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

Chapter 5123:2-9 | HCBS Waiver Services

 
 
 
Rule
Rule 5123:2-9-02 | Home and community-based services waivers - ensuring the suitability of services and service settings.
 

(A) Purpose

This rule establishes standards to ensure that home and community-based services waivers administered by the Ohio department of developmental disabilities maximize opportunities for enrolled individuals to access the benefits of community living and receive services in the most integrated setting.

(B) Definitions

(1) "Agency provider" means an entity that directly employs at least one person in addition to the chief executive officer for the purpose of providing services for which the entity must be certified in accordance with rule 5123:2-2-01 of the Administrative Code.

(2) "County board" means a county board of developmental disabilities.

(3) "Department" means the Ohio department of developmental disabilities.

(4) "Home and community-based services" has the same meaning as in section 5123.01 of the Revised Code.

(5) "Immediate family member" means a spouse, parent or stepparent, child or stepchild, sibling or stepsibling, grandparent, or grandchild.

(6) "Independent provider" means a self-employed person who provides services for which he or she must be certified in accordance with rule 5123:2-2-01 of the Administrative Code and does not employ, either directly or through contract, anyone else to provide the services.

(7) "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, his or her guardian in accordance with section 5126.043 of the Revised Code or other person authorized to give consent.

(8) "Individual service plan" means the written description of services, supports, and activities to be provided to an individual.

(9) "Individual-specific expenses" means standard monthly costs other than rent (e.g., household goods and supplies, food, minor equipment, and medical equipment) that are not reimbursable through medicaid, that are paid by the individual to the landlord, and that have been identified as needed and requested by the individual to be provided by the landlord.

(10) "Intermediate care facility for individuals with intellectual disabilities" has the same meaning as in section 5124.01 of the Revised Code.

(11) "Landlord" means the owner, lessor, or agent of the owner contracted by the owner to manage the premises or to receive rent or room costs in accordance with a residency agreement meeting the requirements set forth in paragraph (F) of this rule or a lease.

(12) "Lease" means a written rental agreement meeting the requirements for rental agreements set forth in Chapter 5321. of the Revised Code.

(13) "Living unit" means a dwelling place or any self-contained area or part thereof that comprises complete living facilities for a family, an individual, or a group of individuals, including space and fixtures for sleeping, cooking, eating, living, bathing, and sanitation.

(14) "Natural supports" means the personal associations and relationships typically developed in the community that enhance the quality of life for individuals. Natural supports may include family members, friends, neighbors, and others in the community or organizations that serve the general public who provide voluntary support to help an individual achieve agreed upon outcomes through the individual service plan development process.

(15) "Provider-controlled residential setting" means a residence where the landlord is:

(a) An entity that is owned in whole or in part by the individual's independent provider;

(b) An immediate family member of the individual's independent provider;

(c) An immediate family member of an owner or a management employee of the individual's agency provider;

(d) Affiliated with the individual's agency provider, meaning the landlord:

(i) Employs a person who is also an owner or a management employee of the agency provider; or

(ii) Has, serving as a member of its board, a person who is also serving as a member of the board of the agency provider;

(e) An entity that is owned in whole or in part by an owner or a management employee of the individual's agency provider; or

(f) An owner or a management employee of the individual's agency provider.

(16) "Rent" means the standard charge to the individual to cover the individual's use of the property, living space, and structure, and where applicable, the appliances, utilities, and furniture.

(17) "Residency agreement" means a written agreement between an individual and a landlord which establishes or modifies the terms, conditions, rules, or any other provisions concerning the use and occupancy of a residence. A residency agreement is not required when the use and occupancy of the residence is subject to a lease.

(18) "Residential facility" means a residential facility licensed by the department in accordance with section 5123.19 of the Revised Code other than an intermediate care facility for individuals with intellectual disabilities.

(19) "Roommate" means a person with whom one shares a bedroom.

(20) "Service and support administrator" means a person, regardless of title, employed by or under contract with a county board to perform the functions of service and support administration and who holds the appropriate certification in accordance with rule 5123:2-5-02 of the Administrative Code.

(C) Home and community-based services

(1) The purpose of home and community-based services is to support full community participation and achievement of individual-specific outcomes. An individual receiving services shall have opportunities to access age-appropriate activities, engage in meaningful employment and non-work activities, and pursue activities with persons of his or her choosing and in settings not created exclusively for individuals with disabilities.

(2) The service and support administrator shall provide the individual with a description of all services and service setting options available through the waiver in which the individual is enrolled. Each individual shall be afforded the opportunity to choose among services or a combination of services and settings that address the individual's assessed needs in the least restrictive manner, promote the individual's autonomy, and minimize the individual's dependency on paid support staff. Services and service setting options (such as technology-based supports, intermittent or drop-in staffing, shared living arrangements, and integrated employment services) with potential to enable the individual to live and work in non-congregate settings shall be explored in accordance with the individual's assessed needs, before congregate settings are considered.

(3) The individual shall receive home and community-based services that:

(a) Are appropriate to meet the individual's assessed needs and desired outcomes identified in the individual service plan;

(b) Supplement and not supplant existing natural supports;

(c) Support the individual in the least restrictive and most cost-effective manner available; and

(d) Are not otherwise available through other resources, including:

(i) Unpaid supports;

(ii) Private insurance;

(iii) Community resources;

(iv) Special education or related services as defined in section 602 of the Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. 1401, as in effect on the effective date of this rule;

(v) Vocational rehabilitation services funded under section 110 of the Rehabilitation Act of 1973, 29 U.S.C. 730, as in effect on the effective date of this rule;

(vi) Medicare; or

(vii) The medicaid state plan.

(4) Home and community-based services funds shall not be used to provide modifications to the physical structure of a residential facility unless the modifications are necessary to meet the needs of an established resident of the residential facility or the modifications are portable and clearly identified as the property of the individual.

(5) Except for the provision of short-term respite services as approved by the centers for medicare and medicaid services, home and community-based services shall not be provided in:

(a) Hospitals;

(b) Institutions for mental diseases;

(c) Intermediate care facilities for individuals with intellectual disabilities;

(d) Nursing facilities; or

(e) Other locations that have been determined by the secretary of the United States department of health and human services or the department as having the qualities of an institution and the effect of isolating individuals from the broader community.

(6) Absent a determination by the centers for medicare and medicaid services that the settings are suitable, home and community-based services shall not be provided in:

(a) Settings located in a building that is a publicly-operated or privately-operated facility that also provides inpatient institutional treatment; or

(b) Settings located in a building on the grounds of or immediately adjacent to a publicly-operated facility that provides inpatient institutional treatment.

(D) Requirements for providers of home and community-based services

A provider of home and community-based services shall:

(1) Meet the requirements set forth in Chapter 5123:2-9 of the Administrative Code for the services delivered; and

(2) Deliver services in accordance with each individual's choices, preferences, and needs and in a manner that supports each individual's full participation in his or her community as identified in the individual service plan.

(E) Requirements for individuals enrolled in home and community-based services waivers

An individual enrolled in a home and community-based services waiver shall:

(1) Communicate, as applicable, to the independent provider and/or assigned staff of the agency provider and the agency provider management staff, personal preferences about the duties, tasks, and procedures to be performed;

(2) Communicate to the service and support administrator any significant change that may affect the provision of services or result in a need for more or fewer hours of service or different types of service;

(3) Use services in accordance with his or her individual service plan; and

(4) Cooperate with the county board in the county board's performance of medicaid local administrative authority in accordance with section 5126.055 of the Revised Code.

(F) Requirement for residency agreement or lease

(1) Each individual living in a residential facility or a provider-controlled residential setting shall have a residency agreement that meets the requirements set forth in paragraph (F)(3) of this rule or a lease consented to by both the individual and the landlord.

(2) When the individual and the landlord enter into a lease, the lease shall not have terms contradictory to the provisions set forth in paragraph (F)(3)(f) of this rule.

(3) When the individual and the landlord enter into a residency agreement, the residency agreement shall include:

(a) Name and contact information of the landlord.

(b) A statement that the residence is, as applicable, a residential facility or a provider-controlled residential setting that includes an explanation of the relationship between the landlord and the provider of residential services.

(c) In a residential facility, a statement regarding whether or not the individual may choose a provider other than the residential facility to deliver services.

(d) In a provider-controlled residential setting, a statement that the individual may choose any provider to deliver services without changing the terms of the residency agreement.

(e) A statement that the landlord:

(i) Is responsible for maintaining in good working order all electrical, plumbing, sanitary, heating, ventilating, and air conditioning systems;

(ii) Shall ensure barrier-free ingress and egress to and from the residence by individuals residing in the residence;

(iii) Is responsible for keeping the residence in a safe condition that meets local health and safety codes; and

(iv) Has a right to reasonable access to the residence in order to complete the terms of the residency agreement.

(f) Unless otherwise specified in the individual service plan, a statement that the individual:

(i) Has a right to select his or her roommates;

(ii) Has a right to privacy and security including locks and keys to his or her living unit;

(iii) Has a right to decorate his or her living unit;

(iv) Has a right to have visitors of his or her choosing at any time;

(v) Has the freedom and support to control his or her schedule and activities; and

(vi) Has a right to access food at any time.

(g) A statement that the individual is responsible for timely monthly payment of the rent or his or her share of the rent, as applicable, to the landlord. When determined to be appropriate by the individual with the support of the team, the residency agreement may designate a person or responsible party to ensure timely payment to the landlord.

(h) The rent amount which:

(i) Shall be reasonable and comparable to community standards;

(ii) Shall be determined based upon the accommodations provided and not upon an individual's assets, resources, or ability to pay;

(iii) In a residential facility, shall include the cost of providing furnishings, equipment, and supplies required by Chapter 5123:2-3 of the Administrative Code; and

(iv) Shall not include items that are reimbursable under the medicaid program.

(i) Individual-specific expenses:

(i) Which shall reflect only items that are available exclusively from the landlord and determined to be needed by the individual with the support of his or her team;

(ii) Which shall reflect only items that the individual has been unable to access or utilize through other available resources; and

(iii) The cost of which may be shared equally when two or more residents agree to share use of the item.

(j) A statement that the individual has a right to terminate the residency agreement:

(i) Without cause upon thirty-day advance written notice to the landlord unless the individual and the landlord mutually agree in writing to an alternative plan; or

(ii) With cause upon five-day advance written notice to the landlord if the landlord has breached an obligation or failed to satisfy required conditions under the residency agreement.

(k) In a provider-controlled residential setting, a statement that the landlord has a right to terminate the residency agreement:

(i) Without cause upon thirty-day advance written notice to the individual unless the individual and the landlord mutually agree in writing to an alternative plan; or

(ii) With cause upon five-day advance written notice to the individual if the individual chooses to leave or otherwise vacates the residence (e.g., upon incarceration).

(l) In a residential facility, a statement that the residential facility shall terminate services in accordance with rule 5123:2-3-05 of the Administrative Code.

(4) A modification to the rights set forth in paragraph (F)(3)(f) of this rule shall be addressed in the individual service plan and implemented in accordance with rule 5123:2-2-06 of the Administrative Code.

Supplemental Information

Authorized By: 5123.04, 5123.19, 5166.21
Amplifies: 5123.04, 5123.19, 5166.21
Five Year Review Date: 11/28/2021
Rule 5123:2-9-03 | Home and community-based services waivers - overtime and limit on number of hours in a work week an independent provider may provide services.
 

(A) Purpose

This rule sets forth procedures related to overtime worked by independent providers, places a limit on the number of hours in a work week an independent provider may provide services under a home and community-based services medicaid waiver component administered by the Ohio department of developmental disabilities, and establishes a process and the circumstances under which the limit may be exceeded.

(B) Definitions

(1) "Agency provider" means an entity that directly employs at least one person in addition to the chief executive officer for the purpose of providing services for which the entity must be certified in accordance with rule 5123:2-2-01 of the Administrative Code.

(2) "County board" means a county board of developmental disabilities.

(3) "Department" means the Ohio department of developmental disabilities.

(4) "Emergency" means an unanticipated and sudden absence of an individual's provider or natural supports due to illness, incapacity, or other cause.

(5) "Home and community-based services" has the same meaning as in section 5123.01 of the Revised Code.

(6) "Home and community-based services medicaid waiver component" has the same meaning as in section 5166.01 of the Revised Code.

(7) "Independent provider" means a self-employed person who provides services for which he or she must be certified in accordance with rule 5123:2-2-01 of the Administrative Code and does not employ, either directly or through contract, anyone else to provide the services.

(8) "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, his or her guardian in accordance with section 5126.043 of the Revised Code or other person authorized to give consent.

(9) "Individual service plan" means the written description of services, supports, and activities to be provided to an individual.

(10) "Overtime" means hours worked in excess of forty in a work week.

(11) "Provider" means an agency provider or an independent provider.

(12) "Service and support administrator" means a person, regardless of title, employed by or under contract with a county board to perform the functions of service and support administration and who holds the appropriate certification in accordance with rule 5123:2-5-02 of the Administrative Code.

(13) "Waiver eligibility span" means the twelve-month period beginning with the individual's initial waiver enrollment date or a subsequent eligibility re-determination date.

(14) "Work week" means the seven consecutive days beginning on Sunday at twelve a.m. and ending on Saturday at eleven fifty-nine p.m. of each week.

(C) Overtime

The department, county boards, individuals who receive services, and independent providers shall work collaboratively to efficiently use available resources and to the extent possible, reduce the need for overtime. To that end, an independent provider shall inform an individual's service and support administrator of the number of persons for whom the independent provider provides any medicaid-funded services as an independent provider anywhere in the state and the number of hours of services the independent provider provides in a work week for each such person:

(1) When the independent provider is selected by the individual to provide services;

(2) When notifying the service and support administrator in accordance with paragraph (D)(4) of this rule; and

(3) At other times upon request of the service and support administrator.

(D) Limit on providing services in a work week

(1) Beginning February 1, 2018, after an independent provider has worked sixty hours in a work week providing any medicaid-funded services as an independent provider, that independent provider may provide additional units of services under a home and community-based services medicaid waiver component administered by the department as an independent provider in that work week only:

(a) When authorized by the service and support administrator for the individual for whom the additional services are provided in accordance with paragraph (D)(3) of this rule; or

(b) Due to an emergency.

(2) Individuals receiving services under a home and community-based services medicaid waiver component administered by the department and their independent providers and service and support administrators shall take all measures necessary to achieve compliance with the limit established in paragraph (D)(1) of this rule by February 1, 2018.

(3) As part of the assessment and person-centered planning process set forth in rule 5123:2-1-11 of the Administrative Code, an individual and his or her team shall identify known or anticipated events or circumstances that will necessitate an individual's independent provider to exceed the limit established in paragraph (D)(1) of this rule.

(a) When known or anticipated events or circumstances will necessitate an individual's independent provider to exceed the limit, the events and circumstances, including authorization for the independent provider to exceed the limit for these specific events and circumstances, shall be addressed in the individual service plan. Examples of known or anticipated events or circumstances include but are not limited to:

(i) Scheduled travel or surgery of the individual, the individual's family member, or the individual's provider;

(ii) Holidays or scheduled breaks from school;

(iii) The individual has a compromised immune system and may be put at risk by having additional providers;

(iv) The independent provider is the only provider that has been trained by a nurse on delegated tasks or trained by a behavioral specialist to implement unique behavioral support strategies; and

(v) A shortage of other available providers.

(b) When an individual requests that an independent provider be authorized to routinely exceed the limit due to a shortage of other available providers, the individual and the service and support administrator shall work together to identify additional providers. When good faith efforts to identify additional providers have not been effective, the service and support administrator may authorize the independent provider to exceed the limit as specified in the individual service plan, for the duration of the individual's waiver eligibility span.

(c) When, pursuant to circumstances described in paragraph (D)(3)(a)(iv) or (D)(3)(a)(v) of this rule, the service and support administrator authorizes an independent provider to exceed the limit, the service and support administrator shall work with the individual and the individual's team to develop and implement a plan to eliminate the circumstances that necessitate the independent provider to exceed the limit.

(4) When an emergency necessitates an individual's independent provider to exceed the limit established in paragraph (D)(1) of this rule, the independent provider shall notify the individual's service and support administrator in accordance with the county board's written procedure described in paragraph (D)(5) of this rule, within seventy-two hours of the events or circumstances creating the emergency and report the hours the independent provider worked that exceeded the limit.

(5) On or before January 1, 2018, a county board shall implement a written procedure for an individual's independent provider to notify the individual's service and support administrator when an emergency requires the independent provider to exceed the limit established in paragraph (D)(1) of this rule. The county board shall notify independent providers at least thirty calendar days in advance of revising the written procedure.

(E) Violations of this rule

(1) An individual's right to obtain home and community-based services from any qualified and willing provider in accordance with 42 C.F.R. 431.51 as in effect on the effective date of this rule and sections 5123.044 and 5126.046 of the Revised Code shall not be interpreted to permit an independent provider to violate this rule.

(2) An independent provider who violates the requirements of this rule may be subject to denial, suspension, or revocation of certification pursuant to rule 5123:2-2-01 of the Administrative Code.

(F) Informal complaint process

(1) If a county board receives a complaint from an individual regarding implementation of this rule, the county board shall respond to the individual within thirty calendar days and provide the department with a copy of the individual's complaint and the county board's response. The department shall review the complaint and the response and take actions it determines necessary.

(2) Initiation of a complaint in accordance with paragraph (F)(1) of this rule shall not limit an individual's ability to exercise his or her due process rights in accordance with paragraph (G) of this rule.

(G) Due process rights and responsibilities

(1) Applicants for and recipients of services under a home and community-based services medicaid waiver component administered by the department may use the process set forth in section 5160.31 of the Revised Code and rules implementing that statute for any purpose authorized by that statute, including being denied the choice of a provider who is qualified and willing to provide home and community-based services. The process set forth in section 5160.31 of the Revised Code is available only to applicants, recipients, and their lawfully appointed authorized representatives. Providers shall have no standing in an appeal under that section.

(2) Applicants for and recipients of services under a home and community-based services medicaid waiver component administered by the department shall use the process set forth in section 5160.31 of the Revised Code and rules implementing that statute, for any challenge related to the type, amount, level, scope, or duration of services included in or excluded from an individual service plan. A county board's denial of authorization for an independent provider to exceed the limit established in paragraph (D)(1) of this rule does not necessarily result in a change in the level of services received by an individual.

Supplemental Information

Authorized By: 5123.04, 5123.049, 5166.21
Amplifies: 5123.04, 5123.049, 5166.21
Five Year Review Date: 11/2/2022
Rule 5123:2-9-15 | Home and community-based services waivers - individual employment support under the individual options, level one, and self-empowered life funding waivers.
 

(A) Purpose

This rule defines individual employment support and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service. The expected outcome of individual employment support is competitive integrated employment in a job well-matched to the individual's interests, strengths, priorities, and abilities that meets the individual's personal and career goals.

(B) Definitions

(1) "Adult day support" has the same meaning as in rule 5123:2-9-17 of the Administrative Code.

(2) "Agency provider" means an entity that directly employs at least one person in addition to the chief executive officer for the purpose of providing services for which the entity must be certified in accordance with rule 5123:2-2-01 of the Administrative Code.

(3) "Budget limitation" has the same meaning as in rule 5123:2-9-19 of the Administrative Code.

(4) "Career planning" has the same meaning as in rule 5123:2-9-13 of the Administrative Code.

(5) "Competitive integrated employment" means work (including self-employment) that is performed on a full-time or part-time basis:

(a) For which an individual is:

(i) Compensated:

(a) At a rate that shall be not less than the higher of the rate specified in the Fair Labor Standards Act of 1938, 29 U.S.C. 206(a)(1), as in effect on the effective date of this rule, or the rate specified in the applicable state or local minimum wage law and is not less than the customary rate paid by the employer for the same or similar work performed by other employees who do not have disabilities, and who are in similar occupations by the same employer and who have similar training, experience, and skills; or

(b) In the case of an individual who is self-employed, yields an income that is comparable to the income received by persons without disabilities, who are self-employed in similar occupations or on similar tasks and who have similar training, experience, and skills; and

(ii) Eligible for the level of benefits provided to other full-time and part-time employees;

(b) At a location where the individual interacts with persons without disabilities to the same extent as employees who are not receiving home and community-based services;

(c) That is not performed in:

(i) Dispersed enclaves in which individuals work in a self-contained unit within a company or service site in the community or perform multiple jobs in the company, but are not integrated with non-disabled employees of the company; or

(ii) Mobile work crews comprised solely of individuals operating as a distinct unit and/or self-contained business working in several locations within the community; and

(d) That, as appropriate, presents opportunities for advancement that are similar to those for persons without disabilities who have similar positions.

(6) "County board" means a county board of developmental disabilities.

(7) "Customized employment" means competitive integrated employment designed to meet the specific abilities of an individual with a significant disability and the business needs of an employer that is carried out through flexible strategies such as job exploration by the individual and working with an employer to facilitate placement including:

(a) Customizing a job description based on current employer needs or on previously unidentified and unmet employer needs;

(b) Developing a set of job duties, a work schedule and job arrangement, and specifics of supervision (including performance evaluation and review), and determining a job location; and

(c) Providing services and supports at the job location.

(8) "Department" means the Ohio department of developmental disabilities.

(9) "Fifteen-minute billing unit" means a billing unit that equals fifteen minutes of service delivery time or is greater or equal to eight minutes and less than or equal to twenty-two minutes of service delivery time.

(10) "Group employment support" has the same meaning as in rule 5123:2-9-16 of the Administrative Code.

(11) "Independent provider" means a self-employed person who provides services for which he or she must be certified in accordance with rule 5123:2-2-01 of the Administrative Code and does not employ, either directly or through contract, anyone else to provide the services.

(12) "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, his or her guardian in accordance with section 5126.043 of the Revised Code or other person authorized to give consent.

(13) "Individual employment support" means individualized support for an individual to maintain competitive integrated employment. Activities that constitute individual employment support include but are not limited to:

(a) Job coaching which is identification and provision of services and supports, utilizing task analysis and systematic instruction that assist the individual in maintaining employment and/or advancing his or her career. Job coaching includes supports provided to the individual and his or her supervisor or coworkers on behalf of the individual, either in-person or remotely via technology. Job coaching may include the engagement of natural supports in the workplace to provide additional supports that allow the job coach to maximize his or her ability to fade. Examples of job coaching strategies include job analysis, job adaptations, instructional prompts, verbal instruction, self-management tools, physical assistance, role playing, coworker modeling, and written instruction. Job coaching for self-employment includes identification and provision of services and supports, including counseling and guidance, which assist the individual in maintaining self-employment through the operation of a business. When job coaching is provided, a plan outlining the steps to reduce job coaching over time shall be in place within thirty calendar days.

(b) Training in assistive or other technology utilized by the individual while on the job.

(c) Other workplace support services including services not specifically related to job skill training that enable the individual to be successful in integrating into the job setting.

(d) Personal care and assistance, which may be a component of individual employment support but shall not comprise the entirety of the service.

(14) "Individual service plan" means the written description of services, supports, and activities to be provided to an individual.

(15) "Mentor" means a person employed by or under contract with the agency provider who has experience providing direct services to persons with developmental disabilities and who is available on a regular basis to provide guidance to new direct services staff regarding techniques and practices that enhance the effectiveness of the provision of individual employment support.

(16) "Natural supports" means the personal associations and relationships typically developed in the community that enhance the quality of life for individuals. Natural supports may include family members, friends, neighbors, and others in the community or organizations that serve the general public who provide voluntary support to help an individual achieve agreed upon outcomes through the individual service plan development process.

(17) "Service and support administrator" means a person, regardless of title, employed by or under contract with a county board to perform the functions of service and support administration and who holds the appropriate certification in accordance with rule 5123:2-5-02 of the Administrative Code.

(18) "Service documentation" means all records and information on one or more documents, including documents that may be created or maintained in electronic software programs, created and maintained contemporaneously with the delivery of services, and kept in a manner as to fully disclose the nature and extent of services delivered that shall include the items delineated in paragraph (E) of this rule to validate payment for medicaid services.

(19) "Vocational habilitation" has the same meaning as in rule 5123:2-9-14 of the Administrative Code.

(20) "Waiver eligibility span" means the twelve-month period following either an individual's initial enrollment date or a subsequent eligibility re-determination date.

(C) Provider qualifications

(1) Individual employment support shall be provided by an agency provider or an independent provider that meets the requirements of this rule and that has a medicaid provider agreement with the Ohio department of medicaid.

(2) An applicant seeking approval to provide individual employment support shall complete and submit an application through the department's website (http://dodd.ohio.gov/) and adhere to the requirements of rule 5123:2-2-01 of the Administrative Code.

(3) An applicant seeking independent provider certification to provide individual employment support shall have:

(a) At least one year of full-time (or part-time equivalent), paid work experience related to supporting individuals to maintain jobs in the general workforce; or

(b) Thirty hours of formal training related to supporting individuals to maintain jobs in the general workforce.

(4) Commencing in the second year of certification, an independent provider shall annually complete at least eight hours of training that enhances his or her skills and competencies relevant to the services he or she provides which shall include, but is not limited to:

(a) An independent provider's role and responsibilities with regard to services including person-centered planning, community integration, self-determination, and self-advocacy;

(b) The rights of individuals set forth in sections 5123.62 to 5123.64 of the Revised Code;

(c) The requirements of rule 5123:2-17-02 of the Administrative Code including a review of health and welfare alerts issued by the department since the previous year's training; and

(d) Services that comprise individual employment support.

(5) An agency provider shall ensure that direct services staff who provide individual employment support successfully complete, no later than ninety calendar days after hire, an orientation program of at least eight hours that addresses, but is not limited to:

(a) Organizational background of the agency provider, including:

(i) Mission, vision, values, principles, and goals;

(ii) Organizational structure;

(iii) Key policies, procedures, and work rules;

(iv) Ethical and professional conduct and practice;

(v) Avoiding conflicts of interest; and

(vi) Working effectively with individuals, families, and other team members.

(b) Components of quality care for individuals served, including:

(i) Interpersonal relationships and trust;

(ii) Cultural and personal sensitivity;

(iii) Effective communication;

(iv) Person-centered philosophy, planning, and practice;

(v) Development of individual service plans;

(vi) Roles and responsibilities of team members; and

(vii) Record keeping including progress notes and incident/accident reports.

(c) Health and safety, including:

(i) Signs and symptoms of illness or injury and procedure for response;

(ii) Building/site-specific emergency response plans; and

(iii) Program-specific transportation safety.

(d) Positive behavioral support, including:

(i) Principles of positive culture;

(ii) Role of direct services staff in creating a positive culture;

(iii) General requirements for intervention and behavioral support strategies and direct services staff role including documentation;

(iv) Human rights committees established in accordance with rule 5123:2-2-06 of the Administrative Code; and

(v) Crisis intervention techniques.

(e) Services that comprise individual employment support.

(6) An agency provider shall ensure that direct services staff who provide individual employment support (other than those who have at least one year of experience providing individual employment support at the point of hire), during the first year after hire, are assigned and have access to a mentor.

(7) An agency provider shall ensure that direct services staff who provide individual employment support (other than those who have at least one year of experience providing individual employment support at the point of hire), no later than one year after hire, successfully complete at least eight hours of training specific to the provision of individual employment support that includes, but is not limited to:

(a) Skill-building in job training and systematic instruction that assists the individual in maintaining employment and or advancing his or her career; and

(b) Self-determination which includes assisting the individual to develop self-advocacy skills, to exercise his or her civil rights, to exercise control and responsibility over the services he or she receives, and to acquire skills that enable him or her to become more independent, productive, and integrated within the community.

(8) An agency provider shall ensure that each direct services staff member who provides individual employment support successfully completes on-the-job training specific to each individual he or she serves that includes:

(a) What is important to the individual and what is important for the individual; and

(b) The individual's support needs including, as applicable, behavioral support strategy, management of the individual's funds, and medication administration/delegated nursing.

(9) An agency provider shall ensure that direct services staff who provide individual employment support, commencing in the second year of hire by the agency provider, annually complete at least eight hours of training, in accordance with the written plan of training priorities described in paragraph (C)(10) of this rule.

(a) The training shall enhance the skills and competencies of the direct services staff member relevant to his or her job responsibilities and shall include, but is not limited to:

(i) The role and responsibilities of direct services staff with regard to services including person-centered planning, community integration, self-determination, and self-advocacy;

(ii) The rights of individuals set forth in sections 5123.62 to 5123.64 of the Revised Code;

(iii) The requirements of rule 5123:2-17-02 of the Administrative Code including a review of health and welfare alerts issued by the department since the previous year's training;

(iv) The requirements relative to the direct services staff member's role in providing behavioral support to the individuals he or she serves; and

(v) Best practices related to the provision of individual employment support.

(b) The training may be structured or unstructured and may include, but is not limited to, lectures, seminars, formal coursework, workshops, conferences, demonstrations, visitations or observations of other services/programs, distance and other means of electronic learning, video and audio-visual training, and staff meetings.

(10) An agency provider shall develop and implement a written plan identifying training priorities for direct services staff who provide individual employment support. The training priorities shall be consistent with the needs of individuals served, best practice, and the provider's mission, vision, and strategic plan. The written plan of training priorities shall describe the method (e.g., written test, skills demonstration, or documented observation by supervisor) that will be used to establish competency in areas of training. The written plan of training priorities shall be updated at least once every twelve months and shall identify who is responsible for arranging or providing the training and projected timelines for completion of the training.

(11) An agency provider shall ensure that a written record of training completed for direct services staff who provide individual employment support is maintained. The written record shall include a description of the training completed including a training syllabus and copies of training materials, the date of training, the duration of training, and the instructor's name, if applicable.

(12) Failure to comply with this rule and rule 5123:2-2-01 of the Administrative Code may result in denial, suspension, or revocation of the provider's certification.

(D) Requirements for service delivery

(1) The expected outcome of individual employment support is competitive integrated employment in a job well-matched to the individual's interests, strengths, priorities, and abilities that meets the individual's personal and career goals.

(2) Individual employment support shall be provided pursuant to a person-centered individual service plan that conforms to the requirements of rules 5123:2-1-11 and 5123:2-2-05 of the Administrative Code and shall be coordinated with other services and supports set forth in the individual service plan.

(3) The service and support administrator shall ensure that documentation is maintained to demonstrate that the service provided as individual employment support to an individual enrolled in a waiver is not otherwise available as vocational rehabilitation services funded under section 110 of the Rehabilitation Act of 1973, 29 U.S.C. 730, as in effect on the effective date of this rule, or as special education or related services as those terms are defined in section 602 of the Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. 1401, as in effect on the effective date of this rule.

(4) Individual employment support, other than services and supports that assist an individual to maintain self-employment through the operation of a business, shall take place in a setting separate from the home of the individual receiving the services.

(5) Individual employment support shall be provided at a ratio of one staff to one individual.

(6) Individual employment support services may extend to those times when the individual is not physically present while the provider is performing individual employment support activities on behalf of the individual (e.g., developing coworker supports or meeting with a supervisor).

(7) A provider of individual employment support shall complete reports and collect and submit data via the department's employment tracking system in accordance with rule 5123:2-2-05 of the Administrative Code.

(8) A provider of individual employment support shall recognize changes in the individual's condition and behavior, report to the service and support administrator, and record the changes in the individual's written record.

(9) A provider of individual employment support shall report identified safety and sanitation hazards that occur at the worksite to employers having the responsibility to remedy the condition.

(E) Documentation of services

Service documentation for individual employment support shall include each of the following to validate payment for medicaid services:

(1) Type of service.

(2) Date of service.

(3) Place of service.

(4) Name of individual receiving service.

(5) Medicaid identification number of individual receiving service.

(6) Name of provider.

(7) Provider identifier/contract number.

(8) Written or electronic signature of the person delivering the service, or initials of the person delivering the service if a signature and corresponding initials are on file with the provider.

(9) Description and details of the services delivered that directly relate to the services specified in the approved individual service plan as the services to be provided.

(10) Times the delivered service started and stopped.

(11) Number of units of the delivered service.

(F) Payment standards

(1) The billing unit, service codes, and payment rates for individual employment support are contained in the appendix to this rule.

(2) Payment for adult day support, career planning, group employment support, individual employment support, and vocational habilitation, alone or in combination, shall not exceed the budget limitations contained in appendix B to rule 5123:2-9-19 of the Administrative Code.

(3) Payment rates for individual employment support shall be modified to reflect the needs of an individual requiring behavioral support upon determination by the department that the individual meets the criteria set forth in paragraph (F)(3)(a) of this rule. The amount of the behavioral support rate modification applied to each fifteen-minute billing unit of service is contained in the appendix to this rule.

(a) The department shall determine that an individual meets the criteria for the behavioral support rate modification when:

(i) The individual has been assessed within the last twelve months to present a danger to self or others or have the potential to present a danger to self or others; and

(ii) A behavioral support strategy that is a component of the individual service plan has been developed in accordance with the requirements in rules established by the department; and

(iii) The individual either:

(a) Has a response of "yes" to at least four items in question thirty-two of the behavioral domain of the Ohio developmental disabilities profile; or

(b) Requires a structured environment that, if removed, will result in the individual's engagement in behavior destructive to self or others.

(b) The duration of the behavioral support rate modification shall be limited to the individual's waiver eligibility span, may be determined needed or no longer needed within that waiver eligibility span, and may be renewed annually.

(c) The purpose of the behavioral support rate modification is to provide funding for the implementation of behavioral support strategies by staff who have the level of training necessary to implement the strategies; the department retains the right to verity that staff who implement behavioral support strategies have received training (e.g., specialized training recommended by clinicians or the team or training regarding an individual's behavioral support strategy) that is adequate to meet the needs of the individuals served.

(4) Payment rates for individual employment support shall be modified to reflect the needs of an individual requiring medical assistance upon determination by the county board that the individual meets the criteria set forth in paragraph (F)(4)(a) of this rule. The amount of the medical assistance rate modification applied to each fifteen-minute billing unit of service is contained in the appendix to this rule.

(a) The county board shall determine that an individual meets the criteria for the medical assistance rate modification when:

(i) The individual requires routine feeding and/or the administration of prescribed medication through gastrostomy and/or jejunostomy tubes, and/or requires the administration of routine doses of insulin through subcutaneous injections and insulin pumps; or

(ii) The individual requires oxygen administration that a licensed nurse agrees to delegate in accordance with rules in Chapter 4723-13 of the Administrative Code; or

(iii) The individual requires a nursing procedure or nursing task that a licensed nurse agrees to delegate in accordance with rules in Chapter 4723-13 of the Administrative Code, which is provided in accordance with section 5123.42 of the Revised Code, and when such procedure or nursing task is not the administration of oral prescribed medication or topical prescribed medication or a health-related activity as defined in rule 5123:2-6-01 of the Administrative Code.

(b) The duration of the medical assistance rate modification shall be limited to the individual's waiver eligibility span, may be determined needed or no longer needed within that waiver eligibility span, and may be renewed annually.

(c) Medical assistance rate modifications are subject to review by the department.

Supplemental Information

Authorized By: 5123.04, 5123.049, 5123.1611
Amplifies: 5123.04, 5123.045, 5123.049, 5123.16, 5123.161, 5123.1611, 5166.21
Five Year Review Date: 4/1/2022
Prior Effective Dates: 10/1/2007
Rule 5123:2-9-16 | Home and community-based services waivers - group employment support under the individual options, level one, and self-empowered life funding waivers.
 

(A) Purpose

This rule defines group employment support and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service. The expected outcome of group employment support is paid employment and work experience leading to further career development and competitive integrated employment.

(B) Definitions

(1) "Adult day support" has the same meaning as in rule 5123:2-9-17 of the Administrative Code.

(2) "Agency provider" means an entity that directly employs at least one person in addition to the chief executive officer for the purpose of providing services for which the entity must be certified in accordance with rule 5123:2-2-01 of the Administrative Code.

(3) "Budget limitation" has the same meaning as in rule 5123:2-9-19 of the Administrative Code.

(4) "Career planning" has the same meaning as in rule 5123:2-9-13 of the Administrative Code.

(5) "Competitive integrated employment" means work (including self-employment) that is performed on a full-time or part-time basis:

(a) For which an individual is:

(i) Compensated:

(a) At a rate that shall be not less than the higher of the rate specified in the Fair Labor Standards Act of 1938, 29 U.S.C. 206(a)(1), as in effect on the effective date of this rule, or the rate specified in the applicable state or local minimum wage law and is not less than the customary rate paid by the employer for the same or similar work performed by other employees who do not have disabilities, and who are in similar occupations by the same employer and who have similar training, experience, and skills; or

(b) In the case of an individual who is self-employed, yields an income that is comparable to the income received by persons without disabilities, who are self-employed in similar occupations or on similar tasks and who have similar training, experience, and skills; and

(ii) Eligible for the level of benefits provided to other full-time and part-time employees;

(b) At a location where the individual interacts with persons without disabilities to the same extent as employees who are not receiving home and community-based services;

(c) That is not performed in:

(i) Dispersed enclaves in which individuals work in a self-contained unit within a company or service site in the community or perform multiple jobs in the company, but are not integrated with non-disabled employees of the company; or

(ii) Mobile work crews comprised solely of individuals operating as a distinct unit and/or self-contained business working in several locations within the community; and

(d) That, as appropriate, presents opportunities for advancement that are similar to those for persons without disabilities who have similar positions.

(6) "County board" means a county board of developmental disabilities.

(7) "Daily billing unit" means a billing unit that may be used when between five and seven hours of group employment support are delivered by the same provider to the same individual during one calendar day in accordance with the conditions specified in paragraph (F)(2) of this rule.

(8) "Department" means the Ohio department of developmental disabilities.

(9) "Fifteen-minute billing unit" means a billing unit that equals fifteen minutes of service delivery time or is greater or equal to eight minutes and less than or equal to twenty-two minutes of service delivery time.

(10) "Group employment support" means services and training activities provided in regular business, industry, and community settings for groups of two or more workers with disabilities.

(a) Activities that constitute group employment support include any combination of the following as necessary and appropriate to meet the community employment goals of the individual:

(i) Person-centered employment planning;

(ii) Work adjustment;

(iii) Job analysis;

(iv) Training and systematic instruction;

(v) Job coaching; and

(vi) Training in independent planning, arranging, and using transportation.

(b) Group employment support is provided in two distinct service arrangements:

(i) Dispersed enclaves in which individuals work in a self-contained unit within a company or service site in the community or perform multiple jobs in the company, but are not integrated with non-disabled employees of the company; or

(ii) Mobile work crews comprised solely of individuals operating as a distinct unit and/or self-contained business working in several locations within the community.

(11) "Independent provider" means a self-employed person who provides services for which he or she must be certified in accordance with rule 5123:2-2-01 of the Administrative Code and does not employ, either directly or through contract, anyone else to provide the services.

(12) "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, his or her guardian in accordance with section 5126.043 of the Revised Code or other person authorized to give consent.

(13) "Individual employment support" has the same meaning as in rule 5123:2-9-15 of the Administrative Code.

(14) "Individual service plan" means the written description of services, supports, and activities to be provided to an individual.

(15) "Mentor" means a person employed by or under contract with the agency provider who has experience providing direct services to persons with developmental disabilities and who is available on a regular basis to provide guidance to new direct services staff regarding techniques and practices that enhance the effectiveness of the provision of group employment support.

(16) "Service and support administrator" means a person, regardless of title, employed by or under contract with a county board to perform the functions of service and support administration and who holds the appropriate certification in accordance with rule 5123:2-5-02 of the Administrative Code.

(17) "Service documentation" means all records and information on one or more documents, including documents that may be created or maintained in electronic software programs, created and maintained contemporaneously with the delivery of services, and kept in a manner as to fully disclose the nature and extent of services delivered that shall include the items delineated in paragraph (E) of this rule to validate payment for medicaid services.

(18) "Vocational habilitation" has the same meaning as in rule 5123:2-9-14 of the Administrative Code.

(19) "Waiver eligibility span" means the twelve-month period following either an individual's initial enrollment date or a subsequent eligibility re-determination date.

(C) Provider qualifications

(1) Group employment support shall be provided by an agency provider that meets the requirements of this rule and that has a medicaid provider agreement with the Ohio department of medicaid.

(2) Group employment support shall not be provided by an independent provider.

(3) An applicant seeking approval to provide group employment support shall complete and submit an application through the department's website (http://dodd.ohio.gov/) and adhere to the requirements of rule 5123:2-2-01 of the Administrative Code.

(4) An agency provider shall ensure that direct services staff who provide group employment support successfully complete, no later than ninety calendar days after hire, an orientation program of at least eight hours that addresses, but is not limited to:

(a) Organizational background of the agency provider, including:

(i) Mission, vision, values, principles, and goals;

(ii) Organizational structure;

(iii) Key policies, procedures, and work rules;

(iv) Ethical and professional conduct and practice;

(v) Avoiding conflicts of interest; and

(vi) Working effectively with individuals, families, and other team members.

(b) Components of quality care for individuals served, including:

(i) Interpersonal relationships and trust;

(ii) Cultural and personal sensitivity;

(iii) Effective communication;

(iv) Person-centered philosophy, planning, and practice;

(v) Development of individual service plans;

(vi) Roles and responsibilities of team members; and

(vii) Record keeping including progress notes and incident/accident reports.

(c) Health and safety, including:

(i) Signs and symptoms of illness or injury and procedure for response;

(ii) Building/site-specific emergency response plans; and

(iii) Program-specific transportation safety.

(d) Positive behavioral support, including:

(i) Principles of positive culture;

(ii) Role of direct services staff in creating a positive culture;

(iii) General requirements for intervention and behavioral support strategies and direct services staff role including documentation;

(iv) Human rights committees established in accordance with rule 5123:2-2-06 of the Administrative Code; and

(v) Crisis intervention techniques.

(e) Services that comprise group employment support.

(5) An agency provider shall ensure that direct services staff who provide group employment support (other than those who have at least one year of experience providing group employment support at the point of hire), during the first year after hire, are assigned and have access to a mentor.

(6) An agency provider shall ensure that direct services staff who provide group employment support (other than those who have at least one year of experience providing group employment support at the point of hire), no later than one year after hire, successfully complete at least eight hours of training specific to the provision of group employment support that includes, but is not limited to:

(a) Skill-building in advancement of individuals on the path to community employment as described in rule 5123:2-2-05 of the Administrative Code and development of individuals' strengths and skills necessary for competitive integrated employment; and

(b) Self-determination which includes assisting the individual to develop self-advocacy skills, to exercise his or her civil rights, to exercise control and responsibility over the services he or she receives, and to acquire skills that enable him or her to become more independent, productive, and integrated within the community.

(7) An agency provider shall ensure that direct services staff who provide group employment support successfully complete on-the-job training specific to each individual he or she serves that includes:

(a) What is important to the individual and what is important for the individual; and

(b) The individual's support needs including, as applicable, behavioral support strategy, management of the individual's funds, and medication administration/delegated nursing.

(8) An agency provider shall ensure that direct services staff who provide group employment support, commencing in the second year of hire by the agency provider, annually complete at least eight hours of training, in accordance with the written plan of training priorities described in paragraph (C)(9) of this rule.

(a) The training shall enhance the skills and competencies of the direct services staff member relevant to his or her job responsibilities and shall include, but is not limited to:

(i) The role and responsibilities of direct services staff with regard to services including person-centered planning, community integration, self-determination, and self-advocacy;

(ii) The rights of individuals set forth in sections 5123.62 to 5123.64 of the Revised Code;

(iii) The requirements of rule 5123:2-17-02 of the Administrative Code including a review of health and welfare alerts issued by the department since the previous year's training;

(iv) The requirements relative to the direct services staff member's role in providing behavioral support to the individuals he or she serves; and

(v) Best practices related to the provision of group employment support.

(b) The training may be structured or unstructured and may include, but is not limited to, lectures, seminars, formal coursework, workshops, conferences, demonstrations, visitations or observations of other services/programs, distance and other means of electronic learning, video and audio-visual training, and staff meetings.

(9) An agency provider shall develop and implement a written plan identifying training priorities for direct services staff who provide group employment support. The training priorities shall be consistent with the needs of individuals served, best practice, and the provider's mission, vision, and strategic plan. The written plan of training priorities shall describe the method (e.g., written test, skills demonstration, or documented observation by supervisor) that will be used to establish competency in areas of training. The written plan of training priorities shall be updated at least once every twelve months and shall identify who is responsible for arranging or providing the training and projected timeliness for completion of the training.

(10) An agency provider shall ensure that a written record of training completed for direct services staff who provide group employment support is maintained. The written record shall include a description of the training completed including a training syllabus and copies of training materials, the date of training, the duration of training, and the instructor's name, if applicable.

(11) Failure to comply with this rule and rule 5123:2-2-01 of the Administrative Code may result in denial, suspension, or revocation of the agency provider's certification.

(D) Requirements for service delivery

(1) The expected outcome of group employment support is paid employment and work experience leading to further career development and competitive integrated employment.

(2) Group employment support shall be provided pursuant to a person-centered individual service plan that conforms to the requirements of rules 5123:2-1-11 and 5123:2-2-05 of the Administrative Code and shall be coordinated with other services and supports set forth in the individual service plan.

(3) The service and support administrator shall ensure that documentation is maintained to demonstrate that the service provided as group employment support to an individual enrolled in a waiver is not otherwise available as vocational rehabilitation services funded under section 110 of the Rehabilitation Act of 1973, 29 U.S.C. 730, as in effect on the effective date of this rule, or as special education or related services as those terms are defined in section 602 of the Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. 1401, as in effect on the effective date of this rule.

(4) Group employment support shall be provided in an integrated setting and support individuals' access to the greater community, including opportunities to seek competitive integrated employment, to engage in community life, and to have control over earned income.

(5) Group employment support shall take place in a setting separate from the home of the individual receiving the services.

(6) Individuals receiving group employment support shall be compensated in accordance with applicable federal and state laws and regulations. A determination that an individual receiving group employment support is eligible to be paid at special minimum wage rates in accordance with 29 C.F.R. Part 525, "Employment of Workers with Disabilities Under Special Certificates," as in effect on the effective date of this rule, shall be based on documented evaluations and assessments.

(7) A provider of group employment support shall ensure that appropriate staff are knowledgeable about the Workforce Innovation and Opportunity Act as in effect on the effective date of this rule, wage and hour laws, benefits, work incentives, and employer tax credits for individuals with developmental disabilities and ensure that individuals served receive this information.

(8) A provider of group employment support shall provide the service in a manner that presumes all participants are capable of working in competitive integrated employment. The provider shall encourage individuals receiving the service, on an ongoing basis, and as part of the annual person-centered planning process, to explore their interests, strengths, and abilities relating to competitive integrated employment. The provider shall, as a component of the service, assist individuals to explore, identify, and pursue opportunities that advance them toward competitive integrated employment.

(9) A provider of group employment support shall complete reports and collect and submit data via the department's employment tracking system in accordance with rule 5123:2-2-05 of the Administrative Code.

(10) A provider of group employment support shall recognize changes in the individual's condition and behavior, report to the service and support administrator, and record the changes in the individual's written record.

(11) A provider of group employment support shall report identified safety and sanitation hazards that occur at the work site to employers having the responsibility to remedy the condition.

(E) Documentation of services

Service documentation for group employment support shall include each of the following to validate payment for medicaid services:

(1) Type of service.

(2) Date of service.

(3) Place of service.

(4) Name of individual receiving service.

(5) Medicaid identification number of individual receiving service.

(6) Name of provider.

(7) Provider identifier/contract number.

(8) Written or electronic signature of the person delivering the service, or initials of the person delivering the service if a signature and corresponding initials are on file with the provider.

(9) Description and details of the services delivered that directly relate to the services specified in the approved individual service plan as the services to be provided.

(10) Times the delivered service started and stopped.

(11) Number of units of the delivered service.

(F) Payment standards

(1) The billing units, service codes, and payment rates for group employment support are contained in appendix A to this rule. Payment rates are based on individuals' group assignments determined in accordance with rule 5123:2-9-19 of the Administrative Code and the county cost-of-doing-business category. The cost-of-doing-business category for an individual is the category assigned to the county in which the service is actually provided for the preponderance of time. The cost-of-doing-business categories are contained in appendix B to this rule.

(2) A provider of group employment support may use the daily billing unit when the provider delivers between five and seven hours of group employment support to the same individual during one calendar day and:

(a) The individual does not qualify for or the provider elects not to receive the behavioral support rate modification described in paragraph (F)(6) of this rule; and

(b) The individual does not qualify for or the provider elects not to receive the medical assistance rate modification described in paragraph (F)(7) of this rule.

(3) A provider of group employment support shall use the fifteen-minute billing unit when:

(a) The provider delivers less than five hours or more than seven hours of group employment support to the same individual during one calendar day;

(b) The individual being served qualifies for and the provider elects to receive the behavioral support rate modification in accordance with paragraph (F)(6) of this rule; or

(c) The individual being served qualifies for and the provider elects to receive the medical assistance rate modification in accordance with paragraph (F)(7) of this rule.

(4) A provider of group employment shall not bill a daily billing unit on the same day the provider bills fifteen-minute billing units for the same individual.

(5) Payment for adult day support, career planning, group employment support, individual employment support, and vocational habilitation, alone or in combination, shall not exceed the budget limitations contained in appendix B to rule 5123:2-9-19 of the Administrative Code.

(6) Payment rates for group employment support shall be modified to reflect the needs of an individual requiring behavioral support upon determination by the department that the individual meets the criteria set forth in paragraph (F)(6)(a) of this rule. The amount of the behavioral support rate modification applied to each fifteen-minute billing unit of service is contained in appendix A to this rule.

(a) The department shall determine that an individual meets the criteria for the behavioral support rate modification when:

(i) The individual has been assessed within the last twelve months to present a danger to self or others or have the potential to present a danger to self or others; and

(ii) A behavioral support strategy that is a component of the individual service plan has been developed in accordance with the requirements in rules established by the department; and

(iii) The individual either:

(a) Has a response of "yes" to at least four items in question thirty-two of the behavioral domain of the Ohio developmental disabilities profile; or

(b) Requires a structured environment that, if removed, will result in the individual's engagement in behavior destructive to self or others.

(b) The duration of the behavioral support rate modification shall be limited to the individual's waiver eligibility span, may be determined needed or no longer needed within that waiver eligibility span, and may be renewed annually.

(c) The purpose of the behavioral support rate modification is to provide funding for the implementation of behavioral support strategies by staff who have the level of training necessary to implement the strategies; the department retains the right to verify that staff who implement behavioral support strategies have received training (e.g., specialized training recommended by clinicians or the team or training regarding an individual's behavioral support strategy) that is adequate to meet the needs of the individuals served.

(7) Payment rates for group employment support shall be modified to reflect the needs of an individual requiring medical assistance upon determination by the county board that the individual meets the criteria set forth in paragraph (F)(7)(a) of this rule. The amount of the medical assistance rate modification applied to each fifteen-minute billing unit of service is contained in appendix A to this rule.

(a) The county board shall determine that an individual meets the criteria for the medical assistance rate modification when:

(i) The individual requires routine feeding and/or the administration of prescribed medication through gastrostomy and/or jejunostomy tubes, and/or requires the administration of routine doses of insulin through subcutaneous injections and insulin pumps; or

(ii) The individual requires oxygen administration that a licensed nurse agrees to delegate in accordance with rules in Chapter 4723-13 of the Administrative Code; or

(iii) The individual requires a nursing procedure or nursing task that a licensed nurse agrees to delegate in accordance with rules in Chapter 4723-13 of the Administrative Code, which is provided in accordance with section 5123.42 of the Revised Code, and when such nursing procedure or nursing task is not the administration of oral prescribed medication or topical prescribed medication or a health-related activity as defined in rule 5123:2-6-01 of the Administrative Code.

(b) The duration of the medical assistance rate modification shall be limited to the individual's waiver eligibility span, may be determined needed or no longer needed within that waiver eligibility span, and may be renewed annually.

(c) Medical assistance rate modifications are subject to review by the department.

View Appendix

Supplemental Information

Authorized By: 5123.04, 5123.049, 5123.1611
Amplifies: 5123.04, 5123.045, 5123.049, 5123.16, 5123.161, 5123.1611, 5166.21
Five Year Review Date: 4/1/2022
Prior Effective Dates: 1/1/2007, 7/23/2012
Rule 5123:2-9-28 | Home and community-based services waivers - nutrition services under the individual options waiver.
 

(A) Purpose

This rule defines nutrition services and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service.

(B) Definitions

(1) "Agency provider" means an entity that directly employs at least one person in addition to the chief executive officer for the purpose of providing services for which the entity must be certified in accordance with rule 5123:2-2-01 of the Administrative Code.

(2) "County board" means a county board of developmental disabilities.

(3) "Department" means the Ohio department of developmental disabilities.

(4) "Independent provider" means a self-employed person who provides services for which he or she must be certified in accordance with rule 5123:2-2-01 of the Administrative Code and does not employ, either directly or through contract, anyone else to provide the services.

(5) "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, his or her guardian in accordance with section 5126.043 of the Revised Code.

(6) "Individual service plan" means the written description of services, supports, and activities to be provided to an individual.

(7) "Nutrition services" means a nutritional assessment and intervention for individuals who are identified as being at nutritional risk and includes development of a nutrition care plan, including appropriate means of nutrition intervention (i.e., nutrition required, feeding modality, nutrition education, and nutrition counseling). Nutrition services shall not supplant existing services provided by the federal women, infants, and children program.

(8) "Service documentation" means all records and information on one or more documents, including documents that may be created or maintained in electronic software programs, created and maintained contemporaneously with the delivery of services, and kept in a manner as to fully disclose the nature and extent of services delivered that shall include the items delineated in paragraph (E) of this rule to validate payment for medicaid services.

(C) Provider qualifications

(1) Nutrition services shall be provided by a dietitian licensed by the state pursuant to section 4759.06 of the Revised Code who is either an independent provider or the employee of an agency provider that meets the requirements of this rule and that has a medicaid provider agreement with the Ohio department of medicaid.

(2) Nutrition services shall not be provided by a county board or a regional council of governments formed under section 5126.13 of the Revised Code by two or more county boards.

(3) An applicant seeking approval to provide nutrition services shall complete and submit an application through the department's website (http://dodd.ohio.gov/).

(4) Failure to comply with this rule and rule 5123:2-2-01 of the Administrative Code may result in denial, suspension, or revocation of the provider's certification.

(D) Requirements for service delivery

(1) Nutrition services shall be provided pursuant to an individual service plan that conforms to the requirements of rule 5123:2-1-11 of the Administrative Code.

(2) A dietitian providing nutrition services shall:

(a) Perform nutritional assessments and evaluations in accordance with the individual service plan;

(b) Develop dietary programs, if indicated by the nutritional assessment and the individual service plan; and

(c) Train the individual, family members, professionals, paraprofessionals, direct care workers, habilitation specialists, and vocational/school staff regarding the dietary program.

(E) Documentation of services

Service documentation for nutrition services shall include each of the following to validate payment for medicaid services:

(1) Type of service.

(2) Date of service.

(3) Place of service.

(4) Name of individual receiving service.

(5) Medicaid identification number of individual receiving service.

(6) Name of provider.

(7) Provider identifier/contract number.

(8) Written or electronic signature of the person delivering the service, or initials of the person delivering the service if a signature and corresponding initials are on file with the provider.

(9) Group size in which the service was provided.

(10) Description and details of the services delivered that directly relate to the services specified in the approved individual service plan as the services to be provided.

(11) Number of units of the delivered service.

(12) Times the delivered service started and stopped.

(F) Payment standards

(1) The billing unit, service codes, and payment rates for nutrition services are contained in appendix A to this rule.

(2) Payment rates for nutrition services are based on the county cost-of-doing-business category. The cost-of-doing-business categories are contained in appendix B to this rule.

(3) Payment rates for nutrition services are established separately for services provided by independent providers and services provided through agency providers.

(4) Payment rates for nutrition services are based on the number of individuals receiving services.

Supplemental Information

Authorized By: 5123.04, 5123.049, 5123.1611
Amplifies: 5123.04, 5123.045, 5123.049, 5123.16, 5123.161, 5123.1611, 5166.21
Five Year Review Date: 7/1/2022
Rule 5123:2-9-36 | Home and community-based services waivers - interpreter services under the individual options waiver.
 

(A) Purpose

This rule defines interpreter services and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service.

(B) Definitions

(1) "Agency provider" means an entity that directly employs at least one person in addition to the chief executive officer for the purpose of providing services for which the entity must be certified in accordance with rule 5123:2-2-01 of the Administrative Code.

(2) "County board" means a county board of developmental disabilities.

(3) "Department" means the Ohio department of developmental disabilities.

(4) "Independent provider" means a self-employed person who provides services for which he or she must be certified in accordance with rule 5123:2-2-01 of the Administrative Code and does not employ, either directly or through contract, anyone else to provide the services.

(5) "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, his or her guardian in accordance with section 5126.043 of the Revised Code.

(6) "Individual service plan" means the written description of services, supports, and activities to be provided to an individual.

(7) "Interpreter services" means the process by which one person's message is conveyed to another in a manner that incorporates both the message and attitude of the communicator.

(8) "Service documentation" means all records and information on one or more documents, including documents that may be created or maintained in electronic software programs, created and maintained contemporaneously with the delivery of services, and kept in a manner as to fully disclose the nature and extent of services delivered that shall include the items delineated in paragraph (E) of this rule to validate payment for medicaid services.

(C) Provider qualifications

(1) Interpreter services shall be provided by a person who:

(a) Holds a certification recognized by the registry of interpreters for the deaf;

(b) Is either an independent provider or the employee of an agency provider that meets the requirements of this rule and that has a medicaid provider agreement with the Ohio department of medicaid; and

(c) Meets one of the following standards:

(i) Has graduated from an interpreter training program (of a minimum of two-years) and has at least one year of documented experience providing interpreter services;

(ii) Has successfully completed a written test administered by the registry of interpreters for the deaf and has at least one year of documented experience providing interpreter services; or

(iii) Has at least two years of documented experience providing interpreter services.

(2) An applicant seeking approval to provide interpreter services shall complete and submit an application through the department's website (http://dodd.ohio.gov/).

(3) Failure to comply with this rule and rule 5123:2-2-01 of the Administrative Code may result in denial, suspension, or revocation of the provider's certification.

(D) Requirements for service delivery

(1) Interpreter services shall be provided pursuant to an individual service plan that conforms to the requirements of rule 5123:2-1-11 of the Administrative Code.

(2) A person providing interpreter services shall:

(a) Maintain a role of facilitator of communication rather than the initiator of communication; and

(b) Render the message faithfully, always conveying the content and spirit of the individual being served, using language most readily understood by the individual.

(3) A person providing interpreter services shall not counsel, advise, or interject his or her personal opinions.

(E) Documentation of services

Service documentation for interpreter services shall include each of the following to validate payment for medicaid services:

(1) Type of service.

(2) Date of service.

(3) Place of service.

(4) Name of individual receiving service.

(5) Medicaid identification number of individual receiving service.

(6) Name of provider.

(7) Provider identifier/contract number.

(8) Written or electronic signature of the person delivering the service, or initials of the person delivering the service if a signature and corresponding initials are on file with the provider.

(9) Group size in which the service was provided.

(10) Description and details of the services delivered that directly relate to the services specified in the approved individual service plan as the services to be provided.

(11) Number of units of the delivered service.

(12) Times the delivered service started and stopped.

(F) Payment standards

(1) The billing unit, service code, and payment rates for interpreter services are contained in appendix A to this rule.

(2) Payment rates for interpreter services are based on the county cost-of-doing-business category. The cost-of-doing-business categories are contained in appendix B to this rule.

(3) Payment rates for interpreter services are established separately for services provided by independent providers and services provided through agency providers.

(4) Payment rates for interpreter services are based on the number of individuals receiving services.

View Appendix

Supplemental Information

Authorized By: 5123.04, 5123.049, 5123.1611
Amplifies: 5123.04, 5123.045, 5123.049, 5123.16, 5123.161, 5123.1611, 5166.21
Five Year Review Date: 7/1/2022
Prior Effective Dates: 11/3/2011
Rule 5123:2-9-37 | Home and community-based services waivers - waiver nursing delegation under the individual options, level one, and self-empowered life funding waivers.
 

(A) Purpose

This rule defines waiver nursing delegation and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service.

(B) Definitions

(1) "Adult day services" means adult day support, career planning, group employment support, individual employment support, and vocational habilitation as those services are defined in Chapter 5123:2-9 of the Administrative Code.

(2) "Agency provider" means an entity that directly employs at least one person in addition to the chief executive officer for the purpose of providing services for which the entity must be certified in accordance with rule 5123:2-2-01 of the Administrative Code.

(3) "County board" means a county board of developmental disabilities.

(4) "Delegating nurse" means the nurse who delegates a nursing task or assumes responsibility for individuals who are receiving delegated nursing care in accordance with Chapter 4723-13 or 5123:2-6 of the Administrative Code.

(5) "Department" means the Ohio department of developmental disabilities.

(6) "Fifteen-minute billing unit" means a billing unit that equals fifteen minutes of service delivery time or is greater or equal to eight minutes and less than or equal to twenty-two minutes of service delivery time.

(7) "Independent provider" means a self-employed person who provides services for which he or she must be certified in accordance with rule 5123:2-2-01 of the Administrative Code and does not employ, either directly or through contract, anyone else to provide the services.

(8) "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, his or her guardian in accordance with section 5126.043 of the Revised Code or other person authorized to give consent.

(9) "Individual service plan" means the written description of services, supports, and activities to be provided to an individual.

(10) "Licensed nurse" means a registered nurse or a licensed practical nurse.

(11) "Licensed practical nurse" has the same meaning as in section 4723.01 of the Revised Code and for purposes of this rule, may practice waiver nursing delegation only at the direction of a registered nurse.

(12) "Provider" means an agency provider or an independent provider.

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

(14) "Service documentation" means all records and information on one or more documents, including documents that may be created or maintained in electronic software programs, created and maintained contemporaneously with the delivery of services, and kept in a manner as to fully disclose the nature and extent of services delivered that shall include the items delineated in paragraph (E) of this rule to validate payment for medicaid services.

(15) "Significant change" means a decline or improvement in an individual's medical condition or a change in location of service delivery.

(16) "Team" has the same meaning as in rule 5123:2-1-11 of the Administrative Code.

(17) "Unlicensed personnel" means a person not currently licensed by the board of nursing as a registered nurse or licensed practical nurse, or a person who does not hold a current valid certificate to practice as a dialysis technician or administer medications as a medication aide.

(18) "Waiver nursing delegation" means activities related to the transfer of responsibility for performance of a specific nursing task from a licensed nurse authorized to perform the task to unlicensed personnel. Waiver nursing delegation has two distinct components:

(a) Waiver nursing delegation/assessment, when the delegating nurse who shall be a registered nurse, conducts a comprehensive assessment of an individual's health for the purpose of determining the appropriateness of delegating nursing tasks to be performed for the individual.

(b) Waiver nursing delegation/consultation, when the delegating nurse who shall be either a registered nurse or a licensed practical nurse at the direction of a registered nurse in accordance with rule 4723-13-05 of the Administrative Code, consults with an individual, a physician who ordered a delegated nursing task, or unlicensed personnel to whom the delegating nurse has delegated responsibility for a nursing task. Waiver nursing delegation/consultation includes:

(i) Evaluation of the ability of unlicensed personnel to perform the delegated task such as:

(a) Verifying that unlicensed personnel have successfully completed prerequisite training; or

(b) Observing a return demonstration of a delegated task performed by unlicensed personnel.

(ii) Development and implementation of a delegation plan such as:

(a) Verifying medications and treatments ordered by physicians;

(b) Creating or modifying individual-specific instructions for performing delegated nursing tasks;

(c) Identifying expected outcomes of delegated nursing tasks;

(d) Identifying possible side effects of prescribed medication being administered under nursing delegation;

(e) Providing instructions for documenting when a delegated task is completed or omitted;

(f) Confirming medications/supplies necessary for the delegated tasks are available in the service setting; or

(g) Completing delegation-related documentation such as medication administration records.

(iii) Evaluation of progress of nursing delegation such as:

(a) Consulting with the individual receiving services, physicians, or unlicensed personnel performing delegated nursing tasks via in-person contact, telephone calls, teleconferencing, videoconferencing, or other means; or

(b) Reviewing delegation-related documentation such as medication administration records, progress notes, physician's orders, or hospital discharge records.

(C) Provider qualifications

(1) Waiver nursing delegation shall be provided by an agency provider or an independent provider that meets the requirements of this rule and that has a medicaid provider agreement with the Ohio department of medicaid.

(2) The person providing waiver nursing delegation shall:

(a) Be a registered nurse or a licensed practical nurse and possess a current, valid, unrestricted license issued by the Ohio board of nursing; and

(b) Be working within the scope of his or her practice as set forth in Chapter 4723. of the Revised Code and administrative rules adopted thereunder.

(3) A county board or a regional council of governments formed under section 5126.13 of the Revised Code by two or more county boards may provide waiver nursing delegation only when no other certified provider is willing and able.

(4) A family member who lives with an individual is not eligible to be paid for waiver nursing delegation provided to that individual.

(5) An applicant seeking approval to provide waiver nursing delegation shall complete and submit an application through the department's website (http://dodd.ohio.gov/).

(6) Failure of a provider to comply with this rule and rule 5123:2-2-01 of the Administrative Code may result in denial, suspension, or revocation of the provider's certification.

(D) Requirements for service delivery

(1) Waiver nursing delegation shall be provided pursuant to a person-centered individual service plan that conforms to the requirements of rule 5123:2-1-11 of the Administrative Code. The individual service plan shall identify the providers that may provide waiver nursing delegation. When an individual receives waiver nursing delegation in multiple settings and/or from multiple providers, the team shall determine and specify in the individual service plan, the allocation of waiver nursing delegation/assessment and/or waiver nursing delegation/consultation services to each provider.

(2) An individual may receive up to:

(a) One waiver nursing delegation/assessment every sixty days in the individual's residential setting; and

(b) One waiver nursing delegation/assessment every sixty days in the individual's adult day services setting.

(3) An individual may receive up to ten hours of waiver nursing delegation/consultation each month, regardless of the number of providers delivering the service.

(4) Waiver nursing delegation/assessment may be billed sequentially to, but not concurrently with, waiver nursing delegation/consultation.

(5) Waiver nursing delegation does not include time spent by a licensed nurse:

(a) Participating in individual service plan development meetings;

(b) Consulting with an individual's team on matters not specifically related to waiver nursing delegation for that individual;

(c) Directly providing nursing services;

(d) Coordinating an individual's health care;

(e) Conducting general health-related training for unlicensed personnel; or

(f) Conducting training described in Chapter 5123:2-6 of the Administrative Code.

(E) Documentation of services

(1) Service documentation for waiver nursing delegation/assessment and waiver nursing delegation/consultation shall include each of the following to validate payment for medicaid services:

(a) Type of service (i.e., waiver nursing delegation/assessment or waiver nursing delegation/consultation).

(b) Date of service.

(c) Place of service.

(d) Name of individual receiving service.

(e) Medicaid identification number of individual receiving service.

(f) Name of provider.

(g) Provider identifier/contract number.

(h) Written or electronic signature of the person delivering the service or initials of the person delivering the service if a signature and corresponding initials are on file with the provider.

(i) Description and details of the service delivered that directly relate to the services specified in the approved individual service plan as the services to be provided, including the name of the unlicensed person for whom a supervisory visit was performed.

(j) Number of units of the delivered service or continuous amount of uninterrupted time during which the service was provided.

(k) Beginning and ending times of the delivered service.

(2) In addition to service documentation specified in paragraph (E)(1) of this rule, service documentation for waiver nursing delegation/assessment shall include the precipitating factor indicating why an assessment was needed, that is:

(a) The individual was discharged from hospital;

(b) The individual has experienced a significant change; or

(c) Initiation of waiver nursing delegation for an individual who has not previously received waiver nursing delegation.

(3) In addition to service documentation specified in paragraph (E)(1) of this rule, service documentation for waiver nursing delegation/consultation shall include a description and details of the consultation purpose and outcomes, including the name of the person with whom the delegating nurse was consulting.

(F) Payment standards

The billing units, procedure codes, and payment rates for waiver nursing delegation are contained in the appendix to this rule.

Supplemental Information

Authorized By: 5123.1611, 5123.049, 5123.04
Amplifies: 5123.04, 5166.21, 5123.1611, 5123.161, 5123.16, 5123.049, 5123.045
Five Year Review Date: 2/15/2023
Rule 5123:2-9-38 | Home and community-based services waivers - social work under the individual options waiver.
 

(A) Purpose

This rule defines social work and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service.

(B) Definitions

(1) "Agency provider" means an entity that directly employs at least one person in addition to the chief executive officer for the purpose of providing services for which the entity must be certified in accordance with rule 5123:2-2-01 of the Administrative Code.

(2) "County board" means a county board of developmental disabilities.

(3) "Department" means the Ohio department of developmental disabilities.

(4) "Family member" means a person who is related to the individual by blood, marriage, or adoption.

(5) "Independent provider" means a self-employed person who provides services for which he or she must be certified in accordance with rule 5123:2-2-01 of the Administrative Code and does not employ, either directly or through contract, anyone else to provide the services.

(6) "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, his or her guardian in accordance with section 5126.043 of the Revised Code.

(7) "Individual service plan" means the written description of services, supports, and activities to be provided to an individual.

(8) "Service and support administrator" means a person, regardless of title, employed by or under contract with a county board to perform the functions of service and support administration and who holds the appropriate certification in accordance with rule 5123:2-5-02 of the Administrative Code.

(9) "Service documentation" means all records and information on one or more documents, including documents that may be created or maintained in electronic software programs, created and maintained contemporaneously with the delivery of services, and kept in a manner as to fully disclose the nature and extent of services delivered that shall include the items delineated in paragraph (E) of this rule to validate payment for medicaid services.

(10) "Social work" means the application of specialized knowledge of human development and behavior as well as social, economic, and cultural systems. This knowledge is used to assist individuals and their families to improve and/or restore their capacity for social functioning. Social work includes the provision of counseling and active participation in problem-solving with individuals and family members; counseling to meet the psychosocial needs of individuals; collaboration with healthcare professionals and other providers to assist them to understand and support the social and emotional needs and problems experienced by individuals and their families; advocacy; referral to community-based and specialized services; development of social work/counseling plans of treatment; and assisting providers of services and family members to understand and implement activities related to implementation of the plan of treatment. Social work is not intended to duplicate the efforts of the service and support administrator.

(C) Provider qualifications

(1) Social work shall be provided by one of the following persons who is either an independent provider or the employee of an agency provider that meets the requirements of this rule and that has a medicaid provider agreement with the Ohio department of medicaid:

(a) An independent social worker licensed by the state pursuant to section 4757.27 of the Revised Code;

(b) A social worker licensed by the state pursuant to section 4757.28 of the Revised Code;

(c) A professional clinical counselor licensed by the state pursuant to section 4757.22 of the Revised Code; or

(d) A professional counselor licensed by the state pursuant to section 4757.23 of the Revised Code.

(2) Social work shall not be provided by a county board or a regional council of governments formed under section 5126.13 of the Revised Code by two or more county boards.

(3) Social work shall not be provided to an individual by his or her family member.

(4) An applicant seeking approval to provide social work shall complete and submit an application through the department's website (http://dodd.ohio.gov/).

(5) Failure to comply with this rule and rule 5123:2-2-01 of the Administrative Code may result in denial, suspension, or revocation of the provider's certification.

(D) Requirements for service delivery

(1) Social work shall be provided pursuant to an individual service plan that conforms to the requirements of rule 5123:2-1-11 of the Administrative Code.

(2) A person providing social work shall:

(a) Document the individual's social needs and develop a social work/counseling plan of treatment;

(b) Provide direct service in the form of counseling and actively participate in resolving problems;

(c) Counsel the individual and involved family members with regard to the individual's psychosocial needs;

(d) Collaborate with the individual's physician and assist various providers of services in understanding emotional and social needs of the individual being served;

(e) Recognize the social needs of the individual and caregiver and take appropriate therapeutic intervention;

(f) Act as an advocate for the individual's social needs;

(g) Assist the individual, staff, and family to resolve challenges which prevent the individual's adjustment or any other challenges which affect the individual's ability to benefit from medical treatment;

(h) Assist the individual to develop self-help, social, and adaptive skills that enable the individual to remain functional within his or her community;

(i) Arrange individual and caregiver counseling and other supportive services to alleviate the pressures of estrangement from social support systems such as family, employment, and residential placement; and

(j) Refer individuals/families to the service and support administrator for financial matters or interagency collaboration and follow-up.

(E) Documentation of services

Service documentation for social work shall include each of the following to validate payment for medicaid services:

(1) Type of service.

(2) Date of service.

(3) Place of service.

(4) Name of individual receiving service.

(5) Medicaid identification number of individual receiving service.

(6) Name of provider.

(7) Provider identifier/contract number.

(8) Written or electronic signature of the person delivering the service or initials of the person delivering the service if a signature and corresponding initials are on file with the provider.

(9) Group size in which the service was provided.

(10) Description and details of the services delivered that directly relate to the services specified in the approved individual service plan as the services to be provided.

(11) Number of units of the delivered service.

(12) Times the delivered service started and stopped.

(F) Payment standards

(1) The billing unit, service codes, and payment rates for social work are contained in appendix A to this rule.

(2) Payment rates for social work are based on the county cost-of-doing-business category. The cost-of-doing-business categories are contained in appendix B to this rule.

(3) Payment rates for social work are established separately for services provided by independent providers and services provided through agency providers.

(4) Payment rates for social work are based on the number of individuals receiving services.

Supplemental Information

Authorized By: 5123.04, 5123.049, 5123.1611
Amplifies: 5123.04, 5123.045, 5123.049, 5123.16, 5123.161, 5123.1611, 5166.21
Five Year Review Date: 7/1/2022
Prior Effective Dates: 11/3/2011