Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-9 - Home and Community-Based Services Waivers › Section 5123-9-39 - Home and community-based services waivers - waiver nursing services under the individual options waiver

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
This rule defines waiver nursing 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) "Adult day support" has the
			 same meaning as in rule
			 5123-9-17 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) "Community respite" has
			 the same meaning as in rule
			 5123-9-22 of the Administrative
			 Code.
(4) "County board" means a
			 county board of developmental disabilities.
(5) "Department" means the Ohio department of
			 developmental disabilities.
(6)
			 "Homemaker/personal care" has the same meaning as in rule
			 5123-9-30 of the Administrative
			 Code.
(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 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.
(9) "Individual service plan" means the
			 written description of services, supports, and activities to be provided to an
			 individual.
(10) "Intermediate care
			 facility for individuals with intellectual disabilities" has the same meaning
			 as in section 5124.01 of the Revised
			 Code.
(11) "Licensed practical
			 nurse" has the same meaning as in section
			 4723.01 of the Revised
			 Code.
(12) "Medically necessary"
			 has the same meaning as "medical necessity" described in rule
			 5160-1-01 of the Administrative
			 Code.
(13) "Plan of care" means the
			 medical treatment plan that is established, approved, and signed by the
			 treating physician, physician's assistant, or advanced
			 practice nurse. The plan of care must be signed and dated by the treating
			 physician, physician's assistant, or advanced practice
			 nurse prior to requesting payment for a service. The plan of care is not
			 the same as the individual service plan.
(14) "Registered nurse" has the same meaning
			 as in section 4723.01 of the Revised
			 Code.
(15) "Residential respite"
			 has the same meaning as in rule
			 5123-9-34 of the Administrative
			 Code.
(16) "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 (F) of this
			 rule to validate payment for medicaid services.
(17) "Significant change" means a change
			 experienced by an individual including but not limited to, a change in health
			 status, caregiver status, or location/residence; referral to or active
			 involvement on the part of a protective services agency; or
			 institutionalization.
(18)
			 "Vocational habilitation" has the same meaning as in rule
			 5123-9-14 of the Administrative
			 Code.
(19) "Waiver nursing
			 services" means services provided to an individual who requires the skills of a
			 registered nurse or licensed practical nurse working at the direction of a
			 registered nurse. Waiver nursing services 
									does not
			 include:
(a) Services delegated in accordance
			 with Chapter 4723. of the Revised Code and rules adopted thereunder, and
			 performed by persons who are not licensed nurses in accordance with Chapter
			 4723. of the Revised Code;
(b)
			 Services that require the skills of a psychiatric nurse;
(c) Visits performed for the purpose of
			 conducting a registered nurse assessment as set forth in rule
			 5160-12-08 of the Administrative
			 Code including but not limited to, an outcome and assessment information set or
			 any other assessment;
(d)
			 Registered nurse consultations as set forth in rule
			 5160-12-08 of the Administrative
			 Code including but not limited to, those performed by registered nurses for the
			 sole purpose of directing licensed practical nurses in the performance of
			 waiver nursing services or directing personal care aides or home health aides
			 employed by a medicare-certified home health agency or otherwise-accredited
			 agency;
(e) Visits performed for
			 the sole purpose of meeting the home care attendant service registered nurse
			 visit requirements set forth in rules
			 173-39-02.24 and
			 5160-46-04.1 of the
			 Administrative Code;
(f) Services
			 performed in excess of the number of hours approved pursuant to, and as
			 specified in, the individual service plan; or
(g) Services performed that meet the
			 definition of waiver nursing delegation/assessment or waiver nursing
			 delegation/consultation set forth in rule 
										5123-9-37
			 of the Administrative Code.