Consumer Homepage

Welcome!
This section is for Consumers in the Ohio Home Care Program (Ohiohcp).

What is a Consumer?
Consumers are individuals enrolled in the Ohiohcp integrated program of home care services.

Consumer Information at your Fingertips
In this section, you will be able to find everything you need to know about the Ohiohcp. Please look through it as well as the entire website to learn more about your rights and responsibilities, the program, providers and Ohio Home Care personnel.

Team Communication
Consumers are responsible for their care and serve as an important part of the care team. Therefore, it is important that they use their lines of communication to keep them active throughout the service. Please share information, comments and other feedback that you feel is important. Use the Ohiohcp Feedback Form in the Contact Us section.

Consumer Handbook

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View the Handbook below.

Welcome
The Ohiohcp wants you to be successful as a Consumer of services. When you join the Ohiohcp you will receive a hard copy of the Consumer Handbook, which was created for your benefit. However, you may also reference the online version of the handbook (below) for your convenience. We hope you find it helpful. Please review the material and feel free to contact us with any questions or comments.

The Department of Job and Family Services has contracted with CareStar, a privately owned business, to provide Case Management for the Ohiohcp. Case Management will assist to improve access to and delivery of home health services. The Ohiohcp will provide you with a Case Manager (CM) and a list of service providers and community resources to help you in your home care choices. There is no charge to the consumer for the Case Management services of the Ohiohcp. The ODJFS has provided this for you to ensure that you have access to the needed services.

Your Case Manager will act as a Team Leader to coordinate services and systems so that you have access to the services needed to keep you safely in the community. Case Management promotes self-sufficiency and personal responsibility by encouraging you to actively participate in the planning and delivering of home health services.

The Ohiohcp will continuously monitor the effectiveness of your home health services and with your involvement make changes necessary to achieve positive outcomes. Those individuals and agencies, paid and non-paid, that contribute to your care will be expected to serve as contributing members on your Home Care Team.

Consumer Responsibilities
We consider you the DIRECTOR of your Ohiohcp Services. When you are well informed, participate in care decisions, and communicate openly with team members, your services will be as effective as possible.

The following is a statement of the responsibilities of individuals receiving Case Management Services. Consumers and Guardians in The Ohiohcp should:
• Communicate openly and honestly with Case Managers, Providers, and other members of the Home Care Team
• Provide accurate and complete information
• Actively participate in the planning, implementation, and resolution of any problems or concerns
• Inform your Case Manager if problems or concerns arise and before you initiate any changes regarding your choice of providers or need of services
• Cooperate with your home care team toward the resolution of any problem or concern
• Refuse participation in any fraudulent or dishonest practices by providers, caregivers and any team members


Consumer Rights
The following is a statement of the rights of individuals receiving case management services. This is an outline of the basic tenets that should be followed in providing services. All individuals who receive services funded by the ODJFS are entitled to the following rights.

Consumers of the Ohiohcp have:

• The right to be fully informed of all rights and responsibilities
• To be treated with dignity and respect
• The right to have services/supports explained to you by the Case Management Agency (CMA) so that you can understand them
• The right to receive a timely response from the CMA
• The right to be protected from abuse, neglect, and mistreatment
• The rights to be kept informed and receive accurate and easily understood information
• The right to choose an authorized Medicaid approved provider that will provide appropriate high-quality services
• The right to talk in confidence and have health care information protected
• The right to self-determination and participation in the development of the all services plan
• The right to voice complaints and suggest changes in service or staff without fear of restraint or discrimination
• The right to question the process for any decision related to eligibility or funding from ODJFS by filing an appeal
• The right to see any files/records related to health care
• The right to be fully informed of the ODJFS agency departments established to receive complaints or inquiries. (ODJFS, Bureau of Home and Community Services: (614) 466-6742 and ODJFS, Consumer Hot Line: (800) 324-8680)

Program Overview
Ohio Home Care Waiver ... is the benefit package which consists of Nursing services, Non-Agency Personal Care Aid and/or Skilled Therapy services plus one or more waiver specific service such as: home modifications, home delivered meals, adult day health care, respite care, supplemental transportation, adaptive/assistive devices, and emergency response systems. It is designed to meet the needs of consumers eligible for Medicaid who have been assessed to require an intermediate or skilled level of care. Without the services available through the Waiver benefit, these consumers are at risk for hospital or nursing home placement. Consumers approved for the Ohiohcp Waiver benefit may receive care and services at home or they may choose to receive their care in a nursing facility.

Transitions MRDD Waiver … is the benefit package which consists of all of the services as listed above however it is designed to meet the needs of consumers eligible for Medicaid who have been assessed to require an ICFMR/DD (intermediate care facility for the mentally retarded/ developmentally disabled) level of care. This Waiver is not open to new enrollees. You must first be on the Ohiohcp Waiver and be “transitioned” due to level of care considerations.

Transitions Carve Out Waiver…is the benefit package which consists of all of the services as listed above however it is designed to meet the needs of consumers who are age 60 and over. Eligibility criteria requires having either an intermediate or skilled level of care. This Waiver is not open to new enrollees. You must first be on the Ohiohcp Waiver and be “transitioned” due reaching age 60.

Home Care Options
For consumers receiving Ohio Home Care, Transitions Carve-Out and Transitions MR/DD Waivers, the following may apply:

Skilled Therapy, Skilled Nursing and Non-Agency Personal Care Aids may be provided by a Medicare Certified Home Health Agency.

Skilled Nursing services and Non-Agency Personal Care Aid services may be provided by a Medicare Certified Home Health Agency, a JCAHO accredited agency or a CHAP accredited agency.

Skilled Therapy services may be provided by any family member if they do so as an employee of a Medicare Certified Home Health Agency.

Skilled Nursing services may be provided by any qualified family member if they do so as an employee or a Medicare Certified Home Health Agency, a JCAHO accredited agency or a CHAP accredited agency.

For consumers receiving Ohio Home Care and Transitions Carve-Out Waivers, the following may apply:

Skilled Nursing services and Non-Agency Personal Care Aid services may be provided by a family member as a Non-Agency Provider if the family member is:
-Not the consumer’s legally responsible party (spouse, parent of a minor, or legal guardian)
-Not the consumer’s foster parent

For consumer’s receiving Transitions MR/DD Waiver, the following may apply:

Skilled Nursing and Non-Agency Personal Care Aid services may be provided by a Non-Agency Provider who is not the consumer’s immediate relative including: husband or wife; birth or adoptive parent, child or sibling; stepparent, stepchild, stepbrother, stepsister, half-brother, or half-sister; father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law or sister-in-law; grandparent or grandchild; or spouse of grandparent or grandchild.

Home Care Providers
There are generally three types of home care providers: Agency Providers, Waiver Service Providers, and Non-Agency Providers.

AGENCIES
Home Care Agencies are companies that have a provider agreement with the ODJFS and have been issued a Medicaid Provider Number. They must be either Medicare certified or accredited by Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or Community Health Accreditation Program (CHAP). As such, they must provide services according to established standards of practice. They are reviewed periodically to ensure that they are following Medicare guidelines and/or the accreditation standards. Agencies must provide supervision and training of Licensed Practical Nurses and Non-Agency Providers (home health aides). They have liability insurance and their employees are covered under Workers Compensation and are usually bonded against loss of property. Agencies are the employer of the individuals performing the in-home services. As such, they handle all employment activities including hiring, firing, scheduling, and paying. JCAHO and CHAP accredited agencies may not provide all services to all consumers. It is necessary to have all agency services authorized by your Case Manager before the services are provided.

WAIVER SERVICES PROVIDERS
Waiver Services Providers are companies that provide the additional services available only to Waiver consumers including: home delivered meals, emergency response systems, supplemental transportation, home modifications, adaptive/assistive devices, adult day health care, and out-of-home respite. They have signed a Provider Agreement with the ODJFS and have been issued a Medicaid Provider Number. The individuals that deliver meals, install emergency response systems, or etc are employees of that business. The management of that business must fulfill all employment responsibilities including hiring, firing, supervising, scheduling and paying. Only approved Medicaid Waiver Providers can provide Waiver Services and all such services must be prior authorized by your Case Manager.

NON-AGENCY PROVIDERS
Individuals may obtain a Medicaid Provider Number from the ODJFS. They are then eligible to provide home care services directly to the consumer. These individuals have signed a Medicaid Provider Agreement so they are self-employed. They are responsible for their own billing, taxes, etc. The consumer provides direct supervision for the Non-Agency Provider. The Ohiohcp provides some oversight and monitoring. All Non-Agency Providers must have a current license and adhere to the standards established by the Ohio Nursing Board. Non-Agency Providers must have completed either:

• home health aide training program and competency evaluation (HHA),
• nursing home training program and competency evaluation (STNA), or
• consumer specific training option

All Non-Agency Providers must complete an annual criminal background investigation and structural review as part of Case Management monitoring.

Non-Agency Providers must understand and follow the rules and Conditions of Participation that have been established by the ODJFS. If a consumer chooses to receive services from a Non-Agency Provider he/she must be willing to:
• Participate in development of his/her All Services Plan
• Participate in selection of service providers
• Select, evaluate and dismiss Non-Agency Provider
• Participate in the training and supervision of Non-Agency Providers
• Obtain Case Manager approval before adding or making changes in providers or services
• Approve individual provider time sheets in writing
• Develop a back-up plan for individual provider absences and emergencies and submit to the Case Manager
• Notify the Case Manager if any problems or concerns arise
• Demonstrate to the Case Manager that there are sufficient skills to direct his/her own care



Provider Management Services
The Ohiohcp assists those individuals and agencies that provide Medicaid services to consumers through the following areas:

Provider Enrollment assists in the identification and utilization of qualified Medicaid Providers by:
• Helping consumers and provider applicants understand the Ohio Home Care Rules and the enrollment process
• Assisting applicants with the completion of the Medicaid Provider Application and forwarding the completed application to the State for issuance of a Medicaid Provider Number
• Maintaining a database of active Medicaid Providers and making this database accessible to consumers
• Identifying under-served areas and recruiting service providers to better meet consumer needs
• Supply education to the providers to assure their continued participation in the Ohiohcp

Provider Monitoring assists in assuring that providers are in compliance with State program requirements and directives by:
• Completing an annual structural review for every Non-Agency Provider which includes an audit of the provider’s billing and a review of the provider’s performance
• Tracking criminal background check updates anually
• Assuring compliance with plans of corrections submitted by providers in response to identified need for performance improvement

Incident Investigation and Reporting provides assurance that consumers are protected from situations that may result in harm, injury or loss by:
• Investigating consumer incidents and provider occurrences for substantiation of risk, identification of violation and violator, establishment of a prevention plan and a provider plan of correction, when appropriate
• Reviewing incidents and occurrences for patterns and trends that may identify the need for further education, processes, or regulation
• Completing reports and making recommendations to assist the State with the assuring that consumers receive appropriate services and are protected from harm

Commonly Asked Questions  
1. Who will be my Case Manager?
2. When should I call my Case Manager?
3. How do I reach my Case Manager?
4. How often will I receive a visit from my Case Manager?
5. What will my Case Manager help me do?
6. What is a Home Care Team?
7. What are State Plan Home Care Services?
8. What is the individual cost range?
9. What are Non-Agency Provider Services?
10. What is an All Services Plan?
11. If I don’t use all the services or hours calculated in my monthly cost, can I save them for use in a future month?
12. What should I do if my nurse or aide doesn’t arrive when I’m expecting him/her?
13. Why do I need a back-up caregiver or plan?
14. What should I do if I have a complaint about any of my services or providers?
15. Can I choose my providers?
16. What do I do if a service is denied, or a decision is made and I don’t agree?
17. What if I’m not pleased with my Case Manager?
18. Who should I call if I have an emergency?
19. Will I have any privacy?
20. Now that I have Case Management services, do I have to continue my involvement with the County Department of Job and Family Services?
21. Will anyone other than my Case Manager check with me to see if I am satisfied with my home care?
22. Do I have to have an OHCP Case Manager?
23. I have the Waiver with a “patient liability”. What does this mean?

 1. Who will be my Case Manager?
Your Case Manager will be a Registered Nurse or a Licensed Social Worker. He/she has completed special training to be able to coordinate the services that you may need. He/she will serve as the leader for your Home Care Team.

2. When should I call my Case Manager?
You should contact your Case Manager when:
• Your services are not meeting your needs
• Your home situation changes
• Your health changes, which includes an accident or fall
• You make a trip to the emergency room or are treated for an infection
• You are admitted to a hospital or nursing home
• You are unhappy with a provider or a service
• You want to change a provider or service
• You have questions about community resources
• You have any other concern or problem


3. How do I reach my Case Manager?
You may contact your Case Manager by calling the regional office. The business hours are 8:00 am until 5:00 pm Monday – Friday; however, for urgent issues, follow the phone prompts to obtain after hours assistance. If your Case Manager is not in the office, you may leave a message on his/her voice mail or speak with a supervisor. Your Case Manager will give you his/her direct voice mail number written on pages 2 and 5. This gives you an opportunity to leave a message for him/her without speaking to office personnel. Case Managers respond to all voice messages by the end of the next business day. Urgent issues should be brought to the immediate attention of a supervisor.

4. How often will I receive a visit from my Ohiohcp Case Manager?
Your Ohiohcp Case Manager will contact and visit you more frequently when you are first approved for the Ohio Home Care Waiver program, then the frequency of visits may be reduced. If a problem occurs, like a trip to the hospital, your Case Manager may make an extra visit. Your Case Manager will establish a schedule with you but never hesitate to call your Case Manager anytime you have any questions or concerns.

5. What will my Ohiohcp Case Manager help me do?
Depending on your program, your Case Manager can help you:
• find a nurse or Non-Agency Provider or change to a different provider
• arrange for meals to be delivered or have an emergency response system installed if medically indicated
• coordinate respite care relief if there is an urgent need for the primary caregiver to be out of the home
• talk with school officials or community agencies to help resolve any troubling issues
• inform you of your choices if your services or living
arrangements are not meeting your needs
• assist in obtaining equipment, home modification and adaptive/assistive equipment

6. What is a Home Care Team?
The individuals and agencies that help you remain in your home make up your Home Care Team. In addition to you and your Ohiohcp Case Manager, your Home Care Team will include all of your Medicaid Providers, other community resources, family members and volunteers.

7. What are State Plan Home Care Services?
State Plan Services are Nursing services, Non-Agency Provider services, and Skilled Therapy services available to all eligible Medicaid consumers.

8. What is the individual cost range?
The Home Care Team establishes goals and identifies services based on the consumer’s functional abilities, living conditions, and medical necessity. The cost range is the amount of money approved to be spent on your Medicaid home care needs for a specified period.

10. What is an All Services Plan?
This is the document that you and your Case Manager develop with the input of the Home care Team. The All Services Plan (ASP) lists your goals, the needed services, the service providers, the cost of services and who is liable for payment, your decision regarding consumer options, and your home care team members. The All Services Plan is used by your providers as authorization for their billing. It is important that the consumer and providers receive a copy of the All Services Plan and understand its contents.

11. If I don’t use all the services or hours calculated in my monthly cost, can I save them for use in a future month?
No. All services stated on the All Services Plan must be determined to be medically necessary. There is no “banking” of hours; however, if in a future month a need develops, the All Services Plan can be adjusted.

12. What should I do if my nurse or aide doesn’t arrive when I’m expecting him/her?
If your service is provided by an agency, call the agency. Do not delay. They may have back-up help available or assist you with other arrangements. If any provider including a Non-Agency Provider does not show up to provide services, call the provider, notify your Case Manager and go to your back-up plan.

13. Why do I need a back-up caregiver or plan?
Unforeseen circumstances, such as sickness and inclement weather, may prevent your nurse or aide from providing services. Be prepared and do not risk your safety.

14. What should I do if I have a complaint about any of my services or providers?
If you have a complaint, let the individual or agency know why you are not pleased. If the situation is not resolved contact your Case Manager.

15. Can I choose my providers?
Yes! As director of your Home Care Team, it is very important that you have an opportunity to choose your team members. Your Case Manager can supply a listing of providers and will help you identify some important issues to consider when making such choices.

16. What do I do if a service is denied, or a decision is made and I don’t agree?
The ODJFS offers you an appeal process. You will receive a notice of the denial and be given an opportunity to appeal the decision at a State hearing. A form will be mailed to you called “Notice of Right to a State Hearing” for you to complete. Your Case Manager or Clinical Supervisor may assist you during this process. When you ask for an appeal, you will be given a chance to explain why you disagree in a hearing with an objective Hearing Officer. You will be assigned a time and date to attend a hearing at your local county office. If you are unable to leave your home, you can request to participate in your hearing by telephone from your home. If you request a State hearing within 15 days of notification, your services may continue during the hearing process. Within a few weeks, the Hearing Office will mail you their decision. If you still disagree, you have the right to make an Administrative Appeal of their decision. For additional information, contact Ohio Legal Rights at 614-466-7264 or 1-800-282-9181.

17. What if I’m not pleased with my Case Manager?
If you are not pleased with your Case Manager, please talk about your feelings with him/her. If you do not get the results you expect or if you are not comfortable talking with him/her, contact the Supervisor.

18. Who should I call if I have an emergency?
If you have a medical emergency, call your doctor or 911. Situations that cause you concern should be referred to your service provider and your Case Manager. It is best to bring these concerns to your Case Manager before they become an emergency.

19. Will I have any privacy?
Receiving health related services in the community does involve allowing agencies and individuals access to your private home. This access should not exceed what is minimally necessary. Your records are protected by Case Management policy and federal standards (HIPAA) from any unauthorized or unnecessary disclosure.

20. Now that I have Case Management services, do I have to continue my involvement with the County Department of Job and Family Services?
Yes! In order to receive Case Management services, you must be eligible for Ohio Medicaid. This is determined by the County Department of Job and Family Services. It is very important that you respond to any communication from the county and keep all appointments as scheduled.

21. Will anyone other than my Case Manager check with me to see if I am satisfied with my home care?
Ohiohcp Quality Improvement and the ODJFS will be making phone calls and conducting visits to consumers. You may be contacted. We welcome your involvement and value your opinion.

22. Do I have to have an Ohiohcp Case Manager?
The ODJFS and Ohiohcp must follow the rules that govern the Ohiohcp. The frequency of contacts and home visits are included in these rules.

23. I have the Waiver with a “patient liability.” What does this mean?
When the County Department of Job and Family Services determines financial eligibility and it is found that the monthly income exceeds the allowable amount, a patient liability is assessed. This is the amount of money that you will need to spend out of your pocket toward your needed Waiver services. Your Case Manager will assist you in identifying whom you will pay your liability to. You will receive your Medicaid card on the first of the month automatically.

Complaints
If at any time you have a complaint about one of your providers or CareStar you should first talk with:

Your Case Manager
If you are not satisfied with his/her response, address your concern(s) to:

Clinical Supervisor, is available at your Regional Office
see Contact US for numbers

Clinical Manager, is available at your Regional Office,
see Contact US for numbers

Director of Clinical Services,
Deborah Wilson at 614-751-7777
or 1-800-616-3718 EXT 3124
or email dwilson@ohiohcp.org

Director of Program Management,
Daryl Shrider at 614-751-7777
or 1-800-616-3718 EXT 3119
or email dshrider@ohiohcp.org

Director of Provider Management,
Anthony Evans at 614-729-6481
or 614-729-6320 EXT 3121
or email aevans@ohiohcp.org

If your concern is still not resolved contact:
Director of Operations,
Carol Price at 614-751-7777
or 1-800-616-3718 EXT 3122
or email cprice@ohiohcp.org