Current through all regulations passed and filed through September 16, 2024
(A)
This rule does
not apply to My Care Ohio plans as defined in rule
5160-58-01 of the Administrative
Code or the Ohio resilience through integrated systems and excellence
(OhioRISE) plan as defined in rule
5160-59-01 of the Administrative
Code.
(B)
The managed care organization (MCO) is responsible for
payment of long-term services and supports (LTSS) respite services as defined
in rule 5160-26-01 of the Administrative
Code.
(C)
To be eligible for respite services, the member has
to:
(1)
Reside
with his or her informal, unpaid primary caregiver in a home that is not owned,
leased, or controlled by a provider of any health-related treatment or support
services;
(2)
Not be a foster child, as defined in Chapter 5101:2-1
of the Administrative Code;
(3)
Be under
twenty-one years of age;
(4)
Have long-term services and supports (LTSS) needs
resulting in the need for respite services as indicated by:
(a)
Skilled nursing
or skilled rehabilitation services at least once per week; or
(b)
Having a need for
at least fourteen hours per week of home health aide services for at least two
consecutive months immediately preceding the date respite services are
requested; or
(c)
Being determined eligible for social security income
for children with disabilities or supplemental security income;
or
(d)
Having an LTSS needs as determined by the MCO through
an institutional level of care determination as set forth in rule
5123-8-01 or 5160-3-08, of the
Administrative Code.
(5)
Be participating
in a care management or coordination arrangement.
(D)
Authorization for
LTSS respite.
(1)
Prior authorization of LTSS respite services will be in
accordance with rule
5160-26-03.1 of the
Administrative Code.
(2)
Respite services can be provided on a planned or
unplanned basis.
(3)
The MCO has to determine that the member's primary
caregiver has a need for temporary relief from the care of the member as a
result of the member's LTSS needs, or in order to prevent an inpatient,
institutional, or out-of-home stay.
(E)
LTSS respite
services have to be provided by individuals employed by medicaid enrolled
agency providers that are either medicare-certified home health agencies
pursuant to Chapter 3701-60 of the Administrative Code, or accredited by the
"Joint Commission," the "Community Health Accreditation Program," or the
"Accreditation Commission for Health Care."
(1)
LTSS respite
providers have to comply with the criminal records check set forth in rules
5160-45-07 and
5160-45-11 of the Administrative
Code.
(2)
The provider has to be awake when the member is awake
during the provision of respite services.
(3)
Respite providers
has to not be the member's "legally responsible family member," as defined in
rule 5160-45-01 of the Administrative
Code.
(4)
Before commencing service delivery, the LTSS provider
agency employee has to:
(a)
Obtain a certificate of completion of either a
competency evaluation program or a training and competency evaluation program
approved or conducted by the director of health under section
3721.31 of the Revised Code, and
be registered as active or in good standing on the Ohio nurse aide registry
maintained by the director of health under section
3721.32 of the Revised
Code.
(b)
Obtain and maintain first aid certification from a
class that is not solely internet-based and that includes hands-on training by
a certified first aid instructor and a successful return demonstration of what
was learned in the course. At its discretion, ODM may accept training conducted
by a solely internet-based class as sufficient for the purposes of first aid
certification.
(c)
After commencing service delivery, the LTSS provider
agency employee has to:
(i)
Maintain evidence of completion of twelve hours of
in-service continuing education within a twelve-month period, excluding agency
and program-specific orientation, and
(ii)
Receive
supervision from an Ohio-licensed registered nurse (RN) and meet any additional
supervisory requirements pursuant to the agency's certification or
accreditation.
