Ohio Admin. Code 5123-2-07 - Personal funds of the individual
(A)
Purpose
This rule establishes standards of accountability for a provider when the individual service plan of an individual served by the provider indicates the provider is responsible for managing the individual's personal funds.
(B)
Scope
This rule applies to persons and entities that provide specialized services regardless of source of payment, including but not limited to:
(1)
County boards and
entities under contract with county boards;
(2)
Residential
facilities licensed pursuant to section
5123.19 of the Revised Code,
including intermediate care facilities for individuals with intellectual
disabilities; and
(3)
Providers of supported living certified pursuant to
section 5123.161 of the Revised Code,
including providers of services funded by medicaid home and community-based
services waivers administered by the department.
(C)
Definitions
For the purposes of this rule, the following definitions apply:
(1)
"Agency provider" has the same meaning as in rule
5123-2-08 of the Administrative
Code.
(2)
"County board" means a county board of developmental
disabilities.
(3)
"Department" means the Ohio department of developmental
disabilities.
(4)
"Earned income" means wages and net earnings from
employment or self-employment.
(5)
"Immediate family
member" means a spouse, parent or stepparent, child or stepchild, sibling or
stepsibling, grandparent, or grandchild.
(6)
"Independent
provider" has the same meaning as in rule
5123-2-09 of the Administrative
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 and
includes an "individual program plan" as that term is used in
42 C.F.R.
483.440 as in effect on the effective date of
this rule.
(9)
"Intermediate care facility for individuals with
intellectual disabilities" has the same meaning as in section
5124.01 of the Revised
Code.
(10)
"Major unusual incident" has the same meaning as in
rule 5123-17-02 of the Administrative
Code.
(11)
"Person responsible for the estate of the individual"
means the executor, administrator, commissioner, or person who filed pursuant
to section 2113.03 of the Revised Code for
release from administration of an estate.
(12)
"Personal funds"
means any financial resources, including but not limited to, earned income,
unearned income, bank accounts, investment accounts, and monies distributed
from a trust fund or inheritance.
(13)
"Provider" means
an agency provider, an independent provider, or a residential
facility.
(14)
"Qualified intellectual disability professional" has
the same meaning as in
42 C.F.R.
483.430 as in effect on the effective date of
this rule.
(15)
"Residential facility" has the same meaning as in
section 5123.19 of the Revised
Code.
(16)
"Service and support administrator" means a person,
regardless of title, employed by or under contract with a county board to
perform the functions of service and support administration and who holds the
appropriate certification in accordance with rule
5123:2-5-02 of the
Administrative Code.
(17)
"Specialized services" means any program or service
designed and operated to serve primarily individuals with developmental
disabilities, including a program or service provided by an entity licensed or
certified by the department. If there is a question as to whether a provider or
entity under contract with a provider is providing specialized services, the
provider or contract entity may request that the director of the department
make a determination. The director's determination is not subject to
appeal.
(18)
"Team," as applicable, has the same meaning as in rule
5123-4-02 of the Administrative
Code or means an "interdisciplinary team" as that term is used in
42 C.F.R.
483.440 as in effect on the effective date of
this rule.
(19)
"Unearned income" means all income that is not earned
income including, but not limited to, social security disability income,
supplemental security income, other benefits an individual receives, and
monetary gifts.
(D)
Establishment of roles and parameters for management of
personal funds
(1)
Each individual shall be afforded the opportunity to
manage the individual's personal funds and taught to do so to the extent of the
individual's ability.
(2)
An individual's ability to manage personal funds will
be addressed through development of the individual service plan and
consideration of what is important to the individual and what is important for
the individual.
(3)
When an individual has been assessed to need assistance
managing personal funds:
(a)
The individual service plan will include:
(i)
The name of the
person or entity responsible for assisting the individual with managing
personal funds and the specific personal funds to which the person or entity
will have access;
(ii)
The specific type of supports to be provided (e.g.,
bill-paying, shopping, budgeting, or increasing the individual's independence
in managing personal funds);
(iii)
The dollar
amount anticipated to be available to the individual upon request for personal
spending;
(iv)
The maximum dollar amount that the individual may
independently manage at any one time;
(v)
The maximum
dollar amount that the provider may spend on behalf of the individual for any
one expenditure without team approval; and
(vi)
When applicable,
the name of the person or entity responsible for providing payee
services.
(b)
The qualified intellectual disability professional or
service and support administrator, as applicable, shall maintain the following
information in the individual service plan or in the individual's official
record:
(i)
The
name of the person responsible for the estate of the individual in the event of
the individual's death; and
(ii)
When applicable,
the name of the person or entity assigned as guardian of the
estate.
(4)
Each individual,
other than an individual who has been assessed to need assistance managing
personal funds, shall have access to personal funds to use as the individual
chooses to purchase items, goods, and services.
(5)
In no
circumstance will an individual be required to use personal funds to purchase
or pay for items or services that are reimbursed by medicaid or any other
funding source of the provider.
(E)
Avoiding
conflicts of interest
Providers, immediate family members of providers, employees of providers, and immediate family members of employees of providers shall not:
(1)
Ask for, otherwise try to secure, or accept loans in
any amount from an individual the provider or employee serves.
(2)
Sell items to an
individual the provider or employee serves unless the transaction is authorized
in writing in advance by the team.
(3)
Buy items from an
individual the provider or employee serves unless the transaction is authorized
in writing in advance by the team.
(F)
Management of an
individual's personal funds by a provider
(1)
A provider
responsible for managing an individual's personal funds shall:
(a)
Retain,
safeguard, and accurately account for the individual's personal
funds.
(b)
Deposit the individual's personal funds in the
individual's account within five calendar days of receipt.
(c)
Ensure the
individual has access to personal funds managed by the provider upon request,
but no later than three calendar days from the date of request.
(d)
Provide an
accounting of the individual's personal funds as described in paragraph (G)(4)
of this rule to the individual or the individual's guardian, the team, or the
department upon request.
(e)
Ensure the team is notified when:
(i)
An individual's
personal funds exceed or are projected to exceed the maximum amount allowed for
the individual to maintain eligibility for medicaid, supplemental security
income, or social security disability insurance; or
(ii)
An individual
receives a lump sum payment (e.g., benefits back payment) or
inheritance.
(2)
A provider
responsible for managing an individual's personal funds shall not:
(a)
Co-mingle the
individual's personal funds with the provider's funds.
(b)
Use the
individual's personal funds to supplement or replace funds of the provider or
another individual on a temporary or permanent basis except in situations where
a practical arrangement (e.g., individuals take turns purchasing household
supplies) is agreed upon and documented in writing.
(3)
An individual's
team will determine, through development of the individual service plan, when a
provider is required to maintain receipts for expenditures of the individual's
personal funds. Receipts, when required, will identify the date, the item or
items purchased, and the amount of the expenditure; other documentation or a
written explanation will be obtained if a receipt is
unavailable.
(4)
When a provider has been appointed to act as the payee
for an individual's benefits:
(a)
The provider shall follow all requirements set forth by
the governing authority (e.g., social security administration or veterans'
administration).
(b)
The provider shall not request nor accept reimbursement
through the individual's home and community-based services waiver for providing
payee services if the provider is paid by the individual or from another
funding source for acting as payee.
(c)
Provisions of
this rule apply without regard to the provider's role (i.e., acting in the
capacity of payee or acting in the capacity of provider).
(5)
When a
provider has possession of an individual's personal funds, the provider
shall:
(a)
Within five calendar days of termination of services,
release any balance of cash to the individual or the individual's guardian, as
applicable, after deducting for actual or estimated expenditures owed by the
individual; and
(b)
Within fourteen calendar days of termination of
services, prepare a final itemized statement of the individual's personal funds
accounts and release any remaining personal funds to the individual or the
individual's guardian, as applicable, with the itemized
statement.
(G)
Accounts
established for individuals' personal funds
(1)
When a provider
has possession of an individual's personal funds, the provider may establish a
banking account on behalf of the individual or the individual may establish the
individual's own account. When the provider establishes a banking account on
behalf of an individual:
(a)
The provider may establish a separate banking account
for each individual's personal funds, combine multiple individuals' personal
funds in one banking account, or a combination of both. When multiple
individuals' personal funds are combined in one banking account, the provider
shall separately account for each individual's personal funds and allocate
interest, if earned, to each individual proportional to the amount of personal
funds each individual maintains in the account.
(b)
The individual's
personal funds may be maintained in a checking account or a savings account or
a combination of both.
(c)
The provider will establish the banking account in a
manner that minimizes banking fees paid by the individual.
(2)
A cash
account may be maintained by the provider as specified in the individual
service plan.
(3)
An investment account opened in accordance with the
Achieving a Better Life Experience Act program and section
529A of the Internal Revenue Code may be
maintained by the provider as specified in the individual service
plan.
(4)
For each type of account established for an individual,
the provider shall maintain a written or electronic system of accounting which
contains:
(a)
The individual's name;
(b)
The source,
amount, and date of all personal funds received;
(c)
The signature of
the person depositing personal funds to the account, unless electronically
deposited;
(d)
The date, amount, and recipient of all personal funds
withdrawn;
(e)
The signature of the person withdrawing personal funds
from the account, unless electronically withdrawn;
(f)
For checking
accounts and savings accounts, a current account balance reconciled to the most
recent bank statement which is signed and dated by the person conducting the
reconciliation; and
(g)
For any cash accounts maintained by the provider,
including gift cards or gift certificates belonging to an individual, a
verification of the reconciliation of the documented balance to the actual
personal funds available no less than once every thirty calendar days which is
signed and dated by the person conducting the reconciliation.
(H)
Management of an individual's personal funds by an
agency provider or residential facility
An agency provider or residential facility responsible for managing an individual's personal funds shall:
(1)
Develop and implement a written policy regarding
management of individuals' personal funds that:
(a)
Describes the
system of accounting principles by which the agency provider or residential
facility retains, safeguards, and accurately accounts for individuals' personal
funds;
(b)
Requires the agency provider or residential facility to
deposit an individual's personal funds in the individual's account within five
calendar days of receipt;
(c)
Prohibits an individual's personal funds from being
co-mingled with the agency provider's or residential facility's
funds;
(d)
Prohibits use of an individual's personal funds to
supplement or replace funds of the agency provider or residential facility or
another individual on a temporary or permanent basis except in situations where
a practical arrangement (e.g., individuals take turns purchasing household
supplies) is agreed upon and documented in writing;
(e)
Requires an
accounting of an individual's personal funds as described in paragraph (G)(4)
of this rule be made available to the individual or the individual's guardian,
the team, or the department upon request;
(f)
Describes how the
agency provider or residential facility will ensure an individual has access to
personal funds managed by the agency provider or residential facility upon
request, but no later than three calendar days from the date of request;
and
(g)
Outlines the agency provider's or residential
facility's system for monitoring and reporting alleged acts of misappropriation
and exploitation in accordance with rule
5123-17-02 of the Administrative
Code.
(2)
Ensure a person employed by or under contract with the
agency provider or residential facility, other than the person who provides
direct assistance to the individual with managing personal funds or the person
who maintains the written or electronic system of accounting for personal
funds, conducts the reconciliations of personal funds required by paragraphs
(G)(4)(f) and (G)(4)(g) of this rule.
(3)
Ensure each
person employed by or under contract with the agency provider or residential
facility who provides direct assistance to an individual with managing personal
funds, maintains the written or electronic system of accounting for personal
funds, or conducts the reconciliations of personal funds required by paragraphs
(G)(4)(f) and (G)(4)(g) of this rule is trained in the requirements of this
rule and follows the agency provider's or residential facility's written policy
regarding management of individuals' personal funds described in paragraph
(H)(1) of this rule.
(I)
Restoration of an
individual's personal funds
(1)
A provider shall restore personal funds to an
individual when:
(a)
The provider's failure to implement the individual
service plan as written results in the loss of the individual's personal funds;
or
(b)
The individual experiences a loss of personal funds
managed by the provider and the provider failed to maintain adequate
documentation; or
(c)
The provider's failure to follow its written policy
regarding management of individuals' personal funds, described in paragraph
(H)(1) of this rule, results in the loss of the individual's personal funds;
or
(d)
The provider or an employee of the provider is the
subject of a substantiated misappropriation or exploitation major unusual
incident which results in the loss of the individual's personal funds, in which
case:
(i)
The
individual's major unusual incident prevention plan will compel the provider to
restore the personal funds in a timely manner;
(ii)
The provider
will restore the personal funds as specified in the major unusual incident
prevention plan; and
(iii)
The major unusual incident case will remain open until
the county board documents that the provider has restored the personal
funds.
(2)
An individual's
team will ensure that restoration of personal funds is structured in a manner
that does not jeopardize the individual's eligibility for medicaid,
supplemental security income, or social security disability
insurance.
(J)
Disposition of personal funds in the event of an
individual's death
(1)
A department-operated intermediate care facility for
individuals with intellectual disabilities that has possession of an
individual's personal funds at the time of the individual's death will dispose
of the personal funds in accordance with section
5123.28 of the Revised
Code.
(2)
An intermediate care facility for individuals with
intellectual disabilities other than one operated by the department that has
possession of an individual's personal funds at the time of the individual's
death will dispose of the personal funds in accordance with Chapter 5123-7 of
the Administrative Code.
(3)
A provider other than an intermediate care facility for
individuals with intellectual disabilities that has possession of an
individual's personal funds at the time of the individual's death will:
(a)
Make inquiries to
determine if the individual has an estate.
(b)
When an estate
has been opened, arrange to transfer the individual's personal funds to the
person responsible for the estate of the individual within ninety calendar
days.
(c)
Allow the individual's personal funds to be used for
the individual's funeral and/or burial expenses if payment is not otherwise
available.
(d)
If after one hundred eighty calendar days following the
individual's death, no estate has been opened, either:
(i)
Transfer the
balance of the individual's personal funds to "Administrator, Medicaid Estate
Recovery, Collections Enforcement Section, Ohio Attorney General's Office, 30
East Broad Street, 14th Floor, Columbus, Ohio 43215" when the individual was a
recipient of medicaid benefits; or
(ii)
Dispose of
unclaimed funds in accordance with Chapter 169. of the Revised Code when the
individual was not a recipient of medicaid benefits.
Replaces: 5123:2-2-07
Notes
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5123.19, 5124.03, 5126.08
Rule Amplifies: 5123.04, 5123.19, 5123.28, 5123.62, 5124.03, 5126.08
Prior Effective Dates: 05/18/1995, 04/27/2000, 01/01/2006, 10/01/2016
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