Ohio Admin. Code 5123-9-13 - Home and community-based services waivers - career planning under the individual options, level one, and self-empowered life funding waivers
(A) Purpose
This rule defines career planning and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service. The expected outcome of career planning is the individual's achievement of competitive integrated employment and/or career advancement in competitive integrated employment.
(B) Definitions
(2)(3) "Agency provider"
means an entity that directly employs at least one person in addition to a
director of operations for the purpose of providing services for which the
entity is certified in accordance with rule
5123-2-08 of the Administrative
Code.
(3)(4) "Career planning"
means individualized, person-centered, comprehensive employment planning and
support that provides assistance for individuals to achieve or advance in
competitive integrated employment. Career planning is a focused and
time-limited engagement of an individual in identification of a career
direction and development of a plan for achieving competitive integrated
employment and the supports needed to achieve that employment. Components of
career planning include:
(4)(5) "Competitive
integrated employment" means work (including self- employment) that is
performed on a full-time or part-time basis:
(5)(6) "County board"
means a county board of developmental disabilities.
(6)(7) "Customized
employment" means competitive integrated employment designed to meet the
specific abilities of an individual with a significant disability and the
business needs of an employer that is carried out through flexible strategies
such as job exploration by the individual and working with an employer to
facilitate placement including:
(7)(8)
"Department" means the Ohio department of developmental disabilities.
(8)(9)
"Fifteen-minute billing unit" means a billing unit that equals fifteen minutes
of service delivery time or is greater or equal to eight minutes and less than
or equal to twenty-two minutes of service delivery time. Minutes of service
delivery time accrued throughout a day will be added together for the purpose
of calculating the number of fifteen-minute billing units for the
day.
(9)(10) "Group employment
support" has the same meaning as in rule
5123-9-16 of the Administrative
Code.
(10)(11) "Independent
provider" means a self-employed person who provides services for which the
person is certified in accordance with rule
5123-2-09 of the Administrative
Code and does not employ, either directly or through contract, anyone else to
provide the services.
(11)(12) "Individual"
means a person with a developmental disability or for purposes of giving,
refusing to give, or withdrawing consent for services, the person's guardian in
accordance with section
5126.043 of the Revised Code or
other person authorized to give consent.
(12)(13)
"Individual employment support" has the same meaning as in rule
5123-9-15 of the Administrative
Code.
(13)(14) "Individual
service plan" means the written description of services, supports, and
activities to be provided to an individual.
(14)(15) "Mentor" means a
person employed by or under contract with the agency provider who has
experience providing direct services to persons with developmental disabilities
and who is available on a regular basis to provide guidance to new direct
support professionals regarding techniques and practices that enhance the
effectiveness of the provision of career planning.
(15)(17) "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
5123-5-02 of the Administrative
Code.
(16)(18) "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 includes the items delineated in paragraph (E) of this
rule to validate payment for medicaid services.
(17)(19) "Vocational
habilitation" has the same meaning as in rule
5123-9-14 of the Administrative
Code.
(18)(20) "Waiver
eligibility span" means the twelve-month period following either an
individual's initial waiver enrollment date or a subsequent eligibility re-
determination date.
For the purposes of this rule, the following definitions apply:
(1)
"Acuity assessment group" means one of four groups (i.e.,
group A-1, group A, group B, or group C) to which an individual is assigned
based on the individual's score resulting from administration of the acuity
assessment instrument in accordance with rule
5123-9-19 of the Administrative
Code.
(a) Benefits
education and analysis. Benefits education and analysis, also known as "work
incentives planning," provides information to individuals, families, guardians,
advocates, service and support administrators, and educators about the impact
of paid employment on a range of public assistance and benefits programs,
including but not limited to supplemental security income, social security
disability insurance, medicaid buy-in for workers with disabilities, medicare
continuation benefits, veteran's benefits, supplemental nutrition assistance
program, and housing assistance. A maximum of four benefits education and
analyses may be funded through the individual's waiver in a waiver eligibility
span.
(b) Career discovery. Career
discovery is an individualized, comprehensive process to help an individual,
who is pursuing individualized integrated employment or self-employment, reveal
how interests and activities of daily life may be translated into possibilities
for integrated employment. Career discovery results in identification of the
individual's interests in one or more specific aspects of the job market; the
individual's skills, strengths, and other contributions likely to be valuable
to employers or valuable to the community if offered through self-employment;
and conditions necessary for the individual's successful employment or
self-employment. This service culminates in development of a written career
discovery profile summarizing the process, revelations, and recommendations for
next steps to be used to develop the individual's vocational portfolio. A
maximum of four career discovery processes may be funded through the
individual's waiver in a waiver eligibility span.
(c) Career exploration. Career exploration
assists an individual to interact with job holders and observe jobs and job
tasks. Career exploration may include informational interviews with and/or
shadowing persons who are actually performing the job duties of the identified
occupation. When possible, the individual will be given an opportunity to
perform actual job duties as well.
(d) Employment/self-employment plan.
Employment/self-employment plan is an individualized service to create a clear
plan for employment or the start-up phase of self-employment and includes a
planning meeting involving the job seeker and other key people who will be
instrumental in supporting the job seeker to become employed in competitive
integrated employment. The service may include career advancement planning for
individuals who are already employed. This service culminates in development of
a written employment plan directly tied to the results of career exploration,
if previously authorized, situational observation and assessment, and/or career
discovery. For individuals seeking self-employment, this service culminates in
development of a self-employment business plan that identifies training and
technical assistance needs and potential supports and resources for those
services as well as potential sources of business financing given that medicaid
funds may not be used to defray the capital expenses associated with starting a
business. A maximum of four employment/self-employment plans may be funded
through the individual's waiver in a waiver eligibility span.
(e) Job development. Job development is an
individualized service to develop a strategy to achieve competitive integrated
employment. The job development strategy will reflect best practices. The
service may include analyzing a job site, identifying necessary accommodations,
and negotiating with an employer for customized employment. This service is
intended to result in achievement of competitive integrated employment
consistent with the job seeker's or job holder's personal and career goals as
identified in the individual service plan, as determined through career
exploration, situational observation and assessment, career discovery, and/or
the employment planning process. This service will not be provided to an
individual on place four of the path to competitive integrated employment as
described in paragraph (D)(2)(d) of rule
5123-2-05 of the Administrative
Code.
(f) Self-employment launch.
Self-employment launch is support to implement a self-employment business plan
and launch a business. This service is intended to result in the achievement of
an integrated employment outcome consistent with the job seeker's or job
holder's personal and career goals as identified in the individual service
plan, as determined through career exploration, situational observation and
assessment, career discovery, and/or the employment planning process. This
service will not be provided to an individual on place four of the path to
competitive integrated employment as described in paragraph (D)(2)(d) of rule
5123-2-05 of the Administrative
Code.
(g) Situational observation
and assessment. Situational observation and assessment is observation and
assessment, not to exceed thirty days, of the individual's interpersonal
skills, work behaviors, and vocational skills through practical, experiential,
community integrated, paid work experiences related to the individual's
preferences as established in the individual service plan. Information gathered
through situational observation and assessment provides a context to further
determine the skills or behaviors to be developed by the individual to ensure
success in the individual's preferred work environment. A maximum of four
situational observations and assessments may be funded through the individual's
waiver in a waiver eligibility span.
(h) Worksite accessibility. Worksite
accessibility includes:
(i) Time spent
identifying the need for and ensuring the provision of reasonable worksite
accommodations that allow the job seeker or job holder to gain, retain, and
enhance employment or self- employment; and
(ii) Time spent ensuring the provision of
reasonable worksite accommodations through partnership efforts with the
employer and, when appropriate, the opportunities for Ohioans with disabilities
agency.
(a) For which an individual is:
(i) Compensated:
(a) At a rate that is not less than the
higher of the rate specified in the Fair Labor Standards Act of 1938,
29 U.S.C.
206(a)(1), as in effect on
the effective date of this rule, or the rate specified in the applicable state
or local minimum wage law and is not less than the customary rate paid by the
employer for the same or similar work performed by other employees who do not
have disabilities, and who are in similar occupations by the same employer and
who have similar training, experience, and skills; or
(b) In the case of an individual who is
self-employed, yields an income that is comparable to the income received by
persons without disabilities, who are self-employed in similar occupations or
on similar tasks and who have similar training, experience, and skills;
and
(ii) Eligible for
the level of benefits provided to other full-time and part- time
employees;
(b) At a
location where the individual interacts with persons without disabilities to
the same extent as employees who are not receiving home and community-based
services;
(c) That is not performed
in:
(i) Dispersed enclaves in which
individuals work in a self-contained unit within a company or service site in
the community or perform multiple jobs in the company, but are not integrated
with non- disabled employees of the company; or
(ii) Mobile work crews comprised solely of
individuals operating as a distinct unit and/or self-contained business working
in several locations within the community; and
(d) That, as appropriate, presents
opportunities for advancement that are similar to those for persons without
disabilities who have similar positions.
(a)
Customizing a job description based on current employer needs or on previously
unidentified and unmet employer needs;
(b) Developing a set of job duties, a work
schedule and job arrangement, and specifics of supervision (including
performance evaluation and review), and determining a job location;
and
(c) Providing services and
supports at the job location.
(16)
"Pay stub" means
a document issued by an employer that shows, for a specified period of time, an
employee's gross earnings, deductions from those earnings, and net
pay.
(C)
Provider qualifications
(1) Career planning
will be provided by an agency provider or an independent provider that meets
the requirements of this rule and that has a medicaid provider agreement with
the Ohio department of medicaid.
(2) An applicant seeking approval to provide
career planning will complete and submit an application and adhere to the
requirements of as applicable, rule
5123-2-08 or
5123-2-09 of the Administrative
Code.
(3) An applicant seeking
independent provider certification to provide career planning will have:
(a) At least one year of full-time (or
part-time equivalent), paid work experience related to employment planning and
support that assists individuals to achieve competitive integrated employment;
or
(b) Thirty hours of formal
training related to employment planning and support that assists individuals to
achieve competitive integrated employment.
(4) In addition to meeting the requirements
set forth in paragraph (C)(3) of this rule, an applicant seeking independent
provider certification to provide some components of career planning will meet
additional requirements:
(a) An independent
provider of the benefits education and analysis component of career planning
will have successfully completed nationally approved or accredited training in
benefits education and analysis.
(b) An independent provider of the worksite
accessibility component of career planning will hold an appropriate license
(e.g., occupational therapist) or certification (e.g., certified professional
ergonomist issued by the "Board of Certification in Professional Ergonomics"),
or have successfully completed appropriate training by an accredited college or
university.
(5) An
agency provider will ensure that direct support professionals who provide
career planning successfully complete, no later than thirty calendar days after
hire, training in:
(a) Services that comprise
career planning including the expectation that career planning will eventually
lead to competitive integrated employment;
(b) Signs and symptoms of illness or injury
and procedure for response;
(c)
Building/site-specific emergency response plans; and
(d) Program-specific transportation
safely.
(6) An agency
provider will ensure that:
(a) Direct support
professionals who perform the benefits education and analysis component of
career planning have successfully completed nationally approved or accredited
training in benefits education and analysis.
(b) Direct support professionals who perform
the worksite accessibility component of career planning hold an appropriate
license (e.g., occupational therapist) or certification (e.g., certified
professional ergonomist issued by the "Board of Certification in Professional
Ergonomics"), or have successfully completed appropriate training by an
accredited college or university.
(7) An agency provider will ensure that
direct support professionals who provide career planning (other than those who
have at least one year of experience providing career planning at the point of
hire), during the first year after hire, are assigned and have access to a
mentor.
(8) An agency provider will
ensure that direct support professionals who provide career planning (other
than those who have at least one year of experience providing career planning
at the point of hire), no later than one year after hire, successfully complete
at least eight hours of training specific to the provision of career planning
that includes, but is not limited to:
(a)
Skill building in advancement of individuals on the path to competitive
integrated employment as described in rule
5123-2-05 of the Administrative
Code and development of individuals' strengths and skills necessary for
competitive integrated employment; and
(b) Self-determination which includes
assisting the individual to develop self-advocacy skills, to exercise civil
rights, to exercise control and responsibility over the services received, and
to acquire skills that enable becoming more independent, productive, and
integrated within the community.
(D)
Requirements for service delivery
(1) The
expected outcome of career planning is the individual's achievement of
competitive integrated employment and/or career advancement in competitive
integrated employment.
(2) The
service and support administrator will ensure that documentation is maintained
to demonstrate that the service provided as career planning to an individual
enrolled in a waiver is not otherwise available as vocational rehabilitation
services funded under section 110 of the Rehabilitation Act of 1973,
29 U.S.C.
730, as in effect on the effective date of
this rule, or as special education or related services as those terms are
defined in section 602 of the Individuals with Disabilities Education
Improvement Act of 2004, 20
U.S.C. 1401, as in effect on the effective
date of this rule.
(3) Career
planning will be provided pursuant to a person-centered individual service plan
that conforms to the requirements of rules
5123-4-02 and
5123-2-05 of the Administrative
Code and be coordinated with other services and supports set forth in the
individual service plan. An individual will be made
aware of the potential impact of outcome-based payments described in paragraph
(F)(6) of this rule before the job development component of career planning is
authorized in the individual service plan.
(4) Career planning may be provided in a
variety of settings but will not be furnished in the individual's home except
when a home visit is conducted as part of the career discovery component of
career planning or when the individual is self- employed and the home is the
site of self-employment.
(5) Career
planning will be provided at a ratio of one direct support professional to one
individual.
(6) Career planning
services may extend to those times when the individual is not physically
present while the provider is performing career planning activities on behalf
of the individual.
(7) A provider
of career planning will complete reports and collect and submit data via the
department's outcome tracking system in accordance with rule
5123-2-05 of the Administrative
Code.
(8) A provider of career
planning will recognize changes in the individual's condition and behavior as
well as safety and sanitation hazards, report to the service and support
administrator, and record the changes in the individual's written
record.
(E)
Documentation of services
(1) Service
documentation for the career exploration, job development, self- employment
launch, and worksite accessibility components of career planning will include
each of the following to validate payment for medicaid services:
(a) Type of service.
(b) Date of service.
(c) Place of service.
(d) Name of individual receiving
service.
(e) Medicaid
identification number of individual receiving service.
(f) Name of provider.
(g) Provider identifier/contract
number.
(h) 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.
(i) 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.
(j) Times the delivered
service started and stopped.
(k)
Number of units of the delivered service.
(2) Service documentation for the benefits
education and analysis, career discovery, employment/self-employment plan, and
situational observation and assessment components of career planning will
include each of the following to validate payment for medicaid services:
(a) Type of service.
(b) Date of service.
(c) Place of service.
(d) Name of individual receiving
service.
(e) Medicaid
identification number of individual receiving service.
(f) Name of provider.
(g) Provider identifier/contract
number.
(h) 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.
(i) 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. The description and details of the services delivered will be
sufficient to demonstrate achievement of the desired outcomes in order to serve
as the report required for payment for delivery of the services.
(F) Payment standards
(1) The billing units, service codes, and
payment rates for career planning provided January
1, 2024 through June 30, 2024 are contained in appendix A to this rule. The
billing units, service codes, and payment rates for career planning provided on
or after July 1, 2024 are contained in appendix B
are contained in the appendix to this
rule.
(2) Payment for adult day
support, career planning, group employment support, individual employment
support, and vocational habilitation, alone or in combination, will not exceed
the budget limitations contained in appendix B to rule
5123-9-19 of the Administrative
Code.
(3) The county board will
authorize payment for the benefits education and analysis, career discovery,
employment/self-employment plan, and situational observation and assessment
components of career planning within ten calendar days of acceptance of a
report required for payment for delivery of services pursuant to paragraph
(E)(2)(i) of this rule.
(4) Payment
rates for the career exploration, job development, self-employment launch, and
worksite accessibility components of career planning will be adjusted by the
behavioral support rate modification to reflect the needs of an individual
requiring behavioral support upon determination by the department that the
individual meets the criteria set forth in paragraph (F)(4)(a) of this rule.
The amount of the behavioral support rate modification applied to each
fifteen-minute billing unit of service is contained in
as applicable, appendix A or appendix B
the appendix to this rule.
(a) The department will determine that an
individual meets the criteria for the behavioral support rate modification
when:
(i) The individual has been assessed
within the last twelve months to present a danger to self or others or have the
potential to present a danger to self or others; and
(ii) A behavioral support strategy that is a
component of the individual service plan has been developed in accordance with
the requirements in rules established by the department; and
(iii) The individual either:
(a) Has a response of "yes" to at least four
items in question thirty- two of the behavioral domain of the Ohio
developmental disabilities profile; or
(b) Requires a structured environment that,
if removed, will result in the individual's engagement in behavior destructive
to self or others.
(b) The duration of the behavioral support
rate modification is limited to the individual's waiver eligibility span, may
be determined needed or no longer needed within that waiver eligibility span,
and may be renewed annually.
(c)
The purpose of the behavioral support rate modification is to provide funding
for the implementation of behavioral support strategies by staff who have the
level of training necessary to implement the strategies; the department retains
the right to verify that staff who implement behavioral support strategies have
received training (e.g., specialized training recommended by clinicians or the
team or training regarding an individual's behavioral support strategy) that is
adequate to meet the needs of the individuals served.
(5) Payment rates for the career exploration,
job development, self-employment launch, and worksite accessibility components
of career planning will be adjusted by the medical assistance rate modification
to reflect the needs of an individual requiring medical assistance upon
determination by the county board that the individual meets the criteria set
forth in paragraph (F)(5)(a) of this rule. The amount of the medical assistance
rate modification applied to each fifteen-minute billing unit of service is
contained in as applicable, appendix A or appendix
B
the appendix to this rule.
(a) The county board will determine that an
individual meets the criteria for the medical assistance rate modification
when:
(i) The individual requires the
administration of fluid, nutrition, and/ or prescribed medication through
gastrostomy and/or jejunostomy tube; and/or requires the administration of
insulin through subcutaneous injection, inhalation, or insulin pump; and/or
requires the administration of medication for the treatment of metabolic
glycemic disorder by subcutaneous injection; or
(ii) The individual requires a nursing
procedure or nursing task that a licensed nurse agrees to delegate in
accordance with rules in Chapter 4723-13 of the Administrative Code, which is
provided in accordance with section
5123.42 of the Revised Code, and
when such procedure or nursing task is not the administration of oral
prescribed medication, topical prescribed medication, oxygen, or metered dose
inhaled medication, or a health-related activity as defined in rule
5123-6-01 of the Administrative
Code.
(b) The duration
of the medical assistance rate modification is limited to the individual's
waiver eligibility span, may be determined needed or no longer needed within
that waiver eligibility span, and may be renewed annually.
(6)
A provider of the
job development component of career planning may be eligible for an
outcome-based payment following an individual's achievement of competitive
integrated employment.
(a)
A provider may obtain either or both of two possible
outcome-based payments for each individual served:
(i)
One payment when
the individual achieves competitive integrated employment.
(ii)
One payment when
the individual achieves competitive integrated employment that:
(a)
Pays at least
twelve dollars per hour; and/or
(b)
Employs the
individual for an average of at least thirty hours per week as determined over
the course of at least four weeks.
(b)
To obtain an
outcome-based payment, a provider will secure one or more pay stubs from the
individual served sufficient to document the competitive integrated employment
and/or hourly wage or average hours worked following provision of the job
development component of career planning. The provider will submit the pay stub
or pay stubs to the individual's service and support administrator, who will
authorize the outcome-based payment in the individual service plan. When pay
stubs cannot be secured, the provider will instead submit an attestation in the
format prescribed by the department that the outcome has been
achieved.
(c)
The amount of the outcome-based payment is determined
by the nature of the competitive integrated employment and the acuity
assessment group assignment of the individual at the time the individual
achieves competitive integrated employment.
(d)
No more than two
outcome-based payments will be made during an individual's waiver eligibility
span.
(e)
The service codes and payment rates for outcome-based
payments are contained in the appendix to this rule.
Notes
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5123.049, 5123.1611
Rule Amplifies: 5123.04, 5123.045, 5123.049, 5123.16, 5123.161, 5123.1611, 5166.21
Prior Effective Dates: 04/01/2017, 01/01/2019, 01/01/2022, 01/01/2024
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