Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-7 - Intermediate Care Facilities for Individuals with Intellectual Disabilities › Section 5123-7-29 - Intermediate care facilities for individuals with intellectual disabilities - ventilator services

Current through all regulations passed and filed through July 1, 2024
(A)
								Purpose
This rule sets forth requirements for
				an intermediate care facility for individuals with intellectual disabilities
				(ICFIID) to provide and be reimbursed for providing services to residents who
				are dependent on invasive mechanical ventilators.
(B)
								Definitions
For the purposes of this rule, the
				following definitions apply:
(1)
									"Adult" means a person twenty-two years of age or
			 older.
(2)
									"Business day" means a day of the week, excluding
			 Saturday, Sunday, or a legal holiday as defined in section
			 1.14 of the Revised
			 Code.
(3)
									"Designated outlier coordinator" means a department
			 staff member who coordinates the general operations of the ICFIID outlier
			 services program. The designated outlier coordinator works with providers of
			 outlier services, individuals requesting and receiving outlier services, other
			 persons whom individuals have identified, other service agencies, and other
			 department staff. The designated outlier coordinator's duties include, but are
			 not limited to:
(a)
										Assisting with the initial approval and ongoing
			 monitoring of an ICFIID providing outlier services;
(b)
										Coordinating the
			 processing of pre-admission and continued stay prior authorization requests for
			 individuals; and
(c)
										Reviewing assessments, individual service plans, day
			 programming plans, staffing plans, and other documents.
(4)
									"Individual service plan" means the written description of
			 services, supports, and activities to be provided to an individual and includes
			 an "individual program plan" as that term is used in
			 42 C.F.R.
			 483.440 as in effect on the effective date of
			 this rule.
(5)
									"Invasive mechanical ventilator" means a ventilator
			 that is interfaced directly with the individual via an artificial airway (e.g.,
			 tracheostomy tube). Invasive mechanical ventilators (volume and/or pressure)
			 are life support devices designed specifically for invasive mechanical
			 ventilation applications and must accommodate direct current backup power
			 supply and include disconnect, high pressure, low pressure, and power loss
			 alarms.
(6)
									"Nurse" means a person authorized by Chapter 4723. of
			 the Revised Code to engage in the practice of nursing as a registered nurse or
			 a licensed practical nurse.
(7)
									"Outlier
			 services" means those clusters of services that have been determined by the
			 department to have reimbursement rates established pursuant to section
			 5124.152 of the Revised Code
			 when delivered by qualified providers to individuals who have been
			 prior-authorized to receive a category of service identified as an outlier
			 service by the department in accordance with Chapter 5123-7 of the
			 Administrative Code.
(8)
									"Pediatric ventilator services" means services provided
			 by an ICFIID in accordance with rule
			 5123:2-7-29 of the
			 Administrative Code as it existed on January 17, 2018.
(9)
									"Physician" means
			 a person authorized by Chapter 4731. of the Revised Code to practice medicine
			 and surgery, osteopathic medicine and surgery, or podiatric medicine and
			 surgery.
(10)
									"Plan of correction" means a corrective action plan
			 prepared by an ICFIID in response to deficiencies cited by the department or
			 the Ohio department of health which conforms to regulations and guidelines and
			 includes information that describes how the deficiency will be corrected, when
			 it will be corrected, how other residents that may be affected by the
			 deficiency will be identified, and how the ICFIID will ensure that compliance
			 is maintained upon correction.
(11)
									"Prior
			 authorization assessment for ventilator services" means an evaluation to
			 determine if an individual meets the eligibility criteria to receive ventilator
			 services set forth in paragraphs (C)(3) to (C)(6) of this rule that will take
			 place only after the individual is determined to meet the financial eligibility
			 and level of care requirements set forth in paragraphs (C)(1) and (C)(2) of
			 this rule.
(12)
									"Prior authorization for ventilator services" means
			 department approval obtained by an ICFIID to provide ventilator services to a
			 specific individual for specific time-limited initial or continued stay
			 periods. Prior authorization for ventilator services is required for the ICFIID
			 to be authorized by the department to provide ventilator services and to
			 receive reimbursement for services rendered to the individual. Reimbursement
			 may be denied for any service not rendered in accordance with Chapters 5160-3
			 and 5123-7 of the Administrative Code.
(13)
									"Registered
			 nurse" has the same meaning as in section
			 4723.01 of the Revised
			 Code.
(14)
									"Respiratory care professional" means a person who is
			 licensed under Chapter 4761. of the Revised Code to practice the full range of
			 respiratory care services described in division (A) of section
			 4761.01 of the Revised
			 Code.
(15)
									"Ventilator services" means services provided by an
			 ICFIID that holds an effective provider agreement with the Ohio department of
			 medicaid and that is approved by the department to deliver outlier services to
			 individuals who are dependent on invasive mechanical
			 ventilators.