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Ohio Laws and Rules
As used in this chapter:
(A) “Assistive technology service” means a service that directly assists a child with a disability in the selection, acquisition or use of an assistive technology device.
(1) Assistive technology services include:
(a) The evaluation of the needs of a child with a disability, including a functional evaluation of the child in the child’s customary environment;
(b) Purchasing, leasing or otherwise providing for the acquisition of assistive technology devices by children with disabilities;
(c) Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing or replacing assistive technology devices;
(d) Coordinating and using other therapies, interventions, or services with assistive technology devices, such as those associated with existing education and rehabilitation plans and programs;
(e) Training or technical assistance for a child with a disability, or, if appropriate, that child’s family; and
(f) Training or technical assistance for professionals (including individuals providing early intervention services) or other individuals who provide services to or are otherwise substantially involved in the major life functions of individuals with disabilities.
(2) Assistive technology device means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain or improve functional capabilities of children with disabilities. This term does not include a medical device that is surgically implanted or the replacement of such device.
(B) “Department” means the Ohio department of health.
(C) “Developmental delay” or “delay” means a delay as identified through the developmental evaluation process in one or more of the following developmental domains:
(1) Cognitive development;
(2) Communication development;
(3) Social or emotional development;
(4) Adaptive development; or
(5) Physical development including vision, hearing and nutrition.
(D) “Developmental disability” or “disability” means a disability that is characterized by all of the following:
(1) It is attributable to a mental or physical impairment or a combination of mental and physical impairments;
(2) It is manifested before twenty-two years of age;
(3) It is likely to continue indefinitely; and
(4) It results in at least one delay or a condition known to result in a delay.
(E) “Developmental evaluation” means an evaluation using an age-appropriate research based tool that measures the level of functioning in the following developmental domains:
(1) Cognitive development;
(2) Communication development;
(3) Social or emotional development;
(4) Adaptive development; and
(5) Physical development, including vision, hearing and nutrition.
(F) “Direct Services” means all of the following:
(1) Family support and community-based services that promote the well being of children and families and increase the strength, stability, confidence and learning environment of families through social services, health and education services, in home visits and parent support groups. Also included are programs designed to improve parenting skills, including skills in child development, family budgeting, coping with stress, health, and nutrition;
(2) Structured activities to strengthen parent-child interaction;
(3) Resource information and referral services;
(4) Developmental screening and evaluation of children;
(5) Developmental services for children to foster growth and development;
(6) Health related services such as public health nursing services and health education;
(7) Service coordination;
(8) Individualized family service plan development for infants and toddlers with a delay or disability and delivery of services;
(9) Family plan development for eligible pregnant women, infants and toddlers for home visiting services;
(10) Early intervention services;
(11) Transition; and
(12) Any other similar service approved by the director.
(G) “Director” means the director of health or his or her authorized designee.
(H) “Expectant family” means a pregnant woman and her family or a family that is in the process of adopting an infant or toddler.
(I) “Family and children first council” or “FCFC” means the council established pursuant to section 121.37 of the Revised Code at state and county levels with a stated purpose of helping families seeking government services by streamlining and coordinating existing services and supports for children.
(J) “Family plan” means a written plan that identifies the activities that will be provided or carried out in the delivery of services for eligible pregnant women, infants and toddlers.
(K) “Help me grow” or “HMG” means Ohio’s birth to age three system designed to provide and maintain a coordinated, community-based infrastructure that promotes trans-disciplinary, family-centered services for eligible expectant families, newborns, infants, toddlers and their families.
(L) “Help me grow system review” means the monitoring system used by the department to determine if a county is in compliance with Chapter 3701-8 of the Administrative Code and part C.
(M) “Home visit” occurs when a home visitor travels to a child or family’s place of residence or a community location agreed upon by the family and home visitor and engages in providing home visiting program elements.
(N) “Home visitor” is the individual who delivers HMG services during home visits within the home visiting program.
(O) “Individualized family service plan” or “IFSP” means a written plan for providing early intervention services to part C eligible children and their families.
(P) “Individuals with Disabilities Education Act” or “IDEA” means the federal law addressing the education of children with disabilities codified at 20 U.S.C. section 1400 and federal regulations codified at 34 C.F.R. parts 300 and 303 in effect as of July 1, 2010.
(Q) “Infant” means a child from birth through age eighteen months.
(R) “Informed clinical opinion” means the observations and perceptions of parents, professionals and other caregivers which are structured, integrated, and then used to reach decisions about a child’s functional and behavioral strengths in order to determine eligibility and program plan of services within early intervention.
(S) “Newborn” means an infant who is less than six weeks of age or less than six weeks from hospital discharge after birth.
(T) “Ohio help me grow advisory council” means the designated advisory group for formal interagency planning, policy development and implementation of the HMG system as required by 34 C.F.R. 303.600 in effect as of July 1, 2010.
(U) “Parent” means a natural or adoptive parent of a child, the parent with legal custody of the child if the parents are separated or divorced, a guardian or custodian but not the state if the child is a ward of the state, a person acting in the place of a parent (such as a grandparent or stepparent with whom the child lives, or a person who is legally responsible for the child’s welfare), or a surrogate parent who has been assigned in accordance with 34 C.F.R. 303.406, in effect as of July 1, 2010.
(V) “Part C” means that part of IDEA addressing infants and toddlers with disabilities, codified at 20 U.S.C. sections 1431 to 20 U.S.C. sections 1445 and federal regulations codified at 34 C.F.R. part 303 in effect as of July 1, 2010.
(W) “Procedural safeguards” means the procedures set forth in rule 3701-8-08 of the Administrative Code.
(X) “Professional” means a person who has a degree, state certification, or license in the discipline or profession which he or she is providing services.
(Y) “Service coordination” means:
(1) For families eligible for part C as set forth in paragraph (C) of rule 3701-8-03 of the Administrative Code, assistance and services provided by a service coordinator to an infant or toddler and the infant or toddler’s family that are in addition to the functions and activities set forth in 34 C.F.R. 303.23 (as in effect on July 1, 2010); and (2) For families eligible for home visiting services as set forth in paragraph (B) of rule 3701-8-03 of the Administrative Code, assistance and services provided by a home visitor to an expectant parent, newborn, infant or toddler and the newborn’s, infant’s or toddler’s family in accordance with rule 3701-8-05 of the Administrative Code.
(Z) “Service coordinator” means a person assigned to assist in determining eligibility and coordinating services for expectant families, infants, toddlers and their families through the HMG part C process.
(AA) “Toddler” means a child who is at least nineteen months old but less than thirty-six months old.
(BB) “Transition” means the change within or exit from HMG services of an expectant family, infant, toddler and their family including:
(1) Transfer or discharge from a hospital or other healthcare facility;
(2) Exit from HMG due to ineligibility at age three years; or
(3) Exit from HMG service due to other reasons.
Effective: 07/16/2010
R.C. 119.032 review dates: 04/16/2010 and 01/16/2012
Promulgated Under: 119.03
Statutory Authority: 3701.61
Rule Amplifies: 3701.61, Section 289.20 of Am. Sub. H.B. 1(128th
G.A.) Prior Effective Dates: 8/8/2005
(A) The purpose of HMG is to provide and maintain a comprehensive, coordinated system to meet the needs of eligible expectant families, newborns, infants and toddlers and their families who reside in Ohio.
(B) Part C and GRF help me grow funds shall be allocated by the Director to each county.
(C) Counties receiving HMG funds shall attempt to enroll and serve at least the number of eligible participants in the county as determined by the director.
(D) Help me grow funds shall be used to:
(1) Provide direct services for eligible participants in accordance with the provisions of this chapter, terms of contracts, grants and subsidy agreements authorizing the allocation of funds, and other state and federal laws as applicable.
(2) To expand and improve on existing services already provided by other public and private sources.
(E) Subject to the availability of funds
and terms of any contract or grant authorizing the award of HMG funds, the following HMG services shall be provided to all families eligible under paragraph (B) of rule 3701-8-03 of the Administrative Code:
(1) Child find;
(2) Developmental screening;
(3) Family assessment;
(4) Development and review of a family plan;
(5) Home visiting services;
(6) Transition services; and
(7) County FCFC dispute resolution process.
(F) The following HMG services are provided at no cost to part C eligible infants, toddlers and their families and shall be provided in accordance with part C regulations:
(1) Child find;
(2) Developmental evaluation and family assessment;
(3) Development, review and evaluation of an IFSP;
(4) Service coordination;
(5) Transition services;
(6) Procedural safeguards and due process procedures; and
(7) Family to family support services.
(G) Early intervention services may be subject to a system of payment or use of private insurance. Early intervention services include, but are not limited to the following:
(1) Assistive technology;
(2) Audiology;
(3) Family training, counseling, and home visits necessary to assist the family in understanding the special needs of the child and enhancing the child’s development;
(4) Health services necessary to enable newborns, infants and toddlers with delays or disabilities to benefit from other services during the time the child is receiving early intervention services;
(5) Medical services only for diagnostic or evaluation purposes;
(6) Nursing;
(7) Nutrition;
(8) Occupational therapy;
(9) Physical therapy;
(10) Psychological and social work;
(11) Special developmental instruction;
(12) Speech-language pathology;
(13) Transportation and related costs;
(14) Vision (including orientation and mobility); and
(15) Other services the IFSP team deems necessary.
(H) Early intervention services shall be paid for through part C funds in accordance with rule 3701-8-10 of the Administrative Code and only if all of the following parameters have been met and documented:
(1) The child is eligible for part C;
(2) The IFSP team is in full agreement regarding the services;
(3) The service best supports the family and its needs;
(4) As payor of last resort, when there is no other alternative source for payment.
Documentation must include evidence of the parent’s inability to pay, as well as alternative funding sources that were sought; and
(5) Unless inappropriate, the service will be provided in the child’s everyday routines, activities and places.
(I) Help me grow funds cannot be used for the following:
(1) Medical health services that are routinely recommended for all children such as immunizations and “well-baby” health care; or
(2) Medical services that are surgical or purely medical in nature.
Effective: 07/16/2010
R.C. 119.032 review dates: 04/16/2010 and 01/16/2012
Promulgated Under: 119.03
Statutory Authority: 3701.61
Rule Amplifies: 3701.61, Section 289.20 of Am.Sub. H.B. 1 (128th
G.A.) Prior Effective Dates: 8/8/2005
(A) Participation in HMG is voluntary. Each county HMG program shall obtain written consent from eligible individuals prior to any service being provided.
(B) Subject to the availability of funds, the following are eligible for HMG home visiting services:
(1) Infant or toddler who has been involved in a substantiated case of abuse or neglect or who has at least one parent engaged in active military duty; and
(2) The following if the family’s income is equal to or less than two hundred per cent of the federal poverty level:
(a) Parent expecting first child;
(b) Infant or toddler who is enrolled before six months of age and is the first born or adopted child in the family.
(C) The following individuals shall be eligible for part C of HMG:
(1) Infant or toddler who has a developmental delay of one and one half standard deviation below the mean in any one area of development using a tool prescribed by the department; and
(2) Infant or toddler who has a diagnosed physical or mental condition determined by the department as having a high probability of resulting in a delay.
Financial eligibility is not a requirement for part C of HMG.
(D) Service coordinators and home visitors shall provide parents a copy of the parent’s rights brochure published by the department.
(E) Each county HMG program shall complete the following utilizing the mechanisms prescribed by the department no later than forty-five days after referral of an infant or toddler suspected of being eligible under paragraph (C) of this rule:
(1) A social-emotional development screening;
(2) A vision screening;
(3) A hearing screening;
(4) A nutritional screening;
(5) Evaluation for eligibility (when applicable) and assessment for program planning; and
(6) An individualized family services plan.
(F) For an infant or toddler with a diagnosed physical or mental condition that has a high probability of resulting in a delay, with parent consent, each county HMG program:
(1) Shall complete all sections of the initial IFSP within forty-five days of initial referral; and
(2) May develop an interim IFSP to immediately begin identified needed services prior to the completion of the developmental assessment and IFSP as required in paragraph (E) of this rule.
(G) Each county HMG program shall document and verify eligibility of HMG participants.
Replaces:
3701-8-03
Effective: 07/16/2010
R.C. 119.032 review dates: 01/16/2012
Promulgated Under: 119.03
Statutory Authority: 3701.61
Rule Amplifies: 3701.61, Section 289.20 of Am.Sub. H.B. 1 (128th
G.A.) Prior Effective Dates: 8/8/2005
(A) Each county FCFC shall assure that an IFSP is developed in conjunction with the family and implemented for each eligible participant no later than forty-five days after initial referral to HMG of an infant or toddler eligible under paragraph (C) of rule 3701-8-03 of the Administrative Code. The IFSP shall be developed in accordance with 34 C.F.R. sections 303.340 to 34 C.F.R. sections 303.346, as in effect on July 1, 2010 and shall:
(1) Focus on intervention and prevention services and strategies;
(2) Include but not be limited to child and family outcomes, resources, priorities and concerns;
(3) Reflect coordination across agencies and services;
(4) Be completed on the form approved by the department;
(5) Contain the name of assigned service coordinator;
(6) Incorporate referral and transition strategies to assure continuity of services from one environment to another;
(7) Include the use of formal and informal community support services; and
(8) Other requirements as designated by the department.
(B) A review of the IFSP for the child and family must be conducted at least every one hundred eighty days, or sooner, upon the request of the family or an IFSP team member. A meeting must be conducted at least annually to evaluate the IFSP for the child and family, and to revise its provisions as needed.
(C) Each FCFC shall assure and document that eligible individuals are informed of their rights at least annually and upon a change in IFSP services throughout the time the individual is receiving HMG services.
(D) Families and providers shall receive written prior notice of all IFSP meetings (initial, annual, and review meetings).
(E) Upon referral of an infant or toddler suspected of being eligible for part C services under paragraph (C) of rule 3701-8-03 of the Administrative Code, a service coordinator shall be assigned. There shall be only one service coordinator assigned for the family at any given time.
(F) The assigned service coordinator shall be responsible for assisting in the determination of a referred individual’s eligibility and coordinating services for individuals who are determined eligible pursuant to paragraph (C) of rule 3701-8-03 of the Administrative Code.
(G) County HMG programs shall assign service coordinators who meet the qualifications and credentials for service coordinators as set forth in policy developed by the department.
Replaces:
3701-8-04
Effective: 07/16/2010
R.C. 119.032 review dates: 01/16/2012
Promulgated Under: 119.03
Statutory Authority: 3701.61
Rule Amplifies: 3701.61, Section 289.20 of Am.Sub. H.B. 1 (128th
G.A.) Prior Effective Dates: 8/8/2005
(A) Prior to providing any HMG services in the home, the HMG provider shall obtain written consent from the parent for home visiting services.
(B) Home visits to provide HMG supports, education and community referrals shall be offered in accordance with the appendices to this rule and shall:
(1) Be offered to all infants, toddlers, and expectant families eligible under paragraph (B) of rule 3701-8-03 of the Administrative Code; and
(2) Be confidential, culturally sensitive, and respectful of the family.
(C) There shall be only one home visitor assigned for the family at any given time.
(D) Each county FCFC shall assure that a family plan is developed with the family for each eligible participant as described under paragraph (B) of rule 3701-8-03 of the Administrative Code no later than forty-five days after referral to HMG.
(E) A review of the family plan must be conducted with the family at least every one hundred eighty days, or sooner, upon the request of the family.
(F) The assigned home visitor shall be responsible for assisting in the determination of a referred individual’s eligibility and, if eligible, the development of a family plan, delivering parenting education through home visiting, informing families of advocacy services, making community referrals, and facilitating a transition of a child to a development-enhancing program by age three, if available and appropriate.
Replaces:
3701-8-05
Effective: 07/16/2010
R.C. 119.032 review dates: 01/16/2012
Promulgated Under: 119.03
Statutory Authority: 3701.61
Rule Amplifies: 3701.61, Section 289.20 of Am.Sub. H.B. 1 (128th
G.A.) Prior Effective Dates: 8/8/2005
(A) Each county FCFC shall assure that providers of county HMG services:
(1) Participate in the department’s electronic data collection system;
(2) Establish and maintain data collection procedures that assure the efficient and effective operation of the HMG program; and
(3) Comply with all related federal and state laws, regulations and policies.
(B) Each county HMG program shall submit program and fiscal reports within required timelines as prescribed by the department and other funding sources.
R.C. 119.032 review dates: 07/06/2010 and 01/16/2012
Promulgated Under: 119.03
Statutory Authority: 3701.61
Rule Amplifies: 3701.61
Prior Effective Dates: 8/8/2005
(A) The department shall monitor each county HMG system for compliance with this chapter, part C regulations and the terms of any contract or grant authorizing the award of HMG funds to the county.
(B) The director shall ensure a help me grow system review is conducted for every county HMG program receiving HMG funding. The department review may include an on-site visit, a desk review, or both.
(1) An onsite visit or desk review may be conducted by one or more of the following team members as designated by the department:
(a) The director of health or the director’s designee, who shall serve as team coordinator;
(b) The director of the Ohio department of developmental disabilities or the director’s designee;
(c) A representative of the Ohio office of family and children first; and
(d) Additional members as appointed to the team by the director of health which include a parent of a child that is or has received services offered under the HMG program.
(2) An on-site visit may include but is not limited to observation of the administration of HMG and provision of direct services, examination of records relevant to HMG, and focus group or individual interviews.
(3) A desk review may include review of electronic data, county records and consumer satisfaction surveys and other documentation as requested.
(C) Following the HMG system review, the team shall submit a written report to the director. The report shall include the team’s findings of fact and conclusions related to the county’s compliance with this chapter, part C regulations and terms of any contract or grant authorizing the award of HMG funds.
(D) If the director determines that the county is not in compliance with this chapter, part C regulations or the terms of a contract or grant authorizing the award of HMG funds, the director shall, within fifteen days of receiving the team’s report, notify the county of non-compliance. The director’s notice shall also require the county FCFC to submit a continuous improvement plan addressing the areas of non-compliance in the report and timelines for achieving compliance.
(E) The county FCFC shall cooperate with the director and review team during any review process and shall provide access to any and all documents and information requested by the director or review team.
(F) The director may withhold funds to a county if:
(1) The county FCFC receives the director’s finding of noncompliance and fails to submit a plan of continuous improvement or fails to come into compliance in accordance with the plan of continuous improvement; or
(2) The county FCFC does not cooperate with the director or review team during a review.
The director’s finding of non-compliance and decision to withhold funds is final and is not subject to appeal.
(G) Delivery of all notices or correspondence regarding HMG funds shall be made to the county’s named project director, FCFC administrative agent and FCFC coordinator.
Effective: 07/16/2010
R.C. 119.032 review dates: 04/16/2010 and 01/16/2012
Promulgated Under: 119.03
Statutory Authority: 3701.61
Rule Amplifies: 3701.61, Section 289.20 of Am.Sub. H.B. 1 (128th
G.A.) Prior Effective Dates: 8/8/2005
(A) Children and their families eligible for the HMG home visiting program may file a complaint through the county family and children first council’s dispute resolution process as required by section 121.37 of the Revised Code.
(B) The department, as the lead agency shall establish procedural safeguards that are consistent with part C regulations. The department in partnership with the state and county family and children first councils is responsible for assuring effective implementation of these procedural safeguards by each state or local agency or a private agency in the state that is involved in the provision of part C services. The department assures implementation through the following activities:
(1) Disseminating written guidance regarding procedural safeguards to:
(a) County family and children first councils;
(b) Help me grow project directors;
(c) Centralized intake and referral sites;
(d) County boards of developmental disabilities;
(e) County departments of job and family services; and
(f) The family support consultant network;
(2) Entering into interagency agreements with the department of developmental disabilities and the department of job and family services, which includes the agreement to work together to consistently implement the part C procedural safeguards, regulations and other applicable policies; and
(3) Monitoring county compliance with this rule.
(C) The department shall develop and assure the implementation of a process for the resolution of complaints regarding the provision of part C services. The process shall specify the procedure for:
(1) Filing a complaint with the county FCFC;
(2) Filing a complaint with the department;
(3) Resolving the dispute through mediation or an administrative hearing within thirty days from receipt of the request for mediation or an administrative hearing; and
(4) Resolving the dispute through investigation by the lead agency within sixty calendar days from receipt of the complaint.
(D) Each county FCFC shall develop and maintain a resolution process for complaints, which shall be consistent with part C.
(1) The FCFC shall notify the department of the complaint in writing (via electronic or U.S. mail or facsimile) within seven calendar days of receipt of the complaint; and
(2) The FCFC shall issue a written decision to the complainant and the department within thirty calendar days from receipt of the complaint.
(E) Each provider of part C services may develop and maintain a resolution process for complaints which shall be consistent with part C. If the provider has a resolution process for complaints:
(1) The provider of part C services shall notify the department and the FCFC of the complaint in writing (via electronic or U.S. mail or facsimile) within seven calendar days of receipt of the complaint; and
(2) The provider of part C services shall issue a written decision to the complainant, FCFC and the department within thirty calendar days from receipt of the complaint.
(F) Upon receiving a complaint, the department, FCFC or provider shall:
(1) Assure the individual registering the complaint has a copy of the procedural safeguards; and
(2) Explain the options available for dispute resolution.
(G) If the department receives notice that a complaint regarding part C services was filed with the county FCFC or a provider, the department shall monitor the resolution process to assure that the complaint is resolved by the county FCFC or provider within thirty calendar days. If the complaint is not resolved within thirty calendar days, the department shall notify the complainant, the county FCFC and the provider, if applicable, that complainant may select one of the following:
(1) To have the department investigate the complaint in accordance with paragraph (C)(4) of this rule. If this option is selected, the department shall assure that the complaint is investigated and resolved within sixty calendar days from the date the county FCFC or provider received the complaint; and
(2) To mediate and/or to go to an administrative hearing in accordance with paragraph (C)(3) of this rule. The department shall assure that if the complainant selects mediation and/or administrative hearing, the hearing is completed within thirty days from receipt of the request for mediation and/or administrative hearing.
(H) Unless the state or other agencies and parents of a child otherwise agree, the child and family must continue to receive appropriate part C services currently being provided, during the resolution of disputes arising under part C. If the complaint involves the initiation of one or more services under this part, the child and family must receive those services that are not in dispute.
(I) The procedural safeguards policy and process is posted on the Ohiohelpmegrow.org website.
Effective: 07/16/2010
R.C. 119.032 review dates: 04/16/2010 and 01/16/2012
Promulgated Under: 119.03
Statutory Authority: 3701.61
Rule Amplifies: 3701.61, Section 289.20 of Am.Sub. H.B. 1 (128th
G.A.) Prior Effective Dates: 8/8/2005
(A) As used in this rule:
(1) “Language” means the mode of communication normally used by the parent of child eligible under this procedure, such as sign language, Braille, oral communication, or native language;
(2) “Personally identifiable” means information that includes:
(a) The name of the child, the child’s parent or other family member;
(b) The address of the child;
(c) A personal identifier such as the child’s or parent’s social security number; and
(d) Personal information that would make it possible to identify the child with reasonable certainty.
(B) Children and their families eligible for HMG have the following rights:
(1) To accept or decline some or all HMG services; except that a child, who has a suspected developmental delay or disability, may not receive other HMG services until the child has been evaluated in all five developmental domains in accordance with rule 3701-8-03 of this chapter;
(2) To be informed of their rights in a language the parents understand, unless it is not feasible to do so;
(3) The right to receive written notice before HMG services are initiated, refused, or changed. The written notice shall be provided in a language the parent understands, unless it is not feasible to do so, and shall include what and why the change is being proposed or denied;
(4) To keep personally identifiable information confidential and to provide written consent before any personally identifiable information about their family is shared between HMG providers or otherwise disclosed, unless such disclosure is authorized under state and federal law;
(5) The right to review HMG records about their family at no cost and without unnecessary delay;
(6) The right to request, be present at and take part in HMG meetings about their family, including the IFSP meetings held in accordance with rule 3701-8-04 of this chapter;
(7) The right to receive service coordination at no cost;
(8) The right to take part in HMG transition planning before the child turns three years of age or upon exit from the program; and
(9) The right to make a formal complaint about HMG services in accordance with rule 3701-8-08(A) of this chapter.
(C) In addition to the rights listed in paragraph (A) of this rule, children and their families eligible for Part C services, have the right to the following services at no cost to the family:
(1) The right to a developmental evaluation of the child to determine eligibility;
(2) The right to have an advocate or friend present at any or all contacts with service providers at the parent’s expense;
(3) The right to receive written notice before HMG services are initiated, refused, or changed.
(a) The written notice shall be in a language the parent understands, unless it is not feasible to do so, and shall include the HMG service the provider is proposing to initiate, deny or change and the reason for the service initiation, denial or change.
(b) If a HMG provider proposes, or refuses, to initiate or change HMG eligibility, evaluation, or placement of a child, or the provision of Part C services to a Part C eligible child or his family, the parent has the right to timely written notice of the following:
(i) The action that is being proposed or refused, including but not limited to, an explanation of the scope, purpose and benefits of any Part C services that are being proposed or refused;
(ii) The reasons for proposing or refusing the action, including but not limited to, a description of other options considered and the reasons for rejecting the options;
(iii) The information upon which the proposal or refusal to act is founded, including, but not limited to, a description of each record or report used as a basis for the proposal or refusal to act; and
(iv) All procedural safeguards that are available under rule 3701-8-08 of this chapter.
(4) To review and make changes to HMG records about their family at no cost. The family has the right to inspect and review their HMG records without unnecessary delay and before any meeting regarding an IFSP or hearing relating to the identification, evaluation or placement of the child and in no case more than forty-five days after the request has been made. The right to inspect and review records includes:
(a) The right to a response from the HMG provider or agency to reasonable requests for explanation and interpretation of records;
(b) The right to receive copies of their HMG records within fifteen days after receipt of a request for copies for a fee not to exceed the actual amount of the copying cost.
(i) The fee may not include any cost for search or retrieval of the records.
(ii) The family has a right to receive the copies at no cost if charging a fee would prevent the parent from obtaining the copies.
(c) The right to have a representative of the parent to inspect and review their HMG records; and
(d) The right to seek corrections, additions and amendments to a HMG record that is inaccurate or misleading. If a HMG provider or agency refuses to correct a record alleged to be inaccurate or misleading by the family, the family may request the county FCFC to provide a hearing to resolve the dispute. The hearing shall be held before an individual who does not have a direct interest in the outcome of the hearing and shall be held within thirty days from the receipt of a request for the hearing, with a written decision issued within ten days from the date of the hearing. The county FCFC shall inform the parent of the date, time, and place of the hearing in advance and in a language the parent understands. If it is decided that the information is inaccurate or misleading, the record shall be amended to reflect the correct information. If it is decided that the information is accurate and not misleading, the parent place in the records a statement commenting on the information or the parent’s disagreement with the written decision. Any statement provided by the parent must be maintained with the record and be disclosed if the contested part of the record is disclosed.
(5) The right to make a formal complaint about HMG services in accordance with rule 3701-8-08(B) of this chapter.
R.C. 119.032 review dates: 07/06/2010 and 01/16/2012
Promulgated Under: 119.03
Statutory Authority: 3701.61
Rule Amplifies: 3701.61
Prior Effective Dates: 8/8/2005
(A) As used in this rule:
(1) “Ability to pay” means that the family unit’s maximum ability to pay for part C early intervention services as defined in paragraph (A)(5) of this rule is greater than or equal to two thousand dollars.
(2) “Family income” means the current year’s projected adjusted gross earnings based on current gross earnings as reported on pay stubs and/or the sum of the annual adjusted gross incomes, as reported to the United States internal revenue service for federal income tax purposes for the previous year, of each member of the family unit.
For purposes of this rule, family income does not include educational scholarships, loans, and grants; amounts spent by the family unit for childcare expenses; amounts spent by the family unit for respite care (with appropriate verification from a qualified respite care provider); and lump-sum death benefits.
(3) “Family unit” means the group consisting of the following persons:
(a) Infant and toddler as defined in rule 3701-8-01 of the Administrative Code;
(b) Parents of the infant or toddler, specifically, the natural or adoptive parent of an infant or toddler or the parent with legal custody if the parents are separated or divorced, or a person acting in the place of a parent such as a grandparent or stepparent with whom the infant or toddler lives.
(c) Other persons, who, for federal income tax purposes, are considered dependents of the parents.
(4) “Income guidelines” means the guidelines, as established by the director on April first of each year, for use in determining financial eligibility for payment for part C early intervention services. The income guidelines shall be equal to one hundred eighty-five per cent of the poverty income for each size family, as reported in the Federal Register by the United States department of health and human services, rounded up to the nearest five hundred dollars.
(5) “Maximum ability to pay for part C early intervention services” means the difference between the amount the family unit spends, including payroll deductions, for health-related insurance coverage and the sum of the following amounts:
(a) Ten per cent of the first fifteen thousand dollars by which the family income exceeds the applicable income guideline, as defined in paragraph (A)(4) of this rule;
(b) Twenty-five per cent of the next twenty-five thousand dollars by which the family income exceeds the applicable income guideline, as defined in paragraph (A)(4) of this rule; and
(c) Thirty-seven and one half per cent of the remaining amount by which the family income exceeds the applicable income guideline, as defined in paragraph (A)(4) of this rule.
(6) “Service level credit” means a credit of two thousand dollars against the maximum ability to pay for part C early intervention services.
(B) The director shall accept from families eligible for part C services applications for payment of part C early intervention services. The director shall process an application within thirty days of receipt of a complete application. A determination that the family is unable to pay for part C early intervention services shall be specified in writing to the family and shall include an effective period of time for the determination, which shall be no more than twelve months.
(1) The family unit shall be determined to be able to pay for part C early intervention services if the family unit’s maximum ability to pay for part C early intervention services as defined in paragraph (A)(5) of this rule is greater than or equal to two thousand dollars.
(2) If the director determines that the family is able to pay for part C early intervention services as defined in paragraph (A)(1) of this rule, the director will provide the family with notice of the amount the director determines to be the family’s maximum ability to pay. Once the family spends an amount equal to their maximum ability to pay, minus the two thousand dollar service level credit, for unreimbursed medical, vision, dental, and part C early intervention services, the department will pay for part C early intervention services within the remaining effective period of time in accordance with paragraph (B)(3) of this rule.
(3) The family unit shall be determined to be unable to pay for part C early intervention services and eligible for payment of part C early intervention services by the department if:
(a) The family is not able to obtain part C early intervention services at no charge to the family through a governmental program, such as medicaid, children with medical handicaps program, or the county board of developmental disabilities;
(b) The family does not have available insurance coverage, as specified in paragraph (H) of this rule, for part C early intervention services; and
(c) The family unit’s income is less than or equal to the applicable income guideline defined in paragraph (A)(4) of this rule, or the family’s maximum ability to pay for part C early intervention services as defined in paragraph (A)(5) of this rule is less than the two thousand dollar service level credit.
(C) Notwithstanding paragraph (B)(3)(c) of this rule, in order to assure that early intervention services to a part C eligible child and family will not be interrupted, the family will be determined to be unable to pay for part C early intervention services if the family unit provides satisfactory evidence of both of the following:
(1) During the twelve-month period before the date of written allegation of inability to pay the family unit paid for unreimbursed medical, vision, dental, or part C early intervention services that were provided to any member of the family unit or the family unit has contracted in writing to pay for any such services during the twelve months after the written allegation of inability to pay; and
(2) The total dollar amount that the family unit spent or is contracted to pay equals or exceeds the difference between the maximum ability to pay for part C early intervention services, as defined in paragraph (A)(5) of this rule, and the service level credit, as defined in paragraph (A)(6) of this rule.
(D) Applicants or recipients who are receiving services from the special supplemental food program for women, infants, and children (WIC), supplemental security income (SSI) benefits, or medicaid benefits, except for delayed medicaid spend-down cases as defined in rule 5101:1-39-10 of the Administrative Code, shall be determined unable to pay for part Cearly intervention services.
(E) The director may contract with and pay as providers for part C early intervention services provided to part C eligible families:
(1) Providers for the bureau for children with medical handicaps;
(2) Providers for the Ohio medicaid program; or
(3) Other provider types as determined necessary by the director.
(F) The department may pay part C providers authorized under paragraph (E) of this rule for part C early intervention services provided to part C eligible families if the family unit has been determined unable to pay for part C early intervention services in accordance with this rule and the early intervention services are listed on the IFSP for the family.
(G) The provider shall bill medicaid or the bureau for children with medical handicaps if such services are covered by medicaid or the bureau for children with medical handicaps. The provider shall accept the payment from medicaid or the bureau for children with medical handicaps as payment in full. If medicaid or the bureau for children with medical handicaps does not cover the services, the provider may bill the department, bureau of early intervention services, for services authorized pursuant to this rule and the provider shall accept the payment from the bureau of early intervention as payment in full.
(H) The director may determine that the family does not have available insurance coverage for part C early intervention services if the family documents to the director’s satisfaction that the family will be subject to a material risk of losing medical insurance coverage because:
(1) The insurance plan or policy covering the child is an individually purchased plan or policy purchased by the head of household who is not eligible for group medical insurance; or
(2) The insurance plan or policy has a lifetime cap that applies to one or more specific types of early intervention services specified in the IFSP and coverage for that service could be exhausted during the period covered by the service plan.
(I) If the director denies an application submitted by an individual under paragraph (B) of this rule, the individual may appeal the denial as follows:
(1) The individual may request reconsideration of the denial by filing a written request with the director no later than forty-five days after the date on the notice of the denial. The request for reconsideration shall contain a statement of the reasons that individual believes the decision is incorrect or inappropriate and may include any written documentation, arguments, or other materials that the individual wishes to submit. An item is filed with the director when it is received by the department.
(2) For the purposes of reconsideration, the director may request from the individual additional, relevant records or documentation within forty-five days of receipt of the request for reconsideration. The individual shall file any requested information with the director no later than forty-five days after the date on the director’s request for additional information.
(3) Within forty-five days after receipt of a request for reconsideration from the individual and all necessary additional information filed pursuant to the director’s request for information, the director shall issue a written notification of the decision to the individual who requested the reconsideration. If the director upholds the denial, the notice shall include the reasons for the denial including citations of statutes, rules or policies directly involved, notice that the individual may request an administrative hearing, and the method for requesting a hearing.
(4) Following receipt of the notice required by paragraph (I)(3) of this rule, an individual may request an administrative hearing concerning the decision to deny payment for services by filing a written request with the director no later than thirty days after the date of mailing the notice. If the hearing is requested timely, a hearing shall be scheduled for a date not later than seventy-five days from the date the written request is received by the director. The director shall notify the individual of the date, time and location of the hearing no less than seven days before the date set for the hearing. The hearing may be continued at the request of individual with the approval of the director or upon his own motion.
(5) The director shall appoint a hearing officer to preside over the hearing. At the hearing, the rules of evidence shall be liberally construed. A stenographic record may be made upon the request of any party at the expense of the party requesting the record. The individual may appear in person at the hearing and may have in attendance legal counsel or such other representative of the individual’s choice and at the individual’s expense. The individual may present testimony, evidence and question witnesses present at the hearing. In lieu of appearing at the hearing, the individual may submit written materials to be examined by the hearing officer
(6) The hearing officer shall submit to the director within thirty days of the date of the conclusion of the hearing a written report setting forth the findings of fact, conclusions of law and a recommendation of action to be taken. The director shall send by certified mail a copy of the hearing officer’s report and recommendation to the individual within seven days of receipt of the written report. The individual or the department may file within ten days of receipt of the written report objections to the report, which shall be considered by the director before approving, modifying, or disapproving the recommendation.
(7) The director shall issue an order to approve, modify or disapprove the report and recommendation of the hearing officer and shall send notice of this action by certified mail to the individual. The decision of the director shall be final. There is no further administrative or judicial review of the director’s decision.
Effective: 07/16/2010
R.C. 119.032 review dates: 04/16/2010 and 01/16/2012
Promulgated Under: 119.03
Statutory Authority: 3701.61
Rule Amplifies: 3701.61, Section 289.20 of Am.Sub. H.B. 1 (128th
G.A.) Prior Effective Dates: 8/8/2005