May 2nd, 2012
Attention: Home Modification/Adaptive Assistive Device and Vehicle Modification Providers for the Ohio Home Care Waiver, Transitions DD Waiver and Transitions Carve Out Waiver.
RE: Changes to the Consumer Approval of Plans and Completed Work Form and additional information regarding bids submitted to Carestar.
Please find below a revised copy of the Consumer Approval of Plans and Completed Work Form as directed by ODJFS/BLTCSS.
- There are no changes in the use of this form, only in the wording on the form itself.
- This form is to be completed by the provider at the time of the face to face visit in consumer's home to assess the requested modification or adaptive device.
- This form MUST be signed by provider and consumer/ legal guardian and included with your bid in order for your bid to be considered for approval.
- If your bid is approved, a second signature needs to be obtained from consumer/legal guardian on the form following the completion of the modification/delivery of services, and sent in with your Prior Authorization request.
PLEASE Print copies of this form and begin using this new form immediately, May 2nd, 2012. Any requests in progress or forms signed prior to today's date with the previous form will still be accepted.
- Please also find below the Consumer Acknowledgement of Routine Care and Maintenance Form. There have been no changes to this form or it's use, however please review this information so that you are using the form correctly.
Please complete the Consumer Acknowledgement of Routine Care and Maintenance Form educating the consumer on the routine care and/or maintenance required for the modification or equipment delivered. The consumer/legal guardian should understand that their waiver program cannot cover costs of ongoing maintenance, nor repairs due to lack of maintenance of their modification/equipment.
- Please be as specific as possible when providing this information to the consumer. For example, this would include notification of the need to treat/seal lumber, replace non skid surfaces on ramps, cleaning materials that should or should not be used to preserve the quality of any materials used in a modification, lubrication of equipment, etc.
Please also include associated costs for materials or inspections.
- If the maintenance includes information provided in a separate brochure, please summarize the information and provide the brochure as well. Please do not simply state "see brochure" on the form.
- Please sign the form acknowledging that you have reviewed this information with the consumer and leave the form with the consumer who will then sign it in the presence of Carestar staff. We highly recommend that you have your own copy of this form and send it in with your bid as well.
Regarding Submission of Bids:
Please be advised that all bids must include:
The completed bid record
2. A written scope of work
3. A before and after drawing of the work to be done including specific area dimensions.
4. A list of materials to be used and costs of materials.
5. Cost of labor
6. A written warranty that must include at least one year on all materials and one year on workmanship for all home modifications.
7. A written statement that the provider and all subcontractors have the necessary skills and experience to perform the job specifications, and have met all provider requirements set forth in OAC 5101:3-45 that include but are not limited to BCI checks, insurance and bonding.
- Please contact the Home Modification Specialist listed on each request to communicate any concerns related to the request or your visit to the home.
Please communicate with the Home Modification Specialist if a consumer requests a change to the original service description. Explain that any and all changes must be approved through Carestar.
Alternately, be sure to communicate concerns to the Home Modification Specialist if in fact you do not believe that the requested modification will effectively meet consumer's needs, or cannot be completed within ADA guidelines.
We are here to work together to meet our consumer's needs! Please communicate with us.
Links to updated forms:
New Consumer Form