Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-9 - Home and Community-Based Services Waivers › Section 5123-9-25 - Home and community-based services waivers - specialized medical equipment and supplies under the individual options and level one waivers

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
This rule defines specialized medical equipment and supplies
				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) "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.
(2) "County board"
			 means a county board of developmental disabilities.
(3) "Department" means
			 the Ohio department of developmental disabilities.
(4) "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.
(5) "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.
(6)
			 "Individual service plan" means the written description of services, supports,
			 and activities to be provided to an individual.
(7) "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.
(8) "Specialized
			 medical equipment and supplies" means adaptive and assistive
			  devices, controls, or appliances, specified in
			 the individual service plan, which enable an individual to increase ability to
			 perform activities of daily living, or to perceive, control, or communicate
			 with the environment in which the individual lives. Specialized medical
			 equipment and supplies includes items necessary for life support, ancillary
			 supplies and equipment necessary to the proper functioning of such items, and
			 durable and non-durable medical equipment not available under the medicaid
			 state plan. Specialized medical equipment and supplies
			 includes repair or maintenance of a previously approved item which is within
			 its useful life, as well as replacement of a previously approved item which is
			 beyond its useful life. All items 
									will meet
			 applicable standards of manufacture, design, and installation. Specialized
			 medical equipment and supplies does not include:
(a)
										Repair or
			 replacement of a previously approved item that has been damaged as a result of
			 confirmed misuse, abuse, or negligence;
(b) Items that are not
			 of direct medical or remedial benefit to the individual;
(c)
			 Items otherwise available as assistive technology described in rule
			 5123-9-12 of the Administrative
			 Code;
(d) For individuals
			 less than twenty-one years of age, equipment 
										or supplies that
			 are  covered under the 
										"Early and Periodic Screening,
			 Diagnostic, and Treatment Program"; or
(e)
										Equipment or
			 supplies that are covered under the medicaid state plan described in Chapter
			 5160-10 of the Administrative Code.
(9)
									"Useful life"
			 means the amount of time during which an item is expected to be in service, as
			 determined by the manufacturer of the item.