1-Attachment 1 - Advanced Conditions of Participation.pdf

ELDERLY SERVICES PROGRAM LEVY FUNDED & home52 TRANSPORTATION

Provider Conditions of Participation - Advanced Provider

Effective October 1, 2026

An Advanced Provider is defined as a Provider that has direct and ongoing client contact for service delivery. The frequency of client contact can vary. The requirements listed in the Conditions of Participation reflect the minimum standards the Provider must meet to participate in any program which receives some or all funding from the Elderly Services levy. These programs may include but not be limited to the Elderly Services Program and home52 Transportation.

Condition 1. Provider Qualifications

1.1 The Provider must comply with all Conditions of Participation, for all funder Agreements, relevant Service Specification(s), monitoring and reporting requirements, billing requirements, and show evidence of whether the Provider furnishes services directly or by sub-contracting the services.

(Providers having multiple services, one of which is considered to be in the highest, advanced, level will be held to the highest COP requirements.)

1.2 The Provider must be a formally organized business or service agency, registered in good standing with the Ohio Secretary of State.

1.3 The Provider must have a physical facility from which to conduct business. COA must be notified of any change in location prior to the relocation.

1.4 The Provider must designate and utilize a locked storage space for the maintenance of client and employee records and have a process to backup computer files including electronic verification, if applicable.

1.5 The Provider must participate in problem resolution as defined in the service specification notice.

1.6 The Provider shall not allow a staff person or volunteer to furnish a service to a client if the person is the client’s spouse, parent, step-parent, legal guardian, power of attorney, or authorized representative.

1.7 The Provider must provide supervision to any volunteer.

1.8 The Provider, if terminating, being purchased by or merge with another entity, must furnish written notice to COA at least ninety (90) days prior to action. Provider must supply COA with the communication to be shared with clients and receive authorization of the content, prior to informing clients.

Condition 2. Reporting

2.1 The Provider must notify the designated staff member assigned to the service (i.e. Care/Case Manager) within twenty-four (24) hours of becoming aware of an incident. Home52 providers must notify home52 Transportation Coordination Center immediately upon becoming aware of an incident. Incident includes but is not limited to any event that may result in harm to property or person. If there is not a designated staff member assigned, the COA Provider Services Manager will serve as the point of contact (Provider_Services@help4seniors.org).

mailto:Provider_Services@help4seniors.org

2.2 Major Unusual Incident (MUI) - An MUI is any alleged, or actual occurrence of an incident/event that could adversely affect the health or safety of a client, the credibility of Provider’s staff or organization, or any incident in which COA or Provider may have liability. MUIs include but are not limited to: abuse; neglect; suspicious accident; death from abuse, neglect, serious injury, or any reason other than natural causes; criminal or suspected criminal acts; a police, court/legal, or public complaint which has the potential to be reported to the media or elected officials or any in which COA or Provider may have liability; lawsuit or potential lawsuit. In case of an MUI, and at any time the Provider must report an incident to a licensure board, the Provider is to notify COA’s Provider Services manager or their designee within one (1) hour after the Provider becomes aware (Provider_Services@help4seniors.org).

2.3 If contacted by the news media regarding a major unusual incident, the Provider is not to respond to the media inquiry but must contact COA’s Communication Director by phone or by email within one (1) hour (communicationsteam@help4seniors.org).

2.4 The Provider must report any suspicion of abuse, neglect, and/or exploitation to Adult Protective

Services at the Ohio Department of Job and Family Services (ODJFS), according to section 5101.61 of the Ohio Revised Code, and if there is a care manager involved in the case, to the care manager.

2.5 The Provider must notify COA’s Provider Service Manager, home52, or their designee of any interruption in service to all or to a significant number of clients served by the Provider.

(Provider_Services@help4seniors.org).

2.6 The Provider must furnish the names of all entities with 5% or more ownership of the agency.

2.7 The Provider must coordinate any community outreach activities including those involving the news media with COA’s Communication director prior to planning such activities. Outreach is defined as activities or services that specify or highlight COA and/or home52

(communicationsteam@help4seniors.org).

2.8 The Provider must notify the assigned Care Manager, and when there is not a care manager, the

COA Provider Services Manager (Provider_Services@help4seniors.org), no later than twenty-four

(24) hours after the Provider is aware of (home52 must report within the same business day) any significant change that may affect the client’s service needs or safety, including one or more the following:

a. The individual moves to another address.

b. The individual’s repeated refusal of services.

c. Any other significant change in the client’s physical, mental emotional status or environment.

Condition 3. Documentation

3.1 Provider shall have written documents which support the operation of their business and for which they abide by and address the following areas:

a. Statement defining the purpose of its business or service agency.

b. Entities with a governing board must have written bylaws; and, if the Provider is incorporated, the Provider must have articles of incorporation.

c. Written table of organization which clearly identifies lines of administrative, advisory, contractual, and supervisory authority and responsibility to the direct care level, with positions and current employees.

d. Follow-up and investigation of client complaints and grievances.

mailto:Provider_Services@help4seniors.org mailto:communicationsteam@help4seniors.org mailto:Provider_Services@help4seniors.org mailto:communicationsteam@help4seniors.org mailto:Provider_Services@help4seniors.org

e. Written process for use of a client release of information form to release client specific information to sources outside of their system. (excludes home52)

f. Written procedure for documenting an escalation of client incidents including reporting timeliness.

g. Written instructions a client would follow to file a claim due to theft or property damage.

h. Confidentiality policy aligned to HIPAA regulations.

i. Written statement supporting compliance with 45 C.F.R. 80.4 (Octoer2,2024 edition) regarding the provision of goods and services. No person in the United States shall; on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity receiving Federal financial assistance from the Department of Health and Human Services.

j. Written statement supporting compliance with the "Equal Employment Opportunity Act of 1972" federal wage-and-hour laws, and workers' compensation laws regarding the recruitment and employment of people.

k. Provider shall maintain annually:

i. Certificate of Insurance evidencing the required coverage.

ii. Statement Provider has paid all applicable federal, state, and local income and employment taxes.

Condition 4. Billing

4.1 The Provider must bill using a format established and approved by COA for the units of service authorized and delivered.

4.2 The Provider must agree to accept reimbursement for service(s) authorized at the rate agreed upon with COA.

4.3 The Provider must maintain dated documentation to support services delivered and billed.

4.4 The Provider may not bill or solicit a donation of any client for authorized service(s) delivered. There is an exception for request of donation for the Title III/ESP home delivered meal service.

Condition 5. Monitoring

5.1 The Provider shall retain all service records and significant business transactions in accordance with the time period identified in the Agreement.

5.2 The Provider must allow representatives of COA and the County or their designee immediate access to the Provider facility and full access to policies, procedures, records, and other documents related to the provision of service to clients. The Provider must cooperate with said representatives in periodic review.