5123-9-02 Placement and discharge of individuals from developmental centers into nursing facilties.

(A) Purpose

The purpose of this rule is to establish procedures for placement and discharge of individuals from developmental centers into nursing faciuties as provided by the Sermak v. Brown consent decree, OBRA legislation, and Medicaid regulations.

(B) Provisions

The provisions of this rule shall be applicable to all developmental centers. The managing officer of each developmental center shall be responsible for designating an employee who shall ensure that all of the requirements of this rule are met.

(C) Definitions

The following definitions shall apply to this rule:

(1) "Active treatment" means a continuous program which includes aggressive, consistent implementation of a program of specialized and generic training, treatment and health services, and related services that is directed toward:

(a) The acquisition of the behaviors necessary for the individual to function with as much self-determ1nation 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 at a minimum with 42 C.F.R. 483.440(C)(3) of the Medicaid regulations.

(3) "DHS" means the Department of Human Services.

(4) "Individual Plan (IP)" means a written plan of interventions and specific objectives necessary to meet the individual's needs, developed by the interdisciplinary team including the individual and the legal guardian, if any. The individual shall be included in the development of the IP unless the individual chooses not to participate. The IP 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 IP shall be developed without regard to the actual availability of the services needed. The IP shall meet the requirements listed in 42 C.F.R. 483.440(C)(4) of the Medicaid regulations.

(5) "Interdisciplinary team" means a group of persons with special training and experience in the diagnosis and management of people with mental retardation and developmental disabilities, representing the professions, disciplines or service areas that are relevant to identifying the individual's needs and designing programs that meet the individual's needs. This team shall include a person who meets the qualifications of a qualified mental retardation specialist (QMRP) FOUND IN 42 C.F.R. 483.430 . The QMRP shall be responsible for integrating, coordinating and monitoring the individual's active treatment program. Whenever possible, the team shall include a representative of the County Board of Mental Retardation and Developmental Disabilities and the nursing facility.

(6) "Nursing facility (NF)" as used in this rule, includes any long- term care facility

(excluding ICFs/MR) currently certified by the Ohio Department of Health as being in compliance with the nursing facility standards and conditions of participation.

(7) "OBRA" means the Omnibus Budget Reconciliation Act of 1987 and 1990.

(8) "ODMRDD" Means the Ohio Department of developmental disabilities.

(9) "OLRS" means the Ohio Legal Rights Service.

(10) "Qualified mental retardation professional (QMRP)" means a person who meets the requirements for education and experience as listed in 42 C.F.R. 483.430(a) of the Medicaid regulations.

(D) Placement of individuals from developmental centers into nursing facilities (NFS).

All potential placements of individuals from developmental centers directly into NFS 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 NF.

(2) An individual shall be placed into a NF 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/her health care programs.

(3) Placement of the individual shall be subject to medicaid regulations listed in 42 C.F.R 483.440(B)(4) and preadmission screening under OBRA as defined by federal statute and implementing regulations.

(4) Written notification of the proposed placement shall be made fifteen days prior to the intended placement date to OLRS.

(5) If the developmental center medical director or ODMRDD medical director determines that the individual is in a "medical crisis," which is defined as a situation in which the individual's medical condition presents an imminent threat or loss of life or serious physical harm in the absence of appropriate care, and the medical director believes that the medical crisis requires immediate placement into a NF. ODMRDD shall provide oral notification to OLRS within twenty-four hours of ODMRDD's awareness of such medical crisis, with written follow-up notification within three business days.

(6) Except when the individual is in medical crisis as defined in paragraph (D)(5) of this rule, the individual must have a current individual plan (IP), updated within thirty 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 of the Medicaid regulations. If the individual's active treatment needs or health care status have changed, the IP shall be updated to reflect these changes.

When an individual in a medical crisis as defined in paragraph (D)(5) of this rule has been placed into a NF the individual's active treatment needs shall be evaluated by ODMRDD within thirty days of the individual's placement.

(a) Whenever possible, development of the individual's IP, including the comprehensive evaluation and postinstitutional plan of care, will be done jointly by the NF and the developmental center.

(b) The individual shall be included in the development of the IP, including the comprehensive evaluation and post-institutional plan of care, unless the individual chooses not to participate.

(7) In no case shall the individual be placed unless the individual has stayed at least seventy-two continuous hours at the receiving facility and the team has met to consider information gathered during the stay.

(8) ODMRDD is responsible for ensuring that the individual's active treatment needs are provided for during the time the individual resides in the NF.

(9) ODMRDD shall ensure that the individual's continued need for services in the NF and active treatment needs are reviewed within the first one hundred twenty days. The review is to be conducted at least every one hundred eighty days thereafter.

(10) Any ind1vidual placed into a NF shall be maintained on the rolls of the developmental center for at least thirty 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.

(11) Prior to discharge from the developmental center. the managing officer shall notify the county board of mental retardation and developmental disabilities of the individual's placement and service needs.

(E) Placement of an individual from a hospital directly into a NF

All potential placements of individuals from developmental centers who are hospitalized and for whom the hospital recommends placement into a NF shall be performed in compliance with this rule.

(1) Unless 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 NF.

(2) Written notice shall be made to OLRS and to DHS of the hospital's recommendation to place the individual into a NF within three business days of ODMRDD'S awareness of such recommendation. This notice shall include the individual's diagnosis and medical needs as specified by the hospital medical staff. The notice shall also include the name of the receiving NF and the date of proposed placement.

(3) The individual shall be subject to preadmission screening under OBRA according to federal law and implementing regulation.

(4) The managing officer of the developmental center is responsible for ensuring that within thirty days of placement the individual's active treatment needs are evaluated.

(5) The individual must have a current individual plan (IP) updated within thirty days prior to the proposed placement, which includes the individual's active treatment and health care needs as defined in 42 C.F.R. 483.330 of the Medicaid regulations. If the individual's active treatment needs or health care status have changed, the IP shall be updated to reflect these changes.

(a) Whenever possible, development of the individual's IP, including the comprehensive evaluation and post institutional plan of care, will be done jointly by the NF and the developmental center.

(b) The individual shall be included in the development of the IP, including the comprehensive evaluation and post-institutional 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 NF and the team has met to consider information gathered dur1ng the stay.

(7) ODMRDD is responsible for ensuring that the individual's active treatment needs are provided for during the time the individual resides in the NF.

(8) ODMRDD shall ensure that the individual's continued need for services in the NF and active treatment needs are reviewed within the first one hundred twenty days by the interdisciplinary team. A review will be conducted at least every one hundred eighty days thereafter, as long as the individual resides in the NF.

(9) If it is determined through the review process that discharge is appropriate, then written notice of the intent to discharge shall be given to OLRS.

(10) The individual will be maintained on the rolls of the developmental center unless discharge is deemed appropriate by ODMRDD. If the individual has indicated in any manner, dissatisfaction with the placement, the individual shall not be discharged.

(11) The county board of mental retardation and developmental disabilities where the individual is to reside shall be notified of the individual's placement and service needs prior to placement.

(F) Each developmental center shall designate an employee who shall be responsible for the following:

(1) Providing notice to OLRS and DHS;

(2) Coordinating joint development wherever possible by the NF and the developmental center of the individual's comprehensive evaluation and IP, including quarterly updates;

(3) Ensuring quarterly visits by appropriate developmental center staff to meet with and observe the individual; and

(4) Coordinating the return to the developmental center or subsequent placement and discharge from the NF.

Effective Date: April 27, 2000