Ohio Home Care

5101:3-51-04 HOME Choice ("Helping Ohioans Move, Expanding Choice") Demonstration Program: Definitions of the Covered Services and Program Service Limitations, Provider Qualifications and Specifications

CSTL 09-02

Effective Date: June 1, 2009

Most Current Prior Effective Date: July 1, 2008

The requirements set forth in this rule begin when the Ohio department of job and family services (ODJFS) receives approval of the HOME choice demonstration program from the centers for medicare and medicaid services (CMS), or on the effective date of this rule, whichever is later. The requirements shall remain in effect through the duration of the HOME choice demonstration program.

This rule sets forth the definitions of the covered services and some program service limitations available to a HOME choice demonstration program participant. This rule also sets forth the provider requirements and specifications for the delivery of HOME choice demonstration program services. The HOME choice demonstration program participant shall have choice and control over the selection of his or her provider of services, and the direction over the provision of the services. HOME choice demonstration program services are reimbursed in accordance with rule 5101:3-51-06 of the Administrative Code.

(A) "Independent living skills training" is information and educational supports and resources provided to a HOME choice demonstration program participant or group of HOME choice demonstration program participants for the purpose of developing or increasing skills, knowledge or abilities needed to live more independently. Independent living skills training services can be furnished individually, or in a group setting or classroom setting as those terms are defined in rule 5101:3-51-01 of the Administrative Code.

(1) Training focuses on:

(a) Financial management skills including, but not limited to:

(i) Finding a bank and establishing an account,

(ii) How to pay bills and taxes,

(iii) Personal budgeting,

(iv) How to manage entitlements and insurance,

(v) How to use a bank machine,

(vi) Understanding credit, and

(vii) Understanding contracts;

(b) Social skills development including, but not limited to:

(i) Communication skill building,

(ii) How to be a good neighbor/roommate,

(iii) How to work with providers, and

(iv) How to know when and how to ask for help;

(i) How to efficiently manage nutrition and diet,

(ii) How to talk to the doctor,

(iii) Training service providers,

(iv) Managing and accessing medical supplies,

(v) Crisis care/recovery services,

(vi) Linking to medical/dental services,

(vii) Assessing the need for, and accessing, adaptive and assistive devices,

(viii) Continuing therapies,

(ix) Emergency preparedness, and

(x) Medication management;

(d) Home management skills including, but not limited to:

(i) Personal shopping,

(ii) Housekeeping and laundry,

(iii) Grocery shopping, cooking and meal planning,

(iv) How to request and/or complete simple repairs,

(v) Safety skills at home, and

(vi) Operating simple technology;

(e) Personal skills including, but not limited to:

(i) Daily functions such as hygiene, dressing and undressing,

(ii) Scheduling, and

(iii) Utilization of leisure/education/physical/emotional activities; and

(f) Community living skills including, but not limited to:

(i) Travel training,

(ii) How to negotiate transportation systems and arrange transportation,

(iii) Identifying and accessing existing community resources,

(iv) Job training and seeking employment opportunities,

(v) Linking to legal resources, and

(vi) Safety skills in the community.

(2) Independent living skills training shall not duplicate community support coaching services available through the HOME choice demonstration program. In addition, independent living skills training shall not duplicate similar waiver or administrative services available on an HCBS waiver on which the HOME choice demonstration program participant is enrolled.

(3) If the HOME choice demonstration program participant is enrolled on an ODMR/DD-administered waiver, the HOME choice demonstration program participant must access homemaker/personal care in lieu of independent living skills training.

(4) The independent living skills training provider shall, as a function of the service, provide the entity responsible for assisting the HOME choice demonstration program participant with the development of his or her all service plan, service plan or non-waiver HOME choice demonstration program service plan, as appropriate, with written status reports during the HOME choice demonstration program participant's transition, as prescribed by the plan.

(5) In order to submit a claim for reimbursement of independent living skills training, the independent living skills training provider delivering the service:

(a) Must be either a non-profit agency provider, or a community mental health center certified by the Ohio department of mental health (ODMH) in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code, or a non-profit agency provider,

(i) Whose staff with direct participant contact:

(a) May have either:

(i) A disability and lived in an institution and successfully transitioned to the community, and/or

(ii) Experience transitioning individuals from an institution to the community, and

(b) Must have knowledge and experience about:

(i) Local community resources,

(ii) Applicable disability laws and regulations, and

(ii) Whose staff that provide transportation:

(a) Possess a valid Ohio driver's license, and

(b) Possess valid automobile liability insurance;

(b) Must meet the conditions of participation set forth in rule 5101:3-51-03 of the Administrative Code;

(c) Must meet the provider enrollment criteria set forth in paragraph (B), (C) or (E) of rule 5101:3-51-05 of the Administrative Code, as applicable;

(d) Must be identified as the provider, and have specified on the participant's all service plan, service plan or non-waiver HOME choice demonstration program service plan, as appropriate, the number of hours for which the provider is authorized to furnish independent living skills training services to the participant; and

(e) Must be providing the service to one individual, or to two or three individuals in a group setting, or four or more individuals in a classroom setting, during the same face-to-face visit.

(B) "Community support coaching" is a service provided for the purpose of guiding, educating and empowering the HOME choice demonstration program participant, authorized representative and family members during the HOME choice demonstration program participant's transition from an institution into the community.

(1) The community support coach shall:

(a) Communicate with and educate the HOME choice demonstration program participant in vital aspects of the transition process;

(b) Assist the HOME choice demonstration program participant in:

(i) Making informed and independent choices,

(ii) Setting and achieving short and long-term goals,

(iii) Managing multiple tasks, and

(iv) Identifying options and problem solving;

(d) Provide follow-up coaching during and after the transition;

(e) Inform and advise the HOME choice demonstration program participant in such a manner that empowers, but protects, the participant from being taken advantage of in the community;

(f) Assist with the identification of community resources and linkages to be used by the HOME choice demonstration program participant; and

(g) Provide the entity responsible for assisting the HOME choice demonstration program participant with the development of his or her all service plan, service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate, with written status reports during the HOME choice demonstration program participant's transition, as prescribed by the all service plan, service plan, ISP or non-waiver HOME choice demonstration program service plan.

(2) Community support coaching shall include assistance after normal business hours when the HOME choice demonstration program participant is not enrolled on an HCBS waiver and is only receiving medicaid state plan services.

(3) Community support coaching shall not duplicate independent living skills training available through the HOME choice demonstration program. In addition, community support coaching shall not duplicate similar waiver or administrative services available on an HCBS waiver on which the HOME choice demonstration program participant is enrolled.

(4) In order to submit a claim for reimbursement of community support coaching, the community support coach provider delivering the service:

(a) Must be:

(i) A non-agency provider who:

(a) May have either:

(i) A disability and lived in an institution and successfully transitioned to the community, and/or

(ii) Experience transitioning individuals from an institution to the community; and

(b) Is age eighteen or older, and

(d) Possesses valid automobile liability insurance, and

(e) Is not the participant's legally responsible family member as that term is defined in rule 5101:3-51-01 of the Administrative Code, and

(f) Is not the participant's case manager (CM), service and support administrator (SSA), or HOME choice demonstration program care coordinator, as those terms are defined in rule 5101:3-51-01 of the Administrative Code; or

(ii) Either a non-profit agency provider, or a community mental health center certified by ODMH in accordance with Chapters 5122-24 to 5122-29 of the Administrative Code, or a non-profit agency provider,:

(a) Whose staff with direct participant contact:

(i) May have either:

(A) A disability and lived in an institution and successfully transitioned to the community; and/or

(B) Experience transitioning individuals from an institution to the community; and

(ii) Are age eighteen or older, and

(b) Whose staff that provide transportation:

(i) Possess a valid Ohio driver's license, and

(ii) Possess valid automobile liability insurance;

(b) Must meet the conditions of participation set forth in rule 5101:3-51-03 of the Administrative Code;

(c) Must meet the provider enrollment criteria set forth in paragraph (B), (C), (D) or (E) of rule 5101:3-51-05 of the Administrative Code, as applicable; and

(d) Must be identified as the provider, and have specified on, the participant's all service plan, service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate, the number of hours for which the provider is authorized to furnish community support coaching services to the participant.

(C) "HOME choice nursing services" are intermittent services provided to HOME choice demonstration program participants that require the skills of a registered nurse (RN) or licensed practical nurse (LPN) at the direction of an RN. All nurses providing HOME choice nursing services shall provide services within the nurse's scope of practice as set forth in Chapter 4723. of the Revised Code and rules of the Administrative Code adopted thereunder, and shall possess a current, valid and unrestricted license with the Ohio board of nursing.

(1) HOME choice nursing services do not include:

(a) Services delegated in accordance with Chapter 4723. of the Revised Code and rules of the Administrative Code adopted thereunder and to be performed by individuals who are not licensed nurses in accordance with Chapter 4723. of the Revised Code;

(b) Services that require the skills of a psychiatric nurse; or

(c) Services performed in excess of the number of hours approved pursuant to the HOME choice demonstration program participant's service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate.

(2) HOME choice nursing services shall not duplicate similar waiver or administrative services available on the HCBS waiver on which the HOME choice demonstration program participant is enrolled, or medicaid state plan home health nursing and/or private duty nursing services.

(3) In order to submit a claim for reimbursement of HOME choice nursing services, the RN, or LPN at the direction of an RN, delivering the service:

(a) Must be employed by a medicare-certified, or otherwise-accredited home health agency, or be a non-agency home care nurse provider;

(b) Must not be the participant's spouse, or in the case of a minor, the participant's birth or adoptive parent, unless the family member is employed by a medicare-certified, or otherwise-accredited home health agency;

(d) Must meet the conditions of participation set forth in rule 5101:3-51-03 of the Administrative Code;

(e) Must meet the provider enrollment criteria set forth in paragraph (C), (D) or (E) of rule 5101:3-51-05 of the Administrative Code, as applicable;

(f) Must be identified as the provider, and have specified on, the participant's service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate, the number of hours for which the provider is authorized to furnish HOME choice nursing services to the participant;

(g) Must be performing HOME choice nursing services pursuant to signed and dated written orders from the treating physician the participant's plan of care, as that term is defined in rule 5101:3-51-01 of the Administrative Code; and

(h) Must be providing the service for one individual during a face-to-face visit, or for two or three individuals in a group setting during the same face-to-face visit.

(4) Non-agency LPNs, at the direction of an RN, must:

(a) Conduct a face-to-face visit with the directing RN at least every sixty days after the initial visit to evaluate the provision of HOME choice nursing services and LPN performance, and to assure that HOME choice nursing services are being provided in accordance with the approved plan of care; and

(b) Conduct a face-to-face visit with the participant and the directing RN no less than once every one hundred twenty days for the purpose of evaluating the provision of HOME choice nursing services, the participant's satisfaction with care delivery, and LPN performance, and to assure that HOME choice nursing services are being provided in accordance with the approved plan of care.

(5) All HOME choice nursing service providers must maintain a clinical record for each participant served in a manner that protects the confidentiality of these records. Medicare-certified, or otherwise-accredited home health agencies, must maintain the clinical records at their place of business. Non-agency HOME choice nursing service providers must maintain the clinical records at their place of business, and maintain a copy in the participant's residence. For the purposes of this rule, the place of business must be a location other than the participant's residence. The clinical record must contain the information listed in paragraphs (C)(5)(a) to (C)(5)(l) of this rule.

(a) Participant identifying information, including but not limited to: name, address, age, date of birth, sex, race, marital status, significant phone numbers, and health insurance identification numbers.

(b) Participant medical history.

(d) A copy of the initial and all subsequent service plans, ISPs or non-waiver HOME choice demonstration program service plans, as appropriate.

(e) A copy of the initial and all subsequent plans of care, specifying the type, frequency, scope and duration of the HOME choice nursing services being performed. When services are performed by an LPN at the direction of an RN, the clinical record shall include documentation that the RN has reviewed the plan of care with the LPN. The plan of care must be recertified by the treating physician every sixty days, or more frequently if there is a significant change in the participant's condition.

(f) In all instances when the treating physician gives verbal orders to the nurse, the nurse must document, in writing, the physician's orders, the date and time the orders were given, and sign the entry in the clinical record. The nurse must subsequently secure documentation of the verbal orders, signed and dated by the treating physician.

(g) In all instances when a non-agency LPN is providing HOME choice nursing services, the LPN must provide clinical notes, signed and dated by the LPN, documenting face-to-face visits between the LPN and the directing RN, and documenting the face-to-face visits between the LPN, the participant and the directing RN. Nothing shall prohibit the use of technology-based systems in collecting and maintaining the documentation required by this paragraph.

(h) Documentation of drug allergies and interactions, and dietary restrictions.

(i) A copy of any advanced directives including, but not limited to, "do not resuscitate order" or medical power of attorney, if they exist.

(j) Clinical notes, signed and dated by the nurse, documenting the services performed during, and outcomes resulting from, each nursing visit. Nothing shall prohibit the use of technology-based systems in collecting and maintaining the documentation required by this paragraph.

(k) Clinical notes, signed and dated by the nurse, documenting all communications between the treating physician and other members of the multidisciplinary team.

(l) A discharge summary, signed and dated by the departing nurse, at the point the nurse is no longer going to provide services to the participant, or when the participant no longer needs HOME choice nursing services.

(D) "Social work/counseling services" are transitional services provided to the HOME choice demonstration program participant, authorized representative, caregiver and/or family member on a short-term basis to promote the participant's physical, social and emotional well-being. Social work/counseling services promote the development and maintenance of a stable and supportive environment for the HOME choice demonstration program participant.

(1) Social work/counseling services can include crisis interventions, grief counseling and/or other social service interventions that support the HOME choice demonstration program participant's health and welfare.

(2) Social work/counseling services shall not:

(a) Take the place of case management services, nor do they include social services provided to the HOME choice demonstration program participant's authorized representative, family member(s) and/or caregiver(s) who are unrelated to the HOME choice demonstration program participant;

(b) Duplicate similar services available on an HCBS waiver on which the HOME choice demonstration program participant is enrolled; or

(c) Include services provided in excess of what is approved on the participant's all service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate.

(3) In order to submit a claim for reimbursement of social work/counseling services, the social work/counseling service provider delivering the service:

(a) Must be either:

(i) A non-agency provider who shall:

(a) Be a licensed professional clinical counselor (LPCC), licensed psychologist, licensed independent social worker (LISW) or RN who holds a certificate of authority from the Ohio board of nursing in psych-mental health nursing specialty, and

(b) Maintain documentation of licensure by the applicable Ohio licensure board and have at least one year of social work/counseling experience, or

(ii) An agency provider who shall:

(a) Assure that direct care staff include LPCCs, licensed professional counselors (LPC), licensed psychologists, LISWs, or licensed social workers (LSW),

(b) Assure that LSWs and LPCs are supervised by an LSW with a master's degree in social work, LISW, LPCC, licensed psychologist, psychiatrist, licensed physician, or an RN who holds a certificate of authority from the Ohio board of nursing in a psych-mental health nursing specialty, and that the supervisor of an LSW or LPC co-signs all initial assessments and social work/counseling intervention plans prepared by the LSW or LPC, and

(c) Maintain documentation that all direct care social work/counseling staff are licensed by the applicable Ohio licensure board, and have at least one year of social work/counseling experience; and

(b) Must conduct an individual assessment to evaluate the HOME choice demonstration program participant's psycho-social, financial and environmental status;

(c) Must develop and revise, as necessary, with the assistance of the participant, and/or the participant's authorized representative, caregiver(s) and the CM or SSA, as appropriate, a treatment plan that includes the recommended method of treatment and the recommended number of counseling sessions;

(d) Must assure the treatment plan is implemented;

(e) Must furnish the CM or SSA, as appropriate, the participant and/or the participant's authorized representative with a copy of the individual assessment report and the treatment plan no later than seven working days after completion of the individual assessment;

(f) Must meet the conditions of participation set forth in rule 5101:3-51-03 of the Administrative Code; and

(g) Must meet the provider enrollment criteria set forth in paragraph (B), (D) or (E) of rule 5101:3-51-05 of the Administrative Code, as applicable; and

(h) Must be identified as the provider, and have specified on the participant's all service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate, the number of hours for which the provider is authorized to furnish social work/counseling services to the participant.

(4) Providers of social work/counseling services must maintain a clinical record for each participant served. The clinical record must contain the information listed in paragraphs (D)(4)(a) to (D)(4)(j) of this rule.

(a) Participant identifying information, including but not limited to name, address, age, date of birth, sex, race, marital status, significant phone numbers and health insurance identification information.

(b) Participant medical history.

(d) A copy of the initial and all subsequent all service plans, ISPs or non-waiver HOME choice demonstration program service plans, as appropriate.

(e) A copy of the initial and all subsequent individual assessments.

(f) A copy of the initial and all revised treatment plans.

(g) A copy of any advanced directives including, but not limited to, "do not resuscitate order" or medical power of attorney, if they exist.

(h) Documentation of drug allergies and interactions, and dietary restrictions.

(i) Documentation that clearly shows the date of social work/counseling service delivery. Nothing shall prohibit the use of technology-based systems in collecting and maintaining the documentation required by this paragraph.

(j) A discharge summary, signed and dated by the departing social work/counseling service provider, at the point the service provider is no longer going to provide social work/counseling services to the participant, or when the participant no longer needs social work/counseling services. The summary should include documentation regarding progress made toward goal achievement and indicate any recommended follow-ups and/or referrals.

(E) "Nutritional consultation services" are services providing guidance to a HOME choice demonstration program participant with special dietary needs, taking into consideration the participant's cultural and ethnic background and dietary preferences and/or restrictions.

(1) Nutritional consultation services shall not:

(a) Duplicate similar services available on an HCBS waiver on which the HOME choice demonstration program participant is enrolled; or

(b) Include services provided in excess of what is approved on the participant's all service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate.

(2) In order to submit a claim for reimbursement of nutritional consultation services, the nutritional consultation service provider delivering the service:

(a) Must be a dietitian registered by the commission on dietetic registration and licensed by the Ohio board of dietetics;

(b) Must be providing services pursuant to a plan of care for nutritional consultation services that is signed and dated by the treating physician. The plan of care must be recertified by the treating physician every sixty days, or more frequently if there is a significant change in the participant's condition;

(d) Must meet the provider enrollment criteria set forth in paragraph (B), (D) or (E) of rule 5101:3-51-05 of the Administrative Code, as applicable; and

(e) Must be identified as the provider, and have specified on the participant's all service plan, ISP or non-waiver HOME choice demonstration program service plan, the number of

hours for which the provider is authorized to furnish nutritional consultation services to the participant.

(3) All providers of nutritional consultation services must:

(a) Conduct an initial individual assessment of the participant's nutritional needs, and subsequent assessments when necessary, using a tool that identifies whether the participant is at nutritional risk. The tool must include the following:

(i) An assessment of height and weight history;

(ii) An assessment of adequacy of nutrient intake;

(iii) A review of medications, diagnoses and diagnostic test results;

(iv) An assessment of verbal, physical and motor skills that could be attributable to, or affect, nutrient needs;

(v) An assessment of caregiver and participant interactions during feeding; and

(vi) An assessment of the need for additional adaptive equipment and/or other community resources and/or services.

(b) Develop, implement, evaluate and revise, as necessary, a nutrition intervention plan with the assistance of the participant and/or authorized representative, and when applicable, the treating physician and other relevant service providers. The plan must include any appropriate food and diet modifications, any specific nutrients that may be required or limited, feeding modality, nutrition education and counseling, and expected measurable outcomes.

(c) Furnish the CM or SSA, as appropriate, the participant and/or the participant's authorized representative with a copy of the assessment and the nutrition intervention plan no later than seven working days after completion of the assessment.

(d) Furnish evidence, upon request, that the nutrition intervention plan was developed and services were delivered in accordance with professional licensure requirements.

(4) Providers of nutritional consultation services must maintain a clinical record for each HOME choice demonstration program participant served. The clinical record must contain the information listed in paragraphs (E)(4)(a) to (E)(4)(j) of this rule.

(b) Participant medical history.

(d) Treating physician's authorization for a nutritional assessment.

(e) A copy of the initial and all subsequent all service plans, ISPs or non-waiver HOME choice demonstration program service plans, as appropriate.

(f) A copy of the initial and all subsequent individual assessments of the participant's nutritional needs.

(g) A copy of the initial and all subsequent plans of care specifying the type, frequency, scope and duration of the nutritional consultation services being performed.

(h) Documentation of drug and food interactions and allergies, and dietary restrictions.

(i) Documentation that clearly shows the date of nutritional consultation service delivery, including copies of all nutritional assessments conducted and all nutrition intervention plans developed and implemented. Nothing shall prohibit the use of technology-based systems in collecting and maintaining the documentation required by this paragraph.

(j) A discharge summary, signed and dated by the departing dietitian providing nutritional consultation services, at the point the dietitian is no longer going to provide services to the participant, or when the participant no longer needs nutritional consultation services.

(F) "Communication aids" are devices, systems or services necessary to assist the HOME choice demonstration program participant with hearing, speech or vision impairments to effectively communicate with service providers, family, friends and the general public.

(1) Communication aids include, but are not limited to:

(a) Augmentative communication devices or systems that transmit or produce a message or symbols in a manner that compensates for the HOME choice demonstration program participant's communication impairment;

(b) Computers and computer equipment;

(d) Cable and internet access; and

(e) The cost of installation, repair, maintenance and support of any covered communication aid.

(2) Communication aids may also include:

(a) Interpreter services that support the HOME choice demonstration program participant's integration into the community. Interpreter services refer to the process by which the interpreter conveys one person's message to another by incorporating both the message and the attitude of the communicator.

(b) New technologies and any other devices so long as the technologies and devices achieve the objective of the service.

(3) Reimbursement for communication aids shall not exceed a total of five thousand dollars within the three hundred sixty-five day HOME choice demonstration program eligibility period per participant. The CM, SSA or ODJFS HOME choice demonstration program care coordinator, as appropriate, shall not approve the same type of communication aid equipment for the same HOME choice demonstration program participant more than once unless there is a documented need for ongoing communication aid services or a change in the HOME choice demonstration program participant's medical and/or physical condition requiring the replacement.

(4) If the HOME choice demonstration program participant is enrolled on an HCBS waiver, then the participant must exhaust similar waiver services that are available to the participant before utilizing communication aid services. Communication aid service costs are not included in the cost of HCBS waiver services.

(5) In order to submit a claim for reimbursement of communication aid services, the communication aid service provider delivering the service:

(a) Must be an agency provider;

(b) Must meet the conditions of participation set forth in rule 5101:3-51-03 of the Administrative Code;

(c) Must meet the provider enrollment criteria set forth in paragraph (B), (C), (D) or (E) of rule 5101:3-51-05 of the Administrative Code, as applicable; and

(d) Must be identified as the provider, and have specified on the participant's all service plan, service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate, the number of hours for which the provider is authorized to furnish communication aid services to the participant.

(G) "Service animals" are animals that are individually trained to perform tasks for HOME choice demonstration program participants that the participants are unable to perform for themselves. They also assist people with disabilities in their day-to-day activities.

(1) Tasks performed by service animals include, but are not limited to:

(a) Guiding people who are blind;

(b) Alerting people who are deaf;

(d) Alerting and protecting participants who are having a seizure;

(e) Carrying and picking up things for participants with mobility impairments; and

(f) Assisting participants with mobility impairments with balance.

(2) Service animals may include, but are not limited to:

(a) Seeing eye dogs;

(b) Hearing dogs; and

(3) Activities related to the use of service animals include, but are not limited to:

(a) First-year costs associated with the raising of the animal;

(b) Housing, feeding, upkeep and medical care of the animal during training;

(c) Actual training of the animal, student training and related transportation, room/board and administrative activities;

(d) Equipment and supplies;

(e) Home care, including cooking/food, housekeeping, laundry for students in training;

(f) Animal health insurance; and

(g) Transportation to the veterinarian.

(4) Reimbursement for service animals shall not exceed a total of eight thousand dollars within the three hundred sixty-five day HOME choice demonstration program eligibility period per participant. The CM, SSA or ODJFS HOME choice demonstration program care coordinator, as appropriate, shall not approve the same type of service animal services for the same HOME choice demonstration program participant more than once unless there is a documented need for ongoing service animal services or a change in the HOME choice demonstration program participant's medical and/or physical condition requiring the replacement.

(5) If the HOME choice demonstration program participant is enrolled on an ODMR/DD-administered waiver, then the participant must exhaust similar waiver services that are available to the participant before utilizing the service animal service. Service animal costs are not included in the cost of waiver services.

(6) In order to submit a claim for reimbursement of service animal services, the service animal service provider delivering the service:

(a) Must be an agency provider;

(b) Must meet the conditions of participation set forth in rule 5101:3-51-03 of the Administrative Code;

(c) Must meet the provider enrollment criteria set forth in paragraph (B), (C), (D) or (E) of rule 5101:3-51-05 of the Administrative Code, as applicable; and

(H) "Community transition services" are services providing goods, services and support for the purpose of addressing an identified need in the HOME choice demonstration program participant's all service plan, service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate, including improving and maintaining the HOME choice demonstration program participant's opportunities for membership in the community.

(1) Community transition services are intended to meet the following criteria:

(a) The goods and services will decrease the need for formal support services and other medicaid services;

(b) The goods and services will take into consideration the appropriateness and availability of a lower cost alternative for comparable services that meet the HOME choice demonstration program participant's needs;

(d) The goods and services will increase the HOME choice demonstration program participant's health and welfare in the home and/or community;

(e) The HOME choice demonstration program participant does not have the funds to purchase the goods and services, or the goods and services are not available through another source;

(f) The goods and services will assist the HOME choice demonstration program participant in developing and maintaining personal, social, physical or work-related skills; and

(g) The goods and services will assist the HOME choice demonstration program participant in living independently in the home and community.

(2) Allowable community transition service expenses include, but are not limited to:

(a) Security deposits that are required to obtain a lease on an apartment or home;

(b) Essential household furnishings, including furniture, window coverings, food preparation items, and bed/bath linens;

(d) Services necessary for the participant's health and welfare, such as pest control and one-time cleaning prior to moving in to the residence;

(e) Moving expenses; and

(f) Necessary home accessibility adaptations.; and

(g) Start-up groceries, i.e., food and household supplies.

(3) Community transition services do not include:

(a) Experimental or prohibited treatments;

(b) The ongoing cost of room and board;

(d) Food Ongoing grocery expenses;

(e) Cigarettes and alcohol;

(e)(f) Uniforms and memberships;

(f)(g) Electronics and other household appliances or items that are used for entertainment or recreational purposes; and

(g)(h) Cable/internet access.

(4) Reimbursement for community transition services shall not exceed a cumulative maximum of two thousand dollars for the items purchased or deposits made during the participant's period of eligibility for the HOME choice demonstration program. The CM, SSA or ODJFS HOME choice demonstration program care coordinator, as appropriate, shall not approve the same type of community transition services for the same HOME choice demonstration program participant

unless there is a documented need for ongoing community transition services or a change in the HOME choice demonstration program participant's medical and/or physical condition requiring the replacement.

(5) Community Except as provided for in paragraph (H)(6) of this rule, community transition services shall not duplicate similar waiver or administrative services available on an HCBS waiver on which the HOME choice demonstration program participant is enrolled.

(6) When the HOME choice demonstration program participant is enrolling on an ODA-administered waiver, the participant may use HOME choice community transition services in lieu of, but not in addition to, the community transition service available through the ODA-administered waiver.

(6)(7) In order for a provider to submit a claim for reimbursement of community transition services,

(a) The specific goods and services to be purchased shall be:

(i) Determined by the HOME choice demonstration program participant in conjunction with his or her CM, SSA or ODJFS HOME choice demonstration program care coordinator, as appropriate,

(ii) Based upon the HOME choice demonstration program participant's established need, and

(iii) Specified on the participant's all service plan, service plan, ISP or non-waiver HOME choice demonstration program service plan, as appropriate, and

(b) The During the HOME choice demonstration period, the purchase of community transition services shall be coordinated by the participant's CM, SSA or ODJFS HOME choice demonstration program care coordinator, as appropriate, in conjunction with the ODJFS-designated HOME choice financial management service (FMS) provider. and Community transition services shall be reimbursed in accordance with rule 5101:3-51-06 of the Administrative Code, and the requirements set forth in the FMS contract and established HOME choice demonstration program policies and procedures.

Effective: 06/01/2009

R.C. 119.032 review dates: 07/01/2013

Certification: CERTIFIED ELECTRONICALLY

Date: 05/11/2009

Promulgated Under: 119.03

Statutory Authority: 5111.02, 5111.85

Rule Amplifies: 5111.01, 5111.02, 5111.85, Section 309.30.70 of Am.

Sub. H.B. 119, 127th G.A.

Prior Effective Dates: 07/01/2008