5123:2-9-06 Home and community-based services waivers - documentation and payment for services under the individual options and level one waivers.

 

 

 

Rule Summary and Fiscal Analysis (Part A)

 

Department of Developmental Disabilities

Agency Name

 

Community Services                                           Becky Phillips

Division                                                                  Contact

 

30 East Broad Street, 12th Floor Columbus OH 43215-3414

[phone]     (614)

644-5013

Agency Mailing Address (Plus Zip)                                       Phone                     Fax

5123:2-9-06

Rule Number

AMENDMENT

TYPE of rule filing

Rule Title/Tag Line              Home and community-based services waivers - payment for

waiver services.

RULE SUMMARY

1.  Is the rule being filed consistent with the requirements of the RC 119.032 review? Yes

2.  Are you proposing this rule as a result of recent legislation? No

3.  Statute prescribing the procedure in accordance with the agency is required to adopt the rule: 119.03

4.  Statute(s) authorizing agency to adopt the rule: 5111.871, 5111.873, 5123.04

5.  Statute(s) the rule, as filed, amplifies or implements: 5111.871, 5111.873, 5123.04

6.  State the reason(s) for proposing (i.e., why are you filing,) this rule:

The rule is being amended to incorporate general service documentation provisions from rule 5123:2-9-05 of the Administrative Code (which is being rescinded) and to eliminate provisions that apply to a specific waiver service (which are being incorporated into the respective service rule).

7.  If the rule is an AMENDMENT, then summarize the changes and the content

of the proposed rule; If the rule type is RESCISSION, NEW or NO CHANGE, then summarize the content of the rule:

References to rules of the Administrative Code have been updated.

Definitions in paragraph (B) are being revised to align with defintions used in newer rules.

A definition for "natural supports" is being added to support incorporation of the concept into the individual service plan development process.

A definition for "service documentation" is being added to support incorporation of general service documentation provisions from rule 5123:2-9-05 of the Administrative Code.

The definition of "transportation" is being eliminated as this term is no longer used in the manner in which it was defined.

Paragraph (F) of the existing rule, which addresses behavior support and medical assistance rate modifications for the Homemaker/Personal Care service, is being eliminated because the rate modifications are addressed in the new rule for the Homemaker/Personal Care service (5123:2-9-30).

Paragraph (G) of the existing rule, which addresses on-site/on-call payment for the Homemaker/Personal Care service, is being eliminated because on-site/on-call is addressed in the new rule for the Homemaker/Personal Care service (5123:2-9-30).

Paragraph (H)(2) of the existing rule, which addresses payment rates for the Homemaker/Personal Care service, is being eliminated because payment rates are addressed in the new rule for the Homemaker/Personal Care service (5123:2-9-30).

A new paragraph (H) is being incorporated to include the general service documentation provisions from rule 5123:2-9-05 (which is being rescinded).

A list of service-specific rules is being incorporated to paragraph (I)(2).

Provisions in paragraphs (I), (J), and (L) that are applicable to specific waiver services are being eliminated because service-specific provisions are being incorporated into the respective service rules.

Appendix A to the existing rule is being rescinded because the billing units, service codes, and payment rates for each waiver service are being incorporated into the respective service rule.

Appendix C to the existing rule is being rescinded and enacted as Appendix A to the amended rule.

8.  If the rule incorporates a text or other material by reference and the agency claims the incorporation by reference is exempt from compliance with sections

121.71 to 121.74 of the Revised Code because the text or other material is generally available to persons who reasonably can be expected to be affected by the rule, provide an explanation of how the text or other material is generally available to those persons:

Not applicable.

9.  If the rule incorporates a text or other material by reference, and it was infeasible for the agency to file the text or other material electronically, provide an explanation of why filing the text or other material electronically was infeasible:

Not applicable.

10.  If the rule is being rescinded and incorporates a text or other material by reference, and it was infeasible for the agency to file the text or other material, provide an explanation of why filing the text or other material was infeasible:

Not Applicable.

11.  If revising or refiling this rule, identify changes made from the previously filed version of this rule; if none, please state so:

Restored the phrase "(including the payment authorization for waiver services or "PAWS")" to paragraph (B)(2) as follows:

"Cost projection and payment authorization" means the process followed and the form used by county boards of developmental disabilities (including the payment authorization for waiver services or "PAWS") to communicate the frequency, duration, scope, and amount of payment requested for each HCBS waiver service that is identified in the individual service plan.

Revised first sentence of paragraph (B)(7) from:

"Funding range" means one of the dollar ranges contained in appendix A to this rule to which individuals enrolled in the individual options waiver have been assigned for the purpose of funding services.

to:

"Funding range" means one of the dollar ranges contained in appendix A to this rule to which individuals enrolled in the individual options waiver have been assigned for the purpose of funding services other than adult day support,

non-medical transportation, supported employment-community, supported employment-enclave, and vocational habilitation.

Revised paragraph (B)(11) from:

"Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, his or her guardian in accordance with section 5126.043 of the Revised Code.

to:

"Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, his or her guardian in accordance with section 5126.043 of the Revised Code or other person authorized to give consent.

Revised paragraph (B)(12) from:

"Individual funding level" means the total funds, calculated on a twelve-month basis, that result from applying the payment rates in service-specific rules in Chapter 5123:2-9 of the Administrative Code to the units of all waiver services other than adult day support, non-medical transportation, supported employment-community, supported employment-enclave, and vocational

habilitation established by the individual service plan development process to be sufficient in frequency, duration, and scope to meet the health and welfare needs of an individual. Unless prior authorization has been obtained in accordance with rule 5101:3-41-12 of the Administrative Code, the individual funding level for services paid in accodance with this rule for individuals enrolled in the individual options waiver shall be within or below the funding range assigned to the individual as the result of administration of the Ohio developmental disabilities profile.

to:

"Individual funding level" means the total funds, calculated on a twelve-month basis, that result from applying the payment rates in service-specific rules in Chapter 5123:2-9 of the Administrative Code to the units of all waiver services other than adult day support, non-medical transportation, supported employment-community, supported employment-enclave, and vocational

habilitation established by the individual service plan development process to be sufficient in frequency, duration, and scope to meet the health and welfare needs of an individual enrolled in the individual options waiver. Unless prior authorization has been obtained in accordance with rule 5101:3-41-12 of the Administrative Code, the individual funding level for services paid in accodance with this rule shall be within or below the funding range assigned to the individual as the result of administration of the Ohio developmental disabilities profile.

Added new paragraph (B)(14):

"Natural supports" means the personal associations and relationships typically developed in the community that enhance the quality of life for individuals. Natural supports may include family members, friends, neighbors, and others in the community or organizations that serve the general public who provide voluntary support to help an individual achieve agreed upon outcomes through the ISP development process.

Revised paragraph (C)(1) from:

Individuals enrolled in the individual options waiver shall be assigned to a funding range based on completion and scoring of the ODDP. The ODDP funding ranges are contained in appendix A to this rule.

to:

Individuals enrolled in the individual options waiver shall be assigned to a funding range based on completion and scoring of the ODDP and the

cost-of-doing-business category that applies to the county in which the individual receives the preponderance of services. The funding ranges are contained in appendix A to this rule. The cost-of-doing-business categories are contained in appendix B to this rule.

Revised paragraph (C)(2)(a) from:

The unpaid care available to the individual. to:

The natural supports available to the individual. Revised paragraph (C)(3) from:

The SSA shall ensure that an ODDP is accurately completed and shall inform the individual of his/her assigned funding range resulting from the ODDP score at the time of enrollment and at any other time a change in circumstances results in an ODDP score that assigns the individual to a different funding range.

to:

The SSA shall ensure that an ODDP is completed with input from the individual and the team. The SSA shall inform the individual, and the team with consent of the individual, of the assigned funding range at the time of enrollment and any time the ODDP is reviewed or updated. The SSA shall ensure the individual, and the team with consent of the individual, have access to review the ODDP and other assessments used in relation to completion of the ODDP.

Revised paragraph (C)(4) from:

Following assignment of a funding range, an ISP shall be reviewed, revised, or developed with the individual. The county board shall apply rates for the units of each waiver service, other than adult day support, non-medical transportation, supported employment-community, supported employment-enclave, and vocational habilitation, resulting from the completion of the ISP development process to calculate the individual funding level.

to:

Following assignment of a funding range, an ISP which ensures health and welfare shall be reviewed, revised, or developed with the individual. The SSA shall ensure that individuals share services to whatever extent practical and with the agreement of the team. Paid services should be used in conjunction with the natural supports an individual has in his or her family home. The SSA shall ensure that development or revision of the ISP addresses the availability of natural supports that currently exist or could be developed to meet assessed needs, including:

Added new paragraph (C)(4)(a):

Supports that family members provide including, but not limited to, basic personal care, performing health care activities, transportation, attending family/social/recreational activities, laundry, meal preparation, and grocery shopping; and

Added new paragraph (C)(4)(b):

Supports that friends, neighbors, and others in the community provide. Added new paragraph (C)(5):

The county board shall apply rates for the units of each waiver service, other than adult day support, non-medical transportation, supported employment-community, supported employment-enclave, and vocational habilitation, resulting from completion of the ISP development process to calculate the individual funding level.

Revised first sentence of paragraph (C)(8) from:

The county board shall complete the cost projection and payment authorization and the SSA shall ensure waiver services are initiated for an individual whose funding level is within the funding range determined by an ODDP assessment.

to:

The county board shall complete the cost projection and payment authorization and the SSA shall ensure waiver services are initiated for an individual whose funding level is within the funding range determined by the ODDP.

Eliminated former paragraphs (C)(9), (C)(9)(a), (C)(9)(b), (C)(9)(c), (C)(9)(d), and (C)(9)(e) which had set forth steps to be followed when the individual funding level is below the assigned funding range.

Eliminated last sentence of paragraph (E)(1) which had stated:

Prior state level review shall not be required for funding level changes that occur within or below a funding range when changes result from a revision to the ISP that has been agreed to by an individual through the ISP development process.

Eliminated former paragraph (F)(1) which had stated:

ISPs shall indicate the typical ratios at which services are to be delivered when individuals share services, regardless of funding source.

Revised paragraph (G)(2) from:

The cost projection shall be based on staffing ratios and the total estimated number of service units the individual is expcted to receive in accordance with his/her ISP during the waiver eligibility span.

to:

The cost projection shall be based on staffing ratios and the total estimated number of service units the individual is expcted to receive in accordance with his/her ISP during the waiver eligibility span. Staffing ratios contained in the CPT shall be considered a part of the ISP.

Revised paragraph (I)(2)(a) from:

5123:2-9-14 (vocational habilitation under the individual options and level one waivers);

to:

5123:2-9-19 (vocational habilitation under the individual options and level one waivers);

Revised paragraph (I)(2)(b)from:

5123:2-9-15 (supported employment-community under the individual options and level one waivers);

to:

5123:2-9-19 (supported employment-community under the individual options and level one waivers);

Revised paragraph (I)(2)(c) from:

5123:2-9-16 (supported employment-enclave under the individual options and level one waivers);

to:

5123:2-9-19 (supported employment-enclave under the individual options and level one waivers);

Revised paragraph (I)(2)(d) from:

5123:2-9-17 (adult day support under the individual options and level one waivers); to:

512:2-9-19 (adult day support under the individual options and level one waivers); Revised paragraph (I)(2)(e) from:

5123:2-9-18 (non-medical transportation under the individual options and level one waivers);

to:

5123:2-9-19 (non-medical transportation under the individual options and level one waivers);

Revised last sentence of paragraph (J)(7) from:

All recoverable amounts are subject to the application of interest in accordance with rule 5101:6-51-03 of the Administrative Code.

to:

All recoverable amounts are subject to the application of interest in accordance

with rules 5101:3-1-25 and 5101:6-51-03 of the Administrative Code, as applicable. Revised last sentence of paragraph (K)(2) from:

A change in staff to waiver recipient service ratios does not automatically result in a change in the level of services received by an individual.

to:

A change in staff to waiver recipient service ratios does not necessarily result in a change in the level of services received by an individual.

12. 119.032 Rule Review Date: 11/22/2011

(If the rule is not exempt and you answered NO to question No. 1, provide the

scheduled review date. If you answered YES to No. 1, the review date for this rule is the filing date.)

NOTE: If the rule is not exempt at the time of final filing, two dates are required: the current review date plus a date not to exceed 5 years from the effective date for Amended rules or a date not to exceed 5 years from the review date for No Change rules.

FISCAL ANALYSIS

13.  Estimate the total amount by which this proposed rule would increase / decrease either revenues / expenditures for the agency during the current biennium (in dollars): Explain the net impact of the proposed changes to the budget of your agency/department.

This will have no impact on revenues or expenditures.

$ 0

Amendments to this rule will neither increase nor decrease revenues or expenditures for the department.

14.  Identify the appropriation (by line item etc.) that authorizes each expenditure necessitated by the proposed rule:

Not applicable.

15.  Provide a summary of the estimated cost of compliance with the rule to all directly affected persons. When appropriate, please include the source for your information/estimated costs, e.g. industry, CFR, internal/agency:

Not applicable.

16.  Does this rule have a fiscal effect on school districts, counties, townships, or municipal corporations? No

17.  Does this rule deal with environmental protection or contain a component dealing with environmental protection as defined in R. C. 121.39? No