5123-9-05 Management of an individual's personal funds by a developmental center.

(A) Purpose

The purpose of this rule is to establish the procedures that a developmental center shall follow when it manages an individual's personal funds.

(B) Definitions

(1) "Earned income" means salary, wages, royalties, honoraria, or net earnings from self-employment as defined in rule 5101:1-39-15 of the Administrative Code. When an individual receives remuneration for services performed in a sheltered workshop, rule 5101:1-39-14.4 of the Administrative Code shall be followed in determining whether that remuneration is earned income or unearned income.

(2) "Individual" means an individual admitted to a developmental center who is enrolled in the intermediate care facility for the mentally retarded program.

(3) "Monthly personal needs allowance" means the amount of earned income and unearned income an individual may retain each month in accordance with paragraph (D) of this rule.

(4) "Personal needs account" has the same meaning as a personal needs allowance account in rule 5101:3-3-16.9 of the Administrative Code.

(5) "Personal needs allowance" has the same meaning as in rule 5101:1-39-24 of the Administrative Code.

(6) "Unearned income" means all income that is not earned income including, but not limited to, social security disability benefits, supplemental security income, and other public benefits an individual receives.

(C) Management of personal funds

(1) A developmental center shall permit an individual to manage his or her financial affairs and teach an individual to do so to the extent of the individual's abilities.

(2) A developmental center shall manage an individual's personal funds if the individual or the individual's guardian makes a written request for such assistance to the developmental center. In the absence of such request, the individual or his or her legal guardian or other authorized representative is responsible for managing the individual's personal funds and ensuring that the funds are used to meet the individual's needs.

(D) Monthly personal needs allowance

(1) Each individual shall retain a portion of his or her monthly income as a monthly personal needs allowance. An individual's monthly personal needs allowance shall be determined in accordance with paragraph (D)(2) of this rule. The remainder of an individual's monthly income shall be applied to the individual's medicaid cost of care in accordance with rule 5101:1-39-24 of the Administrative Code. An individual who does not have monthly income is not eligible to receive a personal needs allowance.

(2) The monthly personal needs allowance of an individual shall be calculated as follows:

(a) An individual who has only unearned income shall receive a personal needs allowance of up to forty dollars of his or her unearned income per month.

(b) An individual who has only earned income shall receive a personal needs allowance of up to sixty-five dollars of his or her gross earnings per month.

(c) An individual who has both unearned income and earned income shall receive a personal needs allowance of up to a combined maximum of one hundred five dollars per month (i.e., forty dollars in unearned income and sixty-five dollars in earned income).

(E) Management of individual's monthly personal needs allowance

(1) A developmental center shall deposit an individual's monthly personal needs allowance into a personal needs account.

(2) An individual's personal needs account is the exclusive property of the individual, who may use the funds in the account as he or she chooses. Funds in the account may be used to purchase only those items and services requested by the individual, the individual's legal guardian, or other authorized representative.

(3) When an individual requests an item or service that may be purchased with funds from the individual's personal needs account, a developmental center shall inform the individual of the cost and the amount that will be withdrawn from his or her personal needs account to pay for the item or service.

(4) Items and services that may be purchased with funds from an individual's personal needs account include, but are not limited to:

(a) Telephone;

(b) Television or radio for personal use;

(c) Personal comfort items including smoking materials, notions, novelties, and confections;

(d) Cosmetics and grooming items and services in excess of those for which payment is made under the medicaid program;

(e) Personal reading material;

(f) Stationary or stamps;

(g) Personal clothing;

(h) Specialty laundry services such as dry cleaning, mending, or hand-washing;

(i) Flowers or plants;

(j) Gifts purchased on behalf of an individual;

(k) Non-covered special care services such as privately hired nurses or nurse aides;

(l) Social events or entertainment offered outside the scope of a developmental center's activities program;

(m) Private rooms, except when therapeutically required for infection control or similar reasons;

(n) Specially prepared or alternative food instead of food generally prepared by the developmental center other than special diets ordered by an individual's physician or that permit an individual to continue with his or her established dietary habits required for good cause;

(o) Irrevocable burial accounts;

(p) Funerals; and

(q) Burial plots.

(5) Irrevocable burial accounts, pre-need funeral contracts, and burial plots are excludable as a countable resource if they meet the requirements of rules 5101:1-39-27.4 and 5101:1-39-32.2 of the Administrative Code.

(6) A developmental center may not charge an individual's personal needs account for items and services that the developmental center is required to furnish in order to participate in the medicaid program, and that are included in medicaid payments made to the developmental center.

(7) Items and services that may not be purchased with funds from an individual's personal needs account include, but are not limited to:

(a) Nursing services;

(b) Dietary services;

(c) Activities programs;

(d) Room and bed maintenance services;

(e) Routine personal hygiene items and services required to meet the needs of the individual, including but not limited to, hair hygiene supplies, comb, brush, bath soap, disinfecting soap or specialized cleaning agents when indicated to treat special skin problems or to fight infection, razor, shaving cream, toothbrush, toothpaste, denture adhesive, denture cleaner, dental floss, moisturizing lotion, tissues, cotton balls, deodorant, incontinence care supplies, sanitary napkins and related supplies, towels, washcloths, hospital gowns, over-the-counter drugs, hair and nail hygiene services, bathing, and basic personal laundry;

(f) Medically-related social services;

(g) Medical supplies such as irrigation trays, catheters, drainage bags, syringes, and needles;

(h) Durable medical equipment;

(i) Air conditioners or charges to an individual for the use of electricity;

(j) Therapy or podiatry services; and

(k) Charges for telephone consultation by physicians or other personnel.

(8) Funds in an individual's personal needs account that are not expended during the month shall be carried forward to the subsequent month and treated as a resource and are subject to resource requirements of Chapter 5101:1-39 of the Administrative Code.

(F) Safeguards to prevent misuse of individual's funds

(1) A developmental center shall establish and maintain a system that ensures full and complete accounting for an individual's funds.

(2) A developmental center shall not commingle the funds in an individual's personal needs account with the developmental center's funds or with the funds of any person other than another individual.

(3) A developmental center shall provide an individual with access to petty cash (less than fifty dollars) on an ongoing basis and arrange for an individual to access a larger amount of funds (fifty dollars or more) as necessary. The developmental center shall document each transaction involving an individual and his or her personal needs account. The developmental center shall maintain receipts for all purchases over fifty dollars for a single item purchased by the individual unless otherwise specified in the individual's plan and for all purchases the developmental center makes on behalf of the individual. The receipt shall identify the item(s) purchased, the date, and the amount of the expenditure. The developmental center shall obtain other proof of purchase if a receipt is unavailable. If other proof of purchase is unavailable, the developmental center shall provide written verification of the amount of funds given to the individual or expended on his or her behalf and what was purchased with the funds.

(4) A developmental center shall maintain a detailed ledger account of revenue and expenses for each personal needs account managed by the developmental center. The ledger account shall:

(a) Specify all funds received by or deposited with the developmental center;

(b) Specify the dates and reasons for all expenditures;

(c) Specify at all times the balance due the individual; and (d) Be available to the individual or the individual's legal guardian or other authorized representative for review.

(5) Upon request, a developmental center shall furnish receipts to an individual or the individual's legal guardian or other authorized representative in accordance with paragraph (F)(3) of this rule for purchases made with funds from the individual's personal needs account.

(6) Within thirty days after the end of the quarter, a developmental center shall make available upon request a written quarterly statement to each individual, the individual's legal guardian, or other authorized representative, of all financial transactions made by the developmental center on the individual's behalf.

(G) Notice to individual of when balance of funds may affect medicaid eligibility

(1) A developmental center shall give written notification to each individual whose personal funds are managed by the developmental center, the individual's legal guardian, or other authorized representative, when the amount of funds in the individual's personal needs account reaches two hundred dollars less than the resource limits set forth in rules 5101:1-39-05 and 5101:1-39-01.1 of the Administrative Code.

(2) The notice shall inform the individual that he or she may lose medicaid eligibility if the funds in the individual's personal needs account, in addition to the value of the individual's other nonexempt resources, reaches the individual's resource limit amount.

(3) The developmental center shall retain a copy of the notice in the individual's file.

(H) Notice to county department of job and family services

A developmental center shall report to the county department of job and family services any balance in an individual's personal needs allowance account that exceeds the individual's resource limit in accordance with paragraph (F)(2) of rule 5101:3-3-16.9 of the Administrative Code.

(I) Referral to county department of job and family services

If an individual is considering using funds in his or her personal needs account to purchase life insurance, grave space, a burial account, or other item that may be considered a countable resource, a developmental center shall refer the individual or the individual's legal guardian or other authorized representative to the county department of job and family services for an explanation of the effect the purchase may have on the individual's medicaid eligibility.

(J) Release of funds upon discharge or transfer

Within thirty days of discharge or transfer of an individual, a developmental center shall release to the individual, the individual's legal guardian, or other authorized representative, all of the funds in the individual's personal needs account, except for those funds that exceed the individual's resource limit, and a final itemized statement of the individual's personal needs account.

(K) Conveyance of funds upon death

Upon the death of an individual, a developmental center shall distribute any funds in the individual's personal needs account in accordance with section 5123.28 of the Revised Code.

(L) Review of rule

This rule shall be reviewed at least every five years to determine whether it should be continued without amendment, be amended, or be rescinded.

Replaces: 5123-9-05

Effective: 01/01/2011
Promulgated Under: 111.15
Statutory Authority: 5111.114 , 5121.01 to 5121.21 , 5123.04 , 5123.06 , 5123.28 , 5123.95
Rule Amplifies: 5111.114 , 5121.01 to 5121.21 , 5123.04 , 5123.06 , 5123.28 , 5123.95
Prior Effective Dates: 02/10/1979, 07/01/1980, 06/12/1981, 07/15/1983, 07/08/1985, 01/21/1991