Chapter 5122-29 Requirements and Procedures for Mental Health Services Provided by Agencies

5122-29-01 Purpose and applicability.

The purpose of this chapter is to state the requirements for the provision of behavioral health services by providers certified by the Ohio department of mental health and addiction services.

The provisions of the rules contained in this chapter are applicable to each provider subject to certification pursuant to rule 5122-25-01 of the Administrative Code.

Replaces: 5122-29-01

Effective: 1/1/2018
Five Year Review (FYR) Dates: 01/01/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1/1/91

5122-29-02 [Rescinded].

Effective: 1/1/2018
Five Year Review (FYR) Dates: 4/14/2017
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1/1/91, 7/15/01, 10/1/03

5122-29-03 General services.

(A) "General services" are the assessment activities, medical activities, and counseling and therapy activities as defined in this rule.

(B) The general services shall be provided by the professional credentials listed in appendix A of this rule within the scope of practice of those credentialed professionals.

(C) Assessment activities:

(1) An assessment:

(a) Is a clinical evaluation of a person which is:

(i) Individualized; and,

(ii) Age, gender, and culturally appropriate.

(b) Determines diagnosis, treatment needs, and establishes a treatment plan to address the person's mental illness or substance use disorder.

(2) When the assessment is to be provided to a client it should started prior to the initiation of other services, except for emergency situations.

(3) An initial assessment must, at a minimum, include an evaluation of:

(a) The presenting problem;

(b) The risk of harm to self and others;

(c) The use of alcohol or drugs;

(d) The treatment history for mental illness or substance use/abuse; and,

(e) A medical history and examination (mental status or physical).

(4) A comprehensive assessment shall expand on the initial assessment and obtain additional information that is required to establish and implement a comprehensive treatment plan, and must be completed within thirty days of the initial assessment encounter.

(5) A person is not required to have an initial assessment prior to receiving a comprehensive assessment.

(6) Initial and comprehensive assessments shall be completed according to prevailing standards of care as defined by:

(a) "The Joint Commission";

(b) "The Commission on Accreditation of Rehabilitation Facilities";

(c) "The Council on Accreditation"; or,

(d) Other entities as designated by the director.

(7) Providers may accept initial or comprehensive assessments from other providers as long as they have been completed within the preceding twelve months. Prior assessments shall be reviewed and updated.

(D) Counseling and therapy

(1) Counseling and therapy is an interaction with a person or persons where the focus is on achieving treatment objectives related to alcohol and other substances; or the person's mental illness or emotional disturbance.

(2) Counseling and therapy involves a face-to-face encounter between a client, group of clients, client and family members, or family members and a behavioral health professional.

(3) Group counseling and therapy encounters may not exceed a one-to-twelve behavioral health professional to patient ratio.

(E) Medical activities.

(1) "Medical activities" are those activities that are performed within professional scope of practice by staff that are licensed or certified by the state medical board of Ohio. the state of Ohio board of nursing, or a pharmacist licensed by the state of Ohio board of pharmacy; and are intended to address the behavioral and other physical health needs of clients receiving treatment for psychiatric symptoms or substance use disorders.

(2) Medical activities include, but are not limited to:

(a) Performing health care screenings, assessments, and exams;

(b) Checking vital signs;

(c) Ordering laboratory tests and reviewing the results; and,

(d) Medication prescribing, administering, and monitoring.

Replaces: 5122-29-03, 5122-29-04, 5122-29-05, 3793:2-1-08

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Effective: 1/1/2018
Five Year Review (FYR) Dates: 01/01/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1/1/91, 10/1/93, 7/15/01, 3/25/04, 12/15/05, 8/23/07, 12/13/07, 7/1/09

5122-29-04 [Rescinded].

Effective: 1/1/2018
Five Year Review (FYR) Dates: 4/14/2017
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1-22-1979, 4-18-1991, 7-15-2001, 3-25-2004, 8-23-2007, 7-1-2008, 7/1/2009

5122-29-05 [Rescinded].

Effective: 1/1/2018
Five Year Review (FYR) Dates: 4/14/2017
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1-1-1991, 10-1-1993, 7- 15.2001, 3-25-2004, 12-15-2005, 12-13-2007, 7/1/2009

5122-29-06 Mental health day treatment service.

(A) Mental health day treatment is an intensive, structured, goal-oriented, distinct and identifiable treatment service that utilizes multiple mental health interventions that address the individualized mental health needs of the client. Mental health day treatment services are clinically indicated by assessment with clear admission and discharge criteria. The environment at this level of treatment is highly structured, and there should be an appropriate staff-to-client ratio in order to guarantee sufficient therapeutic services and professional monitoring, control, and protection.

The purpose and intent of mental health day treatment is to stabilize, increase or sustain the highest level of functioning and promote movement to the least restrictive level of care.

The outcome is for the individual to develop the capacity to continue to work towards an improved quality of life with the support of an appropriate level of care.

(B) In addition to the definitions found in rule 5122-24-01 of the Administrative Code, the following definition applies to this rule:

(1) " Mental health day treatment program day" means the total amount of hours an individual receives mental health day treatment service during a twenty-four hour calendar day.

(C) Mental health day treatment must be an intense treatment service that consists of high levels of face-to-face mental health interventions that address the individualized mental health needs of the individual as identified in their individualized treatment plan (ITP).

(D) The minimum program length of this service shall be in accordance with the appropriate behavioral health standards of the agency's national accrediting body(ies). Such accrediting bodies are identified in rule 5122-25-02 of the Administrative Code.

(E) For purposes of this rule, a mental health day treatment program day shall consist of a minimum of two hours and up to a maximum of seven hours of scheduled intensive activities that may include, but are not limited to, the following:

(1) Determination of needed mental health interventions;

(2) Skills development

(a) Interpersonal and social competency as age, developmentally, and clinically appropriate, such as:

(i) Functional relationships with adults;

(ii) Functional relationship with peers;

(iii) Functional relationship with the community/schools;

(iv) Functional relations with employer/family; and

(v) Functional relations with authority figures.

(b) Problem solving, conflict resolution, and emotions/behavior management.

(c) Developing positive coping mechanisms;

(3) Managing mental health and behavioral symptoms to enhance vocational/school opportunities and/or independent living; and

(4) Psycho-educational interventions including individualized instruction and training of persons served in order to increase their knowledge and understanding of their psychiatric diagnosis(es), prognosis(es), treatment, and rehabilitation in order to enhance their acceptance of these psychiatric disabilities, increase their cooperation and collaboration with treatment and rehabilitation, improve their coping skills, and favorably affect their outcomes. Such education shall be consistent with the individual's ITP and be provided with the knowledge and support of the interdisciplinary/intersystem team providing treatment in coordination with the ITP.

(F) Providers of mental health day treatment services shall have a staff development plan based upon identified individual needs of mental health day treatment program staff. Evidence that the plan is being followed shall be maintained.

(G) Mental health day treatment service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 1/1/2018
Five Year Review (FYR) Dates: 4/14/2017 and 01/01/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1/1/91, 7/15/01, 7/1/06, 8/23/07, 7/1/09

5122-29-07 Forensic evaluation service.

(A) "Forensic evaluation service" means an evaluation resulting in a written expert opinion regarding a legal issue for an individual referred by a criminal court, domestic relations court, juvenile court, adult parole authority, or other agency of the criminal justice system or a Ohio department of mental health and addiction services (OhioMHAS) operated regional psychiatric hospital. Forensic evaluation service includes all related case consultation and expert testimony. Forensic evaluation service also assists courts and the adult parole authority to address behavioral health legal issues such as those referenced in paragraph (B) of this rule.

(B) Forensic evaluation service addresses behavioral health legal issues, including the following:

(1) Competency to stand trial, as defined in division (G)(3) of section 2945.371 of the Revised Code;

(2) Mental condition at the time of the offense charged, as defined in division (G)(4) of section 2945.371 of the Revised Code;

(3) Post-"NGRI" (not guilty by reason of insanity) examination, as defined in division (A) of section 2945.40 of the Revised Code:

(4) Presentence, as defined in section 2951.03 of the Revised Code;

(5) Mitigation of penalty, as defined in section 2947.06 of the Revised Code;

(6) Mitigation of death penalty, as defined in section 2929.03 of the Revised Code;

(7) Domestic violence evaluation, as defined in section 2919.271 of the Revised Code;

(8) Competence to be a witness, as defined in section 2317.01 of the Revised Code;

(9) Adult parole authority, for parole revocation and other legal questions;

(10) Psychological effects of an act upon the victim, as defined in section 2930.13 of the Revised Code;

(11) Domestic relations, for custody and visitation;

(12) Juvenile dependency, neglect, delinquency (Ohio rules of juvenile procedure, rule 32), or competency as defined in section 2152.53 of the Revised Code; ; or waiver to adult court, as defined in division (C) of section 2152.12 of the Revised Code ;

(13) Battered woman syndrome, as defined in section 2945.392 of the Revised Code;

(14) Violation of anti-stalking protection order, as defined in section 2903.212 of the Revised Code;

(15) Intervention in lieu of conviction, as defined in section 2951.041 of the Revised Code;

(16) Non-secured status, as defined in section 2945.401 of the Revised Code;

(17) Post sentence evaluation-probation or parole for involuntary commitment, as defined in section 2967.22 of the Revised Code; or,

(18) Juvenile competency evaluation for serious youthful offenders, as defined in division (C)(2) of section 2152.13 of the Revised Code.

(C) No examiner should undertake a forensic evaluation without an appropriate written order from the court ordering the evaluation, or an official written request if the agency requesting the forensic evaluation is a parole or probation department, or OhioMHAS operated regional psychiatric hospital.

(D) Forensic evaluation service shall provide the following standards of confidentiality:

(1) The relationship between the person being evaluated and the examiner is not confidential in the usual understanding of that term. A written report shall be made to the court or adult parole authority, whether or not the person being evaluated cooperates with the examiner. The relationship between the examiner, evaluee, and court or adult parole authority shall be explained orally and in writing to the person being evaluated. It shall be clearly noted that information gathered and expert opinions reached by the examiners shall be summarized in a written report and/or testimony to the court or adult parole authority or other referring agency.

(2) Reports to the criminal courts shall be forwarded only to the court that referred the person or to other court officials, prosecution and defense attorneys, as designated by the referring court. The court may, at its discretion, distribute the report, and bears the responsibility for that distribution. Reports to the adult parole authority shall be forwarded only to that agency, which may, at its discretion, distribute the report, and bears the responsibility for that distribution. Reports may be distributed to other parties only with the written authorization of the court or adult parole authority, or other referring agency.

(3) Reports of forensic evaluations shall be stored separately from other types of client records, and shall be considered the property of the court that ordered them or the agency that referred the person.

(E) Each forensic evaluation report shall include at least the following:

(1) The name and qualifications of the examiner(s);

(2) The name of the court or agency that referred the person;

(3) The legal or referral question being assessed;

(4) Identifying information about the person being evaluated, including relevant clinical, social, and criminal history;

(5) The duration and location of the interview(s) with the person being evaluated;

(6) A description of collateral information used to develop the report;

(7) Psychological and/or psychiatric data that address the legal or referral issue, if applicable; and

(8) Opinions and recommendations.

(F) The forensic evaluation report shall be presented in non-technical terms and in reasonable detail. The data and recommendations shall be pertinent to the legal or other referral question. Relevant collateral information shall be used in a forensic evaluation to the fullest extent possible. Opinions in a forensic evaluation report shall not be based entirely on self-report of the person being evaluated if collateral information is available.

(G) Reports shall contain sufficient information to substantiate the conclusions and recommendations made. Special caution shall be exercised with self-incriminating statements by the person being evaluated, information about others not being evaluated, or other material of a particularly sensitive, personal nature not related to the issue and for which the forensic evaluation was requested.

(H) For competence to stand trial and not guilty by reason of insanity forensic evaluations , the qualifications of the examiner(s) are regulated by sections 2945.37 and 2945.371 of the Revised Code. All other examinations for which qualifications are not specified by law shall be conducted by staff who are qualified according to paragraph (K) of this rule.

(I) Forensic evaluations shall be completed within the time limits specified by law, unless an extension has been granted by the referral source. Examinations for which no statutory time limit exists shall be completed within a reasonable time, as determined in consultation with the court or agency requesting the service.

(J) The agency shall ensure that:

(1) All staff who perform forensic evaluation services shall have training and continuing education relating to the legal and behavioral health issues involved in the services they provide; and

(2) All persons who perform forensic evaluation services listed in paragraphs (B) (1) to (B)(18) of this rule shall provide written documentation of at least twenty-four hours of training every three calendar years that is specific to the forensic behavioral health area.

(K) Forensic evaluation service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 1/1/2018
Five Year Review (FYR) Dates: 4/14/2017 and 01/01/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1/1/1991, 7/15/2001, 10/1/2003, 7/01/2009, 1/9/2011

5122-29-08 Behavioral health hotline service.

(A) Behavioral health hotline service means a provider's twenty-four hour per day, seven days per week capability to respond to telephone calls, often anonymous, made to a provider for crisis assistance. The person may or may not be a client of the provider.

(B) Behavioral health hotline service shall:

(1) Staff the service so that calls are answered twenty-four hours per day, seven days per week;

(2) Provide referrals to crisis intervention service(s) ;

(3) Include, but not be limited to, the following:

(a) Provide support, intervention, and crisis management by telephone to persons in crisis;

(b) Engage in suicide prevention intervention, including inquiring if the individual has a crisis safety plan and using this information in the intervention;

(c) Provide appropriate linkages to all needed services and other community resources, including peer recovery support as applicable;

(d) Provide information regarding crisis services, including the local crisis center phone number, additional referral to support services as indicated; and,

(e) Provide information and referral to immediate psychiatric and medical services when indicated, such as the crisis center or a hospital emergency room.

(4) Ensure that all staff and volunteers receive training in crisis intervention techniques, safety planning, management of risk, and available resources and supports in the county or region where the provider is located;

(5) Be provided by staff and volunteers qualified according to paragraph (D) of this rule; and,

(6) Document the call in the client medical record if it is known that the person calling is a person served by the provider.

(C) The provider service plan for behavioral health hotline services shall include, but not be limited to the requirements that the service:

(1) Function as part of an integrated, comprehensive system of health, behavioral health, and other human service providers;

(2) Ensure the ability to use and work with case management systems, other involved health care providers, and crisis intervention services on a priority basis;

(3) Coordinate with the community's emergency service systems, such as hospital, crisis centers, fire, police, ambulance services, etc.;

(4) Maintain a current listing of available residential or housing placements that can be accessed quickly when emergency housing is needed in conjunction with a crisis intervention mental health service; and

(5) Is provided as part of the alcohol, drug addiction, and mental health services board's emergency crisis plan for the service district.

(D) Behavioral health hotline service shall be provided and supervised by staff and volunteers who are qualified according to rule 5122-29-30 of the Administrative Code.

Replaces: 5122-29-08; 3793:2-1-08

Effective: 1/1/2018
Five Year Review (FYR) Dates: 4/14/2017 and 01/01/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1/1/91, 7/15/01, 3/25/04, 8/23/07, 7/1/09

5122-29-09 Residential, withdrawal management, and inpatient substance use disorder services.

(A) Residential and inpatient substance use disorder services, including withdrawal management services, shall be provided in accordance with the American society of addiction medicine's (ASAM) level of care three and ASAM's level of care three-withdrawal management, and associated sub levels as appropriate to the needs of the individual being served; as published in the ASAM criteria, third edition, 2013.

(B) A provider certified to provide this service, may provide ASAM level of care two- withdrawal management.

(C) Each provider rendering services pursuant to this rule, and not providing less intensive levels of care, is required to have an affiliation agreement with at least one provider certified by the Ohio department of mental health and addiction services for the purpose of referral to less intensive levels of care. Each provider shall have written policies and procedures to ensure its referral process is appropriately implemented and managed and shall include, at a minimum, the following:

(1) Referral decisions made to the appropriate level of care as determined utilizing the American society of addiction medicine criteria protocols for levels of care. Documentation of referral shall appear in the client record.

(2) Discharge plan stipulating specific recommendations and referrals for alcohol and drug addiction treatment. The discharge plan shall be documented in the client record.

(3) Follow-up communications with client and the service provider to which client is referred. These contacts shall be documented in the client's record.

(D) Each provider of this service shall provide, in addition to the required ASAM level of care:

(1) Food for clients, to include at least three nutritionally-balanced meals and at least one nutritious snack per day, seven days per week;

(2) The opportunity for clients to get eight hours of sleep per night; and,

(3) Services in facilities that are clean, safe, and therapeutic.

(E) Time for meals, unstructured activities, free time, or time spent in attendance of self- help groups, such as alcoholics anonymous or narcotics anonymous shall not be considered for the purposes of meeting ASAM level of care requirements for services.

(F) Providers shall promote interpersonal and group living skills. Clients shall be connected to resources for education, job training, job interviews, employment stabilization and obtaining alternative living arrangements.

(1) A service provider may require clients to perform tasks of a housekeeping nature as specified within service provider guidelines.

(2) Housekeeping tasks shall not be considered for the purposes of meeting ASAM level of care requirements for services.

(G) All component practitioner services must be provided in accordance with Chapter 5122-29 of the Administrative Code.

(H) A health history, including food allergies and drug reactions, shall be completed on or before admission to a provider of this service.

(I) Each provider organized of this service to serve individuals under the age of eighteen shall provide services in a manner that is developmentally appropriate, addresses educational needs, promotes family involvement, and meets the specific developmental needs of the youth.

(J) Services provided pursuant to this rule shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Replaces: 5122-29-36, 5122-29-37, 3793:2-1-08

Effective: 1/1/2018
Five Year Review (FYR) Dates: 01/01/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 7/10/92, 7/1/01, 6/13/04, 11/17/05

5122-29-10 Crisis intervention service.

(A) Crisis intervention is a face-to-face interaction with a person in response to a crisis or emergency situation they are experiencing.

(B) Twenty-three hour observation bed means face-to-face evaluation, for up to twenty- three hours duration under close medical/nursing supervision, of an individual who presents an unpredictable risk of adverse consequences due to intoxication, withdrawal potential and/or co-existing disorders for the purpose of determining the appropriate treatment and plan for the next level of care.

(C) Crisis intervention includes:

(1) An urgent evaluation of the following elements when clinically indicated:

(a) Understanding what happened to initiate the crisis and the individual's response or responses to it;

(b) Risk assessment of lethality, propensity of violence, and medical/physical condition including alcohol or drug use;

(c) Mental status;

(d) Information about the individual's strengths. coping skills, and social support network, including face-to-face contact with family and collateral informants; and,

(e) Identification of treatment needs and appropriate setting of care.

(2) A crisis plan shall be developed to de-escalate the crisis, stabilize the patient, restore safety, provide referral, and linkages to appropriate services, and coordination with other systems.

(D) Providers of crisis intervention shall have current certification in first aid and cardio-pulmonary resuscitation (CPR), and shall be trained in de-escalation techniques.

(E) When a patient appears to be medically unstable, the patient shall be referred to a medical facility or emergency medical service shall be called.

Replaces: 5122-29-10, 3793:2-1-08

Effective: 1/1/2018
Five Year Review (FYR) Dates: 01/01/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1/1/91, 10/1/93, 7/15/01, 3/25/04, 1/9/06, 8/23/07, 7/1/09

5122-29-11 Employment service.

(A) The purpose and intent of an employment service is to promote recovery through the implementation of evidence based and best practices which allow individuals to obtain and maintain integrated competitive meaningful employment by providing training, ongoing individualized support, and skill development that honor client choice. The outcome of an employment service is that individuals will obtain and maintain a job of their choosing through rapid job placement which will increase their self-sufficiency and further their recovery. Employment services should be coordinated with mental health services and substance use treatment and services.

(B) Consistent with the purpose and intent of paragraph (A) of this rule, employment services shall include at least one of the following evidence based and best practice employment activities, unless prior approval has been given for a non-listed activity as provided by paragraph (D) of this rule:

(1) Vocational planning (assessment);

(2) Training (work and personal);

(3) Job seeking skills training (JSST);

(4) Job development and placement;

(5) Job coaching;

(6) Individualized job supports, which may include regular contact with the employers, family members, guardians, advocates, treatment providers, and other community supports;

(7) Benefits planning;

(8) General consultation, advocacy, building and maintaining relationships with employers;

(9) Individualized placement and support supported employment (IPS SE), in accordance with the requirements for qualified providers set forth in rule 5122-29-30 of the Administrative Code;

(10) Rehabilitation guidance and counseling; or,

(11) Time unlimited vocational support.

(C) Any of the following employment supports may be provided in conjuction with at least one employment activitiy either that is listed in paragraph (B) of this rule or which has received prior approval from OhioMHAS:

(1) Facilitation of natural supports;

(2) Transportation; or,

(3) Peer services.

(D) Individualized placement and support supported employment (IPS SE).

Providers who chose to offer IPS SE employment service shall meet the following requirements to be OhioMHAS qualified providers:

(1) IPS SE is an evidence based practice which is integrated and coordinated with mental health treatment and rehabilitation designed to provide individualized placement and support to assist individuals with a severe and persistent mental illness or co-occurring mental illness and substance use disorder obtain, maintain, and advance within competitive community integrated employment positions.

(2) In order to be an IPS SE qualified provider, the provider must:

(a) Provide the evidence-based practice of IPS SE;

(b) Have periodic fidelity reviews completed by an Ohio department of mental health and addiction services (OhioMHAS) approved fidelity reviewer as required by the developer of the practice, and,

(c) Achieve the minimum fidelity score necessary to maintain fidelity, as defined by the developer of the practice.

(3) In the event a provider fails to achieve the required minimum fidelity score, the provider will receive technical assistance to address areas recommended for improvement as identified in the fidelity review by an OhioMHAS approved fidelity reviewer. If the subsequent fidelity review results in a score of less than the required minimum, the provider will no longer by designated as a qualified IPS provider until their fidelity score again reaches the minimum.

(4) Providers implementing IPS SE may become a provisionally qualified IPS SE provider by participating in a baseline fidelity review. Providers may be provisionally qualified one time only and only between the baseline fidelity review and the next subsequent fidelity review. A provider must meet other requirements of this rule in order to receive provisional qualification.

(E) Employment services shall be provided and supervised by staff who:

(1) Are qualified according to rule 5122-29-30 of the Administrative Code; or,

(2) Have experience working with individuals that have a mental illness or substance use disorder.

Replaces: 5122-29-11

Effective: 12/18/2014
Five Year Review (FYR) Dates: 12/18/2019
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1/1/1991, 7/15/2001, 8/23/2007, 7/1/2009

5122-29-12 Driver intervention program.

(A) A driver intervention program is a program of screening, education, and referral for individuals who are arrested or convicted of operation of a vehicle or water craft under the influence of alcohol or a drug of abuse under section 4511.19 or 1547.11 of the Revised Code or a substantially similar municipal ordinance or other alcohol-related traffic statute or ordinance.

(B) No entity may operate, or purport to operate, a driver intervention program in Ohio unless it has received driver intervention program certification from the Ohio department of alcohol and drug addiction services.

(C) Except as otherwise provided in this rule, the provisions of this rule are applicable to all driver intervention programs in Ohio, public or private.

The provisions do not negate the necessity of driver intervention programs to be certified programs in accordance with the provisions of Chapter 5122-25 of the Administrative Code.

(D) Each driver intervention program shall have either representatives from law enforcement officers, judges, prosecuting and defense attorneys, and treatment center representatives on its governing authority or establish an advisory board with such representatives.

If an advisory board is established, it shall:

(1) Meet annually; and,

(2) Minutes shall be maintained for advisory board meetings.

(E) Program administration:

(1) Each driver intervention program shall have a program director that is responsible for the overall day-to-day operation of the driver intervention program. The driver intervention program director shall be responsible to the governing authority of the organization. If the driver intervention program is a component of a larger organization, the driver intervention program director may report to the executive director/chief executive officer of the organization, who would report to the governing authority. A program director hired on or after April 20, 2004 shall meet the following qualifications:

(a) The program director shall have a bachelor's degree and two years' experience in alcohol and other drug addiction services or an allied profession to include one year as a supervisor;

(b) Three years' experience in alcohol and other drug addiction services or an allied profession to include a minimum of one year as a supervisor; or,

(c) Three years' experience in business administration to include a minimum of one year as a supervisor.

(2) The position description of the driver intervention program director shall include, at a minimum, the following responsibilities:

(a) Overseeing the day-to-day operations of the driver intervention program.

(b) Developing and implementing the policies and procedures of the driver intervention program.

(c) Developing and revising as necessary, the driver intervention program's education curriculum.

(d) Preparing an annual plan for the operation of the driver intervention program.

(e) Implementing the driver intervention program's quality assurance and improvement activities and findings.

(f) Hiring and terminating driver intervention program staff.

(g) Ensuring that the driver intervention program is operating in accordance with the Ohio department of alcohol and drug addiction services' driver intervention program certification standards.

(F) Services supervisor:

(1) Each driver intervention program shall have a services supervisor. The driver intervention program director can also be the services supervisor of the driver intervention program if he/she meets the qualifications of a services supervisor as stated in this rule.

(2) An individual hired as the services supervisor of a driver intervention program on or after April 20, 2004 shall have one or more of the following current licenses and/or certifications issued by a professional regulatory board in Ohio:

(a) Licensed physician who is licensed by the state of Ohio medical board.

(b) Licensed psychologist who is licensed by the state of Ohio psychology board.

(c) Professional clinical counselor who is licensed by the state of Ohio counselor, social worker, and marriage and family therapist board.

(d) Licensed independent social worker who is licensed by the state of Ohio counselor, social worker, and marriage and family therapist board.

(e) Licensed chemical dependency counselor III who is licensed by the state of Ohio chemical dependency professionals board.

(f) Licensed independent chemical dependency counselor licensed by the state of Ohio chemical dependency professionals board.

(g) A nurse registered with the Ohio board of nursing.

(h) Licensed social worker who is licensed by the state of Ohio counselor, social worker, and marriage and family therapist board.

(i) Professional counselor who is licensed by the state of Ohio counselor, social worker, and marriage and family therapist board.

(j) Certified prevention specialist I who is certified by the Ohio chemical dependency professionals board.

(k) Certified prevention specialist II who is certified by the Ohio chemical dependency professionals board.

(l) Licensed marriage and family therapist who is licensed by the state of Ohio counselor, social worker, and marriage and family therapist board.

(m) Licensed independent marriage and family therapist who is licensed by the state of Ohio counselor, social worker, and marriage and family therapist board.

(3) The services supervisor's personnel file shall contain copies or verification of, current licenses, certifications, and registrations issued to the individual from professional regulatory boards in Ohio.

(G) Each driver intervention program shall maintain the following:

(1) Outline of the current education curriculum of the driver intervention program.

(2) Copy of the revenue and expenditure budget for the driver intervention program.

(H) Each driver intervention program shall meet, at a minimum, the following handicapped accessibility requirements:

(1) Entrances, hallways and spaces where services are provided and office space for employees shall be handicapped accessible.

(2) Facility shall have at least one handicapped accessible bathroom.

(3) Facility shall have designated handicapped parking space(s) based on the Americans with disabilities act accessibility guidelines.

(4) Facility shall have at least one drinking fountain that is handicapped accessible.

(5) Facility shall have at least one telephone that is handicapped accessible.

(6) Each residential driver intervention programs shall have at least one handicapped accessible shower facility.

(I) Emergency medical plan and first aid supplies:

(1) Each driver intervention program shall have a written emergency medical plan that includes, at a minimum, the following:

(a) Current emergency telephone numbers for fire, emergency squad, police and poison control.

(b) Location of first aid supplies at the program site during operation of the driver intervention program.

(c) General instructions for medical emergencies including supervision of clients during the emergency.

(d) General instructions in case of illness of a client.

(e) Procedure for documenting unusual incidents and notifying families.

(2) A copy of the emergency medical plan shall be conspicuously posted at the program site during the operation of each driver intervention program.

(J) Client records:

(1) Each driver intervention program shall have written policies and/or procedures for maintaining a uniform client records system that include, at a minimum, the following:

(a) Statement that program staff, contract employees, volunteers and student interns shall not convey to a person outside of the program that an individual attends or receives services from the driver intervention program, or disclose any information identifying a client as an alcohol or other drug services client unless the client consents in writing for the release of information; the disclosure is allowed by a court order; the disclosure is to entities with which the provider has entered into a qualified service organization agreement (QSOA) pursuant to 42 CFR part 2;or the disclosure is made to qualified personnel for a medical emergency, research, audit or program evaluation purposes. The driver intervention program has the authority to deny services if a client refuses consent to the release of information.

(b) Statement that the federal laws and regulations do not protect any threat to commit, any information about a crime committed by a client, either at the program or against any person who works for the driver intervention program.

(c) Statement that the federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under state law to appropriate state or local authorities.

(d) Each disclosure made with the client's written consent must be consistent with 42 C.F.R., part 2, by including the following written statement: "This information has been disclosed to you from records protected by federal confidentiality rules. The federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 C.F.R., part 2. A general authorization for the release of medical or other information is not sufficient for this purpose. The federal rules restrict any use of information to criminally investigate or prosecute any alcohol or drug abuse client."

(e) Policy on the access of client records by clients, staff, and others.

(f) Components of client records and time lines, when applicable, for completing each component.

(g) Policy on the storage of client records that requires records be maintained in accordance with 42 C.F.R., part 2, confidentiality of alcohol and drug abuse client records.

(h) Policy on the destruction of client records to include the requirement that records be maintained for at least six years after clients have been discharged from the program. Client records shall be destroyed to maintain client confidentiality as required by state and federal law.

(2) A record shall be maintained for each client of a driver intervention program. Each record shall include, at a minimum, the following components:

(a) Identification of client (name of client and/or client identification number).

(b) Client fee agreement.

(c) Consent for services.

(d) Documentation reflecting receipt of the schedule for the driver intervention program being attended by the client.

(e) Documentation reflecting receipt of the driver intervention program rules and/or expectations of clients.

(f) Documentation reflecting receipt of the program's policy on client rights that lists the client rights required by this rule.

(g) Documentation reflecting receipt of the program's client grievance procedure.

(h) Documentation reflecting receipt of a written summary of the federal laws and regulations that indicate the confidentiality of client records are protected as required by 42 CFR, part 2.

(i) Intake report.

(j) Identification of at least two screening instruments that were administered to the client and documentation of the results of both tests.

(k) Results and recommendations of the screening.

(l) Recommendations for alcohol and/or drug assessment.

(m) Assessment, if completed by the driver intervention program.

(n) Any recommendations made to a court or other organization.

(o) Date of each group session provided.

(p) Length of each group session provided.

(q) Topic/content of each group session provided.

(r) Client's response/feedback during each group session.

(s) Disclosure of client information forms, when applicable.

(3) Disclosure of client information forms shall include the following information as required by 42 C.F.R., part 2:

(a) Name of program making the disclosure.

(b) Name or title of the individual or the name of the organization to which the disclosure is to be made.

(c) Name of the client.

(d) Purpose of the disclosure.

(e) Type and amount of information to be disclosed.

(f) Original signature of the client or person authorized to give consent.

(g) Date client or other authorized person signed the form.

(h) Statement that the consent is subject to revocation at any time except to the extent the program or person who is to make the disclosure has already acted in reliance on it.

(i) The date, event, or condition upon which the consent will expire, unless revoked before that specified time.

(4) Each client record shall include a program completion report which shall include, at a minimum, the following documentation. A copy of the report shall be sent to the court or organization that referred the client to the driver intervention program.

(a) Results and recommendations of the screening.

(b) Any recommendations for alcohol and/or drug assessment.

(c) Any recommendations made to a court or other organization.

(d) Number of hours of driver intervention programming the client attended.

(e) Any referrals made to alcohol and drug addiction treatment programs and any referrals made to other organizations.

(f) Date, signature, and credentials of the program director, services supervisor or program staff of the driver intervention program who makes the recommendation.

(g) Summary of client's participation.

(h) Disclosure of client information form that is prepared in accordance with 42 CFR, part 2, confidentiality of alcohol and drug abuse patient records, for information released to courts, organizations and/or individuals and for management information reports to the Ohio department of alcohol and drug addiction services.

(5) A policy and procedure, in accordance with 42 CFR, part 2, confidentiality of alcohol and drug abuse patient records, for tracking clients for a reasonable time following program completion.

(6) If a program maintains electronic client records, the program must be able to produce hard copies of client records upon legally valid requests and have a written policy and procedure indicating how client original signatures and staff original signatures are obtained and verified for documentation.

(7) If a program discontinues operations or is taken over or acquired by another entity, it shall comply with 42 C.F.R., part 2, subsection 2.19 which governs the disposition of records by discontinued programs.

(K) Intake report:

(1) An intake report shall be completed for each client at the beginning of the first day of the driver intervention program. Documentation shall include, at a minimum, the following:

(a) Client identification number and name.

(b) Prescription and over-the-counter drugs being taken by the client.

(c) Type and amount of any medications brought to the program.

(d) Special dietary requirements.

(e) Known allergies, including but not limited to food and drug reactions.

(f) Pregnancy status of women.

(g) Special needs of clients.

(h) Name, address, and telephone number of a person who is to be contacted in the event of an emergency.

(2) Baggage and materials brought to the driver intervention program shall be inspected to ascertain that they do not contain contraband, which includes, at a minimum, illegal drugs, alcohol, or firearms. Documentation shall appear in the intake report.

(3) The intake report shall be dated and signed by the staff member completing the intake report.

(L) Screening:

(1) Screening means a preliminary gathering and sorting of information used to determine whether a comprehensive assessment is appropriate.

(2) Each client of a driver intervention program shall be administered at least two screening instruments. The results shall be recorded in the client's record.

(3) Screening interviews shall include, at a minimum, the following:

(a) Client identification.

(b) Presenting problem and/or precipitating factors leading to the need for screening.

(c) Past and present use of alcohol and other drugs.

(d) History of treatment for alcohol and other drug abuse.

(e) Medical problems.

(f) Legal history.

(g) Recommendations for referral, if applicable, for a comprehensive assessment to determine the extent and severity of alcohol and other drug abuse problems and need for treatment.

(h) Date, signature, and credentials of program staff who completed the screening.

(M) Referral for assessment:

(1) Each driver intervention program shall have a written procedure for making referrals for assessment which requires that a completed release of information shall be obtained prior to contacting a program.

(2) Each driver intervention program shall have a written policy stating that the basis for making a recommendation to a court or other organization for alcohol and drug addiction comprehensive assessment shall include, at a minimum, the following:

(a) Results of the two screening instruments and screening interview.

(b) Observations of the client during screening, client education on alcohol and drug abuse and addiction and group sessions.

(3) Each driver intervention program shall have a written policy for submitting a copy of the report to the court or organization that referred the client to the driver intervention program, as requested by the referral source.

(N) A driver intervention program may conduct client assessments. Assessments shall be conducted in accordance with rules set forth by the Ohio department of mental health and addiction services.

(O) Dietary services:

Each driver intervention program that prepares and/or serves meals as part of its daily scheduled activities shall operate its dietary services in accordance with laws, regulations, or ordinances of the Ohio board of dietetics, Ohio department of health and/or local health department.

(P) Pharmaceutical services:

(1) Driver intervention programs are prohibited from dispensing and/or administering medications.

(2) Clients who take prescription medications and/or over-the-counter medications may "self-medicate" at driver intervention programs. Each driver intervention program that permits clients to self-medicate shall have written policies and/or procedures for client self-medication that include, at a minimum, the following:

(a) Policy prohibiting clients from having prescription medication in their possession at the program site or while involved in program activities off site, unless required by a physician for medical necessity.

(b) Procedures for obtaining and accounting for controlled substances from clients at the time of admission to or upon entering the program and return of same, as appropriate, at the time of discharge/departure.

(c) Procedures for storing medications in a locked cabinet.

(d) Procedures for reporting theft or loss of over the-counter medications or prescription medication.

(e) Procedures for self-medication.

(3) Clients shall not be denied driver intervention services due solely to their use of prescribed psychotropic medication(s).

(Q) Non-residential driver intervention programs:

(1) Each non-residential driver intervention program shall consist of at least thirteen hours of alcohol and drug addiction programming that includes, at a minimum, the following:

(a) One hour of screening and individual contact.

(b) Eight hours of client education on alcohol and drug abuse and addiction including traffic safety education.

(c) Four hours of small group discussion sessions.

(2) Each non-residential driver intervention program is prohibited from delivering more than eight hours of alcohol and drug addiction programming to clients each day.

(3) Each client shall be administered at least two screening instruments.

(4) An individual screening interview shall be done with each client to discuss the screening findings, recommendations and referrals made to a referring court or other organization.

(5) A program completion report shall be prepared for each client.

(6) Small group discussion sessions:

(a) Small group discussion sessions shall not exceed a staff to client ratio of one to fifteen.

(b) The total number of clients in a group session shall not exceed fifteen, regardless of the number of staff.

(7) If a non-residential driver intervention program is operated within a residential driver intervention program, its programmatic content must be the same as that of the residential driver intervention program, and shall include the mid-day and evening meals.

(8) If a non-residential driver intervention program operates its program for five hours or more on any day, the program shall have provisions for a mid-day meal of at least thirty minutes. This mid-day meal shall be included in the program's schedule that is available to clients upon request. Time for meals may not supplant any of the minimum thirteen-hour alcohol and drug programming.

(9) The program shall have at least one staff member who is on-site and actively supervising and/or monitoring clients at all times during the program.

(R) Forty-eight hour residential driver intervention programs:

(1) Each forty-eight hour residential driver intervention program shall consist of at least sixteen hours of alcohol and drug addiction programming that includes, at a minimum, the following:

(a) One hour of screening and individual contact.

(b) Ten hours of client education on alcohol and drug abuse and addiction including traffic safety education.

(c) Five hours of small group discussion sessions.

(2) Each client shall be administered at least two screening instruments.

(3) An individual screening interview session shall be done with each client to discuss the screening findings, recommendations and referrals to a referring court or other organization.

(4) A program completion report shall be prepared for each client.

(5) Small group discussion:

(a) Small group discussion sessions shall not exceed a staff to client ratio of one to fifteen.

(b) The total number of clients in a small group discussion session shall not exceed fifteen, regardless of the number of staff.

(6) The program shall have at least one staff member who is on-site and actively supervising and/or monitoring clients at all times during the program.

(S) Seventy-two hour residential driver intervention programs:

(1) Each seventy-two hour residential driver intervention program shall consist of at least twenty-one hours of alcohol and drug addiction programming that includes, at a minimum, the following:

(a) One hour of screening and individual contact.

(b) Fifteen hours of client education on alcohol and drug abuse and addiction including traffic safety education.

(c) Five hours of small group discussion sessions.

(2) Each client shall be administered at least two screening instruments.

(3) An individual screening interview shall be conducted with each client to discuss the screening findings, recommendations, referrals, and recommendations made.

(4) Small group discussion:

(a) Small group discussion sessions staff to client ratio shall not exceed one to fifteen.

(b) The total number of clients in a group session shall not exceed fifteen, regardless of the number of staff.

(5) A program completion report shall be prepared for each client.

(6) The program shall provide morning, mid-day, and evening meals of at least thirty minutes duration.

(7) The program shall have at least one staff member who is on-site and actively supervising and/or monitoring clients at all times during the program.

(T) Each driver intervention program shall have a written educational curriculum that includes, at a minimum, the following:

(1) Traffic safety education as it relates to alcohol and drug use.

(2) Client education on alcohol and drug abuse and addiction.

(3) Small group discussion topics.

(U) Each program shall prepare an educational curriculum for its driver intervention program that shall be approved by the program's governing authority that includes, but is not limited to, the following:

(1) Time table for conducting the program.

(2) Instructional outline for each topic/module.

(3) Method of instruction, including audio/visual aids.

(V) Each program shall have a program schedule that can be given to clients upon request.

(W) Traffic safety education:

(1) Traffic safety education shall include, at a minimum, the following information on the criminal justice system and relevant law.

(a) Blood alcohol content (BAC), drugs and impairment.

(b) Levels of license suspension and revocation.

(c) Fines and levels of incarceration.

(2) The driving task and the specific psychomotor skills required.

(3) The physiological and psychological effects of alcohol and other drugs on driving performance.

(4) Traffic safety education sessions shall not exceed an instructor to client ratio of one to forty eight.

(X) Client education on alcohol and drug abuse and addiction:

(1) Client education on alcohol and drug abuse and addiction shall include, at a minimum, the following:

(a) Physical and psychological aspects of the use of alcohol and other drugs.

(b) Combining the use of alcohol with other drugs.

(c) Social consequences of the use of alcohol and other drugs.

(d) Signs and symptoms of abuse and dependence of alcohol and other drugs.

(e) Dysfunctional behavior resulting from the use of alcohol and other drugs.

(f) Progressive nature of alcohol and drug abuse and dependence.

(g) Abstinence as a life-style and self-help programs such as alcoholics anonymous and narcotics anonymous.

(h) Treatment alternatives and local resources.

(2) Programming does not include the following:

(a) Individual and/or group counseling.

(b) Self-help study sessions.

(c) Anger management and stress reduction therapies.

(3) Staffing for client education group sessions on alcohol and drug abuse and addiction shall not exceed an instructor to client ratio of one to forty eight.

(Y) Indigent clients:

(1) A driver intervention program that receives funds that originate and/or pass through the Ohio department of mental health and addiction services shall have a policy and procedure which states that admission to the driver intervention program shall not be denied because an individual is indigent as long as public funds are available to cover the cost of the program.

(2) Indigent individuals are persons who have in their possession at the beginning of a driver intervention program a document which indicates the client is a recipient of public assistance, including, but not limited to, supplemental security income, social security disability income, medicaid, temporary assistance for needy families or other category of assistance as defined by the Ohio department of mental health and addiction services.

(3) The client record of indigent individuals shall include a photocopy of the documentation that was used to verify indigent status.

Effective: 4/1/2016
Five Year Review (FYR) Dates: 04/01/2021
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36

5122-29-13 SUD case management services.

Substance use disorder case management services means those activities provided to assist and support individuals in gaining access to needed medical, social, educational and other services essential to meeting basic human needs. Case management services may include interactions with family members, other individuals or entities.

(A) Case management services shall include, at a minimum, the following activities:

(1) Assessment.

(2) Referral.

(3) Monitoring and follow-up.

(B) Examples of case management activities include: coordinating: client assessments, treatment planning and crisis intervention services; providing training and facilitating linkages for the use of community resources; monitoring service delivery; obtaining or assisting individuals in obtaining necessary services, for example, financial assistance, housing assistance, food, clothing, medical services, educational services, vocational services, recreational services, etc.; assisting individuals in becoming involved with self-help support groups; assisting individuals in increasing social support networks with family members, friends, and/or organizations; assisting individuals in performing daily living activities; and coordinating criminal justice services.

(1) Transportation in and of itself does not constitute case management.

(2) Waiting with clients for appointments at social service agencies, court hearings and similar activities does not, in and of itself, constitute case management.

(C) Case management services do not include the provision of

(1) Direct services to which the client has been referred such as medical, educational, or social; or,

(2) Internal quality assurance activities, such as clinical supervisory activities and/or case reviews/staffing sessions.

Replaces: 3793:2-1-08

Effective: 1/1/2018
Five Year Review (FYR) Dates: 01/01/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 7/1/91, 7/1/01, 7/1/05, 7/1/06, 7/2/07, 10/4/10, 5/19/11, 7/1/12

5122-29-14 [Rescinded].

Effective: 1/1/2018
Five Year Review (FYR) Dates: 4/14/2017
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1-1-1991, 10-1-1993, 7-15-2001, 8-23-2007, 7/1/2009

5122-29-15 Peer recovery services.

(A) Peer recovery services are community-based services for individuals with a mental illness or substance use disorder; and consist of activities that promote recovery, self-determination, self-advocacy, well-being, and independence. Peer recovery services are individualized, recovery-focused, and based on a relationship that supports a person's ability to promote their own recovery.

(B) Peer recovery services promote self-directed recovery by assisting an individual. They promote trauma informed care and diversity competence, encourage self-direction, and advocate for informed choice.

(C) "Recovery" means the personal process of change in which Ohio residents strive to improve their health and wellness, resiliency, and reach their full potential through self-directed actions.

(D) Peer recovery services may include, but are not limited to:

(1) Ongoing exploration of recovery needs;

(2) Supporting individuals in achieving personal independence as identified by the individual;

(3) Encouraging hope;

(4) Supporting the development of life skills such as budgeting and connecting to community resources;

(5) Developing and working toward achievement of personal recovery goals;

(6) Modeling personal responsibility for recovery;

(7) Teaching skills to effectively navigate to the health care delivery system to effectively and efficiently utilize services;

(8) Providing group facilitation that addresses symptoms or behaviors, though processes that assist an individual in eliminating barriers to seeking or maintaining recovery, employment, education, or housing;

(9) Assisting with accessing and developing natural support systems in the community;

(10) Promoting coordination and linkage among similar providers;

(11) Coordinating or assistance in crisis interventions and stabilization as needed;

(12) Conducting outreach;

(13) Attending and participating in treatment team; or,

(14) Assisting individuals in the development of empowerment skills through self-advocacy and activities that mitigate discrimination and inspire hope.

(E) Peer recovery services are not site specific but shall be provided in locations that meet the needs of the individual.

(F) Peer recovery services may be facilitated to individuals or groups.

(G) Peer recovery services shall be provided by certified peer recovery supporters as defined in rule 5122-29-15.1 of the Administrative Code.

(H) Peer recovery services providers shall report for any certified peer recovery supporter employed by or volunteering with the provider to the Ohio department of mental health and addiction services any events that would disqualify the certified peer recovery supporter pursuant to paragraph (I) of rule 5122-29-15.1 of the Administrative Code.

Effective: 10/5/2018
Five Year Review (FYR) Dates: 7/1/2021
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 01/01/1991, 07/15/2001, 03/25/2004, 07/01/2016

5122-29-15.1 Certified peer recovery supporter.

(A) A "certified peer recovery supporter" is an individual, with a direct lived experience, who has self-identified as being in recovery from a mental health or substance use disorder, and has been certified through the department.

Peer recovery supporter certification requires the completion of the following requirements:

(1) A sixteen hour on-line e-based academy administered by the department;

(2) Submission of proof of a minimum of forty hours of peer service delivery training or three equivalent years formal experience in peer service delivery as a peer navigator, peer supporter, peer specialist, or peer recovery coach;

(3) Passing the department peer recovery supporter exam;

(4) Submission of a signed certified peer recovery supporter code of ethics established by the department;

(5) The submission of a completed application; and,

(6) The submission with the completed application, the results of a bureau of criminal identification and investigation criminal records check conducted within thirty days prior to submission.

Certified peer recovery supporters may have an identified specialty of mental health or substance use disorder based upon their personal recovery experience.

(B) Certified peer recovery supporters shall be certified for a period of two years from the date of issuance of certification by the department.

(C) Certified peer recovery supporters must be supervised by an individual who either:

(1) Has been delivering peer services for five years, as a peer navigator, peer supporter, peer specialist, peer recovery coach, or peer recovery supporter; have completed the sixteen hour on-line e-based academy courses offered through the Ohio department of mental health and addiction services, and have completed the four hour in-person supervising peers training by Ohio department of mental health and addiction services recovery support staff; or,

(2) Is a clinician with one of the following licenses:

(a) Licensed social worker;

(b) Licensed independent social worker;

(c) Licensed professional counselor;

(d) Licensed chemical dependency counselor II;

(e) Licensed chemical dependency counselor III;

(f) Licensed professional clinical counselor;

(g) Licensed independent chemical dependency counselor;

(h) Licensed marriage and family therapist;

(i) Licensed independent marriage and family therapist

(j) Psychologist; or,

(k) Psychiatrist.

The behavioral health clinician shall have completed the sixteen hour on-line e-based academy courses offered through the Ohio department of mental health and addiction services, and have completed the four hour in-person supervising peers training administered by the Ohio department of mental health and addiction services recovery support staff or their designee.

(D) Peer recovery supporter certification may be renewed by submission to the department of:

(1) A renewal application;

(2) Proof of thirty hours of continuing education credits; and,

(3) The results of a bureau of criminal identification and investigation criminal records check, or any other state or federal agency designated by the director,conducted within thirty days prior to submission.

Renewal of certified peer recovery supporter status is dependent on all materials being completed and submitted to the department. Renewal of certification is for two years from the date of the expiration of previous certification or the completion of the review of renewal materials, whichever is later.

(E) Peer recovery supporter certification may be denied, not renewed, or revoked for any of the following:

(1) A failure to provide peer recovery supporter services in accordance with the standards set forth in this rule.

(2) A failure to submit a complete certification or renewal application.

(3) A failure to complete any of the requirements for certification or renewal.

(4) The department determines that the certified peer recovery supporter pledge has been violated.

(5) The individual is included in one of the following databases:

(a) The sex offender and child-victim offender database established pursuant to division (A)(11) of section 2950.13 of the Revised Code (available at http://www.icrimewatch.net/index.php?AgencyID=55149&disc=);

(b) The database of incarcerated and supervised offenders established pursuant to section 5120.66 of the Revised Code (available at http://www.drc.ohio.gov/OffenderSearch/Search.aspx).

(6) The individual shall have a criminal records check that is free from any convictions, excluding minor traffic violations, and has been released from all sanctions, for three years prior to application.

Except that individuals with an offense listed in paragraph (I) of this rule shall be permanently excluded from certification and shall not be eligible for a waiver.

(7) The individual has a negative finding from the department conflict of interest review committee.

(F) The denial of an application for certification or renewal, or the revocation of certification is subject to appeal under Chapter 119. of the Revised Code.

(G) Any individual who has been denied certification or had their certification revoked pursuant to this rule shall not be eligible to apply to the department for certification for at least three years from the date of revocation without the written consent of the department.

(H) Continuing education shall be based on individual needs, skill level, and interest of the individual; and shall address, at a minimum, the following:

(1) An understanding of systems care, such as natural support systems, entitlements and benefits, inter and intra-agency systems of care, crisis response systems, medications, culture, trauma informed care, diversity competence, human trafficking, and intent of peer recovery services

(2) Characteristics of populations to be served such as symptoms, medications, culture, age, gender, sexual orientation, and human development

(I) Any individual disqualified from certification due to a criminal offense in paragraph (D) of this rule may request a waiver of that disqualification by submission of a waiver request form. The waiver form shall set forth factors related to conviction, time lapsed since the conviction, related circumstances, and changes in the applicant's life since the charge or conviction. If a waiver a is granted for an individual, the waiver is only for those offenses listed on the waiver and is not subject to review by the department upon the individual's certification renewal.

(J) Applications for certification and renewal, and all accompanying materials, are subject to public records requests pursuant to Chapter 149. of the Revised Code; however the department shall not use the applications for any purpose other than determining certification status and shall be kept confidential unless disclosure is required by state or federal law.

(K) Disqualifying offenses (sections of the Revised Code);.

(1) 2903.01 (aggravated murder);

(2) 2903.15 (permitting child abuse);

(3) 2903.16 (failing to provide for a functionally impaired person);

(4) 2903.21 (aggravated menacing);

(5) 2905.32 (human trafficking);

(6) 2905.33 (unlawful conduct with respect to documents);

(7) 2903.34 (patient abuse and neglect);

(8) 2903.341 (patient endangerment);

(9) 2905.04 (child stealing) as it existed prior to July 1, 1996;

(10) 2905.05 (criminal child enticement);

(11) 2907.02(rape) ;

(12) 2907.03 (sexual battery);

(13) 2907.04 (unlawful sexual conduct with a minor, formerly corruption of a minor);

(14) 2907.05 (gross sexual imposition);

(15) 2907.06 (sexual imposition);

(16) 2907.07(importuning) ;

(17) 2907.08(voyeurism) ;

(18) 2907.12 (felonious sexual penetration);

(19) 2907.21 (compelling prostitution);

(20) 2907.22 (promoting prostitution);

(21) 2907.31 (disseminating matter harmful to juveniles);

(22) 2907.32 (pandering obscenity);

(23) 2907.321 (pandering obscenity involving a minor);

(24) 2907.322 (pandering sexually-oriented matter involving a minor);

(25) 2907.323 (illegal use of minor in nudity-oriented material or performance);

(26) 2907.33 (deception to obtain matter harmful to juveniles);

(27) 2909.22 (soliciting/providing support for act of terrorism);

(28) 2909.23 (making terrorist threat);

(29) 2909.24(terrorism) ;

(30) 2913.40 (medicaid fraud);

(31) 2919.22 (endangering children);

(32) 2925.02 (corrupting another with drugs);

(33) 2925.23 (illegal processing of drug documents);

(34) 2925.24 (tampering with drugs);

(35) 2925.36 (illegal processing of drug samples);

(36) 3716.11 (placing harmful objects in food or confection);

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Effective: 10/5/2018
Five Year Review (FYR) Dates: 7/1/2021
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 07/01/2016

5122-29-16 Peer run organization.

(A) "Peer run organization" means any service or activity that is planned, developed, administered, delivered, and evaluated by persons, a majority of whom have a direct lived experience of a mental health or substance use disorder.

(B) "Recovery" as used in this rule has the same meaning as defined in paragraph (C) of rule 5122-29-15 of the Administrative Code.

(C) Peer run organizations include but are not limited to consumer operated services, recovery community organizations, peer drop-in centers, and club houses.

(D) Peer run organizations shall:

(1) Have a primary goal of enhancing the quantity and quality of support available to individuals seeking recovery from mental health or substance use disorders;

(2) Be grounded in three core principles: a recovery vision, authenticity of voice, and accountability to the recovery community;

(3) Promote the strategies of public awareness and education, personal empowerment, and peer based- and other recovery support services and activities which may include: peer recovery support, telephone recovery support services, all-recovery meetings, structured volunteer/work activities, groups, social activities, or wellness activities;

(4) Be responsive to the needs of individuals participating in services and be based on local needs as identified by the individuals participating in the service.

Replaces: 5122-29-16

Effective: 1/1/2018
Five Year Review (FYR) Dates: 01/01/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1/1/91, 7/15/01

5122-29-17 Community psychiatric supportive treatment (CPST) service.

(A) Community psychiatric supportive treatment (CPST) service provides an array of services delivered by community based, mobile individuals or multidisciplinary teams of professionals and trained others. Services address the individualized mental health needs of the client. They are directed towards adults, children, adolescents and families and will vary with respect to hours, type and intensity of services, depending on the changing needs of each individual. The purpose/intent of CPST services is to provide specific, measurable, and individualized services to each person served. CPST services should be focused on the individual's ability to succeed in the community; to identify and access needed services; and to show improvement in school, work and family and integration and contributions within the community.

(B) Activities of the CPST service shall consist of one or more of the following:

(1) Ongoing assessment of needs;

(2) Assistance in achieving personal independence in managing basic needs as identified by the individual and/or parent or guardian;

(3) Facilitation of further development of daily living skills, if identified by the individual and/or parent or guardian;

(4) Coordination of the ISP, including:

(a) Services identified in the ISP;

(b) Assistance with accessing natural support systems in the community; and

(c) Linkages to formal community service/systems;

(5) Symptom monitoring;

(6) Coordination and/or assistance in crisis management and stabilization as needed;

(7) Advocacy and outreach;

(8) As appropriate to the care provided to individuals, and when appropriate, to the family, education and training specific to the individual's assessed needs, abilities and readiness to learn;

(9) Mental health interventions that address symptoms, behaviors, thought processes, etc., that assist an individual in eliminating barriers to seeking or maintaining education and employment; and

(10) Activities that increase the individual's capacity to positively impact his/her own environment.

(C) The methods of CPST service delivery shall consist of:

(1) Service delivery to the person served and/or any other individual who will assist in the person's mental health treatment.

(a) Service delivery may be face-to-face, by telephone, and/or by video conferencing; and

(b) Service delivery may be to individuals or groups.

(2) CPST services are not site specific. However, they must be provided in locations that meet the needs of the persons served. When a person served is enrolled in a residential treatment or residential support facility setting, CPST services must be provided by staff that are organized and distinct and separate from the residential service as evidenced by staff job descriptions, time allocation or schedules, and development of service rates.

(D) There must be one CPST staff who is clearly responsible for case coordination. This staff person must be an employee of an agency that is certified by ODMH to provide CPST services. This person may delegate CPST services to eligible providers internal and/or external to the certified agency as long as the following requirements and/or conditions are met:

(1) All delegated CPST activities are consistent with this rule in its entirety;

(2) The delegated CPST services may be provided by an entity not certified by ODMH to provide CPST services as long as there is written agreement between the certified agency and the non-certified entity that defines the service expectations, qualifications of staff, program and financial accountability, health and safety requirements, and required documentation; and

(3) An entity that is not certified by ODMH for CPST service may only seek reimbursement for CPST services through a certified agency and with a written agreement as required in this paragraph.

(E) Providers of CPST service shall have a staff development plan based upon identified individual needs of CPST staff. Evidence that the plan is being followed shall be maintained. The plan shall address, at a minimum, the following:

(1) An understanding of systems of care, such as natural support systems, entitlements and benefits, inter- and intra-agency systems of care, crisis response systems and their purpose, and the intent and activities of CPST;

(2) Characteristics of the population to be served, such as psychiatric symptoms, medications, culture, and age/gender development; and

(3) Knowledge of CPST purpose, intent and activities.

(F) Community psychiatric supportive treatment (CPST) service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 9/16/2018
Five Year Review (FYR) Dates: 7/2/2018 and 09/16/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 01/01/1991, 01/01/1994 (Emer.), 06/30/1995, 09/24/1995, 07/15/2001, 03/25/2004, 08/23/2007, 07/01/2008, 12/15/2011, 08/01/2013

5122-29-18 Therapeutic behavioral services and psychosocial rehabilitation.

(A) Therapeutic behavioral services (TBS) and psychosocial rehabilitation (PSR) services are an array of activities intended to provide individualized supports or care coordination of healthcare, behavioral healthcare, and non-healthcare services. TBS and PSR may involve collateral contacts and may be delivered in all settings that meet the needs of the individual.

(B) Service activities.

(1) TBS service activities include, but are not limited to the following:

(a) Consultation with a licensed practitioner or an eligible provider pursuant to paragraph (C) of this rule, to assist with the individual's needs and service planning for individualized supports or care coordination of healthcare, behavioral healthcare, and non-healthcare services and development of a treatment plan;

(b) Referral and linkage to other healthcare, behavioral healthcare, and non- healthcare services to avoid more restrictive levels of treatment;

(c) Interventions using evidence-based techniques;

(d) Identification of strategies or treatment options;

(e) Restoration of social skills and daily functioning; and,

(f) Crisis prevention and amelioration.

(2) PSR service activities include, but are not limited to the following

(a) Restoration, rehabilitation and support of daily functioning to improve self- management of the negative effects of psychiatric or emotional symptoms that interfere with a person's daily functioning;

(b) Restoration and implementation of daily functioning and daily routines critical to remaining successfully in home, school, work, and community; and,

(c) Rehabilitation and support to restore skills to function in a natural community environment.

(C) Eligible providers.

(1) Eligible providers of TBS are those practitioners who have:

(a) A bachelor's or master's degree in social work, psychology, nursing, or in related human services, or

(b) A high school diploma with a minimum of three years of relevant experience.

(2) Eligible providers for PSR services are those practitioners who have a high school diploma and specific training related to persons with mental health conditions or needs.

Effective: 1/1/2018
Five Year Review (FYR) Dates: 01/01/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36

5122-29-19 Consultation service.

(A) "Consultation service" means a formal and systematic information exchange between a provider and a person other than a client, which is directed towards the development and improvement of individualized service plans and/or techniques involved in the delivery of behavioral health services.

(B) Consultation may be focused on the clinical condition of a person served by another system or focused on the functioning and dynamics of another system. Consultation related to the clinical condition of a person served shall be provided by staff qualified according to paragraph (C) of this rule.

(1) The provider shall survey periodically other community systems to determine behavioral health consultation needs that may be desired by the systems, persons or families being served by those other systems.

(2) The provider shall maintain a record of all consultation services provided, including the name of the person or system to whom the service was provided, the nature of the consultation, and the outcome of the consultation.

(C) Consultation service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Effective: 1/1/2018
Five Year Review (FYR) Dates: 4/14/2017 and 01/01/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1/1/91, 7/15/01, 7/1/06, 8/23/07, 7/1/09

5122-29-20 Prevention service.

(A) Prevention services are a planned sequence of culturally relevant, evidenced-based strategies; which are designed to reduce the likelihood of or delay the onset of mental, emotional, and behavioral disorders. Prevention services shall:

(1) Be intentionally designed to reduce risk or promote health before the onset of a disorder; and,

(2) Be population-focused and targeted to specific levels of risk.

Prevention services are reserved for interventions designed to reduce the occurrence of new cases of MEB disorders, and shall not be used for clinical assessment, treatment, recovery support services, relapse prevention or medications of any type.

(B) "Coalition" means a collaboration of groups or individuals which have agreed to work together towards a common goal of reducing local incidence, prevalence, and consequences of MEB disorders.

(C) "Culturally relevant" means the service delivery systems respond to the needs of the community demonstrated through readiness, resource and need assessment activities; capacity development efforts; engaging stakeholders in planning; sound implementation science; evaluation and quality improvement and sustainability activities.

(D) "Evidenced-Based" means an intervention that has been identified as effective by a nationally recognized organization, a federal, or state agency, and has produced a consistent positive pattern of results on the majority of the intended recipients or target population. The intervention must also be implemented to fidelity as defined by the developer; and provided or supervised by licensed, certified, or registered professionals in accordance with paragraph (B) of rule 5122-29-30 of the Administrative Code.

(E) "Mental, emotional, or behavioral" (MEB) disorder means a diagnosable mental illness or substance use disorder.

(F) Levels of risk are:

(1) Universal: targeted to the general public or a whole population group that has not been identified on the basis of individual risk. The intervention is desirable for everyone in that group.

(2) Selective: targeted to individuals or to a subgroup of the population whose risk of developing MEB disorders are significantly higher than average. The risk may be imminent or it may be a lifetime risk. Risk groups may be identified on the basis of biological, psychological, or social risk factors that are known to be associated with the onset of a MEB disorder. Those risk factors may be at the individual level for non-behavioral characteristics (e.g., biological characteristics such as low birth weight), at the family level (e.g., children with a family history of substance abuse but who do not have any history of use), or at the community/population level (e.g., schools or neighborhoods in high-poverty areas).

(3) Indicated: targeted to high-risk individuals who are identified as having minimal but detectable signs or symptoms that foreshadow MEB, as well as biological markers which indicate a predisposition in a person for such a disorder but who does not meet diagnostic criteria at the time of the intervention.

(G) Mandatory strategies: In order to be certified prevention providers must provide at least one of these strategies:

(1) Education: This strategy focuses on the delivery of services to target audiences with the intent of influencing attitude or behavior. It involves two-way communication and is distinguished from information dissemination by the fact that interaction between educator or facilitator and participants is the basis of the activities. Activities influence critical life skills and social or emotional learning including, but not limited to, attachment, emotional regulation, empathy, family and social connectedness, decision-making, refusal skills, critical analysis, and systematic judgment abilities.

(2) Environmental: This strategy seeks to establish or change standards or policies to influence the incidence and prevalence of behavioral health problems in a population. Activities address family, social, neighborhood, school or community norms and seek to reduce identified risk factors and increase protective factors; this is accomplished through media, messaging, policy and enforcement activities conducted at multiple levels.

(H) Supporting strategies: In addition to the strategies in paragraph (G) of this rule, prevention providers must provide at least one of the following strategies in order to be certified:

(1) Community-based process: This strategy focuses on enhancing the ability of the community to provide prevention services through organizing, training, planning, interagency collaboration, coalition building or networking.

(2) Alternatives: This strategy focuses on providing opportunities for positive behavior support as a means of reducing risk taking behavior, and reinforcing protective factors. Alternative programs include a wide range of social, cultural and community service or volunteer activities.

(3) Information dissemination: This strategy focuses on building awareness and knowledge of behavioral health and the impact on individuals, families and communities, as well as the dissemination of information about prevention services. It is characterized by one-way communication from source to audience.

(4) Problem identification and referral: This strategy focuses on referring individuals who are currently involved in primary prevention services and who exhibit behavior that may indicate the need for behavioral health or other assessment. This strategy does not include clinical assessment or treatment for behavioral health. It also does not include SBIRT.

(I) Prevention providers must demonstrate that prevention interventions are:

(1) Culturally relevant;

(2) Age appropriate;

(3) Gender appropriate; and,

(4) Targeted toward multiple settings within the community.

(J) Prevention providers must document procedures for referring consumers to the following:

(1) Alcohol addiction, drug addiction, mental health, gambling addiction and primary care health services;

(2) Social services; and,

(3) Community resources.

(K) Prevention providers must document an evaluation process for the following:

(1) Prevention interventions (2) Prevention workforce development activities

(L) Volunteers

(1) Volunteers assisting with universal prevention interventions must be monitored by an eligible provider other than an Ohio registered applicant.

(2) Volunteers assisting with selective or indicated prevention interventions must be monitored by personnel that are eligible to supervise prevention personnel as set forth in rule 5122-29-30 of the Administrative Code.

(M) Prevention service providers are not required to keep records of individuals who receive prevention services. Any records which are kept shall be kept in manner compliant with the confidentiality requirements of 42 C.F.R. and HIPAA.

(N) Educational entities under the jurisdiction of the Ohio department of education or the Ohio board of regents are exempt from the prevention certification rule.

(O) Coalitions providing services as defined in both paragraph (G)(2) of this rule and either paragraph (H)(1) or (H)(3) of this rule are exempt from the prevention certification rule.

Effective: 4/1/2016
Five Year Review (FYR) Dates: 04/01/2021
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36

5122-29-21 [Rescinded].

Effective: 1/1/2018
Five Year Review (FYR) Dates: 4/14/2017
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1-1-1991, 7-15-2001, 8-23-2007, 7/1/2009

5122-29-22 Referral and information service.

(A) "Referral and information service" means responses, usually by telephone, to inquiries from people about services in the community. Referral may include contacting any agency or a provider in order to secure services for the person requesting assistance.

(B) Referral and information service shall be planned and coordinated with other health and human service providers, and shall:

(1) Have a mechanism to compile information about services available in the service system and the community; and

(2) Have mechanisms to determine whether persons referred were able to access services, were satisfied with the services, or experienced any problems with the referral source. This information shall be used to determine if particular providers shall continue to be used as referrals for persons seeking services. All state and federal confidentiality laws shall be adhered to in this process.

(C) The provider shall ensure access and availability of referral and information service including:

(1) A referral and information service shall have a published telephone number, including a published telephone number for special telephone services for the hearing impaired; and

(2) The provider shall ensure access and availability for persons whose primary means of communication is a language other than english, and for persons with communication impairments such as speech, language or hearing disorders, access to telecommunication relay services (TRS), and for persons with visual impairments.

A TRS is a telephone service that allows persons with hearing or speech disabilities to place and receive telephone calls, such services include but are not limited to text to speech relay and signing to speech relay.

(D) Each call and contact shall be logged and shall include the date, time and person answering the call or contact.

(E) A referral and information service is not hotline service, and is not intended to replace the crisis assistance function of a hotline service.

Replaces: 5122-29-22, 3793:2-1-08

Effective: 1/1/2018
Five Year Review (FYR) Dates: 4/14/2017 and 01/01/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1/1/91, 7/15/01

5122-29-23 [Rescinded].

Effective: 1/1/2018
Five Year Review (FYR) Dates: 4/14/2017
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1/1/91, 7/15/01, 7/1/06, 8/23/07, 7/1/09

5122-29-24 [Rescinded].

Effective: 1/1/2018
Five Year Review (FYR) Dates: 4/14/2017
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1/1/91, 7/15/01, 7/1/09

5122-29-25 [Rescinded].

Effective: 1/1/2018
Five Year Review (FYR) Dates: 4/14/2017
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1/1/91, 7/15/01, 7/1/09

5122-29-27 Supplemental behavioral health services.

(A) " Supplemental behavioral health services" means services other than those specifically listed in this chapter. Supplemental behavioral health services may include representative payeeship, outreach, screening, education, and other supportive behavioral health services and may be offered by a variety of entities, including YMCAs, churches, children's cluster or family and children first.

(B) Supplemental behavioral health services approved by the board of alcohol, drug addiction, and mental health services and the department shall:

(1) Ensure that the provider or organization providing the service meets the appropriate standards or regulations under which they operate;

(2) Ensure that staff providing behavioral health services have participated in orientation or training regarding basic information about mental illness, emotional disturbance, and substance use disorders, and know how to obtain assistance from the behavioral health system if needed; and

(3) Develop mechanisms to solicit and receive feedback about the quality of the service from persons served.

(C) Providers furnishing supplemental-behavioral health services shall receive certification to provide the service(s) according to either paragraph (A)(1)(f) of rule 5122-25-03 of the Administrative Code or paragraph (A) (1)(f) of rule 5122-25-04 of the Administrative Code.

Effective: 1/1/2018
Five Year Review (FYR) Dates: 4/14/2017 and 01/01/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 1/1/91, 7/15/01, 7/1/09

5122-29-28 Intensive home based treatment (IHBT) service.

(A) In addition to the definitions in rule 5122-24-01 of the Administrative Code, the following definitions apply to this rule:

(1) "Caseload" means the individual cases open or assigned to each full-time equivalent IHBT staff.

(2) "Continued stay review" means a review of a child/adolescent's functioning to determine the need for further services to achieve or maintain service goals and objectives.

(3) "Crisis response" means the immediate access and availability, by phone and face- to-face, as clinically indicated, to the child/adolescent and family, which may include crisis stabilization, safety planning, and the alleviation of the presenting crisis.

(4) "Face-to-face contacts" means in-person IHBT provided in the home, school, and community working directly with the person served and his or her family, or on the child/adolescent 's behalf.

(5) "Home" means any long-term family living arrangement including biological, kinship, adoptive, and non-custodial families who have made a long-term commitment to the child/adolescent.

(6) "Out-of-home placement" means any removal of the child/adolescent from his or her home. Planned respite, where the child's main residence remains his or her home, is not considered out-of-home placement.

(B) Intensive home based treatment (IHBT) service is a comprehensive behavioral health service provided to a child/adolescent and his or her family that provides coordination and support for persons with serious emotional disturbance for a person enrolled in the service and integrates assessment, crisis response, individual and family psychotherapy, service and resource coordination, and rehabilitative skill development with the goal of either preventing the out-of-home placement or facilitating a successful transition back to home. These intensive, time-limited behavioral health services are provided in the child/adolescent's natural environment with the purpose of stabilizing and improving his/her behavioral health functioning.

The purpose of IHBT is to enable a child/adolescent with serious emotional disturbance (SED) to function successfully in the least restrictive, most normative environment. IHBT services are culturally, ethnically, racially, developmentally and linguistically appropriate, and respect and build on the strengths of the child/ adolescent and family's race, culture, and ethnicity.

(C) The following describes the activities and components of IHBT:

(1) IHBT is an intensive service that consists of multiple face-to-face contacts per week with the child/adolescent and family, which includes collateral contacts related to the behavioral health needs of the child/adolescent as documented in the ICR. The frequency of contacts may fluctuate based on the assessed needs and unique circumstances of the child, adolescent, and family.

(2) IHBT is strength-based and family-driven, with both the child/adolescent and family regarded as equal partners with the IHBT staff in all aspects of developing the service plan and service delivery;

(3) IHBT is provided in the home, school, and community where the child/adolescent lives and functions;

(4) Provided by staff with a caseload that averages over any six month period and per full time equivalent staff:

(a) Fourteen or less when provided by a team of two, or

(b) Seven or less when provided by an individual staff;

(5) Crisis response is available twenty-four hours a day, seven days a week. Crisis response, at a minimum, may be provided by the provider's on-call system after business hours and weekends, as long as at least one IHBT staff is accessible to the on-call staff, and is available to the client and family as needed;

(6) Each child/adolescent and family receiving IHBT is assessed for risk and safety issues. When clinically indicated, a jointly written safety plan shall be developed that is provided to the child/adolescent and family;

(7) Collaboration occurs with other child-serving agencies or systems, e.g., school, court, developmental disabilities, job and family services, and health care providers that are providing services to the child/adolescent and family, as well as family and community supports identified by the child/adolescent and family;

(8) The service is flexible and individually tailored to meet the needs of the child/ adolescent and family. Appointments are made at a time that is convenient to the child/adolescent and family, including evenings and weekends if necessary;

(9) The service is time-limited, with length of stay matched to the presenting mental health needs of the child/adolescent. IHBT certified providers must have clearly written guidelines for granting extensions and procedures for continued stay of each individual. A continued stay review must be documented for each child/adolescent receiving IHBT beyond six months, and every forty-five days thereafter. The continued stay review must include the criteria in paragraph (F) of this rule; and

(10) The child/adolescent and family's IHBT aftercare service needs are addressed. Continuing care planning shall be collaborative between the child/adolescent, family and IHBT staff.

(D) Practitioner(s) on an IHBT team that provides services to a youth with a co-occurring substance use disorder shall have appropriate credentials from the state licensing board(s) to provide both mental health and substance use treatment.

(E) The provider shall determine who is eligible to receive the service and must document how the child/adolescent meets the following criteria necessary to receive IHBT services:

(1) Is clinically determined to meet the "person with serious emotional disturbance" (SED) criteria in rule 5122-24-01 of the Administrative Code;

(2) Meets one or more of the following criteria as documented in the ICR:

(a) Is at risk for out-of-home placement due to his/her behavioral health/mental health condition;

(b) Has returned within the previous thirty days from an out-of-home placement or is transitioning back to their home within thirty days; or

(c) Requires a high intensity of mental health interventions to safely remain in or return home; and,

(3) IHBT may also be provided to transitional age youth between the ages of eighteen and twenty-one who have had an onset of serious emotional and mental disorders at an age younger than eighteen.

(F) The provider must demonstrate that the following staff requirements and qualifications are met:

(1) A minimum of two full-time equivalent staff provide the service. Services may be provided by a single person, or team of staff clearly sharing various responsibilities for the same child/adolescent and family. Each child/adolescent shall have a staff assigned with lead responsibility. IHBT direct care staff must be fully dedicated to the IHBT program and cannot have mixed service caseloads.

(2) The provider must have a documented plan for clinical supervision, which includes:

(a) The IHBT supervisor shall have a designated responsibility to IHBT;

(b) Each staff person shall receive clinical supervision that is appropriate for the staff person's expertise and caseload complexity; and

(c) Consideration of the staff person's assessed training needs.

(3) The IHBT supervisor shall have primary responsibility for providing supervision to the IHBT staff twenty-four hours a day, seven days a week. If the IHBT supervisor is unavailable, then supervision must be provided by staff qualified according to rule 5122-29-30 of the Administrative Code.

(G) The provider must demonstrate that each IHBT staff has an individualized training plan based on an assessment of his/her specific training needs. The following professional training and development criteria must be met:

(1) Each staff receives an assessment of initial training needs based on the skills and competencies necessary to provide IHBT service prior to providing IHBT service; and

(2) The agency shall have a written description of the skills and competencies required to provide IHBT service, which include, at a minimum, the following:

(a) Family systems;

(b) Risk assessment and crisis stabilization;

(c) Parenting skills and supports for children/adolescents with SED;

(d) Cultural competency;

(e) Intersystem collaboration with a focus on schools, courts, and child welfare:

(i) Knowledge of other systems;

(ii) System advocacy; and

(iii) Roles, responsibilities, and mandates of other child/adolescent-serving entities;

(f) Trauma-informed care;

(g) Educational and vocational functioning:

(i) Assessment and intervention strategies for resolving barriers to successful educational and vocational functioning;

(ii) Knowledge of special education laws; and

(iii) Strategies for developing positive home-school partnerships and connections;

(h) IHBT philosophy, including strength-based assessment and treatment planning; and

(i) Differential diagnosis with special needs children/adolescents, including co-occurring substance use disorders and developmental disabilities, for staff credentialed to diagnose.

(H) The provider's training plan must include provisions for ongoing training specific to the identified training needs of the staff as it relates to the population served, including attention to cultural competency, changing demographics, new knowledge or research, and other areas identified by the agency.

(I) The provider must demonstrate that each IHBT supervisor receives training specific to the clinical and administrative supervision of the service.

(J) The provider shall obtain at least one fidelity review of the provider's entire IHBT service every twelve months by an individual or organization external to the provider, utilizing the IHBT fidelity rating tool (dated September 23, 2016) available at www.medicaid.ohio.gov. The provider shall incorporate the results of the fidelity review into the provider's performance improvement program, if indicated.

(K) Intensive home based treatment service shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Replaces: 5122-29-28

Effective: 1/1/2018
Five Year Review (FYR) Dates: 01/01/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 7/1/2005, 1/9/2006, 8/23/2007, 12/13/2007, 7/1/2009, 2/17/2012, 7/1/13

5122-29-29 Assertive community treatment (ACT).

(A) Assertive community treatment (ACT) services are provided to an individual with a major functional impairment or behavior which present a high risk to the individual due to severe and persistent mental illness and which necessitate high service intensity. ACT services are also provided to the individual's family and other support systems. A client receiving ACT services may also have coexisting substance use disorder, physical health diagnoses, and/or mild intellectual disability. The service is available twenty-four hours a day, seven days a week.

(B) The purpose of ACT team services is to provide the necessary services and supports which maximize recovery, and promote success in employment, housing, and the community.

(C) ACT service providers shall employ one or more teams of practitioners which meet the minimum fidelity criteria as described in paragraphs (D) and (E) of this rule using the tool for measurement of ACT (TMACT) or dartmouth assertive community treatment scale (DACTS).

(D) For initial certification, each ACT team must achieve a minimum average overall fidelity score of 3.0 as determined by an independent validation entity recognized by the department.

(E) For continuing certification, each ACT team must achieve and maintain a minimum average overall fidelity score of 4.0 within three years of initial certification as determined by an independent validation entity recognized by the department.

(F) ACT teams shall have regular repeat fidelity reviews, no more than twelve months from the report date of the previous fidelity review, by an independent validation entity recognized by the department.

(G) At any time after certification of the ACT service, the department may request a new fidelity review based on specific findings of non-compliance with the rules in this chapter.

(H) For a minimum of ninety days, or until the client has stated their desire to discontinue ACT services, the ACT team shall attempt at least two face-to-face contacts per month for a client who has discontinued ACT services unexpectedly. Such attempts and client response, if any, shall be documented in the individual client record.

(I) ACT shall be provided and supervised by staff who are qualified according to rule 5122-29-30 of the Administrative Code.

Replaces: 5122-29-29

Effective: 1/1/2018
Five Year Review (FYR) Dates: 01/01/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 71/2005, 1/9/2006, 8/23/2007, 12/13/2007, 7/1/2009, 3/22/12

5122-29-30 Eligible providers and supervisors.

(A) Individuals are eligible to provide and supervise within their professional scope of practice those services certified by the Ohio department of mental health and addiction services and listed and described in Chapter 5122-29 of the Administrative Code.

(B) Licensed, certified or registered individuals shall comply with current, applicable scope of practice, supervisory, and ethical requirements identified by appropriate licensing, certifying or registering bodies.

(C) Qualified behavioral health specialist.

(1) Qualified behavioral health specialist (QBHS) means an individual who has received training for or education in either mental health or substance use disorder competencies; and who has demonstrated, prior to or within ninety days of hire the minimum competencies in basic mental health or substance use disorder and recovery skills listed in this rule. The individual shall not otherwise be required to perform duties covered under the scope of practice according to Ohio professional licensure.

(2) Basic competencies for each QBHS shall include, at a minimum, an understanding of:

(a) Either mental illness or substance use disorder treatment and recovery;

(b) The community behavioral health system, social service systems, the criminal justice system, and other healthcare systems;

(c) Psychiatric and substance use disorder symptoms and their impact on functioning and behavior,

(d) How to therapeutically engage either with a person with mental illness or a person in substance use disorder treatment and recovery;

(e) Crisis response procedures; and,

(f) De-escalation techniques and an understanding of how the individual's own behavior can impact the behavior of others.

(3) The employing provider shall establish additional competency requirements, as appropriate, for each QBHS based upon the services to be performed, characteristics and needs of the persons to be served, and skills appropriate to the position.

(4) A QBHS must be supervised by an individual qualified to supervise the provisions of services within in their scope of practice.

(D) QBHS includes both a qualified mental health specialist and a care management specialist.

Replaces: 5122-29-30, 3793:2-1-08

Effective: 1/1/2018
Five Year Review (FYR) Dates: 01/01/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 7/1/2009, 3/4/2010, 8/1/2013, 4/1/2016

5122-29-31 Interactive videoconferencing.

(A) For purposes of this chapter, interactive videoconferencing means the use of secure, real-time audiovisual communications of such quality as to permit accurate and meaningful interaction between at least two persons, one of which is a certified provider of the service being provided pursuant to Chapter 5122-25 of the Administrative Code. This expressly excludes telephone calls, images transmitted via facsimile machine, and text messages without visualization of the other person, i.e., electronic mail.

Videophone utilized for communication which allow visual interaction with a deaf or hard of hearing person are permitted under interactive videoconferencing.

(B) "Client site" means the location of a client at the time at which the service is furnished via interactive videoconferencing technology.

(C) "Originating site" means the site where the eligible provider furnishing the service is located at the time the service is rendered via interactive video conferencing technology.

(D) The decision of whether or not to provide initial or occasional in-person sessions shall be based upon client choice, appropriate clinical decision-making, and professional responsibility, including the requirements of professional licensing, registration or credentialing boards.

(E) The following are the services that may be provided via interactive videoconferencing and are considered to be provided on a face-to-face:

(1) General services as defined in rule 5122-29-03 of the Administrative Code;

(2) CPST service as defined in rule 5122-29-17 of the Administrative Code; and,

(3) Therapeutic behavioral services and psychosocial rehabilitation service as defined in rule 5122-29-18 of the Administrative Code.

(F) Progress notes as defined in rule 5122-27-04 of the Administrative Code must include documentation to reflect that the service was conducted via interactive videoconferencing.

(G) The provider must have a written policy and procedure describing how they ensure that staff assisting clients with interactive videoconferencing services or providing treatment services via interactive videoconferencing are fully trained in equipment usage.

(H) Prior to providing services to a client via interactive videoconferencing, an eligible provider of the service to be provided as listed in rule 5122-29-30 of the Administrative Code shall describe to the client the potential risks associated with receiving treatment services via interactive videoconferencing, provide the client with a written document that describes the potential risks associated with receiving treatment services via interactive videoconferencing and obtain a written acknowledgement, indicated by the client's signature that the client consents to receiving treatment services via interactive videoconferencing.

(I) The risks to be communicated to the client pursuant to paragraph (H) of this rule must address at a minimum the following:

(1) Clinical aspects of receiving treatment services via interactive videoconferencing;

(2) Security considerations when receiving treatment services via interactive videoconferencing; and,

(3) Confidentiality for individual and group counseling.

(J) It is the responsibility of the provider to assure contractually that any entity or individuals involved in the transmission of the information guarantee that the confidentiality of the information is protected. When the client chooses to utilize videoconferencing equipment at a client site that is not arranged for by the provider, e.g., at their home or that of a family or friend, the provider is not responsible for any breach of confidentiality caused by individuals present at the client site.

(K) Providers shall have a contingency plan for providing treatment services to clients when technical problems occur during the provision of services via interactive videoconferencing.

(L) Providers shall maintain, at a minimum, the following local resource information. For purposes of this rule, local means the area where the client indicates they reside and where they are receiving services as indicated in paragraph (P) of this rule.

(1) The local suicide prevention hotline if available or national suicide prevention hotline.

(2) Contact information for the local police and fire departments.

The provider shall provide the client written information on how to access assistance in a crisis, including one caused by equipment malfunction or failure.

(M) For the purposes of meeting the requirements of paragraph (L) of this rule, providers shall require that the client provide the street address and city where they are receiving services prior to the first session utilizing interactive videoconferencing and update the address whenever the client site changes.

(N) It is the responsibility of the provider to assure that equipment meets standards sufficient to:

(1) Assure confidentiality of communication;

(2) Provide for interactive videoconferencing communication between the practitioner and the client; and

(3) Assure videoconferencing picture and audio are sufficient to assure real-time interaction between the client and the provider and to assure the quality of the service provided.

(O) The client site must also have a person available who is familiar with the operation of the videoconferencing equipment in the event of a problem with the operation.

If the client chooses to utilize videoconferencing equipment at a client site that is not arranged for by the provider site, e.g., at their home or that of a family or friend, the provider is only responsible for assuring the equipment standards at the originating site.

(P) All services provided by interactive videoconferencing shall:

(1) Begin with the verification of the client through a name and password or personal identification number when treatment service are being provided with a client (s), and

(2) Be provided in accordance with the Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules and 42 C.F.R. Part 2.

(Q) Provider must have a physical location in Ohio or have access to a physical location in Ohio where individuals may opt to receive services that are being provided by interactive videoconferencing.

Replaces: 3793:2-1-11, 3793:2-1-12

Effective: 1/1/2018
Five Year Review (FYR) Dates: 01/01/2023
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 4/4/11

5122-29-33 [Rescinded] Health home service for persons with serious and persistent mental illness.

Effective: 7/1/2018
Five Year Review (FYR) Dates: 4/14/2017
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 10/1/12, 7/1/14

5122-29-34 [Rescinded] Outpatient treatment program certification.

Effective: 10/11/2018
Five Year Review (FYR) Dates: 7/25/2018
Promulgated Under: 119.03
Statutory Authority: 3793.02(D), 3793.06, 3793.11, 5119.36
Rule Amplifies: 3793.06, 5119.36
Prior Effective Dates: 07/01/1991, 07/01/2001, 11/17/2005

5122-29-35 [Rescinded] Licensure to conduct an opioid agonist program.

Effective: 6/1/2017
Five Year Review (FYR) Dates: 03/17/2017
Promulgated Under: 119.03
Statutory Authority: 5119.391
Rule Amplifies: 5119.391
Prior Effective Dates: 7/1/01, 10/1/03

5122-29-36 [Rescinded].

Effective: 1/1/2018
Five Year Review (FYR) Dates: 4/14/2017
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 7/10/92, 7/1/01, 6/13/04, 11/17/05, 2/14/11

5122-29-37 [Rescinded].

Effective: 1/1/2018
Five Year Review (FYR) Dates: 4/14/2017
Promulgated Under: 119.03
Statutory Authority: 5119.36
Rule Amplifies: 5119.36
Prior Effective Dates: 7/10/92, 7/1/01, 11/17/05, 7/1/06, 2/14/11