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This website publishes administrative rules on their effective dates, as designated by the adopting state agencies, colleges, and universities.

Chapter 173-3 | Provider Agreements

 
 
 
Rule
Rule 173-3-01 | Older Americans Act: introduction and definitions.
 

(A) Introduction to Chapter 173-3 of the Administrative Code: This chapter regulates AAA provider agreements for services paid, in whole or in part, with Older Americans Act funds.

(B) Definitions for Chapters 173-3 and 173-4 of the Administrative Code:

"AAA-provider agreement" (agreement) means a contract between an AAA and a provider for the provision of services to consumers.

"Activities of daily living" (ADLs) means bathing; dressing; eating; grooming; toileting; transferring in and out of a bed or chair; and walking.

"Area agency on aging" (AAA) means an entity ODA designates to be an AAA under rule 173-2-04 of the Administrative Code.

"Assessment" means a gathering of information about a person's strengths, problems, financial resources, and care needs in the following major functional areas: physical health, utilization of medical care, ADLs, IADLs, mental and social functioning, physical environment, and utilization of services and supports.

"Assistance with self-administration of medication" has the same meaning as in as in paragraph (C) of rule 4723-13-02 of the Administrative Code when the assistance is provided by an unlicensed person.

"Care-coordination program" means a program coordinating and monitoring the provision of services.

"Caregiver" and "family caregiver" have the same meaning as "family caregiver" in 42 U.S.C. 3022.

"Competency evaluation" includes both written testing and skills testing by return demonstration to ensure the aide is able to address the care needs of the consumer to be served.

"Consumer" means, for the purposes of services paid for, in whole or in part, with Older Americans Act funds, any person sixty years of age or older, unless a different age is required by a state or federal law.

"Consumer's signature" means the signature, mark, or electronic signature of a consumer, or the consumer's caregiver, verifying the provision of services. Examples of technologies used to record electronic signatures are "Co-Pilot," "MealService," "MJM," "MySenior Center," "SAMS Scan," "Santrax," "SeniorDine," "SERVtracker," "SSAID," and call-in verification.

"Contract" has the same meaning as "AAA-provider agreement," unless the context clearly indicates otherwise.

"Day" means a twenty-four-hour period beginning and ending at midnight.

"Incident" means an event that is inconsistent with the routine care or routine provision of services to a consumer. An incident may involve a consumer, caregiver (to the extent it impacts a consumer), provider, provider's staff or facility, another facility, an AAA's staff, ODA's staff, or other administrative authorities. Examples of an incident are abuse, neglect, abandonment, an accident, or an unusual situation resulting in an injury to a person or damage to the person's property or equipment.

"Instrumental activities of daily living" (IADLs) means preparing meals, shopping for personal items, medication management, managing money, using the telephone, doing heavy housework, doing light housework, and the ability to get and use available transportation without assistance.

"Licensed practical nurse" (LPN) has the same meaning as in section 4723.01 of the Revised Code.

"ODA" means the Ohio department of aging.

"Older Americans Act" means 42 U.S.C. Chapter 35.

"Older Americans Act funds" means the federal funds awarded to ODA through Title III of the Older Americans Act (42 U.S.C. Chapter 35, Subchapter III) and any state or local funds used to match those federal funds, regardless of whether the local funds are public or private funds. For the purposes of this chapter and Chapter 173-4 of the Administrative Code, "Older Americans Act funds" does not mean funds for an ombudsman program.

"PCA" means "personal care aide."

"Planning and service area" (PSA) means a geographic region of Ohio that ODA designated as a planning and service area under rule 173-2-02 of the Administrative Code.

"Provider" means a person or entity entering into an AAA-provider agreement with an AAA to provide services to consumers. The three categories of providers are agency providers, self-employed providers, and consumer-directed providers. "Agency provider" means a provider hiring persons to provide services to consumers. "Self-employed provider" means a provider who provides services to consumers and who does not hire, or contract with, other persons to provide those services. "Participant-directed provider" means a provider (e.g., relative, friend, neighbor, or other person) a consumer hired and directs to provide services to the consumer.

"Registered nurse" (RN) has the same meaning as in section 4723.01 of the Revised Code.

"RFP" means "request for proposal."

"Service plan" means a written outline of services authorized for a consumer regardless of the funding source for the services.

"Unique identifier" means an item belonging to a specific consumer, caregiver, or driver (in the case of rule 173-4-05.2 of the Administrative Code) that identifies only that consumer, caregiver, or driver. Examples of a unique identifier are a handwritten or electronic signature or initials, fingerprint, mark, stamp, password, barcode, or swipe card. A consumer, caregiver, or driver offers their unique identifier as an attestation that a provider, or the provider's staff, completed an activity or unit of service.

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11
Amplifies: 173.39, 173.392; 42 U.S.C. 3002; 45 C.F.R. 1321.3
Five Year Review Date: 11/28/2025
Prior Effective Dates: 6/1/2014
Rule 173-3-04 | Older Americans Act: general requirements for AAA-provider agreements.
 

(A) Authority: Each AAA shall enter into AAA-provider agreements ("agreements") to develop and implement a comprehensive and coordinated system of services for consumers and their caregivers. Each AAA is ultimately responsible to ODA for ensuring that all state and federal funds received from ODA are used in a manner that complies with this chapter and the uniform administrative requirements, cost principles, and audit requirements for federal awards under 45 C.F.R. Part 75.

(B) Purchase-of-service agreements:

(1) The AAA shall only enter into purchase-of-service agreements, unless the requirements of paragraph (C) of this rule are met.

(2) As used in this rule, "purchase-of-service agreements" means an agreement through which a provider is paid, wholly or in part, with Older Americans Act funds a pre-determined unit rate for only the services it actually provides in accordance with the agreement.

(C) Time-and-materials agreements:

(1) The AAA is not required to obtain written permission from ODA before entering into a time-and-materials agreement if the agreement only pertains to the provision of one or more of the following services: home maintenance and chores; client finding; home modification; information and assistance (referrals); mass outreach; socialization; telephoning; visiting; or services provided through the national family caregiver support program.

(2) The AAA shall obtain written permission (hard copy or electronic) from ODA before entering into a time-and-materials agreement if the agreement pertains to the provision of a service ODA did not list in paragraph (C)(1) of this rule.

(3) If an AAA enters into a time-and-materials agreement, in the agreement, the AAA shall place a limit on the dollar amount of the AAA's obligation under the agreement, and the provider shall submit evidence to verify its costs before the AAA pays the provider. Only expenses that are reasonable under 45 C.F.R. Part 75 are allowable for payment using Older Americans Act funds. The AAA shall monitor providers with whom it has entered into time-and-materials agreements to ensure that the providers' expenses do not exceed the limits that the AAA established in the agreements.

(4) As used in this rule, "time-and-materials agreement" means a agreement through which a provider is paid, in whole or in part, with Older Americans Act funds for the services it provides to consumers based upon their actual costs (i.e., time and materials) to the provider and not upon a pre-determined unit rate.

(D) Retroactive: The AAA shall not pay a provider for any services unless a valid agreement is in place before the provider begins to provide the services. No agreement is valid unless, and until, it is signed by authorized representatives from both the AAA and the provider.

(E) Ineligible providers: The AAA shall comply with 2 C.F.R. Part 180, as supplemented by 2 C.F.R. Part 376, which prohibits the AAA from entering into an agreement with any provider the SAM database lists as excluded or disqualified from agreements involving federal funds. As used in this paragraph, "SAM database" means the general service administration's "System for Award Management," which is available to the general public for free on www.sam.gov.

(F) Not earning funds: An AAA shall only make a portion of the funds awarded to a provider available for use by one or more other existing providers without first going through one of the competitive procurement processes under 45 C.F.R. 75.329 if, in the agreement, the AAA stated that it may redistribute funds if a provider is not, in a timely manner, earning the funds it was awarded and if the AAA determines that the provider is not, in a timely manner earning the funds it was awarded in an existing agreement. A provider may appeal an AAA's decision to redistribute funds under rule 173-3-09 of the Administrative Code.

Supplemental Information

Authorized By: 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11
Amplifies: 173.39, 173.392; 45 C.F.R. Part 75; 45 C.F.R. 1321.11, 1321.53
Five Year Review Date: 7/1/2025
Prior Effective Dates: 8/1/2016
Rule 173-3-05 | Older Americans Act: procurement standards.
 

(A) Federal requirements: When an AAA procures goods or services paid, in whole or in part, with Older Americans Act funds, the AAA shall comply with the requirements in 45 C.F.R. 75.327 to 75.335.

(1) 48 C.F.R. Subpart 2.1 establishes the federal micro-purchase threshold. 45 C.F.R. 75.329 prohibits an AAA from using micro-purchase procurement for AAA-provider agreements (agreements) worth more than the federal micro-purchase threshold.

(2) 2 C.F.R. Part 300 establishes the federal simplified acquisition threshold. 45 C.F.R. 75.329 prohibits an AAA from using small-purchase procurement for agreements worth more than the federal simplified acquisition threshold.

(B) Additional state requirements: If an AAA submits a written request to ODA seeking permission to use a non-competitive procurement process, the AAA shall comply with paragraph (A) of this rule and the following:

(1) The AAA shall submit its written request to ODA no fewer than thirty days before the AAA needs a decision from ODA.

(2) The AAA's written request shall not consider a public exigency or emergency to be a basis for non-competitive procurement if the AAA created the exigency or emergency.

(3) The AAA's request shall provide ODA with evidence to verify that the circumstances in 45 C.F.R. 75.329(f) exist.

(4) If the AAA wants to procure goods or services from a single source, the AAA's request shall verify that the circumstances in 45 C.F.R. 75.329(f)(1) exist by including the names of all known providers of the goods or services located in, or willing to do business in, the planning and service area. The AAA's request shall also include emails or letters from each of those providers to document their inability to provide the goods or services the AAA wants to procure. If the providers are unwilling to submit emails or letters to the AAA, the AAA shall document its efforts to obtain information from the providers.

Supplemental Information

Authorized By: 173.01, 173.02, 173.392; 42 U.S.C. 3025(a)(1)(C); 45 C.F.R. 1321.11(a).
Amplifies: 173.39, 173.392; 42 U.S.C. 3030d; 45 C.F.R. Part 75, 1321.11(b), 1321.53.
Five Year Review Date: 6/1/2023
Prior Effective Dates: 2/15/2009
Rule 173-3-05.1 | Older Americans Act: procurement standards for renewable and multi-year AAA-provider agreements.
 

(A) An AAA shall not offer a provider a renewable or multi-year AAA-provider agreement ("agreement") unless the AAA procured for the agreement according to rule 173-3-05 of the Administrative Code and this rule.

(B) Renewable:

(1) If an agreement is to be renewable after the agreement's initial term, the AAA shall clearly state the following in the RFP for the renewable agreement:

(a) The AAA shall state that the agreement is renewable after the initial term.

(b) The AAA shall state that it retains the right to decline to renew the agreement.

(c) If the agreement upon which providers would bid includes an opportunity for rate increases upon renewal, the AAA shall state the methodology by which the AAA would determine the amount, if any, of rate increases upon renewal. If the agreement upon which providers would bid does not include an opportunity for rate increases upon renewal, the AAA shall state that the agreement would not include an opportunity for rate increases upon renewal.

(d) The AAA shall state the circumstances, if any, under which it may terminate a renewed agreement.

(2) The AAA shall clearly state the following in each renewable agreement:

(a) The AAA shall state that the agreement is renewable after the initial term.

(b) The AAA shall state that it retains the right to decline to renew the agreement.

(c) If the agreement includes an opportunity for rate increases upon renewal, the AAA shall state the methodology by which the AAA would determine the amount, if any, of rate increases upon renewal. If the agreement does not include an opportunity for rate increases upon renewal, the AAA shall state that the agreement does not include an opportunity for rate increases upon renewal.

(d) A statement indicating the circumstances, if any, under which the AAA may terminate a renewed agreement.

(3) An AAA shall not award a renewable agreement that would remain in effect, whether in its initial term or a renewed term, after the last day the AAA's approved area plan is in effect.

(C) Multi-year term:

(1) If the agreement is for a multi-year term, the AAA shall clearly state the following in the RFP:

(a) The AAA shall state that the agreement is for a multi-year term.

(b) The AAA shall state that it may terminate the agreement, rather than fulfill all years of the multi-year term, under the any one or more of the following circumstances:

(i) The provider does not demonstrate satisfactory performance.

(ii) The AAA does not have funds to pay for the goods or services for a subsequent year.

(iii) A situation arises that was unforeseen at the time the AAA and the provider entered into the agreement. Examples of unforeseen situations are changes in market conditions or changes in the law regulating the goods or services the agreement covers.

(c) If the agreement upon which providers would bid includes an opportunity for rate increases during the multi-year term, the AAA shall state the methodology by which the AAA would determine the amount, if any, of rate increases during the multi-year term. If the agreement upon which providers would bid does not include an opportunity for rate increases during the multi-year term, the AAA shall state that the agreement would not include an opportunity for rate increases.

(2) The AAA shall clearly state the following in each agreement with a multi-year term:

(a) The AAA shall state that the agreement is for a multi-year term.

(b) The AAA shall state that it may terminate the agreement, rather than fulfill all the years of the multi-year term, under any one or more of the following circumstances:

(i) The provider does not demonstrate satisfactory performance.

(ii) The AAA does not have funds to pay for the goods or services for a subsequent year.

(iii) A situation arises that was unforeseen at the time that the AAA and the provider entered into the agreement. Examples of unforeseen situations are changes in market conditions or changes in the law that regulates the goods or services the agreement covers.

(c) If the agreement upon which providers would bid includes an opportunity for rate increases during the multi-year term, in the agreement, the AAA shall include the methodology by which the AAA would determine the amount, if any, of rate increases during the multi-year term. If the agreement does not include an opportunity for rate increases during the multi-year term, in the agreement, the AAA shall state that it does not include an opportunity for rate increases.

(3) An AAA shall not award a multi-year agreement that would remain in effect after the last day the AAA's approved area plan is in effect.

Supplemental Information

Authorized By: 173.01, 173.02, 173.392; Section 305(a)(1)(C) of the Older Americans Act of 1965, 70 Stat. 210, 42 U.S.C. 3001, as amended by the Older Americans Act Reauthorization Act of 2016; 45 C.F.R. 1321.11 (October, 2015 edition).
Amplifies: 173.392; Older Americans Act of 1965, 79 Stat. 210, 42 U.S.C. 3001, as amended by the Older Americans Act Reauthorization Act of 2016.
Five Year Review Date: 8/1/2021
Prior Effective Dates: 1/1/2013
Rule 173-3-06 | Older Americans Act: requirements to include in every AAA-provider agreement.
 

(A) Federal requirements: An AAA shall comply with the following federal requirements when entering into an AAA-provider agreement (agreement) for goods or services paid, in whole or in part, with Older Americans Act funds, the AAA shall comply with the following:

(1) Uniform administrative requirements, cost principles, and audit requirements for federal awards: The agreement shall comply with 45 C.F.R. 75.327 to 75.335, including Appendix II to 45 C.F.R. Part 75.

(2) Targeting:

(a) In the agreement, the AAA shall list the focal points in the service area covered by the agreement that the AAA designated under Section 306(a)(3)(B) of the Older Americans Act.

(b) In the agreement, the AAA shall require the following:

(i) The provider shall specify how it intends satisfy the need for services by consumers with the greatest economic and social needs with particular attention to consumers who are low-income, who are low-income minorities, who have limited proficiency in the English language, who reside in rural areas, and who are at risk for institutional placement.

(ii) The provider shall meet the AAA's specific objectives for giving services to specific consumer groups.

(3) Additional federal laws: The agreement shall comply with the Older Americans Act and any additional federal law governing, or federal rule regulating, the agreement.

(B) Additional state requirements: Every agreement for goods or services paid, in whole or in part, with Older Americans Act funds shall comply with the following:

(1) Program and funding identification:

(a) In the agreement, the AAA shall identify the names of the federal and state programs that are sources for the Older Americans Act funding being used for the procurement of the goods and services being procured through the agreement.

(b) In the agreement, the AAA shall contain the following statement:

"This agreement is for the provision of goods or services paid with federal funds that the United States Department of Health and Human Services appropriated to the Ohio Department of Aging (ODA). ODA, in turn, allocated the federal funds to the area agency on aging. The agreement is subject to federal laws and rules, state laws, and ODA's rules."

(2) Additional state laws:

(a) The agreement shall comply with any rule in Chapter 173-3 or 173-4 of the Administrative Code regulating agreements in general or the provision of specific goods or services being procured through the agreement.

(b) The agreement shall comply with any additional state law governing, or state rule regulating agreements in general or the provision of specific goods or services being procured through the agreement.

(3) Safety:

(a) Disasters: In the agreement, the AAA shall require the provider to cooperate with the AAA and ODA to assess disaster impact upon consumers and to coordinate with public and private resources in the field of aging to assist consumers whenever the president of the United States declares that the provider's service area is a disaster area.

(b) Significant changes: If the provider provides goods and services to a consumer that the AAA case manages through a care-coordination program, in the agreement, the AAA shall require the provider to notify the AAA of any significant change that may necessitate a reassessment the case-managed consumer's need for goods and services no later than one day after the provider is aware of a repeated refusal to receive goods or services; changes in the consumer's physical, mental, or emotional status; documented changes in the consumer's environmental conditions; or, other significant, documented changes to the consumer's health and safety. If "one day after" falls on a weekend or legal holiday, as defined in section 1.14 of the Revised Code, the deadline is extended to the day immediately following "one day after" that is not on a weekend or legal holiday.

(c) APS: In the agreement, the AAA shall require the provider to immediately report any reasonable cause to believe a consumer is the victim of abuse, neglect, or exploitation to the local adult protective services program in accordance with section 5101.61 of the Revised Code, until September 28, 2018, then with section 5101.63 of the Revised Code on or after September 29, 2018.

(d) Terminating the provision of goods and services: If the provider provides goods or services to a consumer that the AAA case manages through a care-coordination program, the agreement shall require the provider to notify the AAA and the case-managed consumer in writing of the anticipated last day of goods or services to the case-managed consumer no later than thirty days before the anticipated last day of goods or services, unless the reason for discontinuing the goods or services is the hospitalization, institutionalization, or death of the consumer; serious risk to the health or safety of the provider; the consumer's decision to discontinue the goods or services; or a similar reason why the provider is unable to notify the AAA thirty days before the anticipated last day of goods or services. The provider shall also notify the case-managed consumer how he or she may reach a long-term care ombudsman. If the thirtieth day falls on a weekend or legal holiday, as defined in section 1.14 of the Revised Code, the deadline is extended to the day immediately after the thirtieth day that is not on a weekend or a legal holiday.

(4) Confidentiality: In the agreement, the AAA shall include any federal or state confidentiality requirements and also the following requirements:

(a) The provider shall not disclose information concerning a consumer unless the provider obtains and retains the consumer's written, informed consent to do so and the purpose for the disclosure is associated with the provider's provision of goods and services to the consumer.

(b) The provider shall not disclose information concerning a consumer for a purpose unassociated with the provider's provision of goods and services even if the provider obtains and retains the consumer's written, informed consent to do so.

(c) If the provider retains consumers' records electronically, the provider shall store the records in a password-protected file. If the provider does not retain records electronically, the provider shall store consumers' records in a designated, locked storage space.

(5) Provider qualifications: In the agreement, the AAA shall include the following requirements:

(a) When hiring an applicant for, or retaining an employee in, a paid direct-care position, the provider shall review databases and check criminal records according to section 173.38 of the Revised Code and Chapter 173-9 of the Administrative Code, unless the provider is self-employed. If the provider is self-employed, the AAA shall review databases and check criminal records of the provider according to section 173.381 of the Revised Code and Chapter 173-9 of the Administrative Code. Division (B)(1) of section 109.572 of the Revised Code requires the bureau of criminal identification and investigation to include sealed criminal records in its criminal records reports for criminal records checks conducted under sections 173.38 and 173.381 of the Revised Code.

(b) If a federal, state, or local government regulatory authority prohibits the provider from providing the goods or services required by the agreement, the provider shall notify the AAA of the disciplinary action and the AAA shall, simultaneous to the date of the regulatory authority's disciplinary action, deem the provider to be ineligible to be paid with Older Americans Act funds for providing goods or services to consumers.

(6) Sub-contracting: In the agreement, the AAA shall prohibit the provider from sub-contracting any of its duties under the agreement to another provider unless the provider obtains authorization from the AAA before sub-contracting.

(7) Modification:

(a) In the agreement, the AAA shall describe the grounds (and the process) for modifying the agreement.

(b) In the agreement, the AAA shall state that any amendments to the laws, rules, or regulations the AAA cites in the agreement will result in a correlative modification to the agreement without the necessity of executing a written amendment.

(c) In every new agreement, the AAA shall require the provider to sign up for email updates on ODA's rules on https://aging.ohio.gov/wps/portal/gov/aging/see-news-and-events/subscribe/subscribe.

(8) Renewable and multi-year: If the agreement is renewable or covers a multi-year term, the agreement shall comply with rule 173-3-05.1 of the Administrative Code.

(9) Service verification and records retention:

(a) In no agreement, shall an AAA prohibit a provider from using electronic systems to verify the provision of goods or services or to retain records.

(b) In the agreement, the AAA shall require providers to retain any record relating to costs, goods and services provided, supporting documentation for payment of goods and services provided, and all deliverables until the last of the following dates:

(i) Three years after the date the provider receives payment for the goods or services.

(ii) The date on which ODA, the AAA, or a duly-authorized law enforcement official concludes monitoring the records and any findings are finally settled.

(iii) The date on which the auditor of the state of Ohio, the inspector general, or a duly-authorized law enforcement official concludes an audit of the records and any findings are finally settled.

(10) Payment:

(a) In the agreement, the AAA shall describe how it shall pay the provider, including the amount and payment method.

(b) In the agreement, the AAA shall include the following requirements:

(i) The provider shall comply with rule 173-3-07 of the Administrative Code.

(ii) The provider shall return any Older Americans Act funds payments for its goods or services, if the provider's provision of the goods or services did not comply with the Administrative Code, the Revised Code, or any other law.

(11) Administrative hearings:

(a) In the agreement, the AAA shall state that the provider may appeal a decision the AAA takes against the provider according to rule 173-3-09 of the Administrative Code.

(b) If the AAA intends to redistribute unearned funds to other providers, in the agreement, the AAA shall state that it may redistribute funds if a provider is not, in a timely manner, earning the funds it was awarded and if the AAA determines the provider is not, in a timely manner earning the funds it was awarded in the agreement.

(C) An AAA may add requirements into an agreement in addition to the requirements in paragraphs (A) and (B) of this rule if the additional requirements do not conflict with any federal or state law.

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11
Amplifies: 173.39, 173.392; 42 U.S.C. 3030d; 45 C.F.R. Part 75, 1321.11, 1321.53, 1321.65, 1321.67
Five Year Review Date: 11/28/2025
Prior Effective Dates: 2/14/2010, 1/1/2013, 6/1/2018
Rule 173-3-06.1 | Older Americans Act: adult day service.
 

(A) "Adult day service" ("ADS") means a regularly-scheduled service delivered at an ADS center, which is a non-institutional, community-based setting. ADS includes recreational and educational programming to support a consumer's health and independence goals; at least one meal, but no more than two meals per day; and, sometimes, health status monitoring, skilled therapy services, and transportation to and from the ADS center. Table 1 to this rule defines the three levels of ADS.

If the provider's ADS center is unable to operate during a state of emergency declared by the governor, "adult day service" also includes ADS components provided in a consumer's home, including activities provided by telephone or video conference.

BASIC ADSENHANCED ADSINTENSIVE ADS
Structured activity programmingYesYesYes
Health assessmentsYesYesYes
Supervision of ADLsOne or more ADLOne or more ADLAll ADLs
Hands-on assistance with ADLsNoYes, one or more ADL (bathing excluded)Yes, minimum of two ADLs (bathing included)
Hands-on assistance with medication administrationNoYesYes
Comprehensive therapeutic activitiesNoYesYes
Monitoring of health statusNoIntermittentRegular
Hands-on assistance with personal hygiene activitiesNoYes (bathing excluded)Yes (bathing included, as needed)
Social work servicesNoNoYes
Skilled nursing servicesNoNoYes
Rehabilitative servicesNoNoYes

(B) Every AAA-provider agreement for ADS that is paid, in whole or in part, with Older Americans Act funds, shall comply with the following requirements:

(1) General requirements: In the AAA-provider agreement, the AAA shall include the requirements in rule 173-3-06 of the Administrative Code for every AAA-provider agreement paid, in whole or in part, with Older Americans Act funds.

(2) Service requirements:

(a) Transportation: The provider shall transport each consumer to and from the ADS center by performing a transportation service that complies with rule 173-3-06.6 of the Administrative Code, unless the provider enters into a contract with another provider who complies with rule 173-3-06.6 of the Administrative Code, or unless the caregiver provides or designates another person or non-provider, other than the ADS center provider, to transport the consumer to and from the ADS center.

(b) Case manager's assessment: If the consumer receives a case management service, as defined in 42 U.S.C. 3002, as part of care coordination:

(i) The case manager shall assess each consumer's needs and preferences then specify which service level will be approved for each consumer; and,

(ii) The provider shall retain records to show that it provides the service at the level that the case manager authorized.

(c) Provider's initial assessment:

(i) The provider shall assess the consumer before the end of the consumer's second day of attendance at the center. If the consumer is enrolled in care coordination, the provider may substitute a copy of the case manager's assessment of the consumer if the case manager assessed the consumer no more than thirty days before the consumer's first day of attendance at the center.

(ii) The initial assessment shall include both of the following components:

(a) Functional and cognitive profiles that identify the ADLs and IADLs that require attention or assistance of ADS center staff; and,

(b) Social profile including social activity patterns, major life events, community services, caregiver data, formal and informal support systems, and behavior patterns.

(d) Health assessment: No later than thirty days after the consumer's initial attendance at the ADS center or before the consumer receives the first ten units of service at the ADS center, whichever comes first, the provider shall either obtain a health assessment of each consumer from a licensed healthcare professional whose scope of practice includes health assessments or require a staff member who is such a licensed healthcare professional to perform a health assessment of each consumer. The health assessment shall include the consumer's psychosocial profile and shall identify the consumer's risk factors, diet, and medications. If the licensed healthcare professional who performs the health assessment is not a staff member of the provider, the provider shall retain a record of the professional's name and phone number.

(e) Activity plan: No later than thirty days after the consumer's initial attendance at the ADS center or before the consumer receives the first ten units of service at the ADS center, whichever comes first, the provider shall either obtain the services of a licensed healthcare professional whose scope of practice includes developing activity plans to draft an activity plan for each consumer or the provider shall require a staff member who is such a licensed healthcare professional to draft an activity plan for each consumer. The plan shall identify the consumer's strengths, needs, problems or difficulties, goals, and objectives. The plan shall describe the consumer's:

(i) Interests, preferences, and social rehabilitative needs;

(ii) Health needs;

(iii) Specific goals, objectives, and planned interventions of ADS that meet the goals;

(iv) Level of involvement in the drafting of the plan, and, if the consumer has a caregiver, the caregiver's level of involvement in the drafting of the plan; and,

(v) Ability to sign his or her signature versus alternate means for a consumer signature.

(f) Plan of treatment: Before administering medication or meals with a therapeutic diet, and before providing a nursing service, nutrition counseling, physical therapy, or speech therapy, the provider shall obtain a plan of treatment from a licensed healthcare professional whose scope of practice includes making plans of treatment. The provider shall obtain the plan of treatment at least every ninety days for each consumer that receives medication, a nursing service, nutrition counseling, physical therapy, or speech therapy. For diet orders that may be part of a plan of treatment, a new diet order is not required every ninety days. Instead, the provider shall comply with the diet-order requirements for therapeutic diets under rule 173-4-06 of the Administrative Code.

(g) Interdisciplinary care conference:

(i) Frequency: The provider shall conduct an interdisciplinary care conference for each consumer at least once every six months.

(ii) Participants: The provider shall conduct the conference between the provider's staff members and invitees who choose to participate. If the consumer receives case management as part of care coordination, the provider shall invite the case manager to participate in the conference. The provider shall invite any licensed healthcare professional who does not work for the provider, but who provided the provider with a health assessment of the consumer or an activity plan for the consumer, to participate in the conference. If the consumer has a caregiver, the provider shall invite the caregiver to the conference. The provider shall also invite the consumer to the conference. The provider shall invite the case manager, licensed healthcare professional, caregiver, or consumer by providing the date and time to the case manager seven days before the conference begins.

(iii) Revise activity plan: If the conference participants identify changes in the consumer's health needs, condition, preferences, or responses to the service, the provider shall obtain the services of a licensed healthcare professional whose scope of practice includes developing activity plans to revise the activity plan accordingly or shall require a staff member who is such a licensed healthcare professional to revise the activity plan accordingly.

(iv) Records: The provider shall retain records on each conference's determinations.

(h) Activities: The provider shall post daily and monthly planned activities in prominent locations throughout the center.

(i) Lunch and snacks:

(i) The provider shall provide lunch and snacks to each consumer who is present during lunchtime or snacktime.

(ii) The provision of lunch shall comply with paragraphs (A)(7) to (A)(12) of rule 173-4-05 of the Administrative Code and paragraph (E) of rule 173-4-05.1 of the Administrative Code.

(3) Center requirements:

(a) Specifications: The provider shall only perform ADS in a center with the following specifications:

(i) If the center is housed in a building with services or programs other than ADS, the provider shall assure that a separate, identifiable space and staff are available for ADS activities during all hours in which the provider provides ADS in the center.

(ii) The center shall comply with the "ADA Accessibility Guidelines for Buildings and Facilities" in appendix A to 28 C.F.R. Part 36.

(iii) The center shall have at least sixty square feet per individual that it serves, excluding hallways, offices, rest rooms, and storage areas.

(iv) The provider shall store consumers' medications in a locked area that the provider maintains at a temperature that meets the storage requirements of the medications.

(v) The provider shall store toxic substances in an area that is inaccessible to consumers.

(vi) The center shall have at least one toilet for every ten individuals present that it serves and at least one wheelchair-accessible toilet.

(vii) If the center provides intensive ADS, the center shall have bathing facilities suitable to the needs of consumers who require intensive ADS.

(b) Emergency safety plan:

(i) The provider shall develop and annually review a fire inspection and emergency safety plan.

(ii) The provider shall post evacuation procedures in prominent locations throughout the center.

(c) Evacuation drills:

(i) At least quarterly, the provider shall conduct an evacuation drill from the center while consumers are present.

(ii) The provider shall retain records on the date and time it completes each evacuation drill.

(d) Fire extinguishers and smoke alarms:

(i) The provider shall have fire extinguishers and smoke alarms in the center and shall provide routine maintenance to them.

(ii) At least annually, the provider shall conduct an inspection of the fire extinguishers and smoke alarms and shall document the completion of each inspection.

(4) Staffing levels:

(a) The provider shall have at least two staff members present whenever more than one consumer is present, including one who is a paid PCA and one who is certified in CPR.

(b) The provider shall maintain a staff-to-consumer ratio of at least one staff member to every six consumers at all times.

(c) The provider shall have one RN, or LPN under the direction of an RN, available whenever a consumer who receives enhanced ADS or intensive ADS requires components of enhanced ADS or intensive ADS that fall within a nurse's scope of practice.

(d) The provider shall employ an activity director to direct consumer activities.

(5) Provider qualification:

(a) Type of provider: A provider shall only provide ADS if the provider is an agency provider.

(b) Staff qualifications:

(i) Every RN, LPN under the direction of an RN, social worker, physical therapist, physical therapy assistant, speech therapist, dietitian, occupational therapist, occupational therapy assistant, or other licensed professional planning to practice in the adult day center shall possess a current, and valid license to practice in their profession.

(ii) The activity director shall possess at least one of the following:

(a) A baccalaureate or associate degree in recreational therapy or a related degree.

(b) At least two years of experience as an activity director, activity assistant or a related position.

(c) Compliance with the qualifications required to direct consumer activities in a nursing facility under paragraph (G) of rule 3701-17-07 of the Administrative Code.

(d) A certification from the national certification council for activity professionals (NCCAP).

(iii) Each activity assistant shall possess at least one of the following:

(a) A high school diploma;

(b) A high school equivalence diploma as defined in section 5107.40 of the Revised Code; or,

(c) At least two years of employment in a supervised position to provide personal care, to provide activities, or to assist with activities.

(iv) Each personal care aide shall possess at least one of the following:

(a) A high school diploma;

(b) A high school equivalence diploma as defined in section 5107.40 of the Revised Code;

(c) At least two years of employment in a supervised position to provide personal care, to provide activities, or to assist with activities; or,

(d) The successful completion of a vocational program in a health or human services field.

(v) Each staff member who provides transportation to consumers shall comply with all requirements under rule 173-3-06.6 of the Administrative Code.

(vi) The provider shall retain records to show that each staff member who has in-person interaction with consumers complies with the staff qualifications under paragraph (B)(4)(b) of this rule.

(c) Staff training:

(i) Orientation: Before each new personal care aide provides an ADS, the provider shall train the staff member on all of the following:

(a) The expectation of employees;

(b) The provider's ethical standards;

(c) An overview of the provider's personnel policies;

(d) A description of the provider's organization and lines of communication;

(e) Incident reporting procedures; and,

(f) Universal precautions for infection control.

(ii) Task-based training: Before each new personal care aide provides an ADS, the provider shall provide task-based training.

(iii) Continuing education: Each staff member shall complete at least eight hours of in-service or continuing education on appropriate topics each calendar year, unless the staff person holds a professional certification that requires at least eight hours in order to maintain the certification.

(iv) Records: The provider shall retain records showing that it complies with the training requirements under paragraph (B)(4)(c) of this rule. In doing so, the provider shall list the instructor's title, qualifications, and signature; date and time of instruction; content of the instruction; and name and signature of ADS personal care staff completing the training.

(d) Performance reviews:

(i) The provider shall complete a performance review of each staff member in relation to the staff member's job description.

(ii) The provider shall retain records to show that it complies with paragraph (B)(5)(d)(i) of this rule.

(6) Service verification:

(a) The provider shall verify that each episode of adult day service for which it bills was provided by one of the following two methods:

(i) The provider may use an electronic system if the system does all of the following:

(a) Collects the consumer's name, date of service, consumer's arrival and departure times (if the service is provided in the ADS center), consumer's mode of transportation (if the service is provided in the ADS center), and a unique identifier of the consumer.

(b) Retains the information it collects.

(c) Produces reports, upon request, that the AAA can monitor for compliance.

(ii) The provider may use a manual system if the provider documents the consumer's name, date of service, consumer's arrival and departure times (if the service is provided in the ADS center), and consumer's mode of transportation (if the service is provided in the ADS center), and collects a unique identifier of the consumer.

(b) In the AAA-provider agreement, the AAA shall not prohibit a provider from using an electronic system or daily attendance roster to collect and retain the records this rule requires.

(c) During a state of emergency declared by the governor, the provider may verify each episode of service provided without collecting the unique identifier of the consumer.

(C) Units of service:

(1) Units of ADS are calculated as follows:

(a) One-half unit is less than four hours of ADS per day.

(b) One unit is four to eight hours of ADS per day.

(c) A fifteen-minute unit is each fifteen-minute period of time over eight hours up to, and including, a maximum of twelve hours of ADS per day.

(2) A unit of ADS does not include a transportation service, as defined by rule 173-3-06.6 of the Administrative Code, even if the transportation service is provided to transport the consumer to or from the ADS center.

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11
Amplifies: 173.39, 173.392; 42 U.S.C. 3025, 3030d, 3032c; 45 C.F.R. 1321.11, 1321.65
Five Year Review Date: 11/28/2025
Prior Effective Dates: 2/15/2009, 9/1/2016, 6/11/2020 (Emer.)
Rule 173-3-06.2 | Older Americans Act: home maintenance and chores.
 

(A) "Home maintenance and chores" means a job providing critical cleaning, maintenance, or repair of elements in a consumer's home or surrounding property which are necessary to preserve the consumer's health and welfare.

(1) "Home maintenance and chores" includes the assessment, materials, and labor involved in any of the following:

(a) Heavy household cleaning, including washing walls and ceilings; washing the outside of windows, washing the inside of difficult-to-reach windows; removing, cleaning, and re-hanging curtains or drapery; and, shampooing carpets or furniture.

(b) Disposing garbage or recyclable materials.

(c) Seasonal outdoor maintenance, including cleaning gutters and downspouts; removing leaves, snow, or ice; trimming shrubs; cutting grass; or installing existing storm windows.

(d) Inspecting HVAC equipment, water heater, or water pump.

(e) Repairing damaged, malfunctioning, or unsafe HVAC equipment, plumbing, electrical systems, roofing, stairs, or floors.

(f) Household maintenance, including replacing light bulbs, unclogging a drain, lighting a pilot light, replacing an electrical fuse, replacing broken window panes, repairing/replacing damaged window or door screens, or changing a furnace filter.

(g) Pest control.

(2) "Home maintenance and chores" does not include any of the following:

(a) A service another person (e.g., a landlord) has a legal or contractual responsibility to provide.

(b) A service available through third-party insurers, community supports, Ohio medicaid state plan, or a medicaid waiver program.

(B) Requirements for every AAA-provider agreement for home maintenance and chores paid, in whole or in part, with Older Americans Act funds:

(1) General requirements: The AAA-provider agreement is subject to the requirements in rule 173-3-06 of the Administrative Code for every AAA-provider agreement paid, in whole or in part, with Older Americans Act funds.

(2) Licensure or accreditation: If a job requires a license or credentials (e.g., pest control), only a provider who possesses the current, valid license or credentials qualifies to provide the job.

(3) Consent agreement: The provider shall not provide a job involving the activities described in paragraphs (A)(1)(e) to (A)(1)(g) of this rule without first obtaining a written (including electronic) consent agreement from the homeowner, which may be the consumer, the consumer's family, or a landlord.

(4) Health and safety: If the provider anticipates health or safety risks to the consumer during the job, the provider shall inform the consumer and the AAA of the risks and provide the service on dates and times that minimize those risks. The provider shall comply with any and all applicable local codes or ordnances in the provision of each job.

(5) Job verification: The provider shall verify each job provided for which it bills the AAA using the provider's choice of either an electronic or manual system that collects all the following information:

(a) Consumer's name.

(b) Job date.

(c) Job description.

(d) Name of each employee providing the job.

(e) Provider's signature.

(f) A unique identifier of the consumer or the consumer's caregiver. During a state of emergency declared by the governor, the provider may verify each job provided without collecting the unique identifier.

(6) Reporting: 45 C.F.R. 1321.65 requires the provider to report information to the AAA on jobs provided.

(C) Unit of service: One unit of home maintenance and chores is one completed job reported in hours. Providers may report partial hours to two decimal places (e.g., "0.25 hours"). Material costs are part of the hourly rate. (For example, if a provider normally charges thirty dollars per hour and a three-hour service involves thirty dollars in materials, the provider would bill for three units at forty dollars per unit.)

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11
Amplifies: 173.39, 173.392; 42 U.S.C. 3025, 3030d; 45 C.F.R. 1321.11, 1321.65
Five Year Review Date: 11/28/2025
Prior Effective Dates: 12/1/2013, 5/8/2020, 6/11/2020 (Emer.)
Rule 173-3-06.3 | Older Americans Act: home modification.
 

(A) "Home modification" means a job modifying elements of the interior or exterior of a consumer's home to increase accessibility and enable the consumer to function with greater independence in the home.

(1) "Home modification" includes the assessment, materials, and labor involved in any of the following:

(a) A job to install grab bars or other devices to improve the consumer's ability to perform ADLs.

(b) A job to modify the interior or exterior of the consumer's home to improve the consumer's health and safety.

(c) A job to install a wheelchair ramp to a doorway or another modification to improve the consumer's accessibility.

(d) A job to repair or replace a home modification previously paid, in whole or in part, with Older Americans Act funds, if the previous modification cannot be repaired or replaced through another resource.

(2) "Home modification" does not include any of the following:

(a) A job another person (e.g., a landlord) has a legal or contractual responsibility to provide.

(b) A job available through Ohio medicaid state plan, a medicaid waiver program, or another government program, pursuant to 45 C.F.R. 1321.3.

(c) A job available through third-party insurers or a community support program.

(d) A job that adds to the total square footage of the home.

(e) A job of general utility and not direct medical or remedial benefit to the consumer.

(f) A job to repair or replace a home modification previously paid, in whole or in part, with Older Americans Act funds, that is damaged as a result of apparent abuse, misuse, or negligence.

(B) Requirements for every AAA-provider agreement for home modification paid, in whole or in part, with Older Americans Act funds:

(1) General requirements: The AAA-provider agreement is subject to requirements in rule 173-3-06 of the Administrative Code for every AAA-provider agreement for home modification paid, in whole or in part, with Older Americans Act funds.

(2) Licensure or accreditation: If a job requires a license or credentials (e.g., an electrician, a HVAC specialist, a plumber), only a provider who possesses the current, valid license or credentials qualifies to provide the job.

(3) Authorization: Before providing a job, the provider shall do the following:

(a) Provide a written (including electronic) estimate to the AAA on the cost of the job.

(b) Obtain the AAA's written (including electronic) authorization to begin the job.

(4) Consent agreement: A provider shall not modify a home without first obtaining a written (including electronic) consent agreement from the homeowner (which may be the consumer, the consumer's family, or a landlord) authorizing the modification and acknowledging that the homeowner understands that the home will remain in the modified state until after the consumer leaves the home.

(5) Permits: Before beginning a job, the provider shall obtain any permit and pre-job inspections required by federal, state, and local laws.

(6) Health and safety: If the provider anticipates health or safety risks to the consumer during the job, the provider shall inform the consumer and the AAA of the risks and provide the job on dates and times that minimize those risks.

(7) Warranty: The provider shall provide a warranty to the AAA covering the workmanship and materials involved in the job provided.

(8) Inspection: The provider shall obtain any necessary inspection, inspection report, or permit required by federal, state, and local laws or a homeowners' association to verify that the job was properly completed.

(9) Job verification: The provider shall verify each job provided for which it bills the AAA using the provider's choice of either an electronic or manual system that collects all the following information:

(a) Consumer's name.

(b) Date the job is completed.

(c) Job description.

(d) Name of each employee providing the job.

(e) Provider's signature.

(f) A unique identifier of the consumer or the consumer's caregiver. During a state of emergency declared by the governor, the provider may verify each job provided without collecting the unique identifier.

(10) Reporting: 45 C.F.R. 1321.65 requires the provider to report information to the AAA on jobs provided.

(C) Units and rates:

(1) A unit of home modification is one completed job.

(2) The per-job rate is negotiable and subject to the approval of the AAA before the job is provided. It includes assessment, materials, and labor.

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11
Amplifies: 173.39, 173.392; 42 U.S.C. 3025, 3030d; 45 C.F.R. 1321.11, 1321.65
Five Year Review Date: 11/28/2025
Prior Effective Dates: 5/8/2020
Rule 173-3-06.4 | Older Americans Act: homemaker.
 

(A) Definitions for this rule:

(1) "Homemaker service" means a service providing routine activities to help a consumer to achieve and maintain a clean, safe, and healthy environment.

(a) "Homemaker" includes the following activities:

(i) Routine meal-related activities: planning a meal, preparing a meal, and planning a grocery purchase.

(ii) Routine household activities: dusting furniture, sweeping, vacuuming, mopping floors, removing trash, and washing the inside of windows that are reachable from the floor, kitchen care (washing dishes, appliances, and counters), bedroom and bathroom care (changing bed linens and emptying and cleaning bedside commodes), and laundry care (folding, ironing, and putting the laundry away).

(iii) Routine transportation activities: providing an errand outside of the presence of the consumer (e.g., picking up a prescription), grocery shopping assistance, or escort, but not transportation under rule 173-3-06.6 of the Administrative Code.

(iv) The activities described in paragraphs (A)(1)(a)(i) to (A)(1)(a)(iii) of this rule when they assist the consumer as respite to the consumer's caregiver or are essential to the health and safety of the consumer as respite to the consumer's caregiver.

(b) "Homemaker" does not include the following activities:

(i) Activities provided outside of the home with the exception of the routine transportation activities listed in paragraph (A)(1)(a)(iii) of this rule.

(ii) Activities within the scope of home maintenance and chores.

(iii) Activities available through third-party insurers, community supports, Ohio medicaid state plan, or a medicaid waiver program.

(iv) Activities to administer or set-up medications.

(2) "Aide" means the person who provides homemaker activities.

(B) Agency providers: requirements for every AAA-provider agreement for homemaker activities paid, in whole or in part, with Older Americans Act funds:

(1) General requirements: The AAA-provider agreement is subject to the requirements in rule 173-3-06 of the Administrative Code for every AAA-provider agreement paid, in whole or in part, with Older Americans Act funds.

(2) Availability: The provider shall maintain the following:

(a) Adequate staffing levels to provide homemaker activities at least five days per week.

(b) A back-up plan for providing homemaker activities when the provider has no aide available.

(c) The availability of an aide supervisor during all hours when aides are scheduled to work.

(3) Aides:

(a) Initial qualifications: The provider shall only allow a person to serve as an aide if the person meets at least one of the following qualifications and the provider meets the verification requirements under paragraph (B)(3)(d) of this rule:

(i) The person meets at least one of the qualifications to be a PCA under paragraph (B)(3)(a) of rule 173-3-06.5 of the Administrative Code.

(ii) The person successfully completed a training and competency evaluation program with the following characteristics:

(a) The training lasted at least twenty hours.

(b) All the following subjects were included in the program's training and its competency evaluation:

(i) Communications skills, including the ability to read, write, and make brief and accurate reports (oral or written (including electronic)).

(ii) Universal precautions for infection control, including hand washing and the disposal of bodily waste.

(iii) Homemaker activities.

(iv) Recognition of emergencies, knowledge of emergency procedures, and basic home safety.

(v) Record-keeping skills.

(b) Orientation: Before allowing aides or other employees to have direct, face-to-face contact with consumers, the provider shall provide the aides or other employees with orientation that, at a minimum, addresses the following topics:

(i) The provider's expectations of employees.

(ii) Person-centered care.

(iii) The provider's ethical standards.

(iv) An overview of the provider's personnel policies.

(v) The organization and lines of communication of the provider's agency.

(vi) Incident reporting.

(vii) Emergency procedures.

(c) In-service training: The provider shall retain records to show that each aide successfully completes eight hours of in-service training very twelve months. Agency- and program-specific orientation shall not count toward the eight hours. If the aide is also a personal care aide (PCA) according to rule 173-3-06.5 of the Administrative Code, the provider may consider eight hours of successfully-completed in-service training as a PCA to count for the eight hours required as an aide by this paragraph.

(d) Verification of compliance with aide requirements:

(i) If a person meets the initial qualifications to be an aide under paragraph (B)(3)(a) of this rule by meeting the qualifications to be a PCA under paragraph (B)(3)(a) of rule 173-3-06.5 of the Administrative Code, the provider shall comply with the verification requirements under paragraph (B)(3)(d) of rule 173-3-06.5 of the Administrative Code.

(ii) If a person meets the initial qualifications to be an aide under paragraph (B)(3)(a) of this rule by completing the training and competency evaluation program under paragraph (B)(3)(a)(ii) of this rule, the provider shall retain copies of certificates of completion earned by each aide after the aide meets qualifications/requirements under paragraph (B)(3) of this rule for successfully completing any training and competency evaluation program, orientation, and in-service training under paragraph (B)(3) of this rule. Additionally, the provider shall also record the following information for each aide, and retain it, if it does not appear on the aide's certificate of completion (or if the aide did not receive a certificate of completion): training dates; training locations; training hours successfully completed; instruction materials used; subjects covered; and to verify the accuracy of the record, the name, qualifications, and signature of each aide trainer and of each aide tester.

(4) Aide supervisors, aide trainers, and aide testers:

(a) Qualifications: The provider shall only allow a person to serve as an aide supervisor, an aide trainer, or an aide tester if the person meets one or more of the following qualifications:

(i) The person is an RN.

(ii) The person is an LPN who works under the supervision of a RN.

(iii) The person successfully completed a baccalaureate or associate degree in a health and human services field.

(iv) The person completed at least two years of work as an aide, as defined by this rule.

(b) Aide supervisor visits: The providers aide supervisor shall do all of the following:

(i) Initial: visit each consumer in person at the consumer's home to develop a written activity plan with the consumer either before allowing an aide to provide an episode of service to the consumer or during the aide's initial episode of service to the consumer. During a state of emergency declared by the governor, the aide supervisor may conduct the visit by telephone, video conference, or in person at the consumer's home.

(ii) Subsequent: visit each consumer in person at the consumer's home at least once every ninety-three days after the aide's initial episode of service with the consumer to evaluate compliance with the activity plan, the consumer's satisfaction, and the aide's performance. The aide supervisor may conduct each visit with or without the presence of the aide being evaluated. During a state of emergency declared by the governor, the aide supervisor may conduct the visit by telephone, video conference, or in person at the consumer's home.

(iii) Verification: retain a record of the initial visit and each subsequent visit that includes the date of the visit; whether the visit occurred by telephone, video conference, or in person at the consumer's home; the aide supervisor's name and signature; the consumer's name; and a unique identifier of the consumer or the consumer's caregiver. During a state of emergency declared by the governor, the provider may verify that the aide supervisor provided the initial visit or subsequent visits without collecting a unique identifier of the consumer or the consumer's caregiver.

(5) Employee policies:

(a) The provider shall develop, implement, comply with, and maintain written policies on all the following topics:

(i) Job descriptions.

(ii) Qualifications to provide homemaker activities.

(iii) Performance appraisals.

(iv) Incident reporting.

(v) Obtaining the consumer's written permission before releasing information concerning the consumer to anyone.

(vi) The required content, handling, storage, and retention of consumer records.

(vii) The provider's ethical standards.

(b) The provider shall make its policies available to all employees and to ODA or the AAA upon request.

(6) Service verification: The provider shall verify each episode of service provided for which it bills the AAA by using the provider's choice of either an electronic or manual system that collects all the following information:

(a) Consumer's name.

(b) Service date.

(c) Arrival time.

(d) Departure time.

(e) Service description.

(f) Service units.

(g) Name of each aide in contact with the consumer.

(h) Signature of each aide in contact with the consumer.

(i) A unique identifier of the consumer or the consumer's caregiver. During a state of emergency declared by the governor, the provider may verify each episode of service provided without collecting the unique identifier.

(7) Reporting: 45 C.F.R. 1321.65 requires the provider to report information to the AAA on the service it provides.

(C) Self-employed (non-agency) and participant-directed providers: In every AAA-provider agreement for homemaker paid, in whole or in part, with Older Americans Act funds, the AAA shall include the same requirements as for agency providers, with the following differences:

(1) Availability: Paragraph (B)(2)(c) of this rule does not apply.

(2) Initial qualifications, in-service training, and verification: Paragraphs (B)(3)(a), (B)(3)(c), and (B)(3)(d) of this rule apply as if "provider" is the AAA and "aide" is either the self-employed or participant-directed provider.

(3) Orientation: Paragraph (B)(3)(b) of this rule does not apply.

(4) Supervision: Paragraph (B)(4) of this rule does not apply.

(5) Employee policies: Paragraphs (B)(5)(iv) to (B)(5)(vii) of this rule of this rule apply, but paragraphs (B)(5)(i) to (B)(5)(iii) do not apply.

(6) Service verification: Paragraph (B)(6) of this rule applies as if "aide" is either the self-employed or participant-directed provider.

(D) Unit of service: A unit of homemaker is one hour of homemaker. Providers may report partial hours to two decimal places (e.g., "0.25 hours").

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11
Amplifies: 173.39, 173.392; 42 U.S.C. 3025, 3030d; 45 C.F.R. 1321.11, 1321.65
Five Year Review Date: 11/28/2025
Rule 173-3-06.5 | Older Americans Act: personal care.
 

(A) Definition for this rule: "Personal care" means a service comprised of activities to help a consumer achieve optimal functioning with ADLs and IADLs.

(1) "Personal care" includes the following activities:

(a) Assisting the consumer with managing the household, handling personal affairs, and providing assistance with self-administration of medications.

(b) Assisting the consumer with ADLs and IADLs.

(c) Homemaker activities listed in rule 173-3-06.4 of the Administrative Code, if the activities are specified in the consumer's activities plan and are incidental to the activities provided, or are essential to the health and safety of the consumer, rather than the consumer's family. The homemaker activities include routine meal-related activities, routine household activities, and routine transportation activities.

(d) The activities described in paragraphs (A)(1)(a) to (A)(1)(c) of this rule when they assist the consumer as respite to the consumer's caregiver or are essential to the health and safety of the consumer as respite to the consumer's caregiver.

(2) "Personal care" does not include the following activities:

(a) Activities provided outside of the home with the exception of the routine transportation activities listed in paragraph (A)(1)(c) of this rule.

(b) Activities within the scope of home maintenance and chores.

(c) Activities available through third-party insurers, community supports, Ohio medicaid state plan, or a medicaid waiver program.

(d) Activities to administer or set-up medications.

(B) Requirements for every AAA-provider agreement for personal care paid, in whole or in part, with Older Americans Act funds:

(1) General requirements: The AAA-provider agreement is subject to the requirements in rule 173-3-06 of the Administrative Code for every AAA-provider agreement paid, in whole or in part, with Older Americans Act funds.

(2) Availability: The provider shall maintain the following:

(a) Adequate staffing levels to provide personal care at least five days per week.

(b) A back-up plan for providing personal care when the provider has no PCA available.

(c) The availability of a PCA supervisor available during all hours when PCAs are scheduled to work.

(3) PCAs:

(a) Initial qualifications: The provider shall only allow a person to serve as a PCA if the person meets at least one of the following qualifications and if the provider meets the verification requirements under paragraph (B)(3)(d) of this rule:

(i) STNA: The person successfully completed a nurse aide training and competency evaluation program approved by Ohio department of health (ODH) under section 3721.31 of the Revised Code.

(ii) Medicare: The person met the qualifications to be a medicare-certified home health aide according to one of the following sets of standards:

(a) The standards in 42 C.F.R. 484.4 and 484.36, if the person met those standards on or before January 12, 2018.

(b) The standards in 42 C.F.R. 484.80 and 484.115, if the person met those standards on or after January 13, 2018.

(iii) Previous experience: The person has at least one year of supervised employment experience as a home health aide or nurse aide, and has successfully completed competency evaluation covering the topics listed under paragraph (B)(3)(a)(v)(b) of this rule.

(iv) Vocational programs: The person successfully completed the COALA home health training program or another vocational school program that included at least sixty hours of training and competency evaluation covering the topics listed under paragraph (B)(3)(a)(v)(b) of this rule.

(v) Other programs: The person successfully completed a training and competency evaluation program with the following characteristics:

(a) The training lasted at least sixty hours.

(b) All the following subjects were included in the program's training and its competency evaluation:

(i) Communications skills, including the ability to read, write, and make brief and accurate reports (oral or written (including electronic)).

(ii) Observation, reporting, and retaining records of a consumer's status and activities provided to the consumer.

(iii) Reading and recording a consumer's temperature, pulse, and respiration.

(iv) Basic infection control, including hand washing and the disposal of bodily waste.

(v) Basic elements of bodily functioning and changes in body function that should be reported to a PCA supervisor.

(vi) The homemaker activities listed in rule 173-3-06.4 of the Administrative Code.

(vii) Recognition of emergencies and knowledge of emergency procedures.

(viii) Physical, emotional, and developmental needs of consumers, including the need for privacy and respect for consumers and their property.

(ix) 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) Orientation: Before allowing PCAs or other employees to have direct, face-to-face contact with consumers, the provider shall provide the PCAs or other employees with orientation training that, at a minimum, addresses the following topics:

(i) The provider's expectations of employees.

(ii) Person-centered care.

(iii) The provider's ethical standards.

(iv) An overview of the provider's personnel policies.

(v) The organization and lines of communication of the provider's agency.

(vi) Incident reporting.

(vii) Emergency procedures.

(c) In-service training: The provider shall retain records to show that each PCA successfully completes eight hours of in-service training every twelve months. Agency- and program-specific orientation shall not count toward the eight hours. If the PCA is also a homemaker aide (aide) according to rule 173-3-06.4 of the Administrative Code, the provider may consider eight hours of successfully-completed in-service training as an aide to count for the eight hours required by this paragraph.

(d) Verification of compliance with PCA requirements:

(i) The provider shall retain copies of certificates of completion earned by each PCA after the PCA meets qualifications/requirements under paragraph (B)(3) of this rule for successfully completing any training and competency evaluation program, orientation, and in-service training under paragraph (B)(3) of this rule. Additionally, the provider shall also record the following information for each PCA, and retain it, if it does not appear on the PCA's certificate of completion (or if the PCA did not receive a certificate of completion): training dates; training locations; training hours successfully completed; instruction materials used; subjects covered; and to verify the accuracy of the record, the name, qualifications, and signature of each PCA trainer and of each PCA tester.

(ii) If a person meets the initial qualifications to be a PCA under paragraph (B)(3)(a) of this rule by successfully completing a nurse aide training and competency evaluation program described in paragraph (B)(3)(a)(i) of this rule, the provider shall retain a copy of the search results from ODH's nurse aide registry (https://odhgateway.odh.ohio.gov/nar/nar_registry_search.aspx) to verify the registry listed the person as "active" or "in good standing."

(iii) If a person meets the initial qualifications to be a PCA under paragraph (B)(3)(a) of this rule only by the previous employment experience described in paragraph (B)(3)(a)(iii) of this rule, the provider shall also retain records to verify the person's name, the former employer's name and contact information, the former supervisor's name, the date the person began working for the former employer, and the date the person stopped working for the former employer.

(4) PCA supervisors, PCA trainers, and PCA testers:

(a) Qualifications: The provider shall only allow a RN (or a LPN under the direction of a RN) to be a PCA supervisor, PCA trainer, or PCA tester.

(b) PCA supervisor visits:

(i) Initial: The PCA supervisor shall visit each consumer in person at the consumer's home to define the expected activities of the PCA and develop a written activity plan with the consumer either before allowing a PCA to provide an episode of service to the consumer or during the PCA's initial episode of service to the consumer. During a state of emergency declared by the governor, the PCA supervisor may conduct the visit by telephone, video conference, or in person at the consumer's home.

(ii) Subsequent: The PCA supervisor shall visit the consumer in person at the consumer's home at least once every sixty days after the PCA's initial episode of service with the consumer to evaluate compliance with the activities plan, the consumer's satisfaction, and the PCA's performance. The PCA supervisor may conduct subsequent visits with or without the presence of the PCA being evaluated. During a state of emergency declared by the governor, the PCA supervisor may conduct subsequent visits by telephone or video conference, unless an emergency requires visiting the consumer in person at the consumer's home.

(iii) Verification: In the consumer's record, the PCA supervisor shall retain a record of the initial visit and each subsequent visit that includes the date of the visit; whether the visit occurred by telephone, video conference, or in person at the consumer's home; the PCA supervisor's name and signature; the consumer's name; and a unique identifier of the consumer or the consumer's caregiver. During a state of emergency declared by the governor, the provider may verify that the PCA supervisor provided the initial or subsequent visit without collecting a unique identifier of the consumer or the consumer's caregiver.

(5) Provider's policies:

(a) The provider shall develop, implement, comply with, and maintain written policies on all the following topics:

(i) Job descriptions.

(ii) Qualifications to provide personal care.

(iii) Performance appraisals.

(iv) Incident reporting.

(v) Obtaining the consumer's written permission before releasing information concerning the consumer to anyone.

(vi) The required content, handling, storage, and retention of consumer records.

(vii) The provider's ethical standards.

(viii) Assistance with self-administration of medication.

(b) The provider shall make its policies available to all employees and provide to ODA or the AAA upon request.

(6) Service verification:

(a) The provider shall use a monitoring system that complies with section 121.36 of the Revised Code.

(b) The provider shall verify each episode of service provided for which it bills the AAA using the provider's choice of either an electronic or manual system that collects all the following information:

(i) Consumer's name.

(ii) Service date.

(iii) Arrival time.

(iv) Departure time.

(v) Service description.

(vi) Service units.

(vii) Name of each PCA in contact with the consumer.

(viii) Signature of each PCA in contact with the consumer.

(ix) A unique identifier of the consumer or the consumer's caregiver.

(c) During a state of emergency declared by the governor, the provider may verify each episode of service provided without collecting the unique identifier in paragraph (B)(6)(b)(ix) of this rule.

(7) Reporting: 45 C.F.R. 1321.65 requires the provider to report information to the AAA on the personal care it provides.

(C) Unit of service: A unit of personal care is one hour of personal care. Providers may report partial hours to two decimal places (e.g., "0.25 hours").

Supplemental Information

Authorized By: 121.07, 121.36, 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11
Amplifies: 121.36, 173.39, 173.392; 42 U.S.C. 3025, 3030d; 45 C.F.R. 1321.11, 1321.65
Five Year Review Date: 11/28/2025
Prior Effective Dates: 2/14/2010, 5/8/2020
Rule 173-3-06.6 | Older Americans Act: transportation.
 

(A) Definitions for this rule:

(1) "Transportation" means a service that transports a consumer from one place to another through the use of a provider's vehicle and driver, and which may, or may not, include providing the consumer with assistance to safely enter and exit the vehicle. "Transportation" does not include the following:

(a) Trips otherwise available, or funded by, Ohio's medicaid program or another source.

(b) Trips provided through a similar service in this chapter or Chapter 173-4 of the Administrative Code.

(2) "Board of EMFTS" means the Ohio board of emergency medical, fire, and transportation services.

(3) "Bus" has the same meaning as in section 4513.50 of the Revised Code.

(4) "CLIA-certified laboratory" means a laboratory ODH lists as a "CLIA Lab" in active status on the "Long-Term Care, Non Long-Term Care, & CLIA Health Care Provider Search" (http://publicapps.odh.ohio.gov/eid/Provider_Search.aspx).

(5) "First responder" has the same meaning as in division (A) of section 4765.01 of the Revised Code.

(6) "EMT" means any of the emergency medical technicians defined in division (A), (B), or (C) of section 4765.01 of the Revised Code.

(B) In every AAA-provider agreement for transportation paid, in whole or in part, with Older Americans Act funds, the AAA shall include the following requirements:

(1) General requirements:

(a) In the AAA-provider agreement, the AAA shall include the requirements in rule 173-3-06 of the Administrative Code for every AAA-provider agreement paid, in whole or in part, with Older Americans Act funds.

(b) Availability: An agency provider shall possess a back-up plan for times when a driver or vehicle is unavailable. A self-employed provider shall possess a back-up plan for times when he/she or his/her vehicle is unavailable. The back-up plan may describe the process for transporting consumers when the driver or vehicle is unavailable or it may describe the process for notifying the consumer when a driver or vehicle is unavailable.

(c) Assisted transportation: In each AAA-provider agreement, the AAA shall list situations when drivers shall provide consumers with assistance to safely enter and exit vehicles, pick-up locations, and drop-off locations.

(2) Vehicle requirements:

(a) Maintenance: The provider shall maintain vehicles according to the manufacturer's maintenance schedule for each vehicle used to transport consumers. If the vehicle includes a wheelchair lift, the provider shall maintain the wheelchair lift according to the manufacturer's maintenance schedule for the wheelchair lift.

(b) Inspections: The provider shall conduct the following inspections on each vehicle used to transport consumers. If the vehicle includes a wheelchair lift, the provider's inspection shall include inspecting the wheelchair lift:

(i) "Annual Vehicle Inspection" on form ODA0004 (rev. 12/15/2010). The provider shall only use a vehicle for transporting consumers if a mechanic who is certified by the national institute for automotive service excellence (i.e., "ASE-certified"), or another mechanic approved by the AAA, inspected it no more than twelve months before and the answers to all questions on the form were "yes."

(ii) "Daily Vehicle Inspection" on form ODA0008 (rev. 02/01/2019) or form ODA0011 (rev. 02/01/2019). The provider shall only use a vehicle if, before providing the first trip of the day, the provider inspected it and the answers to all questions required by the form were "yes."

(c) Exemptions:

(i) A vehicle possessing a current, valid ambulette license is deemed to comply with paragraphs (B)(2)(a) and (B)(2)(b) of this rule. Providers using a vehicle with a current, valid ambulette license may demonstrate compliance with paragraphs (B)(2)(a) and (B)(2)(b) of this rule by providing the AAA with evidence of the vehicle's current, valid ambulette license.

(ii) A bus displaying a current, valid safety-inspection decal issued by the state highway patrol under Chapter 4501-52 of the Administrative Code is deemed to comply with paragraph (B)(2)(b)(i) of this rule. Providers using a vehicle with a current, valid safety-inspection decal issued under section 4513.52 of the Revised Code may demonstrate compliance with paragraph (B)(2)(b)(i) of this rule by providing the AAA with evidence of the vehicle's current, valid decal.

(3) Driver requirements:

(a) Statutory requirements to hire: The provider shall not hire a person to be a driver unless the person meets all the requirements for drivers under divisions (A)(3) and (B) of section 4766.14 of the Revised Code, subject to the following conditions:

(i) To comply with the first-aid requirement, the applicant's training shall come from a training organization approved by the board of EMFTS (http://www.ems.ohio.gov/medical-transportation-faq.aspx).

(ii) To comply with the cardiopulmonary-resuscitation requirement, the applicant's training shall come from a training organization approved by the board of EMFTS (http://www.ems.ohio.gov/medical-transportation-faq.aspx).

(iii) To comply with the drug-testing requirement, the applicant's test results shall come from a CLIA-certified laboratory and shall declare the applicant to be free of alcohol, amphetamines, cannabinoids (THC), cocaine, opiates, or phencyclidine (PCP).

(iv) To comply with the background-check requirement, the provider shall comply with the background-check requirements in Chapter 173-9 of the Administrative Code, which exempts an applicant for a volunteer driver position and an applicant for a position solely involving transporting consumers while working for a county transit system, regional transit authority, or regional transit commission.

(b) Additional requirements to hire: The provider shall not hire a person to be a driver unless the person meets all the following requirements:

(i) The applicant has held a current, valid driver's license for at least two years.

(ii) The applicant holds any driver's license endorsement necessary to operate the type of vehicle the applicant would drive.

(iii) The applicant has the ability to understand written and oral instructions.

(iv) The applicant has the ability to provide transportation assistance.

(v) The applicant has the ability to comply with the trip-verification requirements in paragraph (B)(4)(a) of this rule.

(c) Passenger-assistance training: No later than six months after the provider hires a driver, the driver shall successfully complete a passenger-assistance training course approved by the board of EMFTS (http://www.ems.ohio.gov/medical-transportation-faq.aspx).

(d) Exempted professionals: An applicant with a current, valid license or certificate to be one or more of the following professionals is deemed to meet the requirements in paragraphs (B)(3)(a), (B)(3)(b), and (B)(3)(c) of this rule. Providers hiring an applicant with a current, valid license or certificate to be one or more of the following professionals may demonstrate compliance with paragraphs (B)(3)(a), (B)(3)(b), and (B)(3)(c) of this rule by providing the AAA with evidence the applicant possesses a current, valid license or certificate as one of the following professionals:

(i) An ambulette driver.

(ii) An EMT or first responder. Additionally, an applicant is deemed to meet the requirements in paragraphs (B)(3)(a), (B)(3)(b), and (B)(3)(c) of this rule if the applicant passed the board of EMFTS' curriculum for an EMT or first responder, but does not hold a current, valid certification for either profession. Providers hiring such applicants may demonstrate compliance with paragraphs (B)(3)(a), (B)(3)(b), and (B)(3)(c) of this rule by providing the AAA with evidence the applicant passed the board of EMFTS' curriculum for an EMT or first responder.

(iii) A driver for a county transit system, regional transit authority, or regional transit commission.

(4) Trip verification:

(a) For each trip provided, the driver shall record the consumer's name; type of trip (transportation or assisted transportation); date of trip; pick-up point and time of the pick up; destination point and time of the drop off; driver's name; and a unique identifier of the consumer or the consumer's caregiver. During a state of emergency declared by the governor, the provider may verify each trip provided without collecting the unique identifier if the provider also collects the driver's signature as an attestastion to the completion of the trip.

(b) In the AAA-provider agreement, the AAA shall not prohibit a provider from using an electronic system to collect and retain the records required in paragraph (B)(4)(a) of this rule.

(c) Pursuant to 45 C.F.R. 1321.65, the provider shall report information to the AAA on transportation provided.

(C) Unit and rate:

(1) A one-way trip equals one unit of transportation.

(2) The unit rate in an AAA-provider agreement shall reflect the provider's fully-allocated costs, including administrative costs, training costs, and documentation costs.

(D) Incorporation by reference: This rule's reference to 45 C.F.R. 1321.65 refers to the version of that federal regulation in effect on the date of the trip.

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.392, 4766.14; 42 U.S.C. 3025; 45 C.F.R. 1321.11
Amplifies: 173.39, 173.392, 4766.14, 4766.15; 42 U.S.C. 3025, 3030d, 3032c, 3032e; 45 C.F.R. 1321.11, 1321.65
Five Year Review Date: 11/28/2025
Prior Effective Dates: 2/15/2009, 9/2/2010
Rule 173-3-07 | Older Americans Act: consumer contributions.
 

(A) Introduction: All services paid, in whole or in part, with Older Americans Act funds are subject to voluntary contributions. All services paid, in whole or in part, with Older Americans Act funds are subject to cost sharing, except for services excluded by paragraph (C)(1) of this rule.

(B) Voluntary contributions:

(1) Each provider shall allow consumers to contribute towards the provision of services paid, in whole or in part, with Older Americans Act funds, pursuant to 42 U.S.C. 3030c-2 and 45 C.F.R. 1321.67. The provider may solicit consumers to contribute toward the cost of the services they receive and shall encourage any consumer to contribute if the consumer's self-declared income is at, or above, one hundred eighty-five per cent of the federal poverty guidelines, which the United States department of health and human services establishes annually according to 42 U.S.C. 9902 and publishes on https://aspe.hhs.gov/poverty-guidelines.

(2) The provider shall clearly inform each consumer that contributions are purely voluntary.

(3) The provider shall protect the privacy of each consumer with respect to his or her contribution.

(4) The provider shall safeguard and account for all voluntary contributions.

(5) The provider may develop a suggested contributions schedule for voluntary contributions according to 45 C.F.R. 1321.67.

(6) The provider shall use collected voluntary contributions to expand the services for which consumers contributed and supplement (not supplant) Older Americans Act funds for those services.

(C) Cost sharing:

(1) All good and services paid, in whole or in part, with Older Americans Act funds are subject to cost sharing, except for the following services:

(a) Information and assistance, outreach, benefits counseling, case management, disease prevention, health promotion, or volunteer placement.

(b) Education, training, or a support group provided through the national family caregiver support program.

(c) Congregate and home-delivered meals.

(d) Ombudsman, elder abuse prevention, legal assistance, or another consumer-protection service.

(e) Transportation, although the AAA may apply to ODA for a waiver of this exemption if the transportation is coordinated with other services and is paid, in whole or in part, with Older Americans Act funds.

(2) Each AAA shall implement and administer a cost-sharing policy that includes all of the following:

(a) The policy shall include the following sliding-fee schedule, which determines the percentage of the actual (or partial) contracted cost of a unit of a good or a service provided that the AAA shall suggest that a consumer pay based upon the consumer's individual income as a percentage of the federal poverty guideline. Under no circumstances shall an AAA permit or require a consumer to participate in cost sharing when the consumer's income is below one hundred fifty per cent of the federal poverty guideline.

INCOMESUGGESTED COSTSHARE
149% andbelow0%
150-174%10%
175-199%20%
200-224%30%
225-249%40%
250-274%50%
275-299%60%
300-324%70%
325-349%80%
350-374%90%
375%and above100%

(b) The policy shall include a requirement to determine the consumer's income solely by the consumer's self-declaration of income with no requirement for verification, and no consideration of the consumer's assets, savings, or other property.

(c) The policy shall include a procedure for collecting cost-sharing payments from consumers, including from consumers receiving participant-directed services.

(d) The policy shall include a requirement to widely distribute written materials to consumers that describe the requirements for cost sharing, the services subject to cost sharing, the procedure for cost sharing, and the sliding-fee schedule published in this rule. The written materials shall also state that a provider shall not deny any services paid, in whole or in part, by Older Americans Act funds if the consumer fails to make a cost sharing payment towards those services.

(e) The policy shall include a requirement to provide a receipt to a consumer or caregiver who makes a payment.

(f) The policy shall include a procedure for safeguarding and accounting for all cost-sharing funds collected.

(g) The policy shall include a requirement to retain records of all cost-sharing funds collected.

(h) The policy shall include a requirement to keep the consumer's declaration of income (or non-declaration of income) and cost-sharing payment history confidential.

(i) The policy shall include a requirement to use the funds collected from cost sharing to expand the capacity to provide the service for which the funds were given, unless the funds are used to expand the pool of funds from which the care-coordinated services are paid.

(3) The AAA may delegate the administration of its cost-sharing policy to providers with whom it enters into an AAA-provider agreement under rule 173-3-06 of the Administrative Code.

(4) The AAA may request a waiver from paragraph (C)(3) of this rule to implement and administer a cost-sharing policy. ODA shall approve the request if the AAA demonstrates to ODA, by a preponderance of the evidence, one or more of the following:

(a) At least eighty per cent of the consumers in the PSA have incomes below one hundred fifty per cent of the federal poverty level.

(b) Cost sharing generates fewer funds in the PSA than the funds required to cover its annual, ongoing administrative expenses.

(c) A waiver is necessary in order for the services normally subject to this rule to be coordinated with other service systems.

Supplemental Information

Authorized By: 173.01, 173.02, 173.392; 42 U.S.C. 3025; 45 C.F.R. 1321.11
Amplifies: 173.39, 173.392; 42 U.S.C.3030c-2; 45 C.F.R. 75.403, 1321.11,1321.53, 1321.65, 1321.67
Five Year Review Date: 7/1/2025
Prior Effective Dates: 5/15/2000, 5/16/2005
Rule 173-3-09 | Older Americans Act: administrative hearings for adversely-affected providers.
 

(A) Introduction:

(1) A provider may request an administrative hearing ("hearing") to appeal any adverse action that an AAA has taken against the provider.

(2) AAAs and ODA shall honor all written hearing requests subject to the conditions in this rule.

(3) A hearing under this rule is not an adjudication hearing under Chapter. 119 of the Revised Code.

(B) AAA-level hearings:

(1) Written process: Each AAA shall maintain in writing a process that allows a provider to appeal an adverse action related to an AAA-provider agreement ("agreement") paid, in whole or in part, with Older Americans Act funds.

(2) Final AAA decision: An AAA that conducts an administrative hearing shall forward a copy of the provider's written request for the hearing and a copy of the AAA's final decision on the matter to ODA no later than five days after the date the AAA renders its final decision. If the fifth day falls on a weekend or legal holiday, as defined in section 1.14 of the Revised Code, the deadline is extended to the day immediately following the fifth day that is not on a weekend or legal holiday.

(C) ODA-level hearings:

(1) AAA first: ODA shall only honor a request for an administrative hearing before ODA if the provider has fully complied with the written process for appealing an adverse action by the AAA that committed the adverse action and if that AAA has rendered its final decision on the appeal.

(2) Request a hearing: To request a hearing before ODA, the provider shall submit a written request to ODA's director no later than fifteen days after the date the AAA renders its final decision. In the request, the provider shall describe the adverse action the provider is appealing and why the provider believes the AAA's decision on the matter was inappropriate. If the fifteenth day falls on a weekend or legal holiday, as defined in section 1.14 of the Revised Code, the deadline is extended to the day immediately following the fifteenth day that is not on a weekend or legal holiday.

(3) Scheduling a hearing: After ODA receives the request for an administrative hearing, ODA shall, in a timely manner, schedule a hearing and select a hearing officer to preside over the hearing.

(4) Hearing process:

(a) The hearing officer shall afford an adequate opportunity for both the provider and the AAA to present their positions and provide evidence, but may limit or terminate the discussion/testimony under any one or more of the following conditions:

(i) The provider or the AAA is unruly or combative.

(ii) The provider's or AAA's discussion/testimony is unnecessarily redundant.

(iii) The provider or the AAA negotiate a written agreement that resolves the adverse action(s) that prompted the hearing.

(iv) The provider, in a written statement, withdraws its request for the hearing.

(b) The hearing officer shall make an audio recording of the hearing or ODA shall pay a court reporter to record the hearing.

(5) Final ODA decision: The hearing officer shall review the testimony or evidence collected at the hearing and shall make a written recommendation to ODA regarding whether the AAA's action was appropriate. ODA shall render its final decision on the appeal no later than thirty days after the date of the hearing and shall send a copy of the decision, and the rationale for the decision, to the provider and the AAA. If the thirtieth day falls on a weekend or legal holiday, as defined in section 1.14 of the Revised Code, the deadline is extended to the day immediately following the thirtieth day that is not on a weekend or legal holiday.

(D) Hearings vs. court cases:

(1) A provider may seek redress from a court without waiting for the final decision of an AAA-level hearing or ODA-level hearing.

(2) If a provider enters a lawsuit against the AAA or ODA, the AAA or ODA may cease continuing with any in-progress hearing that the provider requested.

(E) As used in this rule, "adverse action" means an AAA's action concerning a particular provider to not award an agreement; to not renew a renewable agreement; to prematurely terminate an agreement; or to terminate a multi-year agreement for the agreement's second, third, or fourth year.

Supplemental Information

Authorized By: 173.01, 173.02, 173.392; Section 305(a)(1)(C) of the Older Americans Act of 1965, 70 Stat. 210, 42 U.S.C. 3001, as amended by the Older Americans Act Reauthorization Act of 2016; 45 C.F.R. 1321.11 (October, 2015 edition).
Amplifies: 173.392; Section 212 of the Older Americans Act of 1965, 79 Stat. 210, 42 U.S.C. 3001, as amended by the Older Americans Act Reauthorization Act of 2016.
Five Year Review Date: 8/1/2021
Prior Effective Dates: 6/1/2014