(A) "Home maintenance and chore
services" means a service that maintains a
clean and safe living environment through the performance of tasks in the
individual's home that are beyond the individual's capability. Home maintenance
and chore services shall not exceed a total of ten thousand dollars in a
calendar year per individual. Covered home maintenance and
chore services
chore activities include:
(1) Minor home maintenance and repair
including inspecting, maintaining, and repairing furnaces, including pilot
lights and filters; inspecting, maintaining, and repairing water faucets,
drains, heaters, and pumps; replacing or installing electrical fuses; plumbing
and electrical repairs; repair or replacement of screens or window panes;
fixing floor surfaces posing a threat to the individual's health, safety, and
welfare; and moving heavy items to provide safe ingress and egress.
(2) Heavy household cleaning, including
washing walls and ceilings; washing the outside of windows; non-routine washing
of windows; removing, cleaning and rehanging curtains or drapery; and
shampooing carpets or furniture.
(3)
Non-routine
disposal of garbage
Removal of environmental
hazards posing a threat to the individual's health, safety, and
welfare
.
such
as:
(a)
Non-routine disposal of garbage or other accumulated items
in an individual's residence;
(b)
Non-routine yard
maintenance including snow removal;
(c)
Pest control and
related tasks to prevent, suppress, eradicate, or remove pests;
and
(4)
Non-routine
yard maintenance including snow removal posing a threat to the individual's
health, safety, and welfare.
Upkeep and
maintenance of a home modification or adaptive/assistive devices, such
as:
(a)
Routine
maintenance plan;
(b)
Extended warranty; and
(c)
Service call,
labor and parts for a modification or device that ceases to function as
intended.
(5) Pest control and related tasks
to prevent, suppress, eradicate, or remove pests posing a threat to the
individual's health, safety, and welfare.
(B) Home maintenance and chore
services do not include:
(1) Tasks of general utility (including
routine yardwork), and not of direct medical or remedial benefit to the
individual.
(2) Jobs that add to
the total square footage of the home.
(3) Jobs that can be accomplished through
existing informal or formal supports.
(4) Jobs that are the legal or contractual
responsibility of someone other than the individual (e.g., the landlord,
etc.).
(5) Jobs involving the
removal of
home modifications and returning of
property to its prior condition when the individual vacates the
premises.
(6) Replacement or repair
of a previously approved home modification or home maintenance and chore job
that has been damaged as a result of apparent misuse, abuse
, or negligence.
(C) Home maintenance and chore
services may be authorized up to one hundred eighty consecutive days prior to
an individual's transition from an institutional setting into the community.
The service is not considered complete until, and the date of service for
purposes of reimbursement shall be, the date on which the individual leaves the
institutional setting. If an individual fails to transition into the community,
the service is still reimbursable if all other requirements are
met.
(D)(C) Home maintenance
and chore services that are necessary to
ensure the health, safety, and welfare of the individual and will exceed the
ten-thousand-dollar calendar year threshold may be considered for approval by
the Ohio department of medicaid (ODM), Ohio department of aging (ODA) or their
designee.
(E)(D) Authorization
process.
(1) ODM, ODA, or their designee may
require the completion of an in-home evaluation by an appropriately qualified
professional to determine the suitability of the immediate environment where
the service will be performed and the viability of the completion of the
service to improve independence and/or facilitate a healthy and safe
environment.
(2) In consultation
with the individual and/or caregiver(s), ODM, ODA, or their designee
, and if
required
necessary,
the qualified professional,
shall
will develop a referral that addresses the
individual's home maintenance and chore
service needs.
(3) Home maintenance and chore
service providers
shall
will
submit a fixed cost proposal for the services
submitted
described
under the referral which
shall
will be good for the term of the proposal.
(a) At a minimum, the proposal
shall
will
include all of the following:
(i) A breakdown
of all the needed materials;
(ii) A
breakdown of the costs of all the needed materials;
(iii) A breakdown of the labor
costs;
(iv) A list of
all
any
permits that must be obtained;
(v)
An estimate of the time needed to complete the service;
(vi) A written statement of all warranties
provided, including a warranty lasting at least one year from the date of final
acceptance of work against defective workmanship, as applicable; and
(vii) A written guarantee that all materials,
products, and installed or furnished appliances perform their advertised
function.
(b) A fixed
cost proposal may be adjusted for good cause only if the proposal is adjusted
in writing, and the adjustment is approved by ODM, ODA, or their
designee.
(4) ODM, ODA,
or their designee
shall
will review all submitted proposals with the
individual and
shall
will approve the proposal with the lowest cost
alternative that meets the individual's assessed needs and ensures the health,
safety and welfare of the individual.
(5) The provider
shall
will be
reimbursed for the actual cost of material and/or labor as identified in the
proposal.
Reimbursement may only be adjusted if the
fixed cost proposal is adjusted pursuant to the requirements set forth in
paragraph (E) (3)(b) of this rule.
(F)(E)
Provider requirements.
The provider shall
will:
(1)
Know and understand the individual's person-centered services plan related to
home maintenance and chore services, and
personal preferences regarding the specific services to be performed.
(2) Before performing a service, inform the
individual and ODM, ODA, or their designee of any
specific
potential
health or welfare risk
,
expected, and coordinate times and dates of
service to ensure minimal risk to the individual.
(3) Before performing a service,
obtain and maintain all permits and pre-inspections required by law, ordinance,
or by the individual's homeowners' association.
(4)(3)
Comply with applicable federal, state, and local laws, and the individual's
homeowners' association
(HOA) requirements, as
applicable.
(5)(4) Obtain the property
owner's written consent prior to performing the service. This written consent
shall
will
reflect that the property owner has agreed to the maintenance, repair or other
service.
(6) Maintain, and upon request,
furnish proof of appropriate qualifications to perform services requiring
specialized skills such as electrical, heating/ventilation, and plumbing
work.
(7) Maintain, and upon request,
furnish proof of licensure, insurance, and bonding for services from applicable
jurisdictions.
(8) Maintain, and upon request,
furnish a list of the chemicals and substances used for each
proposal.
(9)(5) Furnish to the
individual, ODM, ODA, or their designee a warranty that covers the workmanship
and materials involved in performing the service, as applicable.
(10)(6)
Provide documentation to ODM, ODA, or their designee that the service was
completed in accordance with the agreed upon specifications using the materials
and equipment cited in the proposal.
(11)(7) Provide
documentation to ODM, ODA, or their designee that the service was tested, is in
proper working order, and is usable by the individual, if applicable.
(12) After completing, but before
billing for the service, obtain and maintain any necessary post-inspections and
post-inspection reports required by law, a home owners' association, or both to
verify whether each episode of service meets federal, state, and local laws or
home owners' association requirements.
(13)(8)
Repair any damage incidental to the service
at no
additional cost.
(14) Obtain final written approval
from the individual and the case manager after completion of the
service.
(F)
Home maintenance
and chore may only be provided by an agency or non-agency provider approved by
ODM or certified by ODA as a medicaid waiver provider of home maintenance and
chore.
(G) Provider
qualifications.
(1) Only an agency or non-agency
provider that has been approved by ODM or certified by ODA as a medicaid waiver
provider of home maintenance and chore service shall provide these
services.
(2) Prior to performing a service,
the provider shall have all necessary and required licensure in
place.
(H)(G) Service
verification: The provider
shall
will obtain the individual's or authorized
representative's signature and date of completion of the service to verify
service delivery, verify the provider left the individual's home in
satisfactory condition, and verify repair of any damages incidental to the
service.
(I)(H) Provider record
retention. For each service furnished, the provider
shall
will retain a
record of compliance with all requirements set forth in rule
5160-44-31 of the Administrative
Code, or with the requirements set forth in Chapter
173-39 of the Administrative Code
for the pre-admission screening system providing options and resources today
(PASSPORT) program. The record
shall
will include:
(1) Individual's name.
(2) Date of service delivery.
(3) A copy of the fixed cost proposal
described in paragraph (D)(3) of this rule, including any approved
adjustments.
(4) Service
description, including a comparison between the fixed cost proposal and the
actual services provided.
(5) Name
of each provider staff person in contact with the individual.
(6) List of chemicals and substances
used.
(7)
Proof of appropriate qualifications to perform services
requiring specialized skills such as electrical, heating/ventilation, and
plumbing work.
(8)
Proof of licensure, insurance, and bonding for services
from applicable jurisdictions.
(9)
Proof of all
necessary post-inspections and post-inspection reports required by law, a HOA,
or both to verify whether each episode of service meets federal, state, and
local laws or HOA requirements. Proof will be obtained prior to
billing,
(7)(10) All of the
documents required in paragraphs (
F
E), (
G
F), and (
H
G) of this rule.
(I)
The authorization
of home maintenance and chore may be combined with other waiver services to
meet the assessed needs of the individuals. In such instances, individual
waiver service limits as described in paragraph (C) of this rule still
apply.
(J) ODM and ODA are authorized to
deem any provider approved by ODM or certified by ODA or the Ohio department of
developmental disabilities (DODD) to provide waiver services as having
satisfied the requirements for approval by ODM or certification by ODA for the
same or similar services.
