Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-43 - Specialized Recovery Services Program › Section 5160-43-05 - Specialized recovery services program provider conditions of participation

Current through all regulations passed and filed through July 1, 2024
(A) Specialized
			 recovery service program providers shall maintain professional relationships
			 with the individuals they serve. Providers shall furnish services in a
			 person-centered manner that is in accordance with the individual's approved
			 person-centered service plan, is attentive to the individual's needs
			 and maximizes the individual's independence. Providers shall refrain from any
			 behavior that may detract from the goals, objectives and services outlined in
			 the individual's approved person-centered service plan
			 and/or that may jeopardize the individual's health and welfare.
(B) Specialized recovery services program
			 providers shall:
(1) Maintain an active, valid
			 medicaid provider agreement as set forth in rule 5160-1-17.2 of the
			 Administrative Code.
(2) Comply
			 with all applicable provider requirements set forth in this chapter of the
			 Administrative Code, including but not limited to:
(a) Provider requirements as set forth in
			 rule
			 5160-43-04
			 of the Administrative Code;
(b)
			 Incident reporting as set forth in rule 5160-44-05
			 of the Administrative Code;
(c)
			 Provider monitoring, oversight, reviews and investigations as set forth in rule
			 5160-43-07
			 of the Administrative Code; and
(d)
			 Criminal records checks for providers of home and community-based services
			 (HCBS) as set forth in rule
			 5160-43-09
			 of the Administrative Code.
(3) Deliver services in a person-centered
			 manner, professionally, respectfully and legally.
(4) Ensure that individuals to whom the
			 provider is furnishing services are protected from abuse, neglect, exploitation
			 and other threats to their health, safety and well-being. Upon entering into a
			 medicaid provider agreement, and annually thereafter, all providers including
			 all employees who have direct contact with individuals enrolled in the program
			 must acknowledge in writing they have reviewed rule 5160-44-05
			 of the Administrative Code regarding incident management procedures.
(5) Work with the individual and his or her
			 trans-disciplinary care team to coordinate service delivery, including, but not
			 limited to:
(a) Agreeing to provide and
			 providing services in the amount, scope, location and duration they have
			 capacity to provide, and as specified on the individual's approved
			 person-centered service plan.
(b) Contacting the individual, the recovery
			 manager and/or his or her supervisor, as applicable, when the provider is
			 unable to render services on the appointed date and time, and verify their
			 receipt of information about the absence.
(6) To the extent not otherwise required by
			 rule 5160-44-05 of the Administrative Code, notify the Ohio
			 department of medicaid (ODM) or its designee within twenty-four hours when the
			 provider is aware of issues that may affect the individual and/or provider's
			 ability to render services as directed in the individual's person-centered
			 service
			 plan. Issues may include, but are not limited to:
(a) The individual consistently declines
			 services,
(b) The individual plans
			 to or has moved to another residential address,
(c) There are significant changes in the
			 physical, mental and/or emotional status of the individual,
(d) There are changes in the individual's
			 environmental conditions,
(e) The
			 individual's caregiver status has changed causing service delivery to be
			 impacted or interrupted,
(f) The
			 individual no longer requires medically necessary services as defined in rule
			 5160-1-01
			 of the Administrative Code,
(g) The
			 individual's actions toward the provider are threatening or the provider feels
			 unsafe in the individual's environment,
(h) The individual's requests conflict with
			 his or her person-centered service plan and may jeopardize his or her health and
			 welfare, and
(i) Any other
			 situation that affects the individual's health and welfare.
(7) Upon request and within the
			 time frame prescribed in the request, provide information and documentation to
			 ODM, its designee and the centers for medicare and medicaid services
			 (CMS).
(8) Cooperate with ODM and
			 its designee during all provider monitoring and oversight activities by being
			 available to answer questions during reviews, and by ensuring the availability
			 and confidentiality of documentation that may be requested regarding service
			 delivery to individuals.
(9)
			 Participate in all provider trainings mandated or sponsored by ODM or its
			 designees, including but not limited to those set forth in rule
			 5160-43-04
			 of the Administrative Code.
(10) Be
			 knowledgeable about and comply with all applicable federal and state laws,
			 including the "Health Insurance Portability and Accountability Act of 1996"
			 (HIPAA) regulations set forth in 45 C.F.R. parts 160 and 164(as in effect on
			 October 1, 2020), confidentiality of alcohol and drug abuse patient
			 records set forth in 42 C.F.R part 2 (as in effect on October
			 1, 2020), and the medicaid safeguarding information requirements set
			 forth in
			 42 C.F.R. parts
			 431.300 to
			 431.307
									(as in effect on October 1, 2020), along with sections
			 5160.45
			 to
			 5160.481
			 of the Revised Code.
(11) Ensure
			 that the provider's contact information, including but not limited to address,
			 telephone number, fax number and email address, is current. When contact
			 information changes, the provider shall notify ODM via the medicaid information
			 technology system (MITS) and its designee, no later than seven calendar days
			 after such changes have occurred.
(12) Make arrangements to accept all
			 correspondence sent by ODM or its designee, including certified mail.
(13) Maintain and retain all required
			 documentation related to the services delivered during a visit including but
			 not limited to: an individual-specific description and details of the services
			 provided or not provided in accordance with the person-centered
			 service
			 plan.
(a) Validation of service delivery shall
			 include, but not be limited to, the date and location of service delivery,
			 arrival and departure times and the dated signature of the provider.
(b) Retain all records of service delivery
			 and billing for a period of six years after the date of receipt of the payment
			 based upon those records, or until any initiated audit is completed, whichever
			 is longer.
(14) Submit
			 written notification to the individual and ODM or its designee at least thirty
			 calendar days before the anticipated last date of service if the provider is
			 terminating the provision of program services to the individual. Exceptions to
			 the thirty-day advance notification requirement include:
(a) A verbal and written notification to the
			 individual and ODM or its designee at least ten days before the anticipated
			 last date of services when the individual:
(i)
			 Has been admitted to a hospital;
(ii) Has entered into an institutional
			 setting; or
(iii) Has been
			 incarcerated.
(b) ODM
			 may waive advance notification for a provider upon request and on a
			 case-by-case basis.