Ohio Admin. Code 5123-9-37 - Home and community-based services waivers - waiver nursing delegation under the individual options, level one, and self-empowered life funding waivers
(A) Purpose
This rule defines waiver nursing delegation 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) "Adult day services" means
adult day support, career planning, group employment support, individual
employment support, and vocational habilitation as those services are defined
in Chapter 5123-9 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) "County board" means a
county board of developmental disabilities.
(4) "Delegating nurse" means the nurse who
delegates a nursing task or assumes responsibility for individuals who are
receiving delegated nursing care in accordance with Chapter 4723-13, 5123:2-6, or 5123-6 of the Administrative
Code.
(5) "Department" means the
Ohio department of developmental disabilities.
(6) "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.
(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) "Licensed nurse"
means a registered nurse or a licensed practical nurse.
(11) "Licensed practical nurse" has the same
meaning as in section
4723.01 of the Revised Code and
for purposes of this rule, may practice waiver nursing delegation only at the
direction of a registered nurse.
(12) "Provider" means an agency provider or
an independent provider.
(13)
"Registered nurse" has the same meaning as in section
4723.01 of the Revised
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) "Significant change" means a decline or
improvement in an individual's medical condition or a change in location of
service delivery.
(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.
(17)
"Unlicensed personnel" means a person not currently licensed by the board of
nursing as a registered nurse or licensed practical nurse, or a person who does
not hold a current valid certificate to practice as a dialysis technician or
administer medications as a medication aide.
(18) "Waiver nursing delegation" means
activities related to the transfer of responsibility for performance of a
specific nursing task from a licensed nurse authorized to perform the task to
unlicensed personnel. Waiver nursing delegation has two distinct components:
(a) Waiver nursing delegation/assessment,
when the delegating nurse who shall be
is a registered nurse, conducts a comprehensive
assessment of an individual's health for the purpose of determining the
appropriateness of delegating nursing tasks to be performed for the
individual.
(b) Waiver nursing
delegation/consultation, when the delegating nurse who
shall be
is
either a registered nurse or a licensed practical nurse at the direction of a
registered nurse in accordance with rule
4723-13-05 of the Administrative
Code, consults with an individual, a physician who ordered a delegated nursing
task, or unlicensed personnel to whom the delegating nurse has delegated
responsibility for a nursing task. Waiver nursing delegation/consultation
includes:
(i) Evaluation of the ability of
unlicensed personnel to perform the delegated task such as:(A)(a) Verifying that
unlicensed personnel have successfully completed prerequisite training;
or
(B)(b) Observing a return
demonstration of a delegated task performed by unlicensed personnel.
(ii) Development and
implementation of a delegation plan such as:(A)(a) Verifying
medications and treatments ordered by physicians;
(B)(b) Creating or
modifying individual-specific instructions for performing delegated nursing
tasks;
(C)(c) Identifying
expected outcomes of delegated nursing tasks;
(D)(d) Identifying
possible side effects of prescribed medication being administered under nursing
delegation;
(E)(e) Providing
instructions for documenting when a delegated task is completed or
omitted;
(F)(f) Confirming
medications/supplies necessary for the delegated tasks are available in the
service setting; or
(G)(g) Completing
delegation-related documentation such as medication administration
records.
(iii)
Evaluation of progress of nursing delegation such as:(A)(a) Consulting with the
individual receiving services, physicians, or unlicensed personnel performing
delegated nursing tasks via in-person contact, telephone calls,
teleconferencing, videoconferencing, or other means; or
(B)(b)
Reviewing delegation-related documentation such as medication administration
records, progress notes, physician's orders, or hospital discharge
records.
(C) Provider qualifications
(1) Waiver nursing delegation
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)
The person providing waiver nursing delegation shall
will:
(a) Be a registered nurse or a licensed
practical nurse and possess a current, valid,
unrestricted license issued by the Ohio board of nursing
with current valid licensure in good standing to
practice nursing in Ohio pursuant to Chapter 4723. of the Revised Code;
and
(b) Be working within the scope
of practice as set forth in Chapter 4723. of the Revised Code and
administrative rules adopted thereunder.
(3) 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 waiver nursing delegation only when no
other certified provider is willing and able.
(4) A family member who lives with an
individual is not eligible to be paid for waiver nursing delegation provided to
that individual.
(D)
Requirements for service delivery
(1) Waiver
nursing delegation shall
will be provided pursuant to a person-centered
individual service plan that conforms to the requirements of rule
5123-4-02 of the Administrative
Code. The individual service plan shall
will identify the providers that may provide
waiver nursing delegation. When an individual receives waiver nursing
delegation in multiple settings and/or from multiple providers, the team
shall
will
determine and specify in the individual service plan, the allocation of waiver
nursing delegation/assessment and/or waiver nursing delegation/consultation
services to each provider.
(2) An
individual may receive up to:
(a) One waiver
nursing delegation/assessment every sixty days in the individual's residential
setting; and
(b) One waiver nursing
delegation/assessment every sixty days in the individual's adult day services
setting.
(3) An
individual may receive up to ten hours of waiver nursing
delegation/consultation each month, regardless of the number of providers
delivering the service.
(4) Waiver
nursing delegation/assessment may be billed sequentially to, but not
concurrently with, waiver nursing delegation/consultation.
(5) Waiver nursing delegation does not
include time spent by a licensed nurse:
(a)
Participating in individual service plan development meetings;
(b) Consulting with an individual's team on
matters not specifically related to waiver nursing delegation for that
individual;
(c) Directly providing
nursing services;
(d) Coordinating
an individual's health care;
(e)
Conducting general health-related training for unlicensed personnel;
or
(f) Conducting training
described in Chapter 5123:2-6 or 5123-6 of
the Administrative Code.
(6)
A provider of
waiver nursing delegation will utilize electronic visit verification in
accordance with rule
5160-1-40 of the Administrative
Code.
(E)
Documentation of services
(1) Service
documentation for waiver nursing delegation/assessment and waiver nursing
delegation/consultation shall
will include each of the following to validate
payment for medicaid services:
(a) Type of
service (i.e., waiver nursing delegation/assessment or waiver nursing
delegation/consultation).
(b) Date
of service.
(c) Place of
service.
(d) Name of individual
receiving service.
(e) Medicaid
identification number of individual receiving service.
(f) Name of provider.
(g) Provider identifier/contract
number.
(h) 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.
(i) Description
and details of the service delivered that directly relate to the services
specified in the approved individual service plan as the services to be
provided, including the name of the unlicensed person for whom a supervisory
visit was performed.
(j) Number of
units of the delivered service or continuous amount of uninterrupted time
during which the service was provided.
(k) Beginning and ending times of the
delivered service.
(2)
In addition to service documentation specified in paragraph (E)(1) of this
rule, service documentation for waiver nursing delegation/assessment
shall
will
include the precipitating factor indicating why an assessment was needed, that
is:
(a) The individual was discharged from
hospital;
(b) The individual has
experienced a significant change; or
(c) Initiation of waiver nursing delegation
for an individual who has not previously received waiver nursing
delegation.
(3) In
addition to service documentation specified in paragraph (E)(1) of this rule,
service documentation for waiver nursing delegation/consultation
shall
will
include a description and details of the consultation purpose and outcomes,
including the name of the person with whom the delegating nurse was
consulting.
(F) Payment
standards
The billing units, procedure codes, and payment rates for waiver nursing delegation are contained in the appendix to this rule.
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: 02/15/2018, 07/01/2022
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