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Waiver Guidance

As the Ohio Department of Developmental Disabilities (DODD) responds to coronavirus (COVID-19), please continue to exercise flexibility to ensure the health and safety of Ohioans with developmental disabilities and their families. DODD appreciates the unique role that providers of service and direct support professionals (DSPs) play throughout the developmental disabilities system.

The Ohio Department of Developmental Disabilities (DODD) and the Office of System Support and Standards (OSSAS) resumed regulatory work on August 1, 2020 through virtual meeting options. During these meetings, OSSAS will focus on providing assistance and guidance while taking relaxed requirements into account, as they have been in effect during the state of emergency.

The following information gives recommendations and guidance on important issues for waiver-funded service providers and is effective immediately.

Health and Safety

DODD encourages providers to ensure that people with developmental disabilities and DSPs are familiar with and follow recommendations from the Centers for Disease Control and Prevention (CDC) and the Ohio Department of Health (ODH) related to social distancing and personal hygiene.

Following these guidelines for social distancing, providers may limit the delivery of services in community settings when appropriate.

Providers may not discharge a person from services only due to the diagnosis of COVID-19. It is expected that the provider will follow appropriate procedures as recommended by the CDC, ODH, their local health department, or health care professionals.

Providers are encouraged to ensure that a person-centered approach to services is maintained by communicating with people receiving services, their families, guardians, and DSPs to keep them updated on how they can stay safe during this state of emergency.

DSPs should be familiar with their agency’s emergency response plan.

DODD supports a provider’s ability to prioritize medical appointments, follow-ups, and consultations based on the needs of the person and after consultation with the appropriate medical professional. When possible, telehealth options, such as 24/7 nurse phone lines, should be explored.

Independent providers should be aware for each person they serve who is the designated back-up provider. Providers with questions should contact the person’s service and support administrator (SSA) for details.

Electronic Visit Verification

Updated March 30, 2020*

Providers who are employing a high volume of new staff and/or new clients are reminded that Electronic Visit Verification (EVV) visit logging requirements remain in effect. The Ohio Department of Medicaid (ODM) is monitoring EVV visits as part of a larger strategy to identify people at risk during the state of emergency who may not be receiving the support they require to stay healthy and safe. However, it is understood that no available EVV device and other barriers may exist when logging a visit during service delivery. Please keep in mind that any visit that is not recorded in real-time can be entered manually online at a later point. EVV is not used to deny claims payment at this time.

Please note the certification requirement for EVV training is being waived at this time for new providers and existing providers adding Homemaker/Personal Care (HPC) services during the state of emergency. Providers who have not completed training will not be able to access EVV data and log visits. Because EVV is not used to deny claims payment at this time, this will have no impact on reimbursement for services provided.

Providers who wish to continue delivering HPC services after the state of emergency will be required to take EVV training and begin logging visits at a later date.

Service Delivery

Review DODD’s guidance about Day Support Service Options for new options effective for partnerships between adult day and residential service providers.

DODD encourages providers to explore alternative service delivery methods, such as the use of Remote Support or allowing people to receive services in the homes of direct support professionals. People receiving services, guardians, and teams must be consulted and approve these alternatives.

It is recommended that staffing ratios be maintained whenever possible, but when not possible, the provider should ensure that the SSA is aware and be prepared to discuss ways in which the provider can continue to ensure the health and safety of the person.

Respite in Licensed Residential Facilities

DODD recognizes that many licensed facilities, including ICFs, provide much needed respite services. During this time, facilities should cancel all non-emergency respite stays. If a facility is contacted to provide respite services, they must first contact the person’s local county board of developmental disabilities to discuss the need for the respite service.

If it is determined that the need is of an emergency nature, the facility may provide respite services to the person following the guidance above for initial screening of the person. If, by having a person using respite in the facility, the facility is caused to go over capacity, the facility must still submit a request for a waiver of licensed capacity. Those requests will be reviewed and responded to as quickly as possible.

Independent Providers

Ohioans with developmental disabilities and their families depend on independent providers to deliver personalized care, which they require to remain healthy and safe. Due to the increased need for independent providers in Ohio’s support system for people with developmental disabilities, the Ohio Department of Developmental Disabilities (DODD) is providing the following assistance to encourage more independent providers to be certified and start providing critical services during the state of emergency. The DODD website offers details about how to become an independent provider. In addition to the information on the website, DODD is providing the assistance detailed below.

Independent Certification Initial Application Fee Waived

Updated November 24* 

To help strengthen the provider community during this challenging time, DODD is waiving the $125 initial application fee for people who apply to be independent providers between November 23, 2020, and January 31, 2021. The application for certification must be submitted between these dates to receive a $0 checkout fee.

Background Check Assistance

Updated November 24* 

In Ohio, Webcheck locations have adjusted their hours and process to accommodate COVID-19 safety measures for applicants to request an Ohio Bureau of Criminal Investigation (BCI) check under reason code “5123.169 Applicant for a supported living certificate,” and reason code “5126.28 Employment with DODD” for those who will need a Federal Bureau of Investigation (FBI) check because they lived outside of Ohio in the past 5 years. Background checks provided by Webcheck locations are subject to the regular fees associated with that service.

DODD operated Developmental Centers (DC) throughout Ohio will provide free background checks for independent provider applicants on Tuesdays and Thursdays from 10:00 AM to 11:00 AM. Applicants requesting the background check should follow the following procedure:

  1. The applicant will call the DC human resources (HR) manager to make an appointment.
  2. The HR manager will provide DC specific instructions for where the applicant should report.   
  3. Applicant must report within a 10-minute window of appointment time.
  4. Upon entry to the DC, the applicant will be required to be screened and wear full personal protective equipment (PPE) provided by the DC.
  5. Background check results will be mailed from the DC to DODD provider certification to verify as part of your application.

Applicants should use the following contact information for Developmental Centers when scheduling a background check:

Image of Contacts at the department

 

Positive COVID-19 Diagnosis 

Independent providers are encouraged to maintain a person-centered approach to services. Communication is critical during a state of emergency. Ensure that there is consistent communication among independent providers, the person receiving services, the person’s service and support administrator (SSA), as well as with families or guardians.  

DODD supports independent providers’ abilities to prioritize medical appointments, follow-ups, and consultations based on the needs of the person and any advice from appropriate medical professionals. Independent providers are encouraged to utilize telehealth options when available. 

To maintain the health and safety of people receiving supports, independent providers should be aware of who is the designated back-up provider for each person they support. If there is any question, providers should reach out to the person’s SSA for details.  

Exceeding 60 Hours for Services 

During this state of emergency, independent providers are enabled to exceed the 60-hour ceiling for providing services, if necessary, to maintain the health and safety of people receiving supports. Independent providers will still require authorization from the SSA. Independent providers may be authorized to deliver overtime hours through verbal or electronic authorization from the County Board prior to individual service plan (ISP) updates. Payment authorization for waiver services (PAWS) updates may be needed to reflect additional units for payment.

Training and Service Changes 

Updated November 24* 

Electronic Visit Verification (EVV) training requirements are not being collected as part of the certification application at this time. The applicant may upload a blank page to that part of the independent provider application.

First Aid and CPR online-only classes are being accepted, with in-person requirements to resume in the future.

When entering Supplier ID on the application, be aware that the Supplier ID number and the Registration number from Ohio Shared Services for an account are very similar. Supplier ID numbers can be obtained here.

Even with the lenient training requirements described above, medication administration training requirements have not changed. All independent providers who are responsible for administering medication must have medication administration training.

Alternative Service Delivery Methods 

Updated November 24* 

For independent providers who are currently certified but not engaged in the delivery of services, or who may only be providing services on a part-time basis, there are many opportunities available to meet this high demand for service.

  • Notify the local county board of developmental disabilities (CBDD) of the willingness to assist more people
  • Contract with an agency provider for services
  • Be hired as an employee of an agency provider

If you are an independent provider with current, active certification, you may be hired by an agency provider without undergoing some of the traditional hiring requirements.

Agency providers hiring independent providers for direct services may forgo obtaining a BCII check if the independent provider is currently certified by DODD. Additionally, the agency can assume initial training requirements have been met as part of the independent provider certification process but must provide the independent provider with major unusual incidents (MUIs) and unusual incidents (UIs) training specific to the agency. BCII checks and enrollment in Rap Back must be obtained if the agency maintains the independent provider in a direct support position for more than 90 days.

In addition to MUI training, the agency must provide person-specific training and in a licensed facility emergency response training for the locations in which the independent provider will be working. The condensed training referenced in the Resources for Onboarding DSPs guidance is acceptable.

With the uncertainty that many people with developmental disabilities and their families are facing, some independent providers may not be providing services to every person who they usually do provide services. If you are an independent provider and looking for more work, reach out to your local county board of developmental disabilities or local agency providers. Many people will be requiring more supports during this state of emergency, and agency providers will be looking for additional DSPs. Working for an agency may be a good way to supplement any income that may be lost during this state of emergency. 

Filing for unemployment may be an option for independent providers. The unemployment guidelines have changed due to the state of emergency.  

DODD recognizes that the following situational actions may seem excessive or unattainable due to the lack of personal protective equipment (PPE), residential space, the number of direct support professionals (DSP) or residential waiver settings that do not serve elderly or medically compromised people.

However, the following is intended to serve as a guide and is highly recommended to protect the people who the department serves and those caring for them.

All DSPs entering the residential waiver setting should be screened for symptoms using the Entry Screening Process for Prevention of COVID-19 Transmission tool. Staff performing health check screenings should wear facemasks.

DSPs with symptoms or with temperatures greater than 100.0 degrees Fahrenheit should be sent home, and DSPs who develop symptoms or fever while in the residential waiver setting should immediately go home (not to the urgent care or emergency room unless severely ill). 

Advise people who screen positive to contact their primary care physician by phone or telehealth. The HCP will determine whether the person needs to be evaluated in-person and will make a referral for evaluation and treatment, as necessary.  

Respite

DODD recognizes that many places, including residential waiver settings, provide much-needed respite services. During this time, providers should cancel all non-emergency respite stays. If a residential waiver setting is contacted to provide respite services, they must first contact the person’s local county board of developmental disabilities to discuss the need for the respite service.

If it is determined that the need is of an emergency nature, the provider may provide respite services to the person following the guidance above for the initial screening of the person.

To continue to support people being safe and staying in their current locations, the Ohio Department of Developmental Disabilities has  received approval to temporarily lift the maximum days allowed for Residential Respite services identified in the waiver rules for a person  during their waiver span. 

A county board of developmental disabilities may approve an extension during this time, as appropriate for the person, and begin discharge planning again once the state of emergency has concluded. 

Ohio Public Health Advisory System

LTSS Pre-Surge Planning Toolkit

Visitation

On April 2, 2020, while the stay-at-home order was in effect, DODD issued guidance on best practices for family visitation. Ohio is responsibly restarting, and Ohioans are making choices to resume activities while continuing efforts to control the spread of COVID-19. DODD is rescinding that guidance and issuing the following guidance on visitation in residential waiver settings.

When people with developmental disabilities express an interest in resuming social visits in their homes, their support teams and roommates should have conversations about the appropriateness of visits at this time. Teams and roommates need to determine when and how to safely and responsibly plan for visits inside and outside of the home.

Teams should assist in making visits as safe as possible by working with the person and other members of the household to follow the public health guidelines, including, but not limited to

  • educating all residents on the risks of the spread of COVID-19 and appropriate/applicable safety precautions to take when interacting with visitors,
  • educating all families/friends of the dangers of the spread of COVID-19 and the potential health impact for not just their loved one, but all residents and staff at the home,
  • educating all residents on the importance of face coverings and maintaining social distancing from people they do not currently live with when out of the home,
  • encouraging DSPs and visitors coming into the person’s home to always wear a face covering,
  • continuing frequent cleaning and sanitation of high touch surfaces and shared bathrooms, at least several times per day,
  • continuing to encourage the utilization of technology to keep in touch with families and friends,
  • and evaluating whether outdoor visitation would be more appropriate for members of the home.

Regional Residential Crisis Support Plan

This guidance includes the Regional Residential Crisis Support Plan and the Cross-Functional Flowchart for Residential Resource Crisis Response and Coordination (attached at right) to assist providers who are experiencing a residential crisis due to a lack of capacity or staffing from coronavirus (COVID-19). The regional teams outlined in these documents are to supplement and support local teams already in place and to assist those teams as needed.   

  • When a provider is experiencing a residential crisis, the Ohio Department of Developmental Disabilities (DODD) requests the provider look to first exhaust their internal resources. 
  • If the provider needs additional support, they should contact their local county board of developmental disabilities provider liaison to brainstorm solutions. 
  • If the local team requires additional support, they should contact the DODD regional residential support liaison in their region who will work to resolve concerns and, if appropriate, will engage the DODD Strike Team. 

Billing

In an effort to ensure service authorization and billing requirements are not undue barriers to service delivery and provider reimbursement throughout the coronavirus (COVID-19) state of emergency, the Ohio Department of Developmental Disabilities (DODD) is making the following changes to its processes for services delivered on or after March 12, 2020: 

  • Services authorized through electronic means (by telephone, email, etc.) will be reimbursed without being reflected in DODD’s Payment Authorization for Waiver Services (PAWS) system. County board of developmental disabilities should document the authorization locally through TCM case notes when possible, or by any other means available.  
  • An approved prior authorization (PA) will not be required for services that exceed the Ohio Developmental Disabilities Profile (ODDP) funding range for people enrolled in the Individual Options (IO) Waiver.
  • DODD’s Medicaid Services System (MSS) will not prevent the submission of claims that exceed the three percent (3%) limitation within the Monthly Rate Calculator (MRC).
  • Homemaker/Personal Care (HPC) services will be permitted to be delivered and reimbursed on the same day as Ohio Shared Living, if needed and authorized by the person’s individual service plan (ISP) team. 
  • Services for Level One Waiver enrollees will be reimbursed up to the total available funding within the waiver, which includes the current amount available for non-adult day array services ($6,750), plus the amounts currently available for adult day array services and Non-Medical Transportation.  
  • The $8,520 Emergency Services Benefit for the Level One Waiver will continue to be available, in addition to the funding reference in the previous bullet. 
  • The individual cost caps for the Self-Empowered Life Funding (SELF) Waiver are not being changed, but if enrollees have a need for services that exceed the established cost caps for children or for adults, county boards are being asked to identify ways to meet the specific needs. 

Please direct any questions regarding reimbursement for services to the DODD Support Hotline at 1-800-617-6733, option 2. 

It is likely that the expanded need for services in smaller groups and in residential settings will increase the cost of waiver services during the state of emergency. DODD acknowledges that the financial commitment to support the required state matching funds obligation for waiver services is shared between the department and county boards. As such, expenditures during this period will be closely monitored, and DODD will fully honor its financial partnership with county boards. As more information becomes available regarding the specific details of the various emergency funds that might be utilized to support services, DODD will collaborate with county boards about how to best access and allocate any available funding.

Regional Residential Crisis Support Plan 

Purpose: To create a regional team structured to triage crisis issues that residential providers experience as a result of the COVID-19 state of emergency. 

The Regional Residential Crisis Support Plan is triggered when:   

A residential provider does not have the staff or residential capacity to service a location regardless of suspected or confirmed COVID-19 transmission within the home. 

The Regional Residential Crisis Support Plan operates as follows: 

  1. Provider
  2. County Board
  3. DODD Regional Residential Support Liaison
  4. DODD Strike Team
  5. State Emergency Management Team

STEP 1: Provider Identifies Crisis Scenario and Attempts to Find Solutions 

  • The provider shall try to use existing resources to address the need as best they can using local means within their control. This could include hiring new staff, incentivizing existing staff to return to duty, reaching out to local independent providers (IP), or signing contracts with other residential providers to loan additional direct support professionals (DSPs) during the crisis. 
  • If that does not address the crisis, proceed to Step 2. 

STEP 2: Provider Contacts County Board Provider Support Liaison for Help 

  • After exhausting existing resources within their control, the provider should contact their county board provider support liaison for assistance. The county board liaison will make every effort to work within that county’s provider community to address the staffing shortage through any available means. 
  • If that does not address the crisis, proceed to Step 3.

STEP 3: County Board Contacts DODD Regional Residential Support Liaison for Help 

  • If a county board is unable to use existing resources within their county’s control, the board should contact the DODD regional residential support liaison assigned to their region to explore possible solutions from other providers outside their county. The DODD regional residential support liaison will report all residential crisis issues to Sara Lawson and will utilize any and all means available within their region to address the need. This may include contacting volunteer regional provider association representatives to identify additional capacity available based on the availability of resources within the time frame the crisis is identified. 
  • DODD Regional Residential Support Liaisons 

Region

Assigned

Backup

Northwest

Duana Coleman, CRC

Kim Mayne, Policy

Northeast

Julie Gregg, OSSAS

Heidi Davidson, OSSAS

Southeast

Ann Weisent, OSSAS

Kelly McGuire, CRC

Southwest

Matt Bavlnka, Polcy

Lisa Ahlersmeyer, OSSAS

Central

Angel Morgan, OSSAS

Beth Chambers, OSSAS; Kyle Corbin, Policy

  • If that does not address the crisis, proceed to Step 4.

STEP 4: DODD Regional Contacts DODD Strike Team for Help and Final Resolution

  • If DODD regional residential support liaisons cannot solve the problem with resources available to them, and all volunteer provider association representatives have been unable to identify additional capacity within the provider community, DODD regional staff will elevate the crisis to Sara Lawson, who will engage the DODD Strike Team. The Strike Team will consist of an “all hands-on deck” group of senior leaders at DODD who will work to take extraordinary measures using the all available departmental resources to ensure the crisis can be solved.  
  • If that does not address the crisis, proceed to Step 5.

STEP 5: DODD Strike Team Contacts State Emergency Management Team 

  • If DODD exhausts all options available to it, the department will contact the state’s top health officials and emergency management leaders to seek a final resolution outside the DODD’s control.  
  • The state emergency management team must provide final resolution to the crisis. There is no other option to elevate the concern past this step.

Cares Act Provider Relief Fund Application, Guidance

The CARES Act created a Provider Relief Fund to distribute federal funds to providers in response to COVID-19. The U.S. Department of Health and Human Services (HHS) expects to distribute $15 billion to eligible Medicaid and Children’s Health Insurance Program (CHIP) providers.

All Ohio providers are eligible to apply for relief funds through the provider relief portal. This portal allows providers to attest to relief fund payments made for healthcare-related expenses or lost revenue attributable to COVID-19.

Before applying through the provider relief portal, The Ohio Department of Developmental Disabilities strongly encourages applicants to read the Medicaid Provider Distribution Instructions and download and complete the Medicaid Provider Distribution Application Form.

Questions? Support is available by contacting HHS at (866) 569-3522.

Certification Spans

With the impact of the COVID-19 state of emergency, the Ohio Department of Developmental Disabilities (DODD) will be issuing automatic 90-day certification extensions to all providers expiring in March, April, and May 2020.

For example, a provider’s certification set to expire April 5, 2020, will automatically be extended, and the provider will receive a new expiration date of July 5, 2020.

This will allow providers time to focus on providing services to people with developmental disabilities and delay the need for submitting a renewal application. DODD will continue to monitor the situation during this time of emergency.

Direct Support Professional Onboarding & Training

DODD is asking day program providers to collaborate in order to subcontract employees from day programs to help cover shifts needed. If active treatment cannot be provided, this should be documented on an individual basis. waiver providers should try to be creative and complete goals and activities.

If a provider has not met a specific non-emergency training requirement, they should document the reason. Training must continue to meet each person’s needs, health, and safety.

DODD encourages providers to explore alternative service delivery methods. People receiving services, guardians, and teams must be consulted and approve these alternatives.

Providers may explore the availability of an alternative workforce, such as college students or people without high school diplomas or GEDs. The staff person without a high school diploma or GED may be placed in a direct support position immediately but a rule waiver should must be requested and will be granted expeditiously by DODD. The person may provide direct support while the waiver request is pending.

A provider who chooses to utilize non-traditional staff in direct support positions must initiate appropriate background checks, driver’s abstract (if driving), and the required registry checks, but may place the staff person on the schedule immediately. 

Beginning September 1, 2020, an agency that is hiring a new direct support professional may hire that person, but must initiate the BCII check within 10 days and enroll the person in RAPBACK within 14 days of the receipt of the BCII report.

Online CPR/first aid classes will be accepted until further notice.

DSPs without current CPR/first aid may provide direct supports as long as they are working with a nurse or at least one other staff person who has current CPR/first aid certification.

Even with the relaxed training requirements described above, the medication administration training requirements have not changed. All staff who are responsible for administering medication must have medication administration training. 

Onboarding DSPs

As the Ohio Department of Developmental Disabilities (DODD) responds to coronavirus (COVID-19), please continue to exercise flexibility to ensure the health and safety of Ohioans with developmental disabilities and their families. DODD appreciates the unique role that providers of service and direct support professionals (DSPs) play throughout the developmental disabilities system.

Initial Training

  • New training requirements
    • Ensure that newly hired or reassigned staff have condensed training to recognize and report major unusual incidents (MUIs) and unusual incidents (UIs), as well as universal precautions. The training must include, at minimum, the definitions of MUIs and UIs, as well as the agency’s procedures for reporting.
  • Condensed training resource
    • The Ohio Alliance of Direct Support Professionals (OADSP) created a DSP Abbreviated Training video and accompanying PowerPoint presentation.

CPR/First Aid

  • New training requirements
    • Online CPR/first aid classes will be accepted until further notice
    • Staff without current CPR/first aid may provide direct support if they are working with a nurse or at least one other staff person who has current CPR/first aid.

Medication Administration

Updated April 2*

  • Guidance regarding medication administration
    • The medication administration training requirements have not changed.
    • However, the initial medication administration training can be conducted remotely for a limited portion.
    • It is up to the specific register nurse (RN) trainer as to what this blended training looks like.
    • Providers whose certifications are expired for no more than 180 days may continue to administer medications and get renewal of certifications during that extension.

BCII and/or FBI Background Checks

  • Guidance regarding background checks
    • If a provider is unable to initiate the required Bureau of Criminal Identification and Investigation (BCII) and/or Federal Bureau of Investigation (FBI) check before employment, the provider can employ an applicant and has up to 10 calendar days to initiate the BCII and/or FBI criminal record check.
  • Background check locations
    • Ohio Attorney General’s website
    • Please call ahead before traveling to any location to verify they are open and providing fingerprinting services at this time.

Behavioral Supports, Including Rights Restrictions

Updated September 25

Any plans with new behavioral support strategies must be developed following the behavioral supports rule, 5123-2-2-06.  Any plans that were put in place or continued during the emergency and not following the rule, but as instructed in prior guidance issued by the Ohio Department of Developmental Disabilities (DODD), must be evaluated for necessary action by December 31, 2020. For example, if regular team reviews have been suspended, these reviews should begin again. Each county board of developmental disabilities and intermediate care facility (ICF) should develop a process so that each person’s plan is reviewed by the team by December 31, 2020. Thereafter, plans must be reviewed every 90 days. Meetings may be held virtually.

Similarly, if, under prior DODD guidance, plans with behavioral support strategies were implemented without human rights committee (HRC) review and approval, each county board of DD and ICF should develop a process to begin reviewing these plans and seeking HRC approval when necessary. DODD understands that county boards of DD and ICFs may have suspended restrictive measures notification (RMN) entries during the emergency.  We expect county boards of DD and ICFs to begin implementing the process to accomplish all these activities now. However, the department also realizes that it will take some time to put everything in place.  All plans should meet the requirements of the behavioral support rule by January 31, 2021. HRC meetings may be held virtually.

DODD Support Teams

In this critical time, everyone will be required to work collaboratively, operate differently, and be proactive to limit the spread of COVID-19. During this state of emergency, DODD fully realizes there are on-the-ground issues that require flexibility from normal operations and additional assistance from the department.

DODD support teams are available and consist of staff ready to help county boards and providers.

DODD has set up a dedicated web page for department communications and links to helpful resources that will advise people with disabilities, their families, service providers, direct support professionals, county boards of developmental disabilities, and the community at large.

For specific questions about COVID-19 and additional information and resources, DODD urges you to use the Ohio Department of Health’s call center. Call 1-833-4-ASK-ODH (1-833-427-5634), or visit coronavirus.ohio.gov.