Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-9 - Home and Community-Based Services Waivers › Section 5123-9-40 - 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
For the purposes of this rule, the following definitions
				apply:
(1) "Adult" means an individual
			 who is at least twenty-two years old or an individual who is under twenty-two
			 years old and no longer eligible for educational services based on graduation,
			 receipt of a diploma or equivalency certificate, or permanent discontinuation
			 of educational services within parameters established by the Ohio department of
			 education.
(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 the
			 individual 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 an individual has the authority and responsibility to manage
			 the individual's budget for participant-directed services. This authority
			 supports the individual in determining the budgeted dollar amount for each
			 participant-directed waiver service that will be provided to the individual and
			 making decisions about the acquisition of participant-directed 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 eligible for educational
			 services.
(5) "Co-employer" means
			 an individual who recruits and directs staff providing services to the
			 individual and either an agency with choice or a financial management services
			 entity under contract with the state that functions as the employer of the
			 staff recruited and directed by the individual. The agency with choice or a
			 financial management services entity conducts all necessary payroll functions
			 and is legally responsible for 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 agency with choice or financial management services entity
			 serving as 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 an 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 the individual's
			 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
			 for participant-directed services. 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) "Financial
			 management services entity" means a governmental entity and/or another
			 third-party entity designated by the department to perform necessary financial
			 transactions on behalf of individuals who receive participant-directed
			 services.
(12) "Home and
			 community-based services" has the same meaning as in section
			 5123.01 of the Revised
			 Code.
(13) "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. An individual may designate another
			 person to assist 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 
									will not be employed by a county board or a
			 provider, or a contractor of either.
(14) "Individual service plan" means the
			 written description of services, supports, and activities to be provided to an
			 individual.
(15) "Participant
			 direction" means an individual has authority to make decisions about the
			 individual's waiver services and accepts responsibility for taking a direct
			 role in managing the services. Participant direction includes the exercise of
			 budget authority and/or employer authority as set forth in paragraph (G) of
			 this rule.
(16) "Provider" means a
			 person or entity certified or licensed by the department that has met the
			 provider qualification requirements to provide specific home and
			 community-based services and holds a valid medicaid provider agreement with the
			 Ohio department of medicaid or a person or entity that has been determined by
			 the financial management services entity to be qualified to provide
			 participant-directed goods and services or self-directed
			 transportation.
(17) "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.
(18) "Waiver eligibility span" means the
			 twelve-month period following either an individual's initial waiver enrollment
			 date or a subsequent eligibility redetermination date.