Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-9 - Home and Community-Based Services Waivers › Section 5123-9-32 - Home and community-based services waivers - participantdirected homemaker/personal care 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 participant-directed homemaker/personal care
				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)
									"Acute care
			 hospital" means a hospital that provides inpatient medical care and other
			 related services for surgery, acute medical conditions, or injuries (usually
			 for a short-term illness or condition).
(2) "Adult day support"
			 has the same meaning as in rule
			 5123-9-17 of the Administrative
			 Code.
(3) "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.
(4) "Agency with
			 choice" means an arrangement available to an individual enrolled in the
			 self-empowered life-funding waiver whereby an agency provider acts as a
			 co-employer with the individual for purposes of provision of
			 participant-directed homemaker/personal care. Under this arrangement, the
			 individual is responsible for recruiting, selecting, training, and supervising
			 the persons providing participant-directed homemaker/personal care. Agency with
			 choice enables the individual to exercise choice and control over services
			 without the burden of carrying out financial matters and other legal
			 responsibilities associated with the employment of workers. The agency provider
			 is considered the employer of staff and assumes responsibility for:
(a) Employing and paying staff who have been
			 selected by the individual;
(b)
			 Reimbursing allowable services;
(c)
			 Withholding, filing, and paying federal, state, and local income and employment
			 taxes; and
(d) Providing other
			 supports to the individual as described in the individual service
			 plan.
(5) "Co-employer" means
			 an arrangement available to an individual enrolled in the self-empowered life
			 funding waiver whereby either an agency with choice or a financial management
			 services entity under contract with the state functions as the employer of
			 staff recruited by the individual. The individual directs the staff and is
			 considered their co-employer. The agency with choice or financial management
			 services entity conducts all necessary payroll functions and is legally
			 responsible for the employment-related functions and duties for
			 individual-selected staff based on the roles and responsibilities identified in
			 the individual service plan for the two co-employers.
(6)
			 "Common law employee" means a natural person certified by the department to
			 provide participant-directed homemaker/personal care to an individual who is
			 exercising employer authority. A common law employee 
									will not
			 employ, either directly or through contract, anyone else to provide
			 participant-directed homemaker/personal care.
(7) "Common law
			 employer" means an arrangement available to an individual enrolled in the
			 individual options, level one, or self-empowered life funding waiver whereby
			 the individual is the legally responsible employer of persons selected by the
			 individual to furnish supports. The individual hires, supervises, and
			 discharges those persons. The individual is liable for the performance of
			 necessary employment-related tasks and uses a financial management services
			 entity under contract with the state to perform necessary payroll and other
			 employment-related functions as the individual's agent in order to ensure that
			 the employer-related legal obligations are fulfilled.
(8)
			 "County board" means a county board of developmental disabilities.
(9)
			 "Department" means the Ohio department of developmental disabilities.
(10)
			 "Employer authority" means the individual has the authority to recruit, hire,
			 supervise, and direct the persons who furnish participant-directed
			 homemaker/personal care and functions as either the co-employer or the common
			 law employer of those persons.
(11) "Family" means a
			 person who is related to the individual by blood, marriage, or
			 adoption.
(12) "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 the day.
(13)
			 "Financial management services" means services provided to an individual who
			 directs some or all of 
									the individual's waiver services. When used in
			 conjunction with employer authority, financial management services includes,
			 but is not limited to, operating a payroll service for individual-employed
			 staff and making required payroll withholdings.
(14) "Group employment
			 support" has the same meaning as in rule
			 5123-9-16 of the Administrative
			 Code.
(15) "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.
(16)
			 "Individual employment support" has the same meaning as in rule
			 5123-9-15 of the Administrative
			 Code.
(17) "Individual
			 service plan" means the written description of services, supports, and
			 activities to be provided to an individual.
(18) "Money
			 management" has the same meaning as in rule
			 5123-9-20 of the Administrative
			 Code.
(19) "Non-medical
			 transportation" has the same meaning as in rule
			 5123-9-18 of the Administrative
			 Code.
(20) "Ohio
			 developmental disabilities profile" means the standardized instrument utilized
			 by the department to assess the relative needs and circumstances of an
			 individual compared to other individuals.
(21) "On-site/on-call"
			 means a rate authorized when no need for supervision or supports is anticipated
			 because the individual is expected to be asleep for a continuous period of no
			 less than five hours, and a provider must be present and readily available to
			 provide participant-directed homemaker/personal care if an unanticipated need
			 arises but is not required to remain awake. This rate
			 and service may only be authorized in the residence of the individual or at
			 another location in the community selected by the individual other than the
			 residence of the provider of the service.
(22)
			 "Participant-directed homemaker/personal care" means the coordinated provision
			 of a variety of services, supports, and supervision necessary to ensure the
			 health and welfare of an individual who lives in the community and chooses to
			 exercise employer authority. Participant-directed homemaker/personal care
			 advances the individual's independence within 
									the individual's home and community
			 and helps the individual meet daily living needs. Examples of supports that may
			 be provided as participant-directed homemaker/personal care include:
(a) Self-advocacy training to assist in the
			 expression of personal preferences, self-representation, self-protection from
			 and reporting of abuse, neglect, and exploitation, asserting individual rights,
			 and making increasingly responsible choices.
(b) Self-direction, including the
			 identification of and response to dangerous or threatening situations, making
			 decisions and choices affecting the individual's life, and initiating changes
			 in living arrangements and life activities.
(c) Daily living skills including training in
			 and providing assistance with routine household tasks, meal preparation,
			 personal care, self-administration of medication, and other areas of day-to-day
			 living including proper use of adaptive and assistive devices, appliances, home
			 safety, first aid, and communication skills such as using the
			 telephone.
(d) Implementation of
			 recommended therapeutic interventions under the direction of a professional or
			 extension of therapeutic services, which consist of reinforcing physical,
			 occupational, speech, and other therapeutic programs for the purpose of
			 increasing the overall effective functioning of the individual.
(e)
										Implementation of
			 behavioral support strategies including training and assistance in
			 appropriate expressions of emotions or desires, assertiveness, acquisition of
			 socially-appropriate behaviors, or extension of therapeutic services for the
			 purpose of increasing the overall effective functioning of the
			 individual.
(f) Medical and health
			 care services that are integral to meeting the daily needs of the individual
			 such as routine administration of medication or tending to the needs of
			 individuals who are ill or require attention to their medical needs on an
			 ongoing basis.
(g) Emergency
			 response training including development of responses in case of emergencies,
			 prevention planning, and training in the use of equipment or technologies used
			 to access emergency response systems.
(h) Community access services that explore
			 community services available to all people, natural supports available to the
			 individual, and develop methods to access additional services, supports, and
			 activities needed by the individual to be integrated in and have full access to
			 the community.
(i) When provided in
			 conjunction with other components of participant-directed homemaker/personal
			 care, assistance with personal finances which may include training, planning,
			 and decision-making regarding the individual's personal finances.
(23) "Provider" means
			 an agency with choice or a common law employee.
(24) "Residential
			 respite" has the same meaning as in rule
			 5123-9-34 of the Administrative
			 Code.
(25) "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.
(26) "Shared living"
			 has the same meaning as in rule
			 5123-9-33 of the Administrative
			 Code.
(27) "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.
(28) "Vocational
			 habilitation" has the same meaning as in rule
			 5123-9-14 of the Administrative
			 Code.
(29) "Waiver
			 eligibility span" means the twelve-month period following either an
			 individual's initial waiver enrollment date or a subsequent eligibility
			 re-determination date.