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It took a three year battle,
but Medicaid Waiver and the State of Ohio (& other states) must
now fund automatic standby whole-house generators for
the disabled in need. They must also provide the adequate type of
generator that does not need to be shut down after every 24 hours of
Note: Some downloads on this page require
Microsoft Word (.doc files) and some require Adobe Acrobat
Reader (.pdf files) .
If you have already enrolled in the Ohio Home Care
Program, and have a good working relationship with your Case
Management Agency (CMA), you may choose to simply contact
your case manager and request an appropriate generator
to be funded. Just request the generator
like the one finally approved in Region 2. (Click Here to download
the official CMA approval.)
may want to follow the steps below.
Ohio Home Care Program,
is the only CMA
STEPS FOR ACQUIRING GOVERNMENT
FUNDING FOR GENERATORS
if your condition applies:
(1) Reliant on electrical devices,
with OR without battery backup, for your well-being;
devices without which would increase your chances
of being evacuated or institutionalized during a power
outage (temporarily OR permanently).
(2) Residing in a home owned
by you, your parents/legal guardians, or your authorized
(3) Receiving or eligible to
(4) Currently enrolled, or willing to enroll, in the
Ohio Home Care Waiver Program
Ohio Department of Job and Family
Click here for the contact information needed to enroll in the Ohio Home
Care Waiver Program.
Click here to download the form to enroll in the Ohio Home Care
the appeal which set precedent on 5/11/2006
by clicking here on Medicaid Appeal No. 1274905.
(Print. Familiarize yourself with
the facts. Draw comparisons to your situation.)
the required wattage of your medically-necessary
(1) Sometimes this is done for free by generator
(2) The wattage is found on the back of
the equipment (i.e. 300W, or multiply amps x
volts = watts).
(a) Include life-support equipment even if
it has battery backup, because batteries and
their fuses often fail.
(b) Include equipment that contributes
to your ability to remain safely in the home
(i.e. central air & heat, electric lifts, refrigerator
for medications, waterbed heater, etc.).
Click here to download a sample medically-necessary
(D) Acquire quotes
for generators with installation from local generator
retailers/installers that fall below the home
modifications' cost cap:
(1) Iinclude the general contractor
fee; see (E) below.
$10,000 cost cap by clicking here.
Generator retailers/installers will usually
be accommodating with their quotes:
them with the documented cost cap and wattage
of waiting for the CMA or the general contractor to acquire
a generator and installation quote, personally acquiring
a quote from a generator retailer/installer allows you
to haggle directly to assure the quote + the general contractor
fee falls below the cost cap.
(4) A need for a continual
supply of power requires a liquid-cooled generator:
(a) Even though
generator manuals do not state it,
manufacturers and licensed installers will
confirm that air-cooled
models need to be shut down for at
least one hour every 24 hours to cool down.
(b) After the
latest search of generator brands and models, the only
liquid-cooled whole-house automatic standby generator (with
transfer switch and installation) that falls below the cost
cap is the Guardian QuietSource
18kW model by
Generac Power Systems,
liquid-cooled 18kW Generac QT018 is identical, but the
steel enclosure models, 05398 and 05398T, appear
to be unavailable.)
(c) Life-support compliant generators* would be
best for life-support applications, but usually will not
fall below the cost cap.
(d) If you have already received some
form of home modification, you will either need to accept a
less-expensive generator or wait 12 months after your last home modification
before requesting a more expensive generator.
(5) Click here to download
an acceptable sample of a generator subcontractor quote.
(NOTE: This quote is no longer
a general contractor that is an authorized provider
to oversee home modifications:
(1) A general contractor is
needed, as generator retailers/installers are not yet
authorized providers. (This should change as more
consumers request generators.)
(2) Your CMA will ultimately search for an authorized general
contractor to handle the home modification during
the bidding process, so this step may be skipped.
Authorized providers can be found
on the CMA web site by clicking here.
(4) Acquire a written agreement on the fee
charged by this general contractor to add to the generator
quote, while remaining under the $10,000 cost cap:
(a) Example: $9090 for the generator,
transfer switch and installation by the retailer/installer
+ $909 or 10%
for the general contractor = $9999.
are authorized providers,
are licensed general contractors and have submitted
acceptable bids like the example above; (E)(4)(a). (All
88 Ohio counties are served by Life Access and the southern
half of Ohio is served by T. J. Young.)
providers ARE NOT allowed to request or let consumers cover
any cost that exceeds the cost cap. (NOTE: generator
retailers/installers are not "authorized providers". This
is why a consumer may want to haggle with a generator retailer/installer
before contacting an authorized general contractor or the
(5) Click here to download
a blank bid form (with guide) that the authorized general
contractor will need to fill out.
See below, (L), for the actual
bid form for the first generator approved by the State of
an occupational therapist (OT) or physical therapist (PT) evaluation
from your CMA for an ASSISTIVE AND ADAPTIVE DEVICE:
(1) Present the generator paperwork for the
OT to incorporate into their report.
IF THE GENERATOR IS CLASSIFIED AS A HOME MODIFICATION,
make certain that the OT incorporates
the following home modifications' requirements
in their report:
OAC § 5101:3-12-07(C)(4) This home modification
is not of "general utility", is of "direct medical
or remedial benefit to the consumer", does not
"add to the total square footage of the home" and is being
adapted to a dwelling "owned by the consumer or the parent"
(b) OAC § 5101:3-12-07(C)(3)(b)
It meets the criteria of "medically necessary
to ensure the health, welfare and safety of the consumer"
and OAC § 5101:3-1-01(A) "without which the
patient can be expected to suffer prolonged, increased
or new morbidity, impairment of function, dysfunction
of a body organ or part, or significant pain and discomfort"
(c) OAC § 5101:3-12-07(C)(3)(d)
It meets the criteria to "enable the consumer
to function with greater independence in the home and
without which the consumer would require institutionalization"
(d) OAC § 5101:3-12-07(C)(3)(c)
It meets the criteria to "reduce the extent
to which the need for human assistance is required"
(G) Send a written
request for an appropriate generator, the OT report,
and a request that the generator be added to your All
Services Plan (ASP), to your CMA case manager.
(H) If the CMA
denies your request for a generator, and you still
believe that you qualify, follow the appeal hearing
instructions on the denial the CMA sends you.
(DO NOT MISS DEADLINES.)
Prepare for the
(1) Use written
and oral arguments,
while incorporating all
your paperwork and documentation.
(2) Enter into the record as much evidence as you
a copy of the precedent appeal decision, (B), and
make certain it is entered as an "Appellant's Exhibit".
officers appreciate direct expert testimony at the appeal
hearing (i.e. occupational therapists, respiratory therapists,
expert testimony should be read and entered into the
record as exhibits.
(d) Ask that
your evidence/exhibits be entered with an exhibit number
AND labeled referring to what it pertains to specifically.
(3) Refute all false testimony
and evidence by the CMA. (Ask for a recess, if needed,
to review the CMA's exhibits.)
(4) See the judicial appeal below, (K)(1), for additional
evidence to submit at an appeal hearing.
(J) If you lose the appeal
hearing, you are entitled to appeal this decision
with a written
within 15 calendar days:
(1) The instructions on how to file an administrative
appeal are at the end of the appeal hearing decision.
(2) Immediately follow the instructions
on acquiring an audio tape of the appeal hearing.
(It is not unusual to have these tapes and evidence
specific reasons and laws
for filing the administrative
with more info here.
(a) Justifications for filing an
administrative appeal include: the decision is contrary to
the weight of the evidence presented, a prejudicial error
was committed in the course of the proceedings, and/or, the decision
relies on incorrect application of law or rule.
(4) There is no danger in filing an administrative appeal,
as the ODJFS' administrative decision cannot "result in a determination
more adverse to the individual than was contained in the
initial decision being appealed" [
OAC § 5101:6-8-01(I)(6)]. And if the administrative
appeal does result in a "more adverse" decision, this violation
can be brought up in a judicial appeal; see (K) below.
On September, 21, 2007 (with assistance
from an attorney and a paralegal)
, the Franklin County Court of Common Pleas ruled against
the ODJFS, the CMA (Ohio Home Care Program, a.k.a. CareStar),
and the Ohio Attorney General, and ruled in favor of the
consumers in need of ADEQUATE generators:
Click here to download the official decision;
CASE NO. 07CV-6376
(2) Presenting this decision at
an appeal hearing would help if the consumer has medically-necessary
equipment without battery backup, and the CMA attempts to
force an unacceptable and less-expensive air-cooled generator
as an alternative to an adequate liquid-cooled or life-support
(3) The judge's ruling
required facts and evidence that only the consumer could provide.
(L) The CMA capitulated and approved
a bid for an appropriate liquid-cooled generator on November
(Click here to download the official bid approval.)
18kW Generac QT018 (identical to the Guardian QuietSource
05399) generator was installed on May 19, 2008.
* NFPA 110 compliant generators
are for life-support applications. The National
Fire Protection Association sets the Standard
for Emergency and Standby Power Systems, and the
NFPA 110 standard covers installation, maintenance,
operation, and testing requirements as they pertain
to the performance of the emergency power supply system
(EPSS) for life support systems.
Disclaimer: I am not an attorney, nor do I purport
to give legal advise. Although, the over two years
it took to force the State of Ohio to comply is experience that
would be difficult to ignore.
Individuals who send threatening or harassing email
messages from governmental, commercial, educational,
or other organizations not identified as providing
net access to the general public can expect to have their
message forwarded to their system administrator along with
a request for a statement clarifying that organization's
policy regarding use of their computer facilities for the
purpose of sending harassing or threatening messages. I also reserve
the right to cooperate with law enforcement in any way I see fit.
Retaliation will be dealt with accordingly.