Ohio Admin. Code 5123-9-15 - Home and community-based services waivers - individual employment support under the individual options, level one, and self-empowered life funding waivers
(A) Purpose
This rule defines individual employment support and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service. The expected outcome of individual employment support is competitive integrated employment in a job well-matched to the individual's interests, strengths, priorities, and abilities that meets the individual's personal and career goals.
(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.
(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 that
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" means individualized support for an individual
to maintain competitive integrated employment. Activities that constitute
individual employment support include but are not limited to:
(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 individual employment support.
(15)(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.
(16)(18) "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.
(17)(19) "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.
(18)(20) "Vocational
habilitation" has the same meaning as in rule
5123-9-14 of the Administrative
Code.
(19)(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)
"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) 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.
(a) Job coaching, which is identification and
provision of services and supports, utilizing task analysis and systematic
instruction that assist the individual in maintaining employment and/or
advancing the individual's career. Job coaching includes supports provided to
the individual and the individual's supervisor or coworkers on behalf of the
individual, either in-person or remotely via technology. Job coaching may
include the engagement of natural supports in the workplace to provide
additional supports that allow the job coach to maximize the job coach's
ability to fade. Examples of job coaching strategies include
customized employment, job analysis, job
adaptations, instructional prompts, verbal instruction, self-management tools,
physical assistance, role playing, coworker modeling, and written instruction.
Job coaching for self-employment includes identification and provision of
services and supports, including counseling and guidance, which assist the
individual in maintaining self- employment through the operation of a business.
When job coaching is provided, a plan outlining the steps to reduce job
coaching over time will be in place within thirty calendar days.
(b) Training in assistive or other technology
utilized by the individual while on the job.
(c) Other workplace support services
including services not specifically related to job skill training that enable
the individual to be successful in integrating into the job setting.
(d) Personal care and assistance, which may
be a component of individual employment support but will not comprise the
entirety of the service.
(17)
"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) Individual
employment support 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
individual employment support 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 individual employment support
must have:
(a) At least one year of full-time
(or part-time equivalent), paid work experience related to supporting
individuals to maintain jobs in the general workforce; or
(b) Thirty hours of formal training related
to supporting individuals to maintain jobs in the general workforce.
(4) An agency provider will ensure
that direct support professionals who provide individual employment support
successfully complete, no later than thirty calendar days after hire, training
in:
(a) Services that comprise individual
employment support;
(b) Signs and
symptoms of illness or injury and procedure for response;
(c) Building/site-specific emergency response
plans; and
(d) Program-specific
transportation safety.
(5) An agency provider will ensure that
direct support professionals who provide individual employment support (other
than those who have at least one year of experience providing individual
employment support at the point of hire), during the first year after hire, are
assigned and have access to a mentor.
(6) An agency provider will ensure that
direct support professionals who provide individual employment support (other
than those who have at least one year of experience providing individual
employment support 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 individual employment support that includes, but is not limited
to:
(a) Skill-building in job training and
systematic instruction that assists an individual in maintaining employment and
or advancing the individual's career; and
(b) Self-determination which includes
assisting an 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 individual employment support is competitive integrated
employment in a job well-matched to the individual's interests, strengths,
priorities, and abilities that meets the individual's personal and career
goals.
(2) Individual employment
support 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 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)(5) of this rule before individual employment support is authorized in the
individual service plan.
(3)
The service and support administrator will ensure that documentation is
maintained to demonstrate that the service provided as individual employment
support 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.
(4) Individual
employment support, other than services and supports that assist an individual
to maintain self-employment through the operation of a business, will take
place in a setting separate from the home of the individual receiving the
services.
(5) Individual employment
support will be provided at a ratio of one direct support professional to one
individual.
(6) Individual
employment support services may extend to those times when an individual is not
physically present while the provider is performing individual employment
support activities on behalf of the individual (e.g., developing coworker
supports or meeting with a supervisor).
(7) A provider of individual employment
support 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 individual
employment support will recognize changes in the individual's condition and
behavior, report to the service and support administrator, and record the
changes in the individual's written record.
(9) A provider of individual employment
support will report identified safety and sanitation hazards that occur at the
worksite to employers having the responsibility to remedy the
condition.
(E)
Documentation of services
Service documentation for individual employment support 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 unit, service codes, and
payment rates for individual employment support provided January 1, 2024 through June 30, 2024 are contained
in appendix A to this rule. The billing unit, service codes, and payment rates
for individual employment support 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) Payment rates for
individual employment support 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)(3)(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 verity 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.
(4) Payment rates for individual employment
support 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)(4)(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.
(5)
A provider of
individual employment support may be eligible for an outcome- based payment
following an individual's achievement of a job retention milestone.
(a)
A provider may
obtain either or both of two possible outcome-based payments for each
individual served:
(i)
One payment when the individual retains competitive
integrated employment for ninety calendar days following the first date the
provider was authorized to deliver individual employment support to the
individual.
(ii)
One payment when the individual retains competitive
integrated employment for one hundred eighty calendar days following the first
date the provider was authorized to deliver individual employment support to
the individual.
(b)
To obtain an
outcome-based payment, a provider will secure one or more pay stubs from the
individual served sufficient to document the date span of the individual's
competitive integrated employment (i.e., ninety or one hundred eighty calendar
days, as applicable) following the first date the provider was authorized to
deliver individual employment support to the individual. 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 an
outcome-based payment is determined by the job retention milestone and the
acuity assessment group assignment of the individual at the time the individual
achieves the milestone.
(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: 01/01/2007, 10/01/2007, 07/23/2012, 08/23/2012, 04/01/2017, 01/01/2022, 01/01/2024
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.