Chapter 5123:2-12 Supported Living Programs

(A) The purpose of this rule is to develop a process to ensure that individuals receiving supported living are empowered to exercise choice and enhance the quality of their lives.

(B) The QA process shall be used to determine that the assistance and support required by individuals receiving supported living continues to promote services, supports, and activities that will provide a valued lifestyle for the individual. All reviews shall consider the quality indicators identified in paragraphs (B)(6) and (B)(7) of this rule. This review shall, with the consent of the individual or the parent(s) custodian, or guardian as applicable, consider the quality indicators identified in paragraphs (B)(1) to (B)(5) of this rule, as applicable to the individual.

(1) Choices and Options

(a) The individual has the opportunity to make or is assisted in making choices about all aspects affecting his life.

(b) The individual is provided options for advocacy if he is unable to advocate for himself.

(c) The individual demonstrates an understanding of his rights.

(d) The individual has the space and opportunity for privacy.

(e) The individual chooses where and with whom he lives.

(f) The individual chooses his daily work and leisure routine.

(g) The individual owns and is able to use personal possessions.

(h) When appropriate, the individual has the opportunity to utilize adaptations, and technological or communicative assistance.

(2) Personal income

(a) The individual has a stable source of income that covers his basic living needs including, but not limited to, shelter, food, transportation, and clothing.

(b) There is effective management of the individual’s income to ensure that basic needs are met.

(c) The individual participates as fully as possible in decision-making about the use of his personal income through the development of money and budgeting concepts and values that encourage financial responsibility.

(3) Housing

(a) The individual has the basic furnishing and access to bathing and toileting facilities necessary for daily living.

(b) The individual has the opportunity to live where there is reasonable access to needed resources, such as banking, shopping, recreation, and transportation.

(c) The interior and exterior of the individual’s home are maintained in a manner that promotes basic safety and health.

(d) The individual is able to exercise control over his home environment including choice of location, personalized furnishing and decor, and control of temperature and lighting.

(4) Community membership

(a) The individual has the means to communicate with primary people in his life.

(b) The individual has support people with whom he is able to maintain contact.

(c) The individual has the opportunity for relationships with friends and peers that provide companionship and support.

(d) The individual has the opportunity for relationships with people who are nondisabled.

(e) The individual has opportunities to practice ethnic and religious customs and beliefs of his choice.

(f) The individual is informed about community resources and generic services and is assisted in accessing needed services.

(g) The individual has access to support options through unpaid sources such as neighbors, family, and friends.

(h) As interested, the individual is supported in activities such as voting, attending community meetings, writing letters to political figures, serving on committees and/or boards, and participating in self-advocacy groups.

(5) Personal satisfaction

(a) The individual is satisfied with the services, supports, and activities in which he engages.

(b) The individual is satisfied with his interaction with the persons who provide these services and supports.

(c) The individual feels free to express his desire to change the services, supports, and activities on his ISP.

(d) The individual feels that the county board and service providers listen to and respond to his choices for services, supports, and activities.

(6) Health

(a) The individual’s health is maintained through adequate nutrition, exercise, safe behavior, medical and dental monitoring, and appropriate medications, when needed.

(b) The individual has access to prompt treatment for physical and/or psychological problems and is informed, encouraged and supported to receive such treatment.

(7) Safety

(a) Potential dangers in the individual’s environment are minimized.

(b) The individual has access to prompt and appropriate emergency services when needed such as police, fire ambulance, and crisis line.

(c) The individual feels safe in his home.

(C) County boards shall conduct QA as a continuous process. The county board shall develop policies and procedures governing this QA process which shall include, but not be limited to:

(1) Personally contacting the individual and the custodian or parent(s) if the individual is a minor or the guardian to determine the individual’s:

(a) Active involvement in the ISP development process and consent to the services reflected on the ISP;

(b) Level of satisfaction with the services received;

(c) Receipt of supporting living identified on the ISP;

(d) Satisfaction toward increasing skills, living more independently in the community, accessing community services, increasing feelings of self-worth, and making choices; and

(e) Desire to modify services identified on the ISP or to include additional services.

(2) Personally contacting at least one of the individual’s contracted providers of supported living to determine the provider’s response to the items listed under paragraph (C)(1) of this rule.

(3) Evaluating the relationship between the needs and choices expressed by the individual and the services reflected on the ISP.

(D) A written report prepared by the county board summarizing the findings of the QA process, as described in paragraphs (B) and (C) of this rule, shall be developed as follows:

(1) Each year the county board shall select a representative sample of all individuals receiving supported living from the county board;

(2) The report shall be written for each of the individuals selected as described in paragraph (D)(1) of this rule;

(3) All individuals receiving supported living in a county shall be reviewed at least once every three years.

(4) The report shall highlight areas where positive outcomes of the services were experienced by the individual. The report shall identify the services, supports, and activities that merit improvement and/or are no longer needed or wanted by the individual.

(5) The report shall be forwarded to the individual, the custodian or parent(s) if the individual is a minor or the guardian, the superintendent of the county board, or designee, the affected certified supported living provider(s) and the person(s) responsible for coordinating the ISP development for the identified individuals.

(E) If the report described in paragraph (D) of this rule indicates the need to address service issues, the county board shall resolve these issues with input from the affected parties including, but not limited to, the county board, the person(s) responsible for coordinating the ISP, the individual or his custodian or parent(s) if the individual is a minor or the guardian, and any other person(s) as desired by the individual. The county board shall notify each affected party within twenty-one calendar days following the completion of the report.

(F) The department may review the following areas of compliance by county boards:

(1) Randomly selected ISPs and related service contracts;

(2) County board, supported living advisory committee, and ethics council meeting minutes which relate to supported living issues;

(3) Policies, procedures, and forms developed by the county board to administer supported living;

(4) Information and reports resulting from QA conducted by the county board for individuals receiving supported living;

(5) Compliance with sections 5126.40 to 5126.47 of the Revised Code and administrative rules associated with supported living; and

(6) Compliance with major unusual incident reporting requirements.

(G) Individuals receiving supported living, the custodian or parent(s) if the individual is a minor or the guardian, family members, advocates, and providers of supported living may contact the county board or department to request a QA review. In response to requests directed to the department, the department may initiate or conduct a QA review similar to the review described in paragraph (C) of this rule.

(H) When conducting a review as described in paragraphs (C) and/or (F) of this rule, the department shall conduct an exit conference with county board personnel. The purpose of the exit conference is to note areas of non-compliance with statute and rules and present areas for consideration regarding the quality assurance process. The department shall submit a written report to the superintendent documenting the elements of the exit conference within thirty days of the review.

(I) If applicable, the superintendent shall submit to the department a written response that addresses areas of non-compliance within thirty calendar days of receipt of the department’s report.

(J) The department may request that county boards conduct QA reviews for specific individuals identified by the department, or the department on its own may conduct a QA review.

Replaces: 5123:2-12-01

R.C. 119.032 review dates: 03/28/2006 and 03/26/2007

Promulgated Under: 119.03

Statutory Authority: 5126.431

Rule Amplifies: 5126.40 to 5126.451

Prior Effective Dates: 7/3/89 (emer.), 9/29/89, 7/1/91, 7/24/95

Rescinded eff 10-1-09

(A) The purpose of this rule is to establish standards for individual service plans (ISPs) for eligible individuals receiving supported living.

(B) The individual’s choices shall be the primary factor for developing the ISP. The individual’s choices are those expressed directly by the individual, by the individual’s parent(s), custodian, or guardian as applicable, or by a friend or advocate of the individual’s choice. Individuals, including those who have been adjudicated incompetent pursuant to Chapter 2111. of the Revised Code, have the right to participate in decisions that affect their lives and to have their needs, desires, and preferences considered.

(C) Initial formal and/or informal evaluations shall address all of the quality indicators listed in paragraphs (B)(1) to (B)(7) of rule 5123:2-12-01 (“Supported Living Quality Assurance”) of the Administrative Code. Subsequent formal and/or informal evaluations shall be used as a resource to identify appropriate methods of developing the services and activities necessary to support the choices of and meet the needs of the individual.

(D) Based on the needs and choices expressed by the individual, the service areas to be provided may include, but are not limited to, those areas identified in rule 5123:2-12-01 of the Administrative Code.

(E) The ISP shall be developed by the individual with the support and assistance of a representative of the county board and person(s) of the individual’s choosing, which may include, but is not limited to, family members, friends, and advocates.

(F) The services and activities described in the ISP shall support the individual’s choices, meet the individual’s needs, enhance the individual’s options, and assist the individual in expanding and developing competencies that will lead to a more independent, secure, and responsible life. Dissenting opinions regarding the services and activities selected shall be noted.

(G) Following the selection of service providers, the ISP or an attachment to the ISP shall indicate the provider of each service and activity, the frequency and duration of services, the service cost, and the funding source of the service. The ISP or an attachment to the ISP shall also indicate if any of the services or activities described will not be delivered or will be delivered through natural, unpaid supports, including family members. The provision of paid services is subject to the availability of resources.

(H) The services and activities described in the ISP shall not be provided without the individual’s consent or the consent of the parent(s), custodian, or guardian, as applicable. If the individual is a child, consent shall be obtained from the individual’s parent(s) unless the individual has a custodian in which case consent shall be obtained from the custodian. If the individual has a guardian, consent shall be obtained from the guardian. Consent shall be in writing and may be withdrawn with appropriate notice according to contract provisions.

(I) The county board and the provider shall attempt to resolve disputes that arise when consent is refused or withdrawn by making a reasonable accommodation to provide the individual with alternative services or activities.

(J) An ISP shall be effective for a specified period of time, as agreed to by the individual and the county board. The effective period of the ISP shall be included in the contract(s) developed between the county board and the provider(s). Only those portions of the ISP relevant to the provider shall be included as an attachment to the contract entered into between the county board and the provider unless otherwise consented to by the individual. In determining the period of effectiveness for the ISP, the nature of the services and supports to be provided and the manner in which they are customarily provided shall be considered. ISPs shall be reviewed and/or evaluated as necessary, but at least annually, to determine service effectiveness.

(K) The provider shall have the opportunity for input into the development or revision of the ISP of an individual receiving services from the provider when the provider is under contract with the county board for services to that individual.

(L) The services and activities described in the ISP shall be among the areas reviewed and evaluated as part of all ISP reviews and as part of quality assurance reviews conducted in accordance with rule 5123:2-12-01 of the Administrative Code.

HISTORY: Eff 7-24-95

Rule promulgated under: RC Chapter 119.

Rule authorized by: RC 5126.05

Rule amplifies: RC 5126.012, 5126.05, 5126.41

R.C. 119.032 Review Dates: 9-26-03; 9-26-05

R.C. 119.032 review dates: 03/28/2006 and 03/24/2008

Promulgated Under: 119.03

Statutory Authority: 5126.05

Rule Amplifies: 5126.012, 5126.05, 5126.41

Prior Effective Dates: 7/24/95

(A) Purpose. The purpose of this rule shall be to establish a basis for distribution of funds to county boards for the purpose of providing supported living services to no more than four eligible individuals living together in accordance with sections 5123.182 and 5126.40 of the Revised Code. “Allocations” shall mean state monies for supported living services and shall not include monies from local sources.

(B) Distribution of supported living funding allocation.

(1) Subject to available appropriations, the department shall establish allocations for existing supported living services based on its previous year’s allocation for such services and an adjustment based on the rate of inflation.

(2) The department may set aside a percentage of the total appropriations per year for special projects to be funded at the discretion of the director.

(3) Notwithstanding the provisions of this formula, a floor of no less than twenty thousand dollars for fiscal year 1990 is established for fiscal year 1991 and thereafter a floor shall be established and set by the director each year so that county boards will receive a minimum allocation.

(4) All allocations for new development of supported living services shall be made from the remaining balance after applying paragraphs (B)(1) to (B)(3) of this rule to the appropriation.

(5) The allocation methodology for expansion dollars shall be based upon the following components:

(a) The county board February average daily membership count of individuals enrolled in adult services other than evaluation and case management only services;

(b) The community residential placement availability as determined by:

(i) The number of purchase of service funded beds in the county;

(ii) The number of individuals enrolled in a county board program who reside in an ICF/MR in the county in which they attend said program;

(iii) The prior year supported living allocation divided by a common dollar value to determine units of supported living service availability.

(6) The allocation shall be calculated as follows:

(a) The department shall rank order all county boards based upon the percentage of statewide residential availability by adding the number calculated in paragraph (B)(5)(b)(i) of this rule to the number calculated in paragraph (B)(5)(b)(ii) of this rule and dividing by the average daily membership determined in paragraph (B)(5)(a) of this rule. The resulting percentages will be ranked least to greatest.

(b) Using a cumulative adult services average daily membership, the county board shall be divided into a predetermined number of equivalent groupings.

(c) Until an equitable statewide distribution of services is reached, the director shall apply a percentage factor to the mean availability of dollars which will cause a higher per capita allocation to those counties with a lower residential availability.

(d) Upon establishing the dollar amount for each of the equivalent groupings, the amount is to be multiplied times the average daily membership as determined in paragraph (B)(5)(a) of this rule to compute the allocation.

(C)(1) All county boards shall pass a resolution by February 1, 1990 to request the distribution of funds in fiscal year 1990 and 1991 and to perform the functions authorized pursuant to sections 5126.40 to 5126.45 of the Revised Code. County boards who did not pass a resolution by February 1, 1990 but wish to do so for any subsequent fiscal year must pass a resolution by the first day of February and notify the department accordingly. When such a resolution has been passed by the county board, all new contracts for supported living thereafter shall be entered into by the county board according to sections 5126.43 and 5126.44 of the Revised Code unless the county board gives consent to the department to enter into such a contract.

(2) A contract for residential services entered into by the department with a provider pursuant to section 5123.18 or 5123.182 of the Revised Code shall continue to be a contract of the department unless both the provider and the county board consent in writing to substitution of the county board for the department and the county board so notifies the department. Any renewal of a contract with the provider regarding residential services shall be entered into by the department and the provider unless the provider and the county board agree in writing to have the county board replace the department as party to the contract and the county board so notifies the department. If the county board enters into a contract for existing residential services, the county need not go through the request for proposal process under section 5126.43 of the Revised Code. The department shall transfer the funds committed for a purchase of service or semi-independent living contract to community residential services for distribution to the county board.

(D) Each county board may set aside up to twenty thousand dollars of the first one hundred thousand dollars of its supported living allocation and twenty per cent of the allocation that exceeds one hundred thousand dollars in a reserve balance account for unanticipated costs, emergencies, and future expenditures. A county board may exceed this limitation when it submits to the department its rationale and receives department approval. This rule does not prohibit a county board from using monies from other sources as deemed necessary for supported living services including monies within its reserve balance account.

(E) Family consortium homes shall be recognized as a service model within supported living and may be funded with the supported living allocation to the county board.

(1) Annually, the director shall determine in accordance with paragraph (B)(2) of this rule the amount of the allocation for family consortium projects to be granted as incentive funds in response to the department’s request for proposal (RFP).

(2) The department shall establish criteria for selection of the family consortium utilizing a request for proposal process (RFP).

(3) The department shall review proposals that are submitted for a family consortium and make a selection based upon the available funds, county board approval, and the criteria established.

(4) The county board will receive a department incentive grant of five thousand dollars per eligible individual served in a family consortium. The county board may utilize its supported living allocation to supplement funding of the project.

(F) Each county board shall continue to receive in future years continuation of its current allocation subject to availability of funds so long as the allocation has been utilized to implement supported living services. If the department identifies that a county board has not made a good faith effort to utilize its allocation appropriately, or has a reserve balance account that without prior department approval exceeds the limitations identified in paragraph

(D) of this rule, the department may give the county notice to return the funds or may suspend future distributions of funds until existing distributions are utilized for supported living services. In any such cases, the department shall provide the county board with a right to appeal to the director. The department will utilize any returned portion for emergency residential development.

(G) By the fifteenth day of February of each year on forms developed by the department, the county board shall report to the department the cost of such services for the prior calendar year.

(H) When making allocations, the department shall notify the county board of their allocation, the allocation floor, and the common dollar value as referenced herein.

R.C. 119.032 review dates: 03/28/2006 and 03/26/2007

Promulgated Under: 119.03

Statutory Authority: 5126.42, sec. 10 of A.S.S.B. 336 that amends sec. 76.01 of A.S.H.B. 111 of the 118th General Assembly

Rule Amplifies: 5123.182, 5126.40 to 5126.47

Prior Effective Dates: 11/20/89 (emer.), 2/10/90, 7/1/91

Rescinded eff 10-1-09