Ohio Admin. Code 5123-9-14 - Home and community-based services waivers - vocational habilitation under the individual options, level one, and self-empowered life funding waivers
(A) Purpose
This rule defines vocational habilitation and sets forth
provider qualifications, requirements for service delivery and documentation of
services, and payment standards for the service. The expected outcome of
vocational habilitation is the advancement of an individual on his or her path
to community
competitive integrated employment in accordance with
rule 5123:2-2-05
5123-2-05 of the Administrative Code and the
individual's achievement of competitive integrated employment in a job
well-matched to the individual's interests, strengths, priorities, and
abilities.
(B) Definitions
(5)(4) "Competitive
integrated employment" means work (including self-employment) that is performed
on a full-time or part-time basis:
(6)(5) "County board"
means a county board of developmental disabilities.
(7)(6) "Daily billing
unit" means a billing unit that may be used when between five and seven hours
of vocational habilitation are delivered by the same provider to the same
individual during one calendar day in accordance with the conditions specified
in paragraph (F)(2) of this rule.
(8)(7) "Department" means
the Ohio department of developmental disabilities.
(9)(8) "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.
(10)(9) "Group employment
support" has the same meaning as in rule
5123-9-16 of the Administrative
Code.
(11)(10) "Independent
provider" has the same meaning as in
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.
(12)(11) "Individual"
means a person with a developmental disability or for purposes of giving,
refusing to give, or withdrawing consent for services,
his or her
the
person's guardian in accordance with section
5126.043 of the Revised Code or
other person authorized to give consent.
(13)(12)
"Individual employment support" has the same meaning as in rule
5123-9-15 of the Administrative
Code.
(14)(13) "Individual
service plan" means the written description of services, supports, and
activities to be provided to an individual.
(15)(14) "Integrated
community setting" means a setting that is integrated in and supports full
access of individuals to the greater community to the same degree of access as
persons not receiving home and community-based services.
(16)(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 vocational habilitation.
(17)(16)
"Natural supports" means the personal associations and relationships typically
developed in the community that enhance the quality of life for individuals.
Natural supports may include family members, friends, neighbors, and others in
the community or organizations that serve the general public who provide
voluntary support to help an individual achieve agreed upon outcomes through
the individual service plan development process.
(18)(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 5123:2-5-02
5123-5-02 of the Administrative Code.
(19)(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 shall include
includes the items delineated in paragraph (E) of
this rule to validate payment for medicaid services.
(20)(19) "Virtual support"
means the provision of services by direct support professionals at a distant
site who engage with an individual using interactive technology that has the
capability for two-way, real time audio and video communication.
(21)(20)
"Vocational habilitation" means services that provide learning and work
experiences, including volunteer work, where the individual develops general
skills that lead to competitive integrated employment such as ability to
communicate effectively with supervisors, coworkers, and customers;
generally-accepted community workplace conduct and dress; ability to follow
directions; ability to attend to tasks; workplace problem-solving skills and
strategies; and workplace safety and mobility training. Services are expected
to occur over a defined period of time with specific outcomes to be achieved
determined by the individual and his or her
individual's team. Activities that constitute
vocational habilitation include, but are not limited to:
(22)(21) "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) "Adult day support" has the
same meaning as in rule
5123-9-17 of the Administrative
Code.
(2) "Agency provider"
has the same meaning as in
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) "Budget limitation" has the same
meaning as in rule 5123-9-19 of the Administrative
Code.
(a) For
which an individual is:
(i) Compensated:
(a) At a rate that shall be 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) Ongoing support, that may be provided
in-person or through virtual support, which includes direct supervision,
monitoring and/or counseling, and the provision of some or all of the following
supports to promote the development of general work skills:
(i) Developing a systematic plan of
instruction and support, including task analyses to prepare the individual for
competitive integrated employment;
(ii) Assisting the individual to perform
activities that result in increasing his or
her social integration with other persons employed at the
worksite;
(iii) Supporting and
training the individual in the use of individualized or community-based
transportation services;
(iv)
Providing services and training that assist the individual with problem-solving
and meeting job-related expectations;
(v) Assisting the individual to use natural
supports and community resources;
(vi) Providing training to the individual to
maintain current skills, enhance personal hygiene, learn new work skills,
attain self-determination goals, and improve social skills;
(vii) Developing and implementing a plan to
assist the individual to transition from his or
her
the vocational habilitation setting
to competitive integrated employment emphasizing the use of natural supports;
and
(viii) Providing information
about or referral to career planning services, disability benefits services, or
other appropriate consultative services.
(b) Ongoing support, that may only be
provided in-person, assisting the individual with self-medication or
health-related activities or performing medication administration or
health-related activities in accordance with Chapters 5123-6 and 5123:2-6
Chapter 5123-6 of the Administrative
Code.
(C) Provider qualifications
(1) Vocational habilitation
shall
will be
provided by an agency provider that meets the requirements of this rule and
that has a medicaid provider agreement with the Ohio department of
medicaid.
(2) Vocational
habilitation shall
will not be provided by an independent
provider.
(3) An applicant seeking
approval to provide vocational habilitation shall
will complete
and submit an application through the department's
website (http://dodd.ohio.gov/) and adhere to the requirements of rule
5123-2-08 of the Administrative
Code.
(4) An agency provider
shall
will
ensure that direct support professionals who provide vocational habilitation
successfully complete, no later than thirty calendar days after hire, training
in:
(a) Services that comprise vocational
habilitation including the expectation that vocational habilitation will
eventually lead to competitive integrated employment;
(b) Signs and symptoms of illness or injury
and procedure for response;
(c)
Site-specific emergency response plans; and
(d) Program-specific transportation
safety.
(5) An agency
provider shall
will ensure that direct support professionals who
provide vocational habilitation (other than those who have at least one year of
experience providing vocational habilitation at the point of hire), during the
first year after hire, are assigned and have access to a mentor.
(6) An agency provider
shall
will
ensure that direct support professionals who provide vocational habilitation
(other than those who have at least one year of experience providing vocational
habilitation 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 vocational habilitation that includes, but is not limited to:
(a) Skill building in advancement of
individuals on the path to community
competitive integrated employment as described in
rule 5123:2-2-05
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 his or
her civil rights, to exercise control and responsibility over the
services he or she receives
received, and to acquire skills that enable
him or her to become
becoming more independent, productive, and
integrated within the community.
(7) Failure to comply with this rule and rule
5123-2-08 of the Administrative
Code may result in denial, suspension, or revocation of the agency provider's
certification.
(D)
Requirements for service delivery
(1) The
expected outcome of vocational habilitation is the advancement of an individual
on his or her path to community
the path to competitive integrated employment in
accordance with rule 5123:2-2-05
5123-2-05 of the Administrative Code and the
individual's achievement of competitive integrated employment in a job
well-matched to the individual's interests, strengths, priorities, and
abilities.
(2) Vocational
habilitation is available to individuals who are no longer eligible for
educational services based on their graduation and/or receipt of a diploma or
equivalency certificate and/or their permanent discontinuation of educational
services within parameters established by the Ohio department of
education.
(3) The service and
support administrator shall
will ensure that documentation is maintained to
demonstrate that the service provided as vocational habilitation 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.
(4) Vocational
habilitation shall
will be provided pursuant to a person-centered
individual service plan that conforms to the requirements of rules
5123-4-02 and
5123:2-2-05
5123-2-05 of the Administrative Code and
shall be coordinated with other services
and supports set forth in the individual service plan. An individual receiving
vocational habilitation shall
will have community
competitive
integrated employment outcomes in his or
her
the individual service plan;
vocational habilitation activities shall
will be designed to support the individual's
community
competitive integrated employment outcomes.
(5) Vocational habilitation provided
in-person shall
will take place in a non-residential setting separate
from any individual's home. An individual participating in vocational
habilitation provided through virtual support may do so from
his or her
the
individual's home.
(6)
Vocational habilitation may be provided through virtual support under the
following conditions:
(a) Virtual support
does not have the effect of isolating an individual from the individual's
community or preventing the individual from interacting with people with or
without disabilities.
(b) The use
of virtual support has been agreed to by an individual and the individual's
team and is specified in the individual service plan.
(c) The use of virtual support complies with
applicable laws governing an individual's right to privacy and the individual's
protected health information.
(d)
Provision of vocational habilitation through virtual support does not include
assisting an individual with self-medication or health-related activities or
performing medication administration or health-related activities in accordance
with Chapter 5123-6 of the Administrative Code.
(7) A provider of vocational habilitation
shall
will
notify the department within fourteen calendar days when there is a change in
the physical address (i.e., adding a new location or closing an existing
location) of any facility where vocational habilitation takes place.
(8) A provider of vocational habilitation
shall
will
complete reports and collect and submit data via the department's
employment
outcome tracking system in accordance with rule
5123:2-2-05
5123-2-05 of the Administrative Code.
(9) Individuals receiving vocational
habilitation shall
will be compensated in accordance with applicable
federal and state laws and regulations. A determination that an individual
receiving vocational habilitation is eligible to be paid at special minimum
wage rates in accordance with 29 C.F.R. Part 525, "Employment of Workers with
Disabilities Under Special Certificates," as in effect on the effective date of
this rule, shall
will be based on documented evaluations and
assessments.
(10) A provider of
vocational habilitation shall
will ensure that appropriate staff are
knowledgeable about the Workforce Innovation and Opportunity Act as in effect
on the effective date of this rule, wage and hour laws, benefits, work
incentives, and employer tax credits for individuals with developmental
disabilities and ensure that individuals served receive this
information.
(11) A provider of
vocational habilitation shall
will comply with applicable laws, rules, and
regulations of the federal, state, and local governments pertaining to the
physical environment (building and grounds) where vocational habilitation is
provided. A provider of vocational habilitation shall
will be
informed of and comply with standards applicable to the service
setting.
(12) A provider of
vocational habilitation shall
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
Service documentation for vocational habilitation
shall
will
include each of the following to validate payment for medicaid services:
(1) Type of service.
(2) Date of service.
(3) Place of service.
(4) Name of individual receiving
service.
(5) Medicaid
identification number of individual receiving service.
(6) Name of provider.
(7) Provider identifier/contract
number.
(8) 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.
(9) 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.
(10) Times the delivered
service started and stopped.
(11)
Number of units of the delivered service.
(F) Payment standards
(1) The billing units, service codes, and
payment rates for vocational habilitation 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 vocational habilitation provided on or after July 1, 2024 are
contained in appendix B to this rule. Payment rates, except payment rates
for vocational habilitation provided in-person in an integrated community
setting for a group of four or fewer individuals, are based on individuals'
group assignments determined in accordance with rule
5123-9-19 of the Administrative
Code and the county cost-of-doing-business category. Payment rates for
vocational habilitation provided in-person in an integrated community setting
for a group of four or fewer individuals are based on the county
cost-of-doing-business category. The cost-of-doing-business category for an
individual is the category assigned to the county in which the service is
actually provided for the preponderance of time. The cost-of-doing-business
categories are contained in appendix B
C to this rule.
(2) A provider of vocational habilitation may
use the daily billing unit when the provider delivers between five and seven
hours of vocational habilitation in-person to the same individual during one
calendar day and:
(a) The individual does not
qualify for or the provider elects not to receive the behavioral support rate
modification described in paragraph (F)(6) of this rule;
(b) The individual does not qualify for or
the provider elects not to receive the medical assistance rate modification
described in paragraph (F)(7) of this rule; and
(c) The provider does not provide vocational
habilitation to the individual in multiple modes on the same day (i.e., in an
integrated community setting when the individual is part of a group of four or
fewer individuals and in another setting).
(3) A provider of vocational habilitation
shall
will
use the fifteen-minute billing unit when:
(a)
The provider delivers less than five hours or more than seven hours of
vocational habilitation to the same individual during one calendar
day;
(b) The individual being
served qualifies for and the provider elects to receive the behavioral support
rate modification in accordance with paragraph (F)(6) of this rule;
(c) The individual being served qualifies for
and the provider elects to receive the medical assistance rate modification in
accordance with paragraph (F)(7) of this rule;
(d) The provider provides vocational
habilitation to the individual in multiple modes on the same day (i.e., in an
integrated community setting when the individual is part of a group of four or
fewer individuals and in another setting); or
(e) The provider provides vocational
habilitation to the individual through virtual support.
(4) A provider of vocational habilitation
shall
will
not bill a daily billing unit on the same day the provider bills fifteen-minute
billing units for the same individual.
(5) Payment for adult day support, career
planning, group employment support, individual employment support, and
vocational habilitation, alone or in combination, shall
will not exceed
the budget limitations contained in appendix B to rule
5123-9-19 of the Administrative
Code.
(6) Payment rates for
vocational habilitation provided in-person at the fifteen-minute billing unit
shall be
are
eligible for adjustment 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)(6)(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 to this rule.
(a) The department shall
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 shall
be
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.
(7) Payment rates for vocational habilitation
provided in-person at the fifteen-minute billing unit
shall be
are
eligible for adjustment 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)(7)(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 to this rule.
(a) The county board
shall
will
determine that an individual meets the criteria for the medical assistance rate
modification when:
(i) The individual
requires routine feeding and/or the
administration of fluid, nutrition, and/or
prescribed medication through gastrostomy and/or jejunostomy tube,
; and/or requires
the administration of routine doses 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
5123:2-6-01
5123-6-01 of the Administrative Code.
(b) The duration of the medical
assistance rate modification shall be
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.
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: 01/01/2007, 10/01/2007, 07/23/2012, 04/01/2017, 06/11/2020 (Emer.), 11/19/2020, 06/17/2021 (Emer.), 10/15/2021, 01/01/2022
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