Ohio Admin. Code 5123-9-38 - Home and community-based services waivers - social work under the individual options waiver
(A)
Purpose
This rule defines social work 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 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)
"Family member" means a person who is related to the
individual by blood, marriage, or adoption.
(5)
"Independent
provider" has the same meaning as in rule
5123-2-09 of the Administrative
Code.
(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.
(7)
"Individual service plan" means the written description
of services, supports, and activities to be provided to an
individual.
(8)
"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 of the
Administrative Code.
(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 shall include
the items delineated in paragraph (E) of this rule to validate payment for
medicaid services.
(10)
"Social work" means the application of specialized
knowledge of human development and behavior as well as social, economic, and
cultural systems. This knowledge is used to assist individuals and their
families to improve and/or restore their capacity for social functioning.
Social work includes the provision of counseling and active participation in
problem-solving with individuals and family members; counseling to meet the
psychosocial needs of individuals; collaboration with healthcare professionals
and other providers to assist them to understand and support the social and
emotional needs and problems experienced by individuals and their families;
advocacy; referral to community-based and specialized services; development of
social work/ counseling plans of treatment; and assisting providers of services
and family members to understand and implement activities related to
implementation of the plan of treatment. Social work is not intended to
duplicate the efforts of the service and support administrator.
(C)
Provider qualifications
(1)
Social work shall
be provided by one of the following persons who is either an independent
provider or the employee of an agency provider that meets the requirements of
this rule and that has a medicaid provider agreement with the Ohio department
of medicaid:
(a)
An independent social worker licensed by the state
pursuant to section 4757.27 of the Revised
Code;
(b)
A social worker licensed by the state pursuant to
section 4757.28 of the Revised
Code;
(c)
A professional clinical counselor licensed by the state
pursuant to section 4757.22 of the Revised Code;
or
(d)
A professional counselor licensed by the state pursuant
to section 4757.23 of the Revised
Code.
(2)
Social work shall 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)
Social work shall
not be provided to an individual by the individual's family
member.
(4)
An applicant seeking approval to provide social work
shall complete and submit an application through the department's website
(http://dodd.ohio.gov/
).
(D)
Requirements for service delivery
(1)
Social work shall
be provided pursuant to an individual service plan that conforms to the
requirements of rule
5123-4-02 of the Administrative
Code.
(2)
A person providing social work shall:
(a)
Document the
individual's social needs and develop a social work/ counseling plan of
treatment;
(b)
Provide direct service in the form of counseling and
actively participate in resolving problems;
(c)
Counsel the
individual and involved family members with regard to the individual's
psychosocial needs;
(d)
Collaborate with the individual's physician and assist
various providers of services in understanding emotional and social needs of
the individual being served;
(e)
Recognize the
social needs of the individual and caregiver and take appropriate therapeutic
intervention;
(f)
Act as an advocate for the individual's social
needs;
(g)
Assist the individual, staff, and family to resolve
challenges which prevent the individual's adjustment or any other challenges
which affect the individual's ability to benefit from medical
treatment;
(h)
Assist the individual to develop self-help, social, and
adaptive skills that enable the individual to remain functional within the
community;
(i)
Arrange individual and caregiver counseling and other
supportive services to alleviate the pressures of estrangement from social
support systems such as family, employment, and residential placement;
and
(j)
Refer individuals/families to the service and support
administrator for financial matters or interagency collaboration and
follow-up.
(E)
Documentation of
services
Service documentation for social work shall 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)
Group size in which the service was
provided.
(10)
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.
(11)
Number of units
of the delivered service.
(12)
Times the
delivered service started and stopped.
(F)
Payment
standards
(1)
The billing unit, service codes, and payment rates for social work are
contained in appendix A to this rule.
(2)
Payment rates for
social work are based on the county cost-of-doing-business category. The
cost-of-doing-business categories are contained in appendix B to this
rule.
(3)
Payment rates for social work are established
separately for services provided by independent providers and services provided
through agency providers.
(4)
Payment rates for social work are based on the number
of individuals receiving services.
Replaces: 5123:2-9-38
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, 07/01/2017
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