Ohio Administrative Code
Title 5123:2 - Community Services
Chapter 5123:2-9 - Home and Community-Based Services Waivers
Section 5123:2-9-47 - Home and community-based services waivers - support brokerage under the self-empowered life funding waiver
Universal Citation: OH Admin Code 5123:2-9-47
Current through all regulations passed and filed through September 16, 2024
(A) Purpose
The purpose of this rule is to define support brokerage and set forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service.
(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)
"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.
(9)
"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 (E) of
this rule to validate payment for medicaid services.
(10)
"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.
(11)
"Support
brokerage" means the services of a support broker.
(12)
"Waiver
eligibility span" means the twelve-month period following either an
individual's initial enrollment date or a subsequent eligibility
redetermination date.
(C) Provider qualifications
(1)
Support brokerage shall be provided by one of the
following:
(a)
An independent provider or an agency provider that:
(i)
Meets the
requirements of this rule;
(ii)
Has a medicaid
provider agreement with the Ohio department of job and family services;
and
(iii)
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 support
brokerage.
(b)
An unpaid volunteer who has the qualifications
specified in paragraph (C)(2) of this rule.
(2)
Support
brokerage shall be provided by persons who:
(a)
Have at least an
associate's degree from an accredited college or university or at least two
years of experience providing one-to-one support for a person with a
developmental disability; and
(b)
Prior to
providing support brokerage, have successfully completed the support broker
training established by the department.
(3)
The individual
may determine additional qualifications for a provider of support brokerage;
additional qualifications determined by the individual shall be recorded in the
individual service plan.
(4)
The following persons or entities shall not provide
support brokerage:
(a)
A county board.
(b)
An employee of a
county board.
(c)
A housing or adult services nonprofit corporation
affiliated with a county board.
(d)
An employee of a
housing or adult services nonprofit corporation affiliated with a county
board.
(e)
A regional council of governments formed under section
5126.13 of the Revised Code by
two or more county boards.
(f)
An employee of a
regional council of governments formed under section
5126.13 of the Revised Code by
two or more county boards.
(g)
A certified
provider of any other self-empowered life funding waiver service.
(h)
A
related entity affiliated with a certified provider of any other self-empowered
life funding waiver service including, but not limited to, contractors of the
provider.
(5)
Support brokerage shall not be provided on a paid
basis by the parents of a minor child (under age eighteen) or an individual's
spouse, guardian, or family member if the family member resides with the
individual.
(6)
Failure to comply with this rule and rule
5123:2-2-01
of the Administrative Code, as applicable, may result in the denial,
suspension, or revocation of the provider's certification.
(D) Requirements for service delivery
Support brokerage 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.
(E) Documentation of services
Service documentation for support brokerage 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.
(F) Payment standards
(1)
The billing units, service codes, and payment rates for support brokerage are
contained in the appendix to this rule.
(2)
Payment for
support brokerage shall not exceed eight thousand dollars per waiver
eligibility span.
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