2006 Ohio Revised Code - [5126.03.5] 5126.035.Service contracts generally; addendum.

[§ 5126.03.5] § 5126.035. Service contracts generally; addendum.
 

(A)  As used in this section: 

(1) "Provider" means a person or government entity that provides services to an individual with mental retardation or other developmental disability pursuant to a service contract. 

(2) "Service contract" means a contract between a county board of mental retardation and developmental disabilities and a provider under which the provider is to provide services to an individual with mental retardation or other developmental disability. 

(B)  Each service contract that a county board of mental retardation and developmental disabilities enters into with a provider shall do all of the following: 

(1) If the provider is to provide home and community-based services or medicaid case management services, comply with all applicable statewide medicaid requirements; 

(2) Include a general operating agreement component and an individual service needs addendum. 

(C)  The general operating agreement component shall include all of the following: 

(1) The roles and responsibilities of the county board regarding services for individuals with mental retardation or other developmental disability who reside in the county the county board serves; 

(2) The roles and responsibilities of the provider as specified in the individual service needs addendum; 

(3) Procedures for the county board to monitor the provider's services; 

(4) Procedures for the county board to evaluate the quality of care and cost effectiveness of the provider's services; 

(5) Procedures for payment of eligible claims; 

(6) If the provider is to provide home and community-based services, medicaid case management services, both of the following: 

(a) Procedures for reimbursement that conform to the statewide reimbursement process and the county board's plan submitted under section 5126.054 [5126.05.4] of the Revised Code; 

(b) Procedures that ensure that the county board pays the nonfederal share of the medicaid expenditures that the county board is required by division (A) of section 5126.057 [5126.05.7] of the Revised Code to pay. 

(7) Procedures for the county board to perform service utilization reviews and the implementation of required corrective actions; 

(8) Procedures for the provider to submit claims for payment for a service no later than three hundred thirty days after the date the service is provided; 

(9) Procedures for rejecting claims for payment that are submitted after the time required by division (C)(8) of this section; 

(10) Procedures for developing, modifying, and executing initial and subsequent service plans. The procedures shall provide for the provider's participation. 

(11) Procedures for affording individuals due process protections; 

(12) General staffing, training, and certification requirements that are consistent with state requirements and compensation arrangements that are necessary to attract, train, and retain competent personnel to deliver the services pursuant to the individual service needs addendum; 

(13) Methods to be used to document services provided and procedures for submitting reports the county board requires; 

(14) Methods for authorizing and documenting within seventy-two hours changes to the individual service needs addendum. The methods shall allow for changes to be initially authorized verbally and subsequently in writing. 

(15) Procedures for modifying the individual service needs addendum in accordance with changes to the recipient's individualized service plan; 

(16) Procedures for terminating the individual service needs addendum within thirty days of a request made by the recipient; 

(17) A requirement that all parties to the contract accept the contract's terms and conditions; 

(18) A designated contact person and the method of contacting the designated person to respond to medical or behavioral problems and allegations of major unusual incidents or unusual incidents; 

(19) Procedures for ensuring the health and welfare of the recipient; 

(20) Procedures for ensuring fiscal accountability and the collection and reporting of programmatic data; 

(21) Procedures for implementing the mediation and arbitration process under section 5126.036 [5126.03.6] of the Revised Code; 

(22) Procedures for amending or terminating the contract, including as necessary to make the general operating agreement component consistent with any changes made to the individual service needs addendum; 

(23) Anything else allowable under federal and state law that the county board and provider agree to. 

(D)  The individual service needs addendum shall be consistent with the general operating agreement component and include all of the following: 

(1) The name of the individual with mental retardation or other developmental disability who is to receive the services from the provider and any information about the recipient that the provider needs to be able to provide the services; 

(2) A clear and complete description of the services that the recipient is to receive as determined using statewide assessment tools; 

(3) A copy of the recipient's assessment and individualized service plan; 

(4) A clear and complete description of the provider's responsibilities to the recipient and county board in providing appropriate services in a coordinated manner with other providers and in a manner that contributes to and ensures the recipient's health, safety, and welfare. 

(E)  A service contract does not negate the requirement that a provider of home and community-based services or medicaid case management services have a medicaid provider agreement with the department of job and family services. 
 

HISTORY: 149 v H 94 (Eff 6-6-2001); 149 v H 405. Eff 12-13-2001; 151 v H 66, § 101.01, eff. 7-1-05.
 

The effective date is set by § 612.18 of 151 v H 66. 

 

Effect of Amendments

151 v H 66, effective July 1, 2005, deleted (B)(1), which read: "Comply with rules adopted under division (E) of this section", and redesignated the remaining subdivisions accordingly; in present (B)(1), the introductory language of (C)(6), and (E), deleted "or habilitation center services" following "management services" and made related changes; corrected internal references in (C)(9); and, in (E), deleted the first sentence, which read: "The director of mental retardation and developmental disabilities shall adopt rules in accordance with Chapter 119. of the Revised Code governing service contracts".