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]     [phone]

Agency Mailing Address (Plus Zip)                                       Phone                     Fax

[e-mail]

Email

5123:2-9-06

Rule Number

AMENDMENT

TYPE of rule filing

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

and  payment  for  services  under  the  individual  options  and level one waivers.

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, 5123.049

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

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

The Department is amending the rule to add references to new services (Career Planning, Group Employment Support, Individual Employment Support, Money Management, and Waiver Nursing Services), remove references to eliminated services (Supported Employment-Community and Supported

Employment-Enclave), correct references to the Administrative Code, and align

wording with newer rules for Home and Community-Based services.

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 establishes standards governing documentation and payment for Home and Community-Based Services under the Individual Options and Level One waiver components of the Medicaid program that the Department administers pursuant to Section 5166.21 of the Revised Code. The Department is amending the rule to add references to new services (Career Planning, Group Employment Support, Individual Employment Support, Money Management, and Waiver Nursing Services), remove references to eliminated services (Supported Employment-Community and Supported Employment-Enclave), correct references to the Administrative Code, and align wording with newer rules for Home and Community-Based services.

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 (G)(8) REVISED FROM:

When changes occur that the team determines affect the total estimated direct service hours, the county board shall enter changes to the cost projection tool. These changes shall be made along with any necessary revisions to the individual service plan, daily rate application, cost projection and payment authorization, and prior authorization request (as applicable) for the individual or individuals affected by the changes.

TO:

When changes occur that the team determines affect the service authorization, the county board shall enter changes to the cost projection tool within ten calendar days of a recommendation from the team to change the service authorization. These changes shall be made along with any necessary revisions to the individual service plan, daily rate application, and prior authorization request (as applicable) for the individual or individuals affected by the changes.

12.  Five Year Review (FYR) Date: 1/1/2021

(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

Amending the rule is not expected to increase or decrease revenues or expenditures for the Department during the current biennium.

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

653407

653606

653607

653624

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:

Amending the rule is not expected to have an impact.

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? No

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 (J)(8) sets forth that a provider's failure to produce records requested by the Department, the Ohio Department of Medicaid, the federal Centers for Medicare and Medicaid Services, or the Auditor of State may result in the provider being decertified or losing its Medicaid provider agreement.

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

Paragraph (H)(1) requires providers of services to maintain service documentation.

Paragraph (H)(3) sets forth that service documentation shall be made available to the Department, the Ohio Department of Medicaid, the federal Centers for Medicare and Medicaid Services (CMS), a county board of developmental disabilities or regional council of governments, and other entities designated by the Department or the Ohio Department of Medicaid.

Paragraph (H)(4) requires providers of services that discontinue operations to notify county boards of developmental disabilities and provide information about service documentation.

Paragraph (J)(2) requires providers of services to submit claims for payment to the Department in the format prescribed by the Department.

Paragraph (J)(3) require providers of services to submit claims for payment within 350 calendar days after providing services.

Paragraph (J)(5) sets forth that when an individual served has a patient liability, the provider must report the service to which the patient liability was assigned and the applicable amount on the claim for payment.

Paragraph (J)(6) sets forth that providers of services may be audited and that records pertaining to services shall be made available upon request by the Department, the Ohio Department of Medicaid, CMS, or the Auditor of State.