Ohio Admin. Code 173-39-02.16 - ODA provider certification: assisted living service
(A) Definitions for
this rule: (1)(2)
"Assisted living
Basic service" means all of the following:
(b)(a) A service that
includes the following activities:
(c)(b) A
service that does not include the following:
(3)(4) "Memory care" means
a service that a provider provides in compliance with paragraph (D) of this
rule to an individual that a practitioner assessed,
then issued
with a documented
diagnosis of any form of dementia.
(4)(6)
"Resident call system" has the same meaning as in rule
3701-16-01 of the Administrative
Code.
(5)(7) "Staff member" and
"staff" have the same meanings as in rule
3701-16-01 of the Administrative
Code.
(1)
"Assisted living service" means either a basic service or
memory care that promotes aging in an RCF by supporting the individual's
independence, choice, and privacy.
(a) A service promoting aging in
place by supporting the individual's independence, choice, and
privacy.
(i)
Personal care
under rule
3701-16-09 of the Administrative
Code, which includes
Hands-on
hands-on assistance, supervision, and/or cuing of
ADLs, and IADLs, and
other supportive activities.
(ii) Nursing activities, including the following:
(a) The initial and subsequent health
assessments under rule
3701-16-08 of the Administrative
Code.
(b)
Other activities included in rules
3701-16-09 and
3701-16-09.1 of the
Administrative Code.
(b)
Monitoring the individual according to the
standards of practice for the individual's condition.
(c)
Medication management according to rule 3701-16-09
of the Administrative Code.
(d)
The part-time intermittent skilled nursing care
described in rule 3701-16-09.1 of the Administrative Code when not available to
the individual through a third-party payer.
(iii) Coordinating three meals per
day and snacks according to rule
3701-16-10 of the Administrative
Code with access to food according to rule
5160-44-01 of the Administrative
Code.
(iv) Coordinating the social,
recreational, and leisure activities under rule
3701-16-11 of the Administrative
Code to promote community participation and integration, including non-medical
transportation to services and resources in the community.
(i) Housing.
(ii) Meals.
(iii) Twenty-four-hour skilled nursing
care.
(iv) One-on-one supervision
of an individual.
(2) "Medication management" includes
knowing what medications an individual is self-managing, assistance with
self-administration of medication, ordering medication, medication reminders,
and medication administration.
(3)
"Census" means
the total number of residents in an RCF on a given day and includes any
resident who is temporarily absent from the RCF without being
discharged.
(5)
"Practitioner"
means a health care provider engaging in activities authorized by the
provider's license, certification, or registration.
(B) Certification
types: ODA certifies each provider for either of
the basic assisted living service, memory care, or
both the basic service and memory care.
following:
(1)
The basic service.
(2)
The basic service
and memory care.
(C) Requirements for an ODA-certified
provider of the basic assisted living
service:
(1) General requirements: The
provider is subject to rule
173-39-02 of the Administrative
Code.
(2) RCF qualifications:
(a) Licensure: Only a provider who maintains
a current, valid RCF license from ODH and maintains compliance with Chapter
3721. of the Revised Code and Chapters 3701-13 and 3701-16 of the
Administrative Code qualifies to provide this service.
(b) Public information: The provider shall
display the following on its website:
(i)
Whether the provider is currently certified by ODA to provide the basic
assisted living service, memory care, or both the basic service and memory
care.
(ii) Whether the provider is
currently accepting individuals who are enrolling in the assisted living
program or mycare Ohio.
(c) Resident units: A resident unit qualifies
for this service only if the unit meets all the following standards:
(i) Occupancy:
(a) The resident unit is a single-occupancy
resident unit designated solely for the individual, except as permitted under
paragraph (C)(2)(c)(i)(b) of this rule.
(b) The provider may allow an individual to
share a single- occupancy resident unit only if all of the following conditions
exist:
(i) The individual requests to share
the individual's unit.
(ii) The
individual shares the individual's unit with a person with whom the individual
has an existing relationship.
(iii)
ODA's designee verifies that the conditions of paragraphs (C)(2)(c)(i)(b)(i)
and (C)(2)(c)(i)(b)(ii) of this rule are met and authorizes sharing the unit in
the individual's person-centered services plan.
(ii) Lock: The resident unit has a lock that
allows the individual to control access to the resident unit at all times,
unless the individual's person-centered services plan indicates
otherwise.
(iii) Bathroom: The
resident unit includes a bathroom with a toilet, a sink, and a shower or
bathtub, all of which are in working order.
(iv) Social space: The resident unit includes
identifiable space, separate from the sleeping area, that provides seating for
the individual and one or more visitors for socialization.
(d) Common areas: The provider shall provide
common areas accessible to the individual, including a dining area (or areas)
and an activity center (or centers). A multi-purpose common area may serve as
both a dining area and an activity center.
(3)
Staff
Availability:
availability: The provider shall maintain adequate
staffing levels to comply with rule
3701-16-05 of the Administrative
Code and to provide hands-on assistance,
supervision, and/or cuing of ADLs in a timely manner in response to
individual's unpredictable care needs, supervisory needs, emotional needs, and
reasonable requests for services through the resident call system twenty-four
hours per day.
(4) Minors:
No
Staff
staff
members
member under eighteen years of age
do not qualify
qualifies to do any of the following:
(a) Assist with medication
management
administration.
(b) Provide transportation.
(c) Provide personal care without on-site
supervision, in accordance with rule
3701-16-06 of the Administrative
Code.
(5) Initial staff
qualifications: Only a staff member who successfully completes training in the
following subject areas qualifies to provide this service:
(a) Principles and philosophy of assisted
living.
(b) The aging
process.
(c) Cuing, prompting, and
other means of effective communication.
(d) Common behaviors for cognitively-impaired
individuals, behaviorally- impaired individuals, or other individuals and
strategies to redirect or de- escalate those behaviors.
(e) Confidentiality.
(f) The person-centered planning process in
rule 5160-44-02 of the Administrative
Code, which includes supporting individuals' full access to the greater
community.
(g) The individual's
right to assume responsibility for decisions related to the individual's
care.
(6) In-service
training: The provider shall ensure that each employee
staff member
providing this service successfully completes any training requirements in rule
3701-16-06 of the Administrative
Code and makes verification of successful completion of those requirements
available to ODA or its designee upon request.
(7) Quarterly assessments: The provider's RN
or LPN shall contact the individual at least quarterly to assess, and retain a
record of, all of the following:
(a) The
individual's satisfaction with the individual's activity plan and whether the
activity plan continues to meet the individual's needs.
(b) Whether the individual's records
demonstrate that the individual is receiving activities as ODA or its designee
authorized them in the individual's person-centered service plan.
(c) Whether staff are providing personal care
services to the individual in a manner that complies with rule
3701-16-09 of the Administrative
Code.
(8)
Subcontracting: The provider may subcontract to provide one or more, but not
all, of the activities listed under paragraph (A)(1)(b)
(A)(2)(a)
of this rule that ODA or its designee authorizes for the individual. The
provider is responsible to assure that any activity provided by a
sub-contractor complies with this chapter.
(D) Requirements for an ODA-certified
provider of the basic service and memory care:
(1) The provider is subject to the standards
in paragraphs
paragraph (C) of this rule.
(2) The provider qualifies for certification
to provide memory care only if the provider meets all of the following
standards:
(a) The provider displays a purpose
statement on its website that explains the difference between the provider's
basic assisted living service and its
memory care, or if the provider provides
only a memory care,
a purpose statement on its website that
explains the memory care
if that
is the exclusive service
the provider provides
offers.
(b) The provider designates
the
each
single-occupancy resident unit in paragraph (C)(2)(c) of this rule
to be a stand-alone memory care unit, a memory care
unit in a memory care section of the RCF, or a memory care unit in an RCF of a
provider that provides only memory care.
in
which it plans to provide memory care as one of the following:
(i)
A resident unit
in a memory care section of the RCF. The provider may add a single-occupancy
resident unit to an existing memory care section even if the resident unit is
not next door to the existing section.
(ii)
A resident unit
in an RCF that provides only memory care.
(c)
The
provider
A staff member who successfully
completed the training requirement in paragraph (D)(3) of rule
3701-16-06 of the Administrative
Code provides or arranges for at least three therapeutic, social, or
recreational activities listed in rule
3701-16-11 of the Administrative
Code per day with consideration given to individuals' preferences and designed
to meet individuals' needs.
(d) The
provider ensures safe access to outdoor space for individuals.
(e) The provider assists each individual who
makes a call through the resident call system in person in fewer than ten
minutes after the individual initiates the call.
(3)
Staff
Availability:
availability: The provider qualifies for certification
to provide memory care only if the provider meets all of the following
standards in addition to the requirements in paragraph (C)(3) of this rule:
(a) The provider has a sufficient number of
RNs, or LPNs under the direction of an RN, on call or on site at
all times for individuals receiving memory care.
(b) The provider maintains the appropriate
direct-care staff-to-resident ratio below for its memory care:
(i) If providing both memory care and the basic service
at the same time, a ratio for the provider's memory care that is at least twenty
per cent higher than the provider's ratio for its basic service.
(ii) If providing only memory care and the
average ratio for the basic service provided by a representative sample of
providers participating in the medicaid-funded component of the assisted living
program is readily available to the provider, then a ratio that is at least
twenty per cent higher than that average ratio.
(iii) If providing only memory care and the
average ratio for the basic service provided by a representative sample of
providers participating in the medicaid-funded component of the assisted living
program is not readily available to the provider, then a ratio of at least one
direct-care staff member
who provides personal care services for
every ten individuals receiving memory care with at least one
direct-care staff member
who provides personal care services on each
floor of the RCF if the RCF provides memory care on multiple floors.
(4) Initial staff
qualifications: A staff member qualifies to provide memory care without
in-person supervision only if the staff member successfully completes training
all of the following topics in addition to the topics listed under paragraph
(C)(5) of this rule:
(a) Overview of dementia:
symptoms, treatment approaches, and progression.
(b) Foundations of effective communication in
dementia care.
(c) Common behavior
challenges specific to dementia and recommended
behavior management techniques.
(d)
Current best practices in dementia care.
(e) Missing resident prevention and
response.
(5) In-service
training: A staff member continues to qualify to provide memory care only if
the staff member successfully completes dementia care training when complying
with paragraph (C)(6) of this rule.
(E) Units and rates:
(1) For the assisted living program, the
appendix to rule
5160-1-06.5 of the
Administrative Code lists the following:
(a)
The unit of service as one day.
(b)
The maximum-allowable rates for a unit of a unit of the basic assisted living
service and a unit of memory care.
(c)
Critical access
rates.
(2) For the
assisted living program, rule
5160-33-07 of the Administrative
Code establishes the rate-setting methodology for a unit of service.
(3)
Requirements to
obtain the critical access rate for certified assisted living providers:
(a)
A certified
provider of the service, whether the basic service or memory care, that
provided the service for one or more state fiscal years qualifies for the
critical access rate by meeting all of the following:
(i)
At least an
average of fifty per cent of the residents in the RCF were enrolled in medicaid
during the preceding state fiscal year, whether through the assisted living
program, mycare Ohio, or PACE.
(ii)
The provider
responds to ODA's annual June survey by providing, and attesting to the
veracity of, all of the following information based on the current state fiscal
year:
(a)
The
average daily census of the RCF.
(b)
The average daily
number of residents in paragraph (E)(3)(a) (ii)(a) of this rule who are
enrolled in medicaid.
(c)
The average daily percentage of residents in paragraph
(E)(3) (a)(ii)(a) of this rule who are enrolled in medicaid.
(d)
The medicaid
identification numbers of all residents in paragraph (E)(3)(a)(ii)(a) of this
rule who are enrolled in medicaid.
(e)
For each resident
in paragraph (E)(3)(a)(ii)(a) of this rule who is enrolled in mycare Ohio, the
name of the mycare Ohio plan into which the resident enrolled.
(f)
Any other
information required in the survey.
(b)
A certified
provider of the assisted living service, whether the basic service or memory
care, that has not provided the service for one or more state fiscal years and
intends to provide the service for the duration of the state fiscal year in
which the provider was initially certified, qualifies for the critical access
rate by meeting all of the following:
(i)
The provider
projects and attests that at least an average of fifty percent of the residents
in the RCF will be enrolled in medicaid during the state fiscal year, whether
through the assisted living program, mycare Ohio, or PACE.
(ii)
The provider
responds to ODA's annual June survey by providing, and attesting to the
veracity of, all of the following information for the period beginning with the
provider's attestation date in paragraph (E)(3)(b)(i) of this rule through the
remainder of the current state fiscal year:
(a)
The average daily
census of the RCF.
(b)
The average daily number of residents in paragraph
(E)(3)(a) (ii)(a) of this rule who are enrolled in medicaid.
(c)
The average daily
percentage of residents in paragraph (E)(3) (a)(ii)(a) of this rule who are
enrolled in medicaid.
(d)
The medicaid identification numbers of all residents in
paragraph (E)(3)(a)(ii)(a) of this rule who are enrolled in
medicaid.
(e)
For each resident in paragraph (E)(3)(a)(ii)(a) of this
rule who is enrolled in mycare Ohio, the name of the mycare Ohio plan into
which the resident enrolled.
(f)
Any other
information required in the survey.
(c)
A certified
provider who fails to meet all requirements under paragraph (E)(3)(a) or (E)
(3)(b) of this rule at the end of the fiscal year may requalify for the
critical access rate by meeting the requirement in paragraph (E)(3)(a)(i) of
this rule and satisfying the requirements in paragraph (E)(3)(a) of this
rule.
(d)
The critical access rate is payable for a qualifying
provider for a resident receiving the basic service for the duration of the
state fiscal year without adjustment. This rate is not payable for a resident
also receiving memory care.
Notes
Promulgated Under: 119.03
Statutory Authority: 121.07, 173.01, 173.02, 173.391, 173.54, 173.543
Rule Amplifies: 173.39, 173.391, 173.54, 173.543, 173.547, 173.548; 42 C.F.R. 441.352
Prior Effective Dates: 03/31/2006, 03/22/2008, 10/08/2009, 06/10/2013, 11/01/2020, 01/01/2024
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