Ohio Admin. Code 5123-2-08 - Provider certification - agency providers
(A)
Purpose
This rule establishes procedures and standards for certification of agency providers of supported living services, including home and community-based services provided in accordance with section 5123.045 of the Revised Code.
(B) Definitions
(7)(8) "Direct support
professional" means a person who is at least eighteen
years of age employed in a "direct services position" as that term is
defined in section 5123.081 of the Revised
Code.
(8)(9) "Director of
operations" means a person employed by an agency provider who is responsible
for, and who is directly and actively involved in, the day-to-day operations of
the agency provider. For the purposes of conducting background investigations
pursuant to section 5123.081 of the Revised Code and
rule 5123-2-02 of the Administrative
Code, "director of operations" has the same meaning as "chief executive
officer."
(9)(10) "Health-related
activities" has the same meaning as in rule
5123-6-01 of the Administrative
Code.
(10)(11) "Home and
community-based services" has the same meaning as in section
5123.01 of the Revised
Code.
(11)(12) "Independent
provider" means a self-employed person who provides services for which the
person is certified in accordance with rule
5123-2-09 of the Administrative
Code and does not employ, either directly or through contract, anyone else to
provide the services.
(12)(13) "Individual"
means a person with a developmental disability or for purposes of giving,
refusing to give, or withdrawing consent for services, the person's guardian in
accordance with section
5126.043 of the Revised Code or
other person authorized to give consent.
(13)(14)
"Individual service plan" means the written description of services, supports,
and activities to be provided to an individual.
(14)(15) "Major unusual
incident" has the same meaning as in rule
5123-17-02 of the Administrative
Code.
(15)(16) "Provider network
management module" means a component of the Ohio medicaid enterprise system
platform, maintained by the Ohio department of medicaid at its website
(medicaid.ohio.gov), used by providers of services to initiate applications for
certification, access the provider services management system, and submit
required information and documents.
(16)(17) "Provider
services management system" means the electronic portal, maintained by the
department at its website (dodd.ohio.gov), used by providers of services to
apply for certification and submit required information and
documents.
(17)(18) "Related party"
has the same meaning as in section
5123.16 of the Revised
Code.
(18)(19) "Service and
support administrator" means a person, regardless of title, employed by or
under contract with a county board to perform the functions of service and
support administration as set forth in section
5126.15 of the Revised Code and
who holds the appropriate certification in accordance with rule
5123-5-02 of the Administrative
Code.
(19)(20) "Specialized
services" means any program or service designed and operated to serve primarily
individuals with developmental disabilities, including a program or service
provided by an entity licensed or certified by the department. If there is a
question as to whether an entity is providing specialized services, an agency
provider may request that the director of the department make a determination.
The director's determination is not subject to appeal. Programs or services
available to the general public are not specialized services.
(20)(21)
"Supported living" has the same meaning as in section
5126.01 of the Revised
Code.
(22)(23) "Volunteer" means
a person who donates time, effort, and/or talent to meet a need or advance the
mission of an agency provider and who is not paid or otherwise remunerated by
the agency provider. "Volunteer" does not include a family member, guardian,
friend, or other associate of an individual simply interacting with that
individual.
For the purposes of this rule, the following definitions apply:
(1) "Abuser registry" has the
same meaning as in rule
5123-17-03 of the Administrative
Code.
(2) "Accredited college or
university" means a college or university accredited by a national or regional
association recognized by the secretary of the United States department of
education or a foreign college or university of comparable standing.
(3) "Agency provider" means an entity that
must be certified by the department to provide supported living services in
accordance with section
5123.161 of the Revised Code and
this rule.
(4) "Certificate of high
school equivalence" has the same meaning as in section
3301.80 of the Revised Code and
includes the equivalent of a certificate of high school equivalence described
in division (C) of that section.
(5) "County board" means a county board of
developmental disabilities.
(6)
"Department" means the Ohio department of developmental disabilities.
(7)
"Direct support
assistant" means a person who is sixteen or seventeen years of age employed by
an agency provider to provide limited duties while in the company of a direct
support professional.
(C) General
requirements for agency providers
An agency provider will:
(1) Be in good standing with the Ohio
secretary of state as a for-profit corporation, nonprofit corporation, limited
liability company, or limited liability partnership.
(2) Obtain and maintain a medicaid provider
agreement with the Ohio department of medicaid when the agency provider intends
to provide home and community- based services.
(3) Comply with the requirements of this rule
and other standards and assurances established in Chapter 5123. of the Revised
Code and rules adopted pursuant to that chapter.
(4) At the point of application for
certification and upon request by the department, provide proof of a:
(a) Continuing line of credit in the agency
provider's name in an amount of at least ten thousand dollars; or
(b) Bank account in the agency provider's
name with a daily balance of at least ten thousand dollars for the most recent
ninety days.
(5) At the
point of application for certification and upon request by the department,
provide a certificate of a continuing policy of general liability insurance in
an amount of at least one million dollars which includes coverage for
individuals' losses due to theft or property damage.
(6) Provide and maintain in the provider
services management system and the provider network management module, the
agency provider's current physical address, telephone number, and electronic
mail address.
(7) Provide to the
department via the provider services management system, within fourteen
calendar days of occurrence, the name, date of birth, and social security
number for any person newly acquiring a financial interest of five per cent or
more in the agency provider (including a direct, indirect, security, or
mortgage financial interest).
(8)
Notify the department via the provider services management system, within seven
calendar days of any bankruptcy petition for which the agency provider is the
subject and provide related documents to the department upon request.
(9) Participate as requested by the
department in service delivery system data collection initiatives.
(D) Management of the agency
provider
(1) An agency provider will have
written policies and procedures that address the agency provider's management
practices regarding:
(a) Person-centered
planning and self-determination;
(b) Individuals' satisfaction with services
delivered;
(c) Internal monitoring
and evaluation procedures to improve services delivered;
(d) Supervision of staff;
(e) Training plan described in paragraph
(F)(1) of this rule;
(f) Service
delivery;
(g) Background
investigations for employment in accordance with rule
5123-2-02 of the Administrative
Code; and
(h) Volunteers (when the
agency provider engages volunteers).
(2) An agency provider will demonstrate that
the agency provider has an established internal compliance program to ensure
compliance with requirements for:
(a) Provider
certification in accordance with this rule;
(b) Background investigations and appropriate
actions in accordance with rule
5123-2-02 of the Administrative
Code for its director of operations, supervisors of direct support
professionals, direct support professionals, direct
support assistants, and when
applicable, volunteers;
(c) Service delivery, service documentation,
and billing for services in accordance with Chapter 5123. of the Revised Code
and rules adopted pursuant to that chapter for supported living services and
the specific home and community-based services provided; and
(d) Management of individuals'
funds.
(3) When an
agency provider is governed by a board of directors, board members will:
(a) Ensure the fiscal integrity of the agency
provider by reviewing and approving the agency provider's annual audit, if
otherwise required, or annual financial statements and by monitoring the agency
provider's financial status including trends and challenges;
(b) Review and evaluate all compliance review
reports by the department or a county board and the agency provider's response,
including the plan of correction;
(c) Monitor the effectiveness of the agency
provider's internal compliance program described in paragraph (D)(2) of this
rule; and
(d) Promote the delivery
of high-quality services.
(E) Employment of staff
An agency provider will:
(1) In addition to employing a director of
operations who meets the requirements set forth in paragraph (H) of this rule,
employ at least one other person for the purpose of providing
services.
(2) Comply with
applicable federal, state, and local regulations, statutes, rules, codes, and
ordinances pertaining to employment of staff including, but not limited to,
wage and hour, workers' compensation, unemployment compensation, and
withholding taxes.
(3) Be current
in payment of payroll taxes, workers' compensation premiums, and unemployment
compensation premiums.
(4) Conduct
background investigations and take appropriate actions in accordance with rule
5123-2-02 of the Administrative
Code.
(5) Annually notify in
writing, each of its staff members explaining the conduct for which the staff
member may be placed on the abuser registry and setting forth the requirement
for each staff member who is a supervisor of direct support professionals,
or a direct
support professional, or a direct support
assistant to report in writing to the agency provider, if the staff
member is formally charged with, is convicted of, pleads guilty to, or is found
eligible for intervention in lieu of conviction for any of the offenses listed
or described in divisions (A)(3)(a) to (A)(3)(e) of section
109.572 of the Revised Code
within fourteen calendar days after the date of such charge, conviction, guilty
plea, or finding.
(F)
Staff training documentation
An agency provider will:
(1) Develop and implement a written training
plan for its director of operations, supervisors of direct support
professionals, direct support professionals, direct
support assistants, and when
applicable, volunteers that:
(a) Is
consistent with the needs of individuals served, best practice, and the
requirements set forth in appendix A and appendix C to this rule.
(b) Describes the method (e.g., written test,
skills demonstration, or documented observation by supervisor) that will be
used to establish competency of supervisors of direct support professionals,
and direct
support professionals, and direct support
assistants in areas of training.
(c) Is updated at least once every twelve
months and identifies who is responsible for arranging or providing the
training and projected timelines for completion of the training.
(2) Maintain a written record of
training completed by its director of operations, supervisors of direct support
professionals, direct support professionals, direct
support assistants, and volunteers that includes a description of the
training completed, the date of training, the duration of training, and when
applicable, the instructor's name.
(G) Standards of service provision
An agency provider will:
(1) Provide services only to individuals
whose needs the agency provider can meet.
(2) Communicate effectively with each
individual served by the agency provider.
(3) Ensure that direct support professionals
are knowledgeable in the individual service plan for each individual served
prior to providing services to the individual.
(4) Implement services in accordance with the
individual service plan and in a person- centered manner.
(5) Comply with the requirements of rule
5123-2-06 of the Administrative
Code.
(6) Take all reasonable steps
necessary to prevent the occurrence or recurrence of major unusual incidents
and unusual incidents.
(7) Upon
realization that the agency provider may be unable to continue to effectively
provide services to an individual, immediately engage the individual and the
individual's service and support administrator to consider alternative
strategies for serving the individual that ensure the health and safety of the
individual.
(8) Notify, in writing,
an individual and the individual's service and support administrator in the
event that the agency provider intends to cease providing services to the
individual no less than thirty calendar days prior to termination of services
and convey documents and records to the individual's service and support
administrator as requested.
(9)
Ensure that a direct support professional does not:
(a) Provide services to the direct support
professional's minor child except as permitted pursuant to rule
5160-44-32 of the Administrative
Code;
(b) Provide services to the
direct support professional's spouse except as permitted pursuant to rule
5160-44-32 of the Administrative
Code;
(c) Provide services to the
minor child of an owner of the agency provider;
(d) Provide services to the spouse of an
owner of the agency provider;
(e)
Provide services to the minor child of the director of operations;
(f) Provide services to the spouse of the
director of operations;
(g)
Administer medication or perform health-related activities for individuals who
receive services unless the direct support professional meets the applicable
requirements of Chapters 4723., 5123., and 5126. of the Revised Code and rules
adopted pursuant to those chapters; or
(h) Use or be under the influence of the
following while providing services:
(i)
Alcohol;
(ii) Illegal
drugs;
(iii) Illegal chemical
substances; or
(iv) Controlled
substances that may adversely affect the direct support professional's ability
to furnish services.
(H) Requirements for director of operations
(1) An agency provider will employ a director
of operations who:
(a) Has a valid birth
certificate.
(b) Is at least
twenty-one years of age.
(c) Has a
valid social security card and a valid government-issued photo
identification.
(d) Has at least:
(i) One year of full-time (or equivalent
part-time) paid work experience in the provision of specialized services;
or
(ii) Four years of experience
providing care to a family member (i.e., parent, child, or sibling) with a
developmental disability.
(e) Has at least one year of full-time (or
equivalent part-time) paid work experience in:
(i) Supervision of employees;
(ii) Development, oversight, and/or
supervision of programs or services; and
(iii) Financial management of an
organization.
(f) Holds
either:
(i) A bachelor's degree from an
accredited college or university; or
(ii) A high school diploma or certificate of
high school equivalence and has at least:
(a)
Four years of full-time (or equivalent part-time) paid work experience as a
supervisor of specialized services; or
(b) Four years of experience providing care
to a family member (i.e., parent, child, or sibling) with a developmental
disability.
(g) Is able to read, write, and understand
English at a level sufficient to comply with all requirements set forth in
administrative rules governing the services provided by the agency
provider.
(2) Prior to
the agency provider's application for initial certification, the director of
operations will successfully complete the training specified in appendix A to
this rule.
(3) On an annual basis,
the director of operations will successfully complete the training specified in
appendix A to this rule.
(4) The
director of operations will undergo a background investigation in accordance
with rule
5123-2-02 of the Administrative
Code and consent to be enrolled by the department in the Ohio attorney
general's retained applicant fingerprint database (also known as
"Rapback").
(5) A person may not
serve as the director of operations for an agency provider if the person is:
(a) The parent of a minor child served by the
agency provider; or
(b) The spouse
of an individual served by the agency provider.
(I) Required actions and notifications
regarding director of operations
(1) An agency
provider will notify the department via the provider services management
system, if the director of operations is formally charged with, is convicted
of, pleads guilty to, or is found eligible for intervention in lieu of
conviction for any of the offenses listed or described in divisions (A)(3)(a)
to (A)(3)(e) of section
109.572 of the Revised Code
within fourteen calendar days after the date of such charge, conviction, guilty
plea, or finding.
(2) An agency
provider will notify the department via the provider services management
system, within fourteen calendar days of determining that the director of
operations is or has become a related party of a person or government entity
for which the department refused to issue or renew or revoked certification
pursuant to section 5123.166 of the Revised
Code.
(3) An agency provider will
notify the department via the provider services management system, within
fourteen calendar days of determining that the director of operations has had a
professional registration, certification, or license (other than a driver's
license) suspended or revoked.
(4)
An agency provider will update its record in the provider services management
system, within fourteen calendar days when a director of operations leaves or
joins the agency provider's employ.
(5) When the director of operations leaves an
agency provider's employ, the agency provider will report within fourteen
calendar days via the provider services management system, the agency
provider's plan for identifying a new director of operations and to whom
executive authority has been delegated in the interim period.
(6) A person newly appointed or employed as
director of operations of an agency provider will complete the
department-provided web-based orientation for directors of operations described
in appendix A to this rule within thirty calendar days of appointment or
hire.
(7) A director of operations
will inform the department via the provider services management system, if the
director of operations serves as director of operations for more than one
agency provider.
(8) A director of
operations will inform the department via the provider services management
system, if the director of operations is or was the director of operations of
an agency provider at a point in time within the last five years when the
agency provider had its provider certification revoked or not
renewed.
(9) A director of
operations will designate in writing a staff member to whom executive authority
has been delegated in the temporary absence of the director of
operations.
(J)
Requirements for direct support professionals
(1) An agency provider will ensure that each
direct support professional: (c)(b) Is able to read,
write, and understand English at a level sufficient to comply with all
requirements set forth in administrative rules governing the services provided
by the direct support professional.
(a) Is at least
eighteen years of age.
(b) Meets one of the
following:
(i) Holds a high school
diploma;
(ii) Holds a certificate of high
school equivalence;
(iii) On September 30, 2009, held
independent provider certification issued by the department; or
(iv) On September 30, 2009, was
employed by or under contract with an agency provider certified by the
department.
(2) An agency provider will ensure that each
direct support professional, except for direct support professionals exempted
as specified in appendix B to this rule, holds and maintains:
(a) Valid "American Red Cross" or equivalent
certification in first aid which included an in-person skills assessment
completed with an approved trainer; and
(b) Valid "American Red Cross" or equivalent
certification in cardiopulmonary resuscitation which included an in-person
skills assessment completed with an approved trainer.
(3) An agency provider will ensure that each
direct support professional, except for direct support professionals exempted
as specified in appendix B to this rule, successfully completes the training
specified in appendix C to this rule.
(K) Requirements for supervisory staff
An agency provider will ensure that each staff member who supervises direct support professionals:
(1) Meets the requirements set forth in
paragraphs (J)(1) to (J)(3) of this rule; and
(2) Has successfully completed training
regarding all relevant duties and responsibilities of being a supervisor for
the agency provider within ninety calendar days of becoming a
supervisor.
(L)
Requirements for direct support assistants
(1)
An agency
provider may employ persons who are sixteen or seventeen years of age to
perform limited duties as direct support assistants.
(2)
A person employed
as a direct support assistant will, at all times, work in the company of an
employee of the agency provider who is:
(a)
Physically
present at the location where the direct support assistant is providing
services; and
(b)
A direct support professional who meets the
requirements of paragraph (J) of this rule or a supervisor of direct support
professionals who meets the requirements of paragraph (K) of this
rule.
(3)
An agency provider will ensure that each direct support
assistant:
(a)
Undergoes a background investigation for employment in
accordance with rule
5123-2-02 of the Administrative
Code.
(b)
Meets the training requirements for direct support
professionals set forth in appendix C to this rule.
(c)
Is able to read,
write, and understand English at a level sufficient to comply with all
requirements set forth in administrative rules governing the services provided
by the direct support assistant.
(4)
A person employed
as a direct support assistant will not, under any circumstances:
(a)
Provide intimate
personal care such as dressing, showering, bathing, toileting, or changing
undergarments;
(b)
Operate a vehicle to transport an individual receiving
services;
(c)
Administer medication or perform health-related
activities;
(d)
Provide any care or perform any task for an individual
expressly forbidden by the individual (e.g., provide assistance with eating);
or
(e)
Implement any restrictive measure as defined in rule
5123-2-06 of the Administrative
Code.
(5)
An agency provider will not assign a direct support
assistant to provide services to an individual who does not consent to having
services provided by a direct support assistant.
(1) An agency
provider may engage volunteers to provide supplementary services. An agency
provider will not bill for services provided by volunteers.
(2) An agency provider will ensure that
volunteers are at all times under supervision of paid supervisory staff of the
agency provider.
(3) An agency
provider will ensure that volunteers do not provide intimate personal care
(such as dressing, showering, bathing, toileting, or changing undergarments),
administer medication, or perform health-related activities.
(4) An agency provider will ensure that
volunteers who provide more than forty hours of service working directly with
individuals served by the agency provider during a calendar year:
(a) Receive training in:
(i) The role of a volunteer in supporting
individuals served by the agency provider including the national alliance for
direct support professionals code of ethics and the rights of individuals set
forth in section 5123.62 of the Revised
Code;
(ii) Recognizing and
reporting major unusual incidents and unusual incidents; and
(iii) An overview of emergency
procedures.
(b) Undergo
background investigations.
(i) The background
investigation for a volunteer will include:
(a) Requiring the volunteer to submit a
statement to the agency provider with the volunteer's signature attesting that
the volunteer has not been convicted of, pleaded guilty to, or been found
eligible for intervention in lieu of conviction for any of the offenses listed
or described in divisions (A)(3)(a) to (A)(3)(e) of section
109.572 of the Revised
Code.
(b) Requiring the volunteer
to sign an agreement under which the volunteer agrees to notify the agency
provider within fourteen calendar days if the volunteer is formally charged
with, is convicted of, pleads guilty to, or is found eligible for intervention
in lieu of conviction for any of the offenses listed or described in divisions
(A)(3)(a) to (A)(3)(e) of section
109.572 of the Revised Code. The
agreement will provide that failure to make the notification may result in
termination of the volunteer's services.
(c) Checking each of the databases described
in paragraph (C)(2) of rule
5123-2-02 of the Administrative
Code to determine if the volunteer is included.
(d) Obtaining a criminal records check
conducted by the Ohio bureau of criminal identification and investigation. If
the volunteer does not present proof that the volunteer has been a resident of
Ohio for the five-year period immediately prior to the date upon which the
criminal records check is requested, the criminal records check will include
information from the federal bureau of investigation.
(ii) The agency provider will, at a frequency
of no less than once every five years, conduct a background investigation in
accordance with paragraph (L)(4)(b)(i)
(M)(4)(b)(i) of this rule for each
volunteer.
(iii) The agency
provider will not engage or continue to engage a volunteer who:
(a) Is included in one or more of the
databases described in paragraphs (C)(2)(a) to (C)(2)(f) of rule
5123-2-02 of the Administrative
Code; or
(b) Has a conviction for,
pleads guilty to, or is found eligible for intervention in lieu of conviction
for any of the offenses listed or described in divisions (A)(3)(a) to (A)(3)(e)
of section 109.572 of the Revised Code if
the corresponding exclusionary period as specified in paragraph (E) of rule
5123-2-02 of the Administrative
Code has not elapsed.
(1) An applicant for initial agency provider
certification will submit an application via the provider services management
system, for supported living services and the specific home and community-based
services the applicant seeks to provide in accordance with procedures
prescribed by the department. The application will include required signatures
and supporting documentation to demonstrate that standards are met as required
by this rule and rules in Chapter 5123-9 of the Administrative Code for the
specific home and community-based services the applicant seeks to provide
including, but not limited to:
(a) A
certificate of good standing from the Ohio secretary of state demonstrating the
agency provider's status as a for-profit corporation, nonprofit corporation,
limited liability company, or limited liability partnership.
(b) Proof of an unencumbered line of credit
in the agency provider's name in an amount of at least ten thousand dollars or
proof of a bank account in the agency provider's name with a daily balance of
at least ten thousand dollars during the past ninety days.
(c) A certificate of general liability
insurance in an amount of at least one million dollars which includes coverage
for individuals' losses due to theft or property damage.
(d) Proof that the agency provider employs a
director of operations who meets the requirements set forth in this
rule.
(e) Proof that in addition to
employing a director of operations, the agency provider employs at least one
other person for the purpose of providing services.
(f) An employer identification number from
the internal revenue service.
(g) A
certificate of policy from the Ohio bureau of workers' compensation.
(h) The name, country of birth, date of
birth, and social security number for any person having a financial interest of
five per cent or more in the agency provider (including a direct, indirect,
security, or mortgage financial interest).
(i) Written policies and procedures that
address the agency provider's management practices regarding:
(i) Confidentiality of individuals'
records;
(ii) Management of
individuals' funds;
(iii) Reporting
and investigation of major unusual incidents and unusual incidents;
and
(iv) Documentation and billing
for services.
(j) The
application fee specified in paragraph (Q)
(R) of this rule except when, based on the
specific home and community-based services to be provided, the applicant is
exempted from paying an application fee in accordance with appendix D to this
rule.
(k) The criminal records
check by the Ohio bureau of criminal identification and investigation, and when
applicable by the federal bureau of investigation, for the director of
operations.
(2) The
department will review an application within thirty calendar days of receipt of
all required components to determine if the applicant meets the standards for
the requested certification.
(a) If the
department determines an applicant seeking to provide home and community-based
services meets the standards for the requested certification, the department
will initiate the process for the applicant to obtain a medicaid provider
agreement from the Ohio department of medicaid. The applicant may be subject to
an on-site visit by the Ohio department of medicaid or its designee in
accordance with rule
5160-1-17.8 of the
Administrative Code; successful completion of the on- site visit is required
prior to issuance of the medicaid provider agreement by the Ohio department of
medicaid and certification issued by the department.
(b) If, upon review of the application, the
department determines that supporting documentation does not demonstrate that
the applicant meets the standards for the requested certification, the
department will notify the applicant by electronic mail and advise that the
applicant has thirty calendar days to submit components needed to demonstrate
that the applicant meets the standards for the requested certification.
(i) When the department receives components
needed to demonstrate that the applicant meets the standards for the requested
certification within the specified thirty calendar days, the application will
be advanced for processing.
(ii)
When an applicant fails to submit components needed to demonstrate that the
applicant meets the standards for the requested certification within the
specified thirty calendar days, the department will take no further action with
respect to the application.
(3) When the department has determined the
applicant meets the standards for the requested certification and, when
applicable, after the Ohio department of medicaid has issued a medicaid
provider agreement to an applicant seeking to provide home and community-based
services, the department will notify the applicant by electronic mail that
certification is approved. The notification will specify the effective date and
expiration date of the certification and the specific services for which the
applicant is certified.
(4) The
department's review of an application may extend beyond thirty calendar days
when:
(a) One or more of the submitted
documents requires verification; or
(b) The director of operations:
(i) Has a conviction or notation on the
criminal records check by the Ohio bureau of criminal identification and
investigation or the federal bureau of investigation;
(ii) Is included in one or more of the
databases described in paragraph (C)(2) of rule
5123-2-02 of the Administrative
Code;
(iii) Is the primary person
involved in a major unusual incident;
(iv) Is under consideration for placement on
the abuser registry; or
(v) Is a
related party to an agency provider or an independent provider whose
certification has been suspended or revoked or is proposed for
revocation.
(5) When the department determines an
applicant does not meet the standards for the requested certification, the
department will notify the applicant in accordance with paragraph
(S)(3)
(T)(3)
of this rule that the certification is denied. The notification will specify
the reason for denial.
(1) A certified agency provider seeking to
provide additional home and community- based services will submit an
application via the provider services management system, for the additional
home and community-based services the agency provider seeks to provide
including:
(a) Required signatures and
supporting documentation to demonstrate that standards are met as required by
this rule and rules in Chapter 5123-9 of the Administrative Code for the
specific home and community-based services the applicant seeks to
provide.
(b) The application fee
specified in paragraph (Q)
(R) of this rule except when, based on the
specific home and community-based services to be provided, the applicant is
exempted from paying an application fee in accordance with appendix D to this
rule.
(2) The department
will review an application within thirty calendar days of receipt of all
required components to determine if the applicant meets the standards for the
requested certification. If, upon review of the application, the department
determines that supporting documentation does not demonstrate that the
applicant meets the standards for the requested certification, the department
will notify the applicant by electronic mail and advise that the applicant has
thirty calendar days to submit components needed to demonstrate that the
applicant meets the standards for the requested certification.
(a) When the department receives components
needed to demonstrate that the applicant meets the standards for the requested
certification within the specified thirty calendar days, the application will
be advanced for processing.
(b)
When an applicant fails to submit components needed to demonstrate that the
applicant meets the standards for the requested certification within the
specified thirty calendar days, the department will take no further action with
respect to the application.
(3) When the department determines the
applicant meets the standards for the requested certification, the department
will notify the applicant by electronic mail that certification is approved.
The notification will specify the effective date and expiration date of the
certification and the specific services for which the applicant is
certified.
(4) When the department
determines the applicant does not meet the standards for the requested
certification, the department will notify the applicant in accordance with
paragraph (S)(3)
(T)(3) of this rule that the certification is denied.
The notification will specify the reason for denial.
(1) The department will notify an agency
provider by electronic mail to the address in the provider services management
system, of required certification renewal no later than ninety calendar days
prior to the date the agency provider's certification expires. The notification
will describe the procedures for submitting the certification renewal
application in accordance with this rule.
(2) The agency provider will submit the
certification renewal application via the provider services management system
including:
(a) Required signatures and
supporting documentation to demonstrate that standards are met as required by
this rule and rules in Chapter 5123-9 of the Administrative Code for the
specific home and community-based services the applicant seeks to
provide;
(b) The application fee
specified in paragraph (Q)
(R) of this rule except when, based on the
specific home and community-based services to be provided, the applicant is
exempted from paying an application fee in accordance with appendix D to this
rule; and
(c) The criminal records
check by the Ohio bureau of criminal identification and investigation, and when
applicable by the federal bureau of investigation, for the director of
operations, unless the director of operations has been enrolled without
interruption in the Ohio attorney general's retained applicant fingerprint
database (also known as "Rapback") for the entire previous certification term
and has been a resident of Ohio without interruption for the past five
years.
(3) The
department will review an application within thirty calendar days of receipt of
all required components to determine if the applicant meets the standards for
the requested certification.
(a) If the
department determines an applicant meets the standards for the requested
certification, the department will notify the applicant by electronic mail that
certification is approved. The notification will specify the effective date and
expiration date of the certification and the specific services for which the
applicant is certified.
(b) If,
upon review of the application, the department determines that supporting
documentation does not demonstrate that the applicant meets the standards for
the requested certification, the department will notify the applicant by
electronic mail and advise that the applicant has thirty calendar days to
submit components needed to demonstrate that the applicant meets the standards
for the requested certification.
(i) When the
department receives components needed to demonstrate that the applicant meets
the standards for the requested certification within the specified thirty
calendar days, the application will be advanced for processing.
(ii) When an applicant fails to submit
components needed to demonstrate that the applicant meets the standards for the
requested certification within the specified thirty calendar days, the
department will take no further action with respect to the
application.
(4) The department's review of an application
may extend beyond thirty calendar days when:
(a) One or more of the submitted documents
requires verification; or
(b) The
director of operations:
(i) Has a conviction
or notation on the criminal records check by the Ohio bureau of criminal
identification and investigation or the federal bureau of
investigation;
(ii) Is included in
one or more of the databases described in paragraph (C)(2) of rule
5123-2-02 of the Administrative
Code;
(iii) Is the primary person
involved in a major unusual incident;
(iv) Is under consideration for placement on
the abuser registry; or
(v) Is a
related party to an agency provider or an independent provider whose
certification has been suspended or revoked or is proposed for
revocation.
(5) When the department determines an
applicant does not meet the standards for the requested certification, the
department will notify the applicant in accordance with paragraph
(S)(3)
(T)(3)
of this rule that the certification is denied. The notification will specify
the reason for denial.
(6) When an
agency provider submits an application for renewal certification prior to
certification expiration that demonstrates the applicant meets the standards
for the requested renewal certification, the agency provider's certification
will be renewed without lapse.
(7)
When an agency provider submits an application for renewal certification fewer
than forty-five calendar days in advance of certification expiration that
demonstrates the applicant meets the standards for the requested renewal
certification, the agency provider may experience a gap in its ability to bill
for services provided between the date of certification expiration and the date
the renewal certification is approved. Once the renewal certification is
approved, however, the agency provider may bill for services provided during
that period.
(8) When an agency
provider submits an application for renewal certification after certification
expiration, there will be a lapse of certification from the date of
certification expiration to the date the department receives an application for
renewal certification that demonstrates the applicant meets the standards for
the requested renewal certification. The agency provider will not provide
services nor be reimbursed for provision of services during the
lapse.
(9) An agency provider will
not provide services nor submit claims for reimbursement for services provided
subsequent to expiration of the agency provider's certification.
(1) An
applicant whose certification has been expired for less than one year will be
required to apply for and meet the requirements for renewal
certification.
(2) An applicant
whose certification has been expired for one year or more will be required to
apply for and meet the requirements for initial certification.
(1) Applicants seeking certification to
provide services, other than those exempted in accordance with appendix D to
this rule, will submit an application fee at the time of application for
initial certification, application for certification to provide additional home
and community-based services during the term of existing department-issued
certification, and application for renewal certification.
(a) Application fees for initial
certification and renewal certification
(i)
The application fee for a small agency provider (i.e., one that serves or plans
to serve fifty or fewer individuals) seeking initial certification or renewal
certification is eight hundred dollars.
(ii) The application fee for a large agency
provider (i.e., one that serves or plans to serve fifty-one or more
individuals) seeking initial certification or renewal certification is one
thousand six hundred dollars.
(b) Application fees for certification to
provide additional home and community-based services during the term of
existing department-issued certification
(i)
The application fee for a small agency provider (i.e., one that serves or plans
to serve fifty or fewer individuals) seeking certification to provide
additional home and community-based services is seventy- five
dollars.
(ii) The application fee
for a large agency provider (i.e., one that serves or plans to serve fifty-one
or more individuals) seeking certification to provide additional home and
community-based services is one hundred fifty dollars.
(2) Applicants will pay
application fees by electronic check or credit card.
(3) Application fees are
non-refundable.
(4) The department
will invalidate a certification issued to an applicant whose application fees
cannot be collected due to non-sufficient funds available or for any other
reason. An agency provider whose certification is invalidated in accordance
with this paragraph will be required to initiate and submit an entirely new
application via the provider network
services management system.
(1) Initial certification
will be issued for a term of three years.
(2) Renewal certification will be issued for
a term of three years.
(3)
Certification to provide additional home and community-based services will be
issued for the remainder of the term of the applicant's existing
certification.
(1) Agency
providers are subject to monitoring and compliance reviews as set forth in
rules promulgated by the department. Failure to comply with this rule or other
rules governing services provided by the agency provider may result in
corrective action by the department, up to and including suspension, summary
suspension, denial, or revocation of certification.
(2) The department may deny, suspend, or
revoke an agency provider's certification for good cause pursuant to section
5123.166 of the Revised
Code.
(3) When denying, suspending,
or revoking certification pursuant to this rule, the department will comply
with the notice and hearing requirements of Chapter 119. of the Revised Code
and section 5123.166 of the Revised
Code.
(4) When the department
denies an application for renewal certification, the agency provider will
comply with the department's adjudication order within thirty calendar days of
the date of the mailing of the order.
(1)
For good cause, the department may waive a provision of this rule. The
department's decision to waive a provision of this rule will not be contrary to
the rights, health, or safety of individuals served.
(2) An agency provider or applicant for
agency provider certification may initiate a request for the department to
waive a provision of this rule by submitting the request with justification in
writing.
(a) The department may ask for input
regarding the request from individuals served, individuals' guardians, or
county boards.
(b) The department
will grant or deny a request within fourteen calendar days of receipt of the
request or within such longer period of time as the department deems necessary
and may put whatever conditions on approval as determined to be
necessary.
(c) The department's
decision regarding a request to waive a provision of this rule is not subject
to appeal.
Notes
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5123.1611
Rule Amplifies: 5123.04, 5123.045, 5123.16, 5123.161, 5123.162, 5123.163, 5123.164, 5123.165, 5123.166, 5123.168, 5123.169, 5123.1610, 5123.1611
Prior Effective Dates: 07/03/1989 (Emer.), 09/29/1989, 04/30/1990, 07/01/1991, 07/24/1995, 04/28/2003, 07/01/2005, 10/01/2009, 10/01/2015, 06/11/2020 (Emer.), 09/01/2021, 01/01/2024
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