Ohio Administrative Code › Title 5123:2 - Community Services › Chapter 5123:2-9 - Home and Community-Based Services Waivers › Section 5123:2-9-40 - Home and community-based services waivers - administration of the self-empowered life funding waiver

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
This rule implements the self-empowered life funding waiver, a
				component of the medicaid home and community-based services program
				administered by the department pursuant to section
				5166.21 of the Revised Code.
				Individuals enrolled in the self-empowered life funding waiver exercise
				participant direction through budget authority and/or employer
				authority.
(B) Definitions
(1) "Adult" means an individual who is at
			 least twenty-two years old or an individual who is under twenty-two years old
			 and eligible for adult day support, career planning, group employment support,
			 individual employment support, or vocational habilitation.
(2) "Agency with choice" means
			 a service arrangement in which an agency provider
			  acts as a co-employer with an
			 individual. Under this arrangement, the individual  is responsible
			 for hiring, managing, and dismissing staff. The agency with choice enables the
			 individual to exercise choice and control over services while relieving him or
			 her of the burden of carrying out financial matters and other legal
			 responsibilities associated with the employment of workers. The agency with
			 choice is considered the employer of staff who are selected, hired, and trained
			 by the individual 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.
(3) "Budget
			 authority" means the individual has the authority and responsibility to manage
			 his or her budget. This authority supports the individual in determining the
			 budgeted dollar amount for each waiver service that will be provided to the
			 individual and making decisions about the acquisition of waiver services that
			 are authorized in the individual service plan (e.g., negotiating payment rates
			 to providers within the applicable range as specified in rules adopted by the
			 department).
(4) "Child" means an
			 individual who is under twenty-two years old and is not eligible for adult day
			 support, career planning, group employment support, individual employment
			 support, or vocational habilitation.
(5) "Co-employer" means either an agency with
			 choice or a financial management services entity under contract with the state
			 that functions as the employer of staff recruited by the individual. The
			 individual directs the staff and is considered their co-employer
			 . The
			 co-employer conducts all necessary payroll functions and is legally responsible
			 for discharging the employment-related functions and duties for
			 individual-selected staff with the individual based on the roles and
			 responsibilities identified in the individual service plan for the two
			 co-employers. The co-employer may function solely to support the individual's
			 employment of workers or it may provide other employer-related supports to the
			 individual, including providing traditional agency-based staff.
(6) "Common law employer" means the
			 individual is the legally responsible and liable employer of staff selected by
			 the individual. The individual hires, supervises, and discharges staff. 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.
(7)
			 "County board" means a county board of developmental disabilities.
(8) "Department" means the Ohio department of
			 developmental disabilities.
(9)
			 "Employer authority" means the individual has the authority to recruit, hire,
			 supervise, and direct the staff who furnish supports. The individual functions
			 as the common law employer or the co-employer of these staff.
(10) "Financial management services" means
			 services provided to an individual who directs some or all of his or her waiver
			 services. When used in conjunction with budget authority, financial management
			 services includes, but is not limited to, paying invoices for waiver goods and
			 services and tracking expenditures against the individual's budget. 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. Financial management services
			 also includes acting as the employer of staff on behalf of an individual under
			 the co-employer model of employer authority.
(11) "Home and community-based services" has
			 the same meaning as in section
			 5123.01 of the Revised
			 Code.
(12) "Individual" means a
			 person with a developmental disability or for purposes of giving, refusing to
			 give, or withdrawing consent for services, his or her guardian in accordance
			 with section 5126.043 of the Revised Code or
			 other person authorized to give consent. An individual
			 may
			 designate another person to assist the individual with development of the
			 individual service plan and budget, selection of residence and providers, and
			 negotiation of payment rates for services; the individual's designee shall not
			 be employed by a county board or a provider, or a contractor of
			 either.
(13) "Individual service
			 plan" means the written description of services, supports, and activities to be
			 provided to an individual.
(14)
			 "Participant direction" means the individual has authority to make decisions
			 about some or all of his or her waiver services and accepts responsibility for
			 taking a direct role in managing the services. Participant direction includes
			 the exercise of budget authority and employer authority as set forth in
			 paragraph (I) of this rule.
(15)
			 "Provider" means a person or agency certified or licensed by the department
			 that has met the provider qualification requirements to provide the specific
			 self-empowered life funding waiver service as specified in paragraph (M)(1) of
			 this rule and holds a valid medicaid provider agreement in accordance with
			 paragraph (M)(2) of this rule.
(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
			 5123:2-5-02
			 of the Administrative Code.
(17)
			 "Support broker" means a person who is responsible, on a continuing basis, for
			 providing an individual with representation, advocacy, advice, and assistance
			 related to the day-to-day coordination of services (particularly those
			 associated with participant direction) in accordance with the individual
			 service plan. The support broker assists the individual with the individual's
			 responsibilities regarding participant direction, including understanding
			 employer authority and budget authority, locating and selecting providers,
			 negotiating payment rates, and keeping the focus of the services and support
			 delivery on the individual and his or her desired outcomes. The support broker,
			 working in conjunction with the service and support administrator, assists the
			 individual with creating the individual service plan, developing the waiver
			 budget, and doing day-to-day monitoring of the provision of services as
			 specified in the individual service plan.
(18) "Waiver eligibility span" means the
			 twelve-month period following either an individual's initial
			 waiver enrollment date or a subsequent
			 eligibility redetermination date.