Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-9 - Home and Community-Based Services Waivers › Section 5123-9-37 - Home and community-based services waivers - waiver nursing delegation 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 waiver nursing delegation 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) "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 5123-9 of the Administrative Code.
(2) "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.
(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 5123-6 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. 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 that day.
(7) "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.
(8) "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.
(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
			 
									includes 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"
			 
									means the group of persons chosen by an
			 individual with the core responsibility to support the individual in directing
			 development of the individual service plan. The team includes the individual's
			 guardian or adult whom the individual has identified, as applicable, the
			 service and support administrator, direct support professionals, providers,
			 licensed or certified professionals, and any other persons chosen by the
			 individual to help the individual consider possibilities and make
			 decisions.
(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 
										is 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
			 
										is
			 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.