(A)
Purpose
This rule sets forth requirements for the waiting list
established pursuant to section
5126.042 of the Revised Code
when a county board of developmental disabilities
determines that available resources are insufficient to enroll individuals who
are assessed to need and who choose home and community-based services in
department-administered home and community-based services waivers.
(B) Definitions
For the purposes of this rule, the following
definitions apply:
(1) "Adult" means an
individual who is eighteen years of age or older.
(2) "Alternative services" means the various
programs, funding mechanisms, services, and supports, other than home and
community-based services, that exist as part of the developmental disabilities
service system and other service systems. "Alternative services" includes, but
is not limited to, services offered through Ohio's medicaid state plan such as
home health services and services available at an intermediate care facility
for individuals with intellectual disabilities.
(3) "Community-based alternative services"
means alternative services that are available and
likely to meet an individual's needs in a setting other than a hospital,
an intermediate care facility for individuals with intellectual disabilities,
or a nursing facility. "Community-based alternative
services" includes, but is not limited to, services provided through a
community mental health agency or a public children services agency or services
arranged by a county family and children first council described in section
121.37 of the Revised
Code.
(4) "County board"
means a county board of developmental disabilities.
(5) "Current need" means an unmet need for
home and community-based services within twelve months, as determined by a
county board based upon assessment of the individual using the waiting list
assessment tool. Situations that give rise to current need include:
(a) An individual is likely to be at risk of
substantial harm due to:
(i) The primary
caregiver's declining or chronic physical or psychiatric condition that
significantly limits his or her
the primary caregiver's ability to care for the
individual;
(ii) Insufficient
availability of caregivers to provide necessary supports to the individual;
or
(iii) The individual's declining
skills resulting from a lack of supports.
(b) An individual has an ongoing need for
limited or intermittent supports to address behavioral, physical
care, or medical needs, in order to sustain
existing caregivers and maintain the viability of the individual's current
living arrangement.
(c) An
individual has an ongoing need for continuous supports to address significant
behavioral, physical care, or medical
needs.
(d) An individual is aging
out of or being emancipated from children's services and has needs that cannot
be addressed through community-based alternative services.
(e) An individual requires waiver funding for
adult day services or employment-related supports that are not otherwise
available as vocational rehabilitation services funded under section 110 of the
Rehabilitation Act of 1973, 29 U.S.C.
730, as in effect on the
effective date of this rule, or as
" special
education
" or
"
related services
" as those terms are defined in
section 602 of the Individuals with Disabilities Education Improvement Act of
2004, 20 U.S.C.
1401, as in effect on the effective date of
this rule.
(f) An individual is
living in an intermediate care facility for individuals with intellectual
disabilities or a nursing facility and has a viable discharge plan.
(6) "Date of request" means the
earliest date and time of any written or otherwise documented request for home
and community-based services made prior to September 1, 2018.
(7) "Department" means the Ohio department of
developmental disabilities.
(8)
"Home and community-based services" has the same meaning as in section
5123.01 of the Revised
Code.
(9) "Immediate need" means a
situation that creates a risk of substantial harm to an individual, caregiver,
or another person if action is not taken within thirty calendar days to reduce
the risk. Situations that give rise to immediate need include:
(a) A resident of an intermediate care
facility for individuals with intellectual disabilities has received notice of
termination of services in accordance with rule 5123:2-3-05
5123-3-05
of the Administrative Code.
(b) A
resident of a nursing facility has received thirty-day notice of intent to
discharge in accordance with Chapter 5160-3 of the Administrative
Code.
(c) A resident of a nursing
facility has received an adverse determination in accordance with rule
5123:2-14-01
5123-14-01 of the Administrative Code.
(d) An adult is losing
his or her
a
primary caregiver due to the primary caregiver's declining or chronic physical
or psychiatric condition or due to other unforeseen circumstances (such as
military deployment or incarceration) that significantly limit the primary
caregiver's ability to care for the individual when:
(i) Impending loss of the caregiver creates a
risk of substantial harm to the individual; and
(ii) There are no other caregivers available
to provide necessary supports to the individual.
(e) An adult or
child
individual is engaging in
documented behavior that creates a risk of substantial harm to the individual,
caregiver, or another person.
(f)
There is impending risk of substantial harm to the individual or caregiver as a
result of:
(i) The individual's significant
care needs (i.e., bathing, lifting, high-demand, or twenty-four-hour care);
or
(ii) The individual's
significant or life-threatening medical needs.
(g) An adult has been subjected to abuse,
neglect, or exploitation and requires additional supports to reduce a risk of
substantial harm to the individual.
(10)
"
Individual" means a person with a developmental disability.
(11) "Intermediate care facility for
individuals with intellectual disabilities" has the same meaning as in section
5124.01 of the Revised
Code.
(12) "Locally-funded home and
community-based services waiver" means the county board pays the entire
nonfederal share of medicaid expenditures in accordance with sections
5126.059 and
5126.0510 of the Revised
Code.
(13) "Nursing facility" has
the same meaning as in section
5165.01 of the Revised
Code.
(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) "State-funded home and
community-based services waiver" means the department pays, in whole or in
part, the nonfederal share of medicaid expenditures associated with an
individual's enrollment in the waiver.
(16) "Status date" means the date on which
the individual is determined to have a current need based on completion of an
assessment of the individual using the waiting list assessment tool.
(17) "Transitional list of individuals
waiting for home and community-based services" means the list maintained in the
department's web-based individual data system which
shall include
includes the name and date of request for each
individual on a list of individuals waiting for home and community-based
services on August 31, 2018 established in accordance with rule
5123:2-1-08 of the
Administrative Code as that rule existed on August 31, 2018.
(18) "Waiting list assessment tool" means the
Ohio assessment for immediate need and current need contained in the appendix
to this rule, which shall
will be used for purposes of making a
determination of an individual's eligibility to be added to the waiting list
for home and community-based services defined in paragraph (B)(20) of this rule
and administered by persons who successfully complete training developed by the
department.
(19) "Waiting list
date" means, as applicable, either:
(a) The
date of request for an individual whose name is included on the transitional
list of individuals waiting for home and community-based services; or
(b) The earliest status date for an
individual whose name is not included on the transitional list of individuals
waiting for home and community-based services.
(20) "Waiting list for home and
community-based services" means the list established by county boards and
maintained in the department's web-based waiting list management system which
shall include
includes the name, status date, date of request (as
applicable), waiting list date, and the criteria for current need by which an
individual is eligible based on administration of the waiting list assessment
tool, for each individual determined to have a current need on or after
September 1, 2018.
(C)
Planning for locally-funded home and community-based services waivers
A county board shall
will, in conjunction with development of its plan
described in section 5126.054 of the Revised Code and
its strategic plan described in rule
5123-4-01 of the Administrative
Code, identify how many individuals the county board plans to enroll in each
type of locally-funded home and community-based services waiver during each
calendar year, based on projected funds available to the county board to pay
the nonfederal share of medicaid expenditures and the assessed needs of the
county's residents on the waiting list for home and community-based services.
This information shall
will be made available to any interested person
upon request.
(D)
Administration of the waiting list assessment
tool
(1)
A
county board will administer the initial waiting list assessment tool to an
individual when the individual, the individual's guardian, or a member of the
individual's family:
(a)
Requests the county board administer the waiting list
assessment tool;
(b)
Requests the individual be enrolled in a home and
community-based services waiver or placed on the waiting list for home and
community-based services; or
(c)
Identifies an
unmet need.
(2)
A county board will re-administer the waiting list
assessment tool to an individual when the individual, the individual's
guardian, or a member of the individual's family identifies a change in
circumstance that may result in the individual having a current need or an
immediate need.
(3)
When cause for administering the waiting list
assessment tool is identified in accordance with paragraph (D)(1) or (D)(2) of
this rule, a county board will:
(a)
Explain to the individual, the individual's guardian
(which may include a public children services agency), or the individual's
family member, as applicable, the waiting list assessment tool process and
timeframes set forth in this rule.
(b)
Identify services
available to meet the individual's needs while the waiting list assessment tool
is being completed.
(c)
Assess the individual using the waiting list assessment
tool.
(i)
The
waiting list assessment tool will be initiated by conducting an interview with
the individual and the individual's guardian, as applicable, within fifteen
calendar days of the date that cause for administering the waiting list
assessment tool is identified in accordance with paragraph (D)(1) or (D)(2) of
this rule. The county board will document extenuating circumstances related to
the individual that delay conduct of the interview.
(ii)
The waiting list
assessment tool will be completed within forty-five calendar days of the date
the interview with the individual and/or the individual's guardian is conducted
in accordance with paragraph (D)(3)(c)(i) of this rule. The county board will
document extenuating circumstances related to the individual that delay
completion of the waiting list assessment tool.
(4)
A
county board will notify the individual or the individual's guardian, as
applicable, of the outcome of administration of the waiting list assessment
tool within ten calendar days of completion.
(a)
The notice will
include a copy of the individual's completed waiting list assessment tool and
an explanation of the individual's/guardian's due process rights in accordance
with paragraph (J) of this rule.
(b)
When the county
board determines the individual does not require waiver enrollment or placement
on the waiting list for home and community-based services because
community-based alternative services are available to meet the individual's
assessed needs, the notice will include:
(i)
A list of the
individual's assessed needs.
(ii)
Specific
community-based alternative services that address each assessed
need.
(iii)
The date by which the county board will follow-up with
the individual/guardian to determine if the suggested community-based
alternative services have been accessed.
(iv)
Contact
information for a person at the county board who can assist in identifying and
accessing community-based alternative services.
(D)(E) Waiting list for
home and community-based services
(1) An individual or the
individual's guardian, as applicable, who thinks the individual has an
immediate need or a current need may contact the county board in the
individual's county of residence to request an assessment of the individual
using the waiting list assessment tool. The county board shall initiate an
assessment of the individual using the waiting list assessment tool within
thirty calendar days. An individual or the individual's guardian, as
applicable, shall have access to the individual's completed waiting list
assessment tool maintained in the department's web-based waiting list
management system and upon request, shall be provided a copy by the county
board.
(2)(1) The county board
shall
will
place an individual's name on the waiting list for home and community-based
services when, based on assessment of the individual using the waiting list
assessment tool, the individual:
(a) Has been
determined to have a condition that is:
(i)
Attributable to a mental or physical impairment or combination of mental and
physical impairments, other than an impairment caused solely by mental
illness;
(ii) Manifested before the
individual is age twenty-two; and
(iii) Likely to continue indefinitely;
and
(b) Has a current
need which cannot be met by community-based alternative services in the county
where the individual resides (including a situation in which an individual has
a current need despite the individual's enrollment in a home and
community-based services waiver).
(3)(2) The county board
shall
will
not place an individual's name on the waiting list for home and community-based
services when the individual:
(a) Is a child
who is subject to a determination under section
121.38 of the Revised Code and
requires home and community-based services; or
(b) Has an immediate need, in which case the
county board shall
will take action necessary to ensure the immediate
need is met. The county board shall
will provide the individual or the individual's
guardian (which may include a public children services
agency), as applicable, with the option of having the individual's needs
met in an intermediate care facility for individuals with intellectual
disabilities or through community-based alternative services. Once an
individual or individual's guardian chooses the setting in which he or she prefers to receive
services
preferred setting option, the
county board shall
will take action to ensure the individual's immediate
need is met, including by enrollment in a home and community-based services
waiver, if necessary. Such action may also include assisting the individual or
the individual's guardian, as applicable, in identifying and accessing
alternative services that are available to meet the individual's
needs.
(4)(3) When a county board
places an individual's name on the waiting list for home and community-based
services, the county board
shall
will:
(a)
Record, in the department's web-based waiting list management system:
(i) The individual's status date;
and
(ii) For an individual included
in the transitional list of individuals waiting for home and community-based
services defined in paragraph (B)(17) of this rule, the individual's date of
request.
(b) Notify the
individual or the individual's guardian, as applicable, that the individual's
name has been placed on the waiting list for home and community-based
services.
(c) Provide contact
information to the individual or the individual's guardian, as applicable, for
a person at the county board who can assist in identifying and accessing
alternative services that address, to the extent possible, the individual's
needs.
(5)(4) Annually, a county
board
shall
will:
(a) Review the
waiting list assessment tool and service needs of each individual whose name is
included on the waiting list for home and community-based services with the
individual and the individual's guardian, as applicable; and
(b) Assist the individual or the individual's
guardian, as applicable, in identifying and accessing alternative
services.
(6)(5) Under any
circumstances, when a county board determines an individual's status has
changed with regard to having an immediate need and/or having a current need or
an individual's status date has changed, the county board
shall
will
update the individual's record in the department's web-based waiting list
management system.
(E)(F) Order for enrolling
individuals in locally-funded home and community-based services waivers
(1)
Individuals
shall be selected
A county board will select
individuals for enrollment in locally-funded home and community-based
services waivers in this order:
(a)
Individuals with immediate need who require waiver funding to address the
immediate need.
(b) Individuals who
have met multiple criteria for current need for twelve or more consecutive
months and who were not offered enrollment in a home and community-based
services waiver in the prior calendar year. When two or more individuals meet
the same number of criteria for current need, the individual with the earliest
of either the status date or date of request shall
will be
selected for enrollment.
(c)
Individuals who have met multiple criteria for current need for less than
twelve consecutive months. When two or more individuals meet the same number of
criteria for current need, the individual with the earliest of either the
status date or date of request shall
will be selected for enrollment.
(d) Individuals who meet a single criterion
for current need. When two or more individuals meet a single criterion for
current need, the individual with the earliest of either the status date or
date of request shall
will be selected for enrollment.
(2) Individuals with immediate
need and individuals with current need may be enrolled in locally-funded home
and community-based services waivers concurrently.
(3) Meeting the criteria for immediate need
and/or current need does not guarantee enrollment in a locally-funded home and
community-based services waiver within a specific timeframe.
(4) When an individual is identified as next
to be enrolled in a locally-funded home and community-based services waiver,
the county board shall
will determine the individual's eligibility for
enrollment in a home and community-based services waiver. When the county board
determines an individual is eligible for enrollment in a home and
community-based services waiver, the county board shall
will determine
which type of locally-funded home and community-based services waiver is
sufficient to meet the individual's needs in the most cost-effective
manner.
(F)(G) Order for enrolling
individuals in state-funded home and community-based services waivers
(1) The department shall
will determine
the order for enrolling individuals in state-funded home and community-based
services waivers.
(2) Meeting the
criteria for immediate need and/or current need does not guarantee enrollment
in a state-funded home and community-based services waiver within a specific
timeframe.
(G)(H) Change in an
individual's county of residence
When an individual on the waiting list for home and
community-based services moves from one county to another and the individual or
the individual's guardian, as applicable, notifies the receiving county board,
the receiving county board shall
will, within ninety calendar days of receiving
notice, review the individual's waiting list assessment tool.
(1) When the receiving county board
determines that the individual has a current need which cannot be met by
community-based alternative services in the receiving county (including a
situation in which an individual has a current need despite the individual's
enrollment in a home and community-based services waiver), the receiving county
board shall
will update the individual's county of residence in
the department's web-based waiting list management system without changing the
status date or date of request assigned by the previous county board.
(2) When the receiving county board
determines that the individual has a current need which can be met by
community-based alternative services in the receiving county, the receiving
county board shall
will assist the individual or the individual's
guardian, as applicable, in identifying and accessing those services.
(H)(I) Removal from
waiting list for home and community-based services
A county board shall
will remove an individual's name from the waiting
list for home and community-based services:
(1) When the county board determines that the
individual no longer has a condition described in paragraph
(D)(2)(a)
(E)(1)(a) of this rule;
.
(2) When the county board determines that the
individual no longer has a current need;
.
(3) Upon request of the individual or the
individual's guardian, as applicable;
.
(4) Upon
enrollment of the individual in a home and community-based services waiver that
meets the individual's needs;
.
(5) If
the individual or the individual's guardian, as applicable, declines enrollment
in a home and community-based services waiver or community-based alternative
services that are sufficient to meet the individual's needs;
.
(6) If the individual or the individual's
guardian, as applicable, fails to respond to attempts by the county board to
contact the individual or the individual's guardian by at least two different
methods
, one of which shall be certified
mail
from the following list to the last
known address of the individual or the individual's guardian, as
applicable
;
:
(a)
Electronic
mail;
(b)
Traceable delivery service; or
(c)
Personal
service.
(7) When
the county board determines the individual does not have a developmental
disabilities level of care in accordance with rule 5123:2-8-01
5123-8-01
of the Administrative Code;
.
(8) When the individual is no longer a
resident of Ohio; or
.
(9) Upon
the individual's death.
(I) Advancement from transitional
list of individuals waiting for home and community-based services to waiting
list for home and community-based services
(1) The department shall maintain
the transitional list of individuals waiting for home and community-based
services as defined in paragraph (B)(17) of this rule until December 31,
2020.
(2) A county board shall administer
the waiting list assessment tool to each individual residing in the county
whose name is included on the transitional list of individuals waiting for home
and community-based services.
(a) The county board shall
administer the waiting list assessment tool to each individual residing in the
county whose name is included on the transitional list of individuals waiting
for home and community-based services who receives service and support
administration when the individual service plan is next scheduled for review
following September 1, 2018.
(b) The county board shall
administer the waiting list assessment tool to each individual residing in the
county whose name is included on the transitional list of individuals waiting
for home and community-based services who does not receive service and support
administration no later than December 31, 2020. A county board may request and
the department may provide assistance to identify, locate, contact, or
administer the waiting list assessment tool to individuals residing in the
county but unknown to the county board.
(c) There are three possible
outcomes of administration of the waiting list assessment tool:
(i) The county board determines the
individual has an immediate need, in which case the individual shall receive
services in accordance with paragraph (D)(3)(b) of this rule;
(ii) The county board determines the
individual has a current need, in which case the county board shall use
community-based alternative services in the county to meet the individual's
needs or if the individual's needs cannot be met by community-based alternative
services in the county, the county board shall add the individual's name to the
waiting list for home and community-based services; or
(iii) The county board determines
the individual has neither an immediate need nor a current
need.
(d) Once the waiting list assessment
tool has been administered to an individual whose name is included on the
transitional list of individuals waiting for home and community-based services
and a determination made, the county board shall notify the department and the
department shall remove the individual's name from the transitional list of
individuals waiting for home and community-based services.
(3) The county board or the
department shall attempt to contact each individual whose name is included on
the transitional list of individuals waiting for home and community-based
services or the individual's guardian, as applicable, by at least two different
methods, one of which shall be certified mail to the last known address of the
individual or the individual's guardian, as applicable. The department shall
remove an individual's name from the transitional list of individuals waiting
for home and community-based services when the individual or the individual's
guardian, as applicable:
(a) Fails to respond to attempts by
the county board or the department to establish contact; or
(b) Declines an assessment of the
individual using the waiting list assessment tool.
(J) Due process
(1) Due process shall be afforded to
an individual aggrieved by an action of a county board related
to:
(a) The approval, denial,
withholding, reduction, suspension, or termination of a service funded by the
state medicaid program;
(b) Placement on, denial of
placement on, or removal from the waiting list for home and community-based
services or the transitional list of individuals waiting for home and
community-based services; or
(c) A dispute regarding an
individual's date of request or status date.
(1)
Due process will
be afforded to an individual when a county board takes an action related to
placement on, denial of placement on, or removal from the waiting list for home
and community-based services.
(2)
The county board
will issue and explain due process to the individual or the individual's
guardian, as applicable, using a form approved by the Ohio department of job
and family services (available at odjfs.state.oh.us/forms/).
(2)(3)
Due process
shall
will be provided in accordance with section
5160.31 of the Revised Code and
Chapters 5101:6-1 to 5101:6-9 of the Administrative Code.
Click to view
Appendix
Notes
Ohio Admin. Code
5123-9-04
Effective:
11/1/2024
Five Year Review (FYR) Dates:
8/5/2024 and
11/01/2029
Promulgated
Under: 119.03
Statutory
Authority: 5123.04,
5126.042
Rule
Amplifies: 5123.04,
5126.042,
5126.044,
5126.054,
5126.055
Prior
Effective Dates: 07/01/1976, 12/11/1983, 07/01/1991 (Emer.), 09/13/1991,
04/22/1993, 06/02/1995 (Emer.), 12/09/1995, 02/28/1996 (Emer.), 05/28/1996,
07/12/1997, 08/01/2001, 01/02/2002 (Emer.), 03/21/2002, 12/01/2011, 01/01/2016,
09/01/2018, 11/19/2018
