Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-9 - Home and Community-Based Services Waivers › Section 5123-9-34 - Home and community-based services waivers - residential respite under the individual options, level one, and self- empowered life funding waivers

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
This rule defines residential respite and sets forth provider
				qualifications, requirements for service delivery and documentation of
				services, and payment standards for the service.
(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 is
			 certified in accordance with rule
			 5123-2-08 of the Administrative
			 Code.
(2) "County board" means a
			 county board of developmental disabilities.
(3) "Department" means the Ohio department of
			 developmental disabilities.
(4)
									"Group size" means the number of individuals who are
			 sharing services, regardless of the funding source for those
			 services.
(5) "Homemaker/personal
			 care" has the same meaning as in rule
			 5123-9-30 of the Administrative
			 Code.
(6) "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.
(7) "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.
(8)
			 "Individual service plan" means the written description of services, supports,
			 and activities to be provided to an individual.
(9) "Intermediate care
			 facility for individuals with intellectual disabilities" has the same meaning
			 as in section 5124.01 of the Revised
			 Code.
(10)
			 "Participant-directed homemaker/personal care" has the same meaning as in rule
			 5123-9-32 of the Administrative
			 Code.
(11) "Residential
			 facility" means a home or facility, including an intermediate care facility for
			 individuals with intellectual disabilities, in which an individual with a
			 developmental disability resides, that is licensed by the department pursuant
			 to section 5123.19 of the Revised
			 Code.
(12) "Residential
			 respite" means care and support services furnished to an individual on a
			 short-term basis because of the absence or need for relief of those persons
			 routinely providing care. Depending on the circumstances of service provision,
			 residential respite is billed at a daily billing unit or at a fifteen- minute
			 billing unit:
(a) Residential respite at the
			 daily billing unit
(i) Residential respite at
			 the daily billing unit will be used when:
(a)
			 Residential respite is provided to an individual for more than seven hours
			 during a twenty-four hour period and the individual stays overnight at the
			 residential respite service delivery location; and
(b) A shared living caregiver does not bill
			 for provision of shared living to the individual on that day.
(ii) Residential respite at the
			 daily billing unit will be provided by:
(a) A
			 residential facility;
(b) An agency
			 provider; or
(c) An independent
			 provider.
(iii)
			 Residential respite at the daily billing unit may be provided at:
(a) A residential facility;
(b) The individual's home;
(c) The home of the employee of an agency
			 provider who is providing the service; or
(d) The home of the independent provider who
			 is providing the service.
(b) Residential respite at the fifteen-minute
			 billing unit
(i) Residential respite at the
			 fifteen-minute billing unit is available only to an individual who resides in a
			 shared living setting and will be used when residential respite is provided to
			 the individual on the same day the shared living caregiver bills for provision
			 of shared living.
(ii) Residential
			 respite at the fifteen-minute billing unit may be provided by:
(a) A residential facility other than an
			 intermediate care facility for individuals with intellectual
			 disabilities;
(b) An agency
			 provider; or
(c) An independent
			 provider.
(iii)
			 Residential respite at the fifteen-minute billing unit will be provided at:
(a) A residential facility other than an
			 intermediate care facility for individuals with intellectual
			 disabilities;
(b) The individual's
			 home;
(c) The home of the employee
			 of an agency provider who is providing the service;
(d) The home of the independent provider who
			 is providing the service; or
(e)
			 Another location chosen by the individual.
(iv) The residential respite fifteen-minute
			 billing unit 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. Minutes of service delivery time accrued throughout a day will
			 be added together for the purpose of calculating the number of fifteen-minute
			 billing units for the day.
(13) "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.
(14) "Shared living"
			 has the same meaning as in rule
			 5123-9-33 of the Administrative
			 Code.
(15) "Waiver
			 eligibility span" means the twelve-month period following either an
			 individual's initial waiver enrollment date or a subsequent eligibility re-
			 determination date.