Ohio Admin. Code 5123-9-29 - Home and community-based services waivers - home-delivered meals under the individual options, level one, and self-empowered life funding waivers
(A) Purpose
This rule defines home-delivered meals 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" 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)
"Home-delivered meals" means meals delivered to an individual who is otherwise
unable to prepare or obtain nourishing meals. Meals may be ready-to-eat,
frozen, vacuum-packed, modified-atmosphere-packed, or shelf-stable.
(a) A maximum of two meals per day may be
provided under a home and community-based services waiver.
(b) There are three types of home-delivered
meals:
(i) Kosher meal, meaning a meal
certified as kosher by a recognized kosher certification or a kosher
establishment under orthodox rabbinic supervision.
(ii) Therapeutic meal, meaning a meal that is
part of a therapeutic diet ordered by a licensed healthcare professional whose
scope of practice includes ordering therapeutic diets:
(a) As part of the treatment for a disease or
clinical condition;
(b) To modify,
eliminate, decrease, or increase certain substances in the diet; or
(c) To provide mechanically altered food
(i.e., the texture of food is altered by chopping, grinding, mashing, or
pureeing so that it can be successfully chewed and safely swallowed) when
indicated.
(iii)
Standard meal, meaning a meal that is not a kosher meal or a therapeutic
meal.
(c)
"Home-delivered meals" do not include meals that are processed, frozen, or
pre-packaged and commercially available to the general public.
(5) "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.
(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)
"Modified-atmosphere-packed" means the atmosphere of a package of food is
modified so that its composition is different from air but the atmosphere may
change over time due to the permeability of the packaging material or the
respiration of the food and includes reduction in the proportion of oxygen,
total replacement of oxygen, or an increase in the proportion of other gases
such as carbon dioxide or nitrogen.
(9) "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.
(10) "Shelf-stable" means
non-perishable foods that can be safely stored at room temperature.
(11) "Vacuum-packed" means air is removed
from a package of food and the package is hermetically sealed so that a vacuum
remains inside the package.
(C) Provider qualifications
(1) Home-delivered meals 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) Home-delivered
meals 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.
(D)
Requirements for service delivery
(1)
Home-delivered meals will be provided pursuant to an individual service plan
that conforms to the requirements of rule
5123-4-02 of the Administrative
Code. The individual service plan will specify:
(a) The type of home-delivered meals (i.e.,
kosher meals, therapeutic meals, or standard meals) to be provided.
(b) The number of noontime and/or evening
meals to be provided.
(c) The
location for meal delivery, which will be the individual's residence or an
alternative location chosen by the individual.
(d) The range of time in which the meals are
to be delivered.
(2) A
provider of home-delivered meals will:
(a) Be
able to provide two meals per day, seven days per week.
(b) Ensure that each meal:
(i) Contains at least one-third of the daily
recommended dietary allowances in accordance with the "Dietary Guidelines for
Americans" published by the United States department of health and human
services and the United States department of agriculture (available at
https://health.gov/our-work/nutrition-physical-activity/dietary-guidelines);
and
(ii) Includes clear
instructions on how to safely maintain, heat, reheat, and/or assemble the
meal.
(c) Ensure that a
licensed dietitian approves and signs all menus and develops all therapeutic
meal menus in accordance with the individual service plan.
(d) Ensure handling and delivery of meals
meet applicable federal, state, and local food safety, storage, and sanitation
requirements.
(e) Unless the
provider uses a common carrier for meal delivery, maintain a roster of delivery
drivers who are trained and have available backup staff for scheduled meal
deliveries.
(f) Initiate new orders
for home-delivered meals within seventy-two hours of referral or as otherwise
specified in the individual service plan.
(g) Ensure delivery of home-delivered meals
is verified by:
(i) Signature of the
individual or the individual's representative upon delivery;
(ii) Attestation by the delivery driver,
which may be made via an electronic system, that delivery occurred;
or
(iii) Retaining the common
carrier's tracking statement or returned postage-paid delivery
invoice.
(h) Replace any
home-delivered meal or portion thereof that is lost or stolen between the time
of delivery and intended receipt by the individual at no cost to the
individual, the Ohio department of medicaid, or the department.
(3) On condition that appropriate
methods exist to ensure proper and safe handling by the provider of
home-delivered meals and safe consumption by the individual, the provider may:
(a) Deliver the evening meal with the
noontime meal.
(b) Deliver all
meals for a week at one time during the week when frozen, vacuum-packed,
modified-atmosphere-packed, or shelf-stable meals are provided. Each frozen,
vacuum-packed, modified-atmosphere-packed, or shelf-stable meal will be
individually packaged and labeled with the words, "use before" or "use by,"
followed by the month, day, and year by which the meal is to be used.
(E) Documentation of
services
Service documentation for home-delivered meals will include each of the following to validate payment for medicaid services:
(1) Type of service.
(2) Type of meals provided (i.e., kosher
meals, therapeutic meals, or standard meals).
(3) Date of service.
(4) Place of service.
(5) Name of individual receiving
service.
(6) Medicaid
identification number of individual receiving service.
(7) Name of provider.
(8) Provider identifier/contract
number.
(9) 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. When a provider uses a common carrier for meal delivery, the
provider will verify the success of the delivery by retaining the common
carrier's tracking statement or returned postage-paid delivery invoice. A
provider may use an electronic system to verify delivery.
(10) Number of meals delivered.
(11) Time that meals were
delivered.
(12) Name of person
accepting delivery of meals, name of delivery driver who attested that delivery
occurred, or the common carrier's tracking statement or returned postage-paid
delivery invoice.
(F)
Payment standards
(1) The billing unit,
service codes, and payment rates for home-delivered meals are contained in the
appendix to this rule.
(2) Payment
rates for home-delivered meals are based on the type of meal provided (i.e.,
kosher meal, therapeutic meal, or standard meal).
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: 11/03/2011, 09/01/2013, 07/01/2017, 01/01/2019, 07/01/2022, 07/27/2023
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