Current through all regulations passed and filed through December 16, 2024
(A)
A member may
choose to receive MyCare Ohio waiver services from any combination of providers
on the provider panel of the MyCare Ohio plan selected by the member pursuant
to paragraph (B) of rule
5160-58-04 of the Administrative
Code.
(B)
A member receiving waiver services from any MyCare Ohio
waiver provider will:
(1)
Participate with the waiver service coordinator in the
development of the person-centered services plan as defined in rule
5160-44-02 of the Administrative
Code.
(2)
Decide who from their trans-disciplinary care
management team will participate in the development of the person-centered
services plan.
(3)
Communicate to the service provider and, as
appropriate, the provider's management staff, personal preferences about the
way duties, tasks and procedures are to be performed.
(4)
Work with the
waiver service coordinator and the provider to identify and secure additional
service provider orientation, training and/or continuing education within the
provider's scope of practice to meet the member's specific
needs.
(5)
Not direct the provider to act in a manner that is
contrary to any relevant MyCare Ohio waiver requirements, medicaid rules and
regulations, or the provider's policies and procedures.
(6)
Understand the
incident management and reporting responsibilities of the member as set forth
in rule 5160-44-05 of the Administrative
Code.
(7)
Communicate to the waiver service coordinator and/or
MyCare Ohio plan care manager any significant changes, as defined in rule
5160-58-01 of the Administrative
Code, that may affect service provision or result in a need for more or fewer
hours of service.
(8)
Sign a complete and accurate timesheet or other
documentation, as appropriate, to verify services have been furnished. The
member will never approve blank timesheets, or timesheets that have been
completed before services have been furnished. Verification may be written or
electronic at the discretion of the MyCare Ohio plan, unless otherwise required
by rule 5160-1-40 of the Administrative
Code. If the individual is unable to provide the signature required to verify a
service at the time of the service, the individual will submit an electronic
signature or standard signature via regular mail, or otherwise provide a
signature in no instance any later than at the next face-to-face visit with the
provider.
(9)
Participate in the recruitment, selection and dismissal
of providers in collaboration with the trans-disciplinary care management
team.
(10)
In the manner specified by the waiver service
coordinator, notify the provider if the member is going to miss a scheduled
visit.
(11)
Notify the waiver service coordinator if the assigned
provider misses a scheduled visit.
(12)
Notify the
waiver service coordinator when any change in provider is necessary.
Notification will include the desired end date of the current
provider.
(13)
Participate in the monitoring of the performance of the
provider.
(14)
Understand and abide by the rules governing the MyCare
Ohio program.
(C)
Members who choose to exercise participant-direction
for their waiver services, as outlined in paragraph (F) of rule
5160-58-04 of the Administrative
Code will have the following additional requirements as appropriate to the
service being furnished:
(1)
Take a proactive role in the delivery of their MyCare
Ohio waiver services. This includes identifying and recruiting prospective
providers, training on tasks to meet the member's needs and preferences, and
scheduling and managing the delivery services.
(2)
Designate a
location in their home in which the member and, as appropriate, the provider
can safely store a copy of the member's records in a manner that protects the
confidentiality of the records, and for the purpose of contributing to the
continuity of the member's care.
(3)
Work with ODM's
designated financial management service and the waiver service coordinator
and/or MyCare Ohio care manager to coordinate the authorized service
delivery.
(D)
Members who elect participant-directed services will
demonstrate the ability and willingness to:
(1)
Understand the
service elements the provider furnishes;
(2)
Understand how to
direct the provider; and
(3)
Perform employer-related responsibilities,
including:
(a)
Completing required training;
(b)
Select and
dismiss participant-directed service providers;
(c)
Enter into
written agreements with participant-directed service providers for specific
activities;
(d)
Train participant-directed service providers to meet
the member's specific needs;
(e)
Supervise and
monitor the participant-directed service provider's performance of specific
activities, including written approval of the provider's time
sheets;
(f)
Manage the participant-directed service provider when
they furnish a service.
(E)
If the waiver
service coordinator, in consultation with the trans-disciplinary care
management team, determines that the member and/or the member's representative
cannot meet the requirements set forth in paragraph (C) or (D) of this rule, or
the health and welfare of the member cannot be ensured, the waiver service
coordinator may require the member to receive services from agency or
non-agency providers. The member will be afforded notice and hearing rights in
accordance with division 5101:6 of the Administrative Code.
Replaces: 5160-58-03.2
