HDM Manual | Aiden

1. Purpose & Scope

1.1 Purpose

This Policy and Procedure Manual governs the Home Delivered Meals (HDM) program operated by Dulla Care Home Healthcare. It establishes standards for the delivery of nutritious meals to eligible consumers in their place of residence in compliance with applicable federal, state, and program-specific requirements.

1.2 Scope

This manual applies to all Dulla Care Home Healthcare staff, contractors, and volunteers involved in the planning, preparation, packaging, delivery, and documentation of Home Delivered Meals services under the following programs:

Ohio PASSPORT Medicaid Waiver

Medicare (where applicable)

Ohio Medicaid State Plan

MyCare Ohio (Managed Care Organizations: Molina, Anthem, CareSource)

Other applicable insurance programs and private pay arrangements

1.3 Legal Authority

Ohio Administrative Code (OAC) 5101:3-1, 5160-1, 5160-45

Ohio Revised Code (ORC) Chapter 5111

Title III of the Older Americans Act (OAA)

Centers for Medicare & Medicaid Services (CMS) Conditions of Participation

PASSPORT Waiver Provider Agreement

MyCare Ohio Provider Agreements

1. Purpose & Scope

1.1 Purpose

1.2 Scope

Ohio PASSPORT Medicaid Waiver

Medicare (where applicable)

Ohio Medicaid State Plan

MyCare Ohio (Managed Care Organizations: Molina, Anthem, CareSource)

Other applicable insurance programs and private pay arrangements

1.3 Legal Authority

Ohio Administrative Code (OAC) 5101:3-1, 5160-1, 5160-45

Ohio Revised Code (ORC) Chapter 5111

Title III of the Older Americans Act (OAA)

Centers for Medicare & Medicaid Services (CMS) Conditions of Participation

PASSPORT Waiver Provider Agreement

MyCare Ohio Provider Agreements

2. Consumer Eligibility

2.1 PASSPORT Waiver Eligibility

To receive Home Delivered Meals under the PASSPORT Waiver, a consumer must:

Be age 60 or older (or under 60 with a qualifying disability as determined by the Ohio Department of Aging)

Meet nursing facility level of care as determined by the Ohio Department of Medicaid

Be enrolled in the PASSPORT program through a designated Area Agency on Aging (AAA)

Have Home Delivered Meals authorized in the consumer's Service Plan

Reside in an approved PASSPORT service county

2.2 Medicaid State Plan Eligibility

Consumer must be enrolled in Ohio Medicaid

Service must be ordered by a licensed physician or authorized clinician

Consumer must be homebound or have significant difficulty leaving home without assistance

2.3 Medicare Eligibility

Consumer must be enrolled in Medicare Part A and/or Part B

Home Delivered Meals may be covered as part of a post-acute discharge plan

Prior authorization must be obtained where required by the Medicare Advantage plan

2.4 MyCare Ohio Eligibility

Consumer must be dually eligible for Medicare and Medicaid

Must be enrolled in a participating MyCare Ohio managed care plan

Service must be included in the consumer's approved care plan

Prior authorization is required through the assigned Managed Care Organization (MCO)

2.5 Ineligibility / Denial

Consumers will not be enrolled if they:

Do not meet clinical or financial eligibility criteria

Reside outside Dulla Care's approved service area

Are already receiving duplicative meal services from another provider

Refuse to sign the required consent and service agreements

All denials will be communicated in writing within 5 business days with information on the appeals process.

3. Service Authorization & Prior Authorization

3.1 Service Plan Authorization

Home Delivered Meals must be authorized in the consumer's current Service Plan or Care Plan before services begin. No meals shall be delivered without a valid authorization.

3.2 PASSPORT Prior Authorization

Authorization is obtained through the consumer's assigned PASSPORT Case Manager

Dulla Care must receive a written Service Authorization before initiating services

Authorization specifies: number of meals per day, days per week, and authorization period

Re-authorization must be completed before the expiration date of the current authorization

3.3 MyCare Ohio Prior Authorization

Prior authorization must be submitted to the appropriate MCO (Molina, Anthem, or CareSource)

Include: consumer demographics, Medicaid ID, physician order, clinical justification, and requested service frequency

Authorization response expected within 3–5 business days (urgent requests within 24–72 hours)

Dulla Care will not initiate services until written authorization is received

3.4 Medicare Prior Authorization

Applicable Medicare Advantage plans may require prior authorization

Documentation must include a physician order, homebound status certification, and medical necessity

Dulla Care will follow each plan's specific authorization process

3.5 Changes to Authorization

Any change in meal frequency, duration, or type requires a new or amended authorization

Dulla Care will notify the case manager or MCO of any changes in the consumer's condition that may affect service needs

Emergency meal delivery may occur for up to 2 days pending authorization confirmation with immediate follow-up documentation

3.6 Authorization Tracking

All authorizations are logged in the consumer's record with authorization number, start date, end date, and units authorized

Staff must verify active authorization before each billing cycle

4. Meal Standards & Nutritional Requirements

4.1 Nutritional Standards

All meals provided by Dulla Care Home Healthcare must meet the following minimum standards:

One-third (1/3) of the Dietary Reference Intakes (DRIs) as established by the National Academy of Sciences for individuals 60 years and older

Compliance with the most current Dietary Guidelines for Americans

Ohio Department of Aging (ODA) nutritional guidelines for Title III and PASSPORT-funded meals

4.2 Meal Types

Dulla Care provides the following meal types based on consumer need and physician or dietitian order:

Regular / House Diet: Standard nutritionally balanced meal

Low Sodium: ≤ 2,000 mg sodium per day

Diabetic / Carbohydrate Controlled: Consistent carbohydrate meal plan

Renal Diet: Restricted potassium, phosphorus, and protein

Pureed / Mechanical Soft: For consumers with swallowing difficulties (dysphagia)

Texture Modified: IDDSI (International Dysphagia Diet Standardisation Initiative) compliant

Culturally Appropriate Meals: Available upon request based on religious or cultural preferences

Frozen Meals (Weekend / Supplemental): USDA-approved frozen meals for non-delivery days

4.3 Special Dietary Needs

A licensed dietitian or Registered Dietitian Nutritionist (RDN) must review and approve all therapeutic or modified diet orders

Special dietary accommodations (allergies, intolerances, religious restrictions) must be documented in the consumer's record and communicated to the meal provider/kitchen

Consumer dietary needs are reassessed at every service plan review

4.4 Meal Sourcing

Dulla Care partners only with licensed, inspected food preparation facilities that hold current health department certificates

All food vendors/caterers must comply with FDA Food Safety Modernization Act (FSMA) requirements

Temperature logs and food safety records from vendors must be maintained and available for audit

4.5 Food Safety & Temperature

Hot meals must be maintained at ≥ 140°F (60°C) at time of delivery

Cold meals and refrigerated items must be maintained at ≤ 41°F (5°C)

Frozen meals must remain frozen (≤ 0°F / -18°C) until delivery

Temperature checks are performed and logged at packaging and at delivery

5. Delivery Standards & Procedures

5.1 Delivery Frequency

Services are provided in accordance with the authorized Service Plan (typically 5–7 days per week)

Weekend and holiday meals may be delivered as frozen or shelf-stable meals on the preceding delivery day

5.2 Delivery Windows

Standard delivery window: between 10:00 AM and 2:00 PM unless otherwise arranged

Consumers will be informed of their expected delivery window at intake and when windows change

Delivery staff must not leave meals unattended without explicit written consent from the consumer

5.3 Delivery Personnel Requirements

All HDM delivery staff must:

Complete Dulla Care new hire orientation and HDM-specific training

Hold a current, valid Ohio driver's license

Pass a criminal background check (CBC) including BCII and FBI

Complete annual food safety/food handler training

Comply with Dulla Care's dress code and conduct policies while on delivery routes

Never enter a consumer's home beyond the threshold unless an emergency requires it

5.4 Delivery Vehicles

All delivery vehicles must be clean, roadworthy, and properly insured

Insulated bags, coolers, or hot/cold carriers are required for all deliveries

Vehicle temperature logs must be maintained for each delivery route

Dulla Care delivery vehicles must display company identification

5.5 Failed Delivery / Consumer Not Home

If the consumer does not answer:

1. Attempt to contact the consumer by phone (minimum 2 attempts)

2. Contact the emergency contact on file

3. If no contact is made within 15 minutes, notify the Dulla Care office supervisor immediately

4. Document all attempts in the consumer's delivery log

5. If there is a welfare concern, call 911 and notify the consumer's case manager or MCO

6. Do not leave perishable meals unattended at the door

5.6 Delivery Documentation

For each delivery, the driver must document:

Consumer name and Medicaid / insurance ID

Date and time of delivery

Meal type delivered

Meal temperature at delivery (hot/cold check)

Consumer or authorized representative signature (or reason signature was not obtained)

Driver name and signature

Any concerns or observations about the consumer's condition

6. Consumer Rights & Responsibilities

6.1 Consumer Rights

Every consumer receiving Home Delivered Meals from Dulla Care Home Healthcare has the right to:

Receive services without discrimination based on race, color, national origin, sex, age, disability, religion, or sexual orientation

Be treated with dignity and respect by all Dulla Care staff

Receive nutritious meals that meet their dietary needs and preferences to the extent possible

Be informed of the services they are authorized to receive and any limitations

Refuse services at any time without penalty

File a grievance or complaint without fear of retaliation or service disruption

Access their service records upon request

Have their personal information kept confidential in accordance with HIPAA

6.2 Consumer Responsibilities

Consumers receiving HDM services are expected to:

Be available during the designated delivery window or arrange for an authorized representative to receive meals

Notify Dulla Care at least 24 hours in advance if they will not be home (planned absences)

Inform Dulla Care of any changes in dietary needs, medical conditions, or contact information

Treat Dulla Care staff with respect

Not request that delivery staff perform tasks outside the scope of the HDM program

6.3 Temporary Suspension of Services

Services may be temporarily suspended if:

The consumer is hospitalized or enters a facility (notify the MCO/case manager immediately)

The consumer is temporarily absent from the home (vacation, family stay)

Meals are refused for three (3) or more consecutive days

Suspension will be documented and the MCO/case manager notified within 1 business day.

6.4 Permanent Discharge from Services

Grounds for discharge include:

Consumer no longer meets eligibility criteria

Consumer voluntary withdrawal

Consumer's needs exceed the scope of the HDM program

Safety concerns for Dulla Care staff

Authorization is no longer active

A written discharge notice will be provided with at least 10 days advance notice (except in cases of immediate safety concern).

7. Documentation & Recordkeeping

7.1 Consumer Record Requirements

Each consumer's record must contain:

Signed Consent for Services and HIPAA Notice of Privacy Practices

Current Service Plan / Care Plan with HDM authorization

Physician or clinician order (where required)

Dietary assessment and any special diet orders

Emergency contact information

Delivery logs (daily)

Any incident or concern reports

Correspondence with MCO, case manager, or physician

7.2 Delivery Logs

Daily delivery logs must be completed for every delivery and include:

Consumer full name and Medicaid / insurance ID

Date and time of delivery

Meal type delivered

Temperature check at delivery

Consumer/representative signature or reason for absence

Driver name, signature, and employee ID

Notes on consumer's condition or any observations

7.3 Retention Requirements

All service records must be retained for a minimum of 6 years from the date of service or last entry

Records involving minors (if applicable) must be retained until age 21 or 6 years from last service, whichever is longer

Electronic records must be backed up and protected against unauthorized access

Records must be available for review by ODM, ODA, MCO auditors, or CMS upon request

7.4 Billing Documentation

All billing must be supported by daily service delivery records

Billing must reflect only services actually delivered and documented

Billing staff must reconcile delivery logs against claims prior to submission

Claims must be submitted in accordance with each payer's timely filing requirements

7.5 HIPAA Compliance

Consumer records are confidential and protected under HIPAA

Access is limited to staff with a legitimate need to know

Any suspected breach of consumer PHI must be reported immediately to the Dulla Care Privacy Officer

8. Incident Reporting

8.1 Reportable Incidents

The following must be reported as incidents:

Consumer found unresponsive, injured, or in apparent medical distress during delivery

Consumer reports abuse, neglect, or exploitation

Meal delivered outside of safe temperature range

Consumer received incorrect meal type (wrong diet)

Delivery vehicle accident while on route

Theft, loss, or damage of consumer property by Dulla Care staff

Consumer complaint involving the safety or quality of meals

8.2 Immediate Response

When an incident occurs:

1. Ensure consumer safety first — call 911 if there is immediate danger

2. Notify the Dulla Care office supervisor immediately by phone

3. Do not leave the scene until instructed by the supervisor (unless directed by emergency services)

4. Complete a written Incident Report within 24 hours of the event

8.3 Incident Report Requirements

Each incident report must include:

Consumer name, Medicaid ID, and address

Date, time, and location of incident

Description of what occurred (factual, non-opinion)

Names of all involved parties and witnesses

Action(s) taken at the scene

Follow-up actions required

Staff name, signature, and date of report

8.4 Mandatory Reporting

Dulla Care staff are mandatory reporters under Ohio law. Suspected abuse, neglect, or exploitation of an adult must be reported to:

Adult Protective Services (APS): 1-855-644-6277

Ohio Department of Developmental Disabilities (DODD) — if applicable

The consumer's MCO or PASSPORT case manager

Local law enforcement — if criminal activity is suspected

8.5 MCO / Case Manager Notification

The consumer's MCO or PASSPORT case manager must be notified of any incident within:

24 hours for serious incidents (hospitalization, injury, abuse/neglect report)

5 business days for non-urgent incidents

9. Grievance & Appeals

9.1 Consumer Grievance Process

Consumers or their authorized representatives have the right to file a grievance regarding any aspect of Home Delivered Meals services.

How to File a Grievance:

1. Contact Dulla Care Home Healthcare by phone, in writing, or in person

2. Grievances may also be submitted to the consumer's MCO or PASSPORT case manager

3. Grievances will be acknowledged within 2 business days

4. A written resolution will be provided within 10 business days

9.2 Service Denial or Reduction Appeals

If a consumer's HDM services are denied, reduced, or terminated, the consumer has the right to appeal:

PASSPORT / Ohio Medicaid: Request a State Hearing through the Ohio Department of Medicaid (ODM) — 1-800-324-8680

MyCare Ohio MCO: File an appeal directly with the MCO within 60 days of the adverse action

Medicare Advantage: File an appeal with the plan within 60 calendar days of the denial notice

Continuation of Services: Consumers may request continuation of services during the appeal process (Medicaid due process rights)

9.3 Non-Retaliation

Filing a grievance or appeal will not result in any reduction, suspension, or termination of services. Dulla Care staff are prohibited from retaliating against any consumer or family member who exercises their appeal rights.

9.4 External Complaint Resources

Ohio Department of Medicaid (ODM): 1-800-324-8680

Ohio Department of Aging (ODA): 1-800-266-4346

Long-Term Care Ombudsman: 1-800-282-1206

MyCare Ohio MCO Grievance Departments (per plan)

10. Staff Training & Competency

10.1 Required Training — All HDM Staff

Prior to delivering Home Delivered Meals services, all staff must complete:

Dulla Care new hire orientation (general policies, HIPAA, consumer rights)

HDM program-specific orientation (delivery procedures, documentation, food safety)

Ohio Food Handler / Food Safety certification (ServSafe or equivalent)

Mandatory reporter training (adult abuse/neglect/exploitation)

Emergency and incident response procedures

CPR/First Aid certification (recommended; required for supervisory staff)

10.2 Annual Competency Requirements

All HDM delivery and supervisory staff must complete annually:

HDM policy and procedure review and attestation

Food safety refresher training

HIPAA privacy and security refresher

Consumer rights and dignity/respect training

Mandatory reporter refresher

10.3 Training Documentation

All training completions are documented in each employee's personnel file

Training certificates and competency evaluations must be retained for a minimum of 3 years

The Dulla Care Director of Operations is responsible for ensuring training compliance

10.4 Ongoing Competency Monitoring

Supervisors will conduct unannounced quality monitoring checks on at least 10% of deliveries per month

Delivery staff are subject to annual performance evaluations

Staff who fail to meet competency standards will be placed on a performance improvement plan and provided with remedial training before returning to service

10.5 Driver-Specific Requirements

All HDM drivers must maintain:

Valid Ohio driver's license (Class D or higher)

Clean driving record (reviewed annually by Dulla Care)

Current auto insurance

Completion of defensive driving training every 2 years

11. Quality Assurance & Program Monitoring

11.1 Quality Assurance Program

Dulla Care Home Healthcare maintains an active Quality Assurance (QA) program for HDM services that includes:

Monthly review of delivery logs and temperature records

Consumer satisfaction surveys (minimum quarterly)

Review of all grievances and incident reports

Tracking of failed deliveries, missed meals, and consumer concerns

Annual program audit by the Dulla Care Director or designee

11.2 Consumer Satisfaction

Dulla Care will conduct consumer satisfaction surveys at least once per quarter

Survey results will be reviewed by management and used to identify areas for improvement

Consumers who express dissatisfaction will be contacted within 5 business days for follow-up

11.3 Meal Quality Monitoring

Random temperature checks will be performed on at least 10% of deliveries per month

Meal quality (appearance, portion, labeling) will be reviewed at least monthly

Any vendor or kitchen concerns will be documented and addressed with the food supplier within 5 business days

11.4 Corrective Action

When QA monitoring identifies a deficiency:

1. Document the finding in the QA log

2. Identify root cause

3. Develop and implement a Corrective Action Plan (CAP) within 10 business days

4. Re-monitor to verify resolution within 30 days

5. Report significant findings to the Dulla Care Director

11.5 Payer / Regulatory Audits

Dulla Care cooperates fully with audits conducted by:

Ohio Department of Medicaid (ODM)

Ohio Department of Aging (ODA)

CMS / Medicare auditors

MyCare Ohio MCOs

Area Agencies on Aging (AAA)

All requested records will be produced within the timeframe specified by the auditing entity.

12. Billing & Claims Compliance

12.1 Billing Standards

Dulla Care Home Healthcare bills only for services that were:

Actually delivered and documented

Authorized in the consumer's current Service Plan or Care Plan

Provided by qualified, trained staff

Supported by complete delivery documentation including consumer or representative signature

12.2 PASSPORT Billing

Claims submitted through the Ohio Medicaid Management Information System (MMIS) or approved billing clearinghouse

Timely filing limit: 365 days from date of service (verify current ODM guidance)

Procedure codes and rates per current PASSPORT fee schedule

Units must reflect actual meals delivered

12.3 Medicaid State Plan Billing

Claims submitted per ODM billing guidelines

Prior authorization number must appear on all claims where required

Duplicate billing is strictly prohibited

12.4 MyCare Ohio (MCO) Billing

Billing submitted per each MCO's specific claims submission requirements

Claims must reference the authorization number issued by the MCO

Electronic remittance advice (ERA) must be reconciled monthly

12.5 Medicare Billing

HDM billed under applicable Medicare benefit categories (consult billing specialist for specific codes)

Medicare Advantage plans billed per plan-specific provider agreements

Medicare timely filing limit: 1 year from date of service

12.6 Fraud, Waste & Abuse (FWA)

Dulla Care prohibits:

Billing for services not rendered

Upcoding or misrepresenting services delivered

Duplicate billing across payers

Kickbacks or inducements in exchange for referrals

All staff are trained to recognize and report FWA. Suspected FWA must be reported immediately to the Dulla Care Director and may be reported to the Ohio Medicaid Inspector General (OMIG) at 1-800-686-1516.

12.7 Overpayments

Any identified overpayment must be returned to the payer within 60 days of identification, per CMS and ODM requirements.

13. Policy Review & Acknowledgment

13.1 Policy Review Schedule

This Policy and Procedure Manual will be reviewed:

Annually by the Dulla Care Director of Operations

Whenever there is a material change in Ohio Medicaid, Medicare, PASSPORT, or MyCare Ohio regulations

Following any significant incident or audit finding that reveals a policy gap

Upon request by a regulatory body, MCO, or AAA partner

13.2 Policy Revisions

All revisions to this manual will be:

Dated and version-controlled

Communicated to all affected staff within 10 business days

Incorporated into staff training within 30 days of revision

13.3 Staff Acknowledgment

All Dulla Care Home Healthcare staff involved in Home Delivered Meals services must sign an acknowledgment confirming they have read, understand, and agree to comply with this Policy and Procedure Manual. Acknowledgments are retained in each employee's personnel file.

Staff Acknowledgment Form

I, the undersigned, acknowledge that I have received, read, and understand the Dulla Care Home Healthcare Home Delivered Meals Policy and Procedure Manual. I agree to comply with all policies and procedures outlined herein and understand that violations may result in disciplinary action up to and including termination.

Employee Printed Name: _________________________________________

Employee Signature: ___________________________________________   Date: _______________

Job Title / Role: _______________________________________________

Supervisor Signature: __________________________________________   Date: _______________

*Dulla Care Home Healthcare · Home Delivered Meals Program · Ohio Medicaid / PASSPORT / MyCare Ohio / Medicare*

*Effective Date: October 2026 · Version 1.0*

*This document is confidential and for internal use only. Do not distribute without authorization from the Dulla Care Director.*

Dulla Care Home Healthcare

Home Delivered Meals (HDM) Program

1. Purpose & Scope

1.1 Purpose

1.2 Scope

1.3 Legal Authority

1. Purpose & Scope

1.1 Purpose

1.2 Scope

1.3 Legal Authority

2. Consumer Eligibility

2.1 PASSPORT Waiver Eligibility

2.2 Medicaid State Plan Eligibility

2.3 Medicare Eligibility

2.4 MyCare Ohio Eligibility

2.5 Ineligibility / Denial

3. Service Authorization & Prior Authorization

3.1 Service Plan Authorization

3.2 PASSPORT Prior Authorization

3.3 MyCare Ohio Prior Authorization

3.4 Medicare Prior Authorization

3.5 Changes to Authorization

3.6 Authorization Tracking

4. Meal Standards & Nutritional Requirements

4.1 Nutritional Standards

4.2 Meal Types

4.3 Special Dietary Needs

4.4 Meal Sourcing

4.5 Food Safety & Temperature

5. Delivery Standards & Procedures

5.1 Delivery Frequency

5.2 Delivery Windows

5.3 Delivery Personnel Requirements

5.4 Delivery Vehicles

5.5 Failed Delivery / Consumer Not Home

5.6 Delivery Documentation

6. Consumer Rights & Responsibilities

6.1 Consumer Rights

6.2 Consumer Responsibilities

6.3 Temporary Suspension of Services

6.4 Permanent Discharge from Services

7. Documentation & Recordkeeping

7.1 Consumer Record Requirements

7.2 Delivery Logs

7.3 Retention Requirements

7.4 Billing Documentation

7.5 HIPAA Compliance

8. Incident Reporting

8.1 Reportable Incidents

8.2 Immediate Response

8.3 Incident Report Requirements

8.4 Mandatory Reporting

8.5 MCO / Case Manager Notification

9. Grievance & Appeals

9.1 Consumer Grievance Process

How to File a Grievance:

9.2 Service Denial or Reduction Appeals

9.3 Non-Retaliation

9.4 External Complaint Resources

10. Staff Training & Competency

10.1 Required Training — All HDM Staff

10.2 Annual Competency Requirements

10.3 Training Documentation

10.4 Ongoing Competency Monitoring

10.5 Driver-Specific Requirements

11. Quality Assurance & Program Monitoring

11.1 Quality Assurance Program

11.2 Consumer Satisfaction

11.3 Meal Quality Monitoring

11.4 Corrective Action

11.5 Payer / Regulatory Audits

12. Billing & Claims Compliance

12.1 Billing Standards

12.2 PASSPORT Billing

12.3 Medicaid State Plan Billing

12.4 MyCare Ohio (MCO) Billing

12.5 Medicare Billing

12.6 Fraud, Waste & Abuse (FWA)

12.7 Overpayments

13. Policy Review & Acknowledgment