Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-9 - Home and Community-Based Services Waivers › Section 5123-9-31 - Home and community-based services waivers - homemaker/personal care daily billing unit for sites where individuals enrolled in the individual options waiver share services

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
This rule establishes a daily billing unit for
				homemaker/personal care when individuals share the services of the same agency
				provider at the same site as part of the home and community-based services
				individual options waiver administered by the Ohio department of developmental
				disabilities. The daily billing unit for individuals/sites that qualify
				
									will be
				used by agency providers instead of the fifteen-minute billing unit established
				in rule 5123-9-30 of the Administrative
				Code. Requirements set forth in paragraphs (C) and (D) of rule
				5123-9-30 of the Administrative
				Code apply to the homemaker/personal care daily billing unit.
(B) Definitions
For the purposes of this rule, the following definitions
				 apply:
(1) "Agency provider" means an entity that
			 directly employs at least one person in addition to a director of operations
			 for the purpose of providing services for which the entity must be certified in
			 accordance with rule
			 5123-2-08 of the Administrative
			 Code.
(2) "Cost projection tool"
			 means the web-based analytical tool, that is a component of the medicaid
			 services system, developed and administered by the department, used to project
			 the cost of home and community-based services identified in an individual
			 service plan.
(3) "County board"
			 means a county board of developmental disabilities.
(4) "Daily billing unit" means an agency
			 provider's payment amount for homemaker/personal care services for each
			 individual sharing services at a site in a calendar month. The daily billing
			 unit is calculated based on projected service utilization entered in the
			 medicaid services system by the county board and direct service hours entered
			 in the medicaid services system by the agency provider of homemaker/personal
			 care services.
(5) "Date of
			 service" means a date on which an individual resides at the site where
			 homemaker/personal care services are shared. "Date of service" excludes any
			 date on which an individual is admitted to an intermediate care facility for
			 individuals with intellectual disabilities or a nursing facility.
(6) "Department" means the Ohio department of
			 developmental disabilities.
(7)
			 "Direct service hours" means the direct staff time spent delivering
			 homemaker/personal care services. A direct service hour is comprised of four
			 fifteen-minute billing units.
(8)
			 "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.
(9) "Homemaker/personal care" has the same
			 meaning as in rule
			 5123-9-30 of the Administrative
			 Code.
(10) "Independent provider"
			 means a self-employed person who provides services for which
			 
									the person is certified in accordance with rule
			 
									5123-2-09 of the Administrative Code and does not
			 employ, either directly or through contract, anyone else to provide the
			 services.
(11) "Individual" means a
			 person with a developmental disability or for purposes of giving, refusing to
			 give, or withdrawing consent for services, 
									the person's guardian in accordance
			 with section 5126.043 of the Revised Code or
			 other person authorized to give consent.
(12) "Individual service plan" means the
			 written description of services, supports, and activities to be provided to an
			 individual.
(13) "Medicaid services
			 system" means the comprehensive information system that integrates cost
			 projection, prior authorization, daily rate calculation, and payment
			 authorization of waiver services.
(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
			 
									includes the items delineated in paragraph (E) of this
			 rule to validate payment for medicaid services.
(15) "Shared living" has the same meaning as
			 in rule 5123-9-33 of the Administrative
			 Code.
(16) "Site" means a residence
			 in which two or more individuals share homemaker/personal care services of the
			 same agency provider.
(17) "Waiver
			 eligibility span" means the twelve-month period following either an
			 individual's initial waiver enrollment date or a subsequent eligibility
			 re-determination date.