Ohio Administrative Code|Rule 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) Standards of service provision
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.
(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
			 professional" means a person who is employed in a "direct services
			 position" as that term is defined in section 5123.081 of the Revised
			 Code.
(8) "Director of
			 operations" means a person employed by an agency provider who is
			 responsible for, and who shall be 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) "Health-related
			 activities" has the same meaning as in rule 5123:2-6-01 of the
			 Administrative Code.
(10) "Home and
			 community-based services" has the same meaning as in section 5123.01 of
			 the Revised Code.
(11) "Independent
			 provider" has the same meaning as in rule 5123-2-09 of the Administrative
			 Code.
(12) "Individual" means a person with a
			 developmental disability or for purposes of giving, refusing to give, or
			 withdrawing consent for services, his or her guardian in accordance with
			 section 5126.043 of the Revised Code or other person authorized to give
			 consent.
(13) "Individual
			 service plan" means the written description of services, supports, and
			 activities to be provided to an individual.
(14) "Major unusual
			 incident" has the same meaning as in rule 5123-17-02 of the Administrative
			 Code.
(15) "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 submit change
			 requests online.
(16) "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) "Related
			 party" has the same meaning as in section 5123.16 of the Revised
			 Code.
(18) "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 5123:2-5-02 of
			 the Administrative Code.
(19) "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 final. Programs or services
			 available to the general public are not specialized services.
(20) "Supported
			 living" has the same meaning as in section 5126.01 of the Revised
			 Code.
(21) "Unusual
			 incident" has the same meaning as in rule 5123-17-02 of the Administrative
			 Code.
(22) "Volunteer" means a person who donates time,
			 effort, and/or talent to meet a need or advance a 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.
(C) General requirements for agency
		  providers
An agency provider shall:
(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 continuing line of credit in the agency provider's name in an amount
			 of at least ten thousand dollars.
(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 or provider network management
			 module, as applicable, the agency provider's current physical address,
			 telephone number, and electronic mail address.
(7) Provide to the
			 department via the provider services management system or provider network
			 management module, as applicable, 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 or provider network management
			 module, as applicable, 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
			 shall 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
			 shall 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, 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 shall:
(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 shall:
(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 to report in writing to the agency provider, if he
			 or she 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 shall:
(1) Develop and implement
			 a written training plan for its director of operations, supervisors of direct
			 support professionals, direct support professionals, 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 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, 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 shall:
(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;
(b) Provide services to the direct support
				professional's spouse;
(c) Provide services to the minor child of the director of
				operations;
(d) Provide services to the spouse of the director of
				operations;
(e) 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
(f) 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
			 shall 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 shall successfully complete the training specified in appendix A to
			 this rule.
(3) On an annual basis,
			 the director of operations shall successfully complete the training specified
			 in appendix A to this rule.
(4) The director of
			 operations shall 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").
(I) Required actions and notifications
		  regarding director of operations
(1) An agency provider
			 shall notify the department via the provider services management system or
			 provider network management module, as applicable, 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
			 shall notify the department via the provider services management system or
			 provider network management module, as applicable, 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
			 shall notify the department via the provider services management system or
			 provider network management module, as applicable, 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
			 shall update its record in the provider services management system or provider
			 network management module, as applicable, 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 shall
			 report within fourteen calendar days via the provider services management
			 system or provider network management module, as applicable, 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 shall
			 complete the department-provided web-based orientation for directors of
			 operations and department-provided training in empathy-based care described in
			 appendix A to this rule within thirty calendar days of appointment or
			 hire.
(7) A director of
			 operations shall inform the department via the provider services management
			 system or provider network management module, as applicable, if he or she
			 serves as director of operations for more than one agency
			 provider.
(8) A director of
			 operations shall inform the department via the provider services management
			 system or provider network management module, as applicable, if he or she 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 shall 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
			 shall ensure that each 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.
(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
				professional.
(2) An agency provider
			 shall 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
			 shall ensure that each direct support professional, except for direct support
			 professionals exempted as specified in appendix B to this rule, successfully
			 completes prior to providing direct services, the training specified in
			 appendix C to this rule.
(K) Requirements for supervisory
		  staff
An agency provider shall 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
		  volunteers
(1) An agency provider
			 may engage volunteers to provide supplementary services. An agency provider
			 shall not bill for services provided by volunteers.
(2) An agency provider
			 shall ensure that volunteers are at all times under supervision of paid
			 supervisory staff of the agency provider.
(3) An agency provider
			 shall 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
			 shall 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 shall include:
(a) Requiring the
					 volunteer to submit a statement to the agency provider with the
					 volunteer's signature attesting that he or she 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 shall 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 he or she 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 shall
					 include information from the federal bureau of investigation.
(ii) The agency provider
				  shall, at a frequency of no less than once every five years, conduct a
				  background investigation in accordance with paragraph (L)(4)(b)(i) of this rule
				  for each volunteer.
(iii) The agency provider
				  shall 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.
(M) Procedure for obtaining initial
		  agency provider certification
(1) An applicant for
			 initial agency provider certification shall 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 shall
			 include required signatures and supporting documentation to demonstrate that
			 standards are met as required by this rule and rules in Chapters 5123-9 and
			 5123:2-9 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.
(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) 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 his or her 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) of this rule that the certification is denied. The
			 notification will specify the reason for denial.
(N) Procedure for obtaining certification
		  to provide additional home and community-based services during the term of
		  existing department-issued certification
(1) A certified agency
			 provider seeking to provide additional home and community-based services shall
			 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
				Chapters 5123-9 and 5123:2-9 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) 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) of this rule that the certification is denied. The
			 notification will specify the reason for denial.
(O) Procedure for obtaining renewal
		  agency provider certification
(1) The department will
			 notify an agency provider by electronic mail to the address in the provider
			 services management system or provider network management module, as
			 applicable, 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
			 shall 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
				Chapters 5123-9 and 5123:2-9 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) 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 his or her 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) 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 shall 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 shall not provide
			 services nor be reimbursed for provision of services during the
			 lapse.
(9) An agency provider
			 shall not provide services nor submit claims for reimbursement for services
			 provided subsequent to expiration of the agency provider's
			 certification.
(P) Application for certification
		  subsequent to expiration
(1) An applicant whose
			 certification has been expired for less than one year shall 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 shall be required to apply
			 for and meet the requirements for initial certification.
(Q) Application fees
(1) Applicants seeking
			 certification to provide services, other than those exempted in accordance with
			 appendix D to this rule, shall 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 shall 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 shall be required to initiate and submit an entirely new application
			 via the provider services management system.
(R) Certification terms
(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.
(S) Denial, suspension, or revocation of
		  certification
(1) Agency providers
			 shall be 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 shall
			 comply with the department's adjudication order within thirty calendar
			 days of the date of the mailing of the order.
(T) Department's authority to waive
		  provisions of this rule
(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.

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Last updated September 1, 2021 at 8:23 AM