Ohio Administrative Code|Rule 5160-43-04 | Specialized recovery services program covered services and provider requirements.

                                                
(A) This rule sets forth the covered
		  services available to an individual enrolled in the specialized recovery
		  services program (SRSP) and the requirements for providers of those
		  services.
(B) Individualized placement and support
		  - supported employment (IPS-SE) is the implementation of evidence-based
		  practices allowing individuals to obtain and maintain meaningful employment by
		  providing training, ongoing individualized support, and skill development to
		  promote recovery. IPS-SE is an evidence based practice which is integrated and
		  coordinated with mental health treatment and rehabilitation designed to provide
		  individualized placement and support to assist individuals with a severe and
		  persistent mental illness obtain, maintain, and advance within competitive
		  community integrated employment positions.
(1) IPS-SE activities
			 include:
(a) Benefits planning;
(b) Development of a vocational plan;
(c) General consultation, including advocacy and building and
				maintaining relationships with employers;
(d) Individualized job supports, including regular contact with
				the individual's employer(s), family members, guardians, advocates,
				treatment providers, and other community supports;
(e) Job coaching;
(f) Job development and placement;
(g) Job seeking skills training;
(h) On-the-job training and skill development;
(i) Vocational rehabilitation guidance and
				counseling;
(j) Time unlimited vocational support; and
(k) Vocational assessment.
(2) IPS-SE activities may include the
			 following when provided in conjunction with an IPS-SE activity listed in
			 paragraph (B)(1) of this rule:
(a) Facilitation of natural supports;
(b) Peer services; and/or
(c) Transportation.
(3) The following activities are not
			 payable under IPS-SE:
(a) Adaptations, assistance and training used to meet the
				employer's responsibility to fulfill requirements for reasonable
				accommodations under the Americans with Disabilities Act, 42 U.S.C. 12101 et.
				seq. (as in effect on January 1, 2021); 
(b) Job placements paying below minimum wage;
(c) Supervision, training, support and adaptations typically
				available to the general workforce filling similar positions in the
				business;
(d) Supervisory activities rendered as the normal part of
				business setting;
(e) Unpaid internships, unless they are considered crucial for
				job placement and such experience is vital to the individual achieving his or
				her vocational goal(s);
(f) Services which are not provided in integrated settings
				including sheltered work or other types of vocational services in specialized
				facilities, or incentive payments, subsidies, or unrelated vocational training
				expenses such as the following:
(i) Incentive payments
				  made to an employer to encourage hiring the individual; 
(ii) Payments that are
				  passed through to the individual; or 
(iii) Payments for
				  supervision, training, support and adaptations typically available to other
				  workers without disabilities filling similar positions in the business; or
				  payments used to defray the expenses associated with starting up or operating a
				  business.
(4) To be a provider and submit a claim
			 for payment of IPS-SE services, the provider delivering the service must meet
			 all of the following requirements:
(a) Comply with all rules set forth in this chapter and Chapter
				5160-27 of the Administrative Code;
(b) Request payment for the provision of services in accordance
				with rule 5160-27-03 of the Administrative Code;
(c) Be certified by the Ohio department of mental health and
				addiction services (OhioMHAS) under section 5119.36 of the Revised
				Code;
(d) Not be the individual's legally responsible family
				member, as defined in rule 5160-43-01 of the Administrative Code;
(e) Be identified as the provider and have specified on the
				individual's person-centered service plan, that is prior approved by the
				Ohio department of medicaid (ODM) or its designee, the number of hours the
				provider is authorized to furnish program services to the
				individual;
(f) Provide services that are supported by an identified need or
				recovery goal in a manner that supports and respects the individual's
				communication needs including translation services, and/or assistance with
				communication devices; and
(g) Not provide IPS-SE services simultaneously with other
				rehabilitation services available under the medicaid state plan.
(5) IPS-SE providers must maintain a
			 record for each individual served in a manner that protects the confidentiality
			 of those records. At a minimum, the record must contain:
(a) A copy of the current person-centered service
				plan;
(b) Documentation of each service interaction including the
				duration IPS-SE was provided; and
(c) Documentation that the service is not available under a
				program funded under section 110 of the Rehabilitation Act of 1973, 29 U.S.C.
				701 et. seq. (July 1, 2017), relating to vocational rehabilitation services, or
				the Individuals with Disabilities Education Act (1990), set forth in 20 U.S.C.
				section 1400 et. seq. (as in effect on January 1,2021), relating to special
				education.
(C) Peer recovery support provides
		  community-based supports to an individual with a mental illness with
		  individualized activities that promote recovery, self-determination,
		  self-advocacy, well-being and independence through a relationship that supports
		  the person's ability to promote his or her own recovery. Peer recovery
		  supporters use their own experiences with mental illness to help individuals
		  reach their recovery goals.
(1) Peer recovery support activities
			 include:
(a) Assisting the individual with accessing and developing
				natural support systems in the community;
(b) Attending and participating in care team
				meetings;
(c) Conducting outreach to connect individuals with
				resources;
(d) Coordinating and/or assisting in crisis interventions and
				stabilization as needed;
(e) Developing and working toward achievement of the
				individual's personal recovery goals;
(f) Facilitating development of daily living skills;
(g) Modeling personal responsibility for recovery;
(h) Promoting coordination among similar providers;
(i) Providing group facilitation that addresses symptoms,
				behaviors, and thought processes to assist an individual in eliminating
				barriers to seeking and maintaining recovery, employment, education, and
				housing;
(j) Supporting individuals in achieving personal independence as
				identified by the individual; and
(k) Teaching skills to effectively navigate the health care
				delivery system to utilize services.
(2) The following activities are not
			 payable under peer recovery support:
(a) Assistance with activities of daily living as defined in rule
				5160-3-05 of the Administrative Code;
(b) Management of medications; and
(c) Performance of activities covered under other
				services.
(3) To be a provider and submit a claim
			 for payment of peer recovery support services, the provider delivering the
			 service must meet all of the following requirements:
(a) Comply with all rules set forth in this chapter and Chapter
				5160-27 of the Administrative Code;
(b) Request payment for the provision of services in accordance
				with rule 5160-27-03 of the Administrative Code;
(c) Be certified by OhioMHAS under section 5119.36 of the Revised
				Code;
(d) Not be the individual's legally responsible family
				member, as defined in rule 5160-43-01 of the Administrative Code;
(e) Be identified as the provider and have specified on the
				individual's person-centered service plan, that is prior approved by ODM
				or its designee, the number of hours the provider is authorized to furnish
				services to the individual;
(f) Provide services that are supported by an identified need or
				recovery goal in a manner that supports and respects the individual's
				communication needs including translation services, and/or assistance with
				communication devices;
(g) Not provide peer recovery support activities simultaneously
				with other rehabilitation services available under the state plan;
				and
(h) Be supervised by other senior peers or non-peer staff that
				have been certified to supervise peers and receive regularly scheduled clinical
				supervision from a person meeting the qualifications of a behavioral health
				professional with experience regarding this specialized behavioral health
				service.
(4) All peer recovery support providers
			 must maintain a record for each individual served in a manner that protects the
			 confidentiality of those records. At a minimum, the record must
			 contain:
(a) A copy of the current person-centered service
				plan;
(b) Documentation of each service interaction including the
				duration peer recovery support was provided; and
(c) Documentation that the service is not available under a
				program funded under section 110 of the Rehabilitation Act of 1973, relating to
				vocational rehabilitation services, or the Individuals with Disabilities
				Education Act (1990) set forth in 20 U.S.C. section 1400 et. seq. (as in effect
				on February 1, 2016), relating to special education.
(D) Recovery management is the
		  coordination of all SRSP services received by an individual and assisting him
		  or her in gaining access to needed medicaid services, as well as medical,
		  social, educational, and other resources, regardless of funding
		  source.
(1) Recovery managers
			 shall:
(a) Be a registered nurse, or hold at least a bachelor's
				degree in social work, counseling, psychology, or related field;
(b) Have a minimum of three years post degree experience working
				with individuals with severe and persistent mental illness or have a minimum of
				one year post degree experience working with individuals with diagnosed chronic
				conditions;
(c) Possess an active medicaid provider agreement or be employed
				by an entity that has an active medicaid provider agreement;
(d) Demonstrate knowledge of issues affecting people with severe
				and persistent mental illness (SPMI) or dignosed chronic conditions (DCC) and
				community-based interventions/resources for those individuals;
(e) Attend training activities including, but not limited
				to:
(i) Person-centered
				  service planning;
(ii) Administering the
				  "Adult Needs and Strengths Assessment (ANSA)" (8/2021);
(iii) Home and
				  community-based services (HCBS) settings;
(iv) "Health
				  Insurance Portability and Accountability Act of 1996" (HIPAA) regulations
				  set forth in 45 C.F.R. parts 160 and 164 (as in effect on October 1,
				  2020);
(v) 42 C.F.R. part 2 (as
				  in effect on October 1, 2020), confidentiality of alcohol and drug abuse
				  patient records; and
(vi) Incident management
				  as described in rule 5160-44-05 of the Administrative Code.
(f) Be supervised by clinical staff who possess a current, valid
				and unrestricted license with the appropriate licensure board from the fields
				of nursing, social work, psychology, or psychiatry.
(2) Recovery management activities
			 include:
(a) Face-to-face eligibility evaluation, including:
(i) Administration of the
				  "ANSA" (8/2021);
(ii) Verification of the
				  individual's residence in an HCBS setting; 
(iii) Verification of the
				  individual's qualifying behavioral health diagnoses or diagnosed chronic
				  conditions as described in the qualifying diagnosis appendix which is available
				  on the ODM website at
				  https://medicaid.ohio.gov/resources-for-providers/special-programs-and-initiatives/srs;
				  and
(iv) Evaluation of all
				  other eligibility criteria as described in paragraph (A) of rule 5160-43-02 of
				  the Administrative Code.
(v) At the discretion of
				  ODM or its designee, evaluations may be conducted by video conference or
				  telephonically in lieu of face-to-face unless the individual's needs
				  require a face-to-face visit.
(b) Person-centered care planning and updating the
				individual's service plan;
(c) Facilitation of transitioning to the community for
				individuals who receive medicaid-funded institutional services. Recovery
				management activities for individuals leaving institutions shall be coordinated
				with, and shall not duplicate, institutional, mycare and managed care plan
				discharge planning, and other community resources.
(d) Informing the individual about SRSP services, person centered
				planning, resources for recovery, and individual rights and
				responsibilities;
(e) Supporting the review and approval of the individual's
				person-centered service plan in accordance with rule 5160-44-02 of the
				Administrative Code;
(f) Monitoring the individual's service plan;
(g) Identifying and resolving issues that impede access to needed
				SRSP services;
(h) Identifying resources in the person-centered service plan to
				support the individual's recovery goals, including non-HCBS medicaid,
				medicare, private insurance, and community resources;
(i) Coordinating with other service providers and
				systems;
(j) Assisting with accessing resources necessary to
				complete medicaid redetermination and retain HCBS and medicaid
				eligibility;
(k) Responding to and assessing emergency situations and
				incidents and assuring that appropriate actions are taken to protect the
				health, welfare, wellness, and safety of the individual in accordance with rule
				5160-44-05 of the Administrative Code and assist in meeting the needs of the
				individual in those situations;
(l) Evaluating the individual's progress in meeting
				his or her goals;
(m) Participating in quality oversight activities and
				reporting activities as described in rule 5160-43-07 of the Administrative
				Code;
(n) Participating in case consultations regarding an
				individual's progress with a trans-disciplinary care team, as defined in
				rule 5160-43-01 of the Administrative Code. When an individual is assigned to
				or enrolled in a comprehensive care management program operated by an
				accountable entity (e.g. patient centered medical home or managed care plan),
				the recovery manager will support access to the individuals full set of
				medicaid and medicare benefits and community resources across the continuum of
				care, including behavioral, medical, LTSS and social services;
(o) Updating the assessment at least annually, making
				revisions to the individual's service plan, and making recommendations to
				the accountable care management entity, as appropriate;
(p) Educating the individual about hearing and appeal
				rights; and
(q) Assisting the individual with preparing and submitting
				a hearing request, as needed.
(3) Recovery management activities do not
			 include:
(a) Travel time incurred by the recovery manager billed as a
				discrete unit of service;
(b) Services that constitute the administration of another
				program such as child welfare, child protective services, foster care, parole
				and probation functions, legal services, public guardianship, and special
				education;
(c) Representative payee functions; and
(d) Other activities identified by ODM.
(4) To be a provider and submit a claim
			 for payment of recovery management services, the provider delivering the
			 service shall meet all of the following requirements:
(a) Comply with all rules set forth in this chapter of the
				Administrative Code;
(b) Request payment for the provision of services in accordance
				with rule 5160-43-08 of the Administrative Code;
(c) Not be the individual's legally responsible family
				member;
(d) Be identified as the provider and have specified on the
				individual's person-centered service plan, that is prior approved by ODM
				or its designee, the number of hours the provider is authorized to furnish
				services to the individual;
(e) Provide services that are supported by an identified need or
				recovery goal in a manner that supports and respects the individual's
				communication needs including translation services, and/or assistance with
				communication devices.
(5) All recovery
			 management activities shall be documented in a record using the process
			 prescribed by ODM for each individual served in a manner that protects the
			 confidentiality of these records. At a minimum, the record shall
			 contain:
(a) A copy of the current person-centered service
				plan;
(b) Documentation of each service interaction including the
				duration recovery management was provided; and
(c) Documentation that the service is not available under a
				program funded under section 110 of the Rehabilitation Act of 1973, 29 U.S.C.
				701 et. seq. (as in effect on January 1, 2021) relating to vocational
				rehabilitation services, or the Individuals with Disabilities Education Act, of
				1990 set forth in 20 U.S.C. 1400 et. seq. (as in effect on January 1, 2021),
				relating to special education.


Last updated October 15, 2021 at 8:28 AM