Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-9 - Home and Community-Based Services Waivers › Section 5123-9-33 - Home and community-based services waivers - shared living under the individual options waiver

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
This rule defines shared living 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" means a
			 person eighteen years of age or older.
(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) "Community respite"
			 has the same meaning as in rule
			 5123-9-22 of the Administrative
			 Code.
(5) "County board"
			 means a county board of developmental disabilities.
(6) "Department" means
			 the Ohio department of developmental disabilities.
(7) "Group size" means
			 the number of individuals who are sharing services, regardless of the funding
			 source for those services.
(8) "Homemaker/personal
			 care" has the same meaning as in rule
			 5123-9-30 of the Administrative
			 Code.
(9) "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.
(10) "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.
(11) "Individual
			 service plan" means the written description of services, supports, and
			 activities to be provided to an individual.
(12) "Ohio
			 developmental disabilities profile" 
									means the standardized instrument used by
			 the department to assess the relative needs and circumstances of an individual
			 compared to others. The individual's responses are scored and the individual is
			 linked to a funding range, which enables similarly situated individuals to
			 access comparable waiver services paid in accordance with rules adopted by the
			 department.
(13)
									"Primary legal residence" means the residence where a
			 shared living caregiver has a permanent and principal establishment, where that
			 person has a right to reside, and to where, whenever that person is absent,
			 that person intends to return. A person has one, and only one, primary legal
			 residence at a time.
(14) "Related to"
			 means the caregiver is the individual's:
(a)
			 Parent or stepparent;
(b) Sibling
			 or stepsibling;
(c)
			 Grandparent;
(d)
										Grandchild;
(e) Aunt, uncle,
			 nephew, or niece;
(f) Cousin;
			 or
(g) Child or
			 stepchild.
(15) "Residential
			 respite" has the same meaning as in rule
			 5123-9-34 of the Administrative
			 Code.
(16) "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 
									5123-5-02 of the Administrative Code.
(17)
			 "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.
(18) "Shared living"
			 means individual-specific personal care and support necessary to meet the
			 day-to-day needs of an adult enrolled in the individual options waiver,
			 
									when twenty per cent or more of the personal care and
			 support is provided by one or more adult caregivers who reside in the
			 same home as the individual receiving the services. Shared living is provided
			 in conjunction with residing in the home and is part of the rhythm of life that
			 naturally occurs when people live together in the same home. Due to the
			 environment provided by living together in the same home, segregating these
			 activities into discrete services is impractical.
(a) Shared living:
(i) Enables the individual to experience
			 genuine community life;
(ii)
			 Nurtures stability of long-term relationships within the home and the broader
			 community;
(iii) Contributes to
			 development of life routines chosen by the individual;
(iv) Assists the individual to routinely
			 participate in and make positive contributions to 
											the
			 individual's community;
(v)
			 Supports shared decision-making between the individual and other members of the
			 household; and
(vi) Enhances,
			 rather than replaces, existing family relationships and other community
			 connections.
(b)
			 Examples of supports that may be provided as shared living include:
(i) Basic personal care and grooming,
			 including bathing, care of the hair, and assistance with clothing;
(ii) Assistance with bladder and/or bowel
			 requirements , including helping
			 the individual to and from the bathroom or assisting the individual with bedpan
			 routines;
(iii) Assisting the
			 individual with self-medication or provision of medication administration and
			 assisting the individual with, or performing, health care activities;
(iv) Performing household services essential
			 to the individual's health and comfort in the home (e.g., necessary changing of
			 bed linens or rearranging of furniture to enable the individual to move about
			 more easily in 
											the home);
(v) Assessing, monitoring, and supervising
			 the individual to ensure the individual's safety, health, and
			 welfare;
(vi) Light cleaning tasks
			 in areas of the home used by the individual;
(vii) Preparation of a shopping list
			 appropriate to the individual's dietary needs and financial circumstances,
			 performance of grocery shopping activities as necessary, and preparation of
			 meals;
(viii) Personal
			 laundry;
(ix) Incidental
			 neighborhood errands as necessary, including accompanying the individual to
			 medical and other appropriate appointments and accompanying the individual for
			 walks outside the home;
(x) Skill
			 development to prevent the loss of skills and enhance skills that are already
			 present that lead to greater independence and community integration;
(xi) Exploration of community resources and
			 natural supports and development of methods to access additional resources and
			 supports to ensure the individual is integrated in and has full access to the
			 community to pursue interests and activities of 
											the individual's choosing;
			 and
(xii) When provided in
			 conjunction with other components of shared living, assistance with personal
			 finances which may include training, planning, and decision-making regarding
			 the individual's personal finances.
(19)
			 "Significant change" means a change experienced by an individual including but
			 not limited to:
(a) A change in health status
			 or caregiver status;
(b) Referral
			 to or active involvement on the part of a protective services agency;
			 or
(c)
			 Institutionalization.