(A) Purpose
This rule establishes procedures for placement
and discharge of individuals from developmental centers under the managing
responsibility of the Ohio department of developmental disabilities
("department") into nursing facilities as provided by the Sermak v.
Brown consent decree, section 1919(e)(7) of the Social Security Act, and
medicaid regulations.
(B) Definitions
For the purposes of this rule, the following
definitions shall apply:
(1) "Active
treatment" means a continuous program which includes aggressive,
consistent implementation of specialized and generic training, treatment,
health services, and related services that is directed toward:
(a) The acquisition of behaviors necessary for an
individual to function with as much self-determination and independence as
possible; and
(b) The prevention or deceleration of regression or loss
of current optimal functional status.
(2) "Comprehensive
evaluation" means a study, including a sequence of observations and
standardized examinations, of a person leading to conclusions and
recommendations formulated jointly, with dissenting opinions, if any, by an
interdisciplinary team, and which complies with 42 C.F.R.
483.440(c)(3).
(3) "Individual" means a person
with a developmental disability or for purposes of giving, refusing to give, or
withdrawing consent for services, his or her guardian in accordance with
section 5126.043 of the Revised Code or other person authorized to give
consent.
(4) "Individual plan" means a
written plan of interventions and specific objectives necessary to meet an
individual's needs, developed by an interdisciplinary team including the
individual. The individual shall be included in the development of his or her
individual plan unless the individual chooses not to participate. The
individual plan shall be based upon a comprehensive evaluation and shall
identify sequential behavior objectives to increase the individual's level
of social, physical, intellectual, emotional, and vocational effectiveness. The
individual plan shall be developed without regard to the actual availability of
the services needed. The individual plan shall meet the requirements set forth
in 42 C.F.R. 483.440(c)(4).
(5) "Interdisciplinary team"
means a group of persons with special training and experience in the diagnosis
and support of people with developmental disabilities, representing the
professions, disciplines, or service areas that are relevant to identifying an
individual's needs and designing programs that meet the individual's
needs. The interdisciplinary team shall include a qualified intellectual
disability professional. The qualified intellectual disability professional
shall be responsible for integrating, coordinating, and monitoring the
individual's active treatment program. Whenever possible, the
interdisciplinary team shall include a representative of the county board of
developmental disabilities and the nursing facility.
(6) "Intermediate care facility for
individuals with intellectual disabilities" has the same meaning as in
section 5124.01 of the Revised Code.
(7) "Medical crisis" means a
situation in which an individual's medical condition presents an imminent
threat of loss of life or serious physical harm in the absence of appropriate
care.
(8) "Nursing
facility" means any long-term care facility (other than an intermediate
care facility for individuals with intellectual disabilities) currently
certified by the Ohio department of health as being in compliance with the
nursing facility standards and conditions of participation.
(9) "Qualified
intellectual disability professional" has the same meaning as in 42 C.F.R.
483.430.
(C) Placement of an individual from a developmental center
into a nursing facility
Potential placement of an individual from a
developmental center into a nursing facility shall be performed in compliance
with this rule.
(1) Except as otherwise
provided in this rule, no individual shall be placed or discharged from a
developmental center into a nursing facility.
(2) An individual shall
be placed into a nursing facility only when the individual has a medical
condition which is determined to be unstable, extreme, or complex and prevents
the individual from participating in his or her health care
program.
(3) Placement of an
individual shall be subject to 42 C.F.R. 483.440(b)(4) and preadmission
screening under section 1919(e)(7) of the Social Security Act.
(4) The department shall
provide written notice to disability rights Ohio of the proposed placement
fifteen calendar days prior to the intended placement date.
(5) If the developmental
center's medical director or the department's medical director
determines that an individual is in a medical crisis and the medical director
believes that the medical crisis requires immediate placement into a nursing
facility, the department shall provide oral notice to disability rights Ohio
within twenty-four hours of the department's awareness of such medical
crisis, with follow-up written notice within three business days.
(6) Except when an
individual is in a medical crisis, the individual shall have a current
individual plan, updated within thirty calendar days prior to the proposed
placement, which includes the individual's active treatment and health
care needs as defined in 42 C.F.R. 483.440. If the individual's active
treatment needs or health care status have changed, the individual plan shall
be updated to reflect these changes.
(7) When an individual in a medical
crisis has been placed into a nursing facility, the individual's active
treatment needs shall be evaluated by the department within thirty calendar
days of the individual's placement.
(a) Whenever possible, the individual plan, including the
comprehensive evaluation and post-discharge plan of care, shall be developed
jointly by the nursing facility and the developmental center.
(b) The individual shall be included in the development of
his or her individual plan, including the comprehensive evaluation and
post-discharge plan of care, unless the individual chooses not to
participate.
(8) In no case shall the individual be
placed unless the individual has stayed at least seventy-two continuous hours
at the receiving nursing facility and the interdisciplinary team has met to
consider information gathered during the stay.
(9) The department is responsible for
ensuring that the individual's active treatment needs are provided for
during the time the individual resides in the nursing facility.
(10) The department shall ensure that the
individual's continued need for services in the nursing facility and
active treatment needs are reviewed within the first one hundred twenty
calendar days by the interdisciplinary team. A review shall be conducted at
least every one hundred eighty calendar days thereafter, as long as the
individual resides in the nursing facility.
(11) An individual placed into a nursing
facility shall be maintained on the rolls of the developmental center for at
least thirty calendar days, after which time the individual may be discharged
from the developmental center unless the individual has indicated, in any
manner, dissatisfaction with the placement.
(12) Prior to discharge from the
developmental center, the department shall notify the county board of
developmental disabilities in the county where the individual is to reside of
the individual's placement and service needs.
(D) Placement of an individual from a hospital into a
nursing facility
Potential placement of an individual from a
developmental center who is hospitalized and for whom the hospital recommends
placement into a nursing facility shall be performed in compliance with this
rule.
(1) Except as otherwise
provided in this rule, no individual from a developmental center who has been
hospitalized shall be placed from the hospital or discharged into a nursing
facility.
(2) The department shall
provide written notice to disability rights Ohio and the Ohio department of
medicaid of a hospital's recommendation to place an individual into a
nursing facility within three business days of the department's awareness
of such recommendation. The notice shall include the individual's
diagnosis and medical needs as specified by the hospital medical staff, the
name of the receiving nursing facility, and the date of proposed
placement.
(3) Placement of an
individual shall be subject to preadmission screening under section 1919(e)(7)
of the Social Security Act.
(4) The department is
responsible for ensuring that within thirty calendar days of placement, the
individual's active treatment needs are evaluated.
(5) The individual shall
have a current individual plan, updated within thirty calendar days prior to
the proposed placement, which includes the individual's active treatment
and health care needs as defined in 42 C.F.R. 483.440. If the individual's
active treatment needs or health care status have changed, the individual plan
shall be updated to reflect these changes.
(a) Whenever possible, the individual plan, including the
comprehensive evaluation and post-discharge plan of care, shall be developed
jointly by the nursing facility and the developmental center.
(b) The individual shall be included in the development of
his or her individual plan, including the comprehensive evaluation and
post-discharge plan of care, unless the individual chooses not to
participate.
(6) In no case shall the
individual be placed unless the individual has stayed at least seventy-two
continuous hours at the receiving nursing facility and the interdisciplinary
team has met to consider information gathered during the stay.
(7) The department is
responsible for ensuring that the individual's active treatment needs are
provided for during the time the individual resides in the nursing
facility.
(8) The department shall
ensure that the individual's continued need for services in the nursing
facility and active treatment needs are reviewed within the first one hundred
twenty calendar days by the interdisciplinary team. A review shall be conducted
at least every one hundred eighty calendar days thereafter, as long as the
individual resides in the nursing facility.
(9) If it is determined
through the review process that discharge is appropriate, the department shall
provide written notice of the intent to discharge to disability rights
Ohio.
(10) An individual placed
into a nursing facility will be maintained on the rolls of the developmental
center unless discharge is deemed appropriate by the department. If the
individual has indicated, in any manner, dissatisfaction with the placement,
the individual shall not be discharged.
(11) Prior to discharge
from the developmental center, the department shall notify the county board of
developmental disabilities in the county where the individual is to reside of
the individual's placement and service needs.
(E) Designation of a coordinator
The managing officer of each developmental center
shall designate an employee who shall be responsible for:
(1) Ensuring that all of
the requirements of this rule are met including provision of notice to
disability rights Ohio, the Ohio department of medicaid, and the county board
of developmental disabilities;
(2) Coordinating joint
development wherever possible by the nursing facility and the developmental
center of the individual's comprehensive evaluation and individual plan,
including quarterly updates;
(3) Ensuring quarterly
visits by appropriate developmental center staff to meet with and observe the
individual; and
(4) Coordinating the
individual's return to the developmental center or subsequent placement
and discharge from the nursing facility.
