Ohio Admin. Code 5123-9-23 - Home and community-based services waivers - environmental accessibility adaptations under the individual options and level one waivers
(A) Purpose
This rule defines environmental accessibility adaptations 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 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.
(2) "County board" means a
county board of developmental disabilities.
(3) "Department" means the Ohio department of
developmental disabilities.
(4)
"Environmental accessibility adaptations" means physical adaptations to an
individual's home (e.g., installation of ramps or grab-bars, widening of
doorways, modification of bathroom facilities, or installation of specialized
electrical systems to operate an individual's medical equipment) that comply
with the following requirements:
(a) The
physical adaptation to the individual's home must be:
(i) Determined by the individual's team
necessary to:
(a) Support the individual to
reside in a community-based setting; and
(b) Either:
(i) Ensure the health, welfare, and safety of
the individual; or
(ii) Enable the
individual to function with greater independence while at home.
(ii) Identified in the
individual service plan.
(iii)
Completed in accordance with applicable state and local building
codes.
(b)
"Environmental accessibility adaptations" does not include physical adaptations
to the home that:
(i) Add to the total square
footage of the home;
(ii) Are of
general utility; or
(iii) Are not
of direct medical or remedial benefit to the individual (e.g., carpeting, roof
repair, or central air conditioning).
(5) "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.
(6) "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.
(7) "Individual service plan" means the
written description of services, supports, and activities to be provided to an
individual.
(8) "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.
(9) "Waiver eligibility span" means
the twelve-month period following either an individual's initial waiver
enrollment date or a subsequent eligibility re-determination
date.
(C) Provider qualifications
(3)(2) An applicant
seeking approval to provide environmental accessibility adaptations
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.
(4)(3) An applicant
seeking approval to provide environmental accessibility adaptations
shall
will
submit to the department documentation verifying the applicant's experience in
providing environmental accessibility adaptations.
(1) Environmental accessibility adaptations
shall
will be
provided by an independent provider or an agency provider that meets the
requirements of this rule and that has a medicaid provider agreement with the
Ohio department of medicaid.
(2) A county board or a regional
council of governments formed under section 5126.13 of the Revised Code by two
or more county boards may provide environmental accessibility adaptations only
when no other certified provider is willing and able.
(D)
Requirements for service delivery
(1)
Environmental accessibility adaptations shall
will be
provided pursuant to an individual service plan that conforms to the
requirements of rule
5123-4-02 of the Administrative
Code.
(2)
The
A provider
of environmental accessibility adaptations shall
will comply
with all applicable state and local regulations that apply to the operation of
the provider's business or trade.
(3)
When an
individual is moving from an institutional setting, environmental accessibility
adaptations may be authorized for up to one hundred eighty calendar days prior
to the date on which the individual enrolls in the individual options or level
one waiver. Environmental accessibility adaptations begun while the individual
is living in the institutional setting are not considered complete and the
service may not be billed until the date the individual leaves the institution
and enrolls in the waiver.
(E) Documentation of services
Service documentation for environmental accessibility
adaptations 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.
(F) Payment
standards
(1) The billing unit, service codes,
and payment rates
rate for environmental accessibility adaptations are
provided
contained in the appendix to this rule.
(2) Claims for payment for environmental
accessibility adaptations shall
will be submitted to the department with
verification from the county board that the project meets the requirements
specified in the approved individual service plan, the project is
satisfactorily completed, and the project is in compliance with applicable
state and local requirements, including building codes. The verification
shall
will be
submitted in the format prescribed by the department.
(3) Payment for environmental accessibility
adaptations shall
will not exceed ten thousand dollars per project
unless the county board documents the need for an
exception in accordance with paragraph (F)(4) of this rule.
(4)
When the cost of
needed environmental accessibility adaptations exceeds ten thousand dollars per
project, the department and the county board will collaborate with the
individual and the individual's team to ensure the individual's health and
welfare needs are met either through waiver funding or non-medicaid funds. When
waiver funding is necessary, the county board will submit documentation to the
department establishing how the project will ensure the individual's health and
welfare.
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: 04/28/2003, 07/01/2006, 03/19/2012, 09/01/2013, 09/01/2017, 01/01/2019, 07/01/2022
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