Ohio Admin. Code 5160-44-27 - Nursing facility-based level of care home and community-based services programs: home care attendant services
(A) The following definitions are applicable
to this rule:
(1) "Adult" means an individual
at least eighteen years of age.
(2)
"Authorizing health care professional" means a health care professional who,
pursuant to section 5166.307 of the Revised Code,
authorizes a home care attendant to assist an individual enrolled on a nursing
facility (NF)-based level of care waiver with self-administration of
medication, nursing tasks, or both.
(3) "Controlled substance" has the same
meaning as in section
3719.01 of the Revised
Code.
(4) "Custodian" has the same
meaning as in section
2151.011 of the Revised
Code.
(5) "Gastrostomy tube" means
a percutaneously inserted catheter that terminates in the stomach.
(6) "Group setting" means a situation in
which a home care attendant service provider furnishes home care attendant
services in accordance with this rule and as authorized by the Ohio department
of medicaid (ODM), or certified by the Ohio department of aging (ODA), to two
or three individuals who reside at the same address.
(7) "Guardian" has the same meaning as in
section 2111.01 of the Revised
Code.
(8) "Health care
professional" means a physician or registered nurse who holds a current, valid
unrestricted license.
(9) "Home
care attendant" means a provider, holding a valid medicaid provider agreement
in accordance with section
5166.301 of the Revised Code and
paragraph (G) of this rule, who is authorized to provide home care attendant
services to a specific individual enrolled on a NF-based level of care
waiver.
(10) "Individual enrolled
on a NF-based level of care waiver" and "individual" mean the same as
"consumer" as defined in section
5166.30 of the Revised
Code.
(11) "Jejunostomy tube" means
a percutaneously inserted catheter that terminates in the jejunum.
(12) "Medication" means a drug as defined in
section 4729.01 of the Revised
Code.
(13) "Minor" means an
individual under eighteen years of age.
(14) "Nursing facility (NF) -based level of
care waiver" and "waiver" mean the MyCare Ohio and Ohio home care waivers
administered by ODM and the PASSPORT waiver administered by ODA.
(15) "Nursing tasks" means skilled tasks that
would otherwise be performed by a registered nurse (RN), or a licensed
practical nurse (LPN) at the direction of an RN.
(16) "Oral medication" means any medication
that can be administered through the mouth, through a gastrostomy tube or
jejunostomy tube if through a pre-programmed pump, or through a syringe. Oral
medication may include medication administered through a metered dose
inhaler.
(17) "Physician" means an
individual authorized under Chapter 4731. of the Revised Code to practice
medicine and surgery or osteopathic medicine and surgery.
(18) "Practice of nursing as a registered
nurse," "practice of nursing as a licensed practical nurse (LPN)", and
"registered nurse (RN)" have the same meanings as in section
4723.01 of the Revised Code.
"Registered nurse" includes an advance practice nurse as defined in section
4723.01 of the Revised
Code.
(19) "RN home care attendant
service visit" means the face-to-face visit
every ninety days between the RN and the individual receiving home care
attendant services as required by paragraph (G)(10
8) of this rule.
The face-to-face visit may be conducted by
telephone or electronically
via telehealth, unless the individual's needs
necessitate a face-to-face
in-person visit.
(20) "Schedule II, " "schedule III,"
"schedule IV" and "schedule V" have the same meaning as in section
3719.01 of the Revised
Code.
(21) "Topical medication"
means any medication applied to the outer skin, including transdermal
medications and eye, ear and nose drops. Topical medication may also include
vaginal or rectal suppositories.
(B) Home care attendant services are services
provided to an individual enrolled on a waiver by an unlicensed non-agency
provider in accordance with this rule. Home care attendant services are tasks
that would otherwise be performed by an RN or an LPN at the direction of an RN.
Home care attendant services include:
(1)
Assistance with self-administration of medications as set forth in paragraph
(E) of this rule.
(2) Assistance
with the performance of nursing tasks as set forth in paragraph (F) of this
rule.
(3) Tasks performed as part
of personal care aide services as described in rule
5160-46-04 or
173-39-02.11 of the
Administrative Code when performed during a home care attendant service visit.
Personal care aide tasks are not reimbursable separately as personal care aide
services when they are performed during a home care attendant service
visit.
(C) Home care
attendant services may be provided:
(1) In the
individual's home or in the community; and
(2) To assist an individual to function in
the workplace without duplicating workplace accommodations.
(D) If the individual has an
authorized representative as defined in rule
5160-1-33 of the Administrative Code
5166.3010 of the Revised
Code, the authorized representative shall
will be present
and awake during the delivery of home care attendant services.
(E) Assistance with self-administration of
medication.
(1) A home care attendant
shall
will
only assist an individual enrolled on a waiver with the
self-administration of only the following
medication:
(a) Oral medications;
(b) Topical medications;
(c) Subcutaneous injections only for routine
doses of insulin;
(d) Programming
of a pump only used to deliver a routine dose of insulin;
(e) Medication administered via stable,
labeled gastrostomy or jejunostomy tubes using pre-programmed pumps;
and
(f) Doses of schedule II,
schedule III, schedule IV and schedule V drugs only when administered orally or
topically.
(2)
Medication shall
will be maintained in its original container and the
attached label shall
will match the dosage and means of administration
set forth on the ODM 02389 "Home Care Attendant Medication Authorization" form
(11/2015). The label on the container
shall
will
display all of the following information for the individual enrolled on a
waiver:
(a) The individual's full
name;
(b) A dispensing date within
the prior twelve months; and
(c)
The exact dosage and means of administration.
(3) For schedule II, schedule III, schedule
IV and schedule V drugs, all of the following additional requirements shall apply:
(a) Medication(s) shall
will have a
warning label on the bottle;
(b)
During the first visit, the home care attendant shall
will count the
medication(s) in the presence of the individual enrolled on a waiver or the
authorized representative and shall
will record the count on a log located in the
individual's clinical record.
(c)
The medication(s) shall
will be recounted by the home care attendant in
the presence of the individual enrolled on a waiver or the authorized
representative at least monthly, and the count shall
will be
reconciled on a log located in the individual's clinical record. The home care
attendant shall
will notify the authorizing health care professional,
in writing, within twenty-four hours if:
(i)
Medication is missing; or
(ii) The
count of medication(s) cannot be reconciled.
(d) The medication(s)
shall
will be
stored separately from all other medications, and secured and locked at all
times when not being administered in order to prevent access by unauthorized
persons.
(F)
Assistance with the performance of nursing tasks.
(1) A home care attendant may
provide assistance
assist with the performance of nursing tasks not
expressly excluded in accordance with paragraph (F)(2) of this rule.
(2) A home care attendant
shall
may not
assist an individual who is receiving home care attendant services with the
performance of any of the following nursing tasks:
(a) Intravenous (IV) insertion, removal or
discontinuation;
(b) Intramuscular
injections;
(c) IV medication
administration;
(d) Subcutaneous
injections, except for routine doses of insulin pursuant to paragraph (E)(1)(c)
of this rule;
(e) Programming of a
pump used to deliver medications (including, but not limited to epidural,
subcutaneous and IV), except for routine doses of insulin pursuant to paragraph
(E)(1)(d) of this rule;
(f)
Insertion or initiation of infusion therapies; and
(g) Central line dressing changes.
(3) Performance of nursing tasks
shall
will be
summarized and submitted on the ODM 02390 "Home Care Attendant Skilled Task
Authorization" form (11/2015).
(G) In order to provide services
to an individual enrolled on a waiver and to submit a claim for reimbursement,
home care attendants shall
will meet all of the following requirements:
(10)(8)
In collaboration with the individual receiving
services,
Secure
secure the services of an RN, with agreement of the individual receiving
services, and participate in a
face-to-face
an in-person visit
at least every ninety days with the
individual receiving services, the authorized representative, and the RN for
the purpose of answering any questions the home care attendant and/or
individual receiving services, or authorized representative have about meeting
care needs, medications and other issues. The
face-to-face visit may be conducted by telephone or electronically, unless the
individual's needs necessitate a face-to-face visit.
(a)(b)
The RN performing an RN home care attendant service visit
shall
will:
(b)(c) The RN
shall
will be
present at the first visit between the home care attendant and individual upon
the initiation of home care attendant services. ODM, ODA, or their designee
shall
will
also be present at the first visit.
(c)(d) The home care
attendant and the RN shall
will document the activities of each visit in the
clinical record of the individual receiving services.
(d)(e)
The home care attendant shall
will discuss the results of the RN visit with
ODM, ODA or their designee, the individual receiving services and/or the
authorized representative.
(e)(f) When the RN
performs an RN home care attendant service visit, the RN
shall
may
bill the state plan nursing assessment code set forth in appendix A to rule
5160-12-08 of the Administrative
Code.
(1) As part of the medicaid provider
agreement application process, provide ODM, ODA or their designee with evidence
to its satisfaction of the following:
(a)
Submission of the ODM 02389 "Home Care Attendant Medication Authorization" form
(11/2015) and/or ODM 02390 "Home Care
Attendant Skilled Task Authorization" form (11/2015) as prescribed by paragraph (H) of this
rule.
(b) Successful completion of
at least one of the following:
(i) A
competency evaluation program or training and competency evaluation program
approved or conducted by the director of health under section
3721.31 of the Revised Code, and
registration as active or in good standing on the Ohio nurse aide registry
maintained by the director of health under section
3721.32 of the Revised Code;
or
(ii) A training program and
competency evaluation program for home health aides as specified in 42 C.F.R.
484.4 and 484.36, if the person met those standards as they existed on or
before January 12, 2018, or 42 C.F.R. 484.80 and
484.115, if the person met those
standards since they were adopted on January 13, 2018. A person is not
considered to have completed a training and competency evaluation program, or a
competency evaluation program if, since the person's most recent completion of
this program(s), there has been a continuous period of twenty-four consecutive
months during none of which the person furnished services described in
42 C.F.R.
409.40 (as in effect on October 1,
2020
2023);
or
(iii) A certified vocational
program in a health care field, and written testing and skills testing by
return demonstration; or
(iv) A
written attestation of training, instruction, and as appropriate, skills
testing by return demonstration prior to initiation of service provision on:
(a) Appropriate and safe techniques in
personal hygiene and grooming that include: bed, tub, shower and partial bath
techniques, shampoo in sink, tub or bed, nail and skin care, oral hygiene,
toileting and elimination, safe transfer and ambulation, normal range of motion
and positioning, and adequate nutrition and fluid intake.
(b) The maintenance of a clean, safe and
healthy environment, including but not limited to, house cleaning and laundry,
dusting furniture, sweeping, vacuuming and washing floors, kitchen care
(including dishes, appliances and counters), bathroom care, emptying and
cleaning bedside commodes and urinary catheter bags, changing bed linens,
washing inside windows within reach from the floor, removing trash and folding,
ironing and putting away laundry.
(c) Meal preparation, including special diet
preparation, grocery purchase, planning and shopping, and running
errands.
(d) The physical,
emotional and developmental needs of individuals, including the need for
privacy and respect for individuals and their property.
(e) Universal precautions for the prevention
of disease transmission, including hand-washing and proper disposal of bodily
waste and medical instruments that are sharp or may produce sharp pieces if
broken.
(f) Basic elements of body
functioning and changes in body function that should be reported to a
supervisor.
(g) Basic safety
requirements and knowledge of emergency procedures.
(h) Reading and recording temperature, pulse
and respiration.
(i) Observation,
reporting and documentation of individual status and services
provided.
(j) Communication skills,
including the ability to read, write and make brief and accurate oral or
written reports.
(c) Completion of training and instruction,
prior to beginning
the provision of home care attendant services,
about how to deliver the specific
regarding the delivery of the home care attendant
services authorized by the individual's authorizing health care professional.
The training shall
will be specific to the individual enrolled on a
waiver and may be provided by the individual's authorizing health care
professional, the individual receiving services or the authorized
representative in cooperation with the individual's health care professional as
indicated on the ODM 02389 "Home Care Attendant Medication Authorization" form
(11/2015) and/or ODM 02390 "Home Care
Attendant Skilled Task Authorization" form (11/2015), as appropriate.
(d) Performance of a successful return
demonstration of the home care attendant service to be provided if requested by
the individual enrolled on a waiver or the authorizing health care
professional.
(e) Completion and
maintenance of first aid certification from a class that
may be
is not
solely internet-based and that
does not have to include
includes hands-on training by a certified first aid
instructor and a successful return demonstration of what was learned in the
course, and certification that education was received from the authorizing
health care professional about health and welfare considerations appropriate
for an individual or group setting.
(f) Completion and maintenance of
cardiopulmonary resuscitation (CPR) certification from a class that
may be
is not
solely internet-based that does not have to
include
and that includes hands-on
training by a certified CPR instructor and a successful return demonstration of
what was learned in the course. Maintenance of CPR
certification may be counted toward the in-service continuing education
required pursuant to paragraph (G) (11) of this rule. Current
providers and those provider-applicants whose applications are pending as of
the effective date of this rule shall have one hundred and eighty days from the
effective date of this rule to meet this requirement.
(2) Be a non-agency provider who holds
a current, valid
an
active medicaid provider agreement as a home care attendant and
complies
who
maintains compliance with sections
5166.30 to
5166.3010 of the Revised Code
and applicable rules set forth in Chapters
173-39, 5160-44, 5160-45 and 5160-46 of the Administrative Code.
(3) Request reimbursement for the provision
of home care attendant services in accordance with rule
5160-1-06.1
of the Administrative Code for Ohio department of aging
certified providers or 5160-46-06.1 of the Administrative Code
for providers of Ohio department of medicaid
administrated waiver programs.
(4) Not be the authorizing health care
professional of the individual receiving services.
(5) Not be the
an authorized
representative of the individual receiving services.
(6) Not be the legally responsible family
member as that term is defined in rule
5160-45-01 of the Administrative
Code of the individual receiving services.
(7) Not be the legal guardian or foster
caregiver of the individual receiving services.
(8) Provide home care attendant
services for only one individual, unless authorized to provide services in a
group setting in accordance with paragraph (G)(9) of this rule.
(9) If authorized, provide services
to two or three individuals enrolled on a waiver in a group setting.
Authorization on a case-by-case basis is subject to approval based on a
clinical review conducted by ODM or ODA in consultation with the individual
receiving services, the authorized representative, authorizing health care
professional, care manager and the individual's team. The clinical review will
address the needs and desires of the individual receiving services, the skill
level and training needs of the home care attendant, the ability to ensure the
health and welfare of the individuals enrolled on a waiver served by the home
care attendant, and the back-up plan.
(a)
At least twice
per year, the RN will conduct RN home care attendant service visits
in-person.
All other RN home care
attendant service visits may be conducted via telehealth, unless the
individual's needs necessitate an in-person visit.
(i) Possess a current, valid and unrestricted
license with the Ohio board of nursing;
(ii) Possess an active Ohio medicaid provider
agreement;
(iii) Comply with the
conditions of participation as set forth in rule
5160-44-31 of the Administrative
Code.
(11) Completion of at least twelve
hours of continuing education annually to enhance the skills and competencies
of the provider relevant to his or her job responsibilities and support
person-centered service delivery.
(H)
If
authorized on the person-centered services plan, a home care attendant may
provide services to two or three individuals enrolled on a waiver in a group
setting.
(1) Written consent from the individual
enrolled on a waiver or the authorized representative, as applicable, allowing
the home care attendant to provide home care attendant services, and assuming
responsibility for directing the home care attendant.
If the individual is unable to provide the signature
at the time of service, the individual is to submit an electronic signature or
standard signature via regular mail, or otherwise provide a signature in no
instance any later than at the next face-to-face visit with the
provider.
(2) A written
statement from the authorizing health care professional attesting that the
individual enrolled on a waiver or the authorized representative has
demonstrated the ability to direct the home care attendant. The written
statement shall
will also indicate whether the home care attendant has
demonstrated the ability to furnish the home care attendant service to the
individual enrolled on a waiver. The statement shall
will include
all of the following:
(a) The name and address
of the individual receiving home care attendant services;
(b) A description of the specific nursing
task or self-administration of medication that the home care attendant will
assist with, including, in the case of assistance with self-administration of
medication, the name, dosage, and route of administration of the
medication;
(c) The times or
intervals when the home care attendant is to assist the individual receiving
services with the self-administration of each dosage of the medication or with
the performance of nursing tasks;
(d) The dates on which the home care
attendant is to begin and cease providing assistance;
(e) A list of severe adverse reactions that
the home care attendant shall
will report to the individual's health care
professional should the individual experience one or more reactions;
(f) At least one telephone number at which
the home care attendant can reach the individual's health care professional in
an emergency for consultation after contacting emergency personnel;
(g) At least one contact number at which the
home care attendant can reach the authorizing health care professional when the
home care attendant observes that scheduled medication(s) is missing or cannot
be reconciled; and
(h) Instructions
the home care attendant shall
will follow when assisting the individual
receiving services with the performance of a nursing task or the
self-administration of medications, including, instructions for maintaining
sterile conditions and for the storage of task-related equipment and
supplies.
(1) The back-up plan
shall
will
meet the needs of the individual enrolled on a waiver in the event:
(a) The regularly scheduled home care
attendant cannot or does not meet his or her obligation to provide services to
the individual receiving services; or
(b) The individual receiving services and/or
the authorized representative is not able to direct home care attendant
services.
(2) As
authorized by ODM, ODA, or their designee,
(a)
Waiver nursing as set forth in rule
5160-44-22 of the Administrative
Code, and/or private duty nursing or home health nursing as set forth in
Chapter 5160-12 of the Administrative Code, may be used as back-up to assist
with self-administration of medications and the performance of nursing
tasks;
(b) Personal care aide
services as set forth in rule
5160-46-04 of the Administrative
Code may be used as back-up for personal care aide tasks in an ODM-administered
waiver;
(c) Personal care services
as set forth in rule
173-39-02.11 of the
Administrative Code may be used as back-up for personal care tasks in the
PASSPORT waiver; and
(d) Back-up
may include informal caregivers.
(1) Storage shall
of the clinical
record will be in a manner that protects the confidentiality of these
records and will be in a secure location that may be
the individual's residence or primary location where the individual receives
services.
(2) Storage shall be at the
provider's place of business other than the individual's residence or primary
location where the individual receives services.
(a) Identifying information including name,
address, date of birth, gender/gender identity, race, significant phone numbers
and health identification numbers of the individual.
(b) Information regarding the individual's
medical diagnoses, treatment and preferences.
(c) The individual's medication profile, as
applicable.
(d) The individual's
treatment administration record, as applicable.
(e) The name and contact information for all
of the licensed health care professionals serving the individual.
(f) The name of and current contact
information for the individual's parent/guardian/authorized representative
and/or emergency contact.
(g) A
copy of the initial and all subsequent person-centered services
plans.
(h) All known drug and food
interactions, allergies and dietary needs, preferences and/or
restrictions.
(i) A copy of any
advance directives including, but not limited to, a "do not resuscitate order"
(DNR) or a "medical power of attorney," if they exist.
(j) The ODM 02389 "Home Care Attendant
Medication Authorization" form (11/2015)
and/or the ODM 02390 "Home Care Attendant Skilled Task Authorization" form
(11/2015), as appropriate.
The ODM 02389 "Home Care Attendant Medication
Authorization" form and/or the ODM 02390 "Home Care Attendant Skilled Task
Authorization" form will be updated and reflected in the clinical record should
any changes in home care attendant service provisions be
needed.
(k) Documentation of
home care attendant services performed or not performed, arrival and departure
times, and the dated signature of the provider, and individual receiving
services or the authorized representative, verifying the service delivery upon
its completion and arrival and departure times. The signature method of choice
for the individual receiving services or the authorized representative
shall
will be
documented on the person-centered services plan, and shall
will include,
but not be limited to, any of the following: a handwritten signature, initials,
a stamp or mark, or an electronic signature. If the individual is unable to
provide the signature at the time of service, the individual is to submit an
electronic signature or standard signature via regular mail, or otherwise
provide a signature in no instance any later than within three business days of the completion of the service
delivery that requires signature.
at the next
face-to-face visit with the provider.
(l) A copy of the log detailing the count and
reconciliation of schedule II, schedule III, schedule IV and schedule V drugs
for which assistance with self-administration is provided.
(m) Service notes, signed and dated by the
home care attendant, documenting all communications with ODM, ODA or their
designee, health care professionals including the authorizing health care
professional, and other members of the individual's team, and documenting the
general condition of the individual, any unusual events occurring during the
visit, and the service tasks performed.
(n) Documentation of the
face-to-face RN home care attendant service
visits every ninety days between the home care attendant, individual enrolled
on a waiver and RN, and of any resulting activities, in accordance with
paragraph (G)(10
8) of this rule.
(L)
Unless the
clinical record described in paragraph (K) of this rule is maintained in the
home of the individual and accessible to team members, the home care attendant
will maintain another record which:
(1)
Includes communication logs going back no less than
sixty calendar days in a format agreed upon by the individual and provider for
the purpose of promoting communication between team members.
(2)
Any other
documentation required by the individual.
(3)
Is maintained in
a place and manner that is accessible to the individual and other team members
chosen by the individual at the individual's residence or primary service
location.
(4)
Is maintained in a manner that protects the
confidentiality of the individual.
(K) All home care attendant service
providers shall also maintain documentation at the individual's residence or
primary service location in order to encourage sharing of information between
caregivers and enhance person-centered care.
(1) Storage shall be in a manner
that protects the confidentiality of these records.
(2) The documentation may include,
but not be limited to, a communication log, as designated in the individual's
person-centered services plan.
(3) Documents shall reflect a
minimum of at least the past sixty calendar days, with the individual's right
to maintain more if he or she so chooses.
(4) The individual shall identify
the location in his or her residence or the primary location where the
documentation will be safely maintained.
(M) 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.
Notes
Promulgated Under: 119.03
Statutory Authority: 5166.02, 5166.30
Rule Amplifies: 5162.03, 5164.02, 5166.30, 5166.301, 5166.302, 5166.303, 5166.304, 5166.305, 5166.306, 5166.307, 5166.308, 5166.309, 5166.3010
Prior Effective Dates: 07/01/2010, 08/01/2015, 01/01/2019, 02/01/2020, 06/12/2020 (Emer.), 12/10/2020
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No prior version found.