Regulatory Review of Adult Day Services: Final Report - Section 2. Ohio

08/26/2005

Overview

Ohio certifies providers for adult day service (ADS) under Medicaid through the Pre-Admission Screening System Providing Options and Resources Today (PASSPORT) Waiver, administered by the Department of Aging. The certification requirements for PASSPORT are described in this profile. Ohio also provides and regulates providers for Center-based Day Health (CBDH) services under the Ohio Home Care Waiver under the Department of Job and Family Services. Regulations related to the Ohio Home Care Waiver are listed as Relevant Medicaid Contracting Requirements later in this profile. Ohio does not otherwise regulate ADS providers.

Licensure and Certification Requirements

Licensure and Certification Requirements
Licensure Only  ☐ 
Certification Only  ☒ 
Both Required  ☐ 
Other  ☐ 

Definitions

Adult day service is a nonresidential community based service designed to meet the needs of functionally and/or cognitively impaired adults through an individualized care plan that encourages optimal capacity for self care and/or maximizes functional abilities. It consists of structured, comprehensive, and continually supervised components that are provided in a protective setting. Enrollees who receive ADS attend on a planned basis during specified hours. There are two levels of ADS: enhanced and intensive.

Enhanced adult day service includes supervision of all activities of daily living (ADL) and supervision of medication administration and/or hands on assistance with one ADL (except bathing) and medication administration, comprehensive therapeutic activities, and health assessment and intermittent monitoring of health status.

Intensive adult day service includes all services mentioned in enhanced services above plus assistance with two or more ADLs; assistance with bathing; health assessment and regular monitoring of, or intervention with, health status; skilled nursing services (e.g., dressing changes and other treatments) and rehabilitative nursing procedures; rehabilitative and restorative services, including physical therapy, speech therapy, and occupational therapy; and social work services.

ADS programs shall be certified by the Ohio Department of Aging as enhanced or intensive providers.

Parameters for Who Can Be Served

The definitions of enhanced and intensive adult day services listed above indicate the parameters for who can be served in ADS programs. Participants must meet the state's waiver criteria. No specific criteria for discharge were identified.

Inspection and Monitoring

Inspection and Monitoring
Yes  ☒ 
No  ☐ 

The PASSPORT Administrative Agency conducts an on-site visit within 45 calendar days after the receipt of a complete certification application to measure compliance with the PASSPORT conditions of participation.

An on-site provider structural compliance review shall occur at least annually.

Providers are required to allow representatives of the Centers for Medicaid & Medicare Services (CMS), the Ohio Department of Human Services, the Ohio Department of Aging, and the PASSPORT Administrative Agency general access to the provider facility.

Required and Optional Services

  Adult Day Service Enhanced Adult Day Service Intensive
Required Optional Required Optional
* Note that enhanced services include intermittent monitoring of health status, whereas intensive services include regular monitoring of, or intervention with, health status and skilled nursing services and rehabilitative nursing procedures. Both medication administration and supervision of medication administration are specified services.
Activities of Daily Living (ADL) Assistance  ☒   ☐   ☒   ☐ 
Health Education and Counseling  ☐   ☐   ☒   ☐ 
Health Monitoring/Health-Related Services  ☐   ☒   ☒   ☐ 
Medication Administration  ☒   ☐   ☒   ☐ 
Nursing Services  ☒   ☐   ☒   ☐ 
Physical Therapy, Occupational Therapy, or Speech Therapy  ☐   ☐   ☒   ☐ 
Skilled Nursing Services  ☐   ☐   ☒   ☐ 
Social Services  ☐   ☐   ☒   ☐ 
Transportation  ☒   ☐   ☒   ☐ 

Provisions Regarding Medications

No provisions were identified.

Provisions for Groups with Special Needs

Provisions for Groups with Special Needs
Dementia  ☐ 
Mental Retardation/Developmental Disabilities  ☐ 
Other  ☐ 

Staffing Requirements

Type of staff. A registered nurse (RN) or licensed practical nurse (LPN) under the supervision of an RN shall be on site at the ADS center for those nursing services which require the skills of an RN or an LPN under the supervision of an RN.

An activity director shall supervise enrollee activities.

Staffing ratios. At least two staff shall be present in the ADS center when more than one enrollee is in attendance. At least one of the two staff must be a paid direct service staff. The staff-to-enrollee ratio shall be at least one staff to six enrollees.

Training Requirements

ADS staff must participate in at least 8 hours of in-service or continuing education each calendar year.

Task-based instruction must be provided for center personal care assistant staff that deliver personal care services to enrollees prior to providing personal care service to enrollee(s).

Relevant Medicaid Contracting Requirements for Adult Day Services Providers

Ohio provides ADS under Medicaid through the PASSPORT Waiver under the regulations outlined in this profile, administered by the Ohio Department of Aging.

Ohio also provides CBDH services under the Ohio Home Care Waiver administered by the Ohio Department of Job and Family Services (formerly the Ohio Department of Human Services), which also certifies providers under regulations identified as follows:

Definition. Adult day care provides comprehensive services in a congregate ambulatory care setting to persons who are nonresidents and who are not capable of living independently due to functional impairments. An organized and continually supervised program of therapeutic, rehabilitative, and supportive activities and health and social services is provided.

Inspection and monitoring. The Department shall operate an oversight program of providers of the Ohio home care program. The review process may include on-site visits to the provider's location. The Department reserves the right to conduct unannounced structural reviews at any time, and providers will cooperate by making available appropriate meeting space.

Relevant CBDH services include but are not limited to ADL assistance; therapeutic, recreational, and educational activities; social work counseling; and transportation.

Type of staff. A licensed social worker or licensed independent social worker. Service staff members include nurses, physical therapists, licensed physical therapy assistants, speech therapists, occupational therapists, certified occupational therapy assistants, social service providers, client activity providers, and personal care providers.

Location of Licensing, Certification, or Other Requirements

  1. http://goldenbuckeye.com/pp_oac/5101-3-31-08.pdf
  2. http://goldenbuckeye.com/pp_oac/5101-3-31-09.pdf
  3. http://goldenbuckeye.com/pp_oac/5101-3-31-10.pdf
  4. http://goldenbuckeye.com/pp_oac/5101-3-31-13.pdf
  5. http://onlinedocs.andersonpublishing.com/oh/lpExt.dll?f=templates&fn=main-h.htm&cp=OAC (These sections of the code cannot be accessed directly but are available through this online search engine.)
  6. On file at RTI, provided by Sarah Adult Day Services, Inc., Canton, Ohio. Not available online.

Citations

  1. Provider conditions of participation for the passport HCBS waiver program. Ohio Administrative Code 5101:3-31-08. [Review Date 9/1/03]
  2. Passport HCBS waiver program services specifications. Ohio Administrative Code 5101: 3-31-09. [Review date [undated]
  3. Passport HCBS waiver provider initial and ongoing certification. Ohio Administrative Code 5101:3-31-10. [Review date 9/1/03]
  4. Passport HCBS waiver provider structural compliance review. Ohio Administrative Code 5101:3-31-13. [Review date 9/1/03]
  5. Ohio Home Care Program. Ohio Administrative Code 5101:3-12-07. [Review date 7/1/03]
  6. Ohio Home Care Program. Ohio Administrative Code 5101:3-12-08. [Review date 7/1/03]
  7. Ohio Home and Community-Based Waiver IV. Ohio Department of Human Services, Bureau of Community Services. [Submitted 2/28/90]

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