Section 5123-9-16 - Home and community-based services waivers - group employment support under the individual options, level one, and self-empowered life funding waivers(A) Purpose This rule defines group employment support and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service. The expected outcome of group employment support is paid employment and work experience leading to further career development and competitive integrated employment.
(B) Definitions For the purposes of this rule, the following definitions apply:
(1) "Adult day support" has the same meaning as in rule 5123-9-17 of the Administrative Code.(2) "Agency provider" means an entity that directly employs at least one person in addition to a director of operations for the purpose of providing services for which the entity is certified in accordance with rule 5123-2-08 of the Administrative Code. (3) "Career planning" has the same meaning as in rule 5123-9-13 of the Administrative Code.(4) "Competitive integrated employment" means work (including self-employment) that is performed on a full-time or part-time basis:(a) For which an individual is: (i) Compensated: (a) At a rate that is not less than the higher of the rate specified in the Fair Labor Standards Act of 1938, 29 U.S.C. 206(a)(1), as in effect on the effective date of this rule, or the rate specified in the applicable state or local minimum wage law and is not less than the customary rate paid by the employer for the same or similar work performed by other employees who do not have disabilities, and who are in similar occupations by the same employer and who have similar training, experience, and skills; or(b) In the case of an individual who is self-employed, yields an income that is comparable to the income received by persons without disabilities, who are self-employed in similar occupations or on similar tasks and who have similar training, experience, and skills; and(ii) Eligible for the level of benefits provided to other full-time and part-time employees;(b) At a location where the individual interacts with persons without disabilities to the same extent as employees who are not receiving home and community-based services;(c) That is not performed in: (i) Dispersed enclaves in which individuals work in a self-contained unit within a company or service site in the community or perform multiple jobs in the company, but are not integrated with non-disabled employees of the company; or(ii) Mobile work crews comprised solely of individuals operating as a distinct unit and/or self-contained business working in several locations within the community; and(d) That, as appropriate, presents opportunities for advancement that are similar to those for persons without disabilities who have similar positions.(5) "County board" means a county board of developmental disabilities.(6) "Daily billing unit" means a billing unit that may be used when between five and seven hours of group employment support are delivered by the same provider to the same individual during one calendar day in accordance with the conditions specified in paragraph (F)(2) of this rule.(7) "Department" means the Ohio department of developmental disabilities.(8) "Fifteen-minute billing unit" means a billing unit that equals fifteen minutes of service delivery time or is greater or equal to eight minutes and less than or equal to twenty-two minutes of service delivery time. Minutes of service delivery time accrued throughout a day will be added together for the purpose of calculating the number of fifteen-minute billing units for that day.(9) "Group employment support" means services and training activities provided in regular business, industry, and community settings for groups of two or more workers with disabilities. (a) Activities that constitute group employment support include any combination of the following as necessary and appropriate to meet the community employment goals of the individual: (i) Person-centered employment planning;(iv) Training and systematic instruction;(vi) Training in independent planning, arranging, and using transportation.(b) Group employment support is provided in two distinct service arrangements:(i) Dispersed enclaves in which individuals work in a self-contained unit within a company or service site in the community or perform multiple jobs in the company, but are not integrated with non-disabled employees of the company; or(ii) Mobile work crews comprised solely of individuals operating as a distinct unit and/or self-contained business working in several locations within the community.(10) "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.(11) "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.(12) "Individual employment support" has the same meaning as in rule 5123-9-15 of the Administrative Code.(13) "Individual service plan" means the written description of services, supports, and activities to be provided to an individual.(14) "Mentor" means a person employed by or under contract with the agency provider who has experience providing direct services to persons with developmental disabilities and who is available on a regular basis to provide guidance to new direct support professionals regarding techniques and practices that enhance the effectiveness of the provision of group employment support.(15) "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 and who holds the appropriate certification in accordance with rule 5123-5-02 of the Administrative Code.(16) "Service documentation" means all records and information on one or more documents, including documents that may be created or maintained in electronic software programs, created and maintained contemporaneously with the delivery of services, and kept in a manner as to fully disclose the nature and extent of services delivered that includes the items delineated in paragraph (E) of this rule to validate payment for medicaid services.(17) "Vocational habilitation" has the same meaning as in rule 5123-9-14 of the Administrative Code.(18) "Waiver eligibility span" means the twelve-month period following either an individual's initial waiver enrollment date or a subsequent eligibility re-determination date.(C) Provider qualifications (1) Group employment support will be provided by an agency provider that meets the requirements of this rule and that has a medicaid provider agreement with the Ohio department of medicaid.(2) Group employment support will not be provided by an independent provider.(3) An applicant seeking approval to provide group employment support will complete and submit an application and adhere to the requirements of rule 5123-2-08 of the Administrative Code.(4) An agency provider will ensure that direct support professionals who provide group employment support successfully complete, no later than thirty calendar days after hire, training in: (a) Services that comprise group employment support;(b) Signs and symptoms of illness or injury and procedure for response;(c) Building/site-specific emergency response plans; and(d) Program-specific transportation safety.(5) An agency provider will ensure that direct support professionals who provide group employment support (other than those who have at least one year of experience providing group employment support at the point of hire), during the first year after hire, are assigned and have access to a mentor.(6) An agency provider will ensure that direct support professionals who provide group employment support (other than those who have at least one year of experience providing group employment support at the point of hire), no later than one year after hire, successfully complete at least eight hours of training specific to the provision of group employment support that includes, but is not limited to: (a) Skill-building in advancement of individuals on the path to competitive integrated employment as described in rule 5123-2-05 of the Administrative Code and development of individuals' strengths and skills necessary for competitive integrated employment; and(b) Self-determination which includes assisting an individual to develop self-advocacy skills, to exercise civil rights, to exercise control and responsibility over the services received, and to acquire skills that enable becoming more independent, productive, and integrated within the community.(7) Failure to comply with this rule and rule 5123-2-08 of the Administrative Code may result in denial, suspension, or revocation of the agency provider's certification.(D) Requirements for service delivery(1) The expected outcome of group employment support is paid employment and work experience leading to further career development and competitive integrated employment.(2) Group employment support will be provided pursuant to a person-centered individual service plan that conforms to the requirements of rules 5123-4-02 and 5123-2-05 of the Administrative Code and coordinated with other services and supports set forth in the individual service plan.(3) The service and support administrator will ensure that documentation is maintained to demonstrate that the service provided as group employment support to an individual enrolled in a waiver is not otherwise available as vocational rehabilitation services funded under section 110 of the Rehabilitation Act of 1973, 29 U.S.C. 730, as in effect on the effective date of this rule, or as special education or related services as those terms are defined in section 602 of the Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. 1401, as in effect on the effective date of this rule.(4) Group employment support will be provided in an integrated setting and support individuals' access to the greater community, including opportunities to seek competitive integrated employment, to engage in community life, and to have control over earned income.(5) Group employment support will take place in a setting separate from the home of the individual receiving the services.(6) Individuals receiving group employment support will be compensated in accordance with applicable federal and state laws and regulations. A determination that an individual receiving group employment support is eligible to be paid at special minimum wage rates in accordance with 29 C.F.R. Part 525, "Employment of Workers with Disabilities Under Special Certificates," as in effect on the effective date of this rule, will be based on documented evaluations and assessments.(7) A provider of group employment support will ensure that appropriate staff are knowledgeable about the Workforce Innovation and Opportunity Act as in effect on the effective date of this rule, wage and hour laws, benefits, work incentives, and employer tax credits for individuals with developmental disabilities and ensure that individuals served receive this information.(8) A provider of group employment support will provide the service in a manner that presumes all participants are capable of working in competitive integrated employment. The provider will encourage individuals receiving the service, on an ongoing basis, and as part of the annual person-centered planning process, to explore their interests, strengths, and abilities relating to competitive integrated employment. The provider will, as a component of the service, assist individuals to explore, identify, and pursue opportunities that advance them toward competitive integrated employment.(9) A provider of group employment support will complete reports and collect and submit data via the department's outcome tracking system in accordance with rule 5123-2-05 of the Administrative Code.(10) A provider of group employment support will recognize changes in the individual's condition and behavior, report to the service and support administrator, and record the changes in the individual's written record.(11) A provider of group employment support will report identified safety and sanitation hazards that occur at the work site to employers having the responsibility to remedy the condition.(E) Documentation of services Service documentation for group employment support will include each of the following to validate payment for medicaid services:
(4) Name of individual receiving service.(5) Medicaid identification number of individual receiving service.(7) Provider identifier/contract number.(8) Written or electronic signature of the person delivering the service, or initials of the person delivering the service if a signature and corresponding initials are on file with the provider.(9) Description and details of the services delivered that directly relate to the services specified in the approved individual service plan as the services to be provided.(10) Times the delivered service started and stopped.(11) Number of units of the delivered service.(F) Payment standards (1) The billing units, service codes, and payment rates for group employment support provided January 1, 2024 through June 30, 2024 are contained in appendix A to this rule. The billing units, service codes, and payment rates for group employment support provided on or after July 1, 2024 are contained in appendix B to this rule. Payment rates are based on individuals' group assignments determined in accordance with rule 5123-9-19 of the Administrative Code and the county cost-of-doing-business category. The cost-of-doing-business category for an individual is the category assigned to the county in which the service is actually provided for the preponderance of time. The cost-of-doing-business categories are contained in appendix C to this rule.(2) A provider of group employment support may use the daily billing unit when the provider delivers between five and seven hours of group employment support to the same individual during one calendar day and: (a) The individual does not qualify for or the provider elects not to receive the behavioral support rate modification described in paragraph (F)(6) of this rule; and(b) The individual does not qualify for or the provider elects not to receive the medical assistance rate modification described in paragraph (F)(7) of this rule.(3) A provider of group employment support will use the fifteen-minute billing unit when: (a) The provider delivers less than five hours or more than seven hours of group employment support to the same individual during one calendar day;(b) The individual being served qualifies for and the provider elects to receive the behavioral support rate modification in accordance with paragraph (F)(6) of this rule; or(c) The individual being served qualifies for and the provider elects to receive the medical assistance rate modification in accordance with paragraph (F)(7) of this rule.(4) A provider of group employment will not bill a daily billing unit on the same day the provider bills fifteen-minute billing units for the same individual.(5) Payment for adult day support, career planning, group employment support, individual employment support, and vocational habilitation, alone or in combination, will not exceed the budget limitations contained in appendix B to rule 5123-9-19 of the Administrative Code.(6) Payment rates for group employment support will be adjusted by the behavioral support rate modification to reflect the needs of an individual requiring behavioral support upon determination by the department that the individual meets the criteria set forth in paragraph (F)(6)(a) of this rule. The amount of the behavioral support rate modification applied to each fifteen-minute billing unit of service is contained in as applicable, appendix A or appendix B to this rule. (a) The department will determine that an individual meets the criteria for the behavioral support rate modification when: (i) The individual has been assessed within the last twelve months to present a danger to self or others or have the potential to present a danger to self or others; and(ii) A behavioral support strategy that is a component of the individual service plan has been developed in accordance with the requirements in rules established by the department; and(iii) The individual either: (a) Has a response of "yes" to at least four items in question thirty-two of the behavioral domain of the Ohio developmental disabilities profile; or(b) Requires a structured environment that, if removed, will result in the individual's engagement in behavior destructive to self or others.(b) The duration of the behavioral support rate modification is limited to the individual's waiver eligibility span, may be determined needed or no longer needed within that waiver eligibility span, and may be renewed annually.(c) The purpose of the behavioral support rate modification is to provide funding for the implementation of behavioral support strategies by staff who have the level of training necessary to implement the strategies; the department retains the right to verify that staff who implement behavioral support strategies have received training (e.g., specialized training recommended by clinicians or the team or training regarding an individual's behavioral support strategy) that is adequate to meet the needs of the individuals served.(7) Payment rates for group employment support will be adjusted by the medical assistance rate modification to reflect the needs of an individual requiring medical assistance upon determination by the county board that the individual meets the criteria set forth in paragraph (F)(7)(a) of this rule. The amount of the medical assistance rate modification applied to each fifteen-minute billing unit of service is contained in as applicable, appendix A or appendix B to this rule. (a) The county board will determine that an individual meets the criteria for the medical assistance rate modification when:(i) The individual requires the administration of fluid, nutrition, and/or prescribed medication through gastrostomy and/or jejunostomy tube; and/or requires the administration of insulin through subcutaneous injection, inhalation, or insulin pump; and/or requires the administration of medication for the treatment of metabolic glycemic disorder by subcutaneous injection; or(ii) The individual requires a nursing procedure or nursing task that a licensed nurse agrees to delegate in accordance with rules in Chapter 4723-13 of the Administrative Code, which is provided in accordance with section 5123.42 of the Revised Code, and when such nursing procedure or nursing task is not the administration of oral prescribed medication, topical prescribed medication, oxygen, or metered dose inhaled medication, or a health-related activity as defined in rule 5123-6-01 of the Administrative Code.Ohio Admin. Code 5123-9-16
Effective: 1/1/2024
Five Year Review (FYR) Dates: 1/1/2027
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5123.049, 5123.1611
Rule Amplifies: 5123.04, 5123.045, 5123.049, 5123.16, 5123.161, 5123.1611, 5166.21
Prior Effective Dates: 01/01/2007, 10/01/2007, 07/23/2012, 04/01/2017, 01/01/2022