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 It took a three year battle, but the State of Ohio and Medicaid must now fund automatic standby whole-house generators for those in dire need.  They must also provide the adequate type of generator that does not need to be shut down after every 24 hours of use.  (Liquid-cooled & natural gas and/or liquid propane fueled.)

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.)  Otherwise, you may want to follow the steps below.  (NOTE: Ohio Home Care Program, a.k.a CareStar.com, is the only CMA in Ohio.)
STEPS FOR ACQUIRING GOVERNMENT FUNDING FOR GENERATORS

(A) Determine 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 caregiver.
        (3) Receiving or eligible to receive Medicaid.
        (4) Currently enrolled, or willing to enroll, in the Ohio Home Care Waiver Program run by the Ohio Department of Job and Family Services (ODJFS).
        (5) Click here for the contact information needed to enroll in the Ohio Home Care Waiver Program.
        (6) Click here to download the form to enroll in the Ohio Home Care Waiver Program.

(B) Download 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.)

(C) Determine the required wattage of your medically-necessary equipment:
        (1) Sometimes this is done for free by generator retailers/installers.
        (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 equipment list.

(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.
        (2) Download the $10,000 cost cap by clicking here.
        (3) Generator retailers/installers will usually be accommodating with their quotes:
            (a) Provide them with the documented cost cap and wattage requirements.
            (b) Instead 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 05399 18kW model by Generac Power Systems, Inc.  (The 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 valid.)
   
(E) Find 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.
        (3) 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.
            (b) lifeaccessonline.com and tjyoungcontractors.com 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.)
            (c) Authorized 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 CMA.)
        (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 Ohio.

(F) Request 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.
        (2) IF THE GENERATOR IS CLASSIFIED AS A HOME MODIFICATION, make certain that the OT incorporates the following home modifications' requirements in their report:
             (a) 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.)

(I) Prepare for the appeal hearing:
        (1) Use written and oral arguments, citing specific law, while incorporating all your paperwork and documentation.
        (2) Enter into the record as much evidence as you can acquire.
            (a) Bring a copy of the precedent appeal decision, (B), and make certain it is entered as an "Appellant's Exhibit".
            (b) Hearing officers appreciate direct expert testimony at the appeal hearing (i.e. occupational therapists, respiratory therapists, etc.)
            (c) Written 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 administrative appeal 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 disappear.)
        (3) Quote specific reasons and laws for filing the administrative appeal; 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.

(K) 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:
        (1) 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 compliant generator.
        (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 19, 2007.   (Click here to download the official bid approval.)   The liquid-cooled 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.

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