Provider Occurrence Process OAC 5101:3-12-30 D

1. Provider Occurrence ProcessOAC 5101:3-12-30 (D) This rule requires ODJFS and CareStar to monitor provider occurrences. Provider Occurrence Reports are submitted by CareStar when there is an allegation that a provider is out of compliance or in violation of a program rule.This rule requires ODJFS and CareStar to monitor provider occurrences. Provider Occurrence Reports are submitted by CareStar when there is an allegation that a provider is out of compliance or in violation of a program rule.

2. Occurrences Consumer Care Violations Provider Billing Violation Substandard Provider Performance Medicaid Fraud Occurrence can be: Consumer care violation 1) did not report accident 2) subcontracting Provider Billing Violations: 1) Documentation does not support claim, 2)ASP authorized different amount Substandard Provider Performance: 1) No show for scheduled visits 2)Sleeping on the job Medicaid Fraud: 1) billing for services not provided 2) Billed for patient liability. These are referred to the Attorney General�s office for investigation & prosecution. Occurrence can be: Consumer care violation 1) did not report accident 2) subcontracting Provider Billing Violations: 1) Documentation does not support claim, 2)ASP authorized different amount Substandard Provider Performance: 1) No show for scheduled visits 2)Sleeping on the job Medicaid Fraud: 1) billing for services not provided 2) Billed for patient liability. These are referred to the Attorney General�s office for investigation & prosecution.

3.  Provider�s Responsibility Report Occurrence Cooperate with CareStar Notified by CareStar Cease and Desist Letter Plan of Correction A Providers responsibility includes: Reporting occurrence to the Casemanager Cooperate with CareStar�s investigation if you are contacted. Responding to any notice that CareStar sends you; Notice which may be a Cease and Desist letter. That requires a Plan of Correction from you explaining how you will correct the problem and prevent it from happening again.A Providers responsibility includes: Reporting occurrence to the Casemanager Cooperate with CareStar�s investigation if you are contacted. Responding to any notice that CareStar sends you; Notice which may be a Cease and Desist letter. That requires a Plan of Correction from you explaining how you will correct the problem and prevent it from happening again.

4. Structural Reviews Annual Face-to Face Review Will be required to bring certain types of information All Services Plan Plan of Correction This rule also requires ODJFS and CareStar to monitor providers through Structural Reviews. 1) Structural Reviews are annual face-to-face reviews of the service you are delivering and how your are billing for the service. 2) You are required to meet with CareStar once a year to complete the review. You are required to bring certain types of information which are outlined in the a letter. For example: visit notes, timesheets, ASP and other information to be reviewed by the provider monitor from CareStar. 3) Remember the All services plan authorizes the services needed and authorizes the amount of services you can be reimbursed for. So it is important to have a current ASP and get approval from the Case Manager when changes in your schedule or amounts of service. 4) Providers will receive a written report of the structural review. If you are not in compliance with a program rule, a finding or deficiency will be listed. A plan of correction is required for any deficiency, and it must be submitted within 45 days. This rule also requires ODJFS and CareStar to monitor providers through Structural Reviews. 1) Structural Reviews are annual face-to-face reviews of the service you are delivering and how your are billing for the service. 2) You are required to meet with CareStar once a year to complete the review. You are required to bring certain types of information which are outlined in the a letter. For example: visit notes, timesheets, ASP and other information to be reviewed by the provider monitor from CareStar. 3) Remember the All services plan authorizes the services needed and authorizes the amount of services you can be reimbursed for. So it is important to have a current ASP and get approval from the Case Manager when changes in your schedule or amounts of service. 4) Providers will receive a written report of the structural review. If you are not in compliance with a program rule, a finding or deficiency will be listed. A plan of correction is required for any deficiency, and it must be submitted within 45 days.

5. Sanctions Claims Suspended Terminate Provider Agreement If the provider does not cooperate with responding to: notice by CareStar A cease and Desist letter Meeting for the structural review or submitting their Plan of care. There can be sanctions imposed. Examples of the sanctions are: having your claims suspended or having your provider agreement terminated. If the provider does not cooperate with responding to: notice by CareStar A cease and Desist letter Meeting for the structural review or submitting their Plan of care. There can be sanctions imposed. Examples of the sanctions are: having your claims suspended or having your provider agreement terminated.

6. Questions?

7. Thank You Gracias Merci Danke

8. Ohio Home Care�s Incident Reporting System Today, we are going to take a glimpse into the Incident Reporting Rule and why it is important to you as a provider. By the end of our time together, you will have an understanding about what IMIRS is, what do you need to do, and why you need to report incidents. Today, we are going to take a glimpse into the Incident Reporting Rule and why it is important to you as a provider. By the end of our time together, you will have an understanding about what IMIRS is, what do you need to do, and why you need to report incidents.

9. IMIRS: What is it? Incident Management, Investigation, and Response System; Formalized in OAC 5101:3-12-29 effective July 1, 2004; The rule requires that incidents are reported and investigated in a timely manner. Ohio has the IMIRS program. Incident Manangement Investigation, and Response system. The system was formalized in OAC 5101:3-12-29 July 1, 2004. This rule applies to all of us so we will discuss why we have it, who needs to report, what needs to be reported, and your responsibilities as an independent provider. This system was put into place after the Federal government(CMS) told Ohio Dept. of Job and Family Services that they needed to have an incident system. As a result OAC 5101:3-12-29 became effective July 1, 2004. Today, I will share the abbreviated version of the rule. I ask that you take this rule, as well as the other rules that you are learning about today and understand what this means to you as a provider. Ohio has the IMIRS program. Incident Manangement Investigation, and Response system. The system was formalized in OAC 5101:3-12-29 July 1, 2004. This rule applies to all of us so we will discuss why we have it, who needs to report, what needs to be reported, and your responsibilities as an independent provider. This system was put into place after the Federal government(CMS) told Ohio Dept. of Job and Family Services that they needed to have an incident system. As a result OAC 5101:3-12-29 became effective July 1, 2004. Today, I will share the abbreviated version of the rule. I ask that you take this rule, as well as the other rules that you are learning about today and understand what this means to you as a provider.

10. Program Objectives for Incident Reporting: There are 3 basic objectives: Protect individuals from future and similar harm; Remedy discovered deficiencies in operating practices; and Promote improved treatment and care. As Ohio developed their Incident Reporting System, we had three major objectives. We wanted to first make sure that we do everything possible to get consumers out of harm�s way, which means that when we become aware that a consumer continues to have many incidents or possibly a provider is involved with numerous incidents, we want to do what we can to keep repeating it over and over. For example, a consumer that falls once, that can happen. What about the consumer that continues to fall several times a day for a month. We need to look at why these falls are occurring. Is the doctor aware of these falls? Does the consumer need a PT evaluation? We may determine that the falls occurred because the home health aide was not available to assist the consumer because they stopped showing up. So we would want to look at identified deficiencies to improve the treatment and care of the consumer. An example of improved treatment and care could be the Conditions of Participation�we have learned by what has happened to our consumers.As Ohio developed their Incident Reporting System, we had three major objectives. We wanted to first make sure that we do everything possible to get consumers out of harm�s way, which means that when we become aware that a consumer continues to have many incidents or possibly a provider is involved with numerous incidents, we want to do what we can to keep repeating it over and over. For example, a consumer that falls once, that can happen. What about the consumer that continues to fall several times a day for a month. We need to look at why these falls are occurring. Is the doctor aware of these falls? Does the consumer need a PT evaluation? We may determine that the falls occurred because the home health aide was not available to assist the consumer because they stopped showing up. So we would want to look at identified deficiencies to improve the treatment and care of the consumer. An example of improved treatment and care could be the Conditions of Participation�we have learned by what has happened to our consumers.

11. ODJFS� Philosophical Approach: Individuals often have the benefit of learning the most valuable lessons through examining how mistakes have occurred. Thus, it will be critical that the reporting, documentation, and the evaluation of incident reports and occurrences be viewed by the organization as an educational process rather than a punitive one. In Ohio, when looking at incidents and provider occurrences, we believe that it is important to understand what happened and doing what we can to correct the problem. We believe we need to educate consumers and providers about the program rules and the need to assure health and safety. The ODJFS makes the assurance to the federal government that we will what we can to assure the safety of our consumers enrolled on the ODJFS-administered waiver programs. We believe we need to do all we can do to remedy the situation. Our approach, let�s educate providers rather than punish them. So we use this happens via CareStar�s Cease and Desist letter or a Notice of Deficiency from the Ohio Department of Job and Family Services. Either one will outline the rule that has been violated and what the provider needs to do to fix the situation. Both the Cease and Desist Letter and the Notice of Operational Deficiency will provide time lines for the provide to respond with a Plan of Correction. It is important that providers adhere to the requests of this correspondence.In Ohio, when looking at incidents and provider occurrences, we believe that it is important to understand what happened and doing what we can to correct the problem. We believe we need to educate consumers and providers about the program rules and the need to assure health and safety. The ODJFS makes the assurance to the federal government that we will what we can to assure the safety of our consumers enrolled on the ODJFS-administered waiver programs. We believe we need to do all we can do to remedy the situation. Our approach, let�s educate providers rather than punish them. So we use this happens via CareStar�s Cease and Desist letter or a Notice of Deficiency from the Ohio Department of Job and Family Services. Either one will outline the rule that has been violated and what the provider needs to do to fix the situation. Both the Cease and Desist Letter and the Notice of Operational Deficiency will provide time lines for the provide to respond with a Plan of Correction. It is important that providers adhere to the requests of this correspondence.

12. Roles of the Provider: Observer Reporter Team member Teacher As a provider, you will have different roles in the incident reporting process. First you are an observer to determine what is happening with the consumer. If an incident occurs and you become aware of it, you need to report it to the case manager right away. The rule requires timely reporting and you need to accomplish that within 24 hrs of when you first learn of it. You will also be assisting as a team member. You may be asked to work with the team to find ways to increase safety for that consumer. Your input as a team member is valuable for keeping the consumer safe. You may also be the teacher. It may be that you are educating the consumer, as well as other team members about effective ways to assure the consumers safety. All of these roles are equally important to keeping the consumer out of harm�s way.As a provider, you will have different roles in the incident reporting process. First you are an observer to determine what is happening with the consumer. If an incident occurs and you become aware of it, you need to report it to the case manager right away. The rule requires timely reporting and you need to accomplish that within 24 hrs of when you first learn of it. You will also be assisting as a team member. You may be asked to work with the team to find ways to increase safety for that consumer. Your input as a team member is valuable for keeping the consumer safe. You may also be the teacher. It may be that you are educating the consumer, as well as other team members about effective ways to assure the consumers safety. All of these roles are equally important to keeping the consumer out of harm�s way.

13. What should be reported? Abuse of any kind: physical, verbal, emotional, and or sexual; Neglect of the consumer; Abandonment of the consumer; Exploitation of a consumer; Death of the consumer; Any accident or injury of the consumer; Inappropriate delivery of services to the consumer; By now, you are wondering what you need to report. These are the things that we need to know about. This is one of the most important part of OAC 5101:3-12-29. ABUSE-HITTING,TOUCHING,YELLING, THREATENING, WITHOLDING,INAPROPRIATE COMMENTS OR ANY SEXUAL CONTACT-CAN TAKE MANY FORMS NEGLECT-NOT SHOWING UP OR DOING YOUR JOB ABANDONMENT-LEAVING THE CONSUMER EXPOITATION-JOINT CHECKING ACCOUNTS, BEING A BENEFICIARY FOR LIFE INSURANCE, OPENING A CHARGE CARD IN CONSUMER�S NAME OR USING THEIR CHARGE CARD DEATH-ALL ACCIDENTS/INJURIES-FALLS, ACCIDENTS,WHEN IN DOUBT REPORT. INAPPROPRIATE DELIVERY OF SERVICES-AIDE DOING NURSING TASKS,NURSE DOING OR SERVICES DONE INCORRECTLYBy now, you are wondering what you need to report. These are the things that we need to know about. This is one of the most important part of OAC 5101:3-12-29. ABUSE-HITTING,TOUCHING,YELLING, THREATENING, WITHOLDING,INAPROPRIATE COMMENTS OR ANY SEXUAL CONTACT-CAN TAKE MANY FORMS NEGLECT-NOT SHOWING UP OR DOING YOUR JOB ABANDONMENT-LEAVING THE CONSUMER EXPOITATION-JOINT CHECKING ACCOUNTS, BEING A BENEFICIARY FOR LIFE INSURANCE, OPENING A CHARGE CARD IN CONSUMER�S NAME OR USING THEIR CHARGE CARD DEATH-ALL ACCIDENTS/INJURIES-FALLS, ACCIDENTS,WHEN IN DOUBT REPORT. INAPPROPRIATE DELIVERY OF SERVICES-AIDE DOING NURSING TASKS,NURSE DOING OR SERVICES DONE INCORRECTLY

14. What should be reported?(continued) Services delivered to the consumer that are beyond the provider�s scope of practice; Services delivered to a consumer without physician�s orders; Errors in administration of medication to the consumer; Alleged illegal activity by the consumer resulting in documented police intervention; Consumer�s inappropriate use/abuse of substances; SERVICES BEYONG THE SCOPE OF PRACTICE-AIDE DOING CATHERIZATIONS, INJECTIONS, AIDE DOING MEDICATIONS NO DOCTOR�S ORDER-NO 485 OR SIMILAR FORM-CAN�T BILL WITH OUT SIGNED PLAN OF TREATMENT ERRORS IN MEDICATIONS-WRONG TIME OR WRONG AMOUNT OR NOT DELIVERING. ALLEGED ILLEGAL ACTIVITY BY CONSUMER WITH POLICE INTERVENTION CONSUMERS INAPPROPRIATE USE/ABUSE OF SUBSTANCES-CONSUMER DIRECTED NURSE TO GIVE 6 PACK OF BEER THROUGH GTUBE, MISSING MEDS MAY BE HINT, BEHAVIOR/ACTIONSSERVICES BEYONG THE SCOPE OF PRACTICE-AIDE DOING CATHERIZATIONS, INJECTIONS, AIDE DOING MEDICATIONS NO DOCTOR�S ORDER-NO 485 OR SIMILAR FORM-CAN�T BILL WITH OUT SIGNED PLAN OF TREATMENT ERRORS IN MEDICATIONS-WRONG TIME OR WRONG AMOUNT OR NOT DELIVERING. ALLEGED ILLEGAL ACTIVITY BY CONSUMER WITH POLICE INTERVENTION CONSUMERS INAPPROPRIATE USE/ABUSE OF SUBSTANCES-CONSUMER DIRECTED NURSE TO GIVE 6 PACK OF BEER THROUGH GTUBE, MISSING MEDS MAY BE HINT, BEHAVIOR/ACTIONS

15. What should be reported?  (continued) Theft of consumer�s money, personal property, and medication; Alleged illegal activity occurring in the consumer�s environment without law intervention; Consumer�s exposure to, or diagnosis of communicable disease; ANY THEFT OF CONSUMER�S MEDS, PROPERTY, MONEY ALLEGED ILLEGAL ACTIVITY IN ENVIRONMENT WITHOUT LAW INTERVENTION CONSUMER�S EXPOSURE OR DIAGNOSIS OF COMMUNICABLE DIESEASES ANY THEFT OF CONSUMER�S MEDS, PROPERTY, MONEY ALLEGED ILLEGAL ACTIVITY IN ENVIRONMENT WITHOUT LAW INTERVENTION CONSUMER�S EXPOSURE OR DIAGNOSIS OF COMMUNICABLE DIESEASES

16. What should be reported? (continued) Consumer�s family or environmental crisis; Consumer�s unplanned hospital or nursing home stay; Loss of consumer�s informal (unpaid) caregiver or family member; And any other changes in condition or status of the consumer and the family. CONSUMER�S OR FAMILY�S ENVIRONMENTAL CRISIS-FIRE, FLOOD, EVICTIONS,ETC. CONSUMER�S UNPLANNED HOSPITAL OR NURSING HOME STAY LOSS OF INFORMFAL(UNPAID)CAREGIVER OR FAMILY MEMBER-HOSPITALIZATION, DEATH, MOVED OUT, ARRESTED,ETC. ANY OTHER CHANGES IN CONDITION OR STATUS OF THE CONSUMER OR FAMILY WHEN IN DOUBT, REPORT, REPORT, REPORT. 24 HOUR PHONE AT CARESTAR- REGION 1-1800-538-4218 REGION 2-1800-616-3718 REGION 3 1-800-423-1046 REGION 4-1800-442-1857CONSUMER�S OR FAMILY�S ENVIRONMENTAL CRISIS-FIRE, FLOOD, EVICTIONS,ETC. CONSUMER�S UNPLANNED HOSPITAL OR NURSING HOME STAY LOSS OF INFORMFAL(UNPAID)CAREGIVER OR FAMILY MEMBER-HOSPITALIZATION, DEATH, MOVED OUT, ARRESTED,ETC. ANY OTHER CHANGES IN CONDITION OR STATUS OF THE CONSUMER OR FAMILY WHEN IN DOUBT, REPORT, REPORT, REPORT. 24 HOUR PHONE AT CARESTAR- REGION 1-1800-538-4218 REGION 2-1800-616-3718 REGION 3 1-800-423-1046 REGION 4-1800-442-1857

17. What Do I Need to Do? Assist in keeping consumers safe; When an incident does occur, get the consumer out of the way of harm�s way and safe; Contact agencies responsible for protective services of this consumer (Children�s Protective Services, Mental Retardation/Developmental Disabilities, Adult Protective Services, etc.; Report any incidents to the case manager within 24 hours; You are strongly encouraged to read the rules and understand what you are responsible to do. Your primary role is keeping consumers safe and if they have an incident�getting them out of harm�s way as quickly as possible. May be calling 911, Children�s Services, MR/DD and calling that case manager as soon as possible. If you are aware of danger for that consumer, you need to understand that you have certain responsibilities, especially if you are a licensed person. I encourage you to know what they are and follow through with any mandated reporting. CareStar has a 24 hour service to handle after hours calls. So don�t make it a reason that you didn�t call because it was a holiday, weekend, or very late at night. You are strongly encouraged to read the rules and understand what you are responsible to do. Your primary role is keeping consumers safe and if they have an incident�getting them out of harm�s way as quickly as possible. May be calling 911, Children�s Services, MR/DD and calling that case manager as soon as possible. If you are aware of danger for that consumer, you need to understand that you have certain responsibilities, especially if you are a licensed person. I encourage you to know what they are and follow through with any mandated reporting. CareStar has a 24 hour service to handle after hours calls. So don�t make it a reason that you didn�t call because it was a holiday, weekend, or very late at night.

18. What Do I Need to Do? (continued) Cooperate with any and all investigations that occur; Work with team members to establish a Prevention Plan; If requested to submit a Plan of Correction by CareStar or ODJFS, adhere to the established timelines; and Read and understand the rules. It is important to understand that you need to cooperate when investigations are occurring. We need your eyes and ears. Secrets do not keep consumers safe. Help the team come up with a prevention plan. You are experts and know the consumers. You know what works and what doesn�t. If you are requested to submit a Plan of Correction by CareStar or ODJFS, adhere to the timelines requested whether it be 5, 10, or 15 days. UNFORTUNATELY, IF A PROVIDER DOESN�T, WE CAN CONTINUE AND EVENTUALLY THE PROVIDER AGREEMENT CAN BE ENDED. Understand the rules. It is important to understand that you need to cooperate when investigations are occurring. We need your eyes and ears. Secrets do not keep consumers safe. Help the team come up with a prevention plan. You are experts and know the consumers. You know what works and what doesn�t. If you are requested to submit a Plan of Correction by CareStar or ODJFS, adhere to the timelines requested whether it be 5, 10, or 15 days. UNFORTUNATELY, IF A PROVIDER DOESN�T, WE CAN CONTINUE AND EVENTUALLY THE PROVIDER AGREEMENT CAN BE ENDED. Understand the rules.

19. Is This My Business? OAC 5101:3-12-29 allows sanctions to be imposed for providers who have failed to protect consumers from repeated incidents or have created serious and immediate threat to the health and/or safety of consumers. Many of us may believe that certain things are not our business. Keeping consumers safe is our business and our first priority. Please know this is all of our business and responsibility to keep our consumers safe. Sanctions can be imposed for providers who fail to keep consumers safe. It takes all of us to keep consumers safe and to remedy incidents so they do not happen again.Many of us may believe that certain things are not our business. Keeping consumers safe is our business and our first priority. Please know this is all of our business and responsibility to keep our consumers safe. Sanctions can be imposed for providers who fail to keep consumers safe. It takes all of us to keep consumers safe and to remedy incidents so they do not happen again.

20. Questions?

21. Annual CriminalRecords Check We are here today to explain the Annual Criminal Records Check process and why it is important to you as an independent provider. Most of you here today have either already been through this process or already heard about it. We are here today to explain the Annual Criminal Records Check process and why it is important to you as an independent provider. Most of you here today have either already been through this process or already heard about it.

22. Why do I have to do a records check annually? State Mandated Helps protect consumers from harm Ensure that providers do not have any disqualifying offenses A new rule went into effect in July 2004 requiring all independent providers to submit to an annual criminal background check through the Bureau of Criminal Identification and Investigation. Ohio Department of Job and Family Services has made a commitment to the Federal Government that we would protect the health and safety of Ohio Medicaid consumers. The criminal background check is just one of the measures that ODJFS uses to ensure this requirement is met. This process ensures that providers do not have any convictions that could potentially threaten the safety on a consumer. A new rule went into effect in July 2004 requiring all independent providers to submit to an annual criminal background check through the Bureau of Criminal Identification and Investigation. Ohio Department of Job and Family Services has made a commitment to the Federal Government that we would protect the health and safety of Ohio Medicaid consumers. The criminal background check is just one of the measures that ODJFS uses to ensure this requirement is met. This process ensures that providers do not have any convictions that could potentially threaten the safety on a consumer.

23. How does it work? Notices will be mailed You have 90 days to comply Be sure to have your results mailed directly to ODJFS Each year, the Bureau of Home and Community Services will request a background check from each provider based on the anniversary of their provider agreement. You will be mailed a packet informing your that your background check is due. You will have 90 days from the date of this notice to comply. We will be sending out these notices every three months so you may not get the letter in the month of your anniversary date. The packet will include instructions, a copy of Ohio Administrative Code rule and a fingerprint card. You do not have to use the fingerprint card. We realize that electronic fingerprint identification is becoming more popular and is much faster than the older method. This method is available at numerous locations across the state. Information concerning �Web Check� is available at the attorney general�s website (www.ag.state.oh.us) You are responsible for any fee associated with having your background check processed. Be sure to have your results mailed to ODJFS. We find that many providers have the results sent to themselves in error and the department never gets a copy. Each year, the Bureau of Home and Community Services will request a background check from each provider based on the anniversary of their provider agreement. You will be mailed a packet informing your that your background check is due. You will have 90 days from the date of this notice to comply. We will be sending out these notices every three months so you may not get the letter in the month of your anniversary date. The packet will include instructions, a copy of Ohio Administrative Code rule and a fingerprint card. You do not have to use the fingerprint card. We realize that electronic fingerprint identification is becoming more popular and is much faster than the older method. This method is available at numerous locations across the state. Information concerning �Web Check� is available at the attorney general�s website (www.ag.state.oh.us) You are responsible for any fee associated with having your background check processed. Be sure to have your results mailed to ODJFS. We find that many providers have the results sent to themselves in error and the department never gets a copy.

24. What happens next? If you comply � nothing If you DON�T comply action will be taken against you For those providers that comply with completing their background check No confirmation will be sent to you. If you wish, you may contact the Bureau of Home and Community Services to confirm we have received your results. Contact information will be in your annual notice packet. I�m sorry, we can not send you a copy of your background check. If you want one, you must request it and pay extra when you have your fingerprinting done. If you do not comply, the case management agency (Care Star) will be directed by ODJFS to remove you from any ALL SERVICES PLANS and Provider list until you submit your background check. Providers will be sent a 10 day warning letter. If there is not a response to this warning letter, the termination process will begin. For those providers that comply with completing their background check No confirmation will be sent to you. If you wish, you may contact the Bureau of Home and Community Services to confirm we have received your results. Contact information will be in your annual notice packet. I�m sorry, we can not send you a copy of your background check. If you want one, you must request it and pay extra when you have your fingerprinting done. If you do not comply, the case management agency (Care Star) will be directed by ODJFS to remove you from any ALL SERVICES PLANS and Provider list until you submit your background check. Providers will be sent a 10 day warning letter. If there is not a response to this warning letter, the termination process will begin.

25. What if you have a conviction? Some convictions would disqualify you as a provider Crimes involving violence Theft Drug abuse Sexual offenses It depends on the conviction. The rule sets forth a list of the disqualifying offenses. These disqualifying offenses include � but are not limited to � crimes involving violence, theft, drug abuse and sex. Not all of the crimes are felonies. A disqualifying offense counts even if 10,20 30 years has past since the conviction. Please note that even if a court has sealed a conviction, that conviction will still be on the BCII report that ODJFS will receive. It depends on the conviction. The rule sets forth a list of the disqualifying offenses. These disqualifying offenses include � but are not limited to � crimes involving violence, theft, drug abuse and sex. Not all of the crimes are felonies. A disqualifying offense counts even if 10,20 30 years has past since the conviction. Please note that even if a court has sealed a conviction, that conviction will still be on the BCII report that ODJFS will receive.

26. Some convictions allow you to work under certain conditions Non-repeat offender, not murder, manslaughter, patient abuse or involving a minor Five years has past and consumer agrees What happens if Personal Character Standards do not apply? Some individuals with a disqualifying offense might still be able to be a provider under �Personal Character Standards.� In general, if the provider is a non-repeat offender, their offense was not sexually oriented, it was not murder, manslaughter, or patient abuse or involve a minor, and 5 years have past since conviction they can remain provider ONLY if their consumers agree. Your annual notice packet explains the Personal Character Standards provision. If you do have a disqualifying offense and are NOT eligible to work under the Personal Character Standards provision you will receive a notice from ODJFS. This notice will explain why you do NOT qualify and also affords you an opportunity for a hearing. In conclusion� when you receive the notice that your background check is due� take the notice serious � it is in everyone�s best interest that you submit your background check in a timely fashion. Some individuals with a disqualifying offense might still be able to be a provider under �Personal Character Standards.� In general, if the provider is a non-repeat offender, their offense was not sexually oriented, it was not murder, manslaughter, or patient abuse or involve a minor, and 5 years have past since conviction they can remain provider ONLY if their consumers agree. Your annual notice packet explains the Personal Character Standards provision. If you do have a disqualifying offense and are NOT eligible to work under the Personal Character Standards provision you will receive a notice from ODJFS. This notice will explain why you do NOT qualify and also affords you an opportunity for a hearing. In conclusion� when you receive the notice that your background check is due� take the notice serious � it is in everyone�s best interest that you submit your background check in a timely fashion.

27. Do�s Do take action to respond to ODJFS requests in a timely manner Do make sure that your address is current with ODJFS and with the case management agency Do read your provider updates and stay current with changes Do take action to respond to ODJFS request in a timely manner. If you have your fingerprints done by the ink method it can take six weeks to be processed. So if you delay you might be late. Do make sure that your address is current with ODJFS and with the case management agency. You should contact provider enrollment with any address changes. Do read your provider updates and stay current with changes. Do take action to respond to ODJFS request in a timely manner. If you have your fingerprints done by the ink method it can take six weeks to be processed. So if you delay you might be late. Do make sure that your address is current with ODJFS and with the case management agency. You should contact provider enrollment with any address changes. Do read your provider updates and stay current with changes.

28. Do Not�s Do Not delay in getting your finger prints processed Do Not have a background check done until you are notified Do Not hesitate to call with questions Do Not Delay in getting your finger prints processed. If you put it off until �tomorrow� you might forget. Do NOT have a background check done until you are notified. The background check must be less than 30-days old from the date of the letter. If your background check is older than 30 days you will have to have a new one processed. Do not hesitate to call. We are here to help you.Do Not Delay in getting your finger prints processed. If you put it off until �tomorrow� you might forget. Do NOT have a background check done until you are notified. The background check must be less than 30-days old from the date of the letter. If your background check is older than 30 days you will have to have a new one processed. Do not hesitate to call. We are here to help you.

29. Questions

30. Conditions of Participation (COPs)

31. COPS Maintain active, valid Medicaid provider agreement Act in accordance with: Patient rights Maintaining documentation Consumer incident reporting requirements BCI&I requirements

32. Important COP Highlights Back-Up plans Significant consumer changes: Must notify CMA within 24 hours and written documentation within 5 calendar days 30-day notice if terminating services Must pay taxes

33. Unprofessional, Disrespectful or Illegal Behavior Eating consumer�s food/using their property Taking children, pets, friends, relatives, etc� to the consumer�s home Taking the consumer to your home ETOH, drugs, other chemical substances Sex Leaving the home

34. Activities that Distract from Service Delivery Watching T.V., Computer/Video Games Phone calls Providing care to someone other than the consumer Smoking without the consent of the consumer Sleeping

35. Providers Shall Not ! Cause physical, mental, verbal, or emotional distress or abuse Have inappropriate involvement in the consumer�s personal relationships

36. Providers Shall Not ! Have durable/financial power of attorney, or guardianship Take advantage of, or manipulate program rules resulting in an intended advantage for personal gain that may have detrimental results for the consumer, their family, caregiver or another provider

37. Failure to Meet COP�s May result in sanctions Termination of provider agreement

38. Rate Change The Ohio Home Care program has paid RNs and LPNs the same rate since 1998 LPNs receive 70% of RN salaries in other settings in Ohio (nursing homes, hospitals, home health) Ohio will bring LPN rates of payment to a level comparable to LPN rates paid throughout the State

39. QUESTIONS

40. Bureau of Home and Community Services 30 E Broad Street, Floor 33 Columbus, Ohio 43215-3414 614-466-6742 bhcs@odjfs.state.oh.us Barbara E. Riley, Director, ODJFS