Ohio Admin. Code 5123-9-20 - Home and community-based services waivers - money management under the individual options and level one waivers
(A) Purpose
This rule defines money management and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service.
(B) Definitions
For the purposes of this rule, the following definitions apply:
(1) "Agency provider"
has the same meaning as in
means an entity that 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.
(2) "Authorized
representative" means a person or an organization appointed by an individual to
discuss and negotiate benefits (e.g., medicaid, social security, or veterans'
administration) on behalf of an individual who needs assistance to manage or
direct the management of benefits for which the individual is eligible or may
be eligible.
(3) "County board"
means a county board of developmental disabilities.
(4) "Department" means the Ohio department of
developmental disabilities.
(5)
"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 shall
will be added
together for the purpose of calculating the number of fifteen-minute billing
units for the day.
(6)
"Homemaker/personal care" has the same meaning as in rule
5123-9-30 of the Administrative
Code.
(7) "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.
(8) "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.
(9) "Individual service plan" means the
written description of services, supports, and activities to be provided to an
individual.
(10) "Money management"
means services that provide assistance to individuals who need support managing
personal and financial affairs, including training to assist an individual to
acquire, retain, or improve related skills. The services meet a continuum of
individualized needs, from organizing and keeping track of financial records
and health insurance documentation, to assisting with bill-paying and
maintaining bank accounts. Money management does not take the place of services
provided by professionals in the accounting, investment, or social services
fields. Money management complements the work of other professionals by
facilitating the completion of the day-to-day tasks rather than determining or
executing long-term plans. Money management includes a broad range of tasks
determined necessary in the individual service plan. Examples of supports that
may be provided as a component of money management include:
(a) Bill-paying and preparing checks for
individuals to sign;
(b) Balancing
checkbooks, reconciling bank account statements, and maintaining or organizing
bank records;
(c) Preparing and
delivering bank account deposits;
(d) Assisting an individual with applying for
benefits such as medicaid buy-in for workers with disabilities and other
resources as appropriate;
(e)
Assisting an individual with maintaining eligibility for benefits such as food
stamps;
(f) Consulting or making
referrals for consultation regarding available benefits;
(g) Making referrals as appropriate for
establishment of special needs accounts (e.g., a qualified income trust or an
account established in accordance with the Achieving a Better Life Experience
Act program and section 529A of the Internal
Revenue Code);
(h) Organizing tax
documents and other paperwork;
(i)
Negotiating with creditors;
(j)
Deciphering medical insurance papers and verifying proper processing of
claims;
(k) Providing general
organization assistance;
(l)
Providing referrals to legal, tax, and investment professionals;
(m) Notarizing documents;
(n) Providing assistance associated with
financial tasks when an individual relocates (e.g., transferring bank accounts
or updating address with creditors); and
(o) Acting as power-of-attorney or authorized
representative, when so designated by the individual.
(11) "Participant-directed homemaker/personal
care" has the same meaning as in rule
5123-9-32 of the Administrative
Code.
(12) "Payee" means a person,
agency, organization, or institution appointed by the social security
administration to receive and manage benefits (e.g., medicaid, social security,
or supplemental security income) on behalf of an individual who needs
assistance to manage or direct the management of benefits. A payee has legal
authority to manage the benefits, uses the benefits to pay for the current and
future needs of the individual, and properly saves any benefits not needed to
meet current needs. A payee is required to keep records of expenses and provide
an accounting of how the payee used or saved the benefits. A payee
shall
will
adhere to the standards and regulations set forth by the social security
administration.
(13) "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.
(14) "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.
(15) "Shared living" has the same meaning as
in rule 5123-9-33 of the Administrative
Code.
(16) "Team"
has the same meaning as in rule 5123-4-02 of the
Administrative Code
means the group of persons
chosen by an individual with the core responsibility to support the individual
in directing development of the individual service plan. The team includes the
individual's guardian or adult whom the individual has identified, as
applicable, the service and support administrator, direct support
professionals, providers, licensed or certified professionals, and any other
persons chosen by the individual to help the individual consider possibilities
and make decisions.
(C) Provider qualifications
(1) Money management
shall
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)
Money management shall
will not be provided by a county board or a
regional council of governments formed under section
5126.13 of the Revised Code by
two or more county boards.
(3) An
applicant seeking approval to provide money management
shall
will
complete and submit an application through the
department's website (http://dodd.ohio.gov) and adhere to the
requirements of as applicable, rule
5123-2-08 or
5123-2-09 of the Administrative
Code, as applicable.
(4) Each person providing money management
shall
will:
(a) Achieve a score of at least eighty per
cent on the department-administered money management competency test;
or
(b) Hold a degree from an
accredited college or university in accounting, business administration,
finance, or public administration; or
(c) Be authorized by Chapter 4701. of the
Revised Code to use the designation of certified public accountant.
(5) Each person, prior to providing
money management, shall successfully complete training provided by the
department or by an entity using department-provided curriculum
in:
(a) The rights of individuals set
forth in section 5123.62 of the Revised Code;
(b) The requirements of rule
5123-17-02 of the Administrative Code including a review of health and welfare
alerts issued by the department; and
(c) Empathy-based
care.
(6) Each person providing money
management shall annually complete at least eight hours of training in
accordance with standards established by the department in:
(a) The rights of individuals set
forth in section 5123.62 of the Revised Code;
(b) The requirements of rule
5123-17-02 of the Administrative Code including a review of health and welfare
alerts issued by the department since the previous year's
training;
(c) Empathy-based care;
and
(d) Topics that enhance the person's
skills and competencies relevant to provision of money
management.
(D)
Requirements for service delivery
(1) Money
management shall
will be provided pursuant to an individual service
plan that conforms to the requirements of rule
5123-4-02 of the Administrative
Code. Providers of money management shall
will participate in individual service plan
development meetings when a request for their participation is made by the
individual.
(2) The scope and
intensity of money management services shall
will be
determined by the team based on the individual's needs. Money management
shall
will be
authorized for no more than ten hours per month.
(3) Money management
shall
will
not duplicate or include activities that help link eligible individuals with
medical, social, or educational providers, programs, or services that are
functions of targeted case management pursuant to rule
5160-48-01 of the Administrative
Code.
(4) Money management
shall
will be
provided at a ratio of one staff to one individual.
(5) Money management services may extend to
those times when the individual is not physically present while the provider is
performing money management activities on behalf of the individual.
(6) A provider of money management
shall
will:
(a) Comply with rule
5123:2-2-07
5123-2-07 of the Administrative Code;
(b) Act in the best interest of and take all
reasonable precautions to safeguard the interests and property of each
individual the provider serves;
(c)
Disclose in writing to each individual served and the individual's service and
support administrator, any affiliations, associations, or interests that may
pose a potential conflict of interest or create the appearance of
impropriety;
(d) Keep current of
issues related to the money management services provided (e.g., health
insurance, consumer fraud, or banking fees) and public and private services
available to individuals for use in resource referrals;
(e) Refer individuals to other service
providers or consult with other service providers when additional knowledge and
expertise are required; and
(f)
Maintain detailed and accurate records, documentation, and information (e.g.,
bank statements, checking account transaction register, savings account
balance, spending trends, or income statements) for each individual served
which shall
will be submitted to the individual in accordance with
the individual service plan and upon request by the individual or the
individual's team.
(7) A
provider of money management who is also an individual's payee
shall
will:
(a) Obtain and maintain the individual's
benefits;
(b) Pay all of the
individual's living expenses prior to providing the individual with
discretionary spending money;
(c)
Take all necessary measures to maintain the individual's eligibility for
benefits such as ensuring bank account balances remain within established
resource limitations; and
(d)
Maintain documentation, report information, and comply with all other
requirements and standards, including audit protocols, established by the
social security administration.
(8) A provider of money management who is
also the individual's payee shall
will not request or accept reimbursement through
more than one funding source for the services that fall under the
responsibilities of a payee. Additional money management tasks beyond the
responsibilities of a payee may be determined necessary through the
person-centered planning process and authorized in the individual service
plan.
(9) A provider of money
management shall
will not also provide homemaker/personal care,
participant-directed homemaker/personal care, or shared living to the same
individual.
(10) Providers of money
management shall
will not act or represent themselves as accountants,
financial advisors, attorneys, or other licensed professionals unless licensed
as such by the state of Ohio.
(E) Documentation of services
Service documentation for money management
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) Number of units of
the delivered service or continuous amount of uninterrupted time during which
the service was provided.
(11)
Times the delivered service started and stopped.
(F) Payment standards
(1) The billing units
unit, service
codes, and payment rates for money management 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 money management provided on or after July 1, 2024 are contained in
appendix B to this rule. Payment rates 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) When services meeting the definition of
money management in accordance with paragraph (B)(10) of this rule are the only
supports provided to an individual by the provider, the services
shall
will be
authorized and billed as money management.
(a)
When assistance with personal finances is provided to an individual by the
provider in conjunction with other components of homemaker/personal care
in accordance with paragraph (B)(10)(i) of rule
5123-9-30 of the Administrative Code, the services
shall
will be
authorized and billed as homemaker/personal care.
(b) When assistance with personal finances is
provided to an individual by the provider in conjunction with other components
of participant-directed homemaker/personal care in
accordance with paragraph (B)(21)(i) of rule 5123-9-32 of the Administrative
Code, the services shall
will be authorized and billed as
participant-directed homemaker/personal care.
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, 07/01/2022
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