Ohio Admin. Code 5123-9-46 - Home and community-based services waivers - participant/family stability assistance under the level one and self-empowered life funding waivers
(A) Purpose
This rule defines participant/family stability assistance and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service.
(B) Definitions
(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)
"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
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 the 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. An individual may designate another
person to assist with development of the individual service plan and budget,
selection of residence and providers, and negotiation of payment rates for
services; the individual's designee shall not be employed by a county board or
a provider, or a contractor of either.
(7) "Individual service plan" means the
written description of services, supports, and activities to be provided to an
individual.
(8) "Participant/family
stability assistance" means training (including education and instruction) and
counseling (including consultation) that enhance an individual's ability to
direct services received and/or enable an individual and/or family members who
reside with the individual to understand how best to support the individual in
order that the individual and the individual's family members may live as much
like other families as possible and to prevent or delay unwanted out-of-home
placement.
(a) Participant/family stability
assistance may be utilized only by the individual and family members who reside
with the individual and shall
will be outcome-based, meaning that there is a
specific goal for the service which is recorded in the individual service
plan.
(b) Participant/family
stability assistance includes training and counseling related to accommodating
the individual's disability in the home, accessing supports offered in the
community, effectively supporting the individual so that the individual may be
fully engaged in the life of the family, and supporting the unique needs of the
individual.
(c) Participant/family
stability assistance includes the cost of enrollment fees and materials, but
does not cover travel expenses or experimental and prohibited
treatments.
(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
includes the items delineated in paragraph (F) of
this rule to validate payment for medicaid services.
(10) "Usual and customary charge" means the
amount charged to other persons for the same service.
(C) Provider qualifications for
participant/family stability assistance-training
(4)(3) Participant/family
stability assistance-training shall not be provided to an individual by the
individual's family member.
(1) Participant/family stability
assistance-training shall
will be provided by an independent provider or an
agency provider that:
(a) Meets the
requirements of this rule;
(b) Has
a medicaid provider agreement with the Ohio department of medicaid;
and
(2) An
individual may determine additional qualifications for a provider of
participant/family stability assistance-training; additional qualifications
determined by the individual shall
will be recorded in the individual service plan.
(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 participant/family stability
assistance-training only when no other certified provider is willing and
able.
(D)
Provider qualifications for participant/family stability assistance-counseling
(4)(3) Participant/family
stability assistance-counseling shall not be provided to an individual by the
individual's family member.
(1) Participant/family stability
assistance-counseling shall
will be provided by an independent provider or an
agency provider that:
(a) Meets the
requirements of this rule;
(b) Has
a medicaid provider agreement with the Ohio department of medicaid;
and
(2)
Participant/family stability assistance-counseling shall
will be
provided by a person who is a:
(a)
Psychologist licensed by the state pursuant
to Chapter 4732. of the Revised Code;
(b) Professional clinical counselor licensed
by the state pursuant to section
4757.22 of the Revised
Code;
(c) Professional counselor
licensed by the state pursuant to section
4757.23 of the Revised
Code;
(d) Independent social worker
licensed by the state pursuant to section
4757.27 of the Revised
Code;
(e) Social worker licensed
by the state pursuant to section
4757.28 of the Revised Code
working under the supervision of a licensed independent social worker;
or
(f) Marriage and family
therapist licensed by the state pursuant to
section 4757.30 of the Revised Code.
(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 participant/family stability
assistance-counseling only when no other certified provider is willing and
able.
(E)
Requirements for service delivery
Participant/family stability assistance
shall
will be
provided pursuant to an individual service plan that conforms to the
requirements of rule
5123-4-02 of the Administrative
Code.
(F) Documentation of
services
Service documentation for participant/family stability
assistance 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.
(10) Number of units of
the delivered service or continuous amount of uninterrupted time during which
the service was provided.
(11)
Times the delivered service started and stopped.
(G) Payment standards
(1) The billing unit, service codes, and
payment rate for participant/family stability assistance are contained in the
appendix to this rule.
(2)
Providers of participant/family stability assistance shall
will be paid no
more than their usual and customary charge for the service.
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: 07/01/2012, 09/23/2018, 07/01/2022
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