OAC 317:30-5-763. Description of services (Part 85, ADvantage Program Waiver Services)

What this rule requires your agency to do

• 1ADvantage home care agency skilled nursing staff, working in coordination with the ADvantage case manager, are responsible for developing and monitoring the member's personal care services. (OAC 317:30-5-763(14)(B))(OAC 317:30-5-763. Description of services (Part 85, ADvantage Program Waiver Services))
• 2ADvantage personal care services must be prior-authorized and billed per fifteen (15) minute unit, limited to the units on the approved person-centered service plan. (OAC 317:30-5-763(14)(C))(OAC 317:30-5-763. Description of services (Part 85, ADvantage Program Waiver Services))
• 3ALC reports of critical incidents must be made to the member's ADvantage case manager and the AA within one (1) business day of discovery, with follow-up within five (5) business days and a final report within ten (10) business days. (OAC 317:30-5-763(18)(D)(viii)(III))(OAC 317:30-5-763. Description of services (Part 85, ADvantage Program Waiver Services))
• 4Providers of ADvantage services for a member (or persons with an interest in or employed by such a provider) must not provide case management or develop the person-centered service plan for that member, except under the AA-demonstrated sole-provider exception. (OAC 317:30-5-763(1)(B))(OAC 317:30-5-763. Description of services (Part 85, ADvantage Program Waiver Services))
• 5The ALC must notify the AA and give written notice to the member, member's representative, and case manager ninety (90) calendar days before terminating or not renewing its ADvantage contract or closing all or part of the ALC. (OAC 317:30-5-763(18)(F))(OAC 317:30-5-763. Description of services (Part 85, ADvantage Program Waiver Services))
• 6In-home respite billed per fifteen-minute unit requires a minimum of eight (8) units (two hours) and maximum of twenty-eight (28) units (seven hours) within any one-day period. (OAC 317:30-5-763(2)(B))(OAC 317:30-5-763. Description of services (Part 85, ADvantage Program Waiver Services))
• 7Prior to performing an APSA task for the first time, the APSA must demonstrate competency in an on-the-job training session conducted by the member, and the member must document the attendant's competency in each task in the APSA's personnel file. (OAC 317:30-5-763(16)(A)(ii))(OAC 317:30-5-763. Description of services (Part 85, ADvantage Program Waiver Services))
• 8Providers may only claim time for billable case management activities; ancillary activities such as clerical tasks, driving time, or supervisory and administrative activities are not billable. (OAC 317:30-5-763(1)(C))(OAC 317:30-5-763. Description of services (Part 85, ADvantage Program Waiver Services))