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Consumers & Providers

The rules and regulations of the Ohio Home Care Program are designed to protect all members: consumers, providers, case managers, administrators and others in the exercise of their rights and duties.

 

Rules,Rights & Responsibilities

Topic
Function

New Rules - Ohio

Ohio Department of
Medicaid (ODM) administered
waiver service providers

Click the links on right for specific info about each

NEW Ohio Rules Effective 10/25/10

Conditions of Participation
Terms and Definitions
Waiver Nursing Services
Personal Care Aide Services
Adult Day Health Center Services (ADHCS)
Home-Delivered Meal Services
Supp. Adaptive & Assistive Device Services
Out-of-Home Respite Services
Emergency Response Services
Supplemental Transportation Services
Home Modification Services

Rules - Ohio

Ohio Home Care Program

Provider Enrollment Rule (5101:3-45-04)
Recinded Rule (5101:3-12-28)

IMIRS Rule (5101:3-45-05)
Recinded Rule (5101:3-12-29)

SR and PO Process Rule (5101:3-45-06)
Recinded Rule (5101:3-12-30)

ODM E-Manual
Type in Ohio Home Care in the Search Center

Ohio Home Care Rules
NOTE: Go to the Table of Contents
Begin at 5101:3-12-01


Specific Ohio Home Care Rules
Provider Fact Sheets
(Please note that these are updated frequently)

Rules - Federal

Federal
Office for Civil Rights
HIPAA

The Centers for Medicare & Medicaid Services (CMS)
National Provider Index overview
National Provider Rule

Rights & Responsibilities Ohio Home Care Program
Consumer Rights
Consumer Responsibilities
Case Manager Responsibilities

 

Rights



Consumer Rights

The rights of individuals receiving services in The Ohio Home Care Program are:
• The right to be treated with respect and dignity.
• The right to be treated fairly without discrimination based on race, color, sex national origin, age, religion, and disability.
• The right to self-determination, including participation in developing ones own plan of care and the choice of caregivers or service providers. This includes the right to be informed so that you can make sound decisions.
• The right to be given a fair and comprehensive evaluation of health and safety factors with regard to functional, psychosocial and cognitive ability.
• The right to have access to needed health and social services.
• The right to be told of realistic care alternatives.
• The right to privacy and confidentiality.
• The right to review your records and to have the information explained when necessary.
• The right to be notified in advance of any change in services or issues that may affect the continuation of services.
• The right to voice dissatisfaction and/or initiate the grievance procedure.
• The right to know the cost of any service prior to receiving the service.
• The right to withdraw from the Ohio Home Care Program at any time.• The right to request a State Hearing anytime you disagree with an action taken or to be taken by an ODM State or County employee or their designee.
• The right to express your wishes about future medical treatments should you become incapacitated.

Consumer Responsibilities
We consider you the DIRECTOR of your Core Plus, Home Care/Transitions Waiver 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. This is an outline of the basic tenets that should be followed.

Consumers/Guardians of The Ohio Home Care Program should:

• Communicate openly and honestly with Case Managers, Providers, and other members of the Home Care Team.

• Provide accurate and complete information.

• Actively participate to the extent agreed upon, 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 service needs.

• Cooperate with your home care team towards the resolution of any problem or concern.

• Refuse participation in any fraudulent or dishonest practices by providers, caregivers and any team members.

 

 

 

 

 

 

 

 

Case Manager Responsibilities

Assist consumer in selecting and arranging for the provision of services by direct home care providers.

Ensure that consumers selecting a consumer option have a copy of the appropriate Bill of Rights.

Authorize services after verifying that individual’s provider number is valid.

Monitor services on an ongoing basis developing and changing an All Services Plan as appropriate.