Chapter 3304-4 | Personal Care Assistance Program

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

• Effective: November 15, 2024
• 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 (PCA) 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. In the case of self-employment, full-time or part-time work that yields an income that is comparable to the income received by other individuals who are not individuals with disabilities, and who are self-employed in similar occupations or similar tasks and who have similar training experiences and skills; and for which net profit earnings are equivalent to at least twenty hours per week at the minimum wage.

(D) "Days" means business days.

(E) "Eligible Individual" means a person who is eligible to receive persona care assistance (PCA) program funding for wages and related employer costs paid for personal assistance services through the PCA program.

(F) "Employed" means engaged in competitive employment.

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

(H) "Integrated setting," with respect to an employment outcome, means a setting typically found in the community in which persons with a disability 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.

(I) "PCA program" means the OOD 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) "OOD" is an acronym for the opportunities for Ohioans with disabilities agency that administers the personal care assistance (PCA) program.

(L) "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.

(M) "ADL" means activities of daily living which is an person's routine daily self-care activities. Specific ADLs are defined in paragraph (L).

Last updated November 15, 2024 at 7:36 AM

Supplemental Information

Authorized By: 3304.41
Amplifies: 3304.41
Five Year Review Date: 11/15/2029
Prior Effective Dates: 9/1/1999

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

• Effective: November 15, 2024
• Promulgated Under: 119.03

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

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

(a) The first priority group shall include eligible individuals 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 elegible individuals who are ready for employment and are prepared to actively engage in job seeking activity but cannot accept a job unless personal assistance services are available. Eligible individuals may participate in this priority group for a lifetime maximum of eighteen months and shall demonstrate active job seeking activity. This lifetime maximum may be reaassessed if there are significant changes determined on a case-by-case basis.

(c) The third priority group shall include elegible individuals who are self-employed but not earning competitive wages. Eligible individuals may be considered eligible without earning the minimum wages referenced in paragraph (C) of rule 3304-4-01 of the Administrative Code provided they are currently operating the business and have a viable business plan that supports the continued growth of the business. Eligible individuals may participate in this priority group for a lifetime maximum of sixty months.

(d) The fourth priority group shall include eligible individuals who are preparing for employment and who need personal assistance services to continue an approved training that is leading to a specific employment goal and is state licensed/accredited, if applicable. Eligible individuals within this priority group shall have a maximum of eighteen consecutive months to complete each academic year of the approved training as defined by the academic program. Eligible individuals in other occupational/vocational/job skills training programs shall have a maximum of one and one half times the usual duration of the approved training program to complete the program. Eligible individuals enrolled in other training programs that identify specific timelines to complete the program shall follow the timelines established by the training program.

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

This priority group may contain eligible individuals who, due to an adverse change in medical condition or are permanately retiring from employment, no longer meet the requirements to remain in a higher priority group. Eligible individuals may receive personal assistance services in this group for a maximum of six months over the lifetime of the eligible individuals.

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

(1) Establishing a maximum hourly service rate the eligible individual shall apply to wages to be paid to the assistant.

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

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

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

(5) 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.

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

(7) Monitoring the program for fraud or abuse.

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

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

(C) To be eligible for the PCA program, 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) Demonstrate need beyond other funding sources. If a person is receiving personal assistance services from another funding source, documentation shall be submitted to the PCA program to determine if personal assistance services from the PCA program would be duplicative.

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

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

(6) Demonstrate the ability to instruct and supervise an assistant about the participant's needs as described in paragraph (D)(3) of this rule or arranging for such supervision or instruction.

(7) Demonstrate a level of self-direction to live outside an institution, within the person's family unit or independently with this support.

(8) Agree that the person's need for continuing personal assistance services shall be subject to periodic re-evaluation.

(9) During re-evaluations for PCA program eligibility, eligible individuals shall demonstrate the ability to follow PCA program guidelines, including but not limited to, timely and accurate invoicing, compliance with submitting required documentation by established timelines, and updating the PCA 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 PCA 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) Seeking and identifying persons who have a severe physical disability and who may be eligible for the PCA program.

(2) Pre-screening persons according to the criteria in paragraph (C) of this rule by using guidance provided by OOD.

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

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

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

(6) Assisting OOD to evaluate each elibible individual'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 eligible individual'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.

Eligible individuals shall not use OOD PCA program funding to employ an assistant who is also their legal guardian.

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

Payment to the assistant should occur no later than two weeks after receipt of the invoced funds from OOD.

(3) Comply with applicable employer tax laws.

(4) Complete the re-evaluation within the specified time frames as established by the PCA program.

(5) Ensure assistants perform tasks that are related to the eligible individual'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, signed and dated receipts, and copies of canceled checks to assistants.

(7) If applicable, pay employer costs in a timely manner as required by law.

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

(F) OOD shall provide funding to an eligible individual for wages to be paid for personal assistance services received and, if applicable, approved employer costs (up to the established OOD maximum rates). Payment will be issued to the eligible individual for services received by the eligible individual and approved employer costs.

Last updated November 15, 2024 at 7:36 AM

Supplemental Information

Authorized By: 3304.41, 3304.16
Amplifies: 3304.41
Five Year Review Date: 6/10/2027
Prior Effective Dates: 10/1/1982, 7/1/1986

Rule 3304-4-03 | Grievances.

• Effective: November 15, 2024
• Promulgated Under: 119.03

A person may file a grievance concerning a decision that affects the eligibility status for the personal care assistance (PCA) program or the provision or denial of personal assistance services.

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

(B) A grievant unsatisfied with the PCA program coordinator discussion shall request informal review with the OOD PCA program designee within ten business 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 PCA program designee's decision, shall request an administrative hearing within ten business days of OOD sending the PCA program designee'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) Eligible individuals 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 November 15, 2024 at 7:37 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, 10/29/2018

Rule 3304-4-04 | Disciplinary infractions.

• Effective: November 15, 2024
• Promulgated Under: 119.03

(A) An eligible individual shall have their funding suspended or be removed from the personal care assistance (PCA) 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 costs required by federal/state law;

(2) Failure to submit W-2, 1099, or other pertinent tax documents to the appropriate authorities.

(3) Failure to pay an assistant for all services provided to the eligible individual for which they invoiced to OOD and/or failure to pay an assistant within two weeks after receipt of invoiced funds from OOD;

(4) Paying an assistant for services not rendered;

(5) Using any PCA program funds as personal income;

(6) Make, present, or use any information knowing it to be false and submitting it to OOD or to the local community rehabilitation program;

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

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

(9) Failure to report permanent change of residency;

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

(11) Failure to complete the annual review within the specified time frames;

(12) Failure to complete a fiscal audit within the specified time frames;

(13) Failure to produce any documentation requested by the PCA program within the specified time frames;

(14) Patttern of missing deadlines for submitting reqired documentation to the PCA program;

(15) Failure to report changes in income status, employment status, job seeking status, or training status to the PCA program within ten business days from the change;

(16) Failure to comply PCA program rules, including individualized case decisions; and

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

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

Last updated November 15, 2024 at 7:37 AM

Supplemental Information

Authorized By: 3304.41
Amplifies: 3304.41
Five Year Review Date: 6/10/2027
Prior Effective Dates: 11/14/2013, 10/29/2018