Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-9 - Home and Community-Based Services Waivers › Section 5123-9-45 - Home and community-based services waivers - participant-directed goods and services under the level one and self-empowered life funding waivers

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
This rule defines participant-directed goods and services 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) "Community
			 respite" has the same meaning as in rule
			 5123-9-22
			 of the Administrative Code.
(2)
			 "County board" means a county board of developmental disabilities.
(3) "Department" means the Ohio department of
			 developmental disabilities.
(4)
			 "Financial management services entity" means a governmental entity and/or
			 another third-party entity designated by the department to
			 perform necessary financial transactions on behalf of individuals
			 
									who receive participant-directed
			 services.
(5) "Individual"
			 means a person with a developmental disability or for the 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. An individual
			 may designate another person to assist with development of the individual
			 service plan and budget, selection of residence and providers, and negotiation
			 of payment rates for services; the individual's designee shall not be employed
			 by a county board or a provider, or a contractor of either.
(6) "Individual service plan" means the
			 written description of services, supports, and activities to be provided to an
			 individual.
(7)
									"Participant-directed budget" means the total amount of
			 annual waiver funding available for participant-directed services in the
			 individual service plan of an individual who chooses to receive
			 participant-directed services. An individual may reallocate funds among
			 participant-directed services as long as reallocation is preceded by a
			 corresponding revision to the individual service plan.
(8)
			 "Participant-directed goods and services" means services, equipment, or
			 supplies not otherwise provided through the individual's waiver or through the medicaid state plan
			 that are purchased through the participant-directed
			 budget, address a need clearly identified
			 through assessment of the individual, are
			 specified in the individual service plan,
			 and meet all of the following requirements:
(a) The services, equipment, or supplies are
			 required to :
(i) Decrease the individual's need for other medicaid home and
			 community-based services;
(ii)
											Advance the individual's participation in the
			 community;
(iii) Increase the
			 individual's safety in 
											the home;
(iv) Increase the individual's
			 independence;
(v) Improve
			 or maintain the individual's cognitive, social,
			 or behavioral functions; or
(vi)
											Assist the
			 individual to develop or maintain personal, social, or physical
			 skills.
(b) The
			 individual does not have funds to purchase the services, equipment, or
			 supplies, and they are not available through another source.
(c) The services, equipment, or supplies are
			 required to ensure the health and welfare of the individual.
(d) The services, equipment, or supplies are
			 
										directly
			 linked in the individual service plan as addressing a need clearly identified
			 through assessment of the individual.
(e) The services, equipment, or supplies are
			 for the direct medical or remedial benefit of the individual.
(9) "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.
(10) "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)(2)
			 of this rule to validate payment for medicaid services.
(11)
			 "Specialized services" means any program or service designed and operated to
			 serve primarily a person with a developmental disability, including a program
			 or service provided by an entity licensed or certified by the department.
			 Programs or services available to the general public are not specialized
			 services.
(12) "Usual and
			 customary charge" means the amount charged to other persons for the same
			 service.
(13) "Waiver
			 eligibility span" means the twelve-month period following either an
			 individual's initial waiver enrollment date or a subsequent eligibility
			 redetermination date.