Ohio Admin. Code 5123-7-28 - Intermediate care facilities for individuals with intellectual disabilities - intensive behavioral support rate add-on
(A)
Purpose
This rule sets forth requirements for an intermediate care facility for individuals with intellectual disabilities (ICFIID) to receive a per diem rate add-on established pursuant to section 5124.26 of the Revised Code for providing short-term intensive behavioral support to youth with complex behavioral support needs in a discrete unit or building of six or fewer beds.
(B)
Definitions
For the purposes of this rule, the following definitions apply:
(1)
"Accredited college or university" means a college or
university accredited by a national or regional association recognized by the
secretary of the United States department of education or a foreign college or
university of comparable standing.
(2)
"Aftercare
services" means individualized, intensive, post-discharge services driven by
input from a youth and his or her team, provided by a discharging ICFIID to the
youth and his or her family or other caregivers, as applicable.
(3)
"Business day"
means a day of the week, excluding Saturday, Sunday, or a legal holiday as
defined in section 1.14 of the Revised
Code.
(4)
"County board" means a county board of developmental
disabilities.
(5)
"Follow-along services" means contact, engagement, and
assistance provided by the department to support a youth who has been
discharged from an ICFIID to ensure he or she makes a successful transition
back into his or her home and community.
(6)
"Intensive
behavioral support rate add-on" means per diem reimbursement in the amount of
three hundred dollars paid to an ICFIID that is approved by the department in
accordance with this rule for serving a specific resident who is in middle to
late childhood, generally age ten through seventeen, and who has complex
behavioral support needs. The intensive behavioral support rate addon is
intended to compensate an ICFIID for the additional costs associated with
serving a youth with complex behavioral support needs such as:
(a)
Intensive and
specialized therapies (e.g., occupational, physical, speech, audiology, and
applied behavior analysis);
(b)
Non-traditional
therapies (e.g., art, music, and recreation);
(c)
Higher staffing
levels including one-to-one staffing;
(d)
Specialized
training for staff;
(e)
Higher level and intensity of
supervision;
(f)
Intensive engagement with family or other caregivers;
and
(g)
Participating in the intensive behavioral support
community of practice convened by the department.
(7)
"Person-centered
plan" means a written description of the services to be provided to a resident
of an ICFIID that meets the requirements set forth in
42 C.F.R.
483.440(c) as in effect on
the effective date of this rule for an individual program plan and the
requirements for person-centered planning set forth in rule
5123:2-3-03 of the
Administrative Code.
(8)
"Psychiatrist" means a physician licensed in accordance
with Chapter 4731. of the Revised Code to practice
psychiatry.
(C)
Approval to receive the intensive behavioral support
rate add-on
There are two components of securing approval to receive the intensive behavioral support rate add-on:
(1)
Facility
eligibility
(a)
An ICFIID that is interested in receiving the intensive
behavioral support rate add-on for current or prospective residents may, when
the department is seeking applications, complete and submit an application. The
ICFIID will provide information requested by the department and may be subject
to documentation reviews and on-site visits by department personnel as part of
the application process.
(b)
As part of its application, an ICFIID will submit a
best practices protocol for providing intensive behavioral support which will
be evaluated by the department to determine if it is
acceptable.
(c)
To obtain and maintain approval to receive the
intensive behavioral support rate add-on, an ICFIID will:
(i)
Enter into an
agreement with the department for the provision of intensive behavioral
support.
(ii)
Agree to cooperate with the department's oversight of
intensive behavioral support as described in paragraph (E) of this
rule.
(d)
An ICFIID whose license has been suspended and/or
proposed for revocation by the department within the past twenty-four months is
not eligible to receive the intensive behavioral support rate
add-on.
(2)
Specific youth served
(a)
An ICFIID that
has complied with the requirements and obtained approval in accordance with
paragraph (C)(1) of this rule may request the intensive behavioral support rate
add-on which may be available for serving a specific youth who is:
(i)
Within middle to
late childhood, generally age ten through seventeen.
(ii)
Determined by
the department, in collaboration with the youth's home county board, to need
intensive behavioral support based on a comprehensive review of the youth.
Referral of a youth to the department for a comprehensive review described in
this paragraph may be initiated by the ICFIID or by another entity (such as a
county board or the Ohio department of medicaid). The comprehensive review will
include input from the youth and his or her team and consider:
(a)
The
youth's:
(i)
Clinical diagnosis and history;
(ii)
Current and past
medications;
(iii)
History of living arrangements (e.g., inside or outside
family home, multiple settings, or out-of-state);
(iv)
Educational
history (e.g., previous educational programs, therapies, and
services);
(v)
Sensory integration and functioning (e.g., awareness of
and response to touch, light, color, smell, taste, and
texture);
(vi)
Motor skills (e.g., sitting, standing, walking,
running, climbing stairs, picking up items, and holding
objects);
(vii)
Cognitive abilities (e.g., maintaining attention,
organizing self, recalling information, and connecting behavior with
consequences);
(viii)
Most successful and/or preferred learning style or
modality;
(ix)
Communication skills (e.g., level of speech and
ability/ method for expressing wants and needs);
(x)
Emotional
experience and functioning (e.g., history of trauma; description of the type
and intensity of behaviors that present a danger to self or others; ability to
adapt to change; and if or how the youth demonstrates anxiety, fear, or
symptoms of depression);
(xi)
Social experience and skills (e.g., making and keeping
friends, being able to wait patiently for assistance or attention, and
maintaining personal space);
(xii)
Preferences and
interests, including what is important to and important for the youth, as well
as any skills the youth possesses that are not addressed in other areas;
and
(xiii)
Needs and strengths identified through administration
of the "Child and Adolescent Needs and Strengths" decision-making
tool.
(b)
Positive supports and interventions that have been
found effective in meeting the youth's needs (e.g., successful visual and
environmental supports).
(c)
Assistive technology that has been used or is currently
used to support the youth.
(b)
An ICFIID will
electronically submit a request to secure approval to receive the intensive
behavioral support rate add-on for serving a specific youth to the
department.
(i)
The department will determine whether the ICFIID will receive the intensive
behavioral support rate add-on for serving a specific youth based on the
information contained in the submitted request, the comprehensive review of the
youth conducted in accordance with paragraph (C)(2)(a)(ii) of this rule, the
services offered by the ICFIID, the residents currently served by the ICFIID,
and other information deemed relevant by the department. The department will
notify the ICFIID of its determination within fourteen calendar days after
receipt of the comprehensive review and other relevant
information.
(ii)
The department may issue initial approval for the
intensive behavioral support rate add-on to an ICFIID for serving a specific
youth for a maximum period of one hundred eighty days.
(iii)
The department
may issue approval for continuation of the intensive behavioral support rate
add-on beyond the previously approved period. To ensure continuity, an ICFIID
will electronically submit a request at least thirty calendar days prior to the
last day of the previously approved period. The department will make a
determination based on the submitted request, reports regarding critical events
and the status of the youth's progress, discharge planning options, assessments
conducted by the department, and other information deemed relevant by the
department. The department may approve continuation of the intensive behavioral
support rate add-on for periods of up to one hundred eighty days per
request.
(iv)
The department will issue notice of determination,
indicating approval or denial of the request for the intensive behavioral
support rate add-on for serving a specific youth, to the ICFIID by electronic
mail and provide a copy of the notice to the youth's home county board.
(a)
When a request
for the intensive behavioral support rate add-on is denied, the notice will
specify the reason for denial.
(b)
When a request
for the intensive behavioral support rate add-on is approved, the notice will
include an assigned approval number, the number of days for which the intensive
behavioral support rate add-on is approved, and the date on which payment is
approved to begin. The notice will also include the name, location, and phone
number of the department staff member who is assigned to monitor the youth's
progress at the ICFIID.
(D)
Requirements for services provided With regard to a
youth for whom an ICFIID receives the intensive behavioral support rate add-on,
the ICFIID shall:
(1)
Serve the youth in a discrete unit or building where
only residents age ten through seventeen reside and that has six or fewer
beds.
(2)
Provide the youth with his or her own bedroom which
will not be shared by any other resident.
(3)
Provide services
in accordance with the ICFIID's best practices protocol for providing intensive
behavioral support.
(4)
Utilize trauma-informed approaches to
care.
(5)
Ensure that staff who supervise the day-to-day
provision of services meet one of the following:
(a)
Hold professional
license or certification issued by the Ohio board of psychology; the state
medical board of Ohio; or the Ohio counselor, social worker, and marriage and
family therapist board;
(b)
Hold a certificate to practice as a certified Ohio
behavior analyst pursuant to section
4783.04 of the Revised Code;
or
(c)
Hold a bachelor's or graduate-level degree from an
accredited college or university and have at least three years of paid
full-time (or equivalent part-time) experience in developing and/or
implementing behavioral support and/or risk reduction strategies or
plans.
(6)
Ensure that staff who supervise the day-to-day
provision of services and staff who directly provide services successfully
complete training in:
(a)
Orientation to provision of intensive behavioral
support, including the rights of persons with developmental disabilities set
forth in section 5123.62 of the Revised Code and
the requirements of rule
5123:2-2-06 of the
Administrative Code;
(b)
Accepted best practices and innovative approaches, as
set forth in the ICFIID's best practices protocol for providing intensive
behavioral support, to meet residents' needs;
(c)
Department-provided training in comprehensive supports for
youth with complex behavioral support needs; and
(d)
The specific
needs of, and supports to be provided to, each resident.
(7)
Ensure that nursing services are available twenty-four
hours per day.
(8)
Ensure that psychiatric services are available
twenty-four hours per day and that a psychiatrist reviews the youth's clinical
status at least once every six months.
(9)
Electronically
submit notice to the department no later than by the close of the next business
day when a youth experiences a significant change in status, including
psychiatric hospitalization.
(10)
Obtain the
department's approval prior to initiating a transfer or termination of services
in accordance with rule
5123:2-3-05 of the
Administrative Code.
(11)
Develop a comprehensive person-centered plan including
a viable discharge plan, within thirty calendar days of a youth's admission
that reflects:
(a)
Ongoing collaboration with the youth's parent or
guardian, as applicable, and home county board;
(b)
Arrangement of
school services for the youth;
(c)
Identifying and
accessing necessary supports and services to ensure the youth and the youth's
family or other caregivers, as applicable, are successful; and
(d)
Training the
youth's family or other caregivers, as applicable, in techniques that are found
effective for supporting the youth.
(12)
On a weekly
basis, complete progress notes which describe the youth's progress or lack of
progress, significant changes in functioning, and recommendations for
modification to the person-centered plan, if indicated.
(13)
In collaboration
with a youth's home county board and the department, provide three months of
aftercare services upon the youth's discharge.
(E)
Department
oversight
(1)
The department will oversee provision of intensive
behavioral support to a youth for whom an ICFIID is receiving the intensive
behavioral support rate add-on. Department oversight includes:
(a)
Providing support
to the ICFIID, the youth, and the youth's family or other caregivers to ensure
the youth's needs are met as determined by the team;
(b)
Facilitating
collaboration between the ICFIID and the youth's home county
board;
(c)
Working closely with the ICFIID to discharge the youth
as appropriate or as the youth approaches eighteen years of age;
and
(d)
Providing follow-along services for three years after
the youth is discharged from the ICFIID.
(2)
The department
may withdraw approval of an ICFIID's facility-level eligibility to receive the
intensive behavioral support rate add-on based on:
(a)
The ICFIID's
failure to provide services in accordance with this rule or its agreement with
the department for provision of intensive behavioral support;
(b)
A pattern of
refusing to serve youth referred to the ICFIID by the
department;
(c)
A pattern of requests to involuntarily discharge youth
for whom the ICFIID receives the intensive behavioral support rate add-on based
on the ICFIID's inability to provide necessary services;
(d)
The need to
safeguard the health, safety, or wellbeing of residents or staff of the ICFIID;
or
(e)
The results of a compliance review of the ICFIID
conducted in accordance with rule
5123:2-3-06 of the
Administrative Code.
(3)
The department
will notify an ICFIID by certified mail of withdrawal of approval of the
ICFIID's facility-level eligibility to receive the intensive behavioral support
rate add-on no less than thirty calendar days in advance and assist the ICFIID
and the home county board of an affected resident in securing alternative
accommodations.
(F)
Payment of the
intensive behavioral support rate add-on
(1)
The department
may limit the number of intensive behavioral support rate add-ons that are
available.
(2)
The payment approval date for the intensive behavioral
support rate add-on will be one of the following, but may not be earlier than
the effective date of a youth's developmental disabilities level of care
determination:
(a)
For a youth admitted to an ICFIID on or after the
effective date of this rule, the latter of the date of approval for payment of
the intensive behavioral support rate add-on or the date of admission to the
ICFIID; or
(b)
For a youth admitted to an ICFIID prior to the
effective date of this rule, the date of approval for payment of the intensive
behavioral support rate add-on.
(3)
The intensive
behavioral support rate add-on will be billed and paid in addition to an
ICFIID's typical per diem rate for a specific youth for whom the ICFIID has
secured approval in accordance with paragraph (C)(2) of this
rule.
(4)
The intensive behavioral support rate add-on will be
effective on the payment approval date determined in accordance with paragraph
(F)(2) of this rule through the date authorized by the department in accordance
with paragraph (C)(2)(b)(iv)(b) of this rule or until the date the youth no
longer meets the criteria set forth in paragraph (C)(2)(a) of this
rule.
(5)
An ICFIID shall electronically submit notice to the
department no later than by the close of the next business day when a youth no
longer meets the criteria set forth in paragraph (C)(2)(a) of this
rule.
(6)
An ICFIID shall not bill the intensive behavioral
support rate add-on for a youth who is using bed-hold days in accordance with
rule 5123:2-7-08 of the
Administrative Code.
(7)
Payment of the intensive behavioral support rate add-on
may be denied for any service not rendered in accordance with Chapters 5123-7,
5123:2-7, and 5160-3 of the Administrative Code.
Notes
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5124.03, 5124.26
Rule Amplifies: 5124.26
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