Ohio Admin. Code 5123-9-47 - Home and community-based services waivers - support brokerage under the self-empowered life funding waiver
(A) Purpose
This rule defines support brokerage and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service.
(B) Definitions
(8)(9) "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.
(9)(10)
"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.
(10)(11) "Support broker"
means a person who is responsible, on a continuing basis, for providing an
individual with representation, advocacy, advice, and assistance related to the
day-to-day coordination of services (particularly those associated with
participant direction) in accordance with the individual service plan. The
support broker assists the individual with the individual's responsibilities
regarding participant direction, including understanding employer authority and
budget authority, locating and selecting providers, negotiating payment rates,
and keeping the focus of the services and support delivery on the individual
and his or her
the
individual's desired outcomes. The support broker, working in conjunction
with the service and support administrator, assists the individual with
creating the individual service plan, developing the waiver budget, and doing
day-to-day monitoring of the provision of services as specified in the
individual service plan.
(11)(12) "Support
brokerage" means the services of a support broker.
(12)(13) "Waiver
eligibility span" means the twelve-month period following either an
individual's initial waiver enrollment date or a subsequent eligibility
redetermination date.
(1) "Agency provider" means an entity that
directly employs at least one person in addition to the chief executive officer
a director of operations for the purpose of providing
services for which the entity must be
is certified in accordance with rule
5123:2-2-01
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" means a
self-employed person who provides services for which he or she must be
the
person is certified in accordance with rule 5123:2-2-01
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, his or
her
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 direction" means an individual has
authority to make decisions about the individual's waiver services and accepts
responsibility for taking a direct role in managing the services. Participant
direction includes the exercise of budget authority and/or employer authority
as set forth in rule
5123-9-40 of the Administrative
Code.
(C) Provider qualifications
(1) Support brokerage
shall
will be
provided by one of the following:
(a) An
independent provider or an agency provider that:
(i) Meets the requirements of this
rule;
(ii) Has a medicaid provider
agreement with the Ohio department of medicaid; and
(b) An
unpaid volunteer who has the qualifications specified in paragraph (C)(2) of
this rule.
(2) Support
brokerage shall
will be provided by a person who:
(a) Has at least an associate's degree from
an accredited college or university or at least two years of experience
providing one-to-one support for a person with a developmental disability;
and
(b) Prior to providing support
brokerage, has successfully completed the support broker training established
by the department.
(3)
An individual may determine additional qualifications for a provider of support
brokerage; additional qualifications determined by the individual
shall
will be
recorded in the individual service plan.
(4) The following persons or entities shall
not provide support brokerage:
(a) A county
board.
(b) An employee of a county
board.
(c) A housing or adult
services nonprofit corporation affiliated with a county board.
(d) An employee of a housing or adult
services nonprofit corporation affiliated with a county board.
(e) A regional council of governments formed
under section 5126.13 of the Revised Code by
two or more county boards.
(f) An
employee of a regional council of governments formed under section
5126.13 of the Revised Code by
two or more county boards.
(g) A
certified provider of any other self-empowered life funding waiver
service.
(h) A related entity
affiliated with a certified provider of any other self-empowered life funding
waiver service including, but not limited to, contractors of the
provider.
(5) Support
brokerage shall not be provided on a paid basis by an individual's:
(a) Guardian;
(b) Spouse;
(c) Parent when the individual is less than
eighteen years of age; or
(d)
Family member when the family member resides with the individual.
(D) Requirements for service delivery
Support brokerage shall
will be provided pursuant to an individual
service plan that conforms to the requirements of rule
5123:2-1-11
5123-4-02 of the Administrative Code.
(E) Documentation of services
Service documentation for support brokerage
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.
(F) Payment standards
(1) The billing unit, service codes, and
payment rates for support brokerage are contained in the appendix to this
rule.
(2) Payment for support
brokerage shall
will not exceed eight thousand dollars per waiver
eligibility span.
Notes
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5123.049
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
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.