Public Notice Comment: Ohio Home Care Waiver Amendment

The Autism Society of Ohio (ASO), a coalition of the Ohio affiliates of the Autism Society of America, thanks the Ohio Department of Medicaid for publishing the public notice regarding amending the HCBS waiver program to permanently include flexibilities allowed through Appendix K during the COVID-19 pandemic. Many individuals in our community valued the flexibility of paying family caregivers, primarily due to the shortage of direct support workers. We appreciate that the Department wants to make this a permanent option. We urge that the process to apply for this payment be seamless and not cumbersome, as families already have so much to manage, including no additional assessment tool for parents of minor children to qualify. Similarly, please consider increased services for family caregivers, including respite and adult day health services — as at least five other states have done to better support overly-stretched families.

The proposed rule also burdens parents/spouses/guardians of minors with a disability receiving HCBS services to prove there is “no willing and able provider or direct care worker available to provide HCBS waiver services to the individual” to be paid for their time caring for the individual.  We know that many parents cannot work the same kinds of jobs or hours as parents of children who do not have a disability and need the financial support; we also know that a healthy family means a healthy individual with a disability. This proposed rule should also include additional structure and guidance that provides tracking, reporting, and investigation information into whether a person has access to a DSP; otherwise, it leaves too much discretion to caseworkers.

Moreover, ASO urges the State to reconsider the requirement that if a person has an ownership interest in an agency servicing an individual they also cannot serve as a direct care worker for the individual.  Guardians often are on the front lines of training Direct Support Professionals, overseeing staff, and choosing staff who are the right fit for the person with a disability. Why tie their hands or add additional burden by not allowing them to operate and/or be paid as an agency and a caregiver?

In addition, we urge adding increased oversight capabilities by better funding and training services and support administrators to increase oversight of providers and add capacity to check on individuals with developmental disabilities to ensure they are appropriately cared for as outlined in the ISP. Our current system is a “fox guarding the hen house” situation, which does not best serve the client’s needs and often leads to neglect, abuse, and worse.

We appreciate the private disability provider rate increase as many agencies struggle to make ends meet and had to shut down due to the pandemic. It is important that upon receiving additional funds, providers are held accountable to deliver quality care for all individuals, including incentivizing much-needed changes that support improved services.

Improved quality care includes:

• Training Direct Support Professionals in Autism, including engagement and behavioral support strategies that help individuals achieve their independence, work, and recreational goals;
• Training in balanced meal preparation (including portions) and how to read food labels for allergens (10 states have expanded home-delivered meal options to ensure better nutrition and health outcomes);
• Setting standards for quality control (like any other business), including an anonymous rating system for clients and guardians to weed out providers who are not delivering appropriate services;
• Supporting families/guardians during the transition period in knowing how to choose a provider for care and housing, including providing a range of options depending on need (At least 16 states have increased assistive technology services as one option, such as expanding definitions of assistive technology to include internet and remote support, developing assistive technology pilot programs, or raising spending limit caps);
• Increasing funding for ICF’s so they are appropriately overseen and have the resources to provide quality care.

The Autism Society of Ohio also appreciates that the draft application outlines the person-centered planning process in compliance with the HCBS Settings Rule. We agree that the individual receiving services must be made aware of all service options available and this is an integral part of creating their plan. We also appreciate the flexibility of allowing for electronic signatures and stress that this be an option for the entirety of the HCBS process.

Thank you again for drafting this amendment plan and allowing stakeholders to provide input.

Our sincere thanks,

The Autism Society of Ohio

Autism Society of Greater Akron

Autism Society of Greater Cleveland

Autism Society of Central Ohio

Autism Society of Northwest Ohio

Autism Society of Mahoning Valley