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This website publishes administrative rules on their effective dates, as designated by the adopting state agencies, colleges, and universities.

Chapter 5123-4 | Developmental Disabilities

 
 
 
Rule
Rule 5123-4-01 | Administration and operation of county boards of developmental disabilities.
 

(A) Purpose

This rule establishes standards for the administration and operation of county boards of developmental disabilities that protect the rights of individuals and ensure the safe and equitable provision of services to eligible individuals and their families.

(B) Definitions

(1) "Adult services" has the same meaning as in section 5126.01 of the Revised Code.

(2) "County board" means a county board of developmental disabilities.

(3) "Department" means the Ohio department of developmental disabilities.

(4) "Developmental delay" means that a child has not reached developmental milestones expected for his or her chronological age as measured by qualified professionals using appropriate diagnostic instruments and/or procedures.

(a) For children birth through age two, developmental delay shall be established in accordance with part C and rules promulgated by the department.

(b) For children age three through age five, developmental delay shall be established in accordance with rules promulgated by the Ohio department of education.

(5) "Developmental disability" means a severe, chronic disability that is characterized by all of the following:

(a) It is attributable to a mental or physical impairment or a combination of mental and physical impairments, other than a mental or physical impairment solely caused by mental illness as defined in division (A) of section 5122.01 of the Revised Code;

(b) It is manifested before age twenty-two;

(c) It is likely to continue indefinitely;

(d) It results in one of the following:

(i) In the case of a person birth through age two, at least one developmental delay or a diagnosed physical or mental condition that has a high probability of resulting in a developmental delay;

(ii) In the case of a person age three through age five, at least two developmental delays; or

(iii) In the case of a person age six or older, a substantial functional limitation in at least three of the following areas of major life activity, as appropriate for his or her age: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, and, if the person is age sixteen or older, capacity for economic self-sufficiency; and

(e) It causes the person to need a combination and sequence of special, interdisciplinary, or other type of care, treatment, or provision of services for an extended period of time that is individually planned and coordinated for the person.

(6) "Early intervention services" means developmental services selected in collaboration with the parents of a child birth through age two who is eligible for services under part C, and designed to meet the developmental needs of the child and the needs of the child's family to assist appropriately in the child's development as identified in the individualized family service plan.

(7) "Early intervention system" means Ohio's statewide, coordinated, comprehensive, interagency system for which the department is the lead agency, that promotes transdisciplinary, family-centered services and supports to eligible children birth through age two and their families in accordance with part C.

(8) "Family support services" means a family support services program described in and administered pursuant to section 5126.11 of the Revised Code.

(9) "Home and community-based services" has the same meaning as in section 5123.01 of the Revised Code.

(10) "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.

(11) "Individual service plan" means the written description of services, supports, and activities to be provided to an individual.

(12) "Individualized family service plan" means the written plan for providing early intervention services to an eligible child and the child's family.

(13) "Intermediate care facility for individuals with intellectual disabilities" has the same meaning as in section 5124.01 of the Revised Code.

(14) "Medicaid local administrative authority" has the same meaning as in section 5126.055 of the Revised Code.

(15) "Part C" means part C of the Individuals with Disabilities Education Act, 20 U.S.C. 1431 through 1445, as in effect on the effective date of this rule, and 34 C.F.R. part 303, as in effect on the effective date of this rule.

(16) "Service and support administration" means the duties performed by a service and support administrator pursuant to section 5126.15 of the Revised Code.

(C) Strategic plan

(1) A county board shall develop and adopt by resolution a strategic plan that meets the requirements of sections 5126.04 and 5126.054 of the Revised Code, includes the county board's mission and vision, and addresses the county board's strategy for:

(a) Promoting self-advocacy by individuals served by the county board through the person-centered planning process, activities, and community connections;

(b) Ensuring that individuals receive services in the most integrated setting appropriate to their needs;

(c) Reducing the number of individuals in the county waiting for services;

(d) Increasing the number of individuals of working age engaged in community employment;

(e) Taking measures to recruit sufficient providers of services to meet the needs of individuals receiving services in the county; and

(f) Meeting with each newly certified independent provider within sixty calendar days of the provider being selected to provide services to an individual, for purposes of confirming the provider understands the individual service plan and the provider's responsibilities and ensuring the provider has contact information for the county board.

(2) The strategic plan shall be made readily available to individuals and families who receive services, employees of the county board, citizens of the county, and any other interested persons.

(3) A county board shall prepare a strategic plan progress report at least once per year. The strategic plan progress report shall be made readily available to individuals and families who receive services, employees of the county board, citizens of the county, and any other interested persons.

(4) A county board shall have a mechanism for accepting public feedback regarding the strategic plan and strategic plan progress reports.

(D) Eligibility determination for county board services

(1) Except as provided in paragraph (H) of this rule, a county board shall make eligibility determinations for county board services in accordance with the definition of "developmental disability" in paragraph (B)(5) of this rule.

(2) For persons age sixteen or older, a substantial functional limitation in a major life area is determined through completion of the Ohio eligibility determination instrument (available at http://dodd.ohio.gov) or an alternative instrument issued by the department for use in determining eligibility for county board services and application of criteria found therein.

(3) For persons age six through age fifteen, a substantial functional limitation in a major life area is determined through completion of the children's Ohio eligibility determination instrument (available at http://dodd.ohio.gov) or an alternative instrument issued by the department for use in determining eligibility for county board services and application of criteria found therein. The children's Ohio eligibility determination instrument or an alternative instrument issued by the department for use in determining eligibility for county board services is used in the eligibility determination process for the county board for all services and supports other than special education services.

(4) The Ohio eligibility determination instrument, the children's Ohio eligibility determination instrument, and any alternative instrument issued by the department for use in determining eligibility for county board services shall be administered by persons employed by county boards or regional councils of governments formed under section 5126.13 of the Revised Code by two or more county boards and authorized to do so by the department.

(5) A county board may establish eligibility for county board services for any preschool child with a disability eligible for services under section 3323.02 of the Revised Code whose disability is not attributable solely to mental illness as defined in section 5122.01 of the Revised Code.

(6) A county board shall complete eligibility determination within forty-five calendar days of the request for services or after all necessary information has been received from the referring party or applicant except that:

(a) For children birth through age two, the eligibility report completed by or for the early intervention system shall be used for eligibility determination; and

(b) For children age three through age five, the evaluation completed by or for the school district for preschool special education may be used for eligibility determination.

(7) A county board shall keep on file the documents used to determine eligibility for county board services of all persons who apply after July 1, 1991, whether or not such persons are found to be eligible. Information on persons found to be ineligible shall be maintained for five years after such determination is made.

(8) When a person who has been determined eligible for county board services after July 1, 1991 moves or wants to move to another county in Ohio, that person shall be deemed eligible by the new county board. The new county board, however, may review the person's eligibility. During the review, the person continues to be eligible to receive services according to the new county board's strategic plan and priorities.

(9) All persons who were eligible for county board services and receiving county board services pursuant to Chapter 5126. of the Revised Code on July 1, 1991, shall continue to be eligible for those services and to receive services as long as they are in need of services.

(10) All persons who were eligible for case management services and receiving case management services pursuant to Chapter 5126. of the Revised Code on January 10, 1992, shall continue to be eligible for those services and to receive services as long as they are in need of services.

(11) All persons determined ineligible for county board services shall be referred, with their consent, to other agencies or sources of services.

(12) All persons determined ineligible for county board services shall be informed of the process for resolution of complaints and appeals of adverse action in accordance with rule 5123:2-1-12 of the Administrative Code.

(E) Waiting lists for non-medicaid programs and services

(1) If a county board determines that available resources are not sufficient to meet the needs of all individuals who request non-medicaid programs or services, the county board shall establish one or more waiting lists for such programs or services in accordance with the county board's strategic plan described in paragraph (C) of this rule except that a waiting list shall not be established for early intervention services to eligible children and their families.

(2) Due process in accordance with rule 5123:2-1-12 of the Administrative Code shall be available to an individual aggrieved by an action of a county board related to the establishment or maintenance of, placement on, the failure to offer services in accordance with, or removal from a waiting list for non-medicaid programs and services established in accordance with paragraph (E)(1) of this rule. A county board may, if it has adopted a written policy describing an informal process for resolution of complaints and appeals of adverse action in accordance with rule 5123:2-1-12 of the Administrative Code, attempt to informally resolve the matter. An attempt to informally resolve the matter shall not affect the individual's right to due process.

(3) A county board shall, in the manner specified in rule 5123:2-1-12 of the Administrative Code, give notice to each individual on the waiting list for non-medicaid programs and services established in accordance with paragraph (E)(1) of this rule, the individual's guardian, and in accordance with section 5126.044 of the Revised Code, the individual's family, as applicable, of the individual's due process rights. The county board shall document that such notice was given and the content of the notice.

(4) Upon the department's request, a county board shall submit in a format specified by the department, documentation related to its waiting lists for non-medicaid programs and services established in accordance with paragraph (E)(1) of this rule, including but not limited to, information regarding individuals who requested services or were removed from a waiting list.

(F) Statutory authority

A county board shall carry out its duties and responsibilities in accordance with Chapter 5126. of the Revised Code. If a county board operates classrooms for children, the county board shall be licensed by the Ohio department of job and family services or the Ohio department of education, as applicable.

(G) Medicaid local administrative authority

(1) A county board with medicaid local administrative authority shall abide by all terms and conditions set forth in the federally-approved waiver documents including any appendices and attachments, sections 5126.055 and 5166.21 of the Revised Code, and administrative rules promulgated by the Ohio department of medicaid.

(2) The department shall oversee medicaid local administrative authority activities to ensure compliance with applicable laws. If the department determines that a county board with medicaid local administrative authority is deficient in its administration of medicaid waiver services, the department may take appropriate actions authorized by applicable law including, but not limited to, division (G) of section 5126.055 of the Revised Code or section 5126.056 of the Revised Code.

(3) A county board that participates in the department's medicaid administrative claiming program shall comply with the department's policies and procedures governing medicaid administrative claiming and refund any payments that are disallowed by the department, the Ohio department of medicaid, or the centers for medicare and medicaid services. A county board may challenge a disallowance by the department in accordance with rule 5123:2-17-01 of the Administrative Code.

(4) When the department refers an individual for whom the department is paying the nonfederal share of medicaid expenditures for home and community-based services to a county board for enrollment in home and community-based services, the county board shall assist the department in expediting the enrollment.

(H) Service and support administration

A county board shall determine eligibility for service and support administration, provide service and support administration, and ensure individual service plans are developed in accordance with rule 5123:2-1-11 of the Administrative Code.

(I) Adult services provided to individuals who are not enrolled in home and community-based services waivers

(1) A county board providing adult services to individuals who are not enrolled in home and community-based services waivers shall adopt a written policy outlining provision of the services.

(2) Adult services to individuals who are not enrolled in home and community-based services waivers shall be provided pursuant to section 5126.01 of the Revised Code and rule 5123:2-2-05 of the Administrative Code.

(3) Planning for adult services to individuals who are not enrolled in home and community-based services waivers shall be conducted in accordance with the person-centered planning process described in rule 5123:2-1-11 or 5123:2-3-03 of the Administrative Code, as applicable.

(4) Persons engaged in the direct provision of adult services to individuals who are not enrolled in home and community-based services waivers shall meet the training requirements for persons engaged in the direct provision of comparable home and community-based services as set forth in:

(a) Rule 5123:2-9-13 of the Administrative Code for career planning;

(b) Rule 5123:2-9-14 of the Administrative Code for vocational habilitation;

(c) Rule 5123:2-9-15 of the Administrative Code for individual employment support;

(d) Rule 5123:2-9-16 of the Administrative Code for group employment support; and

(e) Rule 5123:2-9-17 of the Administrative Code for adult day support.

(J) Early intervention services

(1) A county board providing early intervention services shall do so in accordance with part C and rules promulgated by the department.

(2) A county board providing early intervention services shall adopt a written policy describing the county board's role in the county's comprehensive system for early intervention services. The policy shall identify how the county board will provide early intervention services on a year-round basis to eligible children and their families as part of the early intervention system. The policy shall describe the source of funds available to administer early intervention services and the specific role the county board has agreed to fulfill as a partner in the local early intervention system, which may include:

(a) Public awareness/child find;

(b) Evaluation to determine eligibility;

(c) Child and family assessment;

(d) Service coordination;

(e) Early intervention services in everyday routines, activities, and places as developed through the individualized family service plan development process; and

(f) Assurances for procedural safeguards required by part C and rules promulgated by the department.

(K) Family support services

(1) A county board may use funds allocated for the family support services program as match for medicaid home and community-based services waivers.

(2) When a county board directly awards funds allocated for the family support services program to individuals or family members of individuals, the county board shall adopt a written policy governing provision of family support services. The policy shall:

(a) Specify that individuals or family members of individuals may receive family support services funds;

(b) Define family members who are eligible to receive family support services funds;

(c) Describe goods and services that may be purchased with family support services funds;

(d) Address whether or not the county board will use an income-based fee schedule to determine eligibility for family support services funds, and if an income-based fee schedule is used, whether or not the county board will require applicants to submit documentation to verify their income;

(e) Set forth the process for individuals and family members to apply for family support services funds and for the county board to review and approve/disapprove applications; and

(f) Describe payment processes that meet requirements established by the county auditor.

(L) Employees

(1) A county board shall enroll each service and support administrator and each staff member who is engaged in a direct services position in the Ohio attorney general's retained applicant fingerprint database ("Rapback").

(2) A county board shall provide annual written notice to each staff member explaining the conduct for which the staff member may be placed on the abuser registry and setting forth the requirement for each staff member who is engaged in a direct services position to report in writing to the county board, if he or she is formally charged with, convicted of, or pleads guilty to any of the offenses listed or described in divisions (A)(3)(a) to (A)(3)(e) of section 109.572 of the Revised Code within fourteen calendar days after the date of such charge, conviction, or guilty plea.

(M) Volunteers

(1) A county board may engage volunteers to provide supplementary services. A county board shall not submit claims for medicaid reimbursement for services provided by volunteers.

(2) A county board shall ensure that volunteers are at all times under supervision of paid supervisory staff of the county board.

(3) A county board shall ensure that volunteers who provide more than forty hours of service working directly with individuals served by the county board during a calendar year receive training in:

(a) The role and responsibilities of the county board with regard to services including person-centered planning, community participation and integration, self-determination, and self-advocacy;

(b) The rights of individuals set forth in sections 5123.62 to 5123.64 of the Revised Code;

(c) The requirements of rule 5123:2-17-02 of the Administrative Code including a review of health and welfare alerts issued by the department; and

(d) An overview of emergency procedures.

(4) A county board shall ensure that volunteers who provide more than forty hours of service working directly with individuals served by the county board during a calendar year undergo background investigations.

(a) The background investigation for a volunteer shall include:

(i) Requiring the volunteer to submit a statement to the county board with the volunteer's signature attesting that he or she has not been convicted of or pleaded guilty to any of the offenses listed or described in divisions (A)(3)(a) to (A)(3)(e) of section 109.572 of the Revised Code.

(ii) Requiring the volunteer to sign an agreement under which the volunteer agrees to notify the county board within fourteen calendar days if the volunteer is formally charged with, is convicted of, or pleads guilty to any of the offenses listed or described in divisions (A)(3)(a) to (A)(3)(e) of section 109.572 of the Revised Code. The agreement shall provide that failure to make the notification may result in termination of the volunteer's services.

(iii) Establishing the volunteer is not included in any of the databases described in paragraph (C)(2) of rule 5123:2-2-02 of the Administrative Code.

(iv) Obtaining a criminal records check conducted by the Ohio bureau of criminal identification and investigation. If the volunteer does not present proof that he or she has been a resident of Ohio for the five-year period immediately prior to the date upon which the criminal records check is requested, the criminal records check shall include information from the federal bureau of investigation.

(b) A county board shall, at a frequency of no less than once every five years, conduct a background investigation in accordance with paragraph (M)(4)(a) of this rule for each volunteer.

(c) A county board shall not engage or continue to engage a volunteer who:

(i) Is included in one or more of the databases described in paragraph (C)(2) of rule 5123:2-2-02 of the Administrative Code; or

(ii) Has a conviction for any of the offenses listed or described in divisions (A)(3)(a) to (A)(3)(e) of section 109.572 of the Revised Code if the corresponding exclusionary period as specified in paragraph (E) of rule 5123:2-2-02 of the Administrative Code has not elapsed.

(N) Cost reports

A county board shall annually prepare and electronically file a cost report detailing its income and expenditures in accordance with section 5126.131 of the Revised Code and guidelines established by the department and shall:

(1) Reconcile its income and expenditures on a monthly basis in accordance with standards established by the county auditor;

(2) Retain the cost report and accurate records and documentation necessary to support the cost report for six years from the date of receipt of payment for the final settlement of the cost report or until an initiated audit is resolved, whichever is longer; and

(3) Ensure its business manager and other county board personnel who prepare cost reports or supporting documentation successfully complete:

(a) A department-provided orientation program in cost report preparation within ninety calendar days of employment or contract; and

(b) Department-provided annual training in cost report preparation thereafter.

(O) Records

(1) A county board shall maintain fiscal records that are in compliance with county and state auditor's requirements pursuant to section 149.38 of the Revised Code.

(2) A county board shall adopt written policies and procedures which address confidentiality, access, duplication, dissemination, and destruction of county board personnel records.

(3) A county board shall adopt written policies and procedures which address confidentiality, access, duplication, dissemination, and destruction of records of individuals served in accordance with the Health Insurance Portability and Accountability Act, 42 U.S.C. 1320d, as in effect on the effective date of this rule and as applicable, the Family Educational Rights and Privacy Act, 20 U.S.C. 1232g, as in effect on the effective date of this rule.

(4) Records of a county board shall be accessible to department personnel authorized by the director of the department.

(5) A county board shall submit information and reports as directed by the department.

(6) A county board shall ensure that information about individuals served, including the individual's living arrangements and address, guardianship status, and guardian's address and contact information, is updated in the department's information systems within fifteen calendar days of any change.

(P) Safety

(1) The design and maintenance of county board facilities and equipment shall be in conformance with all applicable laws, including the Americans with Disabilities Act and Section 504 of the Rehabilitation Act of 1973 as in effect on the effective date of this rule.

(2) Each facility owned, leased, or operated by a county board shall be inspected annually by the local fire marshal or designee to ensure compliance with fire safety practices.

(3) If a county board provides a swimming program, regardless of location, a person who holds a current "American Red Cross" or equivalent lifeguarding certificate shall be present.

(4) A county board shall develop written building emergency plans which include procedures for fire, tornado, bomb threat, power failure, natural disaster, medical emergency, and other emergencies. The building emergency plans shall be available to all county board personnel, volunteers, individuals served, parents, and guardians.

(Q) Health

(1) When a county board is directly providing facility-based services, the county board shall adopt written policies and procedures that ensure the general health and well-being of all individuals served and address:

(a) Procedure to be followed when individuals are ill or injured, including provision of first aid and emergency treatment;

(b) Securing emergency squad or ambulance services or the services of the individual's personal physician;

(c) Providing first aid training, cardiopulmonary resuscitation training, and training in universal precautions for infection control including hand-washing and disposal of bodily waste to county board personnel engaged in direct services positions in accordance with rule 5123:2-2-01 of the Administrative Code;

(d) Providing suitable first-aid facilities, equipment, and supplies;

(e) Providing for the management of communicable diseases, handling of illness on-site, and return after an illness or other health condition; and

(f) Posting emergency numbers by each telephone.

(2) The written policies and procedures described in paragraph (Q)(1) of this rule shall be communicated to all county board personnel, individuals served, parents, guardians, and providers of services, and shall be available upon request by any person.

(3) A county board shall adopt a written policy consistent with applicable statutes concerning administration of medication by county board personnel.

(4) All medication administered by county board personnel shall be pharmacy-labeled to indicate owner, contents, required dosage, and schedule. Such medication shall be secured in a locked cabinet and removed by designated and qualified personnel.

(R) County board accreditation

(1) The department shall conduct an accreditation review of each county board at least once every three years to determine the county board's compliance with applicable statutes and rules. An accreditation review shall include a comprehensive on-site review conducted by representatives of the department at the county board's offices and facilities and may include off-site review of records, documents, or other materials.

(2) There are three possible outcomes of an accreditation review:

(a) The department shall issue accreditation for a term of three years to a county board that exceeds minimum compliance with applicable statutes and rules;

(b) The department shall issue accreditation for a term of one year to a county board that demonstrates minimum compliance with applicable statutes and rules; or

(c) The department shall hold accreditation in abeyance for a county board that is not in compliance with applicable statutes and rules. The department shall work with the county board to develop an acceptable plan of correction within ninety calendar days. If an acceptable plan of correction is not developed within ninety calendar days, the county board may be subject to receivership pursuant to section 5126.081 of the Revised Code. While a county board's accreditation is in abeyance, the county board shall not enroll individuals in home and community-based services waivers.

(3) The department shall notify a county board at least ninety calendar days prior to conducting an accreditation review.

(4) After conclusion of the comprehensive on-site review, the department shall conduct an exit conference with the superintendent of the county board and any other persons the county board invites. The purpose of the exit conference is to provide the county board with an oral summary of the county board's compliance status and present any findings of noncompliance. The exit conference may be held on-site at the conclusion of the on-site review but shall be conducted no more than five business days following the conclusion of the on-site review except by mutual agreement between the department and the superintendent of the county board.

(5) The department shall issue a written accreditation review summary to the president of the county board or the president's designee and the superintendent of the county board within seven calendar days of conclusion of the on-site review. The accreditation review summary shall be objective in terms of observations and citations, relying upon documentation that clearly addresses the standards reviewed.

(6) Within fourteen calendar days of receipt of a written accreditation review summary that includes one or more citations, the county board shall submit to the department, a written appeal or a written plan of correction for each citation. If the county board does not submit a written appeal within fourteen calendar days, the accreditation review summary shall be final and not subject to appeal by the county board.

(a) The appeal for a citation shall include the county board's basis with supporting documentation for challenging the citation. The department shall allow or disallow the appeal within ten calendar days of receipt.

(b) If the appeal is disallowed, the county board shall submit a written plan of correction for each citation to the department within fourteen calendar days. The written plan of correction shall include:

(i) A description of corrective action, including systemic changes necessary to prevent recurrence;

(ii) Implementation date of corrective action;

(iii) Person responsible for implementing corrective action; and

(iv) Supporting documentation which verifies implementation of corrective action.

(c) The department shall approve or disapprove the plan of correction within twenty calendar days of receipt.

(d) The department shall not issue accreditation until the county board's written plan of correction is approved.

(7) The department shall recognize county boards that demonstrate excellence through achievement of outstanding results or development of successful approaches regarding employment, self-advocacy, substantial downsizing or conversion of an intermediate care facility for individuals with intellectual disabilities, person-centered planning, or serving individuals presenting complex challenges by posting information about the county board's innovative practices at the department's website.

(S) Compliance reviews

A county board that is certified by the department pursuant to section 5123.161 of the Revised Code to provide supported living or home and community-based services is subject to rule 5123:2-2-04 of the Administrative Code and may be eligible for an abbreviated compliance review in accordance with that rule.

(T) Providing applicable statutes and rules

A county board shall upon request, assist any interested party to locate and secure a copy of provisions of Chapter 5126. of the Revised Code and the administrative rules of the department. The county board shall ensure that employees of the county board and entities under contract with the county board receive information about revisions to the Revised Code and administrative rules of the department that are pertinent to their roles.

(U) Waiver of requirements in Chapter 5123-4 or 5123:2-1 of the Administrative Code

A county board may request or the department may initiate a waiver of requirements outlined in Chapter 5123-4 or 5123:2-1 of the Administrative Code that govern the administration and operation of county boards, so long as the requirements are not those of the Revised Code.

Supplemental Information

Authorized By: 5123.011, 5123.04, 5123.171, 5126.04, 5126.05, 5126.08, 5126.081, 5126.082, 5126.11
Amplifies: 5123.011, 5123.04, 5123.171, 5123.19, 5126.01, 5126.04, 5126.041, 5126.046, 5126.05, 5126.054, 5126.055, 5126.08, 5126.081, 5126.082, 5126.11, 5126.131
Five Year Review Date: 9/1/2023
Prior Effective Dates: 3/31/1988, 7/1/1991, 9/13/1991, 9/18/1992, 4/22/1993, 8/31/1995, 12/9/1995, 2/28/1996 (Emer.), 5/28/1996, 7/12/1997, 3/21/2002, 10/16/2003, 12/10/2004, 1/1/2015
Rule 5123-4-02 | Service and support administration.
 

(A) Purpose

This rule defines the responsibilities of a county board of developmental disabilities for service and support administration and establishes a process for individuals who receive service and support administration to have an identified service and support administrator who is the primary point of coordination.

(B) Definitions

(1) "Alternative services" has the same meaning as in rule 5123-9-04 of the Administrative Code.

(2) "Assessment" means the individualized process of gathering comprehensive information concerning the individual's preferences, desired outcomes, needs, interests, abilities, health status, and other available supports.

(3) "Budget for services" means the projected cost of implementing the individual service plan regardless of funding source.

(4) "County board" means a county board of developmental disabilities.

(5) "Department" means the Ohio department of developmental disabilities.

(6) "Home and community-based services waiver" means a medicaid waiver administered by the department in accordance with section 5166.21 of the Revised Code.

(7) "Individual" means a person with a developmental disability.

(8) "Individual service plan" means the written description of services, supports, and activities to be provided to an individual.

(9) "Intermediate care facility for individuals with intellectual disabilities" has the same meaning as in section 5124.01 of the Revised Code.

(10) "Natural supports" means the personal associations and relationships typically developed in the community that enhance the quality of life for individuals. Natural supports may include family members, friends, neighbors, and others in the community or organizations that serve the general public who provide voluntary support to help an individual achieve agreed upon outcomes through the individual service plan development.

(11) "Person-centered planning" means an ongoing process directed by an individual and others chosen by the individual to identify the individual's unique strengths, interests, abilities, preferences, resources, and desired outcomes as they relate to the individual's support needs.

(12) "Primary point of coordination" means the identified service and support administrator who is responsible to an individual for the effective development, implementation, and coordination of the individual service plan.

(13) "Service and support administration" means the duties performed by a service and support administrator pursuant to section 5126.15 of the Revised Code.

(14) "Team" means the group of persons chosen by the individual with the core responsibility to support the individual in directing development of his or her individual service plan. The team includes the individual's guardian or adult whom the individual has identified, as applicable, the service and support administrator, direct support professionals, providers, licensed or certified professionals, and any other persons chosen by the individual to help the individual consider possibilities and make decisions.

(C) Decision-making responsibility

(1) Individuals, including individuals 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.

(2) An individual for whom a guardian has not been appointed shall make decisions regarding receipt of a service or support or participation in a program provided for or funded under Chapter 5123. or 5126. of the Revised Code. The individual may obtain support and guidance from another person; doing so does not affect the right of the individual to make decisions.

(3) An individual for whom a guardian has not been appointed may, in accordance with section 5126.043 of the Revised Code, authorize an adult (who may be referred to as a "chosen representative") to make a decision described in paragraph (C)(2) of this rule on behalf of the individual as long as the adult does not have a financial interest in the decision. The authorization shall be made in writing.

(4) When a guardian has been appointed for an individual, the guardian shall make a decision described in paragraph (C)(2) of this rule on behalf of the individual within the scope of the guardian's authority. This paragraph shall not be construed to require appointment of a guardian.

(5) An adult or guardian who makes a decision pursuant to paragraph (C)(3) or (C)(4) of this rule shall make a decision that is in the best interest of the individual on whose behalf the decision is made and that is consistent with the individual's needs, desires, and preferences.

(D) Provision of service and support administration

(1) A county board shall provide service and support administration to:

(a) An individual, regardless of age or eligibility for county board services, who is applying for or enrolled in a home and community-based services waiver;

(b) An individual three years of age or older who is eligible for county board services and requests, or a person on the individual's behalf requests pursuant to paragraph (C) of this rule, service and support administration; and

(c) An individual residing in an intermediate care facility for individuals with intellectual disabilities who requests, or a person on the individual's behalf requests pursuant to paragraph (C) of this rule, assistance to move from the facility to a community setting.

(2) A county board shall provide service and support administration in accordance with the requirements of section 5126.15 of the Revised Code.

(3) An individual who is eligible for service and support administration in accordance with paragraph (D)(1) of this rule and requests, or a person on the individual's behalf requests pursuant to paragraph (C) of this rule, service and support administration shall receive service and support administration and shall not be placed on a waiting list for service and support administration.

(E) Determination of eligibility for county board services

Service and support administrators shall, in accordance with rules adopted by the department, determine individuals' eligibility for county board services. A county board may assign responsibility for eligibility determination to a service and support administrator who does not perform other service and support administration functions; in such a case, results of the eligibility determination shall be shared with the service and support administrator who is the primary point of coordination for the individual in order to ensure coordination of services and supports. Results of the eligibility determination shall be shared in a timely manner with the individual and the individual's guardian, and/or the adult whom the individual has identified, as applicable.

(F) Primary point of coordination

(1) A county board shall identify a service and support administrator for each individual receiving service and support administration who shall be the primary point of coordination for the individual. An individual shall be given the opportunity to request a different service and support administrator from the county board.

(2) With the active participation of the individual and members of the team, the service and support administrator shall perform the following duties:

(a) Initially, and at least every twelve months thereafter, coordinate assessment of the individual.

(i) The assessment shall take into consideration:

(a) What is important to the individual to promote satisfaction and achievement of desired outcomes;

(b) What is important for the individual to maintain health and welfare;

(c) Known and likely risks;

(d) The individual's place on the path to community employment; and

(e) What is working and not working in the individual's life.

(ii) The assessment shall identify supports that promote the individual's:

(a) Rights (e.g., equality, citizenship, access, due process, and responsibility);

(b) Self-determination (e.g., choices, opportunities, personal control, and self-advocacy);

(c) Physical well-being (e.g., routine and preventative health care and daily living skills appropriate to age);

(d) Emotional well-being (e.g., self-worth, self-esteem, satisfaction with life, and spirituality);

(e) Material well-being (e.g., employment, money, education, and housing);

(f) Personal development (e.g., achievement, success, and personal competence);

(g) Interpersonal relationships (e.g., social contacts, relationships, and emotional supports); and

(h) Social inclusion (e.g., community participation and social supports).

(b) Using person-centered planning, develop, review, and revise the individual service plan and ensure that the individual service plan:

(i) Reflects results of the assessment.

(ii) Includes services and supports that:

(a) Ensure health and welfare;

(b) Assist the individual to engage in meaningful and productive activities;

(c) Support community connections and networking with persons or groups including persons with disabilities and others;

(d) Assist the individual to improve self-advocacy skills and increase the individual's opportunities to participate in advocacy activities, to the extent desired by the individual;

(e) Ensure achievement of outcomes that are important to the individual and outcomes that are important for the individual and address the balance of and any conflicts between what is important to the individual and what is important for the individual;

(f) Address identified risks and include supports to prevent or minimize risks;

(iii) Integrates all sources of services and supports, including natural supports and alternative services, available to meet the individual's needs and desired outcomes;

(iv) Reflects services and supports that are consistent with efficiency, economy, and quality of care; and

(v) Is updated throughout the year.

(c) Establish a recommendation for and obtain approval of the budget for services based on the individual's assessed needs and preferred ways of meeting those needs.

(d) Through objective facilitation, assist the individual in choosing providers by:

(i) Ensuring that the individual is given the opportunity to select providers from all willing and qualified providers in accordance with applicable federal and state laws and regulations including rule 5123:2-9-11 of the Administrative Code; and

(ii) Assisting the individual as necessary to work with providers to resolve concerns involving a provider or direct support professionals who are assigned to work with the individual.

(e) Secure commitments from providers to support the individual in achievement of his or her desired outcomes.

(f) Verify by signature and date that prior to implementation each individual service plan:

(i) Indicates the provider, frequency, and funding source for each service and support; and

(ii) Specifies which provider will deliver each service or support across all settings.

(g) Establish and maintain contact with providers as frequently as necessary to ensure that each provider is trained on the individual service plan and has a clear understanding of the expectations and desired outcomes of the supports being provided.

(h) Establish and maintain contact with natural supports as frequently as necessary to ensure that natural supports are available and meeting desired outcomes as indicated in the individual service plan.

(i) Facilitate effective communication and coordination among the individual and members of the team by ensuring that the individual and each member of the team has a copy of the current individual service plan unless otherwise directed by the individual, the individual's guardian, or the adult whom the individual has identified, as applicable. The individual and his or her providers shall receive a copy of the individual service plan at least fifteen calendar days in advance of implementation unless extenuating circumstances make fifteen-day advance copy impractical and with agreement by the individual and his or her providers.

(i) A member of the team who becomes aware that revisions to the individual service plan are indicated shall notify the service and support administrator.

(ii) A member of the team may disagree with any provision in the individual service plan at any time. All dissenting opinions shall be specifically noted in writing and attached to the individual service plan.

(j) Provide ongoing individual service plan coordination to ensure services and supports are provided in accordance with the individual service plan and to the benefit and satisfaction of the individual. Ongoing individual service plan coordination shall:

(i) Occur with the active participation of the individual and members of the team;

(ii) Focus on achievement of the desired outcomes of the individual;

(iii) Balance what is important to the individual and what is important for the individual;

(iv) Examine service satisfaction (i.e., what is working for the individual and what is not working); and

(v) Use the individual service plan as the fundamental tool to ensure the health and welfare of the individual.

(k) Review and revise the individual service plan at least every twelve months and more frequently under the following circumstances:

(i) At the request of the individual or a member of the team, in which case revisions to the individual service plan shall occur within thirty calendar days of the request;

(ii) Whenever the individual's assessed needs, situation, circumstances, or status changes;

(iii) If the individual chooses a new provider or type of service or support;

(iv) As a result of reviews conducted in accordance with paragraph (F)(2)(q) of this rule;

(v) Identified trends and patterns of unusual incidents or major unusual incidents; and

(vi) When services are reduced, denied, or terminated by the department or the Ohio department of medicaid.

(l) Take the following actions with regard to medicaid services:

(i) Explain to the individual, in conjunction with the process of recommending eligibility and/or assisting the individual in making application for enrollment in a home and community-based services waiver or any other medicaid service, and in accordance with rules adopted by the department:

(a) Alternative services available to the individual;

(b) The individual's due process and appeal rights; and

(c) The individual's right to choose any qualified and willing provider.

(ii) Explain to the individual, at the time the individual is being recommended for enrollment in a home and community-based services waiver:

(a) Choice of enrollment in a home and community-based services waiver as an alternative to residing in an intermediate care facility for individuals with intellectual disabilities; and

(b) Services and supports funded by a home and community-based services waiver.

(iii) Provide an individual with written notification and explanation of the individual's right to a medicaid state hearing if the individual service plan process results in a recommendation for the approval, reduction, denial, or termination of services funded by a home and community-based services waiver. Notice shall be provided in accordance with section 5101.35 of the Revised Code.

(iv) Make a recommendation to the department, in accordance with rule 5123-8-01 of the Administrative Code, as to whether the individual meets the criteria for a developmental disabilities level of care.

(v) Explain to an individual whose individual service plan includes services funded by a home and community-based services waiver or other medicaid services that the services are subject to approval by the department and the Ohio department of medicaid. If the department or the Ohio department of medicaid approves, reduces, denies, or terminates services funded by a home and community-based services waiver or other medicaid services included in an individual service plan, the service and support administrator shall communicate with the individual about this action.

(m) Provide an individual with written notification and explanation of the individual's right to use the administrative resolution of complaint process set forth in rule 5123-4-04 of the Administrative Code if the individual service plan process results in the reduction, denial, or termination of a service other than a service funded by a home and community-based services waiver or targeted case management services. Such written notice and explanation shall also be provided to an individual if the individual service plan process results in an approved service that the individual does not want to receive, but is necessary to ensure the individual's health, safety, and welfare. Notice shall be provided in accordance with rule 5123-4-04 of the Administrative Code.

(n) Advise members of the team of their right to file a complaint in accordance with rule 5123-4-04 of the Administrative Code.

(o) Retain responsibility for all decision-making regarding service and support administration functions and the communication of any such decisions to the individual.

(p) Take actions necessary to remediate any immediate concerns regarding the individual's health and welfare.

(q) Implement a continuous review process to ensure that individual service plans are developed and implemented in accordance with this rule.

(i) The continuous review process shall be tailored to the individual and based on information provided by the individual and the team.

(ii) The scope, type, and frequency of reviews shall be specified in the individual service plan and shall include, but are not limited to:

(a) Face-to-face visits, occurring at a time and place convenient for the individual, at least annually or more frequently as needed by the individual; and

(b) Contact via phone, email, or other appropriate means as needed.

(iii) The frequency of reviews may be increased when:

(a) The individual has intensive behavioral or medical needs;

(b) The individual has an interruption of services of more than thirty calendar days;

(c) The individual encounters a crisis or multiple less serious but destabilizing events within a three-month period;

(d) The individual has transitioned from an intermediate care facility for individuals with intellectual disabilities to a community setting within the past twelve months;

(e) The individual has transitioned to a new provider of homemaker/personal care or participant-directed homemaker/personal care within the past twelve months;

(f) The individual receives services from a provider that has been notified of the department's intent to suspend or revoke the provider's certification or license; or

(g) Requested by the individual, the individual's guardian, or the adult whom the individual has identified, as applicable.

(iv) The service and support administrator shall share results of reviews in a timely manner with the individual, the individual's guardian, and/or the adult whom the individual has identified, as applicable, and the individual's providers, as appropriate.

(v) If the continuous review process indicates areas of non-compliance with standards for providers of services funded by a home and community-based services waiver, the county board shall conduct a provider compliance review in accordance with rule 5123-2-04 of the Administrative Code.

(G) Emergency response system

The county board shall, in coordination with the provision of service and support administration, make an on-call emergency response system available twenty-four hours per day, seven days per week to provide immediate response to an unanticipated event that requires an immediate change in an individual's existing situation and/or individual service plan to ensure health and safety. Persons who are available for the on-call emergency response system shall:

(1) Provide emergency response directly or through immediate linkage with the service and support administrator who is the primary point of coordination for the individual or with the primary provider;

(2) Be trained and have the skills to identify the problem, determine what immediate response is needed to alleviate the emergency and ensure health and welfare, and identify and contact persons to take the needed action;

(3) Notify the providers and the service and support administrator who is the primary point of coordination for the individual to ensure adequate follow-up;

(4) Notify the county board's investigative agent as determined necessary by the nature of the emergency; and

(5) Document the emergency in accordance with county board procedures.

(H) Records

(1) Paper or electronic records shall be maintained for individuals receiving service and support administration and shall include, at a minimum:

(a) Identifying data;

(b) Information identifying guardianship, other adult whom the individual has identified, trusteeship, or protectorship;

(c) Date of request for services from the county board;

(d) Evidence of eligibility for county board services;

(e) Assessment information relevant for services and the individual service plan process for supports and services;

(f) Current individual service plan;

(g) Current budget for services;

(h) Documentation that the individual exercised freedom of choice in the provider selection process;

(i) Documentation of unusual incidents;

(j) Major unusual incident investigation summary reports;

(k) The name of the service and support administrator;

(l) Emergency information;

(m) Personal financial information, when appropriate;

(n) Release of information and consent forms;

(o) Case notes which include coordination of services and supports and continuous review process activities; and

(p) Documentation that the individual was afforded due process in accordance with paragraph (I) of this rule, including but not limited to, appropriate prior notice of any action to deny, reduce, or terminate services and an opportunity for a hearing.

(2) When the county board uses electronic record keeping and electronic signatures, the county board shall establish policies and procedures for verifying and maintaining such records.

(I) Due process

Due process shall be afforded to each individual receiving service and support administration pursuant to section 5101.35 of the Revised Code for services funded by a home and community-based services waiver and targeted case management services or pursuant to rule 5123-4-04 of the Administrative Code for services other than services funded by a home and community-based services waiver and targeted case management services.

(J) Department monitoring and technical assistance

The department shall monitor compliance with this rule by county boards. Technical assistance, as determined necessary by the department, shall be provided upon request and through regional and statewide trainings.

(K) Ohio department of medicaid monitoring of targeted case management services

The Ohio department of medicaid retains final authority to monitor the provision of targeted case management services in accordance with rule 5160-48-01 of the Administrative Code.

Supplemental Information

Authorized By: 5123.04, 5126.041, 5126.05, 5126.08
Amplifies: 5123.04, 5126.041, 5126.05, 5126.055, 5126.08, 5126.15
Five Year Review Date: 5/17/2025
Prior Effective Dates: 3/11/1988
Rule 5123-4-03 | In-service training for members of county boards of developmental disabilities.
 

(A) Purpose

This rule delineates requirements for annual in-service training for members of county boards of developmental disabilities.

(B) Definitions

(1) "Annual organizational meeting" means the meeting held by a county board of developmental disabilities, no later than January thirty-first of each year, to elect its officers and conduct other business pursuant to section 5126.029 of the Revised Code.

(2) "Appointing authority" means the entity with statutory authority to appoint members to county boards of developmental disabilities pursuant to sections 5126.021 and 5126.022 of the Revised Code.

(3) "Board member" means a member of a county board of developmental disabilities.

(4) "County board" means a county board of developmental disabilities.

(5) "Department" means the Ohio department of developmental disabilities.

(6) "Director" means the director of the Ohio department of developmental disabilities or his or her designee.

(7) "In-service training" means training of board members pursuant to section 5126.0210 of the Revised Code that may include, but is not limited to, training arranged by the superintendent, statewide conferences sponsored by the Ohio association of county boards serving people with developmental disabilities or other organizations, webinars offered by the department, training completed on-line, and presentations by outside speakers.

(8) "Superintendent" means the superintendent of a county board of developmental disabilities appointed pursuant to section 5126.0219 of the Revised Code.

(C) In-service training requirements

(1) Within three months after a board member's initial appointment to the county board, the board member shall complete an orientation that addresses duties of the county board, role and requirements of board members, confidentiality, and the ethics laws of the state of Ohio. The orientation completed in accordance with this paragraph may count toward the hours of in-service training specified in paragraphs (C)(2) and (C)(3) of this rule.

(2) During each calendar year of a board member's term, the board member shall complete a minimum of four hours of in-service training, except as provided in paragraph (C)(3) of this rule.

(3) Board members appointed after the county board's annual organizational meeting and board members appointed for the remainder of a former board member's term shall complete in-service training during the first calendar year of the board member's appointment in accordance with the following schedule:

(a) Board members appointed on or before March thirty-first shall complete a minimum of four hours of in-service training.

(b) Board members appointed after March thirty-first but prior to July first shall complete a minimum of three hours of in-service training.

(c) Board members appointed after June thirtieth but prior to October first shall complete a minimum of two hours of in-service training.

(d) Board members appointed after September thirtieth but prior to the succeeding January first shall complete a minimum of one hour of in-service training.

(4) No later than January thirty-first of each year, the director shall identify topics related to the developmental disabilities service delivery system to be addressed during in-service training for the calendar year.

(a) Topics identified by the director may include, but are not limited to:

(i) Authority and responsibility of a county board;

(ii) Medicaid program and the county board's role in medicaid local administrative authority;

(iii) Fiscal obligations of the county board;

(iv) Self-evaluation of the county board;

(v) Evaluation of the superintendent;

(vi) Current federal initiatives;

(vii) Current state initiatives; and

(viii) Self-advocacy by individuals with developmental disabilities.

(b) The director may specify the content of training for identified topics.

(c) The director may require board members to complete specific webinars offered by the department.

(5) The county board and the superintendent shall jointly develop the county board's plan for in-service training for the calendar year which:

(a) Reflects the topics identified by the director in accordance with paragraph (C)(4) of this rule with consideration of priorities within the county;

(b) Includes perspectives from outside the county; and

(c) Recognizes that training for specific board members may vary based on board members' background and experience.

(6) The superintendent shall make board members aware of opportunities to complete in-service training.

(7) The superintendent shall maintain documentation of board members' completion of in-service training which shall include:

(a) An outline or description that details the content of the training;

(b) The date, time, location, and duration of the training; and

(c) A sign-in sheet or email in which the board member attests to completing the training.

(8) In-service training sessions shall not be considered regularly scheduled meetings of the county board.

(9) The department shall monitor compliance with this rule through accreditation reviews of county boards it conducts in accordance with rule 5123-4-01 of the Administrative Code.

Supplemental Information

Authorized By: 5123.04, 5126.0210, 5126.05, 5126.08
Amplifies: 5123.04, 5126.021, 5126.022, 5126.0210, 5126.0211, 5126.0213, 5126.0214, 5126.0215, 5126.0216, 5126.0217, 5126.0218, 5126.05, 5126.08
Five Year Review Date: 5/17/2025
Prior Effective Dates: 1/1/2004
Rule 5123-4-04 | Resolution of complaints involving county boards of developmental disabilities and appeals of adverse action proposed or initiated by county boards of developmental disabilities.
 

(A) Purpose

This rule sets forth the process for resolution of complaints involving the programs, services, policies, or administrative practices of a county board of developmental disabilities or an entity under contract with a county board of developmental disabilities; the process for individuals to appeal adverse actions proposed or initiated by a county board of developmental disabilities; and the requirement for a county board of developmental disabilities to give notice of the process to be followed for resolution of complaints and appeals of adverse action.

(B) Scope

(1) Any individual or person, other than an employee of the county board, may file a complaint using the process set forth in this rule. An individual may appeal an adverse action using the process set forth in this rule. The process set forth in this rule shall be followed before commencing a civil action.

(2) This rule shall not be applicable:

(a) When the county board is a vendor or subcontractor for service delivery.

(b) To education services arranged by the local education agency. Complaints or appeals concerning such services shall follow rules adopted by the Ohio department of education.

(c) To services provided under part C of the Individuals with Disabilities Education Act, 34 C.F.R. 303, as in effect on the effective date of this rule. Complaints or appeals concerning such services shall follow rules in Chapter 5123-10 of the Administrative Code.

(d) To medicaid services including home and community-based services waiver services and targeted case management services. Complaints or appeals concerning such services shall follow rules adopted by the Ohio department of medicaid. The county board shall not require the use of the process set forth in this rule for issues regarding medicaid services.

(e) To performance of health-related activities and administration of medication by developmental disabilities personnel pursuant to the authority granted pursuant to section 5123.42 of the Revised Code or compliance with Chapter 5123:2-6 of the Administrative Code. Complaints or appeals concerning such matters shall be made to the department using the process established in rule 5123:2-17-01 of the Administrative Code.

(f) To services provided to a resident of an intermediate care facility for individuals with intellectual disabilities by that facility, or provided on behalf of or through a contract with an intermediate care facility for individuals with intellectual disabilities. Complaints or appeals concerning such services shall follow regulations governing intermediate care facilities for individuals with intellectual disabilities.

(3) If the county board determines that a complaint or appeal of adverse action filed with the county board is not subject to this rule, the county board shall provide information to the individual or person filing the complaint or appeal, including the name and telephone number, if available, of the appropriate entity with which to file the complaint or appeal of adverse action.

(4) An individual receiving non-medicaid supported living services shall follow the terms of the contract of the service provider, as required by section 5126.45 of the Revised Code, prior to beginning the process for resolution of complaints or appeals of adverse action established in this rule.

(C) Definitions

For the purposes of this rule, the following definitions shall apply:

(1) "Adverse action" means any of the following:

(a) Denial of a request for a non-medicaid service.

(b) Reduction in frequency and/or duration of a non-medicaid service.

(c) Suspension of a non-medicaid service.

(d) Termination of a non-medicaid service (except when the recipient of that service is deceased).

(e) The outcome of an eligibility determination.

(2) "Advocate" means any person selected by an individual to act and/or communicate as authorized by the individual.

(3) "Contracting entity" means an entity under contract with a county board for the provision of services to individuals with developmental disabilities.

(4) "County board" means a county board of developmental disabilities including a county board when acting through a council of governments.

(5) "Department" means the Ohio department of developmental disabilities.

(6) "Director" means the director of the Ohio department of developmental disabilities or his or her designee.

(7) "Hearing" means the opportunity to present one's case regarding a complaint or appeal of adverse action.

(8) "Individual" means a person with a developmental disability who is eligible, or purports to be eligible, for services pursuant to Chapters 5123. and 5126. of the Revised Code and includes a parent of a minor child, an individual's guardian, or an adult authorized in writing by the individual pursuant to section 5126.043 of the Revised Code to make a decision regarding receipt of a service or participation in a program.

(9) "Intermediate care facility for individuals with intellectual disabilities" has the same meaning as in section 5124.01 of the Revised Code.

(10) "Notice" means and is deemed to have occurred upon:

(a) For an individual who has selected email as his or her preferred method of communication, electronic confirmation that the individual has read the email;

(b) Personal delivery to an individual; or

(c) The date of certified mailing to an individual unless:

(i) The original certified mailing is refused, in which case notice is deemed to have occurred on the date the notice is resent by ordinary mail to the individual; or

(ii) The original certified mailing is unclaimed, in which case notice is deemed to have occurred on the date the notice is resent by ordinary mail to the individual unless within thirty calendar days after the date the notice is resent, the resent notice is returned for failure of delivery.

(11) "Person" has the same meaning as in section 1.59 of the Revised Code.

(D) General provisions

(1) Complaints and appeals of adverse action shall be filed in writing. When an individual or person expresses dissatisfaction with an outcome subject to complaint or appeal in accordance with this rule, the county board shall, to the extent necessary, assist the individual or person in filing a complaint or appeal.

(2) At all times throughout the resolution of complaints and appeals of adverse action process, the county board shall maintain the confidentiality of the identities of individuals unless an individual gives written permission to share information.

(3) An advocate may assist an individual at any time during the resolution of complaints and appeals of adverse action process.

(4) The county board shall make all reasonable efforts to ensure that information regarding resolution of complaints and appeals of adverse action, including all notices and responses made pursuant to this rule, is presented using language and in a format understandable to affected individuals and persons. All notices and responses made pursuant to this rule shall include an explanation of the individual's or person's opportunity to file a complaint with or appeal to a higher authority, as applicable.

(5) The time lines set forth in this rule may be extended if mutually agreed upon in writing by all parties involved.

(6) Initiation of the formal process set forth in this rule does not preclude the resolution of a complaint or an appeal of adverse action at any point, as long as the outcome is mutually agreed upon in writing by all parties involved.

(E) Requirements for county boards to provide information about the process for resolution of complaints and appeals of adverse action and to give notice of adverse action

(1) General information about the process for resolution of complaints and appeals of adverse action.

(a) The county board shall give the "Complaint or Appeal of Adverse Action Explanation Form" contained in the appendix to this rule to an individual at the time of the individual's initial request for services, at least annually to each individual receiving or on a waiting list for non-medicaid services, and at the time a complaint within the scope of this rule is received or the county board proposes an adverse action.

(b) Upon request, a county board or contracting entity shall provide a copy of this rule.

(c) The county board shall publicly post the "Complaint or Appeal of Adverse Action Explanation Form" contained in the appendix to this rule.

(2) Specific notice of adverse action.

(a) Except when it is necessary to suspend an individual's services without delay to ensure the health and safety of the individual or other individuals in accordance with paragraph (E)(3) of this rule, the county board shall provide written notice to the affected individual of the county board's decision to deny, reduce, suspend, or terminate services at least fifteen calendar days prior to the effective date of such action. The notice shall include:

(i) An explanation of the county board's policy and/or authority for taking the adverse action;

(ii) A description of the specific adverse action being proposed or initiated by the county board;

(iii) The effective date for the adverse action;

(iv) A clear statement of the reasons for the adverse action including a description of the specific assessments and/or documents that are the basis for the adverse action;

(v) An explanation of the individual's right to appeal the adverse action;

(vi) An explanation of the steps the individual must take to appeal the adverse action;

(vii) A statement that the individual has ninety calendar days to appeal the adverse action;

(viii) A statement that the individual must file his or her appeal prior to the effective date for the adverse action to keep his or her services in place during the appeal process;

(ix) The name and contact information for the staff member of the county board who can assist the individual with his or her appeal; and

(x) The "Complaint or Appeal of Adverse Action Explanation Form" contained in the appendix to this rule.

(b) The county board shall retain written evidence of the date the notice is personally delivered or sent by certified mail to the individual or for an individual who has selected email as his or her preferred method of communication, the date of electronic confirmation that the individual has read the email.

(3) Specific notice of adverse action when it is necessary to suspend an individual's services without delay to ensure the health and safety of the individual or other individuals.

(a) When it is necessary to suspend an individual's services without delay to ensure the health and safety of the individual or other individuals, the county board shall:

(i) Determine what immediate steps are necessary to ensure the health and safety of the individual and other individuals; and

(ii) Provide written notice to the affected individual immediately. The notice shall include:

(a) An explanation of the county board's policy and/or authority for suspending the individual's services;

(b) A description of the specific services being suspended;

(c) The effective date for the suspension of services;

(d) A clear statement of the reasons for the suspension of services including a description of the specific circumstances that jeopardize the health and safety of the individual or other individuals;

(e) An explanation that the county board shall arrange for appropriate alternative services and a description of the specific alternative services available to the individual;

(f) An explanation of the steps the county board shall take in accordance with paragraphs (E)(3)(c) and (E)(3)(d) of this rule;

(g) The name and contact information for the staff member of the county board who can answer questions about the suspension of services; and

(h) The "Complaint or Appeal of Adverse Action Explanation Form" contained in the appendix to this rule.

(b) The county board shall retain written evidence of the date the notice is personally delivered or sent by certified mail to the individual or for an individual who has selected email as his or her preferred method of communication, the date of electronic confirmation that the individual has read the email.

(c) Within five calendar days of the notice of suspension of services, the county board shall convene a team meeting to identify measures that may be implemented to eliminate the circumstances that jeopardize the health and safety of the individual or other individuals.

(d) Within five calendar days of the team meeting, the county board shall:

(i) With the consent of the individual, implement measures to eliminate the circumstances that jeopardize the health and safety of the individual or other individuals as necessary and restore the suspended services; or

(ii) With the consent of the individual, continue to arrange for appropriate alternative services; or

(iii) Provide written notice that includes the components described in paragraphs (E)(2)(a)(i) to (E)(2)(a)(x) of this rule to the individual of the county board's decision to terminate the individual's services at least fifteen calendar days prior to the effective date of such action. If the individual files an appeal prior to the effective date of the termination of services, the county board shall keep the individual's alternative services in place until the appeal process is completed.

(F) Informal process for resolution of complaints and appeals of adverse action

A county board may adopt a written policy describing an informal process that shall take no longer than thirty calendar days for resolution of complaints and appeals of adverse action. An individual or person may elect to participate in the informal process or may initiate the formal process set forth in paragraph (G) of this rule.

(G) Formal process for resolution of complaints and appeals of adverse action

(1) Step one: filing a complaint or appeal of adverse action with the supervisor or manager responsible for the program, service, policy, or administrative practice of the county board.

(a) An individual or person must file a complaint with the supervisor or manager of the county board within ninety calendar days of becoming aware of the program, service, policy, or administrative practice that is the subject of the complaint.

(b) An individual must file an appeal of adverse action with the supervisor or manager of the county board within ninety calendar days of notice of the adverse action or within ninety calendar days of conclusion of the informal process set forth in paragraph (F) of this rule. If the individual appeals an adverse action within the prior notice period (i.e., the period of time between notice of the intended adverse action and the effective date of the adverse action), the individual's services shall not be reduced, suspended, or terminated until the appeal process is completed or the appeal is withdrawn by the individual. An individual who appeals during the prior notice period may voluntarily consent in writing to the reduction, suspension, or termination of services during the appeal process.

(c) The supervisor or manager of the county board shall conduct an investigation of the complaint or appeal which shall include meeting with the individual or person who filed the complaint or appeal.

(d) Within fifteen calendar days of receipt of the complaint or appeal, the supervisor or manager of the county board shall provide and thereafter be available to discuss a written report and decision with the individual or person who filed the complaint or appeal. The written report and decision shall include the rationale for the decision and a description of the next step in the process if the individual or person is not satisfied with the decision of the supervisor or manager.

(2) Step two: filing a complaint or appeal of adverse action with the superintendent of the county board.

(a) If the individual or person filing the complaint or appeal of adverse action is not satisfied with the outcome of the process set forth in paragraph (G)(1) of this rule, the individual or person may file a complaint or appeal with the superintendent of the county board.

(b) The complaint or appeal of adverse action must be filed with the superintendent of the county board within ten calendar days of notice of the decision of the supervisor or manager of the county board. If no decision is provided by the supervisor or manager of the county board within fifteen calendar days in accordance with paragraph (G)(1)(d) of this rule, the complaint or appeal of adverse action must be filed with the superintendent of the county board within twenty-five calendar days of filing the complaint or appeal with the supervisor or manager.

(c) The superintendent of the county board or his or her designee shall, within ten calendar days of receipt of the complaint or appeal, meet with the individual or person and conduct an administrative review.

(d) As part of the administrative review, the superintendent of the county board or his or her designee may ask questions to clarify and review the circumstances and facts related to the supervisor's or manager's decision and shall provide the individual or person the opportunity to present reasons why the supervisor's or manager's decision should be reconsidered.

(e) Within fifteen calendar days of receipt of the complaint or appeal, the superintendent of the county board or his or her designee shall send by certified mail, a copy of his or her decision to the individual or person who submitted the complaint or appeal. Such decision shall include the rationale for the decision and a description of the next step in the process if the individual or person is not satisfied with the decision of the superintendent of the county board or his or her designee.

(3) Step three: filing a complaint or appeal of adverse action with the president of the county board.

(a) If the individual or person filing the complaint or appeal of adverse action is not satisfied with the outcome of the process set forth in paragraph (G)(2) of this rule, the individual or person may file a complaint or appeal with the president of the county board.

(b) The complaint or appeal of adverse action must be filed with the president of the county board within ten calendar days of notice of the decision of the superintendent of the county board or his or her designee. If no decision is provided by the superintendent of the county board or his or her designee within fifteen calendar days in accordance with paragraph (G)(2)(e) of this rule, the complaint or appeal of adverse action must be filed with the president of the county board within twenty-five calendar days of filing the complaint or appeal with the superintendent.

(c) The president of the county board shall ensure that a hearing is conducted within twenty calendar days of receipt of the complaint or appeal at a time and place convenient to all parties. At such hearing:

(i) The county board may hear the complaint or appeal;

(ii) A committee of two or more county board members appointed by the president of the county board with agreement of the county board, may hear the complaint or appeal. The committee shall issue a report and recommendation to the county board within ten calendar days of the conclusion of the hearing; or

(iii) A hearing officer appointed by the county board may hear the complaint or appeal. The hearing officer shall have the same powers and authority in conducting the hearing as granted to the county board. The hearing officer shall not be an employee or contractor of the county board providing any service other than that of hearing officer. The hearing officer need not be an attorney, but shall possess qualifications to be able to make neutral and informed decisions about the complaint or appeal. The county board may ask the department to decide if a person is qualified to be a hearing officer. The hearing officer shall issue a report and recommendation to the county board within ten calendar days of the conclusion of the hearing.

(d) Upon request, the individual or person filing the complaint or appeal shall be provided access to all records and materials related to the complaint or appeal no less than ten calendar days before the hearing.

(e) To the extent permitted by law, the hearing shall be private unless the individual or person requesting the hearing wants it open to the public.

(f) During the hearing, both parties may present evidence to support their positions.

(g) The individual or person requesting the hearing and the county board have the right to be represented by an attorney.

(h) The individual or person requesting the hearing shall have the right to have in attendance at the hearing and question any official, employee, or agent of the county board who may have evidence upon which the complaint or appeal is based.

(i) Evidence presented at the hearing shall be recorded by stenographic means or by use of an audio recorder at the option of the county board. The record shall be made at the expense of the county board and, upon request, one copy of a written transcript shall be provided, at no cost, to the individual or person requesting the hearing.

(j) In making its decision, the county board may request or consider additional information with notice to all affected parties, may request a presentation in writing and/or in person from each party, or take other action necessary to make a determination.

(k) Within fifteen calendar days of conclusion of a county board hearing or the county board's receipt of the report and recommendation from a county board-appointed committee or a hearing officer, the president of the county board or his or her designee shall send by certified mail, a copy of the county board's decision to the individual or person who requested the hearing. Such decision shall include the rationale for the decision and a description of the next step in the process if the individual or person is not satisfied with the decision of the county board.

(4) Step four: filing a complaint or appeal of adverse action with the director.

(a) If the individual filing the complaint or appeal of adverse action is not satisfied with the outcome of the process set forth in paragraph (G)(3) of this rule, the individual may file a complaint or appeal with the director.

(b) The complaint or appeal of adverse action must be filed with the director within fifteen calendar days of notice of the decision of the county board. If no decision is provided by the president of the county board within fifteen calendar days in accordance with paragraph (G)(3)(k) of this rule, the complaint or appeal of adverse action must be filed with the director within fifty-five calendar days of filing the complaint with the president of the county board.

(c) The director shall send a copy of the complaint or appeal of adverse action to the superintendent and president of the county board.

(d) The president of the county board or his or her designee shall send the director the written transcript of the county board hearing, copies of any exhibits, and a copy of the county board's decision within fifteen calendar days of receiving the copy of the complaint or appeal of adverse action from the director.

(e) Upon request by an affected party or at the director's initiation, the director may request or consider additional information with notice to all affected parties, may request a presentation in writing and/or in person from each party, or take other action necessary to make a determination.

(f) Within thirty calendar days of receipt of the written transcript of the county board hearing, copies of any exhibits, and a copy of the county board's decision from the president of the county board, the director shall send by certified mail, a copy of his or her decision to all affected parties. The director shall uphold the decision of the county board if the director determines that the decision is in accordance with applicable statute and administrative rule. The director's decision shall include the rationale for the decision.

(H) Other remedies

After exhausting the administrative remedies required by this rule, an individual or person may commence a civil action if the complaint or appeal of adverse action is not resolved to his or her satisfaction. This rule is not intended to provide any right or cause of action that does not exist absent this rule.

View Appendix

Supplemental Information

Authorized By: 5123.04, 5123.043
Amplifies: 5123.04, 5123.043, 5126.06
Five Year Review Date: 7/25/2024
Prior Effective Dates: 7/1/1991 (Emer.), 9/13/1991, 4/22/1993, 9/1/1995 (Emer.)
Rule 5123-4-05 | Assistance to enable a county board of developmental disabilities to pay the nonfederal share of medicaid expenditures for home and community-based services.
 

(A) Purpose

This rule sets forth the process for a county board to request assistance from the department in the event of failure of an operating levy for services for individuals with developmental disabilities and the process followed by the department to respond to such a request in accordance with section 5123.0413 of the Revised Code.

(B) Definitions

For the purposes of this rule the following definitions apply:

(1) "County board" means a county board of developmental disabilities that performs home and community-based services waiver administration functions.

(2) "Department" means the Ohio department of developmental disabilities.

(3) "Home and community-based services" has the same meaning as in section 5123.01 of the Revised Code.

(C) Process for requesting assistance

(1) Following the failure of a county board operating levy, a county board may request assistance from the department to enable the county board to meet its obligations to pay the nonfederal share of medicaid expenditures for home and community-based services.

(2) Prior to making the request, a county board shall:

(a) By written request, seek financial assistance through the county commissioners;

(b) Reduce costs by restricting expenditures, by reducing or eliminating programs other than home and community-based services, and by consolidating functions or positions with other county boards or a regional council of governments;

(c) Develop a plan of action to resolve the county board's financial situation within a twelve-month period; and

(d) Adopt a resolution to request assistance from the department.

(3) When requesting assistance, a county board shall submit to the department:

(a) A description of the actions the county board took to meet the requirements of paragraph (C)(2) of this rule and the results of those actions;

(b) A history of levies placed on the ballot in the most recent ten years;

(c) A cash flow analysis for the most recent and upcoming twelve months;

(d) Most recent annual financial statements;

(e) Monthly financial statements for the most recent twelve months; and

(f) A copy of the resolution from the county board requesting assistance from the department.

(D) Departmental response to request for assistance

(1) The department may seek additional information, data, or reports regarding:

(a) Cash flow analysis;

(b) Source, amount, and use of revenues of the county board for the most recent ten years;

(c) Levy experience and strategy;

(d) Efficiency and allocation of staff;

(e) Involvement of a council of governments;

(f) Funding sources for programs operated by the county board;

(g) Comparability of salaries of employees of the county board to other local agencies and to other similar county boards;

(h) Most recent strategic plan for the county board;

(i) Programs operated or funded by the county board; and

(j) Any other information determined by the department to be relevant.

(2) The department may further review the operations and financial condition of the county board by:

(a) Examining the financial records of the county board;

(b) Appointing a public accounting firm to examine the financial statements and other records of the county board; and

(c) Appointing a group of peers from other county boards to perform an on-site review of the operations of the county board.

(3) The department will consult with the office of budget and management and the Ohio department of medicaid in accordance with rule 5160-41-16 of the Administrative Code.

(E) Department decision

(1) The department shall decide whether or not to provide assistance based on:

(a) Efficiency of the county board's administration;

(b) Use of medicaid to support services in the county;

(c) The county board's plan to resolve its financial situation;

(d) Reasonableness of costs of the county board in comparison with other agencies; and

(e) Alternatives to assistance such as structural and operational changes to the county board.

(2) The department's decision whether or not to provide assistance shall be at its sole discretion.

(3) If the department decides that assistance should be made available to the county board, the department shall also decide whether the assistance will be in the form of paying the nonfederal share of medicaid expenditures for home and community-based services or reducing the number of individuals required to be enrolled in a waiver component under section 5126.0512 of the Revised Code, or both. The department shall consider:

(a) Amount needed to pay the nonfederal share and impact on other counties;

(b) Number of individuals on the waiting list and progression of the list;

(c) Likelihood of the county board being able to resume paying the nonfederal share after a year; and

(d) Maintenance of home and community-based services waiver assurances.

(4) If the department permits a reduction in the number of individuals required to be enrolled on a waiver component under section 5126.0512 of the Revised Code, no individual may be disenrolled from a waiver as a result of such reduction.

(5) The department shall issue its decision in writing which may include any prerequisites for the county board to receive assistance. Generally, assistance will be made available for a twelve-month period.

(F) Monitoring

(1) Upon the grant of assistance, the county board shall submit to the department on a quarterly basis:

(a) Financial statements;

(b) Updated projection of revenues and expenditures;

(c) Progress on implementing the county board's plan of action to resolve the county board's financial situation; and

(d) Plans and strategy for an operating levy.

(2) The department shall monitor the progress of the county board toward eliminating the need for assistance.

(3) Within six months of issuing its decision, the department and county board shall confer on the impact of the plan of action on resolving the county board's financial situation and any adjustments needed in the plan of action.

Supplemental Information

Authorized By: 5123.04, 5123.0413
Amplifies: 5123.04, 5123.0413, 5126.0512
Five Year Review Date: 1/1/2026
Prior Effective Dates: 9/1/2010