reglab/statecodes huggingface dataset:
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-36 - Program of All-Inclusive Care for the Elderly (PACE) › Section 5160-36-01 - Program of all-inclusive care for the elderly (PACE) definitions

Current through all regulations passed and filed through July 1, 2024
(A) "Authorized representative"
			 has the same meaning as in rule
			 5160:1-1-01
			 of the Administrative Code.
(B) "Capitated
			 payment" means the monthly payment paid to the program
			 of all inclusive care for the elderly PACE organization by
			 the Ohio department of medicaid ( ODM) for medical care and services provided to medicaid
			 recipients enrolled in  PACE.
(C) "Individual" is
			 the applicant for or recipient of a medical assistance program such as
			 medicaid.
(D) "Involuntary disenrollment" means the
			 disenrollment of a participant from 
			 PACE  at the request of the PACE
			 organization or a county department of job and family
			 services.
(E) "PACE" means the
			 'program of all-inclusive care for the elderly' 
								as set forth
								 in 42 C.F.R. Part 460 as in effect on October 1,
			 2019.
(F) "PACE center"
			 means a facility operated by a PACE organization where primary care or other
			 related services offered by  PACE
			  are provided to
			 participants.
(G) "PACE organization" means an entity that has a
			 medicaid provider agreement and also has in effect a PACE
			  agreement with
			 the centers for
			 medicare and medicaid services (CMS) and the Ohio
			 department of aging ( ODA).
(H)
			 "PACE  agreement" means an agreement
			 between a PACE organization, CMS, and ODA.
(I) "Participant"
			 means a person enrolled in  and
			 receiving services through  PACE.
(J) "Private pay
			 participant" means an individual who does not meet the medicaid eligibility
			 criteria but chooses to participate in PACE and is responsible for payment of
			 the PACE organization's private pay premium.
(K) "Service area"
			 means the geographic area in which a PACE organization is approved by CMS and
			 ODA to provide services to PACE participants.
(L)
			 "State administering agency" means the state agency responsible for
			 administering the PACE  agreement.
			 Pursuant to section 173.50 of the Revised Code ODA
			 shall serve as the state administering agency for PACE in Ohio.
(M)
			 "Voluntary disenrollment" means the disenrollment of a participant from
			  PACE  at the request of the participant or the
			 participant's authorized representative.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-36 - Program of All-Inclusive Care for the Elderly (PACE) › Section 5160-36-02 - Program of all-inclusive care for the elderly (PACE) administration

Current through all regulations passed and filed through July 1, 2024
(A) In accordance
			 with section 173.50 of the Revised Code, the
			 Ohio department of aging (ODA) shall serve as the designated state
			 administering agency for 
								PACE and shall adhere to and monitor the
			 implementation of all applicable requirements for the program's administration
			 as set
			 forth in 42 C.F.R Part 460 as in effect on October 1,
			 2019.
(B)
								 ODA shall:
(1) Facilitate the process in which
			 prospective PACE organizations apply to the centers for medicare and medicaid
			 services (CMS) for approval to provide PACE services;
(2) Enter into 
									a PACE
			  agreement with
			 (CMS)
									 and
			 each PACE organization approved by CMS to provide PACE services to participants
			 in Ohio who reside in the PACE organization's designated service area. The
			 content and duration of that agreement shall conform to standards
			 
									set
			 forth in 42 C.F.R. Part 460 as in effect on October 1,
			 2019.
(3)
			 Verify that PACE organizations providing PACE services have signed medicaid
			 provider agreements as required by rule
			 5160-1-17 of
			 the Administrative Code.
(4) Work
			 with PACE organizations to assist individuals seeking enrollment in
			  PACE.
(5) Manage PACE enrollment.
(6)
			 Adopt rules including, but not limited to,  participant eligibility,
			  participant enrollment,
			  participant voluntary disenrollment
			 and  participant involuntary
			 disenrollment.
(7) Confer as necessary and appropriate with the Ohio
			 department of medicaid (ODM) on matters including but not limited to:
(a)
										
										Participant
			 eligibility;
(b)
										Participant enrollment and
										
			 disenrollment, and  program waiting
			 list ;
(c) Establishing the payment
										 for PACE organizations operating in Ohio;
(d) Designating each PACE organization's
			 service area;
(e) The enrollment
			 and disenrollment of PACE organizations;
										 and
(f) The
			 termination of PACE 
			 agreements.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-36 - Program of All-Inclusive Care for the Elderly (PACE) › Section 5160-36-03 - Medicaid funded program of all-inclusive care for the elderly (PACE) eligibility

Current through all regulations passed and filed through July 1, 2024
(A)
								To be eligible
			 and maintain eligibility for PACE, an individual will meet the requirements for
			 PACE participant eligibility set forth in rule
			 173-50-02 of the Administrative
			 Code and will have been determined to be eligible for medicaid in accordance
			 with Chapters
			 5160:1-3 to
			 5160:1-6 of the Administrative
			 Code.
(B)
								If a PACE participant who is also enrolled in medicaid
			 has a continuous period of institutionalization as defined in rule
			 5160:1-6-01.1 of the
			 Administrative Code, that individual's patient liability amount is to be
			 calculated by the county department of job and family services as directed in
			 rule 5160:1-6-07.1 of the
			 Administrative Code.
(C)
								Individuals who fail to meet the eligibility
			 requirements in paragraph (A) of this rule will not be enrolled as a medicaid
			 participant in PACE.
(1)
									Once enrolled, participants who no longer meet the
			 eligibility requirements in paragraph (A) of this rule will be involuntarily
			 disenrolled from the medicaid-funded component of PACE pursuant to rule
			 173-50-05 of the Administrative
			 Code.
(2)
									An individual who no longer meets medicaid eligibility
			 requirements in paragraph (A) of this rule may continue non-medicaid funded
			 enrollment in PACE as defined within rule 173-50-02 of the Administrative
			 Code.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-36 - Program of All-Inclusive Care for the Elderly (PACE) › Section 5160-36-05 - Program of all-inclusive care for the elderly (PACE): care coordination

Current through all regulations passed and filed through July 1, 2024
(A) Each PACE
			 organization shall establish and maintain at each PACE center an
			 interdisciplinary team to assess the care and service needs of
			  participants. The composition, qualifications, and activities of the
			 interdisciplinary team shall be consistent with 42 C.F.R. Part 460 as in effect
			 on October 1, 2019.
(B) PACE organizations shall ensure that all
			  participants have access to all
			 medically necessary services including, but not limited to, services covered by
			 Ohio's medicaid program, in addition to those prescribed in
			 42 C.F.R. Part
			 460.92 as in effect on October 1,
			 
								2019 to
			 42 C.F.R. Part
			 460.96 as in effect on October 1,
			 
								2019.
(1) Services provided shall be sufficient in
			 their amount, duration and scope to meet the participant's medical, physical,
			 emotional, and social needs as identified in the comprehensive assessment to
			 achieve the measurable outcomes identified in the participant's plan of
			 care.
(2) Services provided shall
			 be reflected in the participant's plan of care unless the services are an
			 emergency service.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-36 - Program of All-Inclusive Care for the Elderly (PACE) › Section 5160-36-06 - Program of all-inclusive care for the elderly (PACE): organization reimbursement

Current through all regulations passed and filed through July 1, 2024
(A) PACE is a full-risk program in which the
			 PACE organization assumes all financial risk for the cost of the medical care
			 and services provided to 
			 participants.
(B) PACE
			 organizations shall receive a monthly capitated payment from the Ohio
			 department of medicaid (ODM) for each PACE participant enrolled in the medicaid
			 program including individuals enrolled in both medicaid and medicare.
(C) The amount of the capitated payment shall
			 be established in the PACE 
			 agreement.
(D) The amount paid in accordance with
			 paragraph (B) of this rule represents the total maximum payment obligation of
			 the state administering agency to the PACE organization for the cost of medical
			 care and services provided to 
			 participants enrolled in medicaid including those participants enrolled in both
			 medicaid and medicare.
(E) The PACE
			 organization shall accept the capitation payment amount as payment in full for
			 medicaid participants and shall not bill, charge, collect, or receive any other
			 form of payment from ODM or from, or on behalf of, the participant, except as
			 permitted under
			 42 C.F.R. Part
			 460.182(c) as in effect on
			 October 1, 2019.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-40 - HCBS Waiver VI Program › Section 5160-40-01 - Medicaid home and community-based services program - individual options waiver

Current through all regulations passed and filed through July 1, 2024
(A)
								Purpose
(1)
									The Ohio
			 department of developmental disabilities (DODD) is responsible for the daily
			 operations of the individual options (IO) waiver which will be administered
			 pursuant to sections 5166.02 and
			 5166.20 of the Revised
			 Code.
(2)
									DODD operates the IO waiver program pursuant to an
			 interagency agreement with the Ohio department of medicaid (ODM) in accordance
			 with section 5162.35 of the Revised
			 Code.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-41 - HCBS Waiver VII Program › Section 5160-41-05 - Waiting lists for home and community-based services administered by the Ohio department of developmental disabilities

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
This rule sets forth the requirements of a county board of
				developmental disabilities to establish and maintain a waiting list for home
				and community-based services.
(B) Definitions
(1) "County board" means a county board of
			 developmental disabilities established under Chapter 5126. of the Revised Code with local
			 administrative authority.
(2)
			 "DODD" means the Ohio department of developmental disabilities established
			 under section
			 121.02
			 of the Revised Code.
(3) "Home and
			 community-based services" means services provided under a medicaid-funded
			 waiver pursuant to section 
									
										5166.04
									 of the Revised Code.
(4)
			 "ODM" means the Ohio department of medicaid.
(5) "Waiting lists" means a list established
			 and maintained in accordance with rule
			 5123-9-04
			 of the Administrative Code.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-41 - HCBS Waiver VII Program › Section 5160-41-08 - Free choice of provider requirements for medicaid home and community-based services programs administered by the Ohio department of developmental disabilities

Current through all regulations passed and filed through July 1, 2024
(A) The purpose of this rule is to set forth
			 the requirements the Ohio department of developmental disabilities (DODD) must
			 meet to assure free choice of provider.
(B) The 
								DODD through
			 an interagency agreement with the Ohio department of medicaid (ODM), acts as
			 the administrative agency for components of the medicaid home and
			 community-based services programs in accordance with section
			 5162.35
			 of the Revised Code. In accordance with section
			 5166.21
			 of the Revised Code, the DODD, as the designated administrator, shall
			 promulgate rule(s) to require that recipients of home and community-based
			 services are provided choice of medicaid home and community-based providers
			 consistent with federal free choice of provider requirements set forth in
			 42 C.F.R.
			 431.51 (October 1, 2021). Any
			 rule(s) authorized by this rule and promulgated by the DODD are valid only to
			 the extent they are consistent with
			 42 C.F.R.
			 431.51. If the rules promulgated by DODD are
			 capable of more than one interpretation, they shall be applied in a manner most
			 consistent with the letter and intent of
			 42 C.F.R.
			 431.51.
(C) Rules promulgated by DODD shall establish
			 policies related to the provision of free choice of medicaid home and
			 community-based service providers for each service specified in a recipient's
			 individual service plan and shall include the following:
(1) The general roles and responsibilities of
			 the county board of developmental disabilities as specified in rule 5123-9-11
			 of the Administrative Code.
(2) The
			 roles and responsibilities of the county board of developmental disabilities
			 for the assurance of due process and fair hearing rights regarding recipients'
			 free choice of medicaid home and community-based service providers.
(3) The roles and responsibilities of DODD
			 for monitoring and assuring compliance with recipients' free choice of medicaid
			 home and community-based service provider requirements.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-41 - HCBS Waiver VII Program › Section 5160-41-16 - Assistance to enable a county board of developmental disabilities to pay non-federal share of medicaid expenditures for home and community-based services

Current through all regulations passed and filed through July 1, 2024
(A) Purpose.
This rule authorizes the provisions set forth in rule
				5123-4-05 of the Administrative Code which sets forth
				the process a county board of developmental disabilities must follow to request
				assistance from the department of developmental disabilities (DODD) in the
				event of failure of a county property tax levy for home and community-based
				services (HCBS) to individuals with developmental disabilities in that
				county.
(B) Definitions.
(1) "County board" means a county board of
			 developmental disabilities established under Chapter 5126. of the Revised
			 Code.
(2) "Home and community-based
			 services" means medicaid-funded home and community-based services provided
			 pursuant to section
									5166.20
									 of the Revised Code.
(3) "OBM" means the office of budget and
			 management as established by section
			 121.02 of the Revised
			 Code.
(4) "ODM" means the Ohio
			 department of medicaid.
(5) "DODD"
			 means the Ohio department of developmental disabilities established under
			 section 121.02 of the Revised
			 Code.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-41 - HCBS Waiver VII Program › Section 5160-41-17 - Medicaid home and community-based services program - self-empowered life funding waiver

Current through all regulations passed and filed through July 1, 2024
(A)
								Purpose.
(1)
									The Ohio
			 department of developmental disabilities (DODD) is responsible for the daily
			 operation of the self-empowered life funding (SELF) waiver which will be
			 administered pursuant to sections
			 5166.02 and
			 5166.20 of the Revised
			 Code.
(2)
									DODD operates the SELF waiver program pursuant to an
			 interagency agreement with the Ohio department of medicaid (ODM) in accordance
			 with section 5162.35 of the Revised
			 Code.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-41 - HCBS Waiver VII Program › Section 5160-41-18 - Individual options waiver-payment standards

Current through all regulations passed and filed through July 1, 2024
(A) Purpose.
The purpose of this rule is to establish the payment standards
				for the individual options home and community-based services (HCBS) waiver for
				services provided to individuals enrolled in a HCBS program, as a component of
				the medicaid program and as administered by the department of developmental
				disabilities (DODD) in accordance with sections
				5166.02 and
				5166.23 of the Revised
				Code.
(B) The DODD is
			 responsible for the daily administration of certain components of the medicaid
			 program, to include HCBS, pursuant to an interagency agreement with the Ohio
			 department of medicaid (ODM) in accordance with sections
			 5162.35 and
			 5166.21 of the Revised
			 Code.
(C) Individuals enrolled in
			 the individual options HCBS program administered by DODD shall be subject to
			 payment standards set forth in this rule and the rules associated with the
			 individual options waiver program as established in Chapters 5123:2-9
			 and 5123-9 of the Administrative Code.
(D) Payment for individual options waiver
			 services shall not exceed the maximum rates established in Chapters 5123:2-9
			 and 5123-9 of the Administrative Code.
(E) Claims for the provision of HCBS shall be
			 submitted in accordance with the process specified in rule
			 5123-9-06 of the Administrative Code.
(F) Claims for the provision of HCBS shall be
			 paid as indicated in this rule when the following conditions exist:
(1) The waiver service is provided to an
			 individual who is enrolled in a waiver program at the time of service;
			 and
(2) The waiver service is
			 provided within the limitations specified by the waiver program in which the
			 individual is enrolled; and
(3) The
			 waiver service is provided to an enrollee who is not an inpatient of a hospital
			 and is not residing in a nursing facility or an intermediate care facility for
			 individuals with intellectual disabilities (ICF/IID).
(a) An individual enrolled in a DODD
			 administered waiver program which offers residential respite as one of the waiver services
			 shall not be considered a resident of an
			 ICF/IID if the ICF/IID is providing
			 the residential respite service.
(b) An ICF/IID
			 providing respite services for any DODD administered waiver program that offers
			 such services shall not bill medicaid through the ICF/
			 IID program. Payments for respite services shall be made through the
			 waiver program in which the individual is enrolled.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-41 - HCBS Waiver VII Program › Section 5160-41-19 - Level one waiver-payment standards

Current through all regulations passed and filed through July 1, 2024
(A) Purpose.
The purpose of this rule is to establish the payment standards
				for the level one home and community-based services (HCBS) waiver for services
				provided to individuals enrolled in a HCBS program, as a component of the
				medicaid program and as administered by the department of developmental
				disabilities (DODD) in accordance with sections
				5166.02 and
				5166.23 of the Revised
				Code.
(B) The DODD is
			 responsible for the daily administration of certain components of the medicaid
			 program, to include HCBS, pursuant to an interagency agreement with the Ohio
			 department of medicaid (ODM) in accordance with sections
			 5162.35 and
			 5166.21 of the Revised
			 Code.
(C) Individuals enrolled in
			 the level one HCBS program administered by DODD shall be subject to payment
			 standards set forth in this rule and the rules associated with the level one
			 waiver program as established in Chapters 5123:2-9 and
			 5123-9 of the Administrative Code.
(D) Payment for level one waiver services
			 shall not exceed the maximum rates established in Chapters 5123:2-9
			 and 5123-9 of the Administrative Code.
(E) Claims for the provision of HCBS shall be
			 submitted in accordance with the process specified in rule
			 5123-9-06 of the Administrative Code.
(F) Claims for the provision of HCBS shall be
			 paid as indicated in this rule when the following conditions exist:
(1) The waiver service is provided to an
			 individual who is enrolled in a waiver program at the time of service;
			 and
(2) The waiver service is
			 provided within the limitations specified by the waiver program in which the
			 individual is enrolled; and
(3) The
			 waiver service is provided to an enrollee who is not an inpatient of a hospital
			 and is not residing in a nursing facility or an intermediate care facility for
			 individuals with intellectual disabilities (ICF/IID).
(a) An individual enrolled in a DODD
			 administered waiver program which offers residential respite as one of the
			 waiver services shall not be considered a resident of
			 
										an ICF/IID if the ICF/IID is providing the residential respite
			 service.
(b) An ICF/IID
			 providing residential respite services for any DODD administered waiver program
			 that offers such services shall not bill medicaid through the ICF/IID program. Payments for residential respite
			 services shall be made through the waiver program in which the individual is
			 enrolled.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-41 - HCBS Waiver VII Program › Section 5160-41-20 - Self-empowered life funding waiver - payment standards

Current through all regulations passed and filed through July 1, 2024
(A) Purpose.
The purpose of this rule is to establish the payment standards
				for the self empowered life funding (SELF) home and community-based services
				(HCBS) waiver for services provided to individuals enrolled in a HCBS program,
				as a component of the medicaid program and as administered by the department of
				developmental disabilities (DODD) in accordance with sections
				5166.02 and
				5166.23 of the Revised
				Code.
(B) The DODD is
			 responsible for the daily administration of certain components of the medicaid
			 program, to include HCBS, pursuant to an interagency agreement with the Ohio
			 department of medicaid (ODM) in accordance with sections
			 5162.35 and
			 5166.21 of the Revised
			 Code.
(C) Payment for SELF waiver
			 services shall not exceed the maximum rates established in rule
			 5123-9-40 of the Administrative Code.
(D) Claims for the provision of HCBS shall be
			 submitted in accordance with the process specified in rule
			 5123-9-40 of the Administrative Code.
(E) Claims for the provision of HCBS shall be
			 paid as indicated in this rule when the following conditions exist:
(1) The waiver service is provided to an
			 individual who is enrolled in a waiver program at the time of service;
			 and
(2) The waiver service is
			 provided within the limitations specified by the waiver program in which the
			 individual is enrolled; and
(3) The
			 waiver service is provided to an enrollee who is not an inpatient of a hospital
			 and is not residing in a nursing facility or an intermediate care facility for
			 individuals with intellectual disabilities (ICF/IID).
(a) An individual enrolled in a DODD
			 administered waiver program which offers residential respite as one of the
			 waiver services shall not be considered a resident of
			 an ICF/ IID if the ICF/IID is
			 providing the residential respite service.
(b) An ICF/IID providing respite services for
			 any DODD administered waiver program that offers such services shall not bill
			 medicaid through the ICF/ IID program. Payments for respite services shall be
			 made through the waiver program in which the individual is enrolled.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-42 - Medicaid Home and Community-Based Services-Level One Waiver Program › Section 5160-42-01 - Medicaid home and community-based services program - level one waiver

Current through all regulations passed and filed through July 1, 2024
(A)
								Purpose
(1)
									The Ohio
			 department of developmental disabilities (DODD) is responsible for the daily
			 operation of the level one (L1) waiver which will be administered pursuant to
			 sections 5166.20 and
			 5166.02 of the Revised
			 Code.
(2)
									DODD operates the L1 waiver program pursuant to an
			 interagency agreement with the Ohio department of medicaid (ODM) in accordance
			 with section 5162.35 of the Revised
			 Code.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-43 - Specialized Recovery Services Program › Section 5160-43-04 - Specialized recovery services program covered services and provider requirements

Current through all regulations passed and filed through July 1, 2024
(A) This rule sets forth the covered services
			 available to an individual enrolled in the specialized recovery services
			 program (SRSP) and the requirements for providers of those services.
(B) Individualized placement and support -
			 supported employment (IPS-SE) is the implementation of evidence-based practices
			 allowing individuals to obtain and maintain meaningful employment by providing
			 training, ongoing individualized support, and skill development to promote
			 recovery. IPS-SE is an evidence based practice which is integrated and
			 coordinated with mental health treatment and rehabilitation designed to provide
			 individualized placement and support to assist individuals with a severe and
			 persistent mental illness obtain, maintain, and advance within competitive
			 community integrated employment positions.
(1)
			 IPS-SE activities include:
(a) Benefits
			 planning;
(b) Development of a
			 vocational plan;
(c) General
			 consultation, including advocacy and building and maintaining relationships
			 with employers;
(d) Individualized
			 job supports, including regular contact with the individual's employer(s),
			 family members, guardians, advocates, treatment providers, and other community
			 supports;
(e) Job
			 coaching;
(f) Job development and
			 placement;
(g) Job seeking skills
			 training;
(h) On-the-job training
			 and skill development;
(i)
			 Vocational rehabilitation guidance and counseling;
(j) Time unlimited vocational support;
			 and
(k) Vocational
			 assessment.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-43 - Specialized Recovery Services Program › Section 5160-43-07 - Specialized recovery services program compliance: provider monitoring, oversight and investigations

Current through all regulations passed and filed through July 1, 2024
(A) The Ohio department of medicaid (ODM) is
			 responsible for the ongoing monitoring and oversight of all providers of
			 specialized recovery services (hereafter referred to as providers) and
			 contractors to ensure compliance with program requirements.
(B) Monitoring and oversight of specialized
			 recovery services program providers and recovery management contractors:
(1) ODM and/or its designee (hereafter
			 referred to as ODM) shall conduct ongoing monitoring and oversight of providers
			 and contractors, to verify each provider is:
(a) Complying with the terms and conditions
			 of its medicaid provider agreement or contract, the program and all applicable
			 federal, state and local regulations;
(b) Ensuring the health and welfare of
			 individuals to whom they provide services; and
(c) Ensuring the provision of quality
			 services as part of the program.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-43 - Specialized Recovery Services Program › Section 5160-43-08 - Specialized recovery services program billing procedures and payment rates for recovery management

Current through all regulations passed and filed through July 1, 2024
(A) Definitions of terms used for billing and
			 calculating rates.
(1) "Billing unit" as used
			 in column 4 of paragraph (C) of this rule, means a single fixed item, amount of
			 time or measurement.
(2) "Unit
			 rate" as used in column 3 of paragraph (C) of this rule, means the amount
			 reimbursed by the Ohio department of medicaid (ODM) for each fifteen minutes of
			 service delivered.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-43 - Specialized Recovery Services Program › Section 5160-43-09 - Specialized recovery services program criminal records checks for providers

Current through all regulations passed and filed through July 1, 2024
(A) This rule sets
			 forth the process and requirements for the criminal records checks of providers
			 of home and community-based services (HCBS) to individuals enrolled in the
			 specialized recovery services program. HCBS include recovery management, peer recovery support and
			 individualized placement and support-supported employment (IPS-SE). This rule
			 only applies to all persons under final consideration for employment with an
			 agency and existing employees in a full-time, part-time or temporary position
			 who are providing HCBS and billing medicaid for these services.
(B) For the purposes of this rule:
(1) "Agency" means an entity certified by the
			 Ohio department of mental health and addiction services under section
			 5119.36
			 of the Revised Code.
(2) "Chief
			 administrator" means the head of an agency, or his or her designee.
(3) "Criminal records check" has the same
			 meaning as in section
			 109.572 of
			 the Revised Code.
(4)
			 "Disqualifying offense" means any of the following:
(a) A violation of one or more Revised Code
			 section(s) set forth in the appendix to this rule;
(b) A violation of section
			 2923.01,
			 2923.02,
			 or
			 2923.03 of the Revised
			 Code when the underlying offense that is the object of the conspiracy, attempt,
			 or complicity is a violation of one of the sections set forth in the appendix
			 to this rule; or
(c) A violation of
			 an existing or former municipal ordinance or law of the state of Ohio, any
			 other state or the United States that is substantially equivalent to any of the
			 disqualifying offenses as set forth in paragraphs (B)(4)(a) and (B)(4)(b) of
			 this rule.
(5) "Employ"
			 means to hire a provider applicant to be an employee as defined in paragraph
			 (B)(6) of this rule.
(6) "Employee"
			 means a person employed by an agency in a full-time, part-time or temporary
			 position, including conditional employment as described in paragraph (D)(4) of
			 this rule, that involves providing HCBS  including peer recovery support and IPS-SE
			 when medicaid is billed for these services.
(7) "Provider applicant" means a person who
			 is under final consideration for employment with an agency in a full-time,
			 part-time or temporary position, when the position provides HCBS when medicaid
			 is billed for these services.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-44 - Nursing Facility-Based Level of Care Home and Community-Based Services Programs › Section 5160-44-01 - Nursing facility-based level of care home and community-based services programs: home and community-based settings

Current through all regulations passed and filed through July 1, 2024
(A)
								Individuals
			 receiving home and community-based services (HCBS) through either an Ohio
			 department of medicaid (ODM) or Ohio department of aging (ODA) -administered
			 waiver program authorized under section 1915(c) of the Social Security Act (as
			 in effect on January 1, 2023) or the Ohio medicaid state plan authorized under
			 section 1915(i) of the Social Security Act (as in effect on January 1,
			 2023)
			 
								have to
			 reside in and/or receive HCBS in a private residence or another setting that
			 meets the home and community-based setting requirements set forth in this rule.
(1) A private residence is presumed to be a
			 home and community-based setting provided it meets the requirements set forth
			 in paragraph (B) of this rule. For the purposes of this rule, provider owned or
			 controlled settings are not private residences.
(2) Home and community-based settings do not
			 include any of the following:
(a) A nursing
			 facility;
(b) An institution for
			 mental diseases;
(c) An
			 intermediate care facility for individuals with intellectual
			 disabilities;
(d) A hospital;
(e)
										A psychiatric
			 residential treatment facility; or
(f)
			 Any other locations as determined by the ODM or its designee.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-44 - Nursing Facility-Based Level of Care Home and Community-Based Services Programs › Section 5160-44-02 - Nursing facility-based level of care home and community-based services programs: person-centered planning and documentation standards

Current through all regulations passed and filed through July 1, 2024
(A) Person-centered planning process.
Individuals receiving home and community-based services (HCBS)
				through either an Ohio department of medicaid (ODM) or Ohio department of aging
				(ODA) - administered waiver program authorized under section 1915(c) of the
				Social Security Act (as in effect on January 1, 2024) or the Ohio
				medicaid state plan authorized under section 1915(i) of the Social Security Act
				(as in effect on January 1, 2024) will lead the person-centered planning process
				where possible. The individual's authorized representative should have a
				participatory role, as needed, and as defined by the individual, unless Ohio
				law confers decision-making authority to the legal representative. All
				references to individuals include the role of the individual's authorized
				representative. In addition to being led by the individual receiving services
				and supports, the person-centered planning process will:
(1) Include a team of people chosen by the
			 individual.
(2) Provide necessary
			 information and support to ensure that the individual directs the process to
			 the maximum extent possible and is enabled
			 to make informed choices and decisions.
(3) Be timely and occur at times and
			 locations of convenience to the individual.
(4) Reflect cultural considerations of the
			 individual. The process 
									will be conducted by providing information in
			 plain language and in a manner that is accessible to persons with disabilities
			 and persons who are limited English proficient, consistent with
			 42 CFR
			 435.905(b) (as in effect
			 October 1, 2023).
(5)
			 Include strategies for solving conflict or disagreement within the process, including clear conflict of interest guidelines for all
			 planning participants.
(6)
			 Ensure that providers of HCBS for the individual, or those who have an interest
			 in or are employed by a provider of HCBS for the individual
			 
									will not
			 provide case management, provider oversight, or develop the person-centered
			 services plan.
(7) Offer informed
			 choices to the individual regarding the services and supports he or she
			 receives and from whom.
(8) Include
			 a method for the individual to request updates to the person-centered services plan as needed. The
			 individual may request a person-centered services plan review at any
			 time.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-44 - Nursing Facility-Based Level of Care Home and Community-Based Services Programs › Section 5160-44-11 - Nursing facility-based level of care home and community-based services programs: home delivered meals

Current through all regulations passed and filed through July 1, 2024
(A)
								The following
			 definitions are applicable to this rule:
(1)
									"Dietitian" and
			 "licensed dietitian" mean a person with a current, valid license to practice
			 dietetics under section
			 4759.06 of the Revised
			 Code.
(2)
									"Home delivered meals" is a meal delivery service based
			 on an individual's need for assistance with activities of daily living (ADLs)
			 and/or instrumental activities of daily living (IADLs) in order to safely
			 prepare meals, or ensure meals are prepared to meet the individual's dietary
			 needs or specialized nutritional needs, including kosher meals. The type of
			 home delivered meals are the following
(a)
										Standard meal
			 means a meal that adheres to the version of the "Dietary Guidelines for
			 Americans" in effect on the delivery day and at least thirty-three per cent of
			 the individual's dietary reference intakes. A standard meal may include, but is
			 not limited to, a reduced calorie meal, reduced sodium meal, reduced sugar
			 meal, a gluten-free meal, or vegetarian meal, if the individual chooses the
			 meal by personal preference.
(b)
										Kosher meal is a
			 meal that complies with the kosher practices for meal preparation and dietary
			 restrictions and certified as kosher by a recognized kosher certification or a
			 kosher establishment under orthodox rabbinic supervision.
(c)
										Therapeutic meal
			 means a meal provided in accordance to an order by a licensed healthcare
			 professional whose scope of practice includes ordering therapeutic diets:
(i)
											For management of
			 a disease or clinical condition;
(ii)
											To modify,
			 eliminate, decrease or increase certain substances in the diet;
			 or
(iii)
											To provide mechanically altered food when
			 indicated.
(3)
									"Meals" are
			 single portions that are ready to eat, frozen, vacuum-packed,
			 modified-atmosphere-packed, or shelf-stable. Meals have all the following
			 characteristics:
(a)
										It includes instructions on how to safely maintain,
			 heat, reheat and/or assemble the meal, in a manner understandable to the
			 individual and/or their caregiver.
(b)
										It adheres to the
			 individual's medical restrictions as set forth in their person-centered
			 services plan.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-44 - Nursing Facility-Based Level of Care Home and Community-Based Services Programs › Section 5160-44-12 - Nursing facility-based level of care home and community-based services programs: home maintenance and chore

Current through all regulations passed and filed through July 1, 2024
(A) "Home maintenance and chore
			 " means a service that maintains a
			 clean and safe living environment through the performance of tasks in the
			 individual's home that are beyond the individual's capability. Home maintenance
			 and chore services shall not exceed a total of ten thousand dollars in a
			 calendar year per individual. Covered home maintenance and
			 
								chore activities include:
(1) Minor home maintenance and repair
			 including inspecting, maintaining, and repairing furnaces, including pilot
			 lights and filters; inspecting, maintaining, and repairing water faucets,
			 drains, heaters, and pumps; replacing or installing electrical fuses; plumbing
			 and electrical repairs; repair or replacement of screens or window panes;
			 fixing floor surfaces posing a threat to the individual's health, safety, and
			 welfare; and moving heavy items to provide safe ingress and egress.
(2) Heavy household cleaning, including
			 washing walls and ceilings; washing the outside of windows; non-routine washing
			 of windows; removing, cleaning and rehanging curtains or drapery; and
			 shampooing carpets or furniture.
(3)
									
									Removal of environmental
			 hazards posing a threat to the individual's health, safety, and
			 welfare
									such
			 as:
(a)
										Non-routine disposal of garbage or other accumulated items
			 in an individual's residence;
(b)
										Non-routine yard
			 maintenance including snow removal;
(c)
										Pest control and
			 related tasks to prevent, suppress, eradicate, or remove pests;
			 and
(d)
										Mold eradication.
(4)
									Upkeep and
			 maintenance of a home modification or adaptive/assistive devices, such
			 as:
(a)
										Routine
			 maintenance plan;
(b)
										Extended warranty; and
(c)
										Service call,
			 labor and parts for a modification or device that ceases to function as
			 intended.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-44 - Nursing Facility-Based Level of Care Home and Community-Based Services Programs › Section 5160-44-13 - Nursing facility-based level of care home and community-based services programs: home modification

Current through all regulations passed and filed through July 1, 2024
(A)
								"Home
			 modifications" are environmental adaptations to the private home(s) of the
			 individual authorized by the individual's person-centered services plan, that
			 are necessary to ensure the health, welfare and safety of the individual or
			 that enable the individual to function with greater independence in the home.
			 Such adaptations include, but are not limited to, the installation of ramps and
			 grab-bars, widening of doorways, modification of bathroom or kitchen
			 facilities, or the installation of specialized electric and plumbing systems
			 that are necessary to accommodate the medical equipment and supplies that are
			 necessary for the welfare of the individual. Home modifications also include
			 replacement of previous home modifications when it is determined the
			 modification cannot be repaired through another resource. Home modifications
			 shall not exceed a total of ten thousand dollars in a calendar year per
			 individual. The Ohio department of medicaid (ODM), Ohio department of aging
			 (ODA) or their designee will approve the lowest cost alternative that meets the
			 individual's assessed needs.
(B)
								Home
			 modifications do not include:
(1)
									Adaptations or improvements to the home that are of
			 general utility, and are not of direct medical or remedial benefit to the
			 individual including, but not limited to, carpeting, roof repair and central
			 air conditioning.
(2)
									Adaptations that add to the total square footage of the
			 home, except when necessary to complete an adaptation (e.g., in order to
			 improve entrance/egress to a home or to configure a bathroom to accommodate a
			 wheelchair).
(3)
									New, replacement home modifications or repair of
			 previously approved home modifications that have been damaged as a result of
			 apparent misuse, abuse, or negligence.
(4)
									Removing
			 modifications and returning the property to its prior condition when an
			 individual vacates the premises.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-44 - Nursing Facility-Based Level of Care Home and Community-Based Services Programs › Section 5160-44-14 - Nursing facility-based level of care home and community-based services programs: community integration

Current through all regulations passed and filed through July 1, 2024
(A)
								" Community
			 integration"
								means independent living assistance
			 and community support coaching activities that are necessary to enable an
			 individual to live independently and have access to, choice of, and an
			 opportunity to participate in, a full range of community activities.
(B)
								"
			 Independent living assistance"
								means help
			 for individuals to manage their households and personal affairs,
			 self-administer medications, and retain their community living arrangements.
			 Independent living assistance can be furnished through telephone support,
			 in-person support or travel attendant activities, as applicable to the tasks
			 performed. 
								Activities may include:
(1) Reminding an individual to take their
			 medications;
(2) Contacting
			 individuals at times no other in-home services are being provided to confirm
			 the individual is functioning safely in their home;
(3) Assisting with banking;
(4) Organizing and coordinating health
			 records;
(5) Assisting with
			 applications for public programs including homestead exemption, the home energy
			 assistance program, and subsidized housing;
(6) Monitoring and replenishing needed
			 groceries (does not include cost of groceries);
(7) Assisting with business and personal
			 correspondence;
(8) Accompanying an
			 individual to their medical and other appointments; and
(9) Accompanying an individual on their
			 errands and to other activities in the community.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-44 - Nursing Facility-Based Level of Care Home and Community-Based Services Programs › Section 5160-44-16 - Nursing facility-based level of care home and community-based services programs: personal emergency response systems

Current through all regulations passed and filed through July 1, 2024
(A)
								" Personal
			 emergency response systems" (PERS) is a service
			 with a monitoring, reminder and/or reporting component available to support
			 individuals' independence in the community. PERS include telecommunications
			 equipment, a central monitoring station (station), and a medium for two-way,
			 hands-free communication between the individual and the station. Personnel at
			 the station respond to an individual's alarm signal via the individual's PERS
			 equipment.
(B)
								" PERS equipment"
								
								means
			 equipment that is appropriate to meet the assessed needs of the
			 individual as authorized on the individual's person-centered services plan and
			 that
			 meets all of the following characteristics:
(1)
									Includes an activation device
			 that is wearable and water-resistant
									according to a
			 generally-accepted industry standard for water resistance to a level matching
			 the individual's assessed needs and preferences.
(2)
									
									Has an internal battery providing at least
			 twenty-four hours of power without recharging.
(3)
									
									Accommodates the individual's needs and
			 preferences .
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-44 - Nursing Facility-Based Level of Care Home and Community-Based Services Programs › Section 5160-44-17 - Nursing facility-based level of care home and community-based services programs: out-of-home respite

Current through all regulations passed and filed through July 1, 2024
(A) "Out-of-home respite services" are
			 services delivered to an individual in an out-of-home setting to allow
			 
								a period of
			 rest or relief for caregivers normally providing care. The service
			 
								will
			 include an overnight stay.
(1) An out-of-home
			 respite provider 
									will make available the following:
(a) Waiver nursing services as set forth in
			 rule 5160-44-22 of the Administrative
			 Code;
(b) Personal care services as
			 set forth in rule
			 5160-46-04 of the Administrative
			 Code if the individual is enrolled on an Ohio department of medicaid (ODM)
			 -administered waiver, or rule
			 173-39-02.11 of the
			 Administrative Code if the individual is enrolled in the PASSPORT program
			 administered by the Ohio department of aging (ODA); and
(c) Three meals per day that meet the
			 individual's dietary requirements.
Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-44 - Nursing Facility-Based Level of Care Home and Community-Based Services Programs › Section 5160-44-22 - Nursing facility-based level of care home and community-based services programs: waiver nursing services

Current through all regulations passed and filed through July 1, 2024
(A) "Waiver nursing services" are defined as
			 nursing tasks and activities provided to individuals who require the skills of
			 a registered nurse (RN) or licensed practical nurse (LPN) at the direction of
			 an RN.
(1) All nurses providing waiver nursing
			 services to individuals will:
(a) Possess a
			 current, valid and unrestricted license with the Ohio board of nursing;
			 and
(b) Possess an active medicaid provider
			 agreement or be employed by an entity that has an active medicaid provider
			 agreement; and
(c) Provide services
			 within the nurse's scope of practice as set forth in Chapter 4723. of the
			 Revised Code and agency 4723 of the Administrative Code rules adopted
			 thereunder.