Ohio Admin. Code 173-39-02.1 - ODA provider certification: adult day service
(A)
"Adult day
service" ("ADS") means a regularly-scheduled service provided at an adult day
center (center) in a non-institutional, community-based setting and consisting
of the activities authorized in an individual's person-centered services plan.
ADS includes recreational and educational programming to support an
individual's health and independence goals; at least one, but no more than two,
meals per day; and, sometimes, health status monitoring, skilled therapy
services, and transportation to and from the center. Table 1 to this rule
defines the levels and activities of ADS.
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(B)
Requirements to become, and to remain, an ODA-certified
provider of ADS:
(1)
General requirements: The provider is subject to rule
173-39-02 of the Administrative
Code.
(2)
Service requirements:
(a)
Transportation:
The provider shall transport each individual to and from the center by
performing transportation that complies with rule
173-39-02.18 of the
Administrative Code, unless the provider subcontracts with another provider
that complies with rule
173-39-02.18 of the
Administrative Code, or unless the caregiver transports or designates another
person, other than the center's provider, to transport the individual to and
from the center.
(b)
Provider's initial assessment:
(i)
The provider
shall assess the individual before the end of the individual's second day of
attendance at the center. The provider may substitute a copy of the case
manager's assessment of the individual if the case manager assessed the
individual no more than thirty days before the individual's first day of
attendance at the center.
(ii)
The initial
assessment shall include both of the following components:
(a)
The individual's
functional, cognitive, and social needs.
(b)
A social profile
including social activity patterns, major life events, community services,
caregiver data, formal and informal support systems, and behavior
patterns.
(c)
Health
assessment: No later than thirty days after the individual's initial attendance
at the center or before the individual receives the first ten units of service
at the center, whichever comes first, the provider shall obtain a health
assessment of each individual from a licensed healthcare professional whose
scope of practice includes health assessments or an employee who is such a
licensed healthcare professional to perform a health assessment of each
individual. The health assessment shall include the individual's psychosocial
profile and identify the individual's risk factors, diet, and medications. If
the licensed healthcare professional who performs the health assessment is not
an employee of the provider, the provider shall retain a record of the
professional's name and phone number.
(d)
Activity plan: No
later than thirty days after the individual's initial attendance at the center
or before the individual receives the first ten units of service at the center,
whichever comes first, the provider shall obtain the services of a licensed
healthcare professional whose scope of practice includes developing activity
plans to draft an activity plan for each individual or an employee who is such
a licensed healthcare professional to draft an activity plan for each
individual. The plan shall do all of the following:
(i)
Identify the
individual's strengths, needs, problems or difficulties, and
objectives.
(ii)
Describe the individual's interest, preferences, and
social rehabilitative needs.
(iii)
Describe the
individual's health needs.
(iv)
Describe the
individual's specific goals, objectives, and planned interventions of ADS that
meet the goals.
(v)
Describe the individual's level of involvement in the
drafting of the plan, and, if the individual has a caregiver, the caregiver's
level of involvement in the drafting of the plan.
(vi)
Describe the
individual's ability to provide a unique identifier as an attestation that the
provider, or the provider's staff, completed an activity or unit of
service.
(e)
Plan of treatment: Before administering medication or
meals with a therapeutic diet, and before providing a nursing service,
nutrition consultation, physical therapy, or speech therapy, the provider shall
obtain a plan of treatment from a licensed healthcare professional whose scope
of practice includes making plans of treatment. The provider shall obtain the
plan of treatment at least every ninety days for each individual that receives
medication, a nursing service, nutrition consultation, physical therapy, or
speech therapy. For diet orders that may be part of a plan of treatment, a new
diet order is not required every ninety days. Instead, the provider is subject
to the diet-order requirements for therapeutic diets under rule
5160-44-11 of the Administrative
Code.
(f)
Interdisciplinary care conference (conference):
(i)
Frequency: The
provider shall conduct a conference for each individual at least once every six
months.
(ii)
Participants: The provider shall conduct the conference
between the provider's staff and invitees who choose to participate. At least
seven days before the conference begins, the provider shall invite the
following persons to participate in the conference and provide those persons
with the date and time of the conference:
(a)
The individual's
case manager.
(b)
Any licensed healthcare profession who does not work
for the provider, but who provided the provider with a health assessment of the
individual or an activity plan for the individual.
(c)
The individual's
caregiver, if the individual has a caregiver.
(iii)
Revise activity
plan: If the conference participants identify changes in the individual's
health needs, condition, preferences, or responses to the service, the provider
shall obtain the services of a licensed healthcare professional whose scope of
practice includes developing activity plans to revise the activity plan
accordingly or an employee who is such a licensed healthcare professional to
revise the activity plan accordingly.
(g)
Activities: The
provider shall announce daily and monthly planned activities through two or
more of the following media:
(i)
Posters in prominent locations throughout the
center.
(ii)
An electronic display (e.g., a television) in a
prominent location in the center.
(iii)
The center's
website.
(iv)
Email sent to individuals (and others) who agree to
receive the email.
(v)
Monthly newsletters distributed to individuals by mail,
email, or at the center.
(h)
Lunch and
snacks:
(i)
The
provider shall provide lunch and snacks to each individual who is present
during lunchtime or snack time.
(ii)
Each meal the
provider provides shall comply with all the requirements for home-delivered
meals under rules
173-39-02.14 and
5160-44-11 of the Administrative
Code, except for the requirements in those rules pertaining to the delivery of
the meal.
(3)
Center
requirements: A provider qualifies to be an ODA-certified ADS provider only if
the provider's center has the following specifications:
(a)
If the center is
housed in a building with other services or programs other than ADS, the
provider uses a separate, identifiable space and staff for ADS during all hours
that the provider provides ADS in the center.
(b)
The center
complies with the "ADA Accessibility Guidelines for Buildings and Facilities"
in appendix A to 28 C.F.R. part 36 .
(c)
The center has at
least sixty square feet per individual that it serves (not just individuals who
are enrolled in an ODA-administered program), excluding hallways, offices, rest
rooms, and storage areas.
(d)
The provider stores individuals' medications in a
locked area the provider maintains at a temperature complying with the storage
requirements of the medications.
(e)
The provider
stores toxic substances in an area which is inaccessible to
individuals.
(f)
The center has at least one working toilet for every
ten individuals present that the center serves (not just individuals who are
enrolled in an ODA-administered program) and at least one wheelchair-accessible
toilet.
(g)
If the center seeks certification to provide intensive
ADS, the center has bathing facilities suitable to the needs of individuals who
need intensive ADS.
(4)
Staffing
levels:
(a)
The
provider shall have at least two staff members present, with at least one of
those staff members having a certification in CPR, when more than one
individual is present in the center.
(b)
The provider
shall maintain a staff-to-individual ratio of at least one staff member to six
individuals at all times.
(c)
The provider shall have an RN, or LPN under the
direction of an RN, available to provide nursing services that need the skills
of an RN, or LPN under the direction of an RN, and that are based on the needs
of the individuals and within the nurse's scope of practice.
(d)
The provider
shall employ an activity director to direct activities.
(5)
Provider qualifications:
(a)
Type of
provider:
(i)
Only an agency provider qualifies for ODA's certification to
provide ADS.
(ii)
For each provider that ODA certifies, ODA shall certify
the provider as an enhanced or intensive provider. If ODA certifies a provider
to provide an intensive service level, the provider may also directly provide,
or arrange for, the enhanced service level.
(b)
Staff
qualifications:
(i)
Every person who is an RN, LPN under the direction of
an RN, social worker, physical therapist, physical therapy assistant, speech
therapist, licensed dietitian, occupational therapist, occupational therapy
assistant, or other licensed professional qualifies to practice in the center
only if the person has a current, valid license to practice in their
profession.
(ii)
A person qualifies to be an activity director only if
the person has at least one of the following:
(a)
A baccalaureate
or associate degree in recreational therapy or a related
degree.
(b)
At least two years of experience as an activity
director, activity coordinator, or a related position.
(c)
Compliance with
the qualifications under rule
3701-17-07 of the Administrative
Code for directing resident activities in a nursing home.
(d)
A certification
from the national certification council for activity professionals
(NCCAP).
(iii)
A person qualifies to be an activity assistant only if
the person has at least one of the following:
(a)
A high school
diploma.
(b)
A high school equivalence diploma as defined in section
5107.40 of the Revised
Code.
(c)
At least two years of employment in a supervised
position to provide personal care, to provide activities, or to assist with
activities.
(iv)
A person qualifies to be a PCA only if the person has
at least one of the following:
(a)
A high school diploma.
(b)
A high school
equivalence diploma as defined in section
5107.40 of the Revised
Code.
(c)
At least two years of employment in a supervised
position to provide personal care, to provide activities, or to assist with
activities.
(d)
The successfully completion of a vocational program in
a health or human services field.
(v)
A person
qualifies to transport individuals for the provider only if the person meets
the qualifications for drivers under rule
173-39-02.18 of the
Administrative Code.
(c)
Staff
training:
(i)
Orientation: The provider shall comply with the requirements
for the orientation of PCAs in rule
173-39-02.11 of the
Administrative Code.
(ii)
Task-based training: Before each new PCA provides ADS,
the provider shall provide task-based training.
(iii)
Continuing
education and in-service training: Each PCA, activity director, and activity
assistant shall successfully complete at least eight hours of continuing
education or in-service training each calendar year. Any hour of continuing
education or in-service training successfully completed during a calendar year
to comply with the requirements for certification as an activity director or
activity assistant counts towards the eight-hour requirement in this
paragraph.
(iv)
Verification of compliance: The provider shall comply
with paragraph (C)(3)(f) of rule
173-39-02.11 of the
Administrative Code regarding records of each PCA's successful completion of
any training and competency evaluation program, orientation, and inservice
training.
(6)
Service
verification: The following are the mandatory reporting items that a provider
retains for each ADS session to comply with the requirements under paragraph
(B)(10)(a)(i) of rule
173-39-02 of the Administrative
Code:
(a)
Individual's name.
(b)
Service
date.
(c)
Individual's arrival time.
(d)
Individual's
departure time.
(e)
Individual's mode of transportation.
(f)
Unique identifier
of the individual to attest to receiving the service.
(C)
Units and rates:
(1)
For the PASSPORT
program, the appendix to rule
5160-1-06.1 of the
Administrative Code lists the following:
(a)
The units of ADS
attendance.
(b)
The units of ADS transportation.
(c)
The maximum rates
allowable per unit of ADS attendance or ADS transportation.
(2)
For
the PASSPORT program, the rate-setting methodology is established in rule
5160-31-07 of the Administrative
Code and in the following paragraphs:
(a)
Attendance:
(i)
Units of ADS
attendance are calculated as follows:
(a)
One-half day unit
is less than four hours of ADS per day.
(b)
One day unit is
four to eight hours of ADS per day.
(c)
A fifteen-minute
unit is each fifteen-minute period of time over eight hours up to, and
including, a maximum of twelve hours of ADS per day.
(ii)
A unit of ADS
attendance does not include transportation time.
(b)
Transportation:
If the service is provided to an individual enrolled in the PASSPORT program, a
unit of ADS transportation is a round trip, a one-way trip, or one mile with
the trip cost based on a case manager's pre-determined calculation of distance
between the individual's home and the center multiplied by an established ADS
mileage rate. If the provider provides the transportation simultaneously to
more than one PASSPORT-enrolled individual who resides in the same household in
the same vehicle to the same destination, the provider's payment rate for that
trip is seventy-five per cent of the per-unit rate.
Replaces: 173-39-02.1
Notes
Promulgated Under: 119.03
Statutory Authority: 121.07, 173.01, 173.02, 173.391, 173.52, 173.522
Rule Amplifies: 173.39, 173.391, 173.52, 173.522; 42 CFR 441.352
Prior Effective Dates: 03/31/2006, 03/20/2011, 09/29/2011, 11/01/2013, 09/01/2016, 03/01/2017, 06/11/2020 (Emer.), 01/10/2021, 04/04/2022
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