Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-1 - General Provisions
Section 5160-1-39 - Verification of home care service provision to home care dependent adults
Universal Citation: OH Admin Code 5160-1-39
Current through all regulations passed and filed through September 16, 2024
(A) Home care service providers, as defined in this paragraph, must have a system as follows.
(1) Definitions.
(a) "Home care dependent adult" means a
consumer who:
(i) Resides in a private home or
other non-institutional, unlicensed living arrangement without a parent or
guardian present;
(ii) Requires,
due to health and safety needs, regularly scheduled home care services to
remain in the home or other living arrangement; and,
(iii) Is sixty years of age or older, or is
at least twenty-one years of age but less than sixty years of age, and has a
physical disability or mental impairment.
(b) "Home care service provider" is:
(i) A medicare certified home health agency
or other accredited agency in accordance with Chapter
5160-12 of the Administrative Code that provides
service in the home to the home care dependent adult; or
(ii) A medicare certified hospice provider in
accordance with Chapter 5160-56 of the Administrative Code that provides
services to the terminally ill.
(c) "Life-threatening condition" means a
health condition that will place the consumer at risk of permanent impairment
if the home care service is not provided.
(d) "Mental impairment" means a consumer has
a diminished capacity of judgment such that if the consumer were left alone, it
would place the consumer at risk of permanent impairment.
(e) "Physical disability" means a consumer's
physical condition of severe functional limitations.
(2) A home care service provider, who
provides home care services to a home care dependent adult, must have a system
which effectively monitors the delivery of services by its employee(s). The
system must include:
(a) A mechanism to
verify whether their employees are present (e.g., at the beginning and end of a
visit) at the location and time where services are to be provided for home care
dependent adults who have a mental impairment or life-threatening
condition;
(b) Verification of
whether the provider's employees have provided the services at the proper
location and time at the end of each working day for all other home care
dependent adults not addressed in paragraph (A)(2)(a) of this rule. (e.g.,
adults age sixty or older, or adults that are at least twenty-one years of age
but less than sixty years of age and have a physical disability);
and,
(c) Implementation of a
protocol for scheduling substitute employees when the monitoring system
identifies that an employee has failed to provide home care services at the
proper location and time. The protocol must include a standard for determining
the length of time that may elapse without jeopardizing the health and safety
of the home care dependent adult.
(3) For the information obtained through the
monitoring system in accordance with paragraph (A)(2) of this rule, the home
care service provider must have procedures in place to:
(a) Maintain records;
(b) Compile annual reports which must include
the rate at which home care services were provided at the proper location and
time;
(c) Conduct random checks of
the accuracy of the monitoring system. For purposes of conducting these checks,
a random check is considered to be a check of not more than five per cent or
less than one per cent of the home care visits the provider's employees make to
different home care dependent adults within a particular work shift;
and,
(d) Retain records in
accordance with rule 5160-1- 17.2 of the Administrative Code.
(B) Home care service providers, as defined in paragraph (A) of this rule and as defined by the department of developmental disabilities or department of aging, shall demonstrate their verification system of home care service provision in accordance with section 121.36 of the Revised Code and paragraph (A) of this rule by:
(1)
Participating in periodic compliance reviews; and/or,
(2) Furnishing upon request to
Ohio
department of medicaid (ODM), its designee or the medicaid fraud control
unit any records related to the provisions outlined in section
121.36 of the Revised
Code.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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