Updated: August 1, 2021
Ohio Home Care Waiver Handbook |
A resource guide for Ohioans enrolled on the
Ohio Home Care Waiver
Ohio Home Care Waiver
Handbook
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Fill out the information below.
Keep it on hand for easy access.
Case Managers: Please help with filling in the blanks or attach your card to this page.
My Case Management Agency
24- Hour Toll-Free Phone Number
My Case Manager’s Name and Phone Number
Managed Care Plan (MCP) (if applicable)
MCP Care Manager and Phone Number (if applicable)
Medicaid Consumer Hotline:
1 (800) 324-8680
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How to use this Handbook
This handbook provides important information about the Ohio Home Care Waiver
(OHCW). The information in the handbook should help answer basic questions you
have. If you cannot find answers to your questions in this handbook, contact your
case manager who is available to assist you. You will receive a new copy of this
document each year during your annual assessment.
This handbook is prepared by:
The Ohio Department of Medicaid (ODM)
Bureau of Clinical Operations
Care Coordination Team
For more information, contact the
Medicaid Consumer Hotline:
1 (800) 324-8680
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Introduction
The Ohio Home Care Waiver (OHCW) is a home and community-based waiver
program administered by the Ohio Department of Medicaid. This waiver provides
certain services that allow you to receive supports outside of a hospital or nursing
facility.
Ohio Home Care Waiver Services:
• Adult Day Health Services
• Community Integration Service
• Community Transition Service
• Personal Emergency Response System
• Home Care Attendant
• Home Delivered Meals
• Home Maintenance and Chore Service
• Home Modification Service
• Out-of-Home Respite
• Personal Care Aide
• Supplemental Adaptive and Assistive Devices
• Supplemental Transportation Services
• Waiver Nursing
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Your Rights
As an individual enrolled on the Ohio Home Care Waiver, you have the right to:
• Be fully informed of all your rights, responsibilities, and what
it means to be on a waiver
• Be treated with dignity and respect
• Receive assistance from your case manager (CM)
» What is a case manager? A person assigned to you to
help with coordinating services that meet your needs.
• Have private meetings with your case manager
• Be protected from abuse, neglect and mistreatment
• Receive information that is timely, accurate and easy
to understand
• Choose Medicaid-approved providers who will provide safe,
appropriate and high-quality services
• Control how your services are delivered
• Speak in confidence with your case manager and know that
your information will be kept confidential
• Participate in the development of your Person-Centered
Services Plan
• Request a state hearing to appeal any decisions made by
your case management agency (CMA) or the Ohio
Department of Medicaid about your waiver eligibility or
benefits
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• See any files or records related to your health care
• Be informed about how to report concerns with your case
manager, services or providers to the Ohio Department of
Medicaid
You and your authorized representative (if applicable) direct your waiver services.
• What is an authorized representative? An authorized representative
is a person age 18 or older whom you have authorized in writing to
make decisions on your behalf about your Ohio Home Care Waiver
services.
Your Responsibilities
As an individual enrolled on the Ohio Home Care Waiver, you are
responsible for:
• Communicating openly and honestly with your case
manager, providers, and other members of your care team
• Providing accurate and complete information, including
your medical history
• Actively participating in your service planning and
implementation
• Keeping scheduled appointments
• Reporting problems, concerns, changes or incidents to your
case manager
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• Informing your case manager if you want or need to change
services or providers
• Respecting the rights of your providers
• Working with your care team to resolve problems
or concerns
• Refusing to participate in dishonest or illegal activities
involving your providers, caregivers or members of
your care team.
A complete list of your rights and responsibilities is in the Ohio Administrative
Code at codes.ohio.gov/oac/5160-45-03
or request a printed copy from your
case manager.
Case Management
All individuals enrolled on the Ohio Medicaid Home Care Waiver receive case
management services.
Case management connects you to services and supports that help
you get the care you need in an environment where you can be the
most independent.
Case management activities include:
• Monitoring your health and welfare
• Periodically assessing your needs, service goals and
objectives
• Annually assessing your waiver program eligibility
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• Coordinating meetings with you and your care team
• Authorizing waiver services that meet your needs
• Providing referrals and connecting you to services and
providers
• Monitoring the delivery of all services identified in your
person-centered service plan
• Transition planning for significant changes, including those
changes that occur prior to enrollment on the waiver
program, and at significant life milestones such as entering/
exiting school or work
• Educating you on how to identify and report incidents,
and working with you to develop prevention plans to
reduce risks
• Assisting you to develop a meaningful backup plan in
the event your provider is unable to or does not show
up for work
» What is a backup plan? This plan includes one or
more people who are able to meet your needs and
respond immediately if your regularly scheduled
provider is unable to work his or her shift(s).
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Changing your case manager or your case management agency:
You may request a change in your case manager or case management agency.If
you would like to change
your case manager within your current case management
agency, please contact your CMA directly. If you would like to change your case
management agency (CMA) please submit a brief synopsis of the reason, along
with your change request to ODM. These changes are approved on a case-by-case
basis. The Department of Medicaid will notify you of whether your request has
been approved or declined.
To request a change, submit your request in one of the following ways:
• Send an e-mail: caremanagement@medicaid.ohio.gov
• Send a fax: 614-466-6945
• Mail your request to:
Ohio Department of Medicaid
Bureau of Clinical Operations
Attn: CMA Change
P.O. Box 43214
Columbus, OH 43215
Reporting Incidents
Be sure to report any incidents:
An incident is any event that is inconsistent with your routine care and is
harmful or potentially harmful to you. You or a member of your care team
should notify your case manager within 24 hours of an incident.
The Ohio Department of Medicaid, its case management agencies, and its
provider oversight agency perform activities to make sure that you are
protected from harm.
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Incident investigation and follow up includes:
• Making sure you are healthy and safe, and medical
attention is sought as needed
• Taking steps to prevent incidents from reoccurring
• Identifying patterns to determine whether you or your
providers could benefit from safety education
• Confirming you have the necessary services to remain
healthy and safe
• Making sure providers know how to keep you safe and
cause no harm
• Educating you on how to report incidents when they occur
Person-Centered Service Plan (PCSP)
Your person-centered service plan (PCSP) is a written outline of your waiver
services, other Medicaid services, and all other services (paid and unpaid)
needed to keep you safely in your home.
The plan identifies goals and outcomes related to your health and the
treatments and services you receive.
How is your plan developed?
Your case manager works with you and your care team to develop a
person-centered service plan.
Care team members include your natural supports, an authorized
representative (if applicable), providers, your physician, and any
others who you would like to include who are involved in your care.
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Your case manager will also:
• Document communication records and/or team meeting
minutes in the planning process
• Authorize and assist with arranging services with your
service providers and other caregivers
• Ensure the plan details the amount, frequency, scope, and
duration of your services
• Assist with identifying and contacting all providers and
agencies that are involved in your care
• Schedule meetings, disseminate important information,
complete plan updates, maintain documentation, and
facilitate collaboration among team members
The person-centered service plan will be updated as often as necessary to
continue to reflect your needs.
Your person-centered service plan will address all the following:
• Your care, including your medical and personal
care needs
• Your strengths
• Identified goals and desired outcomes
• The setting where you choose to receive your care
• Upkeep of your home environment, including adaptations
as applicable
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• How you will access your community, including
transportation
• Physical, mental, and behavioral health needs, including any
applicable interventions
• School, work, or other day activities
• Medication procurement and management
• Medical and personal care supplies, including equipment
• Backup and emergency plans
• Case management services
Your Providers
You have the right to choose your Medicaid state plan and waiver service
providers. The case management agency is responsible for ensuring you are
able to choose your providers and assisting you in making a choice, if
necessary.
You may choose agency-based providers and/or non-agency providers (NAP).
Find a Provider:
Go online: myohiohcp.org
Call the Medicaid Consumer Hotline: 1 (800) 324-8680
