Chapter 3304-4 | Personal Care Assistance Program

Rule 3304-4-01 | Definitions for the personal care assistance program.

• Effective: June 10, 2022
• Promulgated Under: 119.03

The following terms are used throughout Chapter 3304-4 of the Administrative Code:

(A) "Applicant" means a person who has applied for services from the personal care assistance program.

(B) "Assistant" means a person who provides personal assistance services.

(C) "Competitive employment" means full-time or part-time work in the competitive labor market in an integrated setting and for which earnings are at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals who are not disabled; and for which earnings are equivalent to at least twenty hours per week at the minimum wage.

(D) "Days" means working days.

(E) "Employed" means engaged in competitive work.

(F) "Employer costs" means costs incurred as a result of employing a personal care attendant as a W2 employee or 1099 contractor.

(G) "Integrated setting," with respect to an employment outcome, means a setting typically found in the community in which participants interact with persons who do not have a disability, other than service providers, to the same extent that non-disabled persons in comparable positions interact with other persons.

(H) "Participant" means an eligible person who is authorized to receive reimbursement for wages paid for personal assistance services through the personal care assistance program.

(I) "PCA" means the personal care assistance program.

(J) "Personal assistance services" means services that help a person who has a severe physical disability perform the activities of daily living.

(K) "Program" means the OOD personal care assistance program.

(L) "OOD" means the opportunities for Ohioans with disabilities agency that administers the personal care assistance program.

(M) "Severe physical disability" means a physical impairment that substantially limits a person's functional capability to engage in major life activities, thus requiring assistance with a minimum of three of the following activities of daily living:

(1) Ambulating - the ability to move about, with or without devices like canes, crutches, walkers, manual or power wheelchairs;

(2) Bathing - getting in and out of the shower/tub, ensuring safety while bathing, applying cleansing agent, rinsing, and drying;

(3) Bladder care - managing the use of a catheter and urine bag;

(4) Bowel program - regular emptying of the bowels for cleansing and health;

(5) Communication services - assisting with verbal, written, and signed communication;

(6) Dressing - selecting clothing, putting on and taking off clothing/prosthesis (including fastening and unfastening clothing articles/prosthesis);

(7) Driver services - assistance with transportation with a driver who is not compensated through other funding sources;

(8) Eating - getting food or drink from a plate/bowl to the mouth, chewing, and swallowing;

(9) Fine motor activities - coordinating small muscles of hand, fingers, toes, wrists, lips, tongue, including the ability to grasp, pick up, and release objects;

(10) Grooming - hair care, nail care, oral hygiene, and skin care (including applying or removing makeup);

(11) Household chores - cleaning, organizing and maintaining the space in the home;

(12) Laundry - washing, drying, folding, hanging, ironing, and mending clothing and household items;

(13) Meal preparation - planning meals, obtaining groceries, opening food packages, safely using kitchen appliances, and cooking/reheating meals;

(14) Medication management - obtaining, organizing, and maintaining medications, and taking medications as directed;

(15) Physical therapy exercises - therapeutic exercises to promote optimal physical functioning and pain management, including range of motion exercises;

(16) Reading services - oral presentation of text;

(17) Record keeping - preparing and managing correspondence, filing, completing forms, writing personal checks;

(18) Toileting - using a toilet/bedpan/urinal, changing incontinence supplies or feminine hygiene products, and self-cleansing, including a formal bowel program;

(19) Transfers / repositioning - moving from one position to another; and

(20) Ventilator maintenance - monitoring and promoting the safe use of a ventilator, including suctioning.

(N) "ADL" means activities of daily living which is an individual's routine daily self-care activities. Specific ADLs are defined in paragraph (M) of this rule,

Last updated June 10, 2022 at 9:04 AM

Supplemental Information

Authorized By: 3304.41
Amplifies: 3304.41
Five Year Review Date: 10/17/2023
Prior Effective Dates: 10/1/1982, 7/1/1986, 10/9/2007, 11/14/2013

Rule 3304-4-02 | Personal care assistance program.

• Effective: June 10, 2022
• Promulgated Under: 119.03

(A) The purpose of the program described in this rule shall be to provide funds to pay for personal assistance services to enable eligible persons with severe physical disabilities to work and/or to live independently. OOD shall administer this program.

(1) Participants shall be served based on the rank order of priority groups listed as follows:

(a) The first priority group shall include persons who are competitively employed by meeting the definition of competitive employment; according to paragraph (C) of rule 3304-4-01 of the Administrative Code and who need personal assistance services to maintain employment.

(b) The second priority group shall include persons who are ready for employment but cannot accept a job unless personal assistance services are available. Participants may participate in this priority group for a maximum of eighteen months and shall demonstrate active job seeking activity.

(c) The third priority group shall include persons who are self-employed but not earning competitive wages. Participants may be considered eligible without earning a minimum wage equivalent income provided they are currently operating the business and have a viable business plan that supports the continued growth of the business. Participants may participate in this priority group for a lifetime maximum of sixty months.

(d) The fourth priority group shall include persons who are preparing for employment and who need personal assistance services to continue training that is leading to a specific employment goal and is state licensed/accredited, if applicable Participants within this priority group shall have a maximum of eighteen consecutive months to complete each academic year of post-secondary training as defined by the degree program. Participants in other training programs shall have a maximum of one and one half times the usual duration of the training program to complete the program.

(e) The fifth priority group shall be closed to new applicants.

(i) This priority group may contain participants who, due to an adverse change in medical condition, no longer meet the requirements to remain in a higher priority group. Participants may receive personal assistance services in this group for a maximum of six months over the lifetime of the participant.

(ii) Participants receiving personal assistance services as of May 1995 under this group for the purpose of independent living who had been grandfathered shall continue to remain on the PCA longer than the maximum indicated in paragraph (A)(1)(e) of this rule, provided the participant submits required documentation and alternative resources have been explored and are unavailable.

(B) OOD's duties and responsibilities for administration and management of the program shall include but not be limited to the following:

(1) Establishing a maximum hourly reimbursement rate for wages to pay an assistant.

(2) Establishing a maximum reimbursement rate for related employer costs.

(3) Establishing the maximum number of hours of funding available to eligible participants.

(4) Determining the need for community rehabilitation programs and, if warranted, negotiating terms with them for operating the program at the local level, as described in paragraphs (D) to (D)(8) of this rule.

(5) Assisting community rehabilitation programs in locating persons with severe physical disabilities to apply for personal assistance services.

(6) Determining a person's eligibility to receive personal assistance services under the program based on the assessment performed by the community rehabilitation program as described in paragraph (D) of this rule.

(7) Evaluating the program to ensure efficiency and to determine ways to improve its effectiveness.

(8) Monitoring the program for fraud or abuse.

(9) Determining eligibility for the program and assigning participants into priority groups.

(10) Evaluating each participant annually to determine the continued need for PCA.

(C) To be eligible for the PCA, a person shall:

(1) Be an Ohio resident eighteen years old or older with a severe physical disability.

(2) Exhaust all available resources before receiving services from the PCA.

(3) Not duplicate services. Participants may receive personal assistance services from the PCA in addition to other resources, but may not bill for personal assistance services for the same hours from more than one resource.

(4) Require not less than six consecutive months of personal assistance services.

(5) Be willing to receive services within Ohio unless otherwise approved.

(6) Require no more than four hundred fifty-five hours of personal assistance services per quarter from the PCA. Participants may pay and arrange for any personal assistance services exceeding this limitation.. These additional resources shall be documented with the program.

(7) Be capable of instructing and supervising an assistant about the participant's needs as described in paragraph (D)(3) of this rule or arranging for such supervision or instruction.

(8) Be capable of enough self-direction to live outside an institution, within the participant's family unit or independently with this support.

(9) Agree that the participant's need for continuing personal assistance shall be subject to periodic reevaluation, and to an in-person evaluation at least once every calender year.

(10) During re-evaluations for PCA eligiblity, participants shall demonstrate the ability to follow program guidelines, including but not limited to, regular billing, compliance with submitting required documentation by established time lines, and updating the program on any and all changes in income and employment, job seeking, and progress in training within ten business days of the change.

(D) To be eligible for selection by OOD to operate this program at the local level, a community rehabilitation program shall be a nonprofit and, as its purpose, shall exist at least in part to provide services to persons with disabilities. The community rehabilitation program's duties and responsibilities shall include, but not be limited to, the following:

(1) Locating persons who have a severe physical disability and who may be eligible for the program.

(2) Pre-screening persons according to the criteria in paragraphs (C)(1) to (C)(10) of this rule by using a checklist and guide to personal assistance services as prescribed by OOD.

(3) Assessing a person's need to receive personal assistance services through this program. The assessment shall include, but not be limited to, determining the ability to instruct and supervise assistants, and to maintain schedules and records or to arrange for such functions to be carried out.

(4) Assessing a person's eligibility for the PCA.

(5) Providing assistant management training to participants to include, but not be limited to, training in how to recruit assistants, how to conduct interviews and screen applicants, how to supervise and instruct assistants on tasks required.

(6) Assisting OOD to annually evaluate each participant's need for continued personal assistance services.

(7) Serving the community as an information resource on personal assistance services.

(8) Providing information and referral services about other financial assistance and social service programs that assist persons who have severe physical disabilities toward employment and/or independent living.

(E) The participant's responsibilities shall include but not be limited to:

(1) Screen, interview, select, instruct, and supervise assistants or arranging for such functions to be carried out.

(2) Pay the assistant wages in a timely manner agreed upon by the participant and the assistant. Payment to assistant, at the latest, should occur no later than two weeks after receipt of reimbursement from OOD.

(3) Investigate the need for compliance with employer tax laws.

(4) Complete the annual review within specified time frames.

(5) Ensure assistants perform tasks that are related to the participant's ADLs and not beyond that scope, such as performing work tasks or other activities that are not considered ADLs.

(6) Maintain financial documentation for audit purposes, such as assistant time sheets and copies of canceled checks to assistants.

(7) Participants shall also follow program guidelines including, but not limited to, regular billing, compliance with submitting required documentation by established time lines, and updating the program on any and all changes in income and employment, job seeking, and progress is training within ten business days of the change.

(F) OOD shall reimburse a participant for wages paid for personal assistance services and approved employer costs. Reimbursement will be paid only for costs incurred and paid by the participant.

Last updated June 10, 2022 at 9:04 AM

Supplemental Information

Authorized By: 3304.41, 3304.16
Amplifies: 3304.41
Five Year Review Date: 6/10/2027
Prior Effective Dates: 7/1/1986, 7/1/1996, 11/1/2002

Rule 3304-4-03 | Grievances.

• Effective: June 10, 2022
• Promulgated Under: 119.03

A person may file a grievance concerning a decision that affects the eligibility status of personal assistance services or the provision or denial of personal assistance services.

(A) The grievant shall first discuss the decision with the PCA program coordinator within five working days of the decision.

(B) A grievant unsatisfied with the PCA program coordinator discussion shall request informal review with the OOD program supervisor within ten working days of the discussion with the PCA program coordinator. The request shall be submitted in writing stating the reason for the request and the requested remedy.

(C) A grievant unsatisfied with the OOD program supervisor decision, shall request an administrative hearing within ten working days of OOD sending the program supervisor's decision. The administrative hearing shall be conducted in accordance with rule 3304-2-62 of the Administrative Code. The independent hearing officer's decision shall be final.

(D) Applicants and participants shall be informed in writing of their appeal rights under this rule at the time they are notified of the eligibility status decision in the person's preferred format.

Last updated June 10, 2022 at 9:04 AM

Supplemental Information

Authorized By: 3304.41, 3304.14, 3304.16
Amplifies: 124.34, 3304.41
Five Year Review Date: 6/10/2027
Prior Effective Dates: 7/1/1996

Rule 3304-4-04 | Disciplinary infractions.

• Effective: June 10, 2022
• Promulgated Under: 119.03

(A) An applicant or participant shall be suspended or removed from the program for the following disciplinary infractions:

(1) A determination by the Ohio department of taxation, the bureau of workers' compensation, the Ohio department of job and family services, or the internal revenue service of non-payment of employer taxes required by federal/state law;

(2) Failure to pay a personal care assistant for all services billed to OOD and/or failure to pay a personal care assistant within two weeks after receipt of reimbursement from OOD;

(3) Paying an assistant for services not rendered;

(4) Using any program funds as personal income;

(5) Falsifying information submitted to OOD or to the local community rehabilitation program including, but not limited to, reimbursement billings, employment, job seeking, or training information, assistant time, and payroll records;

(6) Misrepresenting the need for program funds to OOD or to the local community rehabilitation program during application or any other time thereafter;

(7) Not responding within a designated time frame to a request for information or for a home visit by a local community rehabilitation program and/or OOD;

(8) Failure to report permanent change of residency;

(9) Violation of any requirement contained in Chapter 3304-4 of the Administrative Code;

(10) Failure to complete the annual review within the specified time frames; and.

(11) More than one written notice from the PCA over the course of the PCA case for any of the above disciplinary infractions, or other suspicious activity.

(B) The applicant or participant shall be notified in writing of any decision to suspend or remove the person from the PCA.

Last updated June 10, 2022 at 9:04 AM

Supplemental Information

Authorized By: 3304.41
Amplifies: 3304.41
Five Year Review Date: 6/10/2027
Prior Effective Dates: 7/1/1986