.03
Statutory Authority: 119.03 , 5164.02
Rule Amplifies: 5162.03, 5164.02 , 5166.02, 5164.90
Prior Effective Dates: 7/1/08, 6/1/09, 9/9/10, 8/1/11