5123:2-9-39 Home and community-based services waivers - waiver nursing services under the individual options waiver.

 

 

 

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]     [phone]

Agency Mailing Address (Plus Zip)                                       Phone                     Fax

[e-mail]

Email

5123:2-9-39

Rule Number

NEW

TYPE of rule filing

Rule Title/Tag Line              Home and community-based services waivers - waiver nursing

services under the individual options waiver.

RULE SUMMARY

1.  Is the rule being filed for five year review (FYR)? No

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: 5123.04, 5123.045, 5123.049, 5123.16, 5166.21

5.  Statute(s) the rule, as filed, amplifies or implements: 5123.04, 5123.045, 5123.049, 5123.16, 5166.21

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

The Department is seeking approval from the federal Centers for Medicaid and Medicare Services (CMS) to add Waiver Nursing Services to the Individual Options Waiver, primarily to support approximately 1,700 individuals enrolled in the Transitions Developmental Disabilities Waiver who are transferring to the Individual Options Waiver and rely upon the service to meet their continuing

nursing needs.

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:

The rule defines Waiver Nursing Services under the Individual Options Waiver and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service.

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:

This response left blank because filer specified online that the rule does not incorporate a text or other material by reference.

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:

This response left blank because filer specified online that the rule does not incorporate a text or other material by reference.

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. If applicable, indicate each specific paragraph of the rule that has been modified:

Paragraph (D)(4) revised from:

The department may approve a service authorization request in its entirety or may partially approve a service authorization request if it determines that the services are medically necessary.

to:

The department may approve a service authorization request in its entirety or may partially approve a service authorization request if it determines that the services are medically necessary. A service authorization request shall not be denied without review by a registered nurse.

Paragraph (E)(6) revised from:

In all instances, when a treating physician gives verbal orders to the registered nurse or licensed practical nurse working at the direction of a registered nurse, the nurse shall record, in writing within seven calendar days, the physician's orders, the date and time the orders were given, and sign the entry in the service documentation. The nurse shall subsequently secure documentation of the verbal orders signed and dated by the treating physician.

to:

In all instances, when a treating physician gives verbal orders to the registered nurse or licensed practical nurse working at the direction of a registered nurse, the nurse shall immediately record in writing, the physician's orders, the date and time the orders were given, and sign the entry in the service documentation. The nurse shall subsequently secure documentation of the verbal orders signed and dated by the treating physician within seven calendar days.

Added new paragraph (F)(3):

Providers of waiver nursing services shall maintain, in a confidential manner for at least thirty days at the individual's residence, medication and/or treatment records which indicate the person who prescribed the medication and/or treatment and the date, time, and person who administered the medication and/or treatment.

12.  Five Year Review (FYR) Date:

(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

Adding Waiver Nursing Services to the Individual Options Waiver is not expected to 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:

653407

653606

653639

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:

Waiver Nursing Services already exists as a service under the Transitions Developmental Disabilities Waiver. Making the service available under the Individual Options Waiver is not expected to have any additional costs of compliance.

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

S.B. 2 (129th General Assembly) Questions

18.  Has this rule been filed with the Common Sense Initiative Office pursuant to

R.C. 121.82? Yes

19.  Specific to this rule, answer the following:

A.) Does this rule require a license, permit, or any other prior authorization to engage in or operate a line of business? Yes

Paragraph (C)(1): A provider of Waiver Nursing Services must have a Medicaid Provider Agreement with the Ohio Department of Medicaid.

Paragraph (C)(2): A provider of Waiver Nursing Services must possess a current, valid, and unrestricted license issued by the Ohio Board of Nursing.

Paragraph (C)(5): A provider of Waiver Nursing Services must be certified by the Department.

B.) Does this rule impose a criminal penalty, a civil penalty, or another sanction, or create a cause of action, for failure to comply with its terms? Yes

Paragraph (C)(6): Failure of a provider to comply with this rule may result in denial, suspension, or revocation of the provider's certification.

C.) Does this rule require specific expenditures or the report of information as a condition of compliance? Yes

Paragraph (C)(5): An applicant seeking approval to provide Waiver Nursing Services must submit an application to the Department.

Paragraph (F): A provider of Waiver Nursing Services must maintain documentation regarding the services provided.