Ohio Admin. Code 5123-9-16 - Home and community-based services waivers - group employment support under the individual options, level one, and self-empowered life funding waivers
(A) Purpose
This rule defines group 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 group employment support is paid employment and work experience leading to further career development and competitive integrated employment.
(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 group employment support 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 that
day.
(10)(9) "Group employment
support" means services and training activities provided in regular business,
industry, and community settings for groups of two or more workers with
disabilities.
(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) "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 group employment support.
(16)(15)
"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.
(17)(16)
"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.
(18)(17) "Vocational
habilitation" has the same meaning as in rule
5123-9-14 of the Administrative
Code.
(19)(18) "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
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) Activities that constitute
group employment support include any combination of the following as necessary
and appropriate to meet the community employment goals of the individual:
(i) Person-centered employment
planning;
(ii) Work
adjustment;
(iii) Job
analysis;
(iv) Training and
systematic instruction;
(v) Job
coaching; and
(vi) Training in
independent planning, arranging, and using transportation.
(b) Group employment support is provided in
two distinct service arrangements:
(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.
(C) Provider qualifications
(1) Group employment support
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) Group employment
support shall
will not be provided by an independent
provider.
(3) An applicant seeking
approval to provide group employment support 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 group employment support
successfully complete, no later than thirty calendar days after hire, training
in:
(a) Services that comprise group
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
shall
will
ensure that direct support professionals who provide group employment support
(other than those who have at least one year of experience providing group
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
shall
will
ensure that direct support professionals who provide group employment support
(other than those who have at least one year of experience providing group
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 group employment support 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
an 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 group employment support is paid employment and work
experience leading to further career development and competitive integrated
employment.
(2) Group employment
support 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.
(3) The service and support administrator
shall
will
ensure that documentation is maintained to demonstrate that the service
provided as group 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) Group
employment support shall
will be provided in an integrated setting and
support individuals' access to the greater community, including opportunities
to seek competitive integrated employment, to engage in community life, and to
have control over earned income.
(5) Group employment support
shall
will
take place in a setting separate from the home of the individual receiving the
services.
(6) Individuals receiving
group employment support shall
will be compensated in accordance with applicable
federal and state laws and regulations. A determination that an individual
receiving group employment support 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.
(7) A provider of
group employment support 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.
(8) A provider of
group employment support shall
will provide the service in a manner that
presumes all participants are capable of working in competitive integrated
employment. The provider shall
will encourage individuals receiving the service,
on an ongoing basis, and as part of the annual person-centered planning
process, to explore their interests, strengths, and abilities relating to
competitive integrated employment. The provider shall
will, as a
component of the service, assist individuals to explore, identify, and pursue
opportunities that advance them toward competitive integrated
employment.
(9) A provider of group
employment support 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.
(10) A provider of group employment support
shall
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.
(11) A provider of
group employment support shall
will report identified safety and sanitation
hazards that occur at the work site to employers having the responsibility to
remedy the condition.
(E)
Documentation of services
Service documentation for group employment support
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 group employment support 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 group employment support provided on or after July 1, 2024 are
contained in appendix B to this rule. Payment rates 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. 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 group
employment support may use the daily billing unit when the provider delivers
between five and seven hours of group employment support 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; and
(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.
(3) A provider of group employment
support shall
will use the fifteen-minute billing unit when:
(a) The provider delivers less than five
hours or more than seven hours of group employment support 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; or
(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.
(4) A provider of group employment
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 group
employment support shall be modified
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)(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 group employment
support shall be modified
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)(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 nursing 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, 01/01/2022
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