Current through all regulations passed and filed through September 16, 2024
(A) "Home maintenance and chore
" means a service that maintains a
clean and safe living environment through the performance of tasks in the
individual's home that are beyond the individual's capability. Home maintenance
and chore services shall not exceed a total of ten thousand dollars in a
calendar year per individual. Covered home maintenance and
chore activities include:
(1) Minor home maintenance and repair
including inspecting, maintaining, and repairing furnaces, including pilot
lights and filters; inspecting, maintaining, and repairing water faucets,
drains, heaters, and pumps; replacing or installing electrical fuses; plumbing
and electrical repairs; repair or replacement of screens or window panes;
fixing floor surfaces posing a threat to the individual's health, safety, and
welfare; and moving heavy items to provide safe ingress and egress.
(2) Heavy household cleaning, including
washing walls and ceilings; washing the outside of windows; non-routine washing
of windows; removing, cleaning and rehanging curtains or drapery; and
shampooing carpets or furniture.
(3)
Removal of environmental
hazards posing a threat to the individual's health, safety, and
welfare
such
as:
(a)
Non-routine disposal of garbage or other accumulated items
in an individual's residence;
(b)
Non-routine yard
maintenance including snow removal;
(c)
Pest control and
related tasks to prevent, suppress, eradicate, or remove pests;
and
(d)
Mold eradication.
(4)
Upkeep and
maintenance of a home modification or adaptive/assistive devices, such
as:
(a)
Routine
maintenance plan;
(b)
Extended warranty; and
(c)
Service call,
labor and parts for a modification or device that ceases to function as
intended.
(B) Home maintenance and chore
do not include:
(1) Tasks of general utility (including
routine yardwork), and not of direct medical or remedial benefit to the
individual.
(2) Jobs that add to
the total square footage of the home.
(3) Jobs that can be accomplished through
existing informal or formal supports.
(4) Jobs that are the legal or contractual
responsibility of someone other than the individual (e.g., the landlord,
etc.).
(5) Jobs involving the
removal of home modifications and returning of
property to its prior condition when the individual vacates the
premises.
(6) Replacement or repair
of a previously approved home modification or home maintenance and chore job
that has been damaged as a result of apparent misuse, abuse, or negligence.
(C) Home maintenance
and chore that are necessary to
ensure the health, safety, and welfare of the individual and will exceed the
ten-thousand-dollar calendar year threshold may be considered for approval by
the Ohio department of medicaid (ODM), Ohio department of aging (ODA) or their
designee.
(D) Authorization
process.
(1) ODM, ODA, or their designee may
require the completion of an in-home evaluation by an appropriately qualified
professional to determine the suitability of the immediate environment where
the service will be performed and the viability of the completion of the
service to improve independence and/or facilitate a healthy and safe
environment.
(2) In consultation
with the individual and/or caregiver(s), ODM, ODA, or their designee, and if necessary,
the qualified professional,
will develop a referral that addresses the
individual's home maintenance and chore needs.
(3) Home maintenance and chore
providers
will
submit a fixed cost proposal for the services
described
under the referral which
will be good for the term of the proposal.
(a) At a minimum, the proposal
will
include all of the following:
(i) A breakdown
of all the needed materials;
(ii) A
breakdown of the costs of all the needed materials;
(iii) A breakdown of the labor
costs;
(iv) A list of
any
permits that must be obtained;
(v)
An estimate of the time needed to complete the service;
(vi) A written statement of all warranties
provided, including a warranty lasting at least one year from the date of final
acceptance of work against defective workmanship, as applicable; and
(vii) A written guarantee that all materials,
products, and installed or furnished appliances perform their advertised
function.
(b) A fixed
cost proposal may be adjusted for good cause only if the proposal is adjusted
in writing, and the adjustment is approved by ODM, ODA, or their
designee.
(4) ODM, ODA,
or their designee
will review all submitted proposals with the
individual and
will approve the proposal with the lowest cost
alternative that meets the individual's assessed needs and ensures the health,
safety and welfare of the individual.
(5) The provider
will be
reimbursed for the actual cost of material and/or labor as identified in the
proposal.
(E)
Provider requirements.
The provider will:
(1)
Know and understand the individual's person-centered services plan related to
home maintenance and chore , and
personal preferences regarding the specific services to be performed.
(2) Before performing a service, inform the
individual and ODM, ODA, or their designee of any
potential
health or welfare risk,
and coordinate times and dates of
service to ensure minimal risk to the individual.
(3)
Comply with applicable federal, state, and local laws, and the individual's
homeowners' association (HOA) requirements, as
applicable.
(4) Obtain the property
owner's written consent prior to performing the service. This written consent
will
reflect that the property owner has agreed to the maintenance, repair or other
service.
(5) Furnish to the
individual, ODM, ODA, or their designee a warranty that covers the workmanship
and materials involved in performing the service, as applicable.
(6)
Provide documentation to ODM, ODA, or their designee that the service was
completed in accordance with the agreed upon specifications using the materials
and equipment cited in the proposal.
(7) Provide
documentation to ODM, ODA, or their designee that the service was tested, is in
proper working order, and is usable by the individual, if applicable.
(8)
Repair any damage incidental to the service at no
additional cost.
(F)
Home maintenance
and chore may only be provided by an agency or non-agency provider approved by
ODM or certified by ODA as a medicaid waiver provider of home maintenance and
chore.
(G) Service
verification: The provider
will obtain the individual's or authorized
representative's signature and date of completion of the service to verify
service delivery, verify the provider left the individual's home in
satisfactory condition, and verify repair of any damages incidental to the
service.
(H) Provider record
retention. For each service furnished, the provider
will retain a
record of compliance with all requirements set forth in rule
5160-44-31 of the Administrative
Code, or with the requirements set forth in Chapter 173-39 of the
Administrative Code for the pre-admission screening system providing options
and resources today (PASSPORT) program. The record
will include:
(1) Individual's name.
(2) Date of service delivery.
(3) A copy of the fixed cost proposal
described in paragraph (D)(3) of this rule, including any approved
adjustments.
(4) Service
description, including a comparison between the fixed cost proposal and the
actual services provided.
(5) Name
of each provider staff person in contact with the individual.
(6) List of chemicals and substances
used.
(7)
Proof of appropriate qualifications to perform services
requiring specialized skills such as electrical, heating/ventilation, and
plumbing work.
(8)
Proof of licensure, insurance, and bonding for services
from applicable jurisdictions.
(9)
Proof of all
necessary post-inspections and post-inspection reports required by law, a HOA,
or both to verify whether each episode of service meets federal, state, and
local laws or HOA requirements. Proof will be obtained prior to
billing,
(10) All of the
documents required in paragraphs (E), (F), and (G) of this rule.
(I)
The authorization
of home maintenance and chore may be combined with other waiver services to
meet the assessed needs of the individuals. In such instances, individual
waiver service limits as described in paragraph (C) of this rule still
apply.
