Ohio Administrative Code
Title 5123:2 - Community Services
Chapter 5123:2-9 - Home and Community-Based Services Waivers
Section 5123:2-9-46 - Home and community-based services waivers - participant/family stability assistance under the self-empowered life funding waiver
Universal Citation: OH Admin Code 5123:2-9-46
Current through all regulations passed and filed through March 18, 2024
(A) Purpose
The purpose of this rule is to define participant/family stability assistance and set forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for these services.
(B) Definitions
(1)
"Agency provider" means an entity that employs persons for
the purpose of providing services.
(2)
"County board"
means a county board of developmental disabilities.
(3)
"Department"
means the Ohio department of developmental disabilities.
(4)
"Family member"
means a person who is related to the individual by blood, marriage, or
adoption.
(5)
"Independent provider" means a person who provides
services and does not employ, either directly or through contract, anyone else
to provide the services.
(6)
"Individual" means a person with a developmental
disability or for the 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 who is his or her own
guardian 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
or either.
(7)
"Individual service plan" means the written
description of services, supports, and activities to be provided to an
individual.
(8)
"Participant/family stability assistance" means
training (including education and instruction) and counseling (including
consultation) that enhance an individual's ability to direct his or her own
services and/or enable an individual and/or family members who reside with the
individual to understand how best to support the individual in order that the
individual and his or her family members may live as much like other families
as possible and to prevent or delay unwanted out-of-home placement.
(a)
Participant/family stability assistance may be utilized only by the individual
and family members who reside with the individual and shall be outcome-based,
meaning that there shall be a specific goal for the service which is recorded
in the individual service plan.
(b)
Participant/family stability assistance includes training and counseling
related to accommodating the individual's disability in the home, accessing
supports offered in the community, effectively supporting the individual so
that he or she may be fully engaged in the life of the family, and supporting
the unique needs of the individual.
(c)
Participant/family stability assistance includes the cost of enrollment fees
and materials, but does not cover travel expenses or experimental and
prohibited treatments.
(9)
"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.
(10)
"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 shall include the items delineated in paragraph (F) of
this rule to validate payment for medicaid services.
(11)
"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.
(12)
"Usual and
customary charge" means the amount charged to other persons for the same
service.
(C) Provider qualifications for participant/family stability assistance-training
(1)
Participant/family stability assistance-training shall
be provided by an independent provider or an agency provider that:
(a)
Meets the
requirements of this rule;
(b)
Has a medicaid
provider agreement with the Ohio department of job and family services;
and
(c)
Has completed and submitted an application and adheres
to the requirements of rule
5123:2-2-01
of the Administrative Code, except that paragraphs (C)(3)(a), (C)(3)(b),
(C)(3)(c), and (K) of that rule do not apply to providers of participant/family
assistance-training.
(2)
The individual
may determine additional qualifications for a provider of participant/family
stability assistance-training; additional qualifications determined by the
individual shall be recorded in the individual service plan.
(3)
A county board
or a regional council of governments formed under section
5126.13 of the Revised Code by
two or more county boards may provide participant/family stability
assistance-training only when no other provider is willing and able.
(4)
Participant/family stability assistance-training shall not be provided to an
individual by his or her family member.
(5)
Failure to
comply with this rule and rule
5123:2-2-01
of the Administrative Code, as applicable, may result in denial, suspension, or
revocation of the provider's certification.
(D) Provider qualifications for participant/family stability assistance-counseling
(1)
Participant/family stability assistance-counseling shall be provided by an
independent provider or an agency provider that:
(a)
Meets the
requirements of this rule;
(b)
Has a medicaid
provider agreement with the Ohio department of job and family services;
and
(c)
Has completed and submitted an application and adheres
to the requirements of paragraph (C)(2) of rule
5123:2-2-01
of the Administrative Code. The remainder of rule
5123:2-2-01
of the Administrative Code does not apply to providers of participant/family
assistance-counseling.
(2)
Participant/family stability assistance-counseling shall be provided by persons
who are one of the following:
(a)
Psychologist licensed by the state pursuant to Chapter
4732. of the Revised Code;
(b)
Professional
clinical counselor licensed by the state pursuant to section
4757.22 of the Revised
Code;
(c)
Professional counselor licensed by the state pursuant
to section 4757.23 of the Revised
Code;
(d)
Independent social worker licensed by the state
pursuant to section 4757.27 of the Revised
Code;
(e)
Social worker licensed by the state pursuant to
section 4757.28 of the Revised Code
working under the supervision of a licensed independent social worker; or
(f)
Marriage and family therapist licensed by the state pursuant to section
4757.30 of the Revised
Code.
(3)
A county board or a regional council of governments
formed under section 5126.13 of the Revised Code by
two or more county boards may provide participant/family stability
assistance-counseling only when no other provider is willing and able.
(4)
Participant/family stability assistance-counseling shall not be provided to an
individual by his or her family member.
(5)
Failure to
comply with this rule and rule
5123:2-2-01
of the Administrative Code, as applicable, may result in denial, suspension, or
revocation of the provider's certification.
(E) Requirements for service delivery
Participant/family stability assistance shall be provided pursuant to an individual service plan that conforms to the requirements of paragraph (K) of rule 5123:2-9-40 of the Administrative Code.
(F) Documentation of services
Service documentation for participant/family stability assistance shall include each of the following to validate payment for medicaid services:
(1)
Type of
service.
(2)
Date of service.
(3)
Place of
service.
(4)
Name of individual receiving service.
(5)
Medicaid
identification number of individual receiving service.
(6)
Name of
provider.
(7)
Provider identifier/contract number.
(8)
Written or
electronic signature of the person delivering the service, or initials of the
person delivering the service if a signature and corresponding initials are on
file with the provider.
(9)
Description and details of the services delivered that
directly relate to the services specified in the approved individual service
plan as the services to be provided.
(10)
Number of units
of the delivered service or continuous amount of uninterrupted time during
which the service was provided.
(11)
Times the
delivered service started and stopped.
(G) Payment standards
(1)
The billing units, service codes, and payment rates for participant/family
stability assistance are contained in the appendix to this rule.
(2)
Providers of participant/family stability assistance shall be paid no more than
their usual and customary charge for the service.
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