Ohio Admin. Code 5123-9-35 - Home and community-based services waivers - remote support under the individual options, level one, and self-empowered life funding waivers

(A) Purpose

This rule defines remote support 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) "Backup support person" means the person who is responsible for responding in the event of an emergency or when an individual receiving remote support otherwise needs assistance or the equipment used for delivery of remote support stops working for any reason. Backup support may be provided on an unpaid basis by a family member, friend, or other person selected by the individual or on a paid basis by an agency provider of homemaker/personal care for an individual enrolled in the individual options waiver or level one waiver or in an agency-with-choice arrangement for participant-directed homemaker/personal care provided to an individual enrolled in the self-empowered life funding waiver, as applicable. When backup support is provided on a paid basis by an agency provider or in an agency-with-choice arrangement, the agency provider shall will be the primary contact for the remote support vendor.

(3) "County board" means a county board of developmental disabilities.

(4) "Department" means the Ohio department of developmental disabilities.

(5) "Group size" means the number of individuals who are sharing services, regardless of the funding source for those services.

(6) "Homemaker/personal care" has the same meaning as in rule 5123-9-30 of the Administrative Code.

(7) "Hourly billing unit" means a billing unit and corresponding payment rate that shall will be used when forty-five to sixty minutes of remote support are provided by the same provider to the same individual during one calendar day.

(8) "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.

(9) "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.

(10) "Individual service plan" means the written description of services, supports, and activities to be provided to an individual.

(11) "Monitoring base" means the off-site location from which the remote support staff monitor an individual.

(12) "Participant-directed homemaker/personal care" has the same meaning as in rule 5123-9-32 of the Administrative Code.

(13) "Remote support" means the provision of supports by staff of an agency provider at a remote location who are engaged with an individual through equipment with the capability for live two-way communication. Equipment used to meet this requirement shall will include one or more of the following components:

(a) Motion sensing system;

(b) Radio frequency identification;

(c) Live video feed;

(d) Live audio feed;

(e) Web-based monitoring system; or

(f) Another device that facilitates live two-way communication.

(14) "Remote support provider" means the agency provider identified in the individual service plan as the provider of remote support. The remote support provider may be either:

(a) A remote support vendor with unpaid backup support; or

(b) A provider of homemaker/personal care or participant-directed homemaker/personal care who also acts as a remote support vendor or maintains a contract with a remote support vendor to provide paid backup support.

(15) "Remote support vendor" means the agency provider that supplies the monitoring base, the remote support staff who monitor an individual from the monitoring base, and the equipment used in the delivery of remote support.

(16) "Sensor" means equipment used to notify the remote support staff or other persons designated in the individual service plan of a situation that requires attention or activity which may indicate deviations from routine activity and/or future needs. Examples include, but are not limited to, seizure mats, door sensors, floor sensors, motion detectors, heat detectors, and smoke detectors.

(17) "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.

(18) "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.

(19) "Shared living" has the same meaning as in rule 5123-9-33 of the Administrative Code.

(20) "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.

(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.

(C) Provider qualifications

(1) Remote 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) Remote support shall will not be provided by an independent provider, 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 remote 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) Staff of agency providers and entities under contract with agency providers who monitor individuals from the monitoring base shall will complete the training specified in appendix C to rule 5123-2-08 of the Administrative Code.

(5) Failure of a certified provider to comply with this rule and rule 5123-2-08 of the Administrative Code may result in denial, suspension, or revocation of the provider's certification.

(6) Failure of a licensed provider to comply with this rule and Chapter 5123-3 of the Administrative Code may result in denial, suspension, or revocation of the provider's license.

(D) Requirements for service delivery

(1) Remote support is intended to address an individual's assessed needs in a manner that promotes autonomy and minimizes dependence on paid support staff and should be explored prior to authorizing services that may be more intrusive, including homemaker/personal care or participant-directed homemaker/personal care, as applicable.

(2) An individual's service and support administrator, in consultation with the individual and the individual's team, shall will assess whether remote support is sufficient to ensure the individual's health and welfare.

(3) Remote support shall will be provided pursuant to an individual service plan that conforms to the requirements of rule 5123-4-02 of the Administrative Code.

(4) Remote support shall will be provided in real time, not via a recording, by awake staff at a monitoring base using the appropriate connection. While remote support is being provided, the remote support staff shall will not have duties other than remote support.

(5) Remote support shall will not be provided in shared living or non-residential settings.

(6) When remote support involves the use of audio and/or video equipment that permits remote support staff to view activities and/or listen to conversations in the residence, the individual who receives the service and each person who lives with the individual shall will consent in writing after being fully informed of what remote support entails including, but not limited to, that the remote support staff will observe their activities and/or listen to their conversations in the residence, where in the residence the remote support will take place, and whether or not recordings will be made. If the individual or a person who lives with the individual has a guardian, the guardian shall will consent in writing. The individual's service and support administrator shall will keep a copy of each signed consent form with the individual service plan.

(7) The remote support vendor shall will provide initial and ongoing training to its staff to ensure they know how to use the monitoring base system.

(8) The remote support vendor shall will have a backup power system (such as battery power and/or generator) in place at the monitoring base in the event of electrical outages. The remote support vendor shall will have other backup systems and additional safeguards in place which shall include, but are including but not limited to, contacting the backup support person in the event the monitoring base system stops working for any reason.

(9) The remote support vendor shall will comply with all federal, state, and local regulations that apply to the operation of its business or trade, including but not limited to, 18 U.S.C. section 2510 to section 2522 as in effect on the effective date of this rule and section 2933.52 of the Revised Code.

(10) The remote support vendor shall will have an effective system for notifying emergency personnel such as police, fire, emergency medical services, and psychiatric crisis response entities.

(11) The remote support vendor shall will provide an individual who receives remote support with initial and ongoing training on how to use the remote support system as specified in the individual service plan.

(12) If a known or reported emergency involving an individual arises, the remote support staff shall will immediately assess the situation and call emergency personnel first, if that is deemed necessary, and then contact the backup support person. The remote support staff shall will stay engaged with the individual during an emergency until emergency personnel or the backup support person arrives.

(a) The backup support person shall will verbally acknowledge receipt of a request for assistance from the remote support staff.

(b) The backup support person shall will arrive at the individual's location within a reasonable amount of time (to be specified in the individual service plan) when a request for in-person assistance is made.

(13) When an individual needs assistance but the situation is not an emergency, the remote support staff shall will:

(a) Address the situation as specified in the individual service plan for an individual who receives remote support with unpaid backup support; or

(b) Contact the paid backup support for an individual who receives remote support with paid backup support.

(14) The remote support staff shall will have detailed and current written protocols for responding to an individual's needs as specified in the individual service plan, including contact information for the backup support person to provide assistance when necessary. The individual service plan shall will set forth the protocol to be followed should the individual request that the equipment used for delivery of remote support be turned off.

(15) A monitoring base shall will not be located at the residence of an individual who receives remote support.

(16) A secure network system requiring authentication, authorization, and encryption of data that complies with 45 C.F.R. section 164.102 to section 164.534 as in effect on the effective date of this rule shall will be in place to ensure that access to computer, video, audio, sensor, and written information is limited to authorized persons.

(17) If an unusual incident or a major unusual incident as defined in rule 5123-17-02 of the Administrative Code occurs while an individual is being monitored, the remote support provider shall will retain or ensure the retention of any video and/or audio recordings and any sensor and written information pertaining to the incident for at least seven years from the date of the incident.

(E) Documentation of services

Service documentation for remote 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) Begin and end time of the remote support service when the backup support person is needed on site.

(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.

(10) Number of units of the delivered service per calendar day.

(11) Group size in which the service was provided.

(12) 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 units, service codes, and payment rates for remote support provided January 1, 2024 through June 30, 2024 are contained in the appendix A to this rule. The billing units, service codes, and payment rates for remote support provided on or after July 1, 2024 are contained in appendix B to this rule.

(2) There are two payment rates for remote support, which differ depending on whether an individual is receiving remote support with unpaid backup support or with paid backup support.

(a) When an individual receives remote support with unpaid backup support, the remote support vendor shall will bill for the remote support.

(b) When an individual receives remote support with paid backup support, the remote support provider shall will bill for the remote support and provide the remote support directly or through a contract with a remote support vendor that meets the requirements of this rule. In the event that the remote support staff contact the remote support provider to request emergency or in-person assistance, the paid backup support person's time shall will be billed as homemaker/personal care or participant-directed homemaker/personal care, as applicable.

(3) When remote support is provided to multiple individuals who live in the same residence, the payment rate for remote support shall be is divided equally among the individuals concurrently receiving remote support.

Click to view Appendix

Click to view Appendix

Click to view Appendix

Notes

Ohio Admin. Code 5123-9-35

Effective: 1/1/2024
Five Year Review (FYR) Dates: 10/13/2023 and 01/01/2029
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: 07/15/2011, 07/01/2012, 09/01/2013, 07/06/2017, 01/01/2019, 07/01/2022