1. 1 Home Care Attendant: An Overview of Provider Requirements Bureau of Long Term Care Services and Supports

2. 2 Home Care Attendant New Rules OAC 5101:3-46-04.1 (Ohio Home Care Waiver Program: Home Care Attendant Services) OAC 5101:3-46-06.1 (Ohio Home Care Waiver Program: Home Care Attendant Services Reimbursement Rates and Billing Procedures) OAC 5101:3-50-04.1 (Transitions Carve-Out Waiver Program: Home Care Attendant Services) OAC 5101:3-50-06.1 (Transitions Carve-Out Waiver Program: Home Care Attendant Services Reimbursement Rates and Billing Procedures)

3. 3 Home Care Attendant Home Care Attendant Services: –Permits unlicensed individuals (non-agency providers) to assist consumers with: Self administration of medications Performance of certain skilled tasks that would otherwise be completed by a nurse Personal care tasks

4. 4 HCA services are provided to consumers in lieu of nursing services. HCA services are not in lieu of personal care aide services.

5. 5 Home Care Attendant HCA can assist with certain medications including: Oral medications (includes medication administered through a metered dose inhaler) Topical medications (includes medication applied to outer skin, including transdermal medications and eye, ear and nose drops, vaginal or rectal suppositories) Subcutaneous injections of routine doses of insulin

6. 6 Home Care Attendant HCA can assist with certain medications including: Programming of a pump to administer routine doses of insulin Medication via stable, labeled gastrostomy or jejunostomy tubes Doses of schedule II, III IV or V drugs only when administered orally or topically

7. 7 Home Care Attendant Nursing tasks that Home Care Attendants can not perform: Intravenous insertion, removal, or discontinuation Intramuscular injections IV medication administration Subcutaneous injections (except for routine doses of insulin)

8. 8 Home Care Attendant Nursing tasks that Home Care Attendants can not perform: Programming of a pump to deliver medications (including epidural, subcutaneous and IV), except routine doses of insulin Insertion or initiation of infusion therapies Central line dressing changes

9. 9 HCA’s who provide activities to a consumer in accordance with the limitations as set forth in the rules, including activities in accordance with the authorizing health care professional’s authorization shall not be considered to be engaging in the practice of nursing as an RN or LPN in violation with the Nurse Practice Act.

10. 10 HCAs must: Not be the consumer’s authorized representative. Not be the consumer’s legally responsible family member as defined in 5101:3-45-01 of the Ohio Administrative Code. Not be the consumer’s legal guardian or foster parent.

11. 11 The HCA will secure the services of a RN, in agreement with the consumer and/or authorized representative. The HCA must participate in face-to-face visit upon the initiation of services and every 90 days thereafter with the consumer, authorized representative, and the RN for the purpose of monitoring the consumer’s health and welfare. The RN will serve as a resource for the purpose of answering any questions that the HCA, consumer, and/or authorized representative have about the consumer’s needs, medications and other issues.

12. 12 The face-to-face RN consultation visit activities shall be documented by the HCA and the RN in the consumer’s clinical record. The HCA will discuss the results of the face to face consultation visit with the CM and the consumer and/or authorized representative.

13. 13 Clinical Records must be maintained by the HCA for each consumer in a manner that protects the consumer’s privacy and confidentiality of these records. HCA must maintain the clinical records at their place and business and also maintain a copy at the consumer’s residence. –The HCA’s place of business is considered to be a location other than the consumer’s residence.

14. 14 The HCA’s clinical record must include the following information: –Consumer’s identifying information, including, but not limited to: name, address, age, date of birth, race, marital status, significant phone numbers and health identification numbers. –Consumer medical history.

15. 15 HCA’s clinical record must include the following information: (continued) Names and contact information for all of the consumer’s licensed health care professionals. Copy of the initial and subsequent all service plans. Documentation of all allergies and dietary restrictions.

16. 16 The HCA’s clinical record must include the following information: (continued) –A copy of any advance directives, including but not limited to a “do not resuscitate order” (DNR) or a “medical power of attorney” if they exist. –The ODJFS 2389 and 2390 Forms as appropriate.

17. 17 HCA’s clinical record must include the following information: (continued) –Documentation of HCA services performed or not performed, arrival times, departure times, and the dated signature of the provider, and consumer or authorized representative, verifying service delivery upon completion. Nothing shall prohibit the use of technology-based systems. The consumer’s or authorized representative’s signature of choice shall be documented on the consumer’s all services plan, and shall include, but not be limited to the following forms: handwritten signature, initials, a stamp or mark, or electronic signature.

18. 18 HCA’s clinical record must include the following information: (continued) –Copy of the log detailing the count and reconciliation of schedule II-V drugs for which the HCA is assisting consumer with self- administration.

19. 19 HCA’s clinical record must include the following information: (continued) –Progress notes, signed and dated by the HCA documenting all communications with the CM, licensed health care professionals, including the authorizing health care professional, other members of the multidisciplinary team.

20. 20 HCA’s clinical record must include the following information: (continued) –Documentation of the face-to-face visits at the initiation of service, and every 90 days with HCA, consumer and the authorized representative and the RN. –For the first visit, document that CM was present. –The documentation should include issues discussed at the visit.

21. 21 HCA’s clinical record must include the following information: (continued) –Discharge summary that is signed and dated by the departing HCA when services are no longer provided. The summary should include documentation regarding progress made toward achievement of the goals as specified in the all services plan.

22. 22 HCAs must: Request reimbursement for the provision of HCA services in accordance with 5101:3-46-04.1 and 5101:3-50-04.1

23. 23 To be reimbursed as a HCA, the provider must be identified and specified on the consumer’s all services plan that has been prior-authorized prior authorized by ODJFS or its designee.

24. 24 Upon request of the consumer or the consumer’s authorizing health care professional, the HCA must perform a successful return demonstration of the service to be provided. Meaning the consumer or the authorizing health care professional can ask the HCA to perform in front of the them a specific task to determine that the HCA has the ability to correctly perform task. What does this mean?

25. 25 –HCA must complete at least 12 hours of continuing education regarding HCA services annually. Evidence of completion must be submitted to the department no later than the annual anniversary date of the issuance of the HCA’s initial Medicaid provider agreement.

26. 26 Continuing education topics can include but are not limited to the following: –Consumer health and welfare –CPR –Patient rights –Emergency preparedness –Communication skills –Aging sensitivity –Developmental stages –Nutrition –Transfer techniques –Disease-specific trainings –Mental health issues

27. 27 The consumer, authorized representative, and provider shall report to the case manager all instances that a HCA appears to have: –Provided nursing services, other than assistance with self-medication or the performance of nursing task authorized in the rules. –Provided services not in accordance with the tasks and assistance with self-medication which had been approved by the authorizing health professional’s authorization. Who (in the department) receives this reported information?

28. 28 ODJFS may initiate an investigation based on the report of a HCA providing inappropriate services and shall report the findings to the Ohio Board of Nursing.

29. 29 Home Care Attendant Provider Enrollment New Provider Type 26-Home Care Attendant Interested providers will need to complete a new provider application with HCA provider addendum »Required for all providers including existing waiver providers

30. 30 ODJFS agrees to enter into a provider agreement with an individual to provide HCA services to a consumer enrolled on the following waivers: –Ohio Home Care Waiver –Transitions Carve Out Waiver

31. 31 The HCA must: Agree to comply with all Medicaid provider requirements in Division 5101:3 of the Administrative Code. Agree to comply with all of the waiver provider requirements in 5101:3-45, 5101:-46 and 5101:3- 50 of the Administrative Code.

32. 32 The HCA must: Agree to comply with the requirements in 5111.88 and 5111.8811 of the Revised Code and all requirements set forth in this rule.

33. 33 HCA shall not provide services until: –ODJFS approves the JFS 2389/ 2390 Home Care Attendant Medication Administration Authorization or Home Care Attendant Skilled Nursing Task Authorization that contains the following: Written consent from the consumer or authorizing representative allowing the HCA to provide HCA services, and assuming responsibility for supervising the activities of the HCA. When there is authorized representative, who is supervising activities of the HCA, they will be present and awake during the delivery of the services.

34. 34 –Written consent from the consumer’s authorizing health care professional attesting that the consumer and or the authorized representative have demonstrated the ability to monitor the consumer-specific HCA service for the consumer. This consent includes all of the following: Consumer’s name and address; Description of the specific nursing task or self-administration of medication that the HCA will assist consumer, including the self- administration of medication, name of medication, dosage, and route of administration; Times or intervals when HCA is to assist with self-medication of each dosage of medication or performance of nursing tasks;

35. 35 –This consent includes all of the following: (continued) Dates which HCA is to begin and end providing assistance; List of severe adverse reactions that the HCA must report to the consumer’s health care professional if one should occur; At least one telephone number which the HCA can reach the consumer’s health care professional in an emergency for consultation after contacting an emergency personnel; At least one fax number that the HCA can reach the authorizing health care professional when the HCA observes that the scheduled medication's) is missing or can not be reconciled.

36. 36 This consent includes all of the following: (continued) Instructions the HCA must follow when assisting the consumer with performance of a nursing task or self-administration of medications, including, but not limited to instructions for maintaining sterile conditions and for storage of task-related equipment and supplies.

37. 37 HCAs must: –Be at least 18 years old –Provide HCA services to consumer enrolled on the Ohio Home Care Waiver or Transitions Carve Out Waiver

38. 38 To make application as a HCA, the individual must have a valid Social Security number and one of the following forms of identification: –Alien ID –State of Ohio ID –Valid Driver’s License

39. 39 HCA applicant must: –Provide ODJFS evidence to its satisfaction of all of the following: –HCA either meets the personnel qualifications as specified in 42 CFR 484.4 for home health aides, or has successfully completed at least one of the following: »Competency evaluation program, or training and competency program by the Ohio department of health

40. 40 A training program approved by the department that includes training equivalent to a training and competency evaluation program (CSTO-Consumer Specific Training Option) which includes: Basic Home Safety Universal Precautions Consumer-specific personal care aide services The labeling, counting, and storage requirements for schedule II, schedule III, schedule IV and schedule V medications

41. 41 HCA must provide ODJFS a certificate of completion of a first aid course that: –Is not exclusively internet based –Includes hands-on skills training provided by a certified first aid instructor –Requires the individual to perform a successful demonstration of what was learned in the course Who (in the department) receives this certification?

42. 42 HCA must show ODJFS evidence of training and instruction about how to deliver the HCA services that are authorized by submitting the ODJFS 2389/2390 with application packet. –Training is consumer-specific and may be provided by the authorizing health care professional and/ or the consumer or the authorized representative in cooperation with the consumer’s authorizing health care professional.

43. 43 The HCA must receive education from the authorizing health care professional about health and welfare considerations that are appropriate for an individual or group setting.

44. 44 HCA Services in Group Setting (Approved on a Case by Case basis only) –HCA’s can only provide HCA services to 2 or 3 consumers at the same residence, at the same time within the limitation noted below. –Subject to approval by clinical review by ODJFS in consultation with the consumer, authorizing health care professional, CM and the multidisciplinary team. –Clinical review includes the consumers’ needs, and desires, and the skill level and training needs of the HCA and the ability to assure health and welfare of the consumers.

45. 45 Home Care Attendant HCA service providers are limited to providing a maximum of 12 hours or forty-eight units of HCA services during a 24 hour period. –Exception is made for HCA services that are provided in a group setting.

46. 46 Home Care Attendant Reimbursement This means that claims that are submitted for a single date of service that are in excess of 48 units will be denied.

47. 47 Home Care Attendant Reimbursement This does not mean that a consumer can only receive 12 hours of HCA service a day. If consumer requires more than 12 hours a day of HCA service there would need to be at least 2 shifts and 2 different service providers.

48. 48 Home Care Attendant Provider Requirements Questions

49. 49 Home Care Attendant Billing Instructions

50. 50 Home Care Attendant Reimbursement New Code S5125=Home Care Attendant Services/Nursing »Base Rate=$33.36 »Unit Rate=$4.17

51. 51 Home Care Attendant Reimbursement New Code S5125=Home Care Attendant Services/Personal Care »Unit Rate=$3.00 »New modifier U8

52. 52 Home Care Attendant Codes and U8 Modifier

53. 53 Home Care Attendant S5125 (HCA/N) – This home care attendant code is noted on a claim when authorized nursing tasks and/or authorized medication assistance are provided.

54. 54 Home Care Attendant S5125 with U8 modifier (HCA/PC) – This home care attendant code (modified with the U8 modifier) is noted on a claim when the provider provided personal care tasks to a consumer during the same visit authorized nursing tasks and/or authorized medication assistance were provided.

55. 55 Home Care Attendant NOTE: Providers cannot bill the S5125 code modified with the U8 modifier unless authorized nursing tasks and/or authorized medication assistance were provided during the same visit.

56. 56 Home Care Attendant Modifiers U2 – This modifier reflects the second HCA (HCA/N or HCA/PC) visit provided on the same day, for the same consumer, by the same provider.

57. 57 Home Care Attendant Modifiers U3 – This modifier reflects the third or more HCA (HCA/N or HCA/PC) visit provided on the same day, for the same consumer, by the same provider.

58. 58 Home Care Attendant Modifiers U8 – This modifier reflects the HCA/PC tasks performed during an HCA visit. A provider can only bill the HCA/PC tasks when the provider provided personal care tasks to a consumer during the same visit where authorized nursing tasks and/or authorized medication assistance were provided.

59. 59 Home Care Attendant Visits Each HCA visit must be billed on a separate line, and there must be a two or more hour lapse between any previous or subsequent HCA visits. Therefore, all of the HCA services that aren’t separated by a two hour or more lapse are provided within one HCA visit. However, HCA/N and HCA/PC tasks provided during the same visit are billed on separate lines.

60. 60 Home Care Attendant Questions