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

Chapter 173-39 | Provider Certification

 
 
 
Rule
Rule 173-39-01 | ODA provider certification: introduction and definitions.
 

(A) Introduction:

(1) This chapter establishes the requirements for providers to become, and to remain, certified by ODA, compliance reviews of ODA-certified providers, and disciplinary actions that may be imposed upon ODA-certified providers.

(2) Rule 5160-58-04 of the Administrative Code requires providers to comply with many of the requirements for providing services in this chapter when the provider provides those services to individuals in the mycare Ohio program.

(B) Definitions for this chapter:

"Activity of daily living" (ADL) has the same meaning as in rule 5160-3-05 of the Administrative Code.

"Activity plan" means a description of interventions and the schedule for when to provide those interventions.

"ADS" has the same meaning as in rule 173-39-02.1 of the Administrative Code.

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

"Business site" includes any location at which the provider retains records or provides services. "Business site" does not include the home of an individual receiving services unless the individual employs a participant-directed provider.

"Caregiver" means a relative, friend, or significant other who voluntarily provides assistance to the individual and is responsible for the individual's care on a continuing basis.

"Case manager" means the registered nurse, licensed social worker, or licensed independent social worker that ODA's designee employs to plan, coordinate, monitor, evaluate, and authorize services for ODA-administered programs that require provider certification under this chapter.

"CDJFS" means county department of job and family services.

"Certification" means ODA's approval of a provider to provide one or more of the services that this chapter regulates.

"CMS" means centers for medicare and medicaid services.

"Competency evaluation" includes both standardized testing (whether written or electronic) and skills testing by return demonstration to ensure an applicant or employee is able to address the care needs of the individual to be served.

"Complete application" means the application and all records required by rule 173-39-03, 173-39-03.1, 173-39-03.2, 173-39-03.3, or 173-39-03.4 of the Administrative Code. Although ODA cannot approve an application to become an ODA-certified assisted living provider unless the RCF is licensed, the application is a complete application if the provider indicates in its application that it applied for a RCF license and the provider submits the required RCF licensure information to ODA as soon as it is available.

"Continuing care retirement communities" has the same meaning as in rule 5160:1-6-02.3 of the Administrative Code.

"Current owner" means a person with an ownership interest in an ODA-certified provider whose interest in the provider is being sold or transferred.

"Electronic record" has the same meaning a sin section 1306.01 of the Revised Code. For a health care record, "electronic record" has the same meaning as in section 3701.75 of the Revised Code.

"Electronic signature" has the same meaning as in section 1306.01 of the Revised Code. If attached to, or associated with, a health care record, "electronic signature" has the same meaning as in section 3701.75 of the Revised Code.

"Electronic visit verification" (EVV) means using the ODM-approved EVV system to verify the provision of any service required by ODM, pursuant to rule 5160-1-40 of the Administrative Code.

"Emergency contact person" means a person the individual or caregiver wants the provider to contact in the event of an emergency to inform the person about the nature of the emergency.

"HCBS" means home and community-based services.

"Health care record" has the same meaning as in section 3701.75 of the Revised Code. Examples of a health care record are a plan of treatment or diet order received from a licensed healthcare professional.

"HHS" means the United States department of health and human services.

"Incident" means any event or situation that is not consistent with providing routine care or a service to an individual that may result in injury to a person or damage to property or equipment. Examples of an incident are abuse, neglect, abandonment, accidents, and exploitation. An incident may involve an individual, a caregiver (to the extent the event or situation impacts the individual), a provider, a facility, or a staff member of a provider, facility, ODA, ODA's designee, or another administrative authority.

"Individual" has the same meaning in rule 5160-31-02 of the Administrative Code.

"Instrumental activity of daily living" (IADL) has the same meaning as in rule 5160-3-05 of the Administrative Code.

"Licensed healthcare professional" includes a physician with an "expedited license," as defined in section 4731.11 of the Revised Code; or a licensed audiologist, occupational therapist, occupational therapy assistant, physical therapist, physical therapy assistant, or speech-language pathologist from another state with "compact privilege," as defined in section 4753.17, 4755.14, or 4755.57 of the Revised Code. Beginning on January 1, 2023, "licensed healthcare professional" also includes an RN or LPN with a "multistate license" from another state with "multistate licensure privilege," as those terms are defined in section 4723.11 of the Revised Code.

"Licensed practical nurse" (LPN) has the same meaning as in section 4723.01 of the Revised Code. Beginning on January 1, 2023, "licensed practical nurse" also includes a licensed practical nurse with a "multistate license" from another state with "multistate licensure privilege," as those terms are defined in section 4723.11 of the Revised Code.

"Medicaid-provider agreement" means an agreement between ODM and the provider.

"Medicaid provider number" means a number ODM issued to a provider with whom ODM has entered into a medicaid-provider agreement.

"National provider identifier" (NPI) means a number issued to a provider by HHS.

"Nursing facility" has the same meaning as in section 5165.01 of the Revised Code.

"ODA" means the Ohio department of aging.

"ODA-certified provider" means a provider certified by ODA according to this chapter.

"ODA's designee" means an entity to which ODA delegates one or more of its administrative duties. ODA's current designees include the area agencies on aging that ODA lists in rule 173-2-04 of the Administrative Code and "Catholic Social Services of the Miami Valley." When "its designee" occurs after "ODA," it means "ODA's designee."

"ODH" means the Ohio department of health.

"ODM" means the Ohio department of medicaid.

"Ownership interest" means interest totaling five per cent or more in the provider, indirect ownership interest equal to five percent or more in the provider, a combination of direct and indirect ownership interest equal to five per cent or more in the provider; or an interest of five per cent or more in any mortgage, deed of trust, note, or other obligation if that interest equals at least five per cent of the value of the property or assets of the provider.

"PCA" means "personal care aide."

"Plan of treatment" means the orders of a licensed healthcare professional whose scope of practice includes making plans of treatment.

"Provider" has the same meaning as in section 173.39 of the Revised Code. ODA certifies the following categories of providers: agency providers, assisted living providers, non-agency providers, and participant-directed providers. "Agency provider" means a legally-organized entity that employs staff. "Assisted living provider" means a licensed residential care facility. "Non-agency provider" (i.e., "self-employed provider") means a legally-organized entity that is owned and controlled by one self-employed person who does not employ, either directly or through a contract, anyone else to provide services, and who is unsupervised. "Participant-directed provider" means a person that an individual (participant) directly employs and supervises to provide a service.

"Provider agreement" means an agreement between ODA's designee and the provider.

"Region" means a distinct geographic area in which ODA's designee administers the PASSPORT and assisted living programs. Each region consists of the counties assigned to similarly-numbered planning and service areas (PSAs) in rule 173-2-02 of the Administrative Code, except for "PSA2." In that PSA, Clark, Greene, and Montgomery counties comprise "Region 2" and Champaign, Darke, Logan, Miami, Preble, and Shelby counties comprise "Region CSS."

"Registered nurse" (RN) has the same meaning as in section 4723.01 of the Revised Code. Beginning on January 1, 2023, "registered nurse" also includes a registered nurse with a "multistate license" from another state with "multistate licensure privilege," as those terms are defined in section 4723.11 of the Revised Code.

"Residential care facility" (RCF) has the same meaning as in section 3721.01 of the Revised Code.

"Service plan" means the outline of the services that a case manager authorizes a provider to provide to an individual, regardless of the funding source for those services. "Service plan" includes the person-centered planning in rule 5160-44-02 of the Administrative Code.

"Services" has the same meaning as "community-based long-term care services" in section 173.39 of the Revised Code.

"Significant change" means a variation in the health, care, or needs of an individual that warrants further evaluation to determine if changes to the type, amount, or scope of services are needed. Significant changes include differences in health status, caregiver status, residence, service location, service delivery, hospitalization, and emergency department visits that result in the individual not receiving services for thirty days.

"Unique identifier" means an item belonging to a specific individual, caregiver, driver (in the case of rule 173-39-02.13 of the Administrative Code), participant-directed provider (in the cases of rules 173-39-02.4 and 173-39-02.11 of the Administrative Code), aide (in the case of rule 173-39-02.8 of the Administrative Code), or PCA (in the case of rule 173-39-02.20 of the Administrative Code) that identifies only that individual or caregiver. Examples of a unique identifier are a handwritten or electronic signature or initials, fingerprint, mark, stamp, password, barcode, or swipe card. An individual, caregiver, driver, participant-directed provider, aide, or PCA offers their unique identifier as an attestation that the provider, or the provider's staff, completed an activity or unit of service.

"Vocational program" means a planned series, or a sequence of courses or modules, that incorporate challenging, academic education and rigorous, performance-based training to prepare participants for success in a particular health care career or occupation.

Last updated March 27, 2024 at 9:16 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522, 173.54, 173.543
Amplifies: 173.39, 173.391, 173.52, 173.522, 173.54, 173.543; 42 C.F.R. 441.352
Five Year Review Date: 4/2/2027
Prior Effective Dates: 7/1/2014, 7/1/2016
Rule 173-39-02 | ODA provider certification: requirements for providers to become, and to remain, certified.
 

Introduction: This rule presents requirements for every type of provider to become, and to remain, certified. For agency and assisted living providers, the requirements in this rule include requirements for each provider's employees.

(A) Requirements for every type of provider to become certified:

(1) Qualifications: The provider shall meet all of the following:

(a) Any qualification (e.g., licensure, training requirements, staffing levels) required by this chapter.

(b) Any qualification (e.g., licensure, certification, registration) required by applicable federal, state, and local laws, including the requirement under 45 C.F.R. Part 162 to have a national provider identifier (NPI), if applicable.

(2) Criminal records checks and database reviews: Sections 173.38 and 173.381 of the Revised Code and Chapter 173-9 of the Administrative Code establish the requirements for criminal records checks and database reviews. Rule 173-9-02 of the Administrative Code lists exceptions to the applicability of those requirements. Rule 5160-1-17.8 of the Administrative Code establishes additional provider screening requirements for participation in a medicaid-funded program.

(3) Business site:

(a) The provider shall maintain a business site(s) from which to conduct business, unless the provider is a participant-directed provider.

(b) The provider's business site(s) for providing services are subject to the HCBS setting requirements in rule 5160-44-01 of the Administrative Code. Additionally, any such business site used for providing ADS or assisted living services may be subject to federal heightened scrutiny under 42 C.F.R. 441.301(c)(5)(v) and rules 173-39-03 and 173-39-03.1 of the Administrative Code.

(c) Each business site in which the provider retains records (e.g., headquarters, regional offices) shall have a designated, locked storage space for retaining records that is accessible to ODA and its designee, HHS, the state auditor's office, and ODM.

(4) Contact information: The provider shall have a valid email address and telephone number.

(5) Insurance: The provider shall have the following, unless the provider is a participant-directed provider:

(a) A minimum of one million dollars in commercial liability insurance, which includes coverage for individuals' losses due to theft or property damage. In lieu of commercial liability insurance, a non-agency provider may have a minimum of one million dollars in professional liability insurance, which includes coverage for individuals' losses due to theft or property damage.

(b) Written instructions any individual may use to obtain payment for loss due to theft or property damage caused by the provider, or if applicable, the provider's employee.

(6) Provider agreements: The provider shall enter into, comply with, and maintain an active status with the following:

(a) A medicaid provider agreement under rules 5160-1-17.2 and 5160-1-17.4 of the Administrative Code.

(b) A provider agreement with ODA's designee for the region in which the provider seeks certification to provide services pursuant to rule 173-39-03 of the Administrative Code.

(7) Incident reporting: The provider shall have a written or electronic policy on documenting incidents which complies with paragraph (B)(3)(b) of this rule.

(8) Electronic visit verification (EVV): Rule 5160-1-40 of the Administrative Code establishes the requirements for certain providers to have an ODM-approved EVV system in place.

(B) Requirements for every type of provider to remain certified:

(1) Continuation: The provider shall remain in compliance with all requirements under paragraph (A) of this rule.

(2) Service-related: For any service ODA certified the provider to furnish, the provider shall report all mandatory reporting items to verify the service to ODA or its designee and comply with any rule in this chapter regulating the provision of the service.

(3) Reporting:

(a) APS: Section 5101.63 of the Revised Code, as applicable, establishes a requirement for the provider to report any reasonable cause to believe an individual suffered abuse, neglect, or exploitation to the local adult protective services program. The provider shall also notify ODA or its designee within one business day after becoming aware of the reasonable cause.

(b) Significant changes: The provider shall notify ODA or its designee no later than one business day after the provider is aware of any significant change that may affect the individual's service needs or safety, including one or more of the following:

(i) The provider does not provide an authorized service at the time, or for the period of time, authorized by ODA's designee.

(ii) The individual moves to another address.

(iii) The individual's repeated refusal of services.

(iv) Any incident that is subject to the incident-reporting requirements in rule 5160-44-05 of the Administrative Code.

(v) Any other significant change in the individual's physical, mental, or emotional status or the individual's environment that affects the individual's service needs or safety.

(c) Contact information: The provider shall notify ODA or its designee of any change in the provider's telephone number, mailing address, or email address within seven days after the change.

(d) Last day of service: Unless the provider is an assisted living provider, the provider shall notify the individual and ODA's designee in writing at least thirty days before the last day the provider provides services to the individual, unless one or more of the following occurs:

(i) The individual has been hospitalized, placed in a long-term care facility, or is deceased.

(ii) The health or safety of the individual or provider is at serious, imminent risk.

(iii) The individual chooses to no longer receive services from the provider.

(4) Confidentiality: The provider is subject to all state and federal laws and regulations governing individual confidentiality including sections 5160.45 to 5160.481 of the Revised Code, 42 C.F.R. 431.300 to 431.307, and 45 C.F.R. parts 160, 162, and 164.

(5) Legally-responsible family members: The provider shall not provide a service to an individual if the provider is the individual's spouse, parent, step-parent, legal guardian, power of attorney, or authorized representative. During a state of emergency declared by the governor or a federal public health emergency, a provider may provide a service to an individual if the provider is the individual's spouse, parent, or step-parent. The period in which a spouse, parent, or step-parent is qualified to provide a service to an individual during a state of emergency declared by the governor or a federal public health emergency ends when the provider's medicaid provider agreement is terminated.

(6) Volunteers: The provider shall supervise the provider's volunteers.

(7) Person-centered planning: The provider is subject to the person-centered planning requirements in rule 5160-44-02 of the Administrative Code.

(8) Ethical, professional, respectful, and legal service standards: The provider shall not engage in any unethical, unprofessional, disrespectful, or illegal behavior including the following:

(a) Consuming alcohol while providing services to the individual.

(b) Consuming medicine, drugs, or other chemical substances in a way that is illegal, unprescribed, or impairs the provider from providing services to the individual.

(c) Accepting, obtaining, or attempting to obtain money, or anything of value, including gifts or tips, from the individual or his or her household or family members.

(d) Engaging the individual in sexual conduct, or in conduct a reasonable person would interpret as sexual in nature, even if the conduct is consensual.

(e) Leaving the individual's home when scheduled to provide a service for a purpose not related to providing the service without notifying the agency supervisor, the individual's emergency contact person, any identified caregiver, or ODA's designee.

(f) Failing to cooperate with or treating ODA or its designee respectfully.

(g) Engaging in any activity while providing a service that may distract the provider from providing the service as authorized, including the following:

(i) Watching television, movies, videos, or playing games on computers, personal phones, or other electronic devices whether owned by the individual, provider, or the provider's staff.

(ii) Non-care-related socialization with a person other than the individual (e.g., a visit from a person who is not providing care to the individual; making or receiving a personal telephone call; or, sending or receiving a personal text message, email, or video).

(iii) Providing care to a person other than the individual.

(iv) Smoking tobacco or any other material in any type of smoking equipment, including cigarettes, electronic cigarettes, vaporizers, hookahs, cigars, or pipes.

(v) Sleeping.

(vi) Bringing a child, friend, relative, or anyone else, or a pet, to the individual's place of residence.

(vii) Discussing religion or politics with the individual and others.

(viii) Discussing personal issues with the individual or any other person.

(h) Engaging in behavior that causes, or may cause, physical, verbal, mental, or emotional distress or abuse to the individual including publishing photos of the individual on social media without the individual's written or electronic consent.

(i) Engaging in behavior a reasonable person would interpret as inappropriate involvement in the individual's personal relationships.

(j) Making decisions, or being designated to make decisions, for the individual in any capacity involving a declaration for mental health treatment, power of attorney, durable power of attorney, guardianship, or authorized representative.

(k) Selling to, or purchasing from, the individual products or personal items, unless the provider is the individual's family member who does so only when not providing services.

(l) Consuming the individual's food or drink, or using the individual's personal property without his or her consent.

(m) Taking the individual to the provider's business site, unless the business site is an ADS center, RCF, or (if the provider is a participant-directed provider) the individual's home.

(n) Engaging in behavior constituting a conflict of interest, or taking advantage of, or manipulating services resulting in an unintended advantage for personal gain that has detrimental results to the individual, the individual's family or caregivers, or another provider.

(9) Training: The provider shall participate in ODA's or its designee's mandatory free provider training sessions.

(10) Records and monitoring:

(a) Records retention:

(i) Service records: The provider shall retain all records necessary (including activity plans, assessments (if required), permits (if required), and all mandatory reporting items to verify an episode of service), and in such form, so as to fully disclose the extent of the services the provider provided, and significant business transactions, until all of the following periods of time have passed:

(a) Six years after the date the provider receives payment for the service.

(b) The date on which ODA, its designee, ODM, or a duly-authorized law enforcement official concludes a review of the records and any findings are resolved.

(c) 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 resolved.

(ii) Qualification records: Each provider shall retain all records regarding the provider's or an employee's qualifications to provide a service for the duration of the provider's certification or the duration of the employee's employment and for six years after the provider is no longer certified or no longer retains the employee. Qualification records include records on background checks, initial qualifications, orientation, and training.

(iii) Electronic records: The provider may use an electronic system to collect or retain records.

(b) Compliance reviews: The provider shall participate in good faith in any compliance reviews under rule 173-39-04 of the Administrative Code and assist ODA and its designee with scheduling those reviews.

(c) Access: The provider shall, upon request, immediately provide representatives of ODA, its designee, HHS, the state auditor's office, and ODM with access to its business site(s) during the provider's normal business hours, a place to work in its business site(s), and access to policies, procedures, and records for each unit of service billed.

(11) Payment:

(a) The provider may bill for a service only if the provider complies with the requirements under all applicable laws, rules, and regulations, including service-verification requirements.

(b) ODA's obligation to pay the provider for the costs of services provided as a certified provider is subject to the hold and review process described in rule 5160-1-27.2 of the Administrative Code.

(c) The provider shall accept the payment rates established in its provider agreement with ODA's designee as payment in full for the services it provides, and not seek any additional payment for services from the individual or any other person.

(d) The provider may provide a service not authorized by the individual's person-centered services plan, but ODA (or its designee) pays a provider only for providing services authorized by the individual's person-centered services plan.

(12) Other laws: The provider is subject to all applicable federal, state, and local laws, rules, and regulations and is responsible for ensuring all subcontractors comply with all applicable federal, state, and local laws, rules, and regulations.

(13) Rules updates: The provider shall subscribe to receive email updates on ODAs rules on https://aging.ohio.gov.

(C) Requirements for specific types of providers to become certified:

(1) Agency providers:

(a) Disclosures: The provider shall disclose the following:

(i) The name of any person with an ownership interest in the provider.

(ii) The name of any person with an ownership interest in the provider who was convicted of a felony under a state or federal law.

(iii) A table of organization clearly identifying lines of administrative, advisory, contractual, and supervisory responsibilities.

(iv) The active registration as a business entity with the Ohio secretary of state.

(b) Statements: The provider shall provide ODA or its designee with statements on the following:

(i) The purpose of the provider's business.

(ii) The provider's compliance with 45 C.F.R. 80.4 regarding the provision of services.

(iii) The provider's compliance with the Equal Employment Opportunity Act of 1972, federal wage-and-hour laws, and workers' compensation laws regarding the recruitment and employment of persons.

(iv) The provider's payment of all applicable federal, state, and local income and employment taxes for the most recent year.

(c) Policies: The provider shall have written policies, bylaws, or articles of incorporation (or an electronic record of policies, bylaws, or articles of incorporation) that include requirements for its employees to provide services in a manner compliant with paragraph (B)(8) of this rule.

(2) Non-agency providers: The provider shall provide a statement to ODA or its designee certifying that he or she paid all applicable federal, state, and local income and employment taxes.

(3) Participant-directed providers: A person may qualify to become a participant-directed provider only if the person meets the requirements in rule 173-39-02.4 of the Administrative Code.

(4) Assisted living providers:

(a) Preemption: The provider shall acknowledge that any statute governing, or rule regulating, the assisted living program supersedes any clause in the RCF's resident agreement.

(b) License: The provider shall have an RCF license issued under Chapter 3701-16 of the Administrative Code and comply with section 3721.121 of the Revised Code.

(c) Identifying key persons: The provider shall disclose the following:

(i) The name of any person with an ownership interest in the provider.

(ii) The name of any person with an ownership interest in the provider who was convicted of a felony under a state or federal law.

(iii) A table of organization clearly identifying lines of administrative, advisory, contractual, and supervisory responsibilities.

(d) Statements: The provider shall provide ODA or its designee with statements on the following:

(i) The provider's compliance with 45 C.F.R. 80.4 regarding the provision of services.

(ii) The provider's compliance with the Equal Employment Opportunity Act of 1972, federal wage-and-hour laws, and workers' compensation laws regarding the recruitment and employment of persons.

(e) Policies: The provider shall have written policies, bylaws, or articles of incorporation (or an electronic record of policies, bylaws, or articles of incorporation) that include the following:

(i) A requirement for the residents' rights policy that the provider adopts under section 3721.12 of the Revised Code to apply the prohibition against unethical, unprofessional, disrespectful, or illegal behavior under paragraph (B)(8) of this rule to its employees.

(ii) A requirement for the policy that the provider adopts under rule 3701-64-02 of the Administrative Code on reporting abuse, neglect, or exploitation to ODH to apply the requirement under paragraph (B)(3)(a) of this rule to report abuse, neglect, or exploitation to ODA or its designee to its employees.

(iii) A requirement for the policy that the provider adopts under paragraph (B) of rule 3701-16-12 of the Administrative Code to apply the requirement under paragraph (B)(3)(b) of this rule to report incidents to ODA or its designee to its employees.

(D) Requirements for specific types of providers to remain an ODA-certified provider:

(1) Agency providers: The provider shall remain in compliance with all requirements under paragraphs (B) and (C)(1) of this rule.

(2) Non-agency providers: The provider shall remain in compliance with all requirements under paragraphs (B) and (C)(2) of this rule.

(3) Participant-directed providers:

(a) Continuation: The provider shall remain in compliance with all requirements under paragraphs (B) and (C)(3) of this rule.

(b) Records retention: In addition to the records-retention requirements under paragraph (B)(10)(a) of this rule, the provider shall store the individual's records in the home of the individual in a physical location or an electronic device that is accessible to the provider, individual, and ODA or its designee.

(4) Assisted living providers:

(a) Continuation: The provider shall remain in compliance with all requirements under paragraphs (B) and (C)(4) of this rule.

(b) Payment:

(i) The assisted living program does not pay for any service the provider provides to an individual before ODA's designee enrolls the individual into the program and before ODA's designee authorizes the service in the individual's person-centered services plan.

(ii) If an individual is absent from the RCF, the provider shall not accept a payment for the service under rules 173-39-02.16 and 5160-33-07 of the Administrative Code or charge the individual an additional fee for the service or to hold the unit during the individual's absence.

(c) Transfers/discharges: Section 3721.16 of the Revised Code establishes the terms for transferring or discharging an individual.

(d) Last day of service: If the provider terminates its medicaid-provider agreement, pursuant to section 3721.19 of the Revised Code, it shall provide written notification to the individual and to ODA's designee at least ninety days before terminating the provision of services to the individual.

Last updated April 12, 2024 at 11:08 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522, 173.54, 173.543
Amplifies: 173.39, 173.391, 173.52, 173.522, 173.54, 173.543; 42 CFR 441.352
Five Year Review Date: 6/30/2028
Prior Effective Dates: 3/17/2011, 7/1/2014
Rule 173-39-02.1 | ODA provider certification: adult day service.
 

(A) "Adult day service" ("ADS") means a regularly-scheduled service provided at an adult day center (center) in a non-institutional, community-based setting and consisting of the activities authorized in an individual's person-centered services plan. ADS includes recreational and educational programming to support an individual's health and independence goals; at least one, but no more than two, meals per day; and, sometimes, health status monitoring, skilled therapy services, and transportation to and from the center. Table 1 to this rule defines the levels and activities of ADS.

ENHANCED ADSINTENSIVE ADS
Structured activity programmingYesYes
Health assessmentsYesYes
Supervision of ADLsAll ADLsAll ADLs
Hands-on assistance with ADLsYes, one or more ADL (bathing excluded)Yes, minimum of two ADLs (bathing included)
Hands-on assistance with medication administrationYesYes
Comprehensive therapeutic activitiesYesYes
Monitoring of health statusIntermittentRegular, with intervention
Hands-on assistance with personal hygiene activitiesYesYes
Social work servicesNoYes
Skilled nursing services and rehabilitative nursing servicesNoYes
Rehabilitative and restorative servicesNoYes

(B) Requirements to become, and to remain, an ODA-certified provider of ADS:

(1) General requirements: The provider is subject to rule 173-39-02 of the Administrative Code.

(2) Service requirements:

(a) Transportation: The provider shall transport each individual to and from the center by performing transportation that complies with rule 173-39-02.18 of the Administrative Code, unless the provider subcontracts with another provider that complies with rule 173-39-02.18 of the Administrative Code, or unless the caregiver transports or designates another person, other than the center's provider, to transport the individual to and from the center.

(b) Provider's initial assessment:

(i) The provider shall assess the individual before the end of the individual's second day of attendance at the center. The provider may substitute a copy of the case manager's assessment of the individual if the case manager assessed the individual no more than thirty days before the individual's first day of attendance at the center.

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

(a) The individual's functional, cognitive, and social needs.

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

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

(d) Activity plan: No later than thirty days after the individual's initial attendance at the center or before the individual receives the first ten units of service at the center, whichever comes first, the provider shall obtain the services of a licensed healthcare professional whose scope of practice includes developing activity plans to draft an activity plan for each individual or an employee who is such a licensed healthcare professional to draft an activity plan for each individual. The plan shall do all of the following:

(i) Identify the individual's strengths, needs, problems or difficulties, and objectives.

(ii) Describe the individual's interest, preferences, and social rehabilitative needs.

(iii) Describe the individual's health needs.

(iv) Describe the individual's specific goals, objectives, and planned interventions of ADS that meet the goals.

(v) Describe the individual's level of involvement in the drafting of the plan, and, if the individual has a caregiver, the caregiver's level of involvement in the drafting of the plan.

(vi) Describe the individual's ability to provide a unique identifier as an attestation that the provider, or the provider's staff, completed an activity or unit of service.

(e) Plan of treatment: Before administering medication or meals with a therapeutic diet, and before providing a nursing service, nutrition consultation, 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 individual that receives medication, a nursing service, nutrition consultation, 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 is subject to the diet-order requirements for therapeutic diets under rule 5160-44-11 of the Administrative Code.

(f) Interdisciplinary care conference (conference):

(i) Frequency: The provider shall conduct a conference for each individual at least once every six months.

(ii) Participants: The provider shall conduct the conference between the provider's staff and invitees who choose to participate. At least seven days before the conference begins, the provider shall invite the following persons to participate in the conference and provide those persons with the date and time of the conference:

(a) The individual's case manager.

(b) Any licensed healthcare profession who does not work for the provider, but who provided the provider with a health assessment of the individual or an activity plan for the individual.

(c) The individual's caregiver, if the individual has a caregiver.

(iii) Revise activity plan: If the conference participants identify changes in the individual'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 an employee who is such a licensed healthcare professional to revise the activity plan accordingly.

(g) Activities: The provider shall announce daily and monthly planned activities through two or more of the following media:

(i) Posters in prominent locations throughout the center.

(ii) An electronic display (e.g., a television) in a prominent location in the center.

(iii) The center's website.

(iv) Email sent to individuals (and others) who agree to receive the email.

(v) Monthly newsletters distributed to individuals by mail, email, or at the center.

(h) Lunch and snacks:

(i) The provider shall provide lunch and snacks to each individual who is present during lunchtime or snack time.

(ii) Each meal the provider provides shall comply with all the requirements for home-delivered meals under rules 173-39-02.14 and 5160-44-11 of the Administrative Code, except for the requirements in those rules pertaining to the delivery of the meal.

(3) Center requirements: A provider qualifies to be an ODA-certified ADS provider only if the provider's center has the following specifications:

(a) If the center is housed in a building with other services or programs other than ADS, the provider uses a separate, identifiable space and staff for ADS during all hours that the provider provides ADS in the center.

(b) The center complies with the "ADA Accessibility Guidelines for Buildings and Facilities" in appendix A to 28 C.F.R. part 36.

(c) The center has at least sixty square feet per individual that it serves (not just individuals who are enrolled in an ODA-administered program), excluding hallways, offices, rest rooms, and storage areas.

(d) The provider stores individuals' medications in a locked area the provider maintains at a temperature complying with the storage requirements of the medications.

(e) The provider stores toxic substances in an area which is inaccessible to individuals.

(f) The center has at least one working toilet for every ten individuals present that the center serves (not just individuals who are enrolled in an ODA-administered program) and at least one wheelchair-accessible toilet.

(g) If the center seeks certification to provide intensive ADS, the center has bathing facilities suitable to the needs of individuals who need intensive ADS.

(4) Staffing levels:

(a) The provider shall have at least two staff members present, with at least one of those staff members having a certification in CPR, when more than one individual is present in the center.

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

(c) The provider shall have an RN, or LPN under the direction of an RN, available to provide nursing services that need the skills of an RN, or LPN under the direction of an RN, and that are based on the needs of the individuals and within the nurse's scope of practice.

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

(5) Provider qualifications:

(a) Type of provider:

(i) Only an agency provider qualifies for ODA's certification to provide ADS.

(ii) For each provider that ODA certifies, ODA shall certify the provider as an enhanced or intensive provider. If ODA certifies a provider to provide an intensive service level, the provider may also directly provide, or arrange for, the enhanced service level.

(b) Staff qualifications:

(i) Every person who is an RN, LPN under the direction of an RN, social worker, physical therapist, physical therapy assistant, speech therapist, licensed dietitian, occupational therapist, occupational therapy assistant, or other licensed professional qualifies to practice in the center only if the person has a current, valid license to practice in their profession.

(ii) A person qualifies to be an activity director only if the person has 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 coordinator, or a related position.

(c) Compliance with the qualifications under rule 3701-17-07 of the Administrative Code for directing resident activities in a nursing home.

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

(iii) A person qualifies to be an activity assistant only if the person has 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.

(iv) A person qualifies to be a PCA only if the person has 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.

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

(v) A person qualifies to transport individuals for the provider only if the person meets the qualifications for drivers under rule 173-39-02.18 of the Administrative Code.

(c) Staff training:

(i) Orientation: The provider shall comply with the requirements for the orientation of PCAs in rule 173-39-02.11 of the Administrative Code.

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

(iii) Continuing education and in-service training: Each PCA, activity director, and activity assistant shall successfully complete at least eight hours of continuing education or in-service training each calendar year. Any hour of continuing education or in-service training successfully completed during a calendar year to comply with the requirements for certification as an activity director or activity assistant counts towards the eight-hour requirement in this paragraph.

(iv) Verification of compliance: The provider shall comply with paragraph (C)(3)(f) of rule 173-39-02.11 of the Administrative Code regarding records of each PCA's successful completion of any training and competency evaluation program, orientation, and in-service training.

(6) Service verification: The following are the mandatory reporting items that a provider retains for each ADS session to comply with the requirements under paragraph (B)(10)(a)(i) of rule 173-39-02 of the Administrative Code:

(a) Individual's name.

(b) Service date.

(c) Individual's arrival time.

(d) Individual's departure time.

(e) Individual's mode of transportation.

(f) Unique identifier of the individual to attest to receiving the service.

(C) Units and rates:

(1) For the PASSPORT program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the following:

(a) The units of ADS attendance.

(b) The units of ADS transportation.

(c) The maximum rates allowable per unit of ADS attendance or ADS transportation.

(2) For the PASSPORT program, the rate-setting methodology is established in rule 5160-31-07 of the Administrative Code and in the following paragraphs:

(a) Attendance:

(i) Units of ADS attendance are calculated as follows:

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

(b) One day 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.

(ii) A unit of ADS attendance does not include transportation time.

(b) Transportation: If the service is provided to an individual enrolled in the PASSPORT program, a unit of ADS transportation is a round trip, a one-way trip, or one mile with the trip cost based on a case manager's pre-determined calculation of distance between the individual's home and the center multiplied by an established ADS mileage rate. If the provider provides the transportation simultaneously to more than one PASSPORT-enrolled individual who resides in the same household in the same vehicle to the same destination, the provider's payment rate for that trip is seventy-five per cent of the per-unit rate.

Last updated April 12, 2024 at 11:08 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522
Amplifies: 173.39, 173.391, 173.52, 173.522; 42 CFR 441.352
Five Year Review Date: 11/30/2028
Prior Effective Dates: 3/20/2011, 1/10/2021, 4/4/2022
Rule 173-39-02.2 | ODA provider certification: alternative meals.
 

(A) "Alternative meals" means a participant-directed service for sustaining an individual's health by enabling the individual to procure up to two meals per day from a non-traditional provider, such as a restaurant, but not an adult day center.

(B) Every ODA-certified provider of alternative meals shall comply with the following requirements:

(1) General requirements:

(a) The provider shall comply with the requirements for every ODA-certified provider in rule 173-39-02 of the Administrative Code.

(b) The provider shall comply with all the requirements for home-delivered meals in rule 173-39-02.14 of the Administrative Code except the rule's delivery requirements.

(2) Provider qualifications: Only an ODA-certified agency provider shall provide alternative meals.

(C) Unit and rate:

(1) A unit of an alternative meals equals one meal provided according to this rule.

(2) The maximum rate allowable for one unit of an alternative meals is listed in appendix A to rule 5160-1-06.1 of the Administrative Code.

(3) The rates are subject to the rate-setting methodology in rule 5160-31-07 of the Administrative Code.

Last updated April 12, 2024 at 11:33 AM

Supplemental Information

Authorized By: 173.522, 173.52, 173.391, 173.02, 173.01
Amplifies: 173.39, 173.522; 42 C.F.R. 441.352, 173.52, 173.391
Five Year Review Date: 5/1/2029
Prior Effective Dates: 3/31/2006
Rule 173-39-02.4 | ODA provider certification: choices home care attendant service.
 

(A) "Choices home care attendant service" (service) means a service that provides one or more of the following activities to support the needs of an individual with impaired physical or cognitive functioning:

(1) Assisting the individual with money management and correspondence as directed by the individual, managing the home, handling personal affairs, and providing assistance with self-administration of medications, as defined in rule 173-39-01 of the Administrative Code.

(2) Assisting the individual with ADLs and IADLs.

(3) Homemaker activities listed in rule 173-39-02.8 of the Administrative Code when those activities are specified in the individual's service plan and are incidental to the activities in paragraphs (A)(1) and (A)(2) of this rule or are essential to the health and welfare of the individual instead of other persons living with the individual.

(4) Providing respite services to the individual's caregiver.

(5) Escort and transportation.

(6) Providing an errand outside of the presence of the individual that is needed by the individual to maintain the individual's health and safety (e.g., picking up a prescription or groceries for the individual).

(7) The activities included in home maintenance and chores under rule 5160-44-12 of the Administrative Code, including seasonal yard care and snow removal.

(B) Requirements for an ODA-certified provider of the choices home care attendant service:

(1) The provider is subject to rule 173-39-02 of the Administrative Code.

(2) Availability and scheduling:

(a) The provider shall maintain availability to provide this service as agreed upon with the individual and as authorized in the individual's person-centered services plan.

(b) No participant-directed provider may provide this service in excess of the following limits:

(i) To more than five individuals per week.

(ii) For more than forty hours per week for any individual who employs the provider, unless the individual's case manager authorizes working more than forty hours per week due to an emergency that cannot be resolved by allowing another provider to provide the service after the fortieth hour.

(iii) For more than a total of fifty-six hours per week regardless of the number of individuals who employ the provider.

(3) Oversight: The individual who receives this service is the employer of record. As used in this paragraph, "employer of record" means the individual who employs the provider; supervises the provider; pays the appropriate state, federal, and local taxes; and pays premiums for worker's compensation and unemployment compensation insurance. A financial management service (FMS) acts as the agent of the common-law employer with the participant-directed provider the individual employs.

(4) Provider qualifications:

(a) Initial qualifications: A person may qualify to provide this service only if the person meets all the following qualifications:

(i) The person is an ODA-certified participant-directed provider or an ODA-certified agency provider.

(ii) The person is at least eighteen years of age.

(iii) The person has a valid social security number and at least one of the following current, valid, government-issued, photographic identification cards:

(a) Driver's license.

(b) State of Ohio identification card.

(c) United States of America permanent residence card.

(iv) The person reads, writes, and understands English at a level which enables the person to comply with this rule and rule 173-39-02 of the Administrative Code.

(v) The person is able to effectively communicate with the individual.

(b) Qualifications to transport the individual:

(i) If the provider intends to transport the individual, before providing the first episode of transportation, the provider shall show ODA's designee a valid driver's license and valid insurance identification card to show that the provider has liability insurance for driving a vehicle which complies with the financial responsibility requirements in Chapter 4501:1-02 of the Administrative Code. A provider may transport an individual in a vehicle only if ODAs designee has verified that the vehicle is insured.

(ii) If the provider does not intend to transport the individual, the provider shall provide a written or electronic attestation to ODA's designee declaring the provider will not transport the individual unless the provider complies with paragraph (B)(4)(b) of this rule before the first episode of transportation.

(c) Initial training: The provider shall successfully complete any training that the individual determined the provider needs to meet the individual's specific needs by the deadline the individual establishes.

(d) Continuing education: The provider shall successfully complete eight units of training that the individual determined the provider needs to meet the individual's specific needs by the deadline the individual establishes, but no later than the provider's anniversary certification date. A unit of training includes a course or training activity lasting up to an hour.

(5) Service verification:

(a) Until rule 5160-1-40 of the Administrative Code requires a provider of this service to use EVV, the following are the mandatory reporting items that a provider retains on a time sheet that the individual provides through the FMS for each episode of service to comply with the requirements under paragraph (B)(10)(a)(i) of rule 173-39-02 of the Administrative Code:

(i) Individual's name.

(ii) Service date.

(iii) Provider's name.

(iv) Provider's arrival time.

(v) Provider's departure time.

(vi) Unique identifier of the individual to attest to receiving the service.

(vii) Unique identifier of the provider to attest to providing the service.

(b) The following are the mandatory reporting items that a provider retains on a task sheet that the individual provides through the FMS for each episode of service to comply with the requirements under paragraph (B)(10)(a)(i) of rule 173-39-02 of the Administrative Code:

(i) Description of the activities provided.

(ii) Unique identifier of the provider to attest to providing the service.

(iii) Unique identifier of the individual to attest to receiving the service.

(C) Unit and rates:

(1) For the PASSPORT program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the following for the choices home care attendant service:

(a) The unit as fifteen minutes.

(b) The maximum rate allowable for a unit.

(2) For the PASSPORT program, rule 5160-31-07 of the Administrative Code establishes the rate-setting methodology for the choices home care attendant service.

Last updated April 12, 2024 at 11:33 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522
Amplifies: 173.39, 173.391, 173.52, 173.522; 42 CFR 441.352
Five Year Review Date: 5/1/2029
Prior Effective Dates: 3/31/2006, 11/1/2015
Rule 173-39-02.5 | ODA provider certification: home maintenance and chores.
 

(A) "Home maintenance and chores" means the service defined in rule 5160-44-12 of the Administrative Code.

(B) Every ODA-certified provider of home maintenance and chores shall comply with the following requirements:

(1) General requirements: The provider shall comply with the requirements for every ODA-certified agency provider in rule 173-39-02 of the Administrative Code.

(2) Requirements specific to home maintenance and chores: The provider shall comply with the requirements in rule 5160-44-12 of the Administrative Code.

(3) If a conflict exists between a requirement in rule 173-39-02 of the Administrative Code and a requirement in rule 5160-44-12 of the Administrative Code, the provider shall comply with the requirement in rule 173-39-02 of the Administrative Code.

(C) Units and rates:

(1) One unit of home maintenance and chores is one job.

(2) Appendix A to rule 5160-1-06.1 of the Administrative Code establishes the maximum-allowable rate per job.

(3) Rule 5160-31-07 of the Administrative Code requires the unit rate to be negotiated between the provider and ODA's designee. The negotiated rate shall include all administrative, labor, and material costs for a specific job. The provider shall not bill ODA's designee for any amount in excess of the negotiated rate, unless ODA's designee revises the negotiated rate in one of the following situations:

(a) ODA's designee revises the rate before the provider begins the job.

(b) ODA's designee revises the rate to coincide with authorizing the provider to address an unforeseen issue as part of the original job.

Last updated April 12, 2024 at 11:33 AM

Supplemental Information

Authorized By: 173.01, 173.02, 173.391, 173.52, 173.522
Amplifies: 173.39, 173.391, 173.52, 173.522; 42 C.F.R. 441.352
Five Year Review Date: 5/1/2029
Prior Effective Dates: 3/17/2011
Rule 173-39-02.6 | ODA provider certification: personal emergency response system.
 

(A) "Personal emergency response system" ("PERS") means the service defined in rule 5160-44-16 of the Administrative Code.

(B) Every ODA-certified provider of PERS shall comply with the following requirements:

(1) General requirements: The provider shall comply with the requirements for every ODA-certified agency provider in rule 173-39-02 of the Administrative Code.

(2) PERS-specific requirements: The provider shall comply with the requirements in rule 5160-44-16 of the Administrative Code.

(3) If a conflict exists between a requirement in rule 173-39-02 of the Administrative Code and a requirement in rule 5160-44-16 of the Administrative Code, the provider shall comply with the requirement in rule 173-39-02 of the Administrative Code.

(C) Units and rates:

(1) Two types of PERS units:

(a) Monthly PERS: One unit of monthly PERS is one or more days of PERS in a month.

(b) PERS installation: The one-time cost for installing PERS equipment, the initial training of the individual on how to use the PERS equipment, the initial response plan, the initial training of responders, and verifying the success of the individuals return demonstration.

(2) Appendix A to rule 5160-1-06.1 of the Administrative Code establishes the rates for PERS units.

(3) Rule 5160-31-07 of the Administrative Code establishes rate-setting methodology for PERS units.

Last updated April 12, 2024 at 11:33 AM

Supplemental Information

Authorized By: 173.522, 173.52, 173.391, 173.02, 173.01
Amplifies: 173.39, 173.522; 42 C.F.R. 441.352, 173.52, 173.391
Five Year Review Date: 5/1/2029
Prior Effective Dates: 3/31/2006
Rule 173-39-02.7 | ODA provider certification: home medical equipment and supplies.
 

(A) "Home medical equipment and supplies" (HME) means a service providing rented or purchased home medical equipment and supplies to individuals to enable those individuals to function safely in their homes with greater independence, thereby eliminating the need for placement in a nursing facility.

HME is limited to equipment and supplies allowed under Chapter 5160-10 of the Administrative Code, miscellaneous equipment and supplies, equipment repairs, and equipment and supplies not paid (in full or in part) by medicare, state plan medicaid, or another third-party payer.

(B) Requirements for ODA-certified providers of home medical equipment and supplies:

(1) General requirements: The agency provider shall comply with the requirements for every ODA-certified agency provider in rule 173-39-02 of the Administrative Code and the non-agency provider shall comply with the requirements for every ODA-certified agency provider in rule 173-39-02 of the Administrative Code.

(2) Ongoing assistance: The provider shall provide professional, ongoing assistance when needed to evaluate and adjust equipment and supplies delivered, and/or to instruct the individual or the individuals caregiver in the use of equipment and supplies.

(3) Repairs and replacements: The provider shall assume liability for equipment warranties and shall install, maintain, and/or replace any defective parts or items specified in those warranties. Replacement items or parts for HME are not payable as rental equipment.

(4) Billing:

(a) Before ODA's designee may authorize equipment or supplies, the provider shall document the equipment and supplies to be purchased were not covered (in full or in part) by medicare, state plan medicaid, and any other third-party payer.

(b) The provider shall, in collaboration with the ODA's designee, ascertain and recoup any third-party resource(s) available to the individual before billing ODA or its designee. ODA or its designee may then pay the unpaid balance up to the lesser of the provider's billed charge or the maximum allowable payment established in the appendix to rule 5160-1-06.1 of the Administrative Code.

(c) The provider shall provide the price for an item to be purchased or rented to the ODA's designee no more than two business days after the ODA's designee's request. The provider shall purchase, deliver, and install (as appropriate) the authorized item(s) before billing ODA's designee. The billed amount for each item shall not exceed the item rate authorized by ODA's designee.

(5) Delivery and verification:

(a) The provider shall verify the successful completion of each activity (i.e., delivery, installation, or education) it provides using either an electronic or manual system and shall retain records verifying the delivery of HME. Regardless of the system used, the verification shall include the individuals name, date of delivery, installation, or education, and itemization of each activity completed.

(b) Delivery verification methods: The provider shall verify the delivery of HME by one of the following methods:

(i) A unique identifier of the individual.

(ii) If a provider uses a common carrier to deliver HME, the provider shall verify the success of the delivery by using the method in paragraph (B)(5)(b)(i) of this rule or by retaining the common carrier's tracking statement or returned postage-paid delivery invoice.

(c) If a provider leaves an HME item outside the door of an individual's home, the provider shall contact the individual by telephone at least once per month to alert them to any delivery left outside the door to their home.

(d) The provider shall replace (at no cost to the individual, ODA, or ODA's designee) any HME item lost or stolen between the time of delivery and receipt by the individual.

(e) If a single visit by the provider includes more than one HME activity, the provider may verify the success of all the activities it provides by obtaining only one verification.

(f) The provider shall not verify an HME activity was successfully provided with the signature of the provider, an employee of the provider, or any other person with a financial interest in the HME.

(C) Units and rates:

(1) A unit of HME is the item purchased or rented, and the unit rate is the purchase, installation, and/or rental price authorized for the item by ODAs designee.

(2) The appendix to rule 5160-1-06.1 of the Administrative Code establishes the maximum rate allowable for one unit of HME.

(3) Rule 5160-31-07 of the Administrative Code establishes rate-setting methodology for units of HME.

Last updated April 12, 2024 at 11:08 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522, 173.54, 173.543
Amplifies: 173.39, 173.391, 173.52, 173.522; 42 CFR 441.352
Five Year Review Date: 4/2/2027
Prior Effective Dates: 3/31/2006
Rule 173-39-02.8 | ODA provider certification: homemaker.
 

(A) Definitions for this rule:

(1) "Homemaker" means a service enabling individuals to achieve and maintain clean, safe and healthy environments, assisting individuals to manage their personal appointments and day-to-day household activities, and ensuring individuals maintain their current living arrangements. The service consists of general household activities, such as meal preparation and routine household care when persons regularly responsible for these activities are temporarily absent or unable to manage the home. Homemaker staff may act as travel attendants for individuals. Homemaker activities include the following when authorized in the person-centered services plan:

(a) Assistance with meal planning.

(b) Meal preparation, grocery purchase planning, and assisting individuals with shopping and other errands.

(c) Laundry, including folding, ironing, and putting away laundry.

(d) House cleaning including dusting furniture, sweeping, vacuuming, and mopping floors; kitchen care including dishes, appliances, and counters; bathroom care; emptying and cleaning bedside commodes; changing bed linens; washing inside windows within reach from the floor; and removing trash.

(e) Errands outside of the presence of the individual which are needed by the individual to maintain the individual's health and safety (e.g., picking up a prescription or groceries for the individual).

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

(B) Requirements for ODA-certified providers of homemaker:

(1) General requirements: The provider shall comply with the requirements for every ODA-certified agency provider in rule 173-39-02 of the Administrative Code.

(2) Eligible providers of homemaker are ODA-certified agency providers.

(3) Availability: The provider shall maintain adequate staffing levels to provide the service at least five days per week and shall possess a back-up plan to ensure the service is provided during staff absences.

(4) Provider policies: The provider shall develop written or electronic personnel requirements, including all the following:

(a) Job descriptions for each position.

(b) Documentation of each employee's qualifications for the homemaker activities to be provided.

(c) Performance appraisals for all staff.

(5) Staff qualifications:

(a) Aides:

(i) 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:

(a) The person meets at least one of the qualifications to be a PCA under paragraph (C)(3)(a) of rule 173-39-02.11 of the Administrative Code.

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

(i) The training lasted at least twenty hours.

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

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

(B) Meal preparation/nutrition that includes special diet preparation, grocery purchase planning and shopping; and other errands, such as picking up prescriptions.

(C) Laundry, including folding, ironing, and putting away laundry.

(D) Basic home safety.

(E) House cleaning skills that include dusting furniture; sweeping, vacuuming and washing floors, kitchen care (including washing dishes, appliances and counters), bathroom care, emptying and cleaning bedside commodes, changing bed linens, washing inside windows within reach from the floor, and removing trash.

(F) Body mechanics.

(G) Communication skills.

(H) Emergency protocols.

(I) Record-keeping skills.

(ii) Before providing activities to an individual, the provider shall conduct a competency evaluation of all aides not listed on ODH's nurse aide registry for all subject areas listed under paragraph (B)(5)(a)(i)(b)(ii) of this rule. The provider shall retain records for the name of the school or training organization, name of the course, training dates, and training hours successfully completed.

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

(i) The person has a bachelors or associates degree in a health and human services area.

(ii) The person is an RN or an LPN under the direction of an RN.

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

(c) All staff:

(i) Orientation: Before allowing any staff member to provide homemaker activities to an individual, the provider shall train the staff member on all the following:

(a) The provider's expectations of homemaker staff.

(b) The provider's ethical standards, as required under rule 173-39-02 of the Administrative Code.

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

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

(e) Incident-reporting procedures.

(f) Emergency procedures.

(g) Person-centered planning process.

(ii) In-service training: The provider shall retain records to show that each aide successfully completes a minimum of eight hours of in-service training every twelve months on topics listed under paragraph (B)(5)(a)(i)(b)(ii) of this rule.

(6) Supervisory requirements:

(a) Initial: The supervisor shall complete an initial visit, which may occur at the aide's initial homemaker visit to the individual to define the expected activities of the homemaker aide and prepare a written or electronic activities plan consistent with the case manager authorized plan that has been completed by the case manager and the individual before the individual's first episode of service. During a state of emergency declared by the governor or federal public health emergency, the supervisor may conduct the visit by telephone, video conference, or in person at the individual's home.

(b) Subsequent: The supervisor shall complete an evaluation of the aide's compliance with the activities plan, the individual's satisfaction, and job performance during a home visit with the individual at least every ninety days to evaluate the aides compliance with the plan. The supervisor may conduct each visit with or without the presence of the aide being evaluated. The supervisor may conduct the visit by telephone, video conference, or in person.

(c) Verification: The supervisor shall retain a record of the initial visit and each subsequent visit in the individual's activity plan, including the date of the visit, individual's name, the supervisor's name, and the supervisor's handwritten or electronic signature, and a unique identifier of the individual. During a state of emergency declared by the governor or a federal public health emergency, the provider may verify that the PCA supervisor provided the initial or subsequent visit without collecting a unique identifier of the individual or the individual's caregiver.

(7) Service verification: The provider shall verify each episode of homemaker activities provided to each individual by using the provider's choice of either an electronic or manual system which collects all the following information: the individual's name, the date of service, a description of the activities provided, the name of the aide providing the activities, the aide's arrival and departure times, the unique identifier of the aide, and the unique identifier of the individual to attest to the accuracy of the record.

(C) Units and rates:

(1) One unit of homemaker service is fifteen minutes.

(2) The appendix to rule 5160-1-06.1 of the Administrative Code establishes the maximum rate allowable for a unit of homemaker activities.

(3) The rates are subject to the rate-setting methodology in rule 5160-31-07 of the Administrative Code.

Last updated April 12, 2024 at 11:08 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522, 173.54, 173.543
Amplifies: 173.39, 173.391, 173.52, 173.522; 42 CFR 441.352
Five Year Review Date: 4/2/2027
Rule 173-39-02.9 | ODA provider certification: home modification.
 

(A) "Home modification" has the same meaning as "home modifications" in rule 5160-44-13 of the Administrative Code.

(B) Requirements for ODA-certified providers of home modification:

(1) General requirements: The provider shall comply with the requirements for every ODA-certified provider in rule 173-39-02 of the Administrative Code.

(2) Requirements specific to home modification: The provider shall comply with the requirements in rule 5160-44-13 of the Administrative Code.

(3) If a conflict exists between a requirement in rule 173-39-02 of the Administrative Code and a requirement in rule 5160-44-13 of the Administrative Code, the provider shall comply with the requirement in rule 173-39-02 of the Administrative Code.

(C) Units and rates:

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

(2) The rate per job is subject to the maximum-allowable rate established in appendix A to rule 5160-1-06.1 of the Administrative Code and the limitations in paragraph (A) of rule 5160-44-13 of the Administrative Code.

(3) Rule 5160-31-07 of the Administrative Code requires the unit rate to be negotiated between the provider and ODA's designee. The negotiated rate shall include all administrative, labor, and material costs for a specific job. The provider shall not bill ODA's designee for any amount in excess of the negotiated rate, unless ODA's designee approves a revised rate.

Last updated April 12, 2024 at 11:33 AM

Supplemental Information

Authorized By: 173.01, 173.02, 173.391, 173.52, 173.522
Amplifies: 173.39, 173.391, 173.52, 173.522; 42 C.F.R. 441.352
Five Year Review Date: 5/1/2029
Prior Effective Dates: 12/1/2017
Rule 173-39-02.10 | ODA provider certification: nutritional consultations.
 

(A) Definitions for this rule:

(1) "Nutritional consultation" (consultation) means individualized guidance to an individual who has special dietary needs. Consultations take into consideration the individual's health; cultural, religious, ethnic, socio-economic background; and dietary preferences and restrictions. Consultations are also known as medical nutrition therapy. "Nutritional consultation" does not include either of the following:

(a) A consultation provided to an individual's authorized representative or caregiver to improve the individual's well-being.

(b) A consultation provided to an individual if the individual receives a similar service paid (in full or in part) by medicare state plan medicaid, or another third-party payer.

(2) "Nutritional assessment" (assessment) has the same meaning as in rule 4759-2-01 of the Administrative Code.

(B) Every ODA-certified provider of nutritional consultations shall comply with the following requirements:

(1) General requirements: The provider shall comply with the requirements for every ODA-certified provider in rule 173-39-02 of the Administrative Code.

(2) Dietitian: Only a licensed dietitian (dietitian) working for an ODA-certified agency provider, or a licensed dietitian working as an ODA-certified non-agency provider shall provide consultations to individuals.

(3) Orders: Before the provider provides a consultation to an individual or to the individual's authorized representative or caregiver, the provider shall obtain an order for the consultation from a licensed healthcare professional whose scope of practice includes ordering consultations.

(4) Venue:

(a) The dietitian may conduct the initial consultation by telephone, video conference, or in person in the individual's home.

(b) The dietitian may conduct subsequent consultations by telephone, video conference, or in person in the individual's home.

(5) Nutritional assessment:

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

(i) An assessment of height and weight history.

(ii) An assessment of the adequacy of nutrient intake.

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

(iv) An assessment of verbal, physical, and motor skills that may affect, or contribute to, nutrient needs.

(v) An assessment of interactions with the caregiver during feeding.

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

(b) The provider shall provide the case manager, the individual, and the individual's authorized representative (if the individual has authorized a representative) with a copy of the assessment no later than seven business days after the provider completes the assessment.

(c) The provider may use an electronic system to develop and retain an assessment.

(6) Nutrition intervention plan:

(a) The provider shall develop, evaluate, and revise, as necessary, a nutrition intervention plan with the individual's and case manager's assistance and, when applicable, the assistance of the licensed healthcare professional who authorized the consultations. In the plan, the provider shall outline the purposely-planned actions for changing nutrition-related behavior, risk factors, environmental conditions, or health status, which, at a minimum, shall include the following information about the individual:

(i) Food and diet modifications.

(ii) Specific nutrients to require or limit.

(iii) Feeding modality.

(iv) Nutrition education and consultations.

(v) Expected measurable indicators and outcomes related to the individual's nutritional goals.

(b) The provider shall use the nutrition intervention plan to prioritize and address the identified nutrition problems.

(c) The provider shall provide the case manager, the individual, and the licensed healthcare professional who ordered the consultations with a copy of the nutrition intervention plan no later than seven business days after the provider develops or revises the plan.

(d) The provider may use an electronic system to develop and retain the nutrition intervention plan.

(7) Service verification: By one of the following two methods, the provider shall verify that each consultation for which it bills was provided:

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

(i) Collects the individual's name, date of consultation, time of day each consultation begins and ends, name of licensed dietitian providing consultation, and a unique identifier of the individual.

(ii) Retains the information it collects.

(iii) Produces reports, upon request, that ODA (or its designee) can monitor for compliance.

(b) The provider may use a manual system if the provider records the date of service, time of day that each consultation begins and ends, name of the person providing the consultation, and collects the handwritten signature of the person providing the consultation and a unique identifier of the individual.

(C) Unit and rate:

(1) A unit of a nutritional consultation is fifteen minutes of session time with the individual.

(2) The maximum rate allowable for a unit of nutritional consultations is listed in the appendix to rule 5160-1-06.1 of the Administrative Code.

(3) The rate is subject to the rate-setting methodology in rule 5160-31-07 of the Administrative Code.

Last updated April 12, 2024 at 11:08 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522, 173.54, 173.543
Amplifies: 173.39, 173.391, 173.52, 173.522; 42 CFR 441.352
Five Year Review Date: 4/2/2027
Prior Effective Dates: 8/30/2010
Rule 173-39-02.11 | ODA provider certification: personal care.
 

(A) "Personal care" means hands-on assistance with ADLs and IADLs (when incidental to providing ADLs) in the individual's home and community. Personal care activities include the following when authorized in a person-centered services plan:

(1) Assisting the individual with managing the home, handling personal affairs, and providing assistance with self-administration of medications, as defined in rule 173-39-01 of the Administrative Code.

(2) Assisting the individual with ADLs and IADLs.

(3) Homemaker activities listed in rule 173-39-02.8 of the Administrative Code when those activities are specified in the individual's service plan and are incidental to the activities in paragraphs (A)(1) and (A)(2) of this rule or are essential to the health and welfare of the individual rather than the individual's family.

(4) Providing respite services to the individual's caregiver.

(5) Providing an errand outside of the presence of the individual that is needed by the individual to maintain the individual's health and safety (e.g., picking up a prescription or groceries for the individual).

(B) Qualifying provider types: Eligible providers of personal care are ODA-certified agency providers and ODA-certified participant-directed personal care providers.

(C) Requirements for ODA-certified agency providers of personal care:

(1) General requirements: The provider is subject to rule 173-39-02 of the Administrative Code.

(2) Availability and staffing:

(a) The provider may accept a referral to provide personal care to an individual only if the provider has adequate staffing levels of PCAs and PCA supervisors to provide the number of hours ODA's designee authorized for each individual.

(b) The PCA receives supervision from an RN or LPN under the direction of an RN during all hours that PCAs are scheduled to work.

(c) The provider shall maintain a back-up plan for providing personal care when the provider has no PCA or PCA supervisor available.

(3) PCA requirements:

(a) Initial qualifications: The provider may allow a person to serve as a PCA only if the person meets at least one of the following qualifications, the training and competency evaluation comply with paragraph (C)(3)(e) of this rule, and the provider meets the verification requirements under paragraph (C)(3)(f) of this rule:

(i) STNA: The person successfully completed a nurse aide training and competency evaluation program approved by 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 a competency evaluation covering the topics listed under paragraph (C)(3)(a)(v)(b) of this rule.

(iv) Vocational programs: The person successfully completed the COALA home health training program or a certified vocational training and competency evaluation program in a health care field covering the topics listed under paragraph (C)(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) Communication skills, including the ability to read, write, and make brief and accurate reports (oral, written, or electronic).

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

(iii) Reading and recording an individual's temperature, pulse, and respiration.

(iv) Basic infection control.

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

(vi) Maintaining a clean, safe, and healthy environment, including house cleaning and laundry, dusting furniture, sweeping, vacuuming, and washing floors; kitchen care (including dishes, appliances, and counters), bathroom care, emptying and cleaning beside commodes and urinary catheter bags, changing bed linens, washing inside window within reach from the floor, removing trash, and folding, ironing, and putting away laundry.

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

(viii) The physical, emotional, and developmental needs of individuals, including privacy and respect for personal property.

(ix) Appropriate and safe techniques in personal hygiene and grooming including 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.

(x) Meal preparation and nutrition planning, including special diet preparation; grocery purchase, planning, and shopping; and errands such as picking up prescriptions.

(b) Orientation: Before allowing a PCA or other employee to have direct, in-person contact with an individual, the provider shall ensure the PCA or other employee successfully completed orientation, which, at a minimum, addressed the following topics:

(i) The provider's expectations of employees.

(ii) The provider's ethical standards under rule 173-39-02 of the Administrative Code.

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

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

(v) Incident-reporting procedures.

(vi) Emergency procedures.

(vii) Universal precautions for infection control.

(c) Additional training: The provider shall ensure each PCA successfully completes additional training and competency evaluation if the PCA is expected to perform activities for which the PCA did not receive training or undergo competency evaluation under paragraph (C)(3)(a) of this rule.

(d) In-service training: The provider shall ensure that each PCA successfully completes eight hours of in-service training every twelve months. Agency- and program-specific orientation do not count toward the eight hours.

(e) Training sources:

(i) An organization other than the provider may provide the orientation and training under paragraphs (C)(3)(b) to (C)(3)(d) of this rule. The training completed through https://mylearning.dodd.ohio.gov/ is free of charge.

(ii) The portion of training that is not competency evaluation may occur online.

(iii) The portion of competency evaluation that involves return demonstration only qualifies as competency evaluation under paragraph (C)(3)(a) of this rule if it is conducted in person.

(f) Verification of compliance with PCA requirements:

(i) The provider shall either retain copies of certificates of completion earned by each PCA after the PCA meets requirements under paragraph (C)(3) of this rule for successfully completing any training and competency evaluation program, orientation, additional training, and in-service training under paragraph (C)(3) of this rule or 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): name of the school or training organization, name of the course, training dates, and training hours successfully completed.

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

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

(a) Qualifications: Only an RN or LPN under the direction of an RN qualifies to be a PCA supervisor.

(b) PCA supervisor visits:

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

(ii) Subsequent:

(a) The PCA supervisor shall visit the individual at least once every sixty days after the PCA's initial episode of service with the individual to evaluate compliance with the activities plan, the individual's satisfaction, and the PCA's performance. The PCA supervisor may conduct subsequent visits with or without the presence of the PCA being evaluated.

(b) If the PCA supervisor conducts at least two in-person visits per year, the PCA supervisor may conduct the remainder of the subsequent visits during the same year by telephone, video conference, or in person based upon the individual's needs. To comply, the PCA supervisor may conduct two subsequent in-person visits in the same year or the combination of an initial in-person visit and an in-person subsequent visit in the same year.

(iii) Verification: In the individual'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 individual's home; the PCA supervisor's name and signature; the individual's name; and a unique identifier of the individual or the individual's caregiver. During a state of emergency declared by the governor or a federal public health emergency, the provider may verify that the PCA supervisor provided the initial or subsequent visit without collecting a unique identifier of the individual or the individual's caregiver.

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

(a) Job descriptions for each position.

(b) Retaining records on how each PCA meets the qualifications in paragraph (C)(3) of this rule.

(6) Service verification:

(a) The following are the mandatory reporting items that a provider retains for each episode of personal care to comply with the requirements under paragraph (B)(10)(a)(i) of rule 173-39-02 of the Administrative Code:

(i) Service date.

(ii) PCA's arrival time.

(iii) PCA's departure time.

(iv) Description of the activities provided.

(v) Name of each PCA in contact with the individual.

(vi) Unique identifier of each PCA in contact with the individual to attest to the accuracy of the record.

(b) The provider is subject to rule 5160-1-40 of the Administrative Code regarding EVV.

(c) The provider is subject to section 121.36 of the Revised Code.

(D) Every ODA-certified participant-directed provider of personal care shall comply with the requirements under paragraph (B) of rule 173-39-02.4 of the Administrative Code.

(E) Units and rates:

(1) For the PASSPORT program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the following:

(a) One unit of personal care as fifteen minutes.

(b) The maximum rate allowable for one unit of personal care.

(2) For the PASSPORT program, rule 5160-31-07 of the Administrative Code establishes the rate-setting methodology for personal care. According to that rule, if the same provider provides personal care during the same visit to more than one but fewer than four PASSPORT individuals in the same home, as identified in the individuals' person-centered services plans, the provider's payment rate for personal care provided to one person in the home is one hundred per cent of the per-unit rate listed in the provider agreement and seventy-five per cent of the per-unit rate for each subsequent PASSPORT individual in the home receiving services during the visit. As used in this paragraph, "in the same home" does not refer to a PASSPORT individual who resides alone in an apartment building where another individual may reside alone in a separate apartment.

Last updated April 12, 2024 at 11:08 AM

Supplemental Information

Authorized By: 121.07, 121.36, 173.01, 173.02, 173.391, 173.52, 173.522
Amplifies: 121.36, 173.39, 173.391, 173.52, 173.522; 42 CFR 441.352
Five Year Review Date: 6/30/2028
Prior Effective Dates: 4/16/2006, 5/1/2018
Rule 173-39-02.12 | ODA provider certification: social work or counseling.
 

(A) Definitions for this rule:

(1) "Social work or counseling" (service) means a service to an individual or to an individual's caregiver to promote the individual's physical, social, or emotional well-being; and the development and maintenance of a stable and supportive environment for the individual.

(a) "Social work or counseling" includes crisis interventions, grief counseling, and other social work and counseling interventions that support the individual's health and welfare.

(b) "Social work or counseling" does not include any of the following:

(i) A service provided in place of case management.

(ii) A service provided to the individual's authorized representative or caregiver that is unrelated to the individual's well-being.

(iii) A service provided if the individual receives a similar service paid (in full or in part) by medicare, state plan medicaid, or another third-party payer.

(2) "E.passport" has the same meaning as in section 4732.40 of the Revised Code.

(B) Requirements for a provider of social work or counseling:

(1) General requirements: The provider is subject to rule 173-39-02 of the Administrative Code.

(2) Venue: The provider shall provide this service in the individual's home, or by telephone or video conference as permitted by the licensing board for the licensed healthcare professional providing this service or the state medical board if the licensed healthcare professional is an advanced practice RN designated as a clinical nurse practitioner (CNP) or clinical nurse specialist (CNS) and certified as a psychiatric-mental health CNP or CNS by the American nurses credentialing center.

(3) Assessment:

(a) The provider shall assess each individual, including the individual's psycho-social, financial, and environmental statuses.

(b) The provider shall provide the case manager with the assessment report no later than fourteen days after the provider completes the assessment.

(4) Treatment plan:

(a) With the assistance of the individual, caregiver, and case manager, the provider shall develop and revise, as necessary, a treatment plan that recommends a method of treatment and number of sessions.

(b) The provider shall provide the case manager with the treatment plan no later than fourteen days after the provider completes the assessment.

(c) The provider shall offer the individual the treatment plan no later than fourteen days after the provider completes the assessment, unless there are clinical indications against providing the individual with the treatment plan. If the individual declines to receive the treatment plan, the provider shall retain a record that the provider offered to provide the individual with the treatment plan, but that the individual declined.

(d) The provider shall implement the treatment plan.

(5) Provider qualifications: No person shall provide the service unless the person is employed by a provider that ODA certifies as an agency provider, or unless ODA certifies the person as a non-agency provider.

(a) Agency provider:

(i) An agency provider shall assure that the agency's direct-care staff includes a licensed professional clinical counselor (LPCC), a licensed professional counselor (LPC), a licensed psychologist or a licensed psychologist with an e.passport, an independent marriage and family therapist (IMFT), a marriage and family therapist (MFT), a licensed independent social worker (LISW), or a licensed social worker (LSW).

(ii) No employee shall provide the service under the employment of the agency provider unless the individual is a LPCC, LPC, a licensed psychologist or a licensed psychologist with an e.passport, IMFT, MFT, LISW, LSW, or an advanced practice RN designated as a CNP or CNS and certified as a psychiatric-mental health CNP or CNS by he American nurses credentialing center.

(iii) The provider shall retain records to show that each social work or counseling staff member holds a license in good standing with their respective Ohio professional licensure board or an e.passport, and has at least one year of social work or counseling experience.

(b) Non-agency provider:

(i) No person shall provide the service as a non-agency provider unless the person is an IMFT, LPCC, licensed psychologist or a licensed psychologist with an e.passport, LISW, or an advanced practice RN designated as a CNP or CNS and certified as a psychiatric-mental health CNP or CNS by the American nurses credentialing center.

(ii) The provider shall retain records to show that the provider holds a license in good standing with their Ohio professional licensure board or an e.passport, and has at least one year of social work or counseling experience.

(6) Service verification:

(a) For each session, the provider shall retain a record of all the following:

(i) Individual's name.

(ii) Date of service.

(iii) Time of day each session begins and ends.

(iv) Name of staff member providing social work or counseling to the individual or the individual's caregiver (if an agency provider).

(v) A unique identifier of the individual.

(b) The provider may use an electronic system to collect or retain the records required under this rule.

(C) Unit and rate:

(1) A unit of a social work or counseling is fifteen minutes of session time with the individual.

(2) The appendix to rule 5160-1-06.1 of the Administrative Code establishes the maximum rate allowed for a unit of social work or counseling provided through the PASSPORT program.

(3) Rule 5160-31-07 of the Administrative Code establishes the rate-setting methodology for social work or counseling provided through the PASSPORT program.

Last updated April 12, 2024 at 11:08 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522
Amplifies: 173.39, 173.391, 173.52, 173.522; 42 CFR 441.352
Five Year Review Date: 4/16/2027
Prior Effective Dates: 3/31/2006
Rule 173-39-02.14 | ODA provider certification: home-delivered meals.
 

(A) "Home-delivered meal" means a meal regulated by rule 5160-44-11 of the Administrative Code.

(B) Every ODA-certified provider of home-delivered meals shall comply with the following requirements:

(1) General requirements: The provider shall comply with the requirements for every ODA-certified agency provider in rule 173-39-02 of the Administrative Code.

(2) Requirements specific to home-delivered meals:

(a) For all meals, the provider shall comply with the requirements in rule 5160-44-11 of the Administrative Code.

(b) If ODA's designee authorizes home-delivered meals for an individual, the provider shall provide the individual with home-delivered meals that are kosher if the individual requests a kosher diet.

(3) If a conflict exists between a requirement in rule 173-39-02 of the Administrative Code and a requirement in rule 5160-44-11 of the Administrative Code, the provider shall comply with the requirement in rule 173-39-02 of the Administrative Code.

(C) Units and rates:

(1) A unit of regular home-delivered meals is one home-delivered meal.

(2) A unit of home-delivered meals with a therapeutic diet is one home-delivered meal with a therapeutic diet.

(3) Appendix A to rule 5160-1-06.1 of the Administrative Code establishes the maximum rates allowable for units of home-delivered meals.

(4) Rule 5160-31-07 of the Administrative Code establishes rate-setting methodology for units of home-delivered meals.

(5) Section 173.524 of the Revised Code authorizes the PASSPORT program to pay for home-delivered meals with a kosher diet at the same rate as a therapeutic diet.

Last updated April 12, 2024 at 11:33 AM

Supplemental Information

Authorized By: 173.522, 173.52, 173.391, 173.02, 173.01
Amplifies: 173.391, 173.39, 173.522; 42 C.F.R. 441.352, 173.52
Five Year Review Date: 5/1/2029
Prior Effective Dates: 4/16/2006
Rule 173-39-02.15 | ODA provider certification: community integration.
 

(A) "Community integration" means the service defined in rule 5160-44-14 of the Administrative Code.

(B) Requirements for an ODA-certified provider of community integration:

(1) General requirements: The provider shall comply with the requirements for every ODA-certified agency provider in rule 173-39-02 of the Administrative Code.

(2) Requirements specific to community integration: The provider shall comply with the requirements in rule 5160-44-14 of the Administrative Code.

(3) If a conflict exists between a requirement in rule 173-39-02 of the Administrative Code and a requirement in rule 5160-44-14 of the Administrative Code, the provider shall comply with the requirement in rule 173-39-02 of the Administrative Code.

(C) Units and rates:

(1) One unit of community integration is fifteen minutes.

(2) Appendix A to rule 5160-1-06.1 of the Administrative Code establishes the maximum-allowable rate per unit.

(3) Rule 5160-31-07 of the Administrative Code establishes the rate-setting methodology for a unit of community integration.

Last updated April 12, 2024 at 11:33 AM

Supplemental Information

Authorized By: 173.391, 173.52, 173.522, 173.01, 173.02
Amplifies: 173.39, 173.391, 173.52, 173.522; 42 C.F.R. 441.352
Five Year Review Date: 5/1/2029
Prior Effective Dates: 8/1/2017
Rule 173-39-02.16 | ODA provider certification: assisted living service.
 

(A) Definitions for this rule:

(1) "Assisted living service" means all of the following:

(a) A service promoting aging in place by supporting the individual's independence, choice, and privacy.

(b) A service that includes the following activities:

(i) Hands-on assistance, supervision, and/or cuing of ADLs, IADLs, and other supportive activities.

(ii) Nursing activities, including the following:

(a) The initial and subsequent health assessments under rule 3701-16-08 of the Administrative Code.

(b) Monitoring the individual according to the standards of practice for the individual's condition.

(c) Medication management according to rule 3701-16-09 of the Administrative Code.

(d) The part-time intermittent skilled nursing care described in rule 3701-16-09.1 of the Administrative Code when not available to the individual through a third-party payer.

(iii) Coordinating three meals per day and snacks according to rule 3701-16-10 of the Administrative Code with access to food according to rule 5160-44-01 of the Administrative Code.

(iv) Coordinating the social, recreational, and leisure activities under rule 3701-16-11 of the Administrative Code to promote community participation and integration, including non-medical transportation to services and resources in the community.

(c) A service that does not include the following:

(i) Housing.

(ii) Meals.

(iii) Twenty-four-hour skilled nursing care.

(iv) One-on-one supervision of an individual.

(2) "Medication management" includes knowing what medications an individual is self-managing, assistance with self-administration of medication, ordering medication, medication reminders, and medication administration.

(3) "Memory care" means a service that a provider provides in compliance with paragraph (D) of this rule to an individual with a documented diagnosis of any form of dementia.

(4) "Resident call system" has the same meaning as in rule 3701-16-01 of the Administrative Code.

(5) "Staff member" and "staff" have the same meanings as in rule 3701-16-01 of the Administrative Code.

(B) Certification types: ODA certifies each provider for the basic assisted living service, memory care, or both the basic service and memory care.

(C) Requirements for an ODA-certified provider of the basic assisted living service:

(1) General requirements: The provider is subject to rule 173-39-02 of the Administrative Code.

(2) RCF qualifications:

(a) Licensure: Only a provider who maintains a current, valid RCF license from ODH and maintains compliance with Chapter 3721. of the Revised Code and Chapters 3701-13 and 3701-16 of the Administrative Code qualifies to provide this service.

(b) Public information: The provider shall display the following on its website:

(i) Whether the provider is currently certified by ODA to provide the basic assisted living service, memory care, or both the basic service and memory care.

(ii) Whether the provider is currently accepting individuals who are enrolling in the assisted living program or mycare Ohio.

(c) Resident units: A resident unit qualifies for this service only if the unit meets all the following standards:

(i) Occupancy:

(a) The resident unit is a single-occupancy resident unit designated solely for the individual, except as permitted under paragraph (C)(2)(c)(i)(b) of this rule.

(b) The provider may allow an individual to share a single-occupancy resident unit only if all of the following conditions exist:

(i) The individual requests to share the individual's unit.

(ii) The individual shares the individual's unit with a person with whom the individual has an existing relationship.

(iii) ODA's designee verifies that the conditions of paragraphs (C)(2)(c)(i)(b)(i) and (C)(2)(c)(i)(b)(ii) of this rule are met and authorizes sharing the unit in the individual's person-centered services plan.

(ii) Lock: The resident unit has a lock that allows the individual to control access to the resident unit at all times, unless the individual's person-centered services plan indicates otherwise.

(iii) Bathroom: The resident unit includes a bathroom with a toilet, a sink, and a shower or bathtub, all of which are in working order.

(iv) Social space: The resident unit includes identifiable space, separate from the sleeping area, that provides seating for the individual and one or more visitors for socialization.

(d) Common areas: The provider shall provide common areas accessible to the individual, including a dining area (or areas) and an activity center (or centers). A multi-purpose common area may serve as both a dining area and an activity center.

(3) Availability: The provider shall maintain adequate staffing levels to comply with rule 3701-16-05 of the Administrative Code and to provide hands-on assistance, supervision, and/or cuing of ADLs in a timely manner in response to individual's unpredictable care needs, supervisory needs, emotional needs, and reasonable requests for services through the resident call system twenty-four hours per day.

(4) Minors: Staff members under eighteen years of age do not qualify to do any of the following:

(a) Assist with medication management.

(b) Provide transportation.

(c) Provide personal care without on-site supervision, in accordance with rule 3701-16-06 of the Administrative Code.

(5) Initial staff qualifications: Only a staff member who successfully completes training in the following subject areas qualifies to provide this service:

(a) Principles and philosophy of assisted living.

(b) The aging process.

(c) Cuing, prompting, and other means of effective communication.

(d) Common behaviors for cognitively-impaired individuals, behaviorally-impaired individuals, or other individuals and strategies to redirect or de-escalate those behaviors.

(e) Confidentiality.

(f) The person-centered planning process in rule 5160-44-02 of the Administrative Code, which includes supporting individuals' full access to the greater community.

(g) The individual's right to assume responsibility for decisions related to the individual's care.

(6) In-service training: The provider shall ensure that each employee providing this service successfully completes any training requirements in rule 3701-16-06 of the Administrative Code and makes verification of successful completion of those requirements available to ODA or its designee upon request.

(7) Quarterly assessments: The provider's RN or LPN shall contact the individual at least quarterly to assess, and retain a record of, all of the following:

(a) The individual's satisfaction with the individual's activity plan and whether the activity plan continues to meet the individual's needs.

(b) Whether the individual's records demonstrate that the individual is receiving activities as ODA or its designee authorized them in the individual's person-centered service plan.

(c) Whether staff are providing personal care services to the individual in a manner that complies with rule 3701-16-09 of the Administrative Code.

(8) Subcontracting: The provider may subcontract to provide one or more, but not all, of the activities listed under paragraph (A)(1)(b) of this rule that ODA or its designee authorizes for the individual. The provider is responsible to assure that any activity provided by a sub-contractor complies with this chapter.

(D) Requirements for an ODA-certified provider of memory care:

(1) The provider is subject to the standards in paragraphs (C) of this rule.

(2) The provider qualifies for certification to provide memory care only if the provider meets all of the following standards:

(a) The provider displays a purpose statement on its website that explains the difference between the provider's basic assisted living service and its memory care, or if the provider provides only memory care, a purpose statement on its website that explains the memory care that the provider provides.

(b) The provider designates the single-occupancy resident unit in paragraph (C)(2)(c) of this rule to be a stand-alone memory care unit, a memory care unit in a memory care section of the RCF, or a memory care unit in an RCF of a provider that provides only memory care.

(c) The provider provides or arranges for at least three therapeutic, social, or recreational activities listed in rule 3701-16-11 of the Administrative Code per day with consideration given to individuals' preferences and designed to meet individuals' needs.

(d) The provider ensures safe access to outdoor space for individuals.

(e) The provider assists each individual who makes a call through the resident call system in person in fewer than ten minutes after the individual initiates the call.

(3) Availability: The provider qualifies for certification to provide memory care only if the provider meets all of the following standards in addition to the requirements in paragraph (C)(3) of this rule:

(a) The provider has a sufficient number of RNs, or LPNs under the direction of an RN, on call or on site at all times for individuals receiving memory care.

(b) The provider maintains the appropriate direct-care staff-to-resident ratio below for its memory care:

(i) If providing both memory care and the basic service, a ratio that is at least twenty per cent higher than the provider's ratio for its basic service.

(ii) If providing only memory care and the average ratio for the basic service provided by a representative sample of providers participating in the medicaid-funded component of the assisted living program is readily available to the provider, then a ratio that is at least twenty per cent higher than that average ratio.

(iii) If providing only memory care and the average ratio for the basic service provided by a representative sample of providers participating in the medicaid-funded component of the assisted living program is not readily available to the provider, then a ratio of at least one staff member who provides personal care services for every ten individuals receiving memory care with at least one staff member who provides personal care services on each floor of the RCF if the RCF provides memory care on multiple floors.

(4) Initial staff qualifications: A staff member qualifies to provide memory care without in-person supervision only if the staff member successfully completes training all of the following topics in addition to the topics listed under paragraph (C)(5) of this rule:

(a) Overview of dementia: symptoms, treatment approaches, and progression.

(b) Foundations of effective communication in dementia care.

(c) Common behavior challenges and recommended behavior management techniques.

(d) Current best practices in dementia care.

(e) Missing resident prevention and response.

(5) In-service training: A staff member continues to qualify to provide memory care only if the staff member successfully completes dementia care training when complying with paragraph (C)(6) of this rule.

(E) Units and rates:

(1) For the assisted living program, the appendix to rule 5160-1-06.5 of the Administrative Code lists the following:

(a) The unit of service as one day.

(b) The maximum-allowable rates for a unit of a unit of basic assisted living service and a unit of memory care.

(2) For the assisted living program, rule 5160-33-07 of the Administrative Code establishes the rate-setting methodology for a unit of service.

Last updated April 12, 2024 at 11:08 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.54, 173.543
Amplifies: 173.39, 173.391, 173.54, 173.543, 173.547, 173.548; 42 C.F.R. 441.352
Five Year Review Date: 11/30/2028
Prior Effective Dates: 3/31/2006, 10/8/2009, 6/10/2013, 11/1/2020
Rule 173-39-02.17 | ODA provider certification: community transition.
 

(A) "Community transition" means the service defined in rule 5160-44-26 of the Administrative Code.

(B) Requirements for an ODA-certified provider of community transition:

(1) General requirements: The provider shall comply with the requirements for every ODA-certified agency provider in rule 173-39-02 of the Administrative Code.

(2) Requirements specific to community transition: The provider shall comply with the requirements in rule 5160-44-26 of the Administrative Code.

(3) If a conflict exists between a requirement in rule 173-39-02 of the Administrative Code and a requirement in rule 5160-44-26 of the Administrative Code, the provider shall comply with the requirement in rule 173-39-02 of the Administrative Code.

(C) Units and rates:

(1) One unit of community transition is one completed job per individual per enrollment in the PASSPORT program or the assisted living program and includes includes any of the expenses listed under paragraph (A)(1) of rule 5160-44-26 of the Administrative Code.

(2) The rate per job is subject to the maximum-allowable rate established in appendix A to rule 5160-1-06.1 of the Administrative Code, appendix A to rule 5160-1-06.5 of the Administrative Code, and paragraph (C)(2) of rule 5160-44-26 of the Administrative Code.

(3) Rules 5160-31-07 and 5160-33-07 of the Administrative Code require the unit rate to be negotiated between the provider and ODA's designee. The negotiated rate shall include any expenses listed under paragraph (A)(1) of rule 5160-44-26 of the Administrative Code. The provider shall not bill ODA's designee for any amount in excess of the negotiated rate, unless ODA's designee approves a revised rate.

Last updated April 12, 2024 at 11:33 AM

Supplemental Information

Authorized By: 173.01, 173.02, 173.391, 173.52, 173.522
Amplifies: 173.39, 173.391, 173.52, 173.522; 42 C.F.R. 441.352
Five Year Review Date: 5/1/2029
Rule 173-39-02.18 | ODA provider certification: non-medical transportation.
 

(A) Definitions for this rule:

(1) "Non-medical transportation" (transportation) means using a provider's vehicle and driver to transport individuals from one place to another for a non-medical purpose. "Non-medical transportation" does not include the following:

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

(b) Transportation for a non-emergency medical purpose.

(c) Transportation being provided through a similar service in this chapter.

(d) Transportation that the individual's family, neighbors, friends, or community agencies are willing or legally responsible to provide to the individual free of charge.

(e) Escort or transportation by a participant-directed provider. (See rule 173-39-02.4 of the Administrative Code.)

(2) "Board of EMFTS" means the state board of emergency medical, fire, and transportation services created under section 4765.02 of the Revised Code.

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

(4) "CLIA-certified laboratory" means a laboratory that 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) "EMT" means any of the emergency medical technicians defined in division (A), (B), or (C) of section 4765.01 of the Revised Code.

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

(B) Requirements for ODA-certified providers of non-medical transportation:

(1) General requirements:

(a) The provider is subject to the requirements for every ODA-certified provider in rule 173-39-02 of the Administrative Code.

(b) Availability: The provider shall possess a back-up plan for transporting individuals when an agency provider's driver or vehicle is unavailable or when a non-agency provider or the provider's vehicle is unavailable.

(c) Transferring: As part of each trip, the driver shall help the individual safely transfer between the pick-up point and the vehicle, safely enter and exit the vehicle, and safely transfer between the vehicle and the destination point.

(d) Provider types: ODA certifies only agency and non-agency providers to provide the transportation under this rule.

(2) Vehicle requirements:

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

(i) An annual vehicle inspection on an ODA-approved form. The provider may use a vehicle for transporting individuals only if a mechanic who is certified by the national institute for automotive service excellence (i.e., "ASE-certified") or another mechanic approved by ODA's designee, inspected the vehicle no more than twelve months before and answers all questions on the form in the affirmative.

(ii) A daily vehicle inspection on an ODA-approved form. The provider may use a vehicle only if the provider answers all questions on the form in the affirmative.

(c) Exemptions:

(i) A vehicle possessing a current, valid ambulette license is deemed to comply with paragraph (B)(2)(b)(i) of this rule by providing ODA or its designee 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.

(3) Driver requirements:

(a) Statutory requirements to hire: The provider may hire a person to be a driver only if the person meets all the requirements for drivers under divisions (A)(3) and (B) of section 4766.14 of the Revised Code, as amplified in paragraph (A) (8) of rule 4766-3-13 of the Administrative Code, subject to the following conditions:

(i) The applicant's first-aid training and cardiopulmonary-resuscitation training came from a training organization approved by the board of EMFTS (http://www.ems.ohio.gov/medical-transportation-faq.aspx).

(ii) The applicant's drug test results came from a CLIA-certified laboratory that declared the applicant to be free of alcohol, amphetamines, cannabinoids (THC), cocaine, opiates, or phencyclidine (PCP).

(iii) The provider complies with the background-check requirements in Chapter 173-9 of the Administrative Code.

(b) Additional requirements to hire: The provider may hire a person to be a driver only if 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 understands written and oral instructions.

(iv) The applicant has the ability to comply with paragraph (B)(1)(c) of this rule.

(v) The applicant has the ability to conduct the daily vehicle inspection in paragraph (B)(2)(b)(ii) of this rule.

(vi) The applicant has the ability to collect the mandatory reporting items under paragraph (B)(4) of this rule.

(c) Passenger-assistance training: The provider may retain a driver only if the driver successfully completes a passenger-assistance training course approved by the board of EMFTS (http://www.ems.ohio.gov/medical-transportation-faq.aspx) no later than six months after the provider hires the driver.

(d) Exempted professionals: 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 ODA or its designee 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 who passed the board of EMFTS' curriculum for an EMT or first responder, but does not necessarily hold a current, valid certification for either profession.

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

(4) Trip verification: The following are the mandatory reporting items for each trip provided to comply with the requirements under paragraph (B)(10)(a)(i) of rule 173-39-02 of the Administrative Code:

(a) Individual's name.

(b) Date of trip.

(c) Pick-up point and time of the pick up.

(d) Destination point and time of the drop off.

(e) Driver's name.

(f) Unique identifier of the driver to attest to providing the trip.

(g) Unique identifier of the individual to attest to receiving the trip.

(C) Jobs and rates:

(1) For the PASSPORT program, the appendix to rule 5160-1-06.1 of the Administrative Code lists the following for a job of non-medical transportation:

(a) The job as one trip, whether a one-way or round trip.

(b) The maximum rate allowable for a job.

(2) For the PASSPORT program, rule 5160-31-07 of the Administrative Code establishes the rate-setting methodology for non-medical transportation.

Last updated April 12, 2024 at 11:08 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522
Amplifies: 173.39, 173.391, 173.52, 173.522, 4766.14, and 4766.15
Five Year Review Date: 5/1/2029
Prior Effective Dates: 9/24/2009, 9/2/2010, 9/29/2011, 3/1/2019, 6/11/2020 (Emer.)
Rule 173-39-02.20 | ODA provider certification: enhanced community living.
 

(A) Definitions for this rule:

(1) "Enhanced community living" (ECL) means a service promoting aging in place, in multi-family affordable housing, through access to on-site, individually-tailored, health-related, and supportive interventions for individuals who have functional deficits resulting from one or more chronic health conditions.

(a) ECL includes the following activities:

(i) The establishment of measurable health goals.

(ii) The identification of modifiable healthcare risks.

(iii) The provision of regular health-status monitoring interventions. "Health-status monitoring interventions" mean taking and recording vital signs, weight, nutrition, and hydration statuses.

(iv) Assistance with accessing additional allied health services.

(v) The provision of, or arrangement for, education on self-managing chronic diseases or chronic health conditions.

(vi) Daily wellness checks. "Daily wellness check" means an activity of ECL through which a PCA observes any changes in the individual's level of functioning and determine what, if any, modifications to the activity plan are needed.

(vii) Access to planned and intermittent personal care under rule 173-39-02.11 of the Administrative Code, excluding respite care.

(viii) Activities to assist an individual who is returning home following a hospital or nursing facility stay.

(b) ECL does not include activities provided while the individual is receiving a similar service under this chapter.

(2) "Chronic health condition" means a condition that lasts twelve months or longer and meets one or both of the following tests:

(a) It places limitation on self-care, independent living, and social interactions.

(b) It results in the need for ongoing intervention with medical services, products, and equipment.

(3) "Intermittent" means stopping and starting at intervals; pausing from time to time; periodic, not pre-determined designated time periods (e.g., ten a.m. to eleven a.m.) or for designated lengths of time (e.g., fifteen minutes or two hours).

(4) "Multi-family affordable housing" means a housing site meeting all of the following requirements:

(a) The housing site uses a landlord-tenant rental agreement that complies with Chapter 5321. of the Revised Code.

(b) The housing site provides a minimum of six units of housing under one roof.

(c) The housing site receives assistance through one of the following programs:

(i) Federally-assisted housing program under 24 C.F.R. Part 5.

(ii) Project-based voucher program under 24 C.F.R. Part 983.

(iii) Low-income housing tax credit program based on Section 42 of the Internal Revenue Code.

(5) "Person-centered activity" means an activity directed by the individual's informed choices that is offered at the time and place most preferable to the individual, in a safe and unhurried manner, and in a way that honors the individual's individuality and preferences.

(B) Every ODA-certified ECL provider shall comply with the following requirements:

(1) General requirements: The provider shall comply with the requirements for every ODA-certified provider in rule 173-39-02 of the Administrative Code.

(2) Person-centered activity plan:

(a) Development: Before the provider provides the initial episode of ECL to an individual, the PCA supervisor shall:

(i) Assess the individual's health goals, modifiable health risks, and planned and anticipated intermittent personal care needs; and,

(ii) Develop a person-centered activity plan with the individual that describes the interventions the individual has chosen to reach his or her identified health goals, to minimize his or her modifiable health risks, and to meet his or her planned and anticipated intermittent personal care needs. The provider shall obtain a unique identifier of the individual to verify that the individual was involved in the development of his or her person-centered activity plan.

(b) Regular monitoring: After the individual begins to receive ECL, the PCA supervisor shall do both of the following:

(i) Revise the person-centered activity plan in fewer than five days after each hospital or nursing facility stay, and as otherwise needed to reflect changes in the individual's status, condition, preferences, and response to ECL.

(ii) Facilitate an in-person review of the person-centered activity plan with the individual, the primary team, the individual's case manager, the individual's caregiver (if the individual has a caregiver), and the housing site's service coordinator (if the housing site has a service coordinator) every sixty days to evaluate the effectiveness of the plan in addressing the individual's health goals, reducing modifiable risks, and meeting planned and anticipated intermittent personal care needs.

(c) Records-retention: The provider shall retain a record of the person-centered activity plan, including any revisions to the person-centered activity plan and the in-person review of the person-centered activity plan:

(3) Staffing levels:

(a) The provider shall maintain adequate staffing levels to provide each ECL activity.

(b) The PCA supervisor shall maintain accessibility to respond to individuals' emergencies in the housing site during any time that a PCA is providing ECL to an individual in the housing site.

(c) The provider shall maintain adequate staffing levels to provide person-centered ECL seven days a week for a minimum of six hours a day.

(d) During each hour the provider has a PCA providing ECL to an individual in a housing site, the provider shall ensure that any other individual has a mechanism to contact a PCA to request assistance with intermittent and unplanned personal care needs related to the measurable health goals and modifiable healthcare risks described in the individual's activity plan.

(e) Each day, the provider shall provide adequate staffing levels of on-site PCAs for no fewer than six hours (or, twenty-four units) to meet the individuals' assessed, intermittent, and unscheduled healthcare needs.

(f) The PCA supervisor or another RN (or LPN under the direction of an RN) shall monitor the health status of individuals for no fewer than three hours (or, twelve units) each week.

(4) Provider qualifications:

(a) Type of provider: A provider shall only provide ECL if both of the following conditions are met:

(i) ODA certifies the provider as an agency provider of both personal care and ECL.

(ii) The provider is a legal entity distinct from the housing site owner and property manager so the site is not subject to licensure, as defined in Chapters 3721. and 5119. of the Revised Code, and safeguards are in place to prevent any unremedied conflicts of interest.

(b) Staff designations and minimum staff qualifications:

(i) PCA supervisor: The provider shall only employ a person as a PCA supervisor if the person if the person meets the qualifications in paragraph (C)(4)(a) of rule 173-39-02.11 of the Administrative Code.

(ii) PCAs: The provider shall only employ a person to serve as a PCA if the person meets at least one of the qualifications under paragraph (C)(3)(a) of rule 173-39-02.11 of the Administrative Code, the training and competency evaluation meet the standards under paragraph (C)(3)(e) of rule 173-39-02.11 of the Administrative Code, and the provider meets the verification requirements under paragraph (C)(3)(f) of rule 173-39-02.11 of the Administrative Code.

(iii) Primary team: The provider shall provide person-centered activities to individuals through a primary team that consists of PCAs and PCA supervisors who regularly provide activities within a given housing site and, as a result, are familiar with the individuals in the housing site. The provider shall replace any PCA on the primary team who is absent with a back-up PCA who is familiar with the housing site and the individuals residing in the housing site. A PCA supervisor shall supervise the primary team and also any back-up PCAs.

(c) Staff training:

(i) Before allowing any PCA to have direct, in-person contact with an individual, the provider shall comply with the orientation requirements in paragraphs (C)(3)(b), (C)(3)(e), and (C)(3)(f) of rule 173-39-02.11 of the Administrative Code.

(ii) In-service training: Each PCA shall comply with the in-service training requirements in paragraphs (C)(3)(d), (C)(3)(e), and (C)(3)(f) of rule 173-39-02.11 of the Administrative Code.

(5) Service verification:

(a) The provider shall develop and retain a daily activity record for each individual that includes all of the following:

(i) Individual's name.

(ii) Date of service.

(iii) Activities provided as authorized in the person-centered activity plan.

(iv) Activities provided in response to daily, intermittent needs.

(v) Description of the individual's status and response to the activities provided.

(vi) Total number of units provided to the individual.

(vii) Name and signature of the provider's staff person who provided the activities.

(viii) Unique identifier of the individual, which by offering the individual attests to receiving the activities.

(b) The provider may use an electronic system to collect or retain the records required under this rule.

(C) Unit and rates:

(1) One unit of ECL is fifteen minutes.

(2) The appendix to rule 5160-1-06.1 of the Administrative Code establishes the maximum rate allowable for one unit of ECL.

(3) Rule 5160-31-07 of the Administrative Code establishes the rate-setting methodology for the ECL provided through the PASSPORT program.

Last updated April 12, 2024 at 11:08 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522,
Amplifies: 173.39, 173.391, 173.52, 173.522; 42 CFR 441.352
Five Year Review Date: 4/2/2027
Prior Effective Dates: 3/17/2011
Rule 173-39-02.22 | ODA provider certification: waiver nursing service.
 

(A) "Waiver nursing service" means the service defined in rule 5160-44-22 of the Administrative Code.

(B) Every ODA-certified provider of a waiver nursing service shall comply with the following requirements:

(1) General requirements: The provider shall comply with the requirements for every ODA-certified agency provider in rule 173-39-02 of the Administrative Code.

(2) Requirements specific to a waiver nursing service: The provider shall comply with the requirements in rule 5160-44-22 of the Administrative Code.

(3) If a conflict exists between a requirement in rule 173-39-02 of the Administrative Code and a requirement in rule 5160-44-22 of the Administrative Code, the provider shall comply with the requirement in rule 173-39-02 of the Administrative Code.

(C) Units and rates:

(1) A unit of a waiver nursing service under the PASSPORT program equals a unit of a waiver nursing service that rule 5160-46-06 of the Administrative Code establishes for the Ohio home care waiver program.

(2) Rule 5160-46-06 of the Administrative Code establishes the maximum rate allowable for a unit of a waiver nursing service.

(3) Rule 5160-31-07 of the Administrative Code establishes rate-setting methodology for units of a waiver nursing service.

Last updated April 12, 2024 at 11:33 AM

Supplemental Information

Authorized By: 173.522, 173.52, 173.391, 173.02, 173.01
Amplifies: 173.39, 173.522; 42 C.F.R. 441.352, 173.52, 173.391
Five Year Review Date: 5/1/2029
Rule 173-39-02.23 | ODA provider certification: out-of-home respite.
 

(A) "Out-of-home respite" means the service defined in rule 5160-44-17 of the Administrative Code.

(B) Every ODA-certified provider of out-of-home respite shall comply with the following requirements:

(1) General requirements: The provider shall comply with the requirements for every ODA-certified agency provider in rule 173-39-02 of the Administrative Code.

(2) Requirements specific to out-of-home respite: The provider shall comply with the requirements in rule 5160-44-17 of the Administrative Code.

(3) If a conflict exists between a requirement in rule 173-39-02 of the Administrative Code and a requirement in rule 5160-44-17 of the Administrative Code, the provider shall comply with the requirement in rule 173-39-02 of the Administrative Code.

(C) Units and rates:

(1) A unit of out-of-home respite under the PASSPORT program equals a unit of out-of-home respite that rule 5160-46-06 of the Administrative Code establishes for the Ohio home care waiver program.

(2) Rule 5160-46-06 of the Administrative Code establishes the maximum rate allowable for a unit of out-of-home respite.

(3) Rule 5160-31-07 of the Administrative Code establishes rate-setting methodology for units out-of-home respite.

Last updated April 12, 2024 at 11:33 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522
Amplifies: 173.39, 173.391, 173.52, 173.522; 42 CFR 441.352
Five Year Review Date: 5/1/2029
Prior Effective Dates: 7/1/2014, 11/1/2015
Rule 173-39-02.24 | ODA provider certification: home care attendant service.
 

(A) "Home care attendant service" means the service defined in rule 5160-44-27 of the Administrative Code.

(B) Every ODA-certified provider of a home care attendant service shall comply with the following requirements:

(1) General requirements: The provider shall comply with the requirements for every ODA-certified agency provider in rule 173-39-02 of the Administrative Code.

(2) Requirements specific to a home care attendant service: The provider shall comply with the requirements in rule 5160-44-27 of the Administrative Code.

(3) If a conflict exists between a requirement in rule 173-39-02 of the Administrative Code and a requirement in rule 5160-44-27 of the Administrative Code, the provider shall comply with the requirement in rule 173-39-02 of the Administrative Code.

(C) Units and rates:

(1) A unit of a home care attendant service under the PASSPORT program equals a unit of a home care attendant service that rule 5160-46-06 of the Administrative Code establishes for the Ohio home care waiver program.

(2) Rule 5160-46-06.1 of the Administrative Code establishes the maximum rate allowable for a unit of a home care attendant service.

(3) Rule 5160-31-07 of the Administrative Code establishes rate-setting methodology for units a home care attendant service.

Last updated April 12, 2024 at 11:33 AM

Supplemental Information

Authorized By: 173.522, 173.52, 173.391, 173.02, 173.01
Amplifies: 173.39, 173.522; 42 C.F.R. 441.352, 173.52, 173.391
Five Year Review Date: 5/1/2029
Prior Effective Dates: 11/1/2015
Rule 173-39-03 | ODA provider certification: applying for certification.
 

(A) Initial steps:

(1) To apply for certification, a provider shall complete an application in the provider management system, which includes electronic submission of all supporting records required as part of the application. If the provider does not complete the application within ninety days, the application expires.

(2) ODA shall review an application to determine if the application meets the requirements for the certification the provider is seeking.

(a) ODA shall initiate the process for a pre-certification review if ODA determines that a provider submitted a complete application.

(b) If ODA determines that the supporting records do not demonstrate that the provider submitted a complete application, then ODA shall email the provider to give the provider a deadline to submit supporting records that demonstrate that the provider meets the requirements for certification that is the earlier of thirty days after the email or the deadline in paragraph (A)(1) of this rule.

(B) Voluntary withdrawal of application for certification:

(1) A provider may withdraw its application at any time before enrollment with ODM unless ODA issued a notice of denial of certification.

(2) A provider that withdrew its application may later reapply for certification.

(C) Pre-certification review:

(1) For all providers except providers of community transition provided through the home choice program under rule 5160-51-10 of the Administrative Code and participant-directed providers:

(a) ODA's designee shall visit the provider's business site to determine if the provider meets the applicable requirements in rule 173-39-02 of the Administrative Code and any additional requirements in this chapter regulating a service the provider is seeking certification to provide. During a state of emergency declared by the governor, a federal public health emergency, or during another time if authorized by ODA, ODA's designee may conduct a desk review of the provider's business site in lieu of a visit.

(b) ODA's designee shall complete the review and notify ODA of its recommendation within sixty days after receiving a complete application to become any other type of provider, unless ODA approves an extended deadline.

(c) ODA's designee shall recommend approval of the provider's application if a provider other than an ADS or assisted living provider complies with all applicable requirements.

(d) Paragraph (D) of this rule applies if ODA's designee determines that an ADS or assisted living provider complies with all applicable requirements.

(e) ODA's designee shall recommend denial of the application if the provider does not comply with all applicable requirements.

(2) For providers of community transition provided through the home choice program under rule 5160-51-10 of the Administrative Code:

(a) ODA may direct its designee to conduct the pre-certification review to determine if the provider meets the applicable requirements in rules 173-39-02 and 173-39-02.17 of the Administrative Code.

(b) ODA or its designee shall determine whether the provider complies with all applicable requirements and either approve or deny the provider's application pursuant to this rule.

(3) For participant-directed providers, ODA's designee shall conduct a pre-certification review within thirty days after receiving a complete application to determine whether the provider meets the applicable requirements in rule 173-39-02 of the Administrative Code and any additional requirements in this chapter regulating a service the provider is seeking certification to provide, unless ODA approves an extended deadline.

(D) HCBS settings requirements: A provider may qualify for certification only if the provider provides its services in the individual's home or another setting meeting the HCBS settings requirements in 42 C.F.R. 441.301 and rule 5160-44-01 of the Administrative Code as determined by ODA on form ODM10172 (revised, June 2021), which is entitled, "Home and Community Based Services (HCBS) Settings Evaluation Tool."

(1) ODA may certify the provider if ODA determines the setting is presumed to have the qualities of a HCBS setting and the setting is not subject to the heightened scrutiny described in rule 173-39-03.1 of the Administrative Code.

(2) The setting is subject to the heightened scrutiny described in rule 173-39-03.1 of the Administrative Code if ODA determines the setting is presumed to have the qualities of an institution. ODA defers action on the application for certification until the conclusion of the heightened scrutiny. ODA shall notify the provider that action on the provider's application is deferred.

(E) Final determination: ODA bases its final determination of whether to certify a provider on the review of the application materials and the recommendation of ODA's designee.

(F) Approved application:

(1) Applications for all services except community transition provided through the home choice program under rule 5160-51-10 of the Administrative Code:

(a) When ODA approves an application, ODA notifies ODA's designee for the region in which the provider is being certified to provide services.

(b) ODA's designee shall enter into an agreement with each provider specifying, at a minimum, the following:

(i) The time period during which the agreement is in effect.

(ii) The region for which the provider is certified.

(iii) The rate of payment per unit the provider is willing to accept subject to any limits ODM established in rule 5160-31-07 of the Administrative Code and the appendix to rule 5160-1-06.1 of the Administrative Code for the PASSPORT program, and rule 5160-33-07 of the Administrative Code and the appendix to rule 5160-1-06.5 of the Administrative Code for the assisted living program.

(2) Applications for community transition provided through the home choice program under rule 5160-51-10 of the Administrative Code: After ODA approves an application to be a provider of community transition through the home choice program, ODA's designee shall enter into an agreement with the provider specifying the items under paragraph (F)(1) of this rule.

(G) Deemed providers: ODA may deem any provider certified by ODM or the department of developmental disabilities to provide one or more services through a medicaid-waiver program as having satisfied the requirements for certification by ODA for the same or similar services under this chapter, as determined by ODA. The effective period for a provider to be deemed an ODA-certified provider under this paragraph begins when the provider completes the deeming application process and has a provider agreement with ODA's designee, and ends if the provider cannot comply with all the requirements of Chapter 173-9 of the Administrative Code and this chapter within sixty days after initial deeming or a medicaid provider agreement is terminated, whichever occurs first.

(H) Denied application:

(1) ODA may deny a providers application for any of the following reasons:

(a) The provider made false representations, by omission or commission, on the provider's application.

(b) The provider made false statements, provided false information, or altered records or documents.

(c) The provider is disqualified under section 173.38 or 173.381 of the Revised Code or under Chapter 173-9 of the Administrative Code.

(d) The provider does not meet the applicable requirements in rule 173-39-02 of the Administrative Code or any requirements in this chapter regulating a service that the provider is seeking certification to provide.

(e) ODA previously revoked the provider's certification.

(f) Any reason permitted or required by state or federal law.

(2) When ODA denies a provider's application, ODA notifies the provider of its final determination and any applicable hearing rights established in section 173.391 of the Revised Code.

(3) When ODA denies a provider's application, the provider is ineligible to reapply for certification for one year after the mailing date of ODA's final adjudication order.

Last updated March 26, 2024 at 11:18 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522, 173.54, 173.543
Amplifies: 173.39, 173.391, 173.52, 173.522, 173.54, 173.543; 42 CFR 441.352
Five Year Review Date: 6/30/2028
Prior Effective Dates: 8/30/2010
Rule 173-39-03.1 | ODA provider certification: federal heightened scrutiny of provider settings with institutional characteristics.
 

Introduction: In 42 C.F.R. 441.301(c)(5)(v), HHS requires heightened scrutiny by HHS's secretary to determine if a setting presumed to have the qualities of an institution meets HCBS settings requirements. This rule applies to settings subject to heightened scrutiny to become or remain an ODA-certified provider.

(A) Scope: A setting presumed to have the qualities of an institution requires heightened scrutiny by HHSs secretary, based on information presented by the state or other parties, to determine whether the setting has the qualities of an institution or has the qualities of a HCBS setting. A setting is presumed to have the qualities of an institution if it has any of the following characteristics:

(1) The entire setting is located in a building that is also a publicly or privately-operated facility that provides inpatient institutional treatment.

(2) The setting is in a building on the grounds of, or immediately adjacent to, a public institution.

(3) The setting has the effect of isolating individuals receiving medicaid HCBS from the broader community of individuals not receiving medicaid HCBS.

(B) Process: ODA shall determine if a setting requires heightened scrutiny by HHS's secretary. If ODA determines a setting requires heightened scrutiny under paragraph (A) of this rule, ODA shall review information submitted by the provider, conduct an on-site visit of the setting, and complete form ODM10204, "Heightened Scrutiny Evidence Package" (February 2017). ODA may recommend the provider undertake remediation of any possible deficiencies in its compliance with HCBS settings requirements and may establish deadlines for completion of any remediation. If the provider fails to complete requested remediation or provide evidence of the same to ODA, ODA may withhold submission of the provider's application for heightened scrutiny.

(C) Public-comment periods: Before providing an application for heightened scrutiny to the HHS secretary, ODA shall offer the public a thirty-day opportunity to comment on the application. ODM, on behalf of ODA, shall offer public-comment periods four times per year.

(D) Request for heightened scrutiny: Following the completion of the public-comment period, ODM, on behalf of ODA, shall provide form ODM 10204 and any supplemental material, if requested, to HHS's secretary for heightened scrutiny of the setting.

(E) HHS heightened scrutiny determination:

(1) For providers seeking ODA certification:

(a) If HHS's secretary determines the setting meets HCBS settings requirements, ODA may approve the provider's application for certification.

(b) If HHS's secretary determines the provider's setting does not meet HCBS settings requirements, ODA shall notify the provider of the final determination and any applicable hearing rights established in section 173.391 of the Revised Code. If ODA denies a providers certification, the provider is ineligible to reapply for certification for one year after the mailing date of ODA's final determination.

(2) For certified providers:

(a) If HHS's secretary determines the provider's setting meets HCBS settings requirements, the provider shall retain its certification so long as it continues to comply with this chapter.

(b) If HHS's secretary determines the provider's setting does not meet HCBS settings requirements, ODA may impose discipline against the provider and notify the provider of any applicable hearing rights established in section 173.391 of the Revised Code.

Last updated March 26, 2024 at 11:18 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522, 173.54, 173.543
Amplifies: 173.39, 173.391, 173.52, 173.522, 173.54, 173.543; 42 CFR 441.352
Five Year Review Date: 4/2/2027
Prior Effective Dates: 7/1/2019
Rule 173-39-03.2 | ODA provider certification: changes of ownership interest or organizational structure.
 

Introduction: Section 173.39 of the Revised Code prohibits ODA from paying a provider for services provided to individuals enrolled in the PASSPORT or assisted living programs unless the provider is an ODA-certified provider. ODA-certification is assigned to a provider's federal taxpayer identification number (TIN) and is not transferable. This rule shall apply in all instances where there is a change of ownership interest involving an ODA-certified provider obtaining a new TIN according to any rule adopted by the internal revenue service (IRS) or any change in organizational structure of an ODA-certified provider involving a person with an ownership or management interest, including non-profit providers.

ODA will be unable to process a change of ownership interest or organizational structure while ODA and ODM develop a new electronic infrastructure for processing applications.

(A) Requirements:

(1) Notification: The providers current owner(s) shall notify ODA in writing of a change of ownership interest or change of organizational structure (change) no later than forty-five days before the change, unless this chapter requires notifying ODA sooner. The current owner(s) shall email their written notice to ODA at "provider_enrollment@age.ohio.gov." In the notice, the current owner(s) shall include a notarized statement including all of the following information, as applicable and to the extent it is available to the current owner(s) at the time the notice is provided to ODA. In the event information is not available at the time written notice is required, the current owner(s) shall supplement the written notice until all the following information is provided:

(a) Name of the provider undergoing the change.

(b) Name of each current owner, and, if any, the name of each current owner's authorized agent.

(c) Medicaid provider number and NPI of the provider after the change, if known. ODA considers the notice to be complete if the notice is complete except for indicating the provider's number if ODM has not yet granted the provider a number, so long as the provider provides the number to ODA as soon as it is available.

(d) The following information about each new owner(s):

(i) Name.

(ii) Date of birth.

(iii) Social security number.

(iv) Percentage of ownership or control in the provider.

(v) Whether each new owner has been a resident of Ohio for the five-year period immediately preceding the date of the change of ownership interest.

(e) Date the change takes effect, as evidence by a bill of sale or purchase contract executed by both parties.

(f) Statement indicating whether the provider intends to seek payment from ODA for services it provides after the change.

(g) Names and addresses of the persons to whom ODA and its designee should send correspondence regarding the change.

(h) Any information required to show the ongoing compliance required by paragraph (B) of this rule.

(i) Signatures of the current and new owner(s).

(2) Current certification ends: If IRS rules require a provider to obtain a new TIN, the provider's certification ends on the date the change is finalized. The relinquishment of the provider's certification means a provider shall not bill ODA after the date the change is finalized.

(3) New certification required: If a provider with a new TIN intends to seek payment from ODA for services it provides after a change, the provider shall apply to become an ODA-certified provider according to the application process in rule 173-39-03 of the Administrative Code.

(4) Payment for authorized services: If ODA approves an application to become an ODA-certified provider, ODA may pay for authorized services provided during a change back to the first date on which both of the following have occurred:

(a) The provider provided evidence the change was finalized to ODA, such as a bill of sale or an executed purchase.

(b) The new owner(s) provided a complete application, as defined in rule 173-39-01 of the Administrative Code, to become an ODA-certified provider.

(5) Discharging residents: After an assisted-living provider has applied for new certification from ODA during a change, neither the current nor the new owner(s) shall discharge residents from the RCF for non-payment until ODA makes a final determination regarding certification of the provider.

(B) Compliance with HCBS settings requirements:

(1) Every provider is subject to the HCBS settings requirements in state and federal law, including rule 5160-44-01 of the Administrative Code and 42 C.F.R. Part 441, as indicated in rule 173-39-02 of the Administrative Code. Every provider shall maintain compliance with those requirements from the effective date of ODA certification and thereafter to maintain ODA certification.

(2) For a provider subject to federal heightened scrutiny under rule 173-39-03.1 of the Administrative Code, the new owner(s) shall, at a minimum, implement policies, procedures, to maintain compliance with the HCBS settings requirements under rules 173-39-02 and 5160-44-01 of the Administrative Code, and any other requirements under 42 C.F.R. Part 441 at the time of the change of ownership interest and thereafter. When applying for ODA certification, the new owner(s) shall email a notarized statement demonstrating compliance with this requirement to ODA at "provider_enrollment@age.ohio.gov."

Last updated April 12, 2024 at 11:33 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522, 173.54, 173.543
Amplifies: 173.39, 173.391, 173.52, 173.522, 173.54, 173.543; 42 CFR 441.352
Five Year Review Date: 5/1/2029
Prior Effective Dates: 7/1/2019, 9/16/2019
Rule 173-39-03.3 | ODA provider certification: applying to be certified to provide additional services.
 

Introduction: After ODA initially certifies a provider in a region, the provider may apply to become certified to provide an additional service in that region.

(A) Application: The provider shall provide a complete application to become certified to provide an additional service in a region in which it is already certified. Only complete applications shall be processed. If the provider does not complete the application within ninety days of the date the application is requested, the application shall expire.

(B) Pre-certification review: ODA's designee shall visit the providers business site to conduct an on-site pre-certification review to determine if the provider meets the requirements of this chapter to be certified to provide the additional service. For agency providers, this includes compliance with paragraph (C)(1)(a) of rule 173-39-02 of the Administrative Code. During a state of emergency declared by the governor, a federal public health emergency, or during another time if authorized by ODA, ODA's designee may conduct a desk review of the provider's business site in lieu of a visit.

(C) Approved application: ODA and its designee shall follow the process under paragraph (E) of rule 173-39-03 of the Administrative Code for an approved application for certification to provide an additional service in a region for which it is already certified.

(D) Denied application: ODA and its designee shall follow the process under paragraph (G) of rule 173-39-03 of the Administrative Code for a denied application to become certified to provide an additional service in a region for which it is already certified.

Last updated March 27, 2024 at 9:16 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522, 173.54, 173.543
Amplifies: 173.39, 173.391, 173.52, 173.522, 173.54, 173.543; 42 CFR 441.352
Five Year Review Date: 4/2/2027
Prior Effective Dates: 3/17/2011
Rule 173-39-03.4 | ODA provider certification: applying to be certified in additional regions or to certify additional business sites.
 

Introduction: After ODA initially certifies a provider in a region, the provider may apply to become certified to provide the service for which it is already certified in an additional region or additional business site within the same region.

An assisted-living provider certified by ODA for one RCF shall obtain a new certification for each additional RCF pursuant to rule 173-39-03 of the Administrative Code. This rule would not apply.

(A) Application: The provider shall provide a complete application to become certified to provide the service for which it is already certified in an additional region or additional business site within the same region. Only complete applications shall be processed. If the provider does not complete the application within ninety days of the date the application is requested, the application shall expire.

(B) Pre-certification review: ODA's designee shall visit the provider's business site to conduct an on-site pre-certification review to determine if the provider meets the requirements of this chapter to provide the service for which it is already certified in the additional region or additional business site within the same region. For agency providers seeking certification in an additional region, this includes compliance with paragraph (C)(1)(a) of rule 173-39-02 of the Administrative Code. During a state of emergency declared by the governor, a federal public health emergency, or during another time if authorized by ODA, ODA's designee may conduct a desk review of the provider's business site in lieu of a visit.

(C) Approved application: ODA and its designee shall follow the process under paragraph (E) of rule 173-39-03 of the Administrative Code for an approved application for certification to provide the service for which it is already certified in an additional region or additional business site within the same region.

(D) Denied application: ODA and its designee shall follow the process under paragraph (G) of rule 173-39-03 of the Administrative Code for a denied application to become certified to provide the service for which it is already certified in an additional region or additional business site within the same region.

Last updated April 12, 2024 at 11:14 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522, 173.54, 173.543
Amplifies: 173.39, 173.391, 173.52, 173.522, 173.54, 173.543; 42 CFR 441.352
Five Year Review Date: 4/2/2027
Prior Effective Dates: 8/30/2010, 7/1/2019, 6/11/2020 (Emer.)
Rule 173-39-03.5 | ODA provider certification: military provisions.
 

(A) Applications: Persons who submit with their applications for ODA provider certification proof that they are a service member or veteran, as section 5903.01 of the Revised Code defines those terms, or the spouse or surviving spouse of a service member or veteran, shall receive priority processing of their applications.

(1) If an applicant answers affirmatively that he or she is a service member, veteran, or the spouse or surviving spouse of a service member or veteran, the applicant shall submit supporting documents along with their application. Acceptable forms of documentation include:

(a) A copy of a document issued by the armed forces, such as an identification card or military discharge certificate; and

(b) A marriage certificate or other document showing the applicant and service member or veteran are spouses.

(2) ODA or its designee shall track and monitor the total number of applications submitted by service members, veterans, or their spouse or surviving spouse, and the average number of business days it takes to process the applications.

(B) Training: Pursuant to section 5903.03 of the Revised Code, a person subject to the training requirements in this chapter may request that ODA or its designee consider their successfully completed military training to satisfy the training requirements in this chapter. The person shall provide ODA or its designee with supporting documents demonstrating that the military training was successfully completed and is substantially equivalent to or exceeds the training requirements in this chapter.

Last updated March 26, 2024 at 11:18 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522, 173.54, 173.543, 5903.03, 5903.04
Amplifies: 121.07, 173.01, 173.02, 173.39, 173.391, 173.52, 173.522, 173.54, 173.543, 5903.03, 5903.04; 43 CFR 441.352
Five Year Review Date: 10/1/2025
Prior Effective Dates: 7/1/2019
Rule 173-39-04 | ODA provider certification: structural compliance reviews.
 

Introduction: Each ODA-certified provider is subject to a regular structural compliance review (review) to ascertain if it complies with this chapter.

(A) Deadline for ODA's designee to conduct the first review: The one-year anniversary of the provider's certification date.

(B) Deadlines for ODA's designee to conduct subsequent reviews:

(1) The one-year anniversary of the previous review if the provider is one of the following:

(a) A provider of an adult day service.

(b) A provider of an assisted living service.

(c) An agency provider of personal care that is neither certified by medicare nor accredited by the accreditation commission for health care, the community health accreditation partner, the joint commission, or another national accreditation organization that is approved by CMS and ODH.

(2) The three-year anniversary of the previous review if the provider is not listed under paragraph (B)(1) of this rule.

(C) Deadline extensions: ODA may extend a deadline for ODA's designee under paragraph (A) or (B) of this rule if both of the following occur:

(1) ODA's designee provides ODA with a request for an extension that includes the rationale for a delay and a forecast on the time needed to complete the review.

(2) ODA's designee retains the request for an extension in the provider's file and makes a note in the provider contact section of the PASSPORT information management system (PIMS).

(D) ODA or its designee may conduct an unannounced review of a provider at any time to review compliance with this chapter.

(E) ODA's designee may review a provider at any time without waiting for a deadline in paragraph (A), (B), or (C) of this rule to near.

(F) Responsible designees, type of reviews to conduct, and scope of reviews:

(1) Based on the provider type and situation, Appendix A to this rule establishes when a designee is responsible for conducting a review, the type of review it is responsible to conduct, and the scope of that review.

(2) ODA may authorize a designee to conduct a desk review even if Appendix A to this rule establishes a requirement for an on-site review.

(G) Review components: For each review, ODA's designee shall do the following:

(1) Inform the provider of the review before beginning the review and before conducting an introductory conference with the provider, unless the review is an unannounced review under paragraph (D) of this rule.

(2) Conduct an introductory conference with the provider to explain the purpose and scope of the review.

(3) Review compliance with each applicable requirement in rule 173-39-02 of the Administrative Code other than the records and monitoring requirements in that rule, unless appendix A to this rule determines that this paragraph is not a component of the review.

(4) Review compliance with each applicable requirement in rules 173-39-02.1 to 173-39-02.24 of the Administrative Code and the records and monitoring requirements in rule 173-39-02 of the Administrative Code.

(5) Verify that a sample of paid service units were provided according to the applicable requirements in rules 173-39-02.1 to 173-39-02.24 of the Administrative Code and the records and monitoring requirements in rule 173-39-02 of the Administrative Code.

(6) Review a sample of paid service units for ten per cent of the individuals that the provider served since being certified (if an initial review) or since the previous review (if a subsequent review) so long as the ten-per-cent sample contains no fewer than three individuals and no more than thirty individuals, with the following exceptions:

(a) If non-compliance is identified, ODA or its designee may review a larger sample size or order an independent audit at the provider's expense.

(b) If the provider operates from multiple business sites, ODA's designee shall review a sample of paid service units for ten per cent of the individuals that the provider served from each business site.

(c) If the provider did not bill ODA for providing a service to any individual during the period in paragraph (G)(6) of this rule, ODA or its designee shall indicate in the review record that ODA did not pay the provider for providing a service to any individual during the review period, then complete the remaining elements of the review under this rule.

(d) If the provider is a participant-directed provider, ODA or its designee shall review records for each individual served during the review period in paragraph (G)(6) of this rule. If the provider did not bill ODA for providing any units of service during the review period in paragraph (G)(6) of this rule, ODA or its designee shall indicate in the review record that ODA did not pay the provider to provide any units of service during the review period, then complete the remaining elements of the review under this rule.

(e) If the provider is certified to provide both personal care and homemaker, ODA or its designee shall combine the review for each service so that the aggregate sample size for the combined services equals the sample size in paragraph (G)(6) of this rule.

(f) During a state of emergency declared by the governor or a federal public health emergency, ODA may determine a lesser review sample and issue this determination by notice.

(7) Review the qualifications of the employees who provided services to individuals in the sample in paragraph (G)(6) of this rule according to the following standards:

(a) The sample size of employees corresponds to the sample size of individuals in appendix B to this rule.

(b) If the provider hired or subcontracted with RNs or LPNs under the direction of RNs, the number of RNs or LPNs in the sample corresponds to the sample size of individuals in appendix B to this rule.

(c) The sample of employees includes any employees providing services to individuals in the sample in paragraph (G)(6) of this rule that the provider hired since the previous review.

(d) The sample of employees does not need to include an employee providing services to individuals in the sample in paragraph (G)(6) of this rule if one or more of ODA's designees already reviewed the employee's qualifications when conducting a review of the same provider at a different business site within the past three hundred sixty-five days.

(e) For a provider that provides only home-delivered meals or a personal emergency response system, the maximum sample size is ten employees.

(H) At the conclusion of the review:

(1) If ODA's designee determines a provider engaged in conduct determined injurious or posing a threat to the health or safety of an individual, ODA's designee shall ensure all of the following occur:

(a) ODA's designee notifies the provider at the exit interview or, if the provider is unavailable for the exit interview, with a detailed email within one day after the review.

(b) ODA's designee records the method of notification in paragraph (H)(1)(a) of this rule in PIMS.

(c) ODA's designee notifies ODA within one day.

(d) The provider demonstrates compliance within five days after receiving notification from ODA's designee.

(e) ODA or its designee determine whether to impose an immediate disciplinary action under rule 173-39-05 of the Administrative Code.

(2) Within sixty days after the review, ODA's designee shall issue a written or electronic structural compliance review report to the provider, including a summary of all areas of non-compliance and disciplinary action imposed by ODA or its designee.

(3) Within sixty days after the date ODA's designee issues the written or electronic structural compliance review report to the provider, the provider shall provide evidence of compliance with the laws, rules, or regulations determined to have been violated during the review which were not subject to disciplinary action under rule 173-39-05 of the Administrative Code.

(4) If a unit-of-service error is detected during unit-of-service verification, the provider shall return the overpayment of funds to ODA or its designee using appropriate auditing procedures.

(I) ODA may suspend any review during a state of emergency declared by the governor or a federal public health emergency.

(J) If any deadline in this rule occurs on a Saturday, Sunday, or legal holiday under section 1.14 of the Revised Code, the deadline is extended to the next day that is not a Saturday, Sunday, or legal holiday under section 1.14 of the Revised Code.

View AppendixView Appendix

Last updated March 26, 2024 at 11:18 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522, 173.54, 173.543
Amplifies: 173.39, 173.391, 173.52, 173.522, 173.54, 173.543; 42 CFR 441.352
Five Year Review Date: 6/30/2028
Prior Effective Dates: 3/31/2006, 8/30/2010, 3/17/2011
Rule 173-39-05 | ODA provider certification: disciplinary actions.
 

(A) Introduction: Pursuant to section 173.391 of the Revised Code, ODA or its designee may impose disciplinary action against an ODA-certified provider (provider) for good cause, including misfeasance, malfeasance, nonfeasance, confirmed abuse or neglect, financial irresponsibility, or other conduct ODA determines is injurious, or poses a threat, to the health or safety of individuals being served.

(B) Disciplinary actions by ODA's designee:

(1) Disciplinary actions imposed by ODA's designee may include any one or more of the following:

(a) Plan of correction: ODA's designee may require the provider to provide a plan of correction with all areas of non-compliance within seven days after the disciplinary action is imposed.

(b) Evidence of compliance: ODA's designee may require the provider to provide evidence of compliance according to the following deadlines:

(i) Health or safety: If the non-compliance is injurious or poses a threat to the health or safety of individuals being served, the provider shall provide evidence of compliance within five days after the disciplinary action is imposed.

(ii) Non health or safety: If the non-compliance is not injurious or poses no threat to the health or safety of individuals being served, the provider shall provide evidence of compliance within sixty days after the disciplinary action is imposed.

(c) Suspending referrals: ODA's designee may cease to refer individuals to the provider until ODA's designee determines the provider complies with all requirements in this chapter.

(2) When ODA's designee imposes a disciplinary action, it shall do the following:

(a) Notify the provider of the disciplinary action via encrypted email or mail.

(b) Notify ODA of the disciplinary action via an ODA-approved method.

(c) Complete the required fields in ODA's provider information management system related to the disciplinary action.

(d) Indicate in ODA's provider information management system anytime it grants an extension to the deadlines in paragraph (B)(1)(a) or (B)(1)(b) of this rule.

(3) ODA's designee does not have authority to impose more than one disciplinary action against a provider for the same episode of non-compliance.

(4) ODA may require ODA's designee to rescind or modify any pending disciplinary action.

(C) Disciplinary actions imposed by ODA:

(1) ODA may impose any discipline authorized in section 173.391 of the Revised Code, including the following:

(a) Plan of correction.

(b) Evidence of compliance.

(c) Suspension of referrals.

(d) Removal of clients.

(e) Fiscal sanctions, including a civil monetary penalty or an order that unearned funds be repaid.

(f) Suspension of certification.

(g) Permanent revocation of certification.

(h) Another disciplinary action.

(2) ODA may consider any one or more of the following when imposing disciplinary action:

(a) Whether the conduct is injurious or poses a threat to the health or safety of individuals being served.

(b) The provider's previous disciplinary history.

(c) Any other factors ODA may consider relevant.

(D) A provider may appeal a disciplinary action listed in column B of table 1 to this rule unless the reason for the disciplinary action is listed under division (E) of section 173.391 of the Revised Code. As used in table 1 to this rule, "another sanction" does not include any of the disciplinary actions listed in column A of the table.

COLUMN ACOLUMN B
Written warningFiscal sanction such as a civil monetary penalty or an order to repay unearned funds
Requirement to submit a plan of correction or provide evidence of complianceSuspended certification
Suspended referralsRevoked certification
Removal of clientsAnother sanction

(E) The provider may request a hearing under Chapter 119. of the Revised Code only if it does so within thirty days after the mailing date of the notice.

(F) If any deadline in this rule occurs on a Saturday, Sunday, or legal holiday under section 1.14 of the Revised Code, the deadline is extended to the next day that is not a Saturday, Sunday, or legal holiday under section 1.14 of the Revised Code.

Last updated March 26, 2024 at 11:18 AM

Supplemental Information

Authorized By: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522, 173.54, 173.543
Amplifies: 173.39, 173.391, 173.52, 173.522, 173.54, 173.543; 42 C.F.R. 441.352
Five Year Review Date: 6/30/2028
Prior Effective Dates: 1/1/2020