Ohio Admin. Code 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
For the purposes of this rule, the following definitions apply:
(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) "Ohio
individual service plan" means the web-based information technology platform
created and maintained by the department used to carry out the person centered
process for assessing and planning with Ohioans with developmental disabilities
and includes an information technology platform maintained by a county board or
an intermediate care facility for individuals with intellectual disabilities to
manage, store, and electronically exchange information with the department's
web-based information technology platform.
(12) "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.
(13) "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.
(14) "Service and support administration"
means the duties performed by a service and support administrator pursuant to
section 5126.15 of the Revised
Code.
(15) "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.
(16) "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
the 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) Each
individual, including an individual who has been adjudicated incompetent
pursuant to Chapter 2111. of the Revised Code, has the right to participate in
decisions that affect the individual's life and to have what is important to
the individual and what is important for the individual supported.
(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.,
5124., 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
will 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
will not be construed to
require
compel 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 what is important to the individual, what is
important for the individual, and the individual's desired outcomes.
(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
will 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
will 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
will 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
will
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) The
individual's skills and abilities.
(ii) The assessment
shall
will
identify supports that promote the individual's:
(a) Communication (expressing oneself and
understanding others);
(b) Advocacy
and engagement (valued roles and making choices; responsibility and
leadership);
(c) Safety and
security (safety and emergency skills; behavioral well-being; emotional
well-being; supervision considerations);
(d) Social and spirituality (personal
networks, activities, and faith; friends and relationships);
(e) Daily life and employment (school and
education; employment; finance);
(f) Community living (life at home; getting
around); and
(g) Healthy living
(medical and dental care; nutrition; wellness).
(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
5123-9-11 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
the
individual's 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
the individual's 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
the
individual's 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
will 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
will:
(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
will 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
will 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
will 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
will 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
will 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
will 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 support 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
will 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
will 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
will monitor compliance with this rule by county
boards. Technical assistance, as determined necessary by the department,
shall
will 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.
(L) Transition to
Ohio individual service plan
The use of Ohio individual service plan to capture assessments and individual service plans by June 30, 2024 is required only for individuals enrolled in home and community-based services waivers.
(1) Prior to September 1, 2022, a
county board may conduct assessments and develop and review individual service
plans of individuals who receive service and support administration from the
county board in accordance with the provisions set forth in this rule or in
accordance with the provisions set forth in rule 5123-4-02 of the
Administrative Code as it existed on the day immediately prior to the effective
date of this rule.
(2) Beginning no later than
September 1, 2022, a county board shall use Ohio individual service plan to
conduct assessments and develop and review individual service plans of
individuals who receive service and support administration from the county
board in accordance with the provisions set forth in this rule.
(3) No later than September 1, 2023,
a county board shall ensure that all assessments and individual service plans
for individuals who receive service and support administration from the county
board are captured in Ohio individual service plan.
Notes
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5126.041, 5126.05, 5126.08
Rule Amplifies: 5123.04, 5126.041, 5126.05, 5126.055, 5126.08, 5126.15
Prior Effective Dates: 08/23/1985 (Emer.), 11/22/1985 (Emer.), 01/18/1986, 03/11/1988, 03/03/1990, 11/18/1995, 07/01/2005, 03/17/2014, 05/17/2020, 10/01/2021
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