Ohio Adm.Code 5123 | Ohio Administrative Code 5123 — Department of Developmental Disabilities

Chapter 5123-1 Community Capital Assistance Funds

Ohio Adm.Code 5123-1-01 Community capital assistance funds - non-residential capital facilities.

(A) Purpose

This rule sets forth a process for the department to make available community capital assistance funds to boards of county commissioners, county boards of developmental disabilities, and nonprofit corporations for the purchase, construction, and renovation of non-residential capital facilities.

(B) Definitions

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

(1) "Applicant" means any of the following who submit an application to the department for community capital assistance funds:

(a) A board of county commissioners;

(b) A county board of developmental disabilities; or

(c) A nonprofit corporation incorporated pursuant to Chapter 1702. of the Revised Code, granted 501(c)(3) status by the internal revenue service, and specifically chartered to provide a developmental disability service when such service fulfills a public purpose as provided by section 154.20 of the Revised Code. When the applicant is a nonprofit corporation, the applicant shall submit with the application, in addition to all other documents required by this rule, a copy of its articles of incorporation, code of regulations, and a current list of all directors, officers, and members.

(i) The articles of incorporation will contain, in addition to provisions otherwise required by law, a specific statement of purpose that the corporation will provide a developmental disability service.

(ii) The code of regulations will contain the following provisions in addition to those specifically required by law:

(a) A provision stating that services will neither be rendered nor denied on the basis of race, color, religion, national origin, disability, age, or unless programmatically justifiable, sex;

(b) A provision that upon dissolution of the corporation, if such dissolution occurs within the length of the project agreement, the department or its successor will be a party to any judicial proceeding or dissolution agreement and that the department or its successor may be a distributee under such order or agreement to the extent of its participation and to the extent provided by law or the project agreement which originally set forth disbursal of funds to the corporation;

(c) A provision that no persons related by blood, marriage, or adoption (to a degree of first cousin) will constitute a majority of the board of directors; and

(d) A provision requiring disclosure of potential conflicts of interest of a director, procedures for determining whether there is a conflict of interest, and establishing a course of action if a conflict of interest is identified.

(2) "Approved project costs" means total costs of capital facilities and includes, without limitation thereto, site acquisition, design and project administration fees paid to an outside consultant, construction costs, costs of permits and inspections, bid advertising, construction document printing costs, and equipping the capital facility to accommodate the approved program. The applicant must obtain written approval from the department for costs other than those items listed in this paragraph.

(3) "Capital facilities" has the same meaning as in section 154.01 of the Revised Code.

(4) "Community capital assistance funds" means funds appropriated by the general assembly to the department for capital projects.

(5) "Construction" means the construction of new buildings or renovation of existing buildings provided by section 154.01 of the Revised Code, except that renovation does not include work that consists primarily of maintenance repairs and replacement due to normal use, wear and tear, or deterioration.

(6) "Controlling board" means the board established by section 127.11 of the Revised Code.

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

(8) "Renovation" means work done to a building to restore it to an acceptable condition meeting Ohio basic building code and to make it functional for the purpose set forth in an application for community capital assistance funds, including architectural and structural changes and the modernization of mechanical and electrical systems. Renovation does not include work that consists primarily of maintenance repairs and replacement due to normal use, wear and tear, or deterioration.

(1) Prior to purchasing a capital facility or initiating a construction or renovation project, the applicant shall submit an application for community capital assistance funds to the department in a form and manner prescribed the department.

(2) The department will evaluate applications based upon:

(a) Submission of a complete and accurate application;

(b) Projects that are programmatically acceptable;

(d) Availability of local matching funds.

(D) Awarding of funds

(1) The department will inform the applicant in writing of approval or disapproval of a project. If a project is approved, the letter will indicate the amount of state funding approved, subject to favorable fund release action by the controlling board.

(2) Upon approval of a project and prior to payment of community capital assistance funds, an applicant shall enter into a project agreement with the department that assures:

(a) The completion of the project in accordance with standards set forth by the department and other applicable federal, state, and local statutes.

(b) The operation of the capital facility in accordance with the project agreement.

(c) The applicant will use and maintain the capital facility for the length of the project agreement for the purpose stated in the application unless otherwise agreed to in writing by the department.

(d) If the capital facility is not used for said purpose, the applicant shall pay to the department, on a pro rata basis, any community capital assistance funds disbursed to the applicant or permit the department to operate or transfer the operation of the capital facility, including the assignment of any contracts or other interests, to another approved organization for the balance of the project agreement. The terms of the project agreement will expire as of the earlier of:

(i) Fifteen years from the date of the project agreement; or

(ii) The date when all capital bonds, any of the proceeds of which were expended for project costs, are no longer outstanding.

(3) The department will participate at a percentage level of the total project cost based upon a funding formula developed by the department.

(4) The department, as a part of a construction or purchase and renovation project and contingent upon the availability of department funds, may consider and include in the development of the participation schedule the value of property purchased by an applicant and may use such value as part or all of the applicant's share of approved project costs under the following provisions:

(a) The department has final discretion to:

(i) Approve the use of the value of property and/or buildings thereon which are owned by an applicant as part or all of the local participation share in a project;

(ii) Determine the part or percentage of a building and/or property which may be used as local participation share; and

(iii) Determine that the property and/or buildings thereon are suitable for the intended purpose both programmatically and economically.

(b) The property value to be used in the participation schedule for projects involving property owned by the applicant for less than one year will be based on the purchase price or the appraised value, whichever is less. For projects involving property owned by the applicant for one year or more, the value to be used will be based on the appraised value. The appraised value will be determined by an appraisal made by an accredited appraiser. The appraisal will be based on the fair market value of the property as determined by the appraisal. The appraisal fee will be considered as an element or project cost eligible for state participation. Two appraisals are required if the value exceeds one hundred thousand dollars, and the appraisals must be descriptive narratives.

(5) The applicant shall verify that sufficient funds will be available to meet the applicant's share of project cost from project initiation through project completion.

(6) The applicant has one year from the date of controlling board approval to begin the construction/renovation project. The department has the discretion to withdraw funds at any time if the project is not proceeding in a timely manner.

(E) Standards of construction, design criteria, site criteria, and reimbursement

(1) The department will pay the applicant for approved costs for an amount up to but not exceeding the maximum state share of project cost stated in the approved application. No additional funds will be approved over the maximum state share of project cost once the funds are released from the controlling board.

(2) The applicant shall hold the department harmless for any liability resulting from liens issued against the project by any contractors, subcontractors, material suppliers, or laborers.

(3) The applicant shall obtain the services of registered architects or engineers to perform any design work required for the project. The applicant agrees that if design fees for the project equal or exceed twenty-five thousand dollars, any architectural or engineering services will meet the requirements of sections 153.65 to 153.70 of the Revised Code. The applicant shall provide and maintain competent and adequate architectural or engineering supervision and observation at the construction site. On the basis of on-site observations as an architect, the architect shall keep the applicant informed of the progress and quality of the work and endeavor to guard the applicant against defects and deficiencies in the work.

(4) No funds for the project will be used by the applicant for renovation, rehabilitation, or construction unless the mechanics, laborers, or workers are paid the prevailing wage rates as described in section 4115.04 of the Revised Code.

(5) The applicant shall agree to solicit or cause to be solicited through a public solicitation or an invitation for bids, bids in accordance with federal, state, and local laws.

(6) The applicant shall agree to complete a life cycle cost analysis when required by Chapter 123:4-1 of the Administrative Code.

(7) The applicant shall agree to provide and maintain insurance or self-insurance against general liability for accidents or injuries that may occur on the premises of the project. The applicant shall also ensure that the capital facility design and construction conform to all applicable building codes, standards, zoning, and licensing requirements.

(8) The project agreement between the department and the applicant will include the following terms:

(a) That all contractors agree to comply with all applicable federal, state, and local laws in the conduct of the work hereunder. The contractors shall accept full responsibility for payment of all unemployment compensation, insurance premiums, income tax deductions, social security deductions, and any and all other taxes or payroll deductions required for all employees engaged by contractors in the performance of the work authorized by the project agreement.

(b) That the project is located upon, or will be located upon, real estate which the applicant owns in fee simple or in which it has a leasehold interest; the terms of lease are subject to the department's approval. The applicant further covenants that the premises are, and will remain for the term of the project agreement, free and clear of all liens, encumbrances, restrictions, and conditions, which prevent or interfere with the use of the project facilities, except such as may be imposed by zoning ordinances and regulations.

(c) That requirements for approval of title on capital projects as approved by the office of the attorney general will include a current title insurance policy (no more than sixty days old) or current attorney opinion of title, a map outlining the project site, and a deed.

(d) That if leased property is being used:

(i) The term of the lease will be at least fifteen years.

(ii) The department will have an opportunity to absolutely cure any default to avoid the reversion of the property to the lessor, and the department may at its option assume operation of the capital facility or may transfer or assign the leasehold interest and the operation of the program in the capital facility, upon approval of the lessor, which approval will not be unreasonably withheld, to a nonprofit corporation or other agency to provide substantially similar services in the capital facility for the remainder of the lease term.

(iii) The lease will state the exact location of the space being leased, if only a portion of the property is being leased.

(iv) Documentation will be submitted establishing who owns the underlying land or building. If the applicant is subleasing part of a building, a copy of the prime lease with a certification that the copy is a true copy as well as the document that gives the lessor permission to sublet the property must be provided.

(v) Proof will be submitted to the department that all leasehold interests are recorded in the county recorder's office.

(e) That a certified copy of a resolution with a secretary's certificate that the persons who signed the lease or sublease were authorized to do so must be provided.

(f) That the lease provision is consistent with the series II lease agreements and attachment A of the project agreement and clearly stated that the property is to be leased for a minimum of fifteen years.

(9) The department may participate in the cost or value of real property to be used for capital facilities. Such property may include land only or land with existing buildings thereon which is to be purchased.

(a) All real property proposed as a project site will be evaluated by the department as applicable to cost adaptability for renovation, programmatic suitability, economic feasibility, and ability or potential to meet applicable building and fire codes, licensure, and department or other governmental requirements and with consideration of the following criteria for construction project sites:

(i) Location, including sociological and demographic considerations of area and access to site;

(ii) Program needs;

(iii) Cost of property, including comparison of similar property in the area;

(iv) Size, including needs for future expansion;

(v) Zoning, transportation, and utilities, including gas, electric, water, and sewerage;

(vi) Configuration, topography, suitability for construction; and

(vii) Environmental assessment that includes, but is not limited to, asbestos, polyvinyl chlorides, and chemical contaminants that may be present on the site.

(b) Property value determination

(i) The value of real property proposed for a project will be based on a descriptive narrative appraisal made by a qualified appraiser. The appraised value will be based on the fair market value of the property as determined by the appraisal and approved by the department.

(ii) Department participation in real property will be based on the purchase price or approved appraised value, whichever is the lesser.

(i) In addition to all other provisions of this rule, for projects involving the purchase or purchase and renovation of existing buildings, the department will determine the maximum approved renovation/acquisition cost excluding land. This maximum approved renovation/acquisition cost plus land cost will be the basis upon which maximum state participation is calculated.

(ii) To reflect the fact that older buildings generally are less suitable than newer buildings, the maximum approved project cost will in all cases be less than one hundred per cent of the cost of new construction. This percentage will be eighty-five per cent less one per cent for each year of age of the existing building. For buildings which have had additions, the age will be the weighted average age of the various portions of the building. For existing buildings fifteen years old or older, the maximum percentage will be seventy per cent.

(10) Payment schedule

(a) Once the project has been bid and the contractors have been awarded their contracts, the applicant shall notify the department of the contract amount and also certify that the selected construction contractor submitted the lowest best bid. An initial award installment that equals fifteen per cent of the total approved project costs will be forwarded to the applicant at that point. Additional installments will be made to the applicant in accordance with the construction project payment schedule contained in the appendix to this rule.

(b) The department may adjust the construction project payment schedule based upon written justification provided by the applicant.

(c) The applicant shall keep records of all receipts and expenditures for a project in a separate account which will be available for inspection or audit by the department. The applicant shall submit paid receipts to the department when requesting the next installment. The department, after appropriate audit or required documentation is received and a determination is made of the percentage level of project completion, will promptly take necessary action to forward the next installment.

(d) The department reserves the right to withhold an installment for any project.

(11) The final submission of receipts for payment will include a letter from the contractor(s) certifying that the work has been completed in accordance with the approved application, the drawings and specifications, and contract documents; that prevailing wages have been paid during the project; and that affidavits of release of liens from all prime contractors on the project have been obtained. The applicant shall certify that the applicant or the applicant's agent has inspected the work and that it complies with the approved application, the drawings and specifications, and all other contract documents.

(12) All contracts awarded by the applicant for the project will contain provisions by which:

(a) The contractor agrees that in the hiring of employees for the performance of work under the contract or any subcontract, no contractor, subcontractor, nor any person acting on the contractor's behalf shall by reason of race, creed, sex, disability or military status as defined in section 4112.01 of the Revised Code, or color, discriminate against or intimidate any citizen of the state of Ohio in the employment of labor or workers who are qualified and available to perform the work to which the employment relates.

(b) The contractor agrees that no contractor, subcontractor, nor any person acting on the contractor's behalf shall in any manner discriminate against or intimidate any employee hired for the performance of work under the contract on account of race, creed, sex, disability or military status as defined in section 4112.01 of the Revised Code, or color.

(13) The applicant shall ensure that the contractor(s) provide for an affirmative action program for the employment and effective utilization of disadvantaged persons whose disadvantage may arise from cultural, racial, or ethnic background, or other similar cause, including but not limited to, race, religion, sex, disability or military status as defined in section 4112.01 of the Revised Code, national origin, or ancestry.

(14) In awarding contracts for the project, the applicant shall ensure that equal consideration is given to contractors, subcontractors, or joint venturers who qualify as a minority business enterprise as defined in section 122.71 of the Revised Code.

(15) The applicant shall keep all financial records in a manner consistent with generally accepted accounting procedures. Documentation to support each action will be filed in a manner allowing it to be readily located. Such documentation will be maintained by the applicant until fifteen years after the project is completed, or the date when all capital bonds, any of which were expended for project costs, are no longer outstanding, whichever is earlier.

(16) The department reserves the right to audit the expenditure of community capital assistance funds to determine whether they were applied to the project. The department may bring action to recoup any funds expended for purposes other than the project or not expended in conformance with the procedures outlined in the project agreement and in this rule, or if the applicant breaches the project agreement in any manner.

(F) Waiving a condition or requirement of this rule

The director of the department may, for good cause, waive a condition or requirement of this rule. The director's decision with regard to waiving a condition or requirement of this rule is not subject to appeal.

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Last updated June 25, 2025 at 11:25 PM

History

Effective: May 4, 2023
Promulgated Under: 119.03

Ohio Adm.Code 5123-1-02 Community capital assistance funds - acquisition of housing by county boards of developmental disabilities for youth with intensive behavioral support needs.

(A) Purpose

This rule sets forth a process for the department to make available community capital assistance funds to assist county boards of developmental disabilities to acquire housing for youth with intensive behavioral support needs receiving supported living, including supported living funded by a home and community-based services waiver administered by the department.

(B) Definitions

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

(1) "Appraisal" means a written report completed by a certified or licensed appraiser which includes a floor plan sketch of the housing; front, back, and street scene photographs of the housing; three interior photographs of the housing; a street map that shows the location of the housing and the comparable sales; front photographs of the comparable sales; a statement of assumptions and limiting conditions; and the appraiser's certification.

(2) "Community capital assistance funds" means funds appropriated by the general assembly to the department for capital projects.

(3) "Construction" means the act or process of assembling or building a fully-accessible one-story single-family home, one-story duplex, or one-story quadplex from raw materials upon a permanent foundation. Construction includes contracting with a builder to construct a residence or the purchase of a manufactured home from a manufacturer.

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

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

(6) "Duplex" means a separate or detached residence with two dwelling units designed and arranged for use by two families separated by a horizontal or vertical wall, each of which is heated independently of the other and has its own separate, private means of ingress and egress.

(7) "Dwelling unit" means a single, self-contained unit providing independent living facilities for one or more individuals and which contains eating, living, sanitary, sleeping, and cooking facilities, all for the exclusive use by the occupants.

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

(9) "Housing" means a single-family home, a duplex, or a quadplex.

(10) "Housing construction project" means a department-approved construction project that enables a county board to contract for the construction of a fully accessible one-story single-family home, one-story duplex, or one-story quadplex.

(11) "Quadplex" means a separate or detached residence with four one-bedroom dwelling units designed and arranged for use by four individuals separated by a horizontal or vertical wall, each of which is heated independently of the others and has its own separate, private means of ingress and egress.

(12) "Single-family home" means a residential building consisting of one dwelling unit designed and arranged for use by one family. The term includes a permanently-sited manufactured home and a condominium under Chapter 5311. of the Revised Code.

(13) "Supported living" has the same meaning as in section 5126.01 of the Revised Code.

(14) "Youth" means an individual with a developmental disability who is:

(a) Under the age of eighteen; and

(b) Has intensive behavioral needs as evidenced by:

(i) Aggressive behavior;

(ii) A significant history of trauma; and

(iii) Involvement with another child-serving agency.

(1) Community capital assistance funds may be used to acquire housing or to fund a housing construction project for youth receiving supported living in accordance with sections 5126.40 to 5126.47 of the Revised Code or youth receiving supported living funded by a home and community-based services waiver administered by the department.

(2) The housing will:

(a) Serve as residences for no more than four youth; and

(b) Be used as residences for individuals with developmental disabilities for at least one hundred eighty months.

(3) A county board may own the housing but will not be the provider of services delivered in the housing.

(4) Community capital assistance funds will not be used to purchase:

(a) Furniture and household items other than those fixed items customarily included in a purchase agreement or a construction contract;

(b) Mobile homes; or

(5) A county board will repay community capital assistance funds if any provision of this rule is violated. The repayment will be calculated by multiplying the amount of funds provided under this rule by the ratio of one hundred eighty minus the number of months the housing is used for residences for individuals with developmental disabilities (as determined by the department) to the total term of one hundred eighty months, that is:

repayment = funds provided x [(180 - number of months used for residences)/180]

(D) Application procedure

(1) Prior to purchasing housing or initiating a housing construction project, a county board will submit a letter of intent and an application to the department in a form and manner prescribed by the department. Each application will include:

(a) A specification of whether the housing will be used for respite (i.e., a stay of thirty or fewer days) or long-term residences.

(b) A pro forma for fifteen years demonstrating the source of funds for operating the housing and costs of operating the housing, including maintenance.

(d) Demonstration of support from other child-serving agencies in the county, including the children's services board, the mental health board, and the family and children first council.

(e) A projection over the next three years of the number of youth in the county who might benefit from the housing.

(f) A description of the planned use of the housing including, but not limited to, the age range of the youth for whom the housing would be appropriate and whether the housing is planned for only males or only females.

(2) The department will notify the county board whether the application is approved or disapproved.

(3) Based on available funding, the department will distribute community capital assistance funds to a county board utilizing a formula developed by the department. The department may participate at a percentage level of the cost of the housing.

(E) County board assurances

(1) Only one single-family home, duplex, or quadplex may be located on a lot or parcel of land. Community capital assistance funds will not be used to purchase housing on adjoining lots or parcels if the department determines doing so would create the appearance of congregating individuals with developmental disabilities.

(2) Housing will be kept in good order and condition by:

(a) Making all necessary or appropriate repairs and replacements;

(b) Complying with all laws, rules, insurance policies, and regulations;

(c) Obtaining and maintaining any governmental licenses and permits required for the use, maintenance, repair, and operation of the housing;

(d) Paying all costs, claims, damages, fees, and charges arising out of the possession, use, operation, or maintenance of the housing; and

(e) Remaining free of all liens, encumbrances, restrictions, and conditions which prevent or interfere with its use as residences for individuals with developmental disabilities.

(3) Before receiving community capital assistance funds, the county board will enter into a contract with the department.

(4) Within sixty calendar days of acquiring the housing, the county board will provide the department with copies of the final closing statement and the recorded deed (with restrictions noted as necessary).

(5) The county board will annually report to the department, the number of youth served in the housing, the average length of stay, and the involvement of other child-serving agencies.

(F) Distribution of community capital assistance funds

(1) For purchased housing, the department will issue a check for all or a portion of the community capital assistance funds awarded to a county board after receiving the documents listed in paragraphs (F)(1)(a) to (F)(1)(f) of this rule and after determining that all requirements of this rule have been met. The department may present the check at the closing.

(a) A completed application;

(b) An appraisal that is not more than six months old;

(d) A copy of the title insurance policy;

(e) If the housing is a condominium, a copy of the condominium description, deed restrictions, and homeowner association rules and by-laws; and

(f) Any other documents specified by the department.

(2) For a housing construction project, the department will issue a check for all or a portion of the community capital assistance funds awarded to a county board after receiving the documents listed in paragraphs (F)(2)(a) to (F)(2)(e) of this rule and after determining that all requirements of this rule have been met:

(a) A copy of the mortgage;

(b) A copy of the title insurance policy;

(d) An appraisal that is not more than six months old; and

(e) Any other documents specified by the department.

(G) Acquisition of replacement housing

(1) To sell housing purchased under this rule and obtain replacement housing, the county board will:

(a) Comply with sections 5123.37 to 5123.375 of the Revised Code;

(b) Provide the department with an appraisal that is not more than six months old, promissory note, mortgage, and recorded deed for the replacement housing; and

(2) The net sale proceeds will equal the amount of community capital assistance funds owed to the department in accordance with the formula in paragraph (C)(5) of this rule.

(H) Failure to comply with this rule

Failure to comply with this rule may result in the repayment of the community capital assistance funds awarded under this rule and/or the denial of future requests for funds.

(I) Waiving a condition or requirement of this rule

The director of the department may, for good cause, waive a condition or requirement of this rule except as otherwise required by law. The director's decision with regard to waiving a condition or requirement of this rule is not subject to appeal.

Last updated September 16, 2022 at 8:28 AM

History

Effective: September 16, 2022
Promulgated Under: 119.03

Ohio Adm.Code 5123-1-03 Community capital assistance funds - acquisition of housing.

(A) Purpose

This rule sets forth a process for the department to make available community capital assistance funds to assist county boards of developmental disabilities to acquire housing for individuals receiving supported living, including supported living funded by a home and community-based services waiver administered by the department.

(B) Definitions

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

(2) "Community capital assistance funds" means funds appropriated by the general assembly to the department for capital projects.

(3) "Construction" means the act or process of assembling or building a one-story single-family home, a one-story duplex, or a one-story quadplex from raw materials upon a permanent foundation. Construction includes contracting with a builder to construct a residence or the purchase of a manufactured home from a manufacturer.

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

(5) "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) "Housing" means a single-family home, a duplex, or a quadplex.

(10) "Housing construction project" means a department-approved construction project that enables a county board to authorize a nonprofit corporation or local housing authority to contract for the construction of a fully accessible, one-story single-family home, duplex, or quadplex.

(11) "Individuals" mean persons with developmental disabilities.

(12) "Manufactured home" has the same meaning as in section 3781.06 of the Revised Code.

(13) "Mobile home" has the same meaning as in section 4501.01 of the Revised Code.

(14) "Mortgage" means a consensual interest in real property, including fixtures, that secures payment or performance of an obligation between the county board and the nonprofit corporation or a local housing authority memorialized in a mortgage deed and recorded in the county in which the subject real property is located.

(15) "Newly constructed housing" means housing that is for sale and for which an occupancy permit has been issued.

(16) "Nonprofit corporation" means a nonprofit corporation incorporated pursuant to Chapter 1702. of the Revised Code, granted 501(c)(3) status by the internal revenue service, and specifically chartered to develop, acquire, and manage permanent, affordable housing for individuals.

(17) "Permanent foundation" has the same meaning as in section 3781.06 of the Revised Code.

(18) "Permanently sited manufactured home" means a manufactured home that meets all of the following criteria:

(a) The structure is affixed to a permanent foundation and is connected to appropriate facilities;

(b) The structure, excluding any addition, has a width of at least twenty-two feet at one point, a length of at least twenty-two feet at one point, and a total living area, excluding garages, porches, or attachments, of at least nine hundred square feet;

(c) The structure has a minimum 3:12 residential roof pitch, conventional residential siding, and a six-inch minimum eave overhang, including appropriate guttering;

(d) The structure was manufactured after January 1, 1995; and

(e) The structure is not located in a manufactured home park as defined by section 4781.01 of the Revised Code.

(19) "Promissory note" means a written instrument that a county board enters into with a nonprofit corporation or local housing authority that evidences a promise to pay a monetary obligation, establishes a schedule for forgiveness of a monetary obligation through installments or otherwise, or a combination thereof, and which may be used to support a mortgage on real property.

(20) "Quadplex" means a separate or detached residence with four one-bedroom dwelling units designed and arranged for use by four individuals separated by a horizontal or vertical wall, each of which is heated independently of the others and has its own separate, private means of ingress and egress.

(21) "Single-family home" means a residential building consisting of one dwelling unit designed and arranged for use by one family. The term includes a manufactured home and a condominium under Chapter 5311. of the Revised Code.

(22) "Supported living" has the same meaning as in section 5126.01 of the Revised Code.

(1) Community capital assistance funds shall be used to acquire housing for individuals receiving supported living in accordance with sections 5126.40 to 5126.47 of the Revised Code or individuals receiving supported living funded by a home and community-based services waiver administered by the department.

(2) The housing acquired with community capital assistance funds shall be used as residences for individuals for at least one hundred eighty months.

(3) Community capital assistance funds shall be used to acquire a single-family home, a duplex, a quadplex, a permanently sited manufactured home, a condominium, or newly constructed housing.

(4) Community capital assistance funds may be used for housing construction projects.

(5) Community capital assistance funds shall not be used to purchase:

(a) Furniture and household items other than those fixed items customarily included in a purchase agreement or a construction contract;

(b) Mobile homes; or

(6) Community capital assistance funds shall be repaid if any provision of this rule is violated. The repayment shall be calculated by multiplying the amount of funds provided under this rule by the ratio of one hundred eighty minus the number of months the housing is used for residences for individuals (as determined by the department) to the total term of one hundred eighty months, that is:

repayment = funds provided x [(180 - number of months used for residences)/180]

(D) Application procedure

(1) Prior to purchasing housing or initiating a housing construction project, a county board shall submit a letter of intent and an application to the department in a form and manner prescribed by the department.

(2) The department shall notify the county board whether the application is approved or disapproved.

(3) Based on available funding, the department shall distribute community capital assistance funds to a county board utilizing a formula developed by the department. The department may participate at a percentage level of the cost of the housing.

(E) County board assurances

(1) The county board shall enter into a contract with either a nonprofit corporation or a local housing authority. The contract and mortgage shall include the following terms:

(a) The use and ownership of the housing if the contract is terminated;

(b) The use and ownership of the housing if the nonprofit corporation or local housing authority is dissolved;

(d) A provision that upon dissolution of the nonprofit corporation or local housing authority, the county board or the department shall be a party to any judicial proceeding or dissolution agreement and that the county board or the department may be a distributee under such order or agreement based upon the amount of community capital assistance funds provided to the nonprofit corporation or local housing authority under this rule and to the extent provided by law; and

(e) A requirement that any proceeds from the sale of the housing shall be used to acquire replacement housing.

(2) The county board shall maintain a mortgage interest in the housing that at least equals the amount of community capital assistance funds used to purchase the housing. The term of the mortgage shall be one hundred eighty months.

(3) Only individuals receiving supported living in accordance with sections 5126.40 to 5126.47 of the Revised Code or receiving supported living funded by a home and community-based services waiver administered by the department shall live in the housing. A person who does not have a developmental disability may live in the housing if the department concludes:

(a) The individuals living in the housing consent; and

(b) The housing remains primarily for the use of individuals.

(4) The individuals who will be living in the housing shall take part in its selection. The individuals shall be given appropriate residential options and allowed to make reasonable and responsible choices among them.

(5) Only one single-family home, duplex, or quadplex shall be located on a lot or parcel of land. Community capital assistance funds shall not be used to purchase housing on adjoining lots or parcels if the department determines it would create the appearance of congregating individuals.

(6) Housing shall be kept in good order and condition by:

(a) Making all necessary or appropriate repairs and replacements;

(b) Complying with all laws, rules, insurance policies, and regulations;

(c) Obtaining and maintaining any governmental licenses and permits required for the use, maintenance, repair, and operation of the housing;

(d) Paying all costs, claims, damages, fees, and charges arising out of the possession, use, operation, or maintenance of the housing; and

(e) Remaining free of all liens, encumbrances, restrictions, and conditions which prevent or interfere with its use as residences for individuals.

(7) Before receiving community capital assistance funds, the county board shall enter into a contract with the department.

(8) Within sixty calendar days of acquiring the housing, the county board shall provide the department with copies of the final closing statement, the promissory note, the recorded deed (with restrictions noted as necessary), and the recorded mortgage.

(F) Distribution of community capital assistance funds

(1) For purchased housing, the department shall issue a check for all or a portion of the community capital assistance funds awarded to a county board after receiving all of the documents listed below and after determining that all requirements of this rule have been met. The department may present the check at the closing.

(a) A completed application;

(b) An appraisal that is not more than six months old;

(d) A copy of the title insurance policy;

(e) The documents required in paragraphs (E)(1) and (E)(7) of this rule;

(f) If the housing is a condominium, a copy of the condominium description, deed restrictions, and homeowner association rules and by-laws; and

(g) Any other documents specified by the department.

(2) For a housing construction project, the department shall issue a check for all or a portion of the community capital assistance funds awarded to a county board after receiving all of the documents listed below and after determining that all requirements of this rule have been met:

(a) The documents required in paragraphs (E)(1) and (E)(7) of this rule;

(b) A copy of the mortgage;

(d) A copy of the occupancy permit which has been issued for the housing construction project;

(e) An appraisal that is not more than six months old; and

(f) Any other documents specified by the department.

(G) Acquisition of replacement housing

(1) To sell housing purchased under this rule and obtain replacement housing, a county board shall:

(a) Comply with sections 5123.37 to 5123.375 of the Revised Code;

(b) Provide the department with the appraisal that is not more than six months old, promissory note, mortgage, and recorded deed for the replacement housing; and

(2) The net sale proceeds shall equal the amount of community capital assistance funds owed to the department in accordance with the formula in paragraph (C)(6) of this rule.

(H) Waiving a condition or specific requirement of this rule

(1) For good cause, the director of the department may waive a condition or specific requirement of this rule. The director's decision to waive a condition or specific requirement will not be contrary to the rights, health, or safety of individuals served.

(2) A county board may initiate a request for the director of the department to waive a condition or specific requirement of this rule by submitting the request in writing.

(a) The director may require or solicit input regarding the county board's request from individuals receiving services, individuals' guardians, nonprofit corporations, local housing authorities, or other persons.

(b) The director will grant or deny a request submitted by a county board within ten business days of receipt of the request or within such longer period of time as the director deems necessary.

(d) The director's decision to grant or deny a request is not subject to appeal.

(I) Failure to comply with this rule

Failure to comply with this rule may result in the repayment of community capital assistance funds awarded under this rule and/or the denial of future requests for funds.

Last updated November 6, 2025 at 12:52 PM

History

Effective: November 6, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5123-1-04 Community capital assistance funds - development of licensed residential facilities.

(A) Purpose

This rule sets forth a process for the department to make available community capital assistance funds for boards of county commissioners, county boards of developmental disabilities, and nonprofit corporations to develop licensed residential facilities for individuals who are transitioning from developmental centers or converted facilities and who are enrolled in a home and community-based services waiver administered by the department.

(B) Definitions

(1) "Applicant" means any of the following who submit an application to the department for state community capital assistance funds:

(a) A board of county commissioners;

(b) A county board of developmental disabilities; or

(i) The articles of incorporation shall contain, in addition to provisions otherwise required by law, a specific statement of purpose that the corporation will provide a developmental disability service.

(ii) The code of regulations shall contain the following provisions in addition to those specifically required by law:

(a) A provision stating that services will neither be rendered nor denied on the basis of race, color, religion, national origin, disability, age, or unless programmatically justifiable, sex;

(b) A provision that upon dissolution of the corporation, if such dissolution occurs within the length of the project agreement, the department or its successor shall be a party to any judicial proceeding or dissolution agreement and that the department or its successor may be a distributee under such order or agreement to the extent of its participation and to the extent provided by law or the project agreement which originally set forth disbursal of funds to the corporation;

(c) A provision that no persons related by blood, marriage, or adoption (to a degree of first cousin) shall constitute a majority of the board of directors; and

(2) "Appraisal" means a written report completed by a certified or licensed appraiser which includes a floor plan sketch of the residential facility; front, back, and street scene photographs of the residential facility; three interior photographs of the residential facility; a street map that shows the location of the residential facility and the comparable sales; front photographs of comparable sales; a statement of assumptions and limiting conditions; and the appraiser's certification. The appraisal shall be completed on the appropriate "Fannie Mae" form.

(3) "Community capital assistance funds" means tax-exempt capital bond funds that are used for the purchase or construction of community-based housing projects. Based on available funding, the department shall distribute community capital assistance funds to applicants using a formula developed by the department. The department may participate at a percentage level of the cost of the residential facility.

(4) "Construction" means the construction of new buildings or renovation of existing buildings as provided by section 154.01 of the Revised Code.

(5) "Controlling board" means the board established by section 127.11 of the Revised Code.

(6) "Converted facility" means an intermediate care facility for individuals with intellectual disabilities or a former intermediate care facility for individuals with intellectual disabilities that converted some or all of its beds to providing home and community-based services funded by the individual options waiver pursuant to section 5124.60 of the Revised Code.

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

(8) "Developmental center" means a state-operated intermediate care facility for individuals with intellectual disabilities.

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

(10) "Individuals" means persons with developmental disabilities.

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

(12) "Manufactured home" has the same meaning as in division (C) of section 4781.01 of the Revised Code.

(13) "Mortgage" means a consensual interest in real property, including fixtures, that secures payment or performance of an obligation between the department and the applicant memorialized in a mortgage deed and recorded in the county in which the real property is located.

(14) "Promissory note" means a written instrument that the department enters into with an applicant that evidences a promise to pay a monetary obligation, establishes a schedule for forgiveness of a monetary obligation through installments or otherwise, or a combination thereof, and which may be used to support a mortgage on real property.

(15) "Renovation" means work done to a building to restore it to an acceptable condition and to make it functional for the purposes set forth in an application for community capital assistance funds, including architectural and structural changes and the modernization of mechanical and electrical systems. Renovation does not include work that consists primarily of maintenance repairs and replacement due to normal use, wear and tear, or deterioration.

(16) "Residential facility" has the same meaning as in section 5123.19 of the Revised Code.

(1) Community capital assistance funds may be used for the purchase or construction of a residential facility of four or fewer beds for individuals who were residents of a developmental center or a converted facility immediately prior to enrollment in a home and community-based services waiver administered by the department when the department determines that:

(a) Viable alternative housing options in the community where the individuals desire to live are not otherwise available; and

(b) The residential facility purchased or constructed with community capital assistance funds will be compliant with federal guidelines for home and community-based services settings.

(2) A residential facility purchased or constructed with community capital assistance funds shall be used as residences for individuals for at least one hundred eighty months.

(3) The department shall maintain a mortgage interest in the residential facility that at least equals the amount of community capital assistance funds used to purchase or construct the residential facility. The term of the mortgage shall be one hundred eighty months.

(4) Community capital assistance funds shall not be used to:

(a) Purchase equipment, furniture, and household items other than those fixed items customarily included in a purchase agreement or a construction contract;

(b) Purchase mobile homes; or

(c) Purchase or construct a residential facility when the purchase price or construction cost exceeds, by more than ten percent, the residential facility's appraised value.

(D) Community capital assistance funds application and evaluation

(1) The applicant shall secure approval for development of residential facilities pursuant to rule 5123:2-3-08 of the Administrative Code.

(2) Prior to purchasing a residential facility or initiating a residential facility construction project, the applicant shall submit an application for community capital assistance funds to the department in a form and manner prescribed by the department.

(3) The department shall evaluate applications with regard to compliance with federal guidelines for home and community-based services settings, programmatic suitability, economic feasibility, and ability or potential to meet applicable building and fire codes, licensure, and department or other governmental requirements and with consideration of the following criteria for residential facility construction project sites:

(a) Location, including sociological and demographic considerations of area and access to site and extent to which the site is integrated in a residential neighborhood;

(b) Cost of property, including comparison of similar property in the area;

(d) Configuration, topography, and suitability for construction; and

(e) Environmental assessment that includes, but is not limited to, asbestos, polyvinyl chlorides, and chemical contaminants that may be present on the site.

(4) The director of the department or his or her designee shall have final discretion to determine if the purchase or construction project is suitable for the intended purpose.

(5) The department shall notify the applicant in writing whether the application is approved or disapproved. If an application is approved, the notification shall indicate the amount of community capital assistance funds approved, subject to favorable fund release action by the controlling board. The amount of community capital assistance funds awarded shall not exceed ninety per cent of the purchase price or construction cost.

(E) Applicant assurances and obligations after approval of the application

(1) The applicant shall enter into an agreement and mortgage with the department which shall include:

(a) An assurance that the applicant shall operate and maintain the residential facility in accordance with the agreement for one hundred eighty months. If the facility is used for an alternative purpose, the applicant shall pay to the department on a pro rata basis in accordance with paragraph (H)(1) of this rule any state funds reimbursed to the applicant or shall permit the department to operate or transfer the operation of the residential facility, including the assignment of any contracts or other interests, to another approved organization for the balance of the agreement.

(b) An assurance that the applicant shall keep the residential facility in good order and condition by:

(i) Making all necessary or appropriate repairs and replacements;

(ii) Complying with all laws, rules, insurance policies, and regulations;

(iii) Obtaining and maintaining any governmental licenses and permits required for the use, maintenance, repair, and operation of the residential facility;

(iv) Paying all costs, claims, damages, fees, and charges arising out of the possession, use, operation, or maintenance of the residential facility; and

(v) Remaining free of all liens, encumbrances, restrictions, and conditions which prevent or interfere with its use as a residential facility except such as may be imposed by zoning ordinances and regulations.

(d) The use and ownership of the residential facility if the licensee is dissolved.

(e) The use and ownership of the residential facility if the licensee files for bankruptcy.

(f) A provision that upon dissolution of the licensee, the department or its successor shall be a party to any judicial proceeding or dissolution agreement and that the department or its successor may be a distributee under such order or agreement based upon the amount of funds provided to the applicant under this rule and to the extent provided by law.

(g) A requirement that any proceeds from the sale of the residential facility shall be used to acquire a replacement residential facility in accordance with paragraph (G) of this rule.

(2) For purchase of a residential facility, the applicant shall provide:

(a) An appraisal that is no more than six months old;

(b) A signed purchase contract showing the intent to purchase and the purchase price;

(d) Any other documents specified by the department.

(3) For a residential facility construction project, the applicant shall:

(a) Provide:

(i) An appraisal that is no more than six months old that appraises what the value of the real estate will be once the residential facility construction project is completed;

(ii) A signed purchase contract showing the intent to purchase the vacant real estate, which shall include the purchase price, or if the real estate is already in the name of the applicant, a copy of the current recorded deed;

(iii) A copy of the current title insurance policy that is no more than sixty days old, a map outlining the residential facility construction project site, and a deed;

(iv) A "bid tabulation," which means a list in tabular form of all of the project bidders' names, addresses, and dollar bid amount (with alternates as applicable) that are compiled, signed, and dated by the applicant's representatives officiating at the bid opening;

(v) A signed construction contract for the residential facility; and

(vi) Any other documents specified by the department.

(b) Enter into an agreement with the department that assures the completion of the residential facility construction project in accordance with standards set forth by the department and applicable federal, state, and local statutes.

(d) Ensure that the residential facility design and construction conforms to all applicable building codes, standards, zoning, and licensing requirements.

(e) Ensure that all contractors agree to comply with applicable federal, state, and local laws in the conduct of the work hereunder and accept full responsibility for payment of all unemployment compensation, insurance premiums, income tax deductions, social security deductions, and any and all other taxes or payroll deductions required for all employees engaged by contractors in the performance of the work authorized by this agreement.

(f) Hold the department harmless for any liability resulting from liens issued against the project by contractors, subcontractors, material suppliers, or laborers.

(g) Begin the construction project within one year from the date of department approval. The director of the department or his or her designee has the discretion to withdraw funds at any time if the project is not proceeding in a timely manner.

(F) Distribution of community capital assistance funds

(1) The department shall pay the applicant for approved costs for an amount up to but not exceeding the maximum state share of the purchase or construction project cost stated in the approved application. No additional funds will be approved over the maximum state share of the purchase or construction project cost once the funds are awarded.

(2) For purchase of a residential facility:

(a) The department shall issue a check for all or a portion of the funds awarded to an applicant after determining that all requirements of this rule have been met. The department may present the check at the closing.

(b) Within sixty calendar days of closing, the applicant shall provide the department with copies of the final closing statement, the promissory note, the recorded deed (with restrictions noted as necessary), and the recorded mortgage.

(3) For a residential facility construction project:

(a) The department shall issue a check for all or a portion of the funds awarded to an applicant after determining that all requirements of this rule have been met.

(b) Within sixty calendar days of completion, the applicant shall provide the department with a copy of the occupancy permit which has been issued for the residential facility construction project.

(G) Acquisition of a replacement residential facility

(1) To sell a residential facility purchased or constructed with community capital assistance funds under this rule and obtain a replacement residential facility, the applicant shall:

(a) Comply with sections 5123.37 to 5123.375 of the Revised Code;

(b) Secure approval for development of residential facilities pursuant to rule 5123:2-3-08 of the Administrative Code;

(c) Provide the department with an appraisal that is no more than six months old, promissory note, mortgage, and recorded deed for the replacement residential facility; and

(d) Comply with all other requirements of this rule.

(2) The net sale proceeds shall equal the amount of funds owed to the department on a pro rata basis in accordance with paragraph (H)(1) of this rule.

(H) Failure to comply with this rule

(1) The applicant shall repay community capital assistance funds if any provisions of this rule are violated. The repayment shall be calculated by multiplying the amount of funds provided under this rule by the ratio of one hundred eighty minus the number of months used as a residential facility (as determined by the department) to the total term of one hundred eighty months, that is: funds provided x [(180 - number of months used as residential facility)/180] = repayment.

(2) Failure to comply with this rule may result in the denial of future requests for community capital assistance funds.

Last updated September 22, 2025 at 6:47 PM

History

Effective: October 1, 2020
Promulgated Under: 119.03

Ohio Adm.Code 5123-1-05 Community capital assistance funds - residential accessibility and renovation projects.

(A) Purpose

This rule sets forth a process for the department to make available community capital assistance funds to county boards of developmental disabilities, governmental entities, and nonprofit corporations for residential accessibility and renovation projects.

(B) Definitions

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

(1) "Applicant" means any of the following who submit an application to the department for community capital assistance funds:

(a) A county board of developmental disabilities;

(b) A governmental entity; or

(ii) The code of regulations will contain the following provisions in addition to those specifically required by law:

(a) A provision stating that services will neither be rendered nor denied on the basis of race, color, religion, national origin, disability, age, or unless programmatically justifiable, sex;

(c) A provision that no persons related by blood, marriage, or adoption (to a degree of first cousin) will constitute a majority of the board of directors; and

(2) "Community capital assistance funds" means funds appropriated by the general assembly to the department for capital projects.

(3) "Controlling board" means the board established by section 127.11 of the Revised Code.

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

(5) "Maintenance" means a repair to a structure or component, if that structure has not reached the end of its useful life.

(6) "Renovation" means work done to a building to restore it to an acceptable condition meeting Ohio basic building code and to make it functional for the purpose set forth in an application for community capital assistance funds, including architectural and structural changes and the modernization of mechanical and electrical systems. Renovation does not include work that consists primarily of maintenance repairs and replacement due to normal use, wear and tear, or deterioration.

To be eligible for community capital assistance funds for residential accessibility and renovation projects, an applicant shall:

(1) Have a stable programmatic and financial history; and

(2) Acquire residential properties for persons with developmental disabilities receiving services, through:

(a) The supported living program;

(b) A medicaid home and community-based services waiver; or

(c) Other types of residential programs serving persons eligible for services by the department as may be approved by the department.

(D) Awarding of funds

(1) The department will develop priorities and program guidelines.

(2) The department will use data from the letters of intent to determine the allocation for each project.

(3) No community capital assistance funds will be distributed until the appropriation is released by the controlling board.

(4) The residential property to be made accessible or renovated will be home to no more than four persons with developmental disabilities.

(5) An addition to an existing structure is allowed only as part of an authorized accessibility modification.

(6) The department will review requests based upon:

(a) Submission of complete and accurate information within the time-frame allowed in accordance with paragraph (E) of this rule.

(b) Architectural and economical feasibility of the accessibility modification or renovation, as determined by the department. The cost of the project will not exceed seventy-five per cent of the appraised value of the home.

(7) Costs that are suitable for reimbursement are limited to:

(a) Design and project administration fees paid to an outside consultant;

(b) Construction costs;

(d) Construction document printing costs; and

(e) Interest, subject to prior approval of the department at the time of application.

(8) Community capital assistance funds may not be used for:

(a) Maintenance projects;

(b) Movable equipment (e.g., furniture);

(c) Painting, wallpapering, and re-siding, unless in conjunction with an approved accessibility or renovation project; or

(d) Any project involving asbestos abatement or underground storage tank removal.

(E) Application process

(1) The applicant shall submit a letter of intent to the department which includes:

(a) A detailed description of the proposed project;

(b) The maximum estimated project costs;

(d) An appraisal, if requested.

(2) The department will review applications for community capital assistance funds and notify the applicant, in writing, of the approval or disapproval of a project. When the department approves a project, the department will indicate the maximum amount of community capital assistance funds approved, subject to fund release action by the controlling board. The department will reimburse the applicant for approved costs for an amount up to but not exceeding the maximum total project cost stated in the initial approval notification.

(3) The department will provide technical assistance to any applicant upon request. Assistance to an applicant will be supplementary in scope and will not relieve the applicant of responsibility to administer the project and comply with this rule.

(F) Responsibilities of the applicant

(1) Upon approval of a project and prior to payment of community capital assistance funds, the applicant shall enter into a project agreement with the department that assures:

(a) The applicant has received a copy of the series II lease agreement and has read and fully understands the document and its binding effect on the applicant.

(b) The completion of the project in accordance with standards set forth by the department and other applicable federal, state, and local statutes.

(d) The applicant will use and maintain the residential property for persons with developmental disabilities for the length of the project agreement.

(e) If the project is not used for said purpose, the applicant shall pay to the department, on a pro rata basis, community capital assistance funds disbursed to the applicant. The terms of the project agreement will expire as of the earlier of:

(i) Fifteen years from the date of the project agreement; or

(ii) The date when all capital bonds, any of the proceeds of which were expended for project costs, are no longer outstanding.

(f) If the applicant is a nonprofit corporation, the applicant will execute a promissory note and mortgage between the department and the nonprofit corporation.

(2) The applicant shall begin work on the project within the biennium budget period funding the project. Any changes to the project or scope of work, including changes in the physical location of the project, require approval by the department. Project approval and community capital assistance funds may be withdrawn at any time for failure to comply with the applicable assurances, certifications, or requirements in this rule.

(3) If all or part of the project defined in the scope of work is canceled by the applicant or the department, or not completed, the department reserves the right to withhold the monies allocated for the work not completed.

(4) The applicant shall not be the contractor for its own project.

(5) The applicant shall assure that:

(a) The project is located upon, or will be located upon, real estate which the applicant owns in fee simple or in which it has a leasehold interest.

(b) The premises are, and will remain for the term of the project agreement, free and clear of all liens, encumbrances, restrictions, and conditions which prevent or interfere with the use of the property for the purpose of the project.

(6) If leased property is being used:

(a) The lease must be consistent with the series II lease agreement and clearly state that the property is to be leased for a minimum of fifteen years.

(b) The applicant shall certify that it has notified the owner of its intent to enter into a project agreement with the department and has obtained written commitment from the owner to permit operation of the residential property for a minimum of fifteen years.

(d) The department will have an opportunity to absolutely cure any default to avoid the reversion of the property to the lessor, and the department may at its option assume operation of the residential property or may transfer or assign the leasehold interest and the operation of the program in the residential property, upon approval of the lessor, which approval will not be unreasonably withheld, to a nonprofit corporation or other agency to provide substantially similar services in the residential property for the remainder of the lease term.

(e) The lease will state the exact location of the space being leased, if only a portion of the property is being leased.

(f) Documentation will be submitted establishing who owns the underlying land or building. If the applicant is subleasing part of a building, a copy of the prime lease with a certification that the copy is a true copy as well as the document that gives the lessor permission to sublet the property must be provided.

(g) Proof will be submitted to the department that all leasehold interests are recorded in the county recorder's office.

(7) The applicant shall obtain the services of a registered architect or engineer to perform any design required for the project if required by the political subdivision having jurisdiction for the occupancy involved. Where permitted by law, the design work and related services may be performed by unlicensed persons.

(8) The applicant shall assure, for projects which equal or exceed twenty-five thousand dollars in design fees, that any architectural or engineering services for the project meet the requirements of sections 153.65 to 153.70 of the Revised Code.

(a) This fee will cover design services, bidding costs, and construction observation.

(b) For projects that are one hundred thousand dollars or less, the acceptable architect fee is ten per cent of the construction costs only, not the total project cost.

(9) The applicant shall certify through the project agreement that all work will comply with all state and local codes and ordinances, including zoning regulations. Furthermore, the applicant shall certify that it will obtain all required plan approvals, permits, and inspections.

(10) The applicant shall solicit, or cause to be solicited, sealed competitive bids from no fewer than three contractors. If, after a good faith effort of the applicant, fewer than three contractors submit bids, the other contractor(s) shall submit a stated "no bid" on their letterhead. The bids will be based on bid documents which are in written and/or drawn form and are sufficiently complete and clear so that all bidders are bidding on the same scope of work.

(a) For projects with a total estimated cost of less than fifty thousand dollars:

(i) The bids will be solicited within sixty calendar days of the effective date of the project agreement.

(ii) Bids may be solicited informally, without advertising, and submitted informally on the bidder's letterhead.

(b) For projects with a total estimated cost equal to or exceeding fifty thousand dollars:

(i) The project will be advertised with a legal notice in a newspaper of general circulation to solicit bids from all interested contractors.

(ii) The notice will be published once a week for not less than two consecutive weeks, with the bids due no sooner than eight calendar days after the last date of publication.

(iii) The legal notice will state the estimated construction cost.

(iv) The project may be bid as a single prime contract through a general contractor.

(v) The applicant shall prepare a bid tabulation sheet which shows the official estimate amount for the contract and lists all contractors who received bid documents.

(vi) The bid opening will be open to the public. The person officiating at the bid opening shall sign and date the bid tabulation sheet to certify that it is an accurate record of the bid results.

(vii) The applicant shall submit to the department the completed and signed bid tabulation sheet and photocopy of the low bid for the contract.

(viii) No contract will be awarded if the low bid received (aggregate bids if multiple contracts) exceeds the estimate by more than ten per cent.

(ix) The applicant shall not enter into contracts and construction will not begin until notified by the department, in writing, that controlling board approval has been obtained. Any costs not authorized by the department will not be reimbursed by the department.

(x) If the applicant is an agency of the county government, the bidding procedures will comply with the conditions the county prosecuting attorney may require. If there is a conflict between the local and state requirements, the state requirements supersede the local requirements.

(11) No funds for the project will be used by the applicant unless the mechanics, laborers, or workers are paid the prevailing wage rates as described in section 176.05 of the Revised Code.

(12) The applicant shall ensure that all contractors comply with all applicable federal, state, and local laws in the conduct of the work related to the project. The applicant shall ensure that the contractors accept full responsibility for payment of all workers' compensation and unemployment compensation insurance premiums, all income tax deductions, social security deductions, and any and all other taxes or payroll deductions required for all employees engaged by contractors in the performance of work on the project.

(13) All contracts awarded by the applicant for the project will contain provisions by which the contractor agrees that in the hiring of employees for the performance of work under the contract or any subcontract, no contractor, subcontractor, nor any person acting on the contractor's behalf will by reason of race, creed, sex, disability or military status as defined in section 4112.01 of the Revised Code, or color, discriminate against or intimidate any citizen of the state in the employment of labor or workers who are qualified and available to perform the work to which the employment relates.

(14) The applicant shall ensure that the contractor provides for an affirmative action program for the employment and effective utilization of disadvantaged persons whose disadvantage may arise from cultural, racial, or ethnic background, or other similar cause including, but not limited to, race, religion, sex, disability or military status as defined in section 4112.01 of the Revised Code, national origin, or ancestry.

(15) In awarding contracts for the project, the applicant shall ensure that equal consideration be given to contractors, subcontractors, or joint venturers who qualify as a minority business enterprise as defined in section 122.71 of the Revised Code.

(16) The applicant shall indemnify, and hold harmless, the department from any and all liabilities, claims, and actions arising from the project including, without limitation, any liens of contractors, subcontractors, material suppliers, or laborers.

(17) The applicant shall keep all financial records in a manner consistent with generally accepted accounting procedures. Documentation to support each action will be filed in a manner allowing it to be readily located. Such documentation will be maintained by the applicant until fifteen years after the project is completed, or the date when all capital bonds, any of which were expended for project costs, are no longer outstanding, whichever is earlier.

(18) The applicant shall ensure that the work outlined in the scope of work has been completed.

(G) Reimbursement

(1) The applicant shall pay for all approved costs and then be reimbursed by the department after submittal of appropriate paid receipts.

(2) Projects with maximum total project costs under fifty thousand dollars will be reimbursed on a schedule established by the department.

(3) Upon submission of paid receipts for reimbursement, the applicant shall certify that the construction contractor selected was the low bidder and that the applicant has obtained an affidavit of release of liens from all prime contractors on the project.

(4) Upon submission of paid receipts for reimbursement, the applicant shall also certify that it or its agent has inspected the work and that it complies with the scope of work outlined in the project agreement, the drawings and specifications, and any other construction documents.

(5) The applicant shall identify the final submission of receipts as the last to be submitted. The final submission of receipts for reimbursement will include a letter from the contractor(s) stating that the work has been completed in accordance with the construction documents.

(6) The department reserves the right to audit the expenditure of community capital assistance funds to determine whether they were applied to the project. The department may bring action to recoup any funds expended for purposes other than the project or not expended in conformance with the procedures outlined in the project agreement and in this rule, or if the applicant breaches the project agreement in any manner.

(H) Waiving a condition or requirement of this rule

Last updated May 4, 2023 at 8:21 AM

History

Effective: May 4, 2023
Promulgated Under: 119.03

Chapter 5123-2 Provider Standards

Ohio Adm.Code 5123-2-01 Technology first.

(A) Purpose

This rule implements the technology first policy in accordance with section 5123.025 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.

(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.

(4) "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, the person's guardian in accordance with section 5126.043 of the Revised Code or other person authorized to give consent.

(5) "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.

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

(7) "Technology first policy" means the state of Ohio policy, established in section 5123.025 of the Revised Code, that individuals with developmental disabilities have access to technology solutions.

(8) "Technology solution" means any product, device, equipment, or service used to maintain, increase, or improve the functional capabilities of an individual with developmental disabilities and that is deployed in accordance with applicable federal, state, and local rules and regulations. The efficacy of a technology solution is subject to review and approval by the department.

(1) Each county board and each intermediate care facility for individuals with intellectual disabilities will:

(a) Within one hundred eighty calendar days of the effective date of this rule or within one hundred eighty calendar days of licensure of a new intermediate care facility for individuals with intellectual disabilities, as applicable, develop and implement a written local policy to enact the technology first policy. The written local policy will:

(i) Clearly delineate that technology solutions are to be:

(a) Explored and documented throughout the initial and ongoing person-centered assessment and planning process; and

(b) Used to the greatest extent possible to support the outcomes in an individual service plan.

(ii) Address ability to increase capacity for use of technology solutions and outline specific steps, as applicable, to be taken including, when applicable, establishment of benchmarks for increasing the number of individuals who benefit from the use of technology solutions.

(iii) Identify strategies for increasing the level of knowledge, skill, and comfort of staff related to assessing how technology may help meet needs or achieve outcomes and the use of technology solutions.

(b) Annually review and update, as applicable, its goals and objectives related to increasing the use of technology solutions by individuals served.

(2) Each county board will actively collaborate with individuals served and their families, providers of services, the department, and community partners (e.g., local schools, mental health agencies, area agencies on aging, county departments of job and family services, public transit authorities, local vocational rehabilitation centers, and employers) to expand awareness and use of technology solutions by individuals served.

(3) Each intermediate care facility for individuals with intellectual disabilities will actively collaborate with residents served and their families, persons or entities under contract to provide services to residents, the department, and community partners (e.g., county boards, local schools, mental health agencies, local vocational rehabilitation centers, and employers) to expand awareness and use of technology solutions by residents served.

(4) Each individual served by a county board or an intermediate care facility for individuals with intellectual disabilities will participate in a person-centered assessment and planning process in accordance with rule 5123-3-03 or 5123-4-02 of the Administrative Code, as applicable, which identifies the individual's unique strengths, interests, abilities, preferences, and resources and explores how technology solutions might support the individual's desired outcomes.

(a) Through the person-centered planning process:

(i) The individual and the individual's team will discuss any technology solution previously or currently used by the individual and the effectiveness of the technology solution;

(ii) The individual and the individual's team will discuss the individual's needs, explore information regarding available technology solutions, and consider how each technology solution might:

(a) Enhance the individual's personal freedom;

(b) Increase the individual's ability to communicate effectively with others;

(c) Expand opportunities for the individual to access and pursue available activities and establish meaningful relationships with people who are important to the individual;

(d) Enable the individual to perform tasks that support the individual's efforts to obtain or maintain employment; or

(e) Help the individual increase and/or maintain independence with daily tasks and activities.

(iii) After discussing whether or not technology solutions may be appropriate, the individual and the individual's team:

(a) Will discuss how available technology solutions may advance what is important to or important for the individual;

(b) May make referrals for assessments by technology subject matter experts to identify technology solutions; and

(c) May identify additional evaluations needed to determine whether other available technology solutions meet the individual's assessed needs.

(iv) When available technology solutions have been determined by the individual and the individual's team to meet the individual's assessed needs, they will be included in the individual service plan.

(a) Technology solutions included for the duration of the individual service plan may be reviewed and modified at any time based on a request by the individual or the individual's team. Technology solutions included on a trial basis are to be reviewed by the individual and the individual's team at the conclusion of the trial period.

(b) When reviewing a technology solution to determine whether the technology solution is effective and should continue, the individual and the individual's team are to consider:

(i) The individual's experience in terms of achieving outcomes described in paragraph (C)(4)(a)(ii) of this rule;

(ii) Whether the technology solution enhanced the individual's health or safety;

(iii) Whether additional support is needed to facilitate use of the technology solution (e.g., scheduled battery replacements or more frequent communication with the technology solution vendor).

(iv) Whether the technology solution reduced dependence on staff by increasing the individual's independence and without having the effect of isolating the individual from the individual's community or preventing the individual from interacting with people with or without disabilities; and

(v) Whether the individual has a desire to continue to use the technology solution.

(b) The results of the person-centered planning process, including, as applicable, the individual's desired outcomes as they relate to technology solutions and the activities that will occur to expand the individual's exploration, awareness, and use of technology solutions, will be integrated into the individual service plan. The individual service plan will be amended if the individual's service needs change.

(5) The department will consult and collaborate with individuals and families who receive services, county boards, providers of home and community-based services, intermediate care facilities for individuals with intellectual disabilities, vendors of technology solutions, and other state agencies to:

(a) Identify best practices;

(b) Share information about available technology solutions and ways the technology solutions provide individuals with more independence;

(d) Identify and expand capacity for technology-related assessment;

(e) Facilitate effective partnerships; and

(f) Identify ways the department can support statewide efforts to expand use of technology solutions.

Last updated April 21, 2022 at 8:13 AM

History

Effective: April 21, 2022
Promulgated Under: 119.03

Ohio Adm.Code 5123-2-02 Background investigations for employment.

(A) Purpose

This rule establishes standards for conducting background investigations on persons employed or seeking employment in Ohio's service delivery system for individuals with developmental disabilities.

(B) Definitions

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

(1) "Agency provider" means a person, association, corporation, nonprofit organization, partnership, trust, or other group of persons that provides specialized services and employs, directly or through contract, one or more persons in a direct services position.

(2) "Applicant" means:

(a) A person who is under final consideration for appointment to or employment with the department or a county board;

(b) A person who is being transferred to the department or a county board;

(d) A person under final consideration for a direct services position with an agency provider or subcontractor.

(3) "Candidate" means:

(a) The director of operations of an agency provider that applies pursuant to section 5123.161 or 5123.164 of the Revised Code for supported living certification; or

(b) A person who applies pursuant to section 5123.161 or 5123.164 of the Revised Code for supported living certification as an independent provider.

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

(5) "Criminal records check" has the same meaning as in section 109.572 of the Revised Code.

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

(7) "Direct services position" means an employment position in which the employee has the opportunity to be alone with or exercises supervision or control over one or more individuals.

(8) "Disqualifying offense" means any of the offenses listed or described in divisions (A)(3)(a) to (A)(3)(e) of section 109.572 of the Revised Code.

(9) "Employee" means a person appointed to or employed by the department or a county board or a person employed in a direct services position by an agency provider or subcontractor. "Employee" does not mean a person who provides only respite care to the person's family member under a family support services program established pursuant to section 5126.11 of the Revised Code.

(10) "Independent provider" means a self-employed person who provides services for which the person is certified in accordance with rule 5123-2-09 of the Administrative Code and does not employ, either directly or through contract, anyone else to provide the services.

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

(12) "Minor drug possession offense" has the same meaning as in section 2925.01 of the Revised Code.

(13) "Multiple disqualifying offenses" means two or more convictions or guilty pleas to disqualifying offenses. Convictions or guilty pleas resulting from or connected with the same act, or resulting from offenses committed at the same time, shall be counted as one conviction or guilty plea.

(14) "Responsible entity" means:

(a) The department in the case of an applicant under final consideration for appointment to or employment with the department, being transferred to the department, or being recalled to or reemployed by the department after a layoff or a person appointed to or employed by the department;

(b) A county board in the case of an applicant under final consideration for appointment to or employment with the county board, being transferred to the county board, or being recalled to or reemployed by the county board after a layoff or a person appointed to or employed by the county board;

(c) An agency provider in the case of an applicant under final consideration for a direct services position with the agency provider or a person employed in a direct services position by the agency provider; or

(d) A subcontractor in the case of an applicant under final consideration for a direct services position with the subcontractor or a person employed in a direct services position by the subcontractor.

(15) "Retained applicant fingerprint database" means the database also known as "Rapback," maintained by the bureau of criminal identification and investigation pursuant to section 109.5721 of the Revised Code that contains the fingerprints of persons for whom the bureau of criminal identification and investigation has conducted criminal records checks.

(16) "Specialized services" mean 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 subcontractor is providing specialized services, the provider or subcontractor may request that the director of the department make a determination. The director's determination is not subject to appeal. Programs or services available to the general public are not specialized services.

(17) "Subcontractor" means a person to which both of the following apply:

(a) The person has:

(i) A subcontract with an agency provider to provide specialized services included in the contract between the agency provider and the department or a county board; or

(ii) A subcontract with another subcontractor to provide specialized services included in a subcontract between the other subcontractor and an agency provider or other subcontractor.

(b) The person employs one or more persons in direct services positions.

(1) A responsible entity shall, prior to employing an applicant, or conditionally employing an applicant in accordance with paragraph (C)(7) of this rule:

(a) Require the applicant to complete an employment application and provide the names and addresses of present and former employers; and

(b) Attempt to obtain references from the applicant's present and former employers and maintain written evidence that reference checks were attempted and/or completed.

(2) Prior to employing an applicant, or conditionally employing an applicant in accordance with paragraph (C)(7) of this rule, a responsible entity shall check each of the following databases to determine if the applicant is included:

(a) The list of excluded persons and entities maintained by the office of inspector general in the United States department of health and human services pursuant to section 1128 of the Social Security Act, 94 Stat. 2619 (1980), 42 U.S.C. 1320a-7, and section 1156 of the Social Security Act, 96 Stat. 388 (1982), 42 U.S.C. 1320c-5 (available at https://exclusions.oig.hhs.gov);

(b) The abuser registry established pursuant to section 5123.52 of the Revised Code (available at https://its.prodapps.dodd.ohio.gov/abr_default.aspx);

(c) The nurse aide registry established pursuant to section 3721.32 of the Revised Code (available at https://nurseaideregistry.odh.ohio.gov/Public/PublicNurseAideSearch) and there is a statement detailing findings by the director of the Ohio department of health that the applicant or employee neglected or abused a resident of a long-term care facility or residential care facility or misappropriated property of such a resident;

(d) The sex offender and child-victim offender database established pursuant to division (A)(11) of section 2950.13 of the Revised Code (available at https://www.icrimewatch.net/index.php?agencyid=55149&disc=);

(e) The United States general services administration system for award management database (available at https://www.sam.gov);

(f) The Ohio department of medicaid provider exclusion and suspension list (available at https://medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-enrollment/provider-exclusion-and-suspension-list); and

(g) The database of incarcerated and supervised offenders established pursuant to section 5120.66 of the Revised Code (available at https://appgateway.drc.ohio.gov/offendersearch).

(3) A responsible entity shall not employ an applicant, conditionally employ an applicant in accordance with paragraph (C)(7) of this rule, or continue to employ an employee if the applicant or employee is included in one or more of the databases described in paragraphs (C)(2)(a) to (C)(2)(f) of this rule.

(4) Prior to employing an applicant, or conditionally employing an applicant in accordance with paragraph (C)(7) of this rule, in a position that involves transporting individuals or operating the responsible entity's vehicles for any purpose, a responsible entity shall verify that the applicant has a valid motor vehicle operator's license and obtain the applicant's driving record prepared by the bureau of motor vehicles. A person whose driving record includes six or more points charged within the preceding twenty-four months is prohibited from transporting individuals.

(5) Prior to employing an applicant, or conditionally employing an applicant in accordance with paragraph (C)(7) of this rule, a responsible entity shall require the applicant:

(a) Submit a statement to the responsible entity with the applicant's signature attesting that the applicant has not been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for a disqualifying offense. An applicant or employee shall disclose to the responsible entity a conviction for any offense that has been sealed.

(b) Sign an agreement under which the applicant agrees to notify the responsible entity within fourteen calendar days if, while employed by the responsible entity, the applicant is formally charged with, is convicted of, pleads guilty to, or is found eligible for intervention in lieu of conviction for a disqualifying offense. The agreement shall provide that failure to make the notification may result in termination of employment.

(6) Prior to employing an applicant, or conditionally employing an applicant in accordance with paragraph (C)(7) of this rule, a responsible entity shall request the bureau of criminal identification and investigation to conduct a criminal records check of the applicant. If an applicant does not present proof that the applicant 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 responsible entity shall request that the bureau of criminal identification and investigation obtain information from the federal bureau of investigation as part of the criminal records check. If an applicant presents proof that the applicant 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 responsible entity may request that the bureau of criminal identification and investigation obtain information from the federal bureau of investigation as part of the criminal records check. For purposes of this paragraph, an applicant may provide proof of Ohio residency by presenting, with a signed statement asserting that the applicant has been a resident of Ohio for that five-year period, a valid driver's license, notification of registration as an elector, a copy of an officially filed federal or state tax form identifying the applicant's permanent residence, or any other document the responsible entity considers acceptable.

(7) A responsible entity may conditionally employ an applicant, for a period not to exceed sixty calendar days, pending receipt of information concerning the applicant's criminal records check under the following conditions:

(a) Prior to conditionally employing an applicant, the responsible entity shall have:

(i) Received the completed employment application and names and addresses of present and former employers from the applicant as required by paragraph (C)(1)(a) of this rule;

(ii) Attempted to obtain references from the applicant's present and former employers as required by paragraph (C)(1)(b) of this rule;

(iii) Checked each of the databases described in paragraph (C)(2) of this rule and determined the applicant is not included in one or more of the databases;

(iv) Verified the applicant has a valid motor vehicle operator's license and obtained the applicant's driving record prepared by the bureau of motor vehicles as required by paragraph (C)(4) of this rule for a position that involves transporting individuals or operating the responsible entity's vehicles for any purpose, and determined the applicant's driving record does not include six or more points charged within the preceding twenty-four months;

(v) Received the attestation from the applicant as required by paragraph (C)(5)(a) of this rule; and

(vi) Received the signed agreement from the applicant as required by paragraph (C)(5)(b) of this rule.

(b) The responsible entity shall terminate the applicant's employment:

(i) Immediately, if the responsible entity is informed that the applicant has been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for a disqualifying offense; or

(ii) On the sixty-first calendar day, if the responsible entity has not yet received the applicant's criminal records check from the bureau of criminal identification and investigation, and when applicable, the federal bureau of investigation.

(8) A responsible entity shall:

(a) Enroll each employee in a direct services position in the retained applicant fingerprint database within fourteen calendar days of receiving the employee's criminal records check from the bureau of criminal identification and investigation or within fourteen calendar days of the employee's date of hire, whichever is later;

(b) Maintain enrollment in the retained applicant fingerprint database for each employee in a direct services position throughout the employee's tenure; and

(i) Check the databases specified in paragraph (C)(2) of this rule for each employee in a direct services position; and

(ii) Request the bureau of criminal identification and investigation to obtain a federal bureau of investigation criminal records check of each employee in a direct services position who does not present proof that the employee has been a resident of Ohio for the five-year period immediately prior. For purposes of this paragraph, an employee in a direct services position may provide proof of Ohio residency by presenting, with a signed statement asserting that the employee has been a resident of Ohio for that five-year period, a valid driver's license, notification of registration as an elector, a copy of an officially filed federal or state tax form identifying the employee's permanent residence, or any other document the responsible entity considers acceptable.

(9) In the case that a responsible entity is notified by the bureau of criminal identification and investigation that an employee in a direct services position cannot be enrolled in the retained applicant fingerprint database, the responsible entity shall, at a frequency of no less than once every five years, request the bureau of criminal identification and investigation to conduct a criminal records check of the employee. If an employee in a direct services position does not present proof that the employee 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 responsible entity shall request that the bureau of criminal identification and investigation obtain information from the federal bureau of investigation as part of the criminal records check. If an employee in a direct services position presents proof that the employee 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 responsible entity may request that the bureau of criminal identification and investigation obtain information from the federal bureau of investigation as part of the criminal records check. For purposes of this paragraph, an employee in a direct services position may provide proof of Ohio residency by presenting, with a signed statement asserting that the employee has been a resident of Ohio for that five-year period, a valid driver's license, notification of registration as an elector, a copy of an officially filed federal or state tax form identifying the employee's permanent residence, or any other document the responsible entity considers acceptable.

(D) Requirements for candidates

(1) At the point of a candidate's application for initial supported living certification, the candidate shall request the bureau of criminal identification and investigation to conduct a criminal records check of the candidate. If a candidate does not present proof that the candidate 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 candidate shall request that the bureau of criminal identification and investigation obtain information from the federal bureau of investigation as part of the criminal records check. If a candidate presents proof that the candidate 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 department may require the candidate to request that the bureau of criminal identification and investigation obtain information from the federal bureau of investigation as part of the criminal records check. For purposes of this paragraph, a candidate may provide proof of Ohio residency by presenting, with a signed statement asserting that the candidate has been a resident of Ohio for that five-year period, a valid driver's license, notification of registration as an elector, a copy of an officially filed federal or state tax form identifying the candidate's permanent residence, or any other document the department considers acceptable.

(a) The candidate shall pay to the bureau of criminal identification and investigation the fee prescribed pursuant to division (C)(3) of section 109.572 of the Revised Code for each criminal records check requested.

(b) The candidate shall instruct the bureau of criminal identification and investigation to submit the completed report of the criminal records check directly to the department.

(2) At the point of a candidate's application for initial or renewal supported living certification, the department shall check the databases specified in paragraph (C)(2) of this rule to determine if the candidate is included. The department shall not issue supported living certification to a candidate if the candidate is included in one or more of the databases described in paragraphs (C)(2)(a) to (C)(2)(f) of this rule.

(3) At the point of a candidate's application for initial or renewal supported living certification, the candidate shall submit a statement to the department with the candidate's signature attesting that the candidate has not been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for a disqualifying offense. A candidate shall disclose a conviction for any offense that has been sealed.

(4) At the point of a candidate's application for initial or renewal supported living certification, the candidate shall sign an agreement under which the candidate agrees to notify the department within fourteen calendar days if, while holding supported living certification, the candidate is formally charged with, is convicted of, pleads guilty to, or is found eligible for intervention in lieu of conviction for a disqualifying offense. The agreement shall provide that failure to make the notification may result in denial, revocation, or suspension of the candidate's supported living certification.

(5) At the point of a candidate's application for initial or renewal supported living certification as an independent provider, the candidate shall obtain and provide to the department the candidate's driving record prepared by the bureau of motor vehicles if the services the candidate will provide involve transporting individuals. The department may consider the candidate's driving record when determining whether to issue supported living certification. A person whose driving record includes six or more points charged within the preceding twenty-four months is prohibited from transporting individuals.

(6) When the department issues initial supporting living certification to a candidate, the department shall enroll the candidate in the retained applicant fingerprint database. In the case that the department is notified by the bureau of criminal identification and investigation that a candidate cannot be enrolled in the retained applicant fingerprint database, the candidate shall, at a frequency of no less than once every five years, request the bureau of criminal identification and investigation to conduct a criminal records check of the candidate. If a candidate does not present proof that the candidate 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 candidate shall request that the bureau of criminal identification and investigation obtain information from the federal bureau of investigation as part of the criminal records check. If a candidate presents proof that the candidate 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 department may require the candidate to request that the bureau of criminal identification and investigation obtain information from the federal bureau of investigation as part of the criminal records check. For purposes of this paragraph, a candidate may provide proof of Ohio residency by presenting, with a signed statement asserting that the candidate has been a resident of Ohio for that five-year period, a valid driver's license, notification of registration as an elector, a copy of an officially filed federal or state tax form identifying the candidate's permanent residence, or any other document the department considers acceptable.

(b) The candidate shall instruct the bureau of criminal identification and investigation to submit the completed report of the criminal records check directly to the department.

(E) Disqualifying offenses

(1) There are five tiers of disqualifying offenses with corresponding time periods that preclude an applicant from being employed or an employee from remaining employed by a responsible entity and preclude a candidate from receiving supported living certification issued by the department.

(a) Tier one: permanent exclusion

No responsible entity shall employ an applicant or continue to employ an employee, nor shall the department issue supported living certification to a candidate, if the applicant, employee, or candidate has been convicted of, pleaded guilty to, or has been found eligible for intervention in lieu of conviction for any of the following sections of the Revised Code:

(i) 2903.01 (aggravated murder);

(ii) 2903.02 (murder);

(iii) 2903.03 (voluntary manslaughter);

(iv) 2903.11 (felonious assault);

(v) 2903.15 (permitting child abuse);

(vi) 2903.16 (failing to provide for a functionally impaired person);

(vii) 2903.34 (patient abuse or neglect);

(viii) 2903.341 (patient endangerment);

(ix) 2905.01 (kidnapping);

(x) 2905.02 (abduction);

(xi) 2905.32 (trafficking in persons);

(xii) 2905.33 (unlawful conduct with respect to documents);

(xiii) 2907.02 (rape);

(xiv) 2907.03 (sexual battery);

(xv) 2907.04 (unlawful sexual conduct with minor);

(xvi) 2907.05 (gross sexual imposition);

(xvii) 2907.06 (sexual imposition);

(xviii) 2907.07 (importuning);

(xix) 2907.08 (voyeurism);

(xx) 2907.12 (felonious sexual penetration);

(xxi) 2907.31 (disseminating matter harmful to juveniles);

(xxii) 2907.32 (pandering obscenity);

(xxiii) 2907.321 (pandering obscenity involving a minor or impaired person);

(xxiv) 2907.322 (pandering sexually oriented matter involving a minor or impaired person);

(xxv) 2907.323 (illegal use of minor or impaired person in nudity-oriented material or performance);

(xxvi) 2909.22 (soliciting or providing support for act of terrorism);

(xxvii) 2909.23 (making terroristic threat);

(xxviii) 2909.24 (terrorism);

(xxix) 2913.40 (medicaid fraud);

(xxx) 2923.01 (conspiracy), 2923.02 (attempt to commit an offense), or 2923.03 (complicity) when the underlying offense is any of the offenses or violations described in paragraphs (E)(1)(a)(i) to (E)(1)(a)(xxix) of this rule;

(xxxi) A conviction related to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct involving a federal or state-funded program, excluding the disqualifying offenses set forth in section 2913.46 of the Revised Code (illegal use of supplemental nutrition assistance or WIC program benefits); or

(xxxii) A violation of an existing or former municipal ordinance or law of this state, any other state, or the United States that is substantially equivalent to any of the offenses or violations described in paragraphs (E)(1)(a)(i) to (E)(1)(a)(xxxi) of this rule.

(b) Tier two: ten-year exclusion

No responsible entity shall employ an applicant or continue to employ an employee, nor shall the department issue supported living certification to a candidate, for a period of ten years from the date the applicant, employee, or candidate was fully discharged from imprisonment, probation, and parole, if the applicant, employee, or candidate has been convicted of, pleaded guilty to, or has been found eligible for intervention in lieu of conviction for any of the following sections of the Revised Code:

(i) 2903.04 (involuntary manslaughter);

(ii) 2903.041 (reckless homicide);

(iii) 2905.04 (child stealing) as it existed prior to July 1, 1996;

(iv) 2905.05 (criminal child enticement);

(v) 2905.11 (extortion);

(vi) 2907.21 (compelling prostitution);

(vii) 2907.22 (promoting prostitution);

(viii) 2907.23 (enticement or solicitation to patronize a prostitute; procurement of a prostitute for another);

(ix) 2909.02 (aggravated arson);

(x) 2909.03 (arson);

(xi) 2911.01 (aggravated robbery);

(xii) 2911.11 (aggravated burglary);

(xiii) 2913.46 (illegal use of supplemental nutrition assistance or WIC program benefits);

(xiv) 2913.48 (workers' compensation fraud);

(xv) 2913.49 (identity fraud);

(xvi) 2917.02 (aggravated riot);

(xvii) 2923.12 (carrying concealed weapons);

(xviii) 2923.122 (illegal conveyance or possession of deadly weapon or dangerous ordnance or of object indistinguishable from firearm in school safety zone);

(xix) 2923.123 (illegal conveyance of deadly weapon or dangerous ordnance into courthouse - illegal possession or control in courthouse);

(xx) 2923.13 (having weapons while under disability);

(xxi) 2923.161 (improperly discharging firearm at or into a habitation, in a school safety zone or with intent to cause harm or panic to persons in a school building or at a school function);

(xxii) 2923.162 (discharge of firearm on or near prohibited premises);

(xxiii) 2923.21 (improperly furnishing firearms to minor);

(xxiv) 2923.32 (engaging in pattern of corrupt activity);

(xxv) 2923.42 (participating in criminal gang);

(xxvi) 2925.02 (corrupting another with drugs);

(xxvii) 2925.03 (trafficking, aggravated trafficking in drugs);

(xxviii) 2925.04 (illegal manufacture of drugs - illegal cultivation of marihuana - methamphetamine offenses);

(xxix) 2925.041 (illegal assembly or possession of chemicals for manufacture of drugs);

(xxx) 3716.11 (placing harmful or hazardous objects in food or confection);

(xxxi) 2923.01 (conspiracy), 2923.02 (attempt to commit an offense), or 2923.03 (complicity) when the underlying offense is any of the offenses or violations described in paragraphs (E)(1)(b)(i) to (E)(1)(b)(xxx) of this rule; or

No responsible entity shall employ an applicant or continue to employ an employee, nor shall the department issue supported living certification to a candidate, for a period of seven years from the date the applicant, employee, or candidate was fully discharged from imprisonment, probation, and parole, if the applicant, employee, or candidate has been convicted of, pleaded guilty to, or has been found eligible for intervention in lieu of conviction for any of the following sections of the Revised Code:

(i) 959.13 (cruelty to animals);

(ii) 959.131 (prohibitions concerning companion animals);

(iii) 2903.12 (aggravated assault);

(iv) 2903.21 (aggravated menacing);

(v) 2903.211 (menacing by stalking);

(vi) 2905.12 (coercion);

(vii) 2909.04 (disrupting public services);

(viii) 2911.02 (robbery);

(ix) 2911.12 (burglary);

(x) 2913.47 (insurance fraud);

(xi) 2917.01 (inciting to violence);

(xii) 2917.03 (riot);

(xiii) 2917.31 (inducing panic);

(xiv) 2919.22 (endangering children);

(xv) 2919.25 (domestic violence);

(xvi) 2921.03 (intimidation);

(xvii) 2921.11 (perjury);

(xviii) 2921.13 (falsification - in theft offense - to purchase firearm);

(xix) 2921.34 (escape);

(xx) 2921.35 (aiding escape or resistance to lawful authority);

(xxi) 2921.36 (illegal conveyance of weapons, drugs or other prohibited items onto grounds of detention facility or institution);

(xxii) 2925.05 (funding, aggravated funding of drug or marihuana trafficking);

(xxiii) 2925.06 (illegal administration or distribution of anabolic steroids);

(xxiv) 2925.24 (tampering with drugs);

(xxv) 2927.12 (ethnic intimidation);

(xxvi) 2923.01 (conspiracy), 2923.02 (attempt to commit an offense), or 2923.03 (complicity) when the underlying offense is any of the offenses or violations described in paragraphs (E)(1)(c)(i) to (E)(1)(c)(xxv) of this rule; or

(xxvii) A violation of an existing or former municipal ordinance or law of this state, any other state, or the United States that is substantially equivalent to any of the offenses or violations described in paragraphs (E)(1)(c)(i) to (E)(1)(c)(xxvi) of this rule.

(d) Tier four: five-year exclusion

No responsible entity shall employ an applicant or continue to employ an employee, nor shall the department issue supported living certification to a candidate, for a period of five years from the date the applicant, employee, or candidate was fully discharged from imprisonment, probation, and parole, if the applicant, employee, or candidate has been convicted of, pleaded guilty to, or has been found eligible for intervention in lieu of conviction for any of the following sections of the Revised Code:

(i) 2903.13 (assault);

(ii) 2903.22 (menacing);

(iii) 2907.09 (public indecency);

(iv) 2907.24 (soliciting; solicitation after a positive HIV test);

(v) 2907.25 (prostitution - after a positive HIV test);

(vi) 2907.33 (deception to obtain matter harmful to juveniles);

(vii) 2911.13 (breaking and entering);

(viii) 2913.02 (theft);

(ix) 2913.03 (unauthorized use of a vehicle);

(x) 2913.04 (unauthorized use of property - computer, cable, or telecommunication property);

(xi) 2913.05 (telecommunications fraud);

(xii) 2913.11 (passing bad checks);

(xiii) 2913.21 (misuse of credit cards);

(xiv) 2913.31 (forgery - forging identification cards or selling or distributing forged identification cards);

(xv) 2913.32 (criminal simulation);

(xvi) 2913.41 (defrauding a rental agency or hostelry);

(xvii) 2913.42 (tampering with records);

(xviii) 2913.43 (securing writings by deception);

(xix) 2913.44 (personating an officer);

(xx) 2913.441 (unlawful display of law enforcement emblem);

(xxi) 2913.45 (defrauding creditors);

(xxii) 2913.51 (receiving stolen property);

(xxiii) 2919.12 (unlawful abortion);

(xxiv) 2919.121 (unlawful abortion upon minor);

(xxv) 2919.123 (unlawful distribution of an abortion-inducing drug);

(xxvi) 2919.124 (unlawful performance of a drug-induced abortion);

(xxvii) 2919.23 (interference with custody);

(xxviii) 2919.24 (contributing to unruliness or delinquency of a child);

(xxix) 2921.12 (tampering with evidence);

(xxx) 2921.21 (compounding a crime);

(xxxi) 2921.24 (disclosure of confidential information);

(xxxii) 2921.32 (obstructing justice);

(xxxiii) 2921.321 (assaulting or harassing police dog or horse or service dog);

(xxxiv) 2921.51 (impersonation of peace officer or private police officer);

(xxxv) 2925.09 (unapproved drugs - dangerous drug offenses involving livestock);

(xxxvi) 2925.11 (possession of controlled substances other than a minor drug possession offense);

(xxxvii) 2925.13 (permitting drug abuse);

(xxxviii) 2925.22 (deception to obtain a dangerous drug);

(xxxix) 2925.23 (illegal processing of drug documents);

(xl) 2925.36 (illegal dispensing of drug samples);

(xli) 2925.55 (unlawful purchase of pseudoephedrine or ephedrine product);

(xlii) 2925.56 (unlawful sale of pseudoephedrine or ephedrine product);

(xliii) 2923.01 (conspiracy), 2923.02 (attempt to commit an offense), or 2923.03 (complicity) when the underlying offense is any of the offenses or violations described in paragraphs (E)(1)(d)(i) to (E)(1)(d)(xlii) of this rule; or

(xliv) A violation of an existing or former municipal ordinance or law of this state, any other state, or the United States that is substantially equivalent to any of the offenses or violations described in paragraphs (E)(1)(d)(i) to (E)(1)(d)(xliii) of this rule.

(e) Tier five: no exclusion

A responsible entity may employ an applicant or continue to employ an employee, and the department may issue supported living certification to a candidate, if the applicant, employee, or candidate has been convicted of, pleaded guilty to, or has been found eligible for intervention in lieu of conviction for any of the following sections of the Revised Code:

(i) 2925.11 (possession of controlled substances);

(ii) 2925.14 (illegal use or possession of drug paraphernalia);

(iii) A violation of an existing or former municipal ordinance or law of this state, any other state, or the United States that is substantially equivalent to any of the offenses or violations described in paragraph (E)(1)(e)(i) or (E)(1)(e)(ii) of this rule.

(2) Exclusionary periods for multiple disqualifying offenses

(a) If an applicant, employee, or candidate has been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for multiple disqualifying offenses, including an offense listed in paragraph (E)(1)(b) of this rule, and another offense or offenses listed in paragraph (E)(1)(b), (E)(1)(c), or (E)(1)(d) of this rule, the applicant, employee, or candidate is subject to a fifteen-year exclusionary period beginning on the date the applicant, employee, or candidate was fully discharged from imprisonment, probation, or parole for the most recent offense.

(b) If an applicant, employee, or candidate has been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for multiple qualifying offenses, including an offense listed in paragraph (E)(1)(c) of this rule, and another offense or offenses listed in paragraph (E)(1)(c) or (E)(1)(d) of this rule, the applicant, employee, or candidate is subject to a ten-year exclusionary period beginning on the date the applicant, employee, or candidate was fully discharged from imprisonment, probation, or parole for the most recent offense.

(c) If an applicant, employee, or candidate has been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for multiple qualifying offenses listed in paragraph (E)(1)(d) of this rule, the applicant, employee, or candidate is subject to a seven-year exclusionary period beginning on the date the applicant, employee, or candidate was fully discharged from imprisonment, probation, or parole for the most recent offense.

(F) A conviction of or plea of guilty to a disqualifying offense listed or described in paragraph (E)(1) of this rule shall not preclude an applicant from being employed or an employee from remaining employed by a responsible entity or preclude a candidate from receiving supported living certification issued by the department under the following circumstances:

(1) The applicant, employee, or candidate has been granted an unconditional pardon for the offense pursuant to Chapter 2967. of the Revised Code;

(2) The applicant, employee, or candidate has been granted an unconditional pardon for the offense pursuant to an existing or former law of this state, any other state, or the United States, if the law is substantially equivalent to Chapter 2967. of the Revised Code;

(3) The applicant's, employee's, or candidate's conviction or guilty plea has been overturned pursuant to law;

(4) The applicant, employee, or candidate has been granted a conditional pardon for the offense pursuant to Chapter 2967. of the Revised Code and the conditions under which the pardon was granted have been satisfied;

(5) The applicant's, employee's, or candidate's conviction or guilty plea is not for an offense listed or described in paragraph (E)(1)(a) of this rule and the applicant, employee, or candidate presents a certificate of qualification for employment issued by a court of common pleas with competent jurisdiction pursuant to section 2953.25 of the Revised Code; or

(6) The applicant's, employee's, or candidate's conviction or guilty plea is not for an offense listed or described in paragraph (E)(1)(a) of this rule and the applicant, employee, or candidate presents a certificate of achievement and employability in a home and community-based services-related field, issued by the Ohio department of rehabilitation and correction pursuant to section 2961.22 of the Revised Code.

(G) A responsible entity may continue to employ a person who is excluded by paragraph (E)(1)(d) of this rule if the conviction for a tier four offense occurred prior to January 1, 2013, the employee was hired prior to January 1, 2013, and if the responsible entity has considered the nature and seriousness of the offense and attested in writing to the character and fitness of the person based on the person's demonstrated work performance. The responsible entity must have made this determination and attestation by April 1, 2013 and maintain the written attestation in the employee's personnel record. The determination and attestation are subject to review by the department.

(H) The department may renew the supported living certification of a candidate who is excluded by paragraph (E)(1)(d) of this rule if the conviction for a tier four offense occurred prior to January 1, 2013, the candidate was originally certified to provide supported living prior to January 1, 2013, and if the department has considered the nature and seriousness of the offense and determines that the candidate has demonstrated the appropriate character and fitness to have the supported living certification renewed based on the candidate's demonstrated work performance. The department shall keep a written record of its determination for each candidate.

(I) Any report obtained pursuant to this rule is not a public record for purposes of section 149.43 of the Revised Code and shall not be made available to any person other than:

(1) The applicant, employee, or candidate who is the subject of the report or the applicant's, employee's, or candidate's representative;

(2) The responsible entity that requested the report or its representative;

(3) The department if a county board, agency provider, or subcontractor is the responsible entity that requested the report and the department requests the responsible entity to provide a copy of the report to the department;

(4) A county board if an agency provider or subcontractor is the responsible entity that requested the report and the county board requests the responsible entity to provide a copy of the report to the county board; or

(5) A court, hearing officer, or other necessary person involved in a case dealing with the denial of employment to the applicant or employee; the denial, suspension, or revocation of certification issued pursuant to section 5123.166 or 5123.45 of the Revised Code; or a civil or criminal action regarding the medicaid program or a program the department administers.

(J) For purposes of this rule, reports from the bureau of criminal identification and investigation or any other state or federal agency regarding a person's criminal record and records supplied by the bureau of motor vehicles regarding a person's record of convictions for violations of motor vehicle laws are valid for a period of one year from the date of the report.

Last updated February 19, 2026 at 7:47 AM

History

Effective: February 19, 2026
Promulgated Under: 119.03

Ohio Adm.Code 5123-2-03 Quality assurance.

(A) The Ohio department of developmental disabilities promotes services, supports, and activities that enhance the quality of life for Ohioans with developmental disabilities with regard to:

(1) Rights as set forth in section 5123.62 of the Revised Code;

(2) Self-determination;

(3) Physical well-being;

(4) Emotional well-being;

(5) Material well-being;

(6) Personal development;

(7) Interpersonal relationships; and

(8) Social inclusion.

(B) The department employs multiple processes, set forth in administrative rules, to achieve quality outcomes for individuals who receive services:

(1) Rule 5123-2-04 of the Administrative Code (compliance reviews of certified providers);

(2) Rule 5123-4-01 of the Administrative Code (accreditation of county boards of developmental disabilities);

(3) Rule 5123-17-02 of the Administrative Code (major unusual incidents and unusual incidents);

(4) Rule 5123-4-02 of the Administrative Code (service and support administration);

(5) Rules 5123-2-08 and 5123-2-09 of the Administrative Code (provider certification);

(6) Rule 5123-2-05 of the Administrative Code (employment first);

(7) Rule 5123-2-06 of the Administrative Code (behavioral support);

(8) Rule 5123-2-07 of the Administrative Code (personal funds);

(9) Chapter 5123-3 of the Administrative Code (residential facilities licensed pursuant to section 5123.19 of the Revised Code);

(10) Rule 5123-6-07 of the Administrative Code (performance of health-related activities and administration of medication);

(11) Rule 5123-9-02 of the Administrative Code (suitability of service settings); and

(12) Rule 5123-9-11 of the Administrative Code (free choice of providers).

(C) Additionally, the department participates in "National Core Indicators," a collaboration among state agencies that serve individuals with developmental disabilities, the "National Association of State Directors of Developmental Disabilities Services," and the "Human Services Research Institute," which offers a systemic approach to performance and outcome measurement.

(D) Individuals who receive services, legal guardians, or family members may request a review of services or may request the results of prior reviews that have been conducted. In response, the department may initiate or conduct a review, request that a review be conducted by a county board of developmental disabilities, or take other appropriate action.

Last updated November 1, 2024 at 8:38 AM

History

Effective: November 1, 2024
Promulgated Under: 119.03

Ohio Adm.Code 5123-2-04 Compliance reviews of certified providers.

(A) Purpose and scope

This rule governs compliance reviews conducted by the department and county boards of developmental disabilities to ensure compliance by certified providers with applicable requirements. This rule applies to all certified providers, including certified providers licensed in accordance with section 5123.19 of the Revised Code.

(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) "Applicable requirements" means:

(a) Federal and state laws and regulations which govern the conduct of the certified provider, including but not limited to, Chapters 4723., 5123., 5126., and 5160. of the Revised Code and all administrative rules promulgated under the authority of those statutes.

(b) Requirements set forth in a home and community-based services waiver administered by the department pursuant to an interagency agreement between the department and the Ohio department of medicaid.

(3) "Certification revocation" means the revocation of a certified provider's certification to serve one or more individuals in one or more counties.

(4) "Certification suspension" means either:

(a) Suspension of a certified provider's certification to serve one or more individuals in one or more counties for a specified time period; or

(b) Suspension of a certified provider's certification to serve additional individuals in one or more counties.

(5) "Certified provider" means an agency provider or independent provider certified by the department pursuant to section 5123.161 of the Revised Code to provide supported living, including home and community-based services.

(6) "Compliance review" means a review of a certified provider conducted by the department or a county board for the purpose of determining provider compliance with applicable requirements in order to ensure the health, safety, and welfare of individuals served.

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

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

(9) "Director of operations" means the person employed by an agency provider who is responsible for and directly and actively involved in the day-to-day operation of the agency provider.

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

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

(12) "Investigative agent" means a person, regardless of title, employed by or under contract with a county board to conduct administrative investigations of major unusual incidents.

(13) "Major unusual incident" has the same meaning as in rule 5123-17-02 of the Administrative Code.

(14) "Protocol for compliance reviews" means the forms, instructions for the completion of written documentation, and process developed by the department and used by the department and county boards to conduct compliance monitoring in accordance with this rule. The protocol for compliance reviews does not create provider standards or qualifications.

(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.

(1) There are three types of compliance reviews:

(a) Routine compliance reviews

In accordance with priorities established by the department in the protocol for compliance reviews, the department will coordinate with county boards to ensure that each certified provider receives a routine compliance review within one year of the certified provider's initial billing for provision of services. Thereafter, routine compliance reviews of certified providers will be conducted so that each certified provider that has billed for provision of services within the past twenty-four months is reviewed once during the term of certification.

(b) Special compliance reviews

The department or a county board may conduct special compliance reviews as necessary:

(i) Pertaining to the health, safety, or welfare of an individual;

(ii) Based on a complaint or allegation; or

(iii) Based on a major unusual incident that may indicate the certified provider's failure to comply with applicable requirements.

(i) The department may conduct an abbreviated compliance review when a certified provider holds accreditation by a national accrediting entity. An abbreviated compliance review focuses on individuals served and their health and safety, examines fewer policies, and relies on smaller sample sizes of staff and individuals served. A certified provider that is accredited by a national accrediting entity may be eligible for an abbreviated compliance review when the standards of the national accrediting entity:

(a) Meet or exceed the department's standards;

(b) Are compatible with the centers for medicare and medicaid services home and community-based services core set of quality measures;

(d) Ensure the health and safety of individuals served.

(ii) An abbreviated compliance review will examine the certified provider's compliance with applicable requirements regarding:

(a) Background investigations and training of the certified provider's director of operations and employees;

(b) Behavioral support strategies;

(d) Major unusual incidents; and

(e) Service delivery.

(iii) To be eligible for an abbreviated compliance review, the certified provider will submit a written request to the department that includes a copy of the most recent survey/review of the certified provider by the national accrediting entity.

(iv) The certified provider will notify the department in writing within ten calendar days if the certified provider's accreditation by the national accrediting entity is amended, suspended, terminated, or not renewed and provide a copy of related correspondence from the national accrediting entity.

(v) An abbreviated compliance review may not be available when:

(a) The certified provider has not yet received an initial routine compliance review by the department or county board.

(b) The certified provider has had multiple or significant substantiated major unusual incidents since the most recent compliance review by the department or county board or survey/review by the national accrediting entity.

(c) The certified provider's director of operations and/or key members of the certified provider's management team have changed since the most recent compliance review by the department or county board or survey/review by the national accrediting entity.

(d) The certified provider's accreditation by the national accrediting entity has been amended or suspended.

(2) Only the department may conduct compliance reviews of residential facilities licensed in accordance with section 5123.19 of the Revised Code and administrative rules promulgated under its authority.

(3) The department will maintain a protocol for compliance reviews. A county board will implement the protocol for compliance reviews and, absent extenuating circumstances, may not change or augment the protocol for compliance reviews.

(a) The protocol for compliance reviews will include, but is not limited to:

(i) The method for selecting certified providers to be reviewed;

(ii) The types and scope of reviews that may be conducted;

(iii) The process and procedures for notifying certified providers of upcoming reviews;

(iv) The elements of provider compliance which will be based on the applicable requirements;

(v) The elements of a written compliance review summary to a certified provider that will include an explanation of any citations, the process to develop and implement a plan of correction, and an explanation of the due process afforded to a certified provider;

(vi) The criteria for conducting announced and unannounced reviews; and

(vii) Any forms or methods of documentation approved by the department.

(b) The department will make the protocol for compliance reviews available at its website (https://dodd.ohio.gov).

(D) Compliance review summary and plan of correction

(1) Within ten calendar days of conclusion of a compliance review, the department or county board, as applicable, will issue to the certified provider, a written compliance review summary or a written explanation of the reason for delay in issuance of the written compliance review summary.

(a) A written compliance review summary will be in the format described in the protocol for compliance reviews and objective in terms of observations and citations, relying upon documentation that clearly addresses the standards reviewed.

(b) A written explanation of the reason for delay in issuance of the written compliance review summary will include the date by which the department or county board, as applicable, will issue a written compliance review summary, which will not be more than twenty calendar days of conclusion of the compliance review.

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

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

(i) If the compliance review was conducted by the department and the appeal is disallowed, the certified provider will submit a written plan of correction for the citation to the department within fourteen calendar days.

(ii) If the compliance review was conducted by a county board and the appeal is disallowed, the certified provider will either:

(a) Submit a written plan of correction for the citation to the county board within fourteen calendar days; or

(b) If the certified provider objects to the county board's decision to disallow the appeal, submit to the department a written appeal within fourteen calendar days of the county board's decision. The department will notify the certified provider and the county board of its decision to allow or disallow the appeal within ten calendar days of receipt. If the department disallows the appeal, the certified provider will submit a written plan of correction for the citation to the county board within fourteen calendar days.

(b) The written plan of correction for a citation will include action steps and timelines for remediation. The department or county board, as applicable, will approve or disapprove the plan of correction within twenty calendar days of receipt. When the department or county board disapproves a plan of correction, the certified provider will work with the department or county board, as applicable, to develop an acceptable plan of correction.

(E) Qualifications for persons conducting compliance reviews

(1) A person conducting compliance reviews will either:

(a) Hold a bachelor's degree or graduate-level degree from an accredited college or university and have at least two years of full-time (or equivalent part-time) paid work experience working directly with individuals; or

(b) Have been, without interruption, employed by or under contract with the department or a county board to conduct compliance reviews since June 30, 2019.

(2) A person conducting compliance reviews will complete training in accordance with paragraph (F) of this rule.

(3) A person conducting compliance reviews will not be an investigative agent or a service and support administrator.

(F) Training

(1) The department will provide or arrange for initial training to county boards and certified providers regarding the requirements and procedures outlined in this rule and in the protocol for compliance reviews.

(2) Any employees or agents of the department or a county board whose responsibilities include conducting compliance reviews in accordance with this rule will successfully complete the initial training in the requirements and procedures outlined in this rule prior to being authorized by the department to conduct compliance reviews.

(3) The department will provide documentation of a person's successful completion of the initial training to the county board. The county board will maintain a list of the persons in its county that have successfully completed the initial training and are authorized by the department to conduct compliance reviews in accordance with this rule.

(4) The department may require persons who have received the initial training to receive continuing training in the implementation of this rule in a manner prescribed by the department.

(G) Certification suspension and certification revocation

(1) The department may initiate certification suspension or certification revocation proceedings if the department finds:

(a) Substantial violation of applicable requirements which present a risk to an individual's health and welfare; or

(b) A pattern of non-compliance with plans of correction approved in accordance with this rule; or

(d) A licensed provider has had its license revoked by the licensing authority; or

(e) Failure to cooperate with the compliance review process set forth in this rule; or

(f) Other good cause, including misfeasance, malfeasance, nonfeasance, substantiated abuse or neglect, financial irresponsibility, or other conduct the department determines is injurious to individuals being served. The department may gather and evaluate information from a variety of sources, including the county board and the provider, in making such a determination.

(2) Certification suspension and certification revocation proceedings will be conducted in accordance with Chapter 119. of the Revised Code.

(3) When the department issues a notice of its intent to suspend or revoke a certified provider's certification, the department will give written notice to the Ohio department of medicaid and to the county board of each county in which the proposed suspension or revocation is proposed to be effective.

(4) Each county board that is notified in writing by the department of the department's intent to suspend or revoke a certified provider's certification will so notify in writing each individual in the county who is receiving services for which the provider's certification is proposed to be suspended or revoked (or as applicable, the individual's parent or guardian).

(5) The department may suspend or revoke a certified provider's certification regardless of whether some or all of the deficiencies enumerated in accordance with this rule that prompted the department's intent to suspend or revoke the certification have been corrected at the time of the hearing.

(6) When the department suspends or revokes a certified provider's certification, the certified provider will comply with the department's adjudication order within thirty calendar days of the date of the mailing of the order.

(7) The department will give written notice of the certified provider's suspension or revocation to the Ohio department of medicaid and to the county board of each county in which the suspension or revocation is effective.

(8) Each county board that is notified in writing by the department of suspension or revocation of a certified provider's certification will so notify in writing each individual in the county who is receiving services for which the provider's certification is suspended or revoked (or as applicable, the individual's parent or guardian).

(H) Issuance of a citation to a county board

The department may issue a citation to a county board if the department determines, based on a compliance review of a certified provider, that the county board failed to follow applicable requirements set forth in Chapter 5123. or 5126. of the Revised Code or rules adopted pursuant to those chapters.

Last updated November 9, 2023 at 8:21 AM

History

Effective: November 9, 2023
Promulgated Under: 119.03

Ohio Adm.Code 5123-2-05 Employment first.

(A) Purpose

This rule implements Ohio's employment first policy in accordance with section 5123.022 of the Revised Code.

(B) Scope

This rule applies to county boards of developmental disabilities and providers of employment services, regardless of funding source, to individuals with developmental disabilities.

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

(1) "Benefits analysis" means information provided to individuals about the impact of earning wages on public assistance programs including but not limited to, social security disability insurance, supplemental security income, medicaid/medicare eligibility, medicaid buy-in for workers with disabilities, veteran's benefits, housing assistance, and food stamps.

(2) "Community employment" means competitive employment that takes place in an integrated setting.

(3) "Competitive integrated employment" means work (including self-employment) that is performed on a full-time or part-time basis:

(a) For which an individual is:

(i) Compensated:

(A) At a rate that is not less than the higher of the rate specified in the Fair Labor Standards Act of 1938, 29 U.S.C. 206(a)(1), as in effect on the effective date of this rule, or the rate specified in the applicable state or local minimum wage law and is not less than the customary rate paid by the employer for the same or similar work performed by other employees who do not have disabilities, and who are in similar occupations by the same employer and who have similar training, experience, and skills; or

(B) In the case of an individual who is self-employed, yields an income that is comparable to the income received by persons without disabilities, who are self-employed in similar occupations or similar tasks and who have similar training, experience, and skills; and

(ii) Eligible for the level of benefits provided to other full-time and part-time employees;

(b) At a location where the individual interacts with persons without disabilities to the same extent as employees who are not receiving home and community-based services;

(i) Dispersed enclaves in which individuals work in a self-contained unit within a company or service site in the community or perform multiple jobs in the company, but are not integrated with non-disabled employees of the company; or

(ii) Mobile work crews comprised solely of individuals operating as a distinct unit and/or self-contained business working in several locations within the community; and

(d) That, as appropriate, presents opportunities for advancement that are similar to those for persons without disabilities who have similar positions.

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

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

(6) "Employment first policy" means the state of Ohio policy, established in section 5123.022 of the Revised Code, that employment services for individuals with developmental disabilities be directed at community employment and that individuals with developmental disabilities are presumed capable of community employment.

(7) "Employment services" means:

(a) The following medicaid-funded home and community-based services:

(i) Career planning in accordance with rule 5123-9-13 of the Administrative Code;

(ii) Group employment support in accordance with rule 5123-9-16 of the Administrative Code;

(iii) Individual employment support in accordance with rule 5123-9-15 of the Administrative Code; and

(iv) Vocational habilitation in accordance with rule 5123-9-14 of the Administrative Code.

(b) Any services, regardless of funding, that are comparable to the services described in paragraph (C)(7)(a) of this rule.

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

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

(10) "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.

(11) "Informed consent" means a documented written agreement to allow a proposed action, treatment, or service after full disclosure provided in a manner the individual or the individual's guardian understands, of the relevant facts necessary to make the decision. Relevant facts include the risks and benefits of the action, treatment, or service; the risks and benefits of the alternatives to the action, treatment, or service; and the right to refuse the action, treatment, or service. The individual or the individual's guardian, as applicable, may withdraw informed consent at any time.

(12) "Integrated setting" means a setting typically found in the community where individuals interact with persons who do not have disabilities to the same extent as persons who do not have disabilities in comparable positions. "Integrated setting" includes employment settings in which employees interact with the community through technology.

(13) "Provider" means an agency provider or an independent provider that is certified by the department or a residential facility that is licensed by the department.

(14) "Working age" means at least eighteen years of age.

(D) Person-centered planning process

(1) Each individual of working age and each individual approaching completion of a program or service under Chapter 3323 of the Revised Code will participate in a person-centered planning process in accordance with rule 5123-3-03 or 5123-4-02 of the Administrative Code, as applicable, to identify the individual's unique strengths, interests, abilities, preferences, resources, and desired outcomes as they relate to competitive integrated employment.

(a) The person-centered planning process will begin with a review of available information to determine what additional information is needed and what supplemental situational and/or other formal or informal evaluations are needed to discover this information and culminate in informed consent.

(b) For an individual who receives public assistance, the importance of obtaining a benefits analysis will be emphasized to enable the individual to make informed decisions regarding employment. Resources available for obtaining a benefits analysis will be identified for the individual prior to job development.

(2) The person-centered planning process will include identification and documentation of the individual's place on the path to competitive integrated employment, that is:

(a) Place I - the individual is already engaged in competitive integrated employment and needs support for job stabilization, job improvement, or career advancement;

(b) Place II - the individual expresses a desire to obtain competitive integrated employment but is not currently employed and needs support to obtain employment or identify career options and employment opportunities;

(c) Place III - the individual is unsure about competitive integrated employment and needs support to identify career options and employment opportunities and the economic impact of the individual's decision; or

(d) Place IV - the individual has been offered, within the most recent twelve-month period, information and support to identify career options, employment opportunities, and the economic impact of the individual's decision and does not currently desire to pursue competitive integrated employment.

(3) The individual service plan will:

(a) For an individual on place I or place II of the path to competitive integrated employment, include the individual's desired competitive integrated employment outcome and related action steps.

(b) For an individual on place III of the path to competitive integrated employment, describe the activities that will occur to advance the individual on the path to competitive integrated employment.

(c) For an individual on place IV of the path to competitive integrated employment, document the information and support offered to the individual within the most recent twelve-month period about career options, employment opportunities, the economic impact of the individual's decision, and outcomes centered around the individual's capabilities and successes of engaging in meaningful activities within the individual's community.

(4) The results of the person-centered planning process will be reviewed at least once every twelve months and whenever a significant change in employment, training, continuing education, services, or supports occurs or is proposed.

(E) Requirements for county boards

A county board will:

(1) Adopt and implement a local policy to implement the employment first policy which clearly identifies competitive integrated employment as the desired outcome for every individual of working age.

(2) Outline and periodically update its strategy and benchmarks for increasing the number of individuals of working age engaged in competitive integrated employment.

(3) Collaborate with workforce development agencies, vocational rehabilitation agencies, and mental health agencies in the county to support individuals to obtain competitive integrated employment.

(4) Collaborate with school districts in the county to:

(a) Ensure a framework exists for individuals approaching completion of a program or service under Chapter 3323 of the Revised Code such that the county board and school districts in the county use similar methods to support students with developmental disabilities to obtain competitive integrated employment.

(b) Identify and attempt to resolve any duplication of efforts.

(5) Disseminate information to individuals served, families, schools, community partners, employers, and providers of services about resources and opportunities, including medicaid buy-in for workers with disabilities and other work incentive programs, that facilitate competitive integrated employment.

(6) Collect and annually submit to the department, individual-specific data regarding the cost of non-medicaid employment services, employment outcomes for individuals who receive non-medicaid employment services, and the place on the path to competitive integrated employment for individuals of working age.

(F) Requirements for providers of employment services

A provider of employment services will:

(1) Submit to each individual's team at least once every twelve months, or more frequently as decided by the team, a written progress report that demonstrates that employment services provided are consistent with the individual's desired competitive integrated employment outcome and that the individual receiving employment services has obtained competitive integrated employment or is advancing on the path to competitive integrated employment.

(a) The written progress report will include the individual's annual wage earnings and identify the anticipated time-frame and tangible progress made toward achievement of each desired outcome of the employment services provided as set forth in the individual service plan.

(b) If no progress is reported, the individual service plan will be amended to identify the barriers toward achieving desired outcomes and the action steps to overcome the identified barriers.

(2) Collect and annually submit to the department's outcome tracking system, individual-specific data regarding employment services and employment outcomes for individuals served by the provider including but not limited to, type of employment services provided, how individuals obtained employment, hours worked, wages earned, and occupations.

(3) Disseminate to individuals seeking employment services and others upon request, aggregate data regarding employment services and employment outcomes for individuals served by the provider including but not limited to, type of employment services provided, how individuals obtained employment, hours worked, wages earned, and occupations. The data will be disseminated in a manner that does not disclose confidential information regarding individuals receiving employment services.

Last updated June 25, 2025 at 7:18 PM

History

Effective: June 30, 2023
Promulgated Under: 119.03

Ohio Adm.Code 5123-2-06 Development and implementation of behavioral support strategies.

(A) Purpose

This rule sets forth requirements for development and implementation of behavioral support strategies including both positive measures and restrictive measures for the purpose of ensuring:

(1) Individuals with developmental disabilities are supported in a caring and responsive manner that promotes dignity, respect, and trust and with recognition that they are equal citizens with the same rights and personal freedoms granted to Ohioans without developmental disabilities;

(2) An individual's services and supports are based on an understanding of the individual and the reasons for the individual's actions;

(3) Effort is directed at creating opportunities for individuals to exercise choice in matters affecting their everyday lives and supporting individuals to make choices that yield positive outcomes; and

(4) Restrictive measures are used only when necessary to keep people safe and always in conjunction with positive measures.

(B) Scope

(1) This rule applies to persons and entities that provide specialized services regardless of source of payment, including but not limited to:

(a) County boards of developmental disabilities and entities under contract with county boards;

(b) Residential facilities licensed pursuant to section 5123.19 of the Revised Code, including intermediate care facilities for individuals with intellectual disabilities;

(d) Providers of services funded by medicaid home and community-based services waivers administered by the department pursuant to section 5166.21 of the Revised Code.

(2) Individuals receiving services in a setting governed by the Ohio department of education shall be supported in accordance with rule 3301-35-15 of the Administrative Code.

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

(1) "Chemical restraint" means the use of medication in accordance with scheduled dosing or pro re nata ("PRN" or as needed) for the purpose of causing a general or non-specific blunt suppression of behavior (i.e., the effect of the medication results in a noticeable or discernible difference in the individual's ability to complete activities of daily living) or for the purpose of treating sexual offending behavior.

(a) A behavioral support strategy may include chemical restraint only when an individual's actions pose risk of harm or an individual engages in a precisely-defined pattern of behavior that is very likely to result in risk of harm.

(b) A medication prescribed for the treatment of a physical or psychiatric condition in accordance with the standards of treatment for that condition and not for the purpose of causing a general or non-specific blunt suppression of behavior, is presumed to not be a chemical restraint.

(c) "Chemical restraint" does not include a medication that is routinely prescribed in conjunction with a medical procedure for patients without developmental disabilities.

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

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

(4) "Director" means the director of the Ohio department of developmental disabilities.

(5) "Emergency" means an individual's behavior presents an immediate danger of physical harm to the individual or another person or the individual being the subject of a legal sanction and all available positive measures have proved ineffective or infeasible.

(6) "Human rights committee" means a standing committee formed by a county board or an intermediate care facility for individuals with intellectual disabilities to safeguard individuals' rights and protect individuals from physical, emotional, and psychological harm. At an intermediate care facility for individuals with intellectual disabilities, the human rights committee may also be referred to as a "specially constituted committee" as that term is used in 42 C.F.R. 483.440 as in effect on the effective date of this rule.

(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) "Informed consent" means a documented written agreement to allow a proposed action, treatment, or service after full disclosure provided in a manner an individual or the individual's guardian, as applicable, understands, of the relevant facts necessary to make the decision. Relevant facts include the risks and benefits of the action, treatment, or service; the risks and benefits of the alternatives to the action, treatment, or service; and the right to refuse the action, treatment, or service. An individual or guardian, as applicable, may withdraw informed consent at any time.

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

(11) "Manual restraint" means use of a hands-on method, but never in a prone restraint, to control an identified action by restricting the movement or function of an individual's head, neck, torso, one or more limbs, or entire body, using sufficient force to cause the possibility of injury and includes holding or disabling an individual's wheelchair or other mobility device.

(a) A behavioral support strategy may include manual restraint only when an individual's actions pose risk of harm.

(b) An individual in a manual restraint shall be under constant visual supervision by staff.

(d) "Manual restraint" does not include a method that is routinely used during a medical procedure for patients without developmental disabilities.

(12) "Mechanical restraint" means use of a device, but never in a prone restraint, to control an identified action by restricting an individual's movement or function.

(a) A behavioral support strategy may include mechanical restraint only when an individual's actions pose risk of harm.

(b) Mechanical restraint shall cease immediately once risk of harm has passed.

(i) A seatbelt of a type found in an ordinary passenger vehicle or an age-appropriate child safety seat;

(ii) A medically-necessary device (such as a wheelchair seatbelt or a gait belt) used for supporting or positioning an individual's body; or

(iii) A device that is routinely used during a medical procedure for patients without developmental disabilities.

(13) "Precisely-defined pattern of behavior" means a documented and predictable sequence of actions that if left uninterrupted, will very likely result in physical harm to self or others.

(14) "Prohibited measure" means a method that shall not be used by persons or entities providing specialized services. "Prohibited measures" include:

(a) Prone restraint.

(b) Use of a manual restraint or mechanical restraint that has the potential to inhibit or restrict an individual's ability to breathe or that is medically contraindicated.

(d) Disabling an individual's communication device.

(e) Denial of breakfast, lunch, dinner, snacks, or beverages (excluding denial of snacks or beverages for an individual with primary polydipsia or a compulsive eating disorder attributed to a diagnosed condition such as "Prader-Willi Syndrome," and denial is based on specific medical treatment of the diagnosed condition and approved by the human rights committee).

(f) Placing an individual in a room with no light.

(g) Subjecting an individual to damaging or painful sound.

(h) Application of electric shock to an individual's body (excluding electroconvulsive therapy prescribed by a physician as a clinical intervention to treat a diagnosed medical condition and administered by a physician or a credentialed advanced practice registered nurse).

(i) Subjecting an individual to any humiliating or derogatory treatment.

(j) Squirting an individual with any substance as an inducement or consequence for behavior.

(k) Using any restrictive measure for punishment, retaliation, convenience of providers, or as a substitute for specialized services.

(15) "Prone restraint" means a method of intervention where an individual's face and/or frontal part of an individual's body is placed in a downward position touching any surface for any amount of time.

(16) "Provider" means any person or entity that provides specialized services.

(17) "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.

(18) "Restrictive measure" means a method of last resort that may be used by persons or entities providing specialized services only when necessary to keep people safe and with prior approval in accordance with paragraph (H) of this rule. "Restrictive measures" include:

(a) Chemical restraint;

(b) Manual restraint;

(d) Rights restriction; and

(e) Time-out

(19) "Rights restriction" means restriction of an individual's rights as enumerated in section 5123.62 of the Revised Code.

(a) A behavioral support strategy may include a rights restriction only when an individual's actions pose risk of harm or are very likely to result in the individual being the subject of a legal sanction such as eviction, arrest, or incarceration.

(b) Absent risk of harm or likelihood of legal sanction, an individual's rights shall not be restricted (e.g., by imposition of arbitrary schedules or limitation on consumption of tobacco products).

(20) "Risk of harm" means there exists a direct and serious risk of physical harm to an individual or another person. For risk of harm:

(a) An individual must be capable of causing physical harm to self or others; and

(b) The individual must be causing physical harm to self or others or very likely to begin doing so.

(21) "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.

(22) "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 make a determination. The director's determination is not subject to appeal.

(23) "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.

(24) "Time-out" means confining an individual in a room or area and preventing the individual from leaving the room or area by applying physical force or by closing a door or constructing another barrier, including placement in such a room or area when a staff person remains in the room or area.

(a) A behavioral support strategy may include time-out only when an individual's actions pose risk of harm.

(b) Time-out shall not exceed thirty minutes for any one incident nor one hour in any twenty-four hour period.

(c) A time-out room or area shall not be key-locked, but the door may be held shut by a staff person or by a mechanism that requires constant physical pressure from a staff person to keep the mechanism engaged.

(d) A time-out room or area shall be adequately lighted and ventilated and provide a safe environment for the individual.

(e) An individual in a time-out room or area shall be protected from hazardous conditions including but not limited to, sharp corners and objects, uncovered light fixtures, or unprotected electrical outlets.

(f) An individual in a time-out room or area shall be under constant visual supervision by staff.

(g) Time-out shall cease immediately once risk of harm has passed or if the individual engages in self-abuse, becomes incontinent, or shows other signs of illness.

(h) "Time-out" does not include periods when an individual, for a limited and specified time, is separated from others in an unlocked room or area for the purpose of self-regulation of behavior and is not physically restrained or prevented from leaving the room or area by physical barriers.

(D) Development of a behavioral support strategy

(1) The focus of a behavioral support strategy is the proactive creation of supportive environments that enhance an individual's quality of life by understanding and respecting the individual's needs and expanding opportunities for the individual to communicate and exercise choice and control through identification and implementation of positive measures such as:

(a) Emphasizing alternative ways for the individual to communicate needs and to have needs met;

(b) Adjusting the physical or social environment;

(d) Adjusting schedules; and

(e) Establishing trusting relationships.

(2) A behavioral support strategy that includes restrictive measures requires:

(a) Documentation that demonstrates that positive measures have been employed and have been determined ineffective.

(b) An assessment conducted within the past twelve months that clearly describes:

(i) The behavior that poses risk of harm or likelihood of legal sanction or the individual's engagement in a precisely-defined pattern of behavior that is very likely to result in risk of harm;

(ii) The level of harm or type of legal sanction that could reasonably be expected to occur with the behavior;

(iii) When the behavior is likely to occur;

(iv) The individual's interpersonal, environmental, medical, mental health, communication, sensory, and emotional needs; diagnosis; and life history including traumatic experiences as a means to gain insight into origins and patterns of the individual's actions; and

(v) The nature and degree of risk to the individual if the restrictive measure is implemented.

(i) Mitigate risk of harm or likelihood of legal sanction;

(ii) Reduce and ultimately eliminate the need for restrictive measures; and

(iii) Ensure environments where the individual has access to preferred activities and is less likely to engage in unsafe actions due to boredom, frustration, lack of effective communication, or unrecognized health problems.

(3) A behavioral support strategy shall never include prohibited measures.

(4) Persons who conduct assessments and develop behavioral support strategies that include restrictive measures shall:

(a) Hold a valid license issued by the Ohio board of psychology;

(b) Hold a valid license issued by the Ohio counselor, social worker and marriage and family therapist board;

(d) 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.

(5) A behavioral support strategy that includes restrictive measures shall:

(a) Be designed in a manner that promotes healing, recovery, and resilience;

(b) Have the goal of helping the individual to achieve outcomes and pursue interests while reducing or eliminating the need for restrictive measures to ensure safety;

(d) Recognize the role environment has on behavior;

(e) Capitalize on the individual's strengths to meet challenges and needs;

(f) Delineate restrictive measures to be implemented and identify those who are responsible for implementation;

(g) Specify steps to be taken to ensure the safety of the individual and others;

(h) As applicable, identify needed services and supports to assist the individual in meeting court-ordered community controls such as mandated sex offender registration, drug-testing, or participation in mental health treatment; and

(i) As applicable, outline necessary coordination with other entities (e.g., courts, prisons, hospitals, and law enforcement) charged with the individual's care, confinement, or reentry to the community.

(6) A behavioral support strategy that includes chemical restraint, manual restraint, or time-out will specify when and how the provider will notify the individual's guardian when such restraint is used.

(7) When a behavioral support strategy that includes restrictive measures is proposed by an individual and the individual's team, the qualified intellectual disability professional or the service and support administrator, as applicable, shall:

(a) Ensure the strategy is developed in accordance with the principles of person-centered planning and trauma-informed care and incorporated as an integral part of the individual service plan.

(b) When indicated, seek input from persons with specialized expertise to address an individual's specific support needs.

(d) Submit to the human rights committee the strategy and documentation, including the record of restrictive measures described in paragraph (F)(4) of this rule, based upon an assessment that clearly indicates:

(i) The justification for the proposed restrictive measure, that is:

(a) When manual restraint, mechanical restraint, or time-out is proposed -- risk of harm;

(b) When chemical restraint is proposed -- risk of harm or how the individual's engagement in a precisely-defined pattern of behavior is very likely to result in risk of harm; or

(c) When rights restriction is proposed -- risk of harm or how the individual's actions are very likely to result in the individual being the subject of a legal sanction.

(ii) The nature and degree of risk to the individual if the restrictive measure is implemented.

(e) Ensure the strategy is reviewed and approved in accordance with paragraph (H) of this rule prior to implementation and whenever the behavioral support strategy is revised to add restrictive measures.

(f) Ensure the strategy is reviewed by the individual and the individual's team at least every ninety calendar days or more frequently when specified by the human rights committee to determine and document the effectiveness of the strategy and whether the strategy should be continued, discontinued, or revised.

(i) The review shall consider:

(a) Numeric data on changes in the severity or frequency of behaviors that had been targeted for reduction due to a threat to safety or wellbeing;

(b) New skills that have been developed which have reduced or eliminated threats to safety or wellbeing;

(d) Observations by paid staff and/or natural supports as they relate to safety or wellbeing and the individual's achievement of desired outcomes and pursuit of interests.

(ii) When a manual restraint has been used in the past ninety calendar days, the review shall include seeking the perspective of the individual and at least one direct support professional involved in use of the manual restraint regarding the reason the manual restraint occurred and what could be done differently in the future to avoid manual restraint.

(iii) A decision to continue the strategy shall be based upon review of up-to-date information justifying the continuation of the strategy.

(E) Reconsideration of a medication initially presumed to not be a chemical restraint

(1) When administration of a medication initially presumed to not be a chemical restraint in accordance with paragraph (C)(1)(b) of this rule actually results in a general or non-specific blunt suppression of behavior, the provider is to alert the individual's qualified intellectual disability professional or service and support administrator, as applicable. The qualified intellectual disability professional or the service and support administrator is to ensure the prescriber of the medication and the individual's team are notified.

(a) The prescriber of the medication may adjust the medication (type or dose) in an effort to abate the general or non-specific blunt suppression of behavior.

(b) When the prescriber of the medication is not inclined to adjust the medication, the individual's team is to meet to consider what actions may be necessary (e.g., seeking an opinion from a different prescriber or introducing activities that may mitigate the impact of the medication on the individual's ability to complete activities of daily living).

(2) When a medication (as originally administered or as adjusted) continues to cause a general or non-specific blunt suppression of behavior beyond thirty calendar days, the medication is to be regarded as a chemical restraint and submitted to the human rights committee in accordance with paragraph (H) of this rule.

(F) Implementation of behavioral support strategies with restrictive measures

(1) Restrictive measures shall be implemented with sufficient safeguards and supervision to ensure the health, welfare, and rights of individuals receiving specialized services.

(2) Each person providing specialized services to an individual with a behavioral support strategy that includes restrictive measures shall successfully complete training in the strategy prior to serving the individual.

(3) After each incidence of manual restraint, a provider shall take any measures necessary to ensure the safety and wellbeing of the individual who was restrained, individuals who witnessed the manual restraint, and staff and minimize traumas for all involved.

(4) Each provider shall maintain a record of the date, time, and antecedent factors regarding each event of a restrictive measure other than a restrictive measure that is not based on antecedent factors (e.g., bed alarm or locked cabinet). The record for each event of a manual restraint or a mechanical restraint will include the duration. The provider will share the record with the individual or the individual's guardian, as applicable, and the individual's team whenever the individual's behavioral support strategy is being reviewed or reconsidered.

(G) Establishment of human rights committees

(1) Each county board and each intermediate care facility for individuals with intellectual disabilities shall actively participate in an established human rights committee. A human rights committee may be established by a county board or an intermediate care facility for individuals with intellectual disabilities acting independently or jointly in collaboration with one or more other county boards and/or intermediate care facilities for individuals with intellectual disabilities. The human rights committee shall:

(a) Be comprised of at least four persons;

(b) Include at least one individual who receives or is eligible to receive specialized services;

(c) Include qualified persons who have either experience or training in contemporary practices for behavioral support; and

(d) Reflect a balance of representatives from each of the following two groups:

(i) Individuals who receive or are eligible to receive specialized services or family members or guardians of individuals who receive or are eligible to receive specialized services; and

(ii) County boards, intermediate care facilities for individuals with intellectual disabilities or other providers, or other professionals.

(2) All information and documents provided to the human rights committee and all discussions of the committee are confidential and shall not be shared or discussed with anyone other than the individual, the individual's guardian, and the individual's team.

(3) Members of the human rights committee shall receive department-approved training within three months of appointment to the committee in:

(a) Rights of individuals as enumerated in section 5123.62 of the Revised Code;

(b) Person-centered planning;

(d) Confidentiality; and

(e) The requirements of this rule.

(4) Members of the human rights committee shall annually receive department-approved training in relevant topics which may include but are not limited to:

(a) Self-advocacy and self-determination;

(b) Role of guardians and section 5126.043 of the Revised Code;

(d) Court-ordered community controls and the role of the court, the county board or intermediate care facility for individuals with intellectual disabilities, and the human rights committee.

(H) Review of behavioral support strategies that include restrictive measures

There are two distinct processes for review of behavioral support strategies that include restrictive measures based on the nature of the request:

(1) Emergency request.

(a) An emergency request for a behavioral support strategy that includes restrictive measures shall consist of:

(i) A description of the restrictive measures to be implemented;

(ii) Documentation of risk of harm or legal sanction which demonstrates the situation is an emergency;

(iii) A description of positive measures that have been implemented and proved ineffective or infeasible;

(iv) Any medical contraindications; and

(v) Informed consent by the individual or the individual's guardian, as applicable.

(b) Prior to implementation of a behavioral support strategy submitted via the emergency request process, the strategy must be approved by:

(i) A quorum of members of the human rights committee in accordance with 42 C.F.R. 483.440 as in effect on the effective date of this rule for an individual who resides in an intermediate care facility for individuals with intellectual disabilities; or

(ii) The superintendent of the county board or the superintendent's designee for an individual who does not reside in an intermediate care facility for individuals with intellectual disabilities.

(c) A behavioral support strategy approved via the emergency request process may be in place for a period not to exceed forty-five calendar days. Continuation of the strategy beyond the initial forty-five calendar days requires approval by the human rights committee in accordance with the process for a routine request described in paragraph (H)(2) of this rule.

(2) Routine request.

(a) Absent an emergency, a human rights committee shall review a request to implement a behavioral support strategy that includes restrictive measures.

(b) An individual or the individual's guardian, as applicable, is to be notified at least seventy-two hours in advance of the date, time, and location of the human rights committee meeting at which the individual's behavioral support strategy will be reviewed. The individual or guardian has the right to attend to present related information in advance of the human rights committee commencing its review.

(i) Ensure that the planning process outlined in this rule has been followed and that the individual or the individual's guardian, as applicable, has provided informed consent.

(ii) Ensure that the proposed restrictive measures are necessary to reduce risk of harm or likelihood of legal sanction.

(iii) When indicated, seek input from persons with specialized expertise to address an individual's specific support needs.

(iv) Ensure that the overall outcome of the behavioral support strategy promotes the physical, emotional, and psychological wellbeing of the individual while reducing risk of harm or likelihood of legal sanction.

(v) Ensure that a restrictive measure is temporary in nature and occurs only in specifically-defined situations based on:

(a) Risk of harm for manual restraint, mechanical restraint, or time-out;

(b) Risk of harm or an individual's engagement in a precisely-defined pattern of behavior that is very likely to result in risk of harm for chemical restraint; or

(vi) Verify that any behavioral support strategy that includes restrictive measures also incorporates positive measures designed to enable the individual to feel safe, respected, and valued while emphasizing choice, self-determination, and an improved quality of life.

(vii) Determine the period of time for which a restrictive measure is appropriate and may approve a strategy that includes restrictive measures for any number of days not to exceed three hundred sixty-five.

(viii) Approve in whole or in part, reject in whole or in part, monitor, and when indicated, reauthorize behavioral support strategies that include restrictive measures.

(ix) Communicate the committee's determination including an explanation of its rejection of a strategy in writing to the qualified intellectual disability professional or service and support administrator that submitted the request for approval.

(d) The qualified intellectual disability professional or service and support administrator shall communicate in writing to the individual or the individual's guardian, as applicable, the determination of the human rights committee including an explanation of rejection of a strategy as well as the individual's or guardian's right to seek reconsideration when the human rights committee rejects a strategy.

(e) An individual or the individual's guardian, as applicable, may seek reconsideration of rejection by the human rights committee of a strategy that includes restrictive measures by submitting the request for reconsideration with additional information provided as rationale for the request to the qualified intellectual disability professional or service and support administrator, as applicable, in writing within fourteen calendar days of being informed of the rejection. The qualified intellectual disability professional or service and support administrator is to forward the request to the human rights committee within seventy-two hours. The human rights committee will consider the request for reconsideration and respond in writing to the individual or guardian within fourteen calendar days of receiving the request.

(f) An individual who resides in an intermediate care facility for individuals with intellectual disabilities or the individual's guardian, as applicable, may appeal to the facility's specially constituted committee in accordance with the facility's procedure if the individual or guardian, as applicable, is dissatisfied with the strategy or the process used for development of the strategy.

(g) An individual who does not reside in an intermediate care facility for individuals with intellectual disabilities or the individual's guardian, as applicable, may seek administrative resolution in accordance with rule 5123-4-04 of the Administrative Code if the individual or guardian is dissatisfied with the strategy or the process used for development of the strategy.

(I) Use of a restrictive measure without prior approval

(1) Nothing in this rule shall be construed to prohibit or prevent any person from intervening in a crisis situation as necessary to ensure a person's immediate health and safety.

(2) Use of a restrictive measure, including use of a restrictive measure in a crisis situation (e.g., to prevent an individual from running into traffic), without prior approval in accordance with paragraph (H) of this rule shall be reported as an "unapproved behavioral support" in accordance with rule 5123-17-02 of the Administrative Code.

(J) Reporting of behavioral support strategies that include restrictive measures

Each county board and each intermediate care facility for individuals with intellectual disabilities shall enter information regarding behavioral support strategies that include restrictive measures in the department's restrictive measures notification system. Corresponding entries are to be made:

(1) After securing approval in accordance with paragraph (H) of this rule and prior to implementation of a behavioral support strategy that includes restrictive measures; and

(2) When a restrictive measure is discontinued.

(K) Analysis of behavioral support strategies that include restrictive measures

(1) Each county board and each intermediate care facility for individuals with intellectual disabilities shall annually compile and analyze aggregate data extracted from the department's restrictive measures notification application regarding behavioral support strategies that include restrictive measures and furnish the data and analyses to the human rights committee by March fifteenth of each year for the preceding calendar year. Data compiled and analyzed shall include, but are not limited to:

(a) Nature and frequency of risk of harm or likelihood of legal sanction that triggered development of strategies that include restrictive measures;

(b) Number of strategies that include restrictive measures by type of restrictive measure (i.e., chemical restraint, manual restraint, mechanical restraint, rights restriction, and time-out) reviewed, approved, rejected, and reauthorized in accordance with paragraph (H) of this rule;

(c) Number of restrictive measures by type of restrictive measure (i.e., chemical restraint, manual restraint, mechanical restraint, rights restriction, and time-out) implemented;

(d) Number of strategies that include restrictive measures that have been discontinued and the reasons for discontinuing the strategies; and

(e) An in-depth review and analysis of either:

(i) Trends and patterns regarding strategies that include restrictive measures for purposes of determining methods for enhancing risk reduction efforts and outcomes, reducing the frequency of restrictive measures, and identifying technical assistance and training needs; or

(ii) A sample of implemented strategies that include restrictive measures for purposes of ensuring that strategies are developed, implemented, documented, and monitored in accordance with this rule.

(2) County boards and intermediate care facilities for individuals with intellectual disabilities shall make the data and analyses available to the department upon request.

(L) Department oversight

(1) The department will take immediate action as necessary to protect the health and welfare of individuals which may include, but is not limited to:

(a) Suspension of a behavioral support strategy not developed, implemented, documented, or monitored in accordance with this rule or where trends and patterns of data suggest the need for further review;

(b) Provision of technical assistance in development or redevelopment of a behavioral support strategy; and

(2) The department will compile and analyze data regarding behavioral support strategies for purposes of determining methods for enhancing risk reduction efforts and outcomes, reducing the frequency of restrictive measures, and identifying technical assistance and training needs. The department will make the data and analyses available.

(3) The department may periodically select a sample of behavioral support strategies for review to ensure that strategies are developed, implemented, documented, and monitored in accordance with this rule.

(4) The department will conduct reviews of county boards and providers as necessary to ensure the health and welfare of individuals and compliance with this rule. Failure to comply with this rule may be considered by the department in any regulatory capacity, including certification, licensure, and accreditation.

(M) Waiving provisions of this rule

For good cause, the director may waive a condition or specific requirement of this rule except that the director shall not permit use of a prohibited measure as defined in paragraph (C)(14) of this rule. The director's decision to waive a condition or specific requirement of this rule shall not be contrary to the rights, health, or safety of individuals receiving services. The director's decision to grant or deny a request is not subject to appeal.

Last updated October 3, 2022 at 8:46 AM

History

Effective: October 1, 2022
Promulgated Under: 119.03

Ohio Adm.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.

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.

(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.

(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;

(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.

Last updated December 1, 2022 at 10:45 AM

History

Effective: December 1, 2022
Promulgated Under: 119.03

Ohio Adm.Code 5123-2-08 Provider certification - agency providers.

(A) Purpose

This rule establishes procedures and standards for certification of agency providers of supported living services, including home and community-based services provided in accordance with section 5123.045 of the Revised Code.

(B) Definitions

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

(1) "Abuser registry" has the same meaning as in rule 5123-17-03 of the Administrative Code.

(2) "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.

(3) "Agency provider" means an entity that must be certified by the department to provide supported living services in accordance with section 5123.161 of the Revised Code and this rule.

(4) "Certificate of high school equivalence" has the same meaning as in section 3301.80 of the Revised Code and includes the equivalent of a certificate of high school equivalence described in division (C) of that section.

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

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

(7) "Direct support assistant" means a person who is sixteen or seventeen years of age employed by an agency provider to provide limited duties while in the company of a direct support professional.

(8) "Direct support professional" means a person who is at least eighteen years of age employed in a "direct services position" as that term is defined in section 5123.081 of the Revised Code.

(9) "Director of operations" means a person employed by an agency provider who is responsible for, and who is directly and actively involved in, the day-to-day operations of the agency provider. For the purposes of conducting background investigations pursuant to section 5123.081 of the Revised Code and rule 5123-2-02 of the Administrative Code, "director of operations" has the same meaning as "chief executive officer."

(10) "Health-related activities" has the same meaning as in rule 5123-6-01 of the Administrative Code.

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

(12) "Independent provider" means a self-employed person who provides services for which the person is certified in accordance with rule 5123-2-09 of the Administrative Code and does not employ, either directly or through contract, anyone else to provide the services.

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

(15) "Major unusual incident" has the same meaning as in rule 5123-17-02 of the Administrative Code.

(16) "Provider network management module" means a component of the Ohio medicaid enterprise system platform, maintained by the Ohio department of medicaid at its website (medicaid.ohio.gov), used by providers of services to initiate applications for certification, access the provider services management system, and submit required information and documents.

(17) "Provider services management system" means the electronic portal, maintained by the department at its website (dodd.ohio.gov), used by providers of services to apply for certification and submit required information and documents.

(18) "Related party" has the same meaning as in section 5123.16 of the Revised Code.

(19) "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 as set forth in section 5126.15 of the Revised Code and who holds the appropriate certification in accordance with rule 5123-5-02 of the Administrative Code.

(20) "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 an entity is providing specialized services, an agency provider may request that the director of the department make a determination. The director's determination is not subject to appeal. Programs or services available to the general public are not specialized services.

(21) "Supported living" has the same meaning as in section 5126.01 of the Revised Code.

(22) "Unusual incident" has the same meaning as in rule 5123-17-02 of the Administrative Code.

(23) "Volunteer" means a person who donates time, effort, and/or talent to meet a need or advance the mission of an agency provider and who is not paid or otherwise remunerated by the agency provider. "Volunteer" does not include a family member, guardian, friend, or other associate of an individual simply interacting with that individual.

An agency provider will:

(1) Be in good standing with the Ohio secretary of state as a for-profit corporation, nonprofit corporation, limited liability company, or limited liability partnership.

(2) Obtain and maintain a medicaid provider agreement with the Ohio department of medicaid when the agency provider intends to provide home and community-based services.

(3) Comply with the requirements of this rule and other standards and assurances established in Chapter 5123. of the Revised Code and rules adopted pursuant to that chapter.

(4) At the point of application for certification and upon request by the department, provide proof of a:

(a) Continuing line of credit in the agency provider's name in an amount of at least ten thousand dollars; or

(b) Bank account in the agency provider's name with a daily balance of at least ten thousand dollars for the most recent ninety days.

(5) At the point of application for certification and upon request by the department, provide a certificate of a continuing policy of general liability insurance in an amount of at least one million dollars which includes coverage for individuals' losses due to theft or property damage.

(6) Provide and maintain in the provider services management system and the provider network management module, the agency provider's current physical address, telephone number, and electronic mail address.

(7) Provide to the department via the provider services management system, within fourteen calendar days of occurrence, the name, date of birth, and social security number for any person newly acquiring a financial interest of five per cent or more in the agency provider (including a direct, indirect, security, or mortgage financial interest).

(8) Notify the department via the provider services management system, within seven calendar days of any bankruptcy petition for which the agency provider is the subject and provide related documents to the department upon request.

(9) Participate as requested by the department in service delivery system data collection initiatives.

(D) Management of the agency provider

(1) An agency provider will have written policies and procedures that address the agency provider's management practices regarding:

(a) Person-centered planning and self-determination;

(b) Individuals' satisfaction with services delivered;

(d) Supervision of staff;

(e) Training plan described in paragraph (F)(1) of this rule;

(f) Service delivery;

(g) Background investigations for employment in accordance with rule 5123-2-02 of the Administrative Code; and

(h) Volunteers (when the agency provider engages volunteers).

(2) An agency provider will demonstrate that the agency provider has an established internal compliance program to ensure compliance with requirements for:

(a) Provider certification in accordance with this rule;

(b) Background investigations and appropriate actions in accordance with rule 5123-2-02 of the Administrative Code for its director of operations, supervisors of direct support professionals, direct support professionals, direct support assistants, and volunteers;

(c) Service delivery, service documentation, and billing for services in accordance with Chapter 5123. of the Revised Code and rules adopted pursuant to that chapter for supported living services and the specific home and community-based services provided; and

(d) Management of individuals' funds.

(3) When an agency provider is governed by a board of directors, board members will:

(a) Ensure the fiscal integrity of the agency provider by reviewing and approving the agency provider's annual audit, if otherwise required, or annual financial statements and by monitoring the agency provider's financial status including trends and challenges;

(b) Review and evaluate all compliance review reports by the department or a county board and the agency provider's response, including the plan of correction;

(c) Monitor the effectiveness of the agency provider's internal compliance program described in paragraph (D)(2) of this rule; and

(d) Promote the delivery of high-quality services.

(E) Employment of staff

An agency provider will:

(1) In addition to employing a director of operations who meets the requirements set forth in paragraph (H) of this rule, employ at least one other person for the purpose of providing services.

(2) Comply with applicable federal, state, and local regulations, statutes, rules, codes, and ordinances pertaining to employment of staff including, but not limited to, wage and hour, workers' compensation, unemployment compensation, and withholding taxes.

(3) Be current in payment of payroll taxes, workers' compensation premiums, and unemployment compensation premiums.

(4) Conduct background investigations and take appropriate actions in accordance with rule 5123-2-02 of the Administrative Code.

(5) Annually notify in writing, each of its staff members 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 a supervisor of direct support professionals, a direct support professional, or a direct support assistant to report in writing to the agency provider, if the staff member is formally charged with, is convicted of, pleads guilty to, or is found eligible for intervention in lieu of 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 within fourteen calendar days after the date of such charge, conviction, guilty plea, or finding.

(F) Staff training documentation

An agency provider will:

(1) Develop and implement a written training plan for its director of operations, supervisors of direct support professionals, direct support professionals, direct support assistants, and volunteers that:

(a) Is consistent with the needs of individuals served, best practice, and the requirements set forth in appendix A and appendix C to this rule.

(b) Describes the method (e.g., written test, skills demonstration, or documented observation by supervisor) that will be used to establish competency of supervisors of direct support professionals, direct support professionals, and direct support assistants in areas of training.

(c) Is updated at least once every twelve months and identifies who is responsible for arranging or providing the training and projected timelines for completion of the training.

(2) Maintain a written record of training completed by its director of operations, supervisors of direct support professionals, direct support professionals, direct support assistants, and volunteers that includes a description of the training completed, the date of training, the duration of training, and when applicable, the instructor's name.

(G) Standards of service provision

An agency provider will:

(1) Provide services only to individuals whose needs the agency provider can meet.

(2) Communicate effectively with each individual served by the agency provider.

(3) Ensure that direct support professionals are knowledgeable in the individual service plan for each individual served prior to providing services to the individual.

(4) Implement services in accordance with the individual service plan and in a person-centered manner.

(5) Comply with the requirements of rule 5123-2-06 of the Administrative Code.

(6) Take all reasonable steps necessary to prevent the occurrence or recurrence of major unusual incidents and unusual incidents.

(7) Upon realization that the agency provider may be unable to continue to effectively provide services to an individual, immediately engage the individual and the individual's service and support administrator to consider alternative strategies for serving the individual that ensure the health and safety of the individual.

(8) Notify, in writing, an individual and the individual's service and support administrator in the event that the agency provider intends to cease providing services to the individual no less than thirty calendar days prior to termination of services and convey documents and records to the individual's service and support administrator as requested.

(9) Ensure that a direct support professional does not:

(a) Provide services to the direct support professional's minor child except as permitted pursuant to rule 5160-44-32 of the Administrative Code;

(b) Provide services to the direct support professional's spouse except as permitted pursuant to rule 5160-44-32 of the Administrative Code;

(d) Provide services to the spouse of an owner of the agency provider;

(e) Provide services to the minor child of the director of operations;

(f) Provide services to the spouse of the director of operations;

(g) Administer medication or perform health-related activities for individuals who receive services unless the direct support professional meets the applicable requirements of Chapters 4723., 5123., and 5126. of the Revised Code and rules adopted pursuant to those chapters; or

(h) Use or be under the influence of the following while providing services:

(i) Alcohol;

(ii) Illegal drugs;

(iii) Illegal chemical substances; or

(iv) Controlled substances that may adversely affect the direct support professional's ability to furnish services.

(H) Requirements for director of operations

(1) An agency provider will employ a director of operations who:

(a) Has a valid birth certificate.

(b) Is at least twenty-one years of age.

(d) Has at least:

(i) One year of full-time (or equivalent part-time) paid work experience in the provision of specialized services; or

(ii) Four years of experience providing care to a family member (i.e., parent, child, or sibling) with a developmental disability.

(e) Has at least one year of full-time (or equivalent part-time) paid work experience in:

(i) Supervision of employees;

(ii) Development, oversight, and/or supervision of programs or services; and

(iii) Financial management of an organization.

(f) Holds either:

(i) A bachelor's degree from an accredited college or university; or

(ii) A high school diploma or certificate of high school equivalence and has at least:

(a) Four years of full-time (or equivalent part-time) paid work experience as a supervisor of specialized services; or

(b) Four years of experience providing care to a family member (i.e., parent, child, or sibling) with a developmental disability.

(g) Is able to read, write, and understand English at a level sufficient to comply with all requirements set forth in administrative rules governing the services provided by the agency provider.

(2) Prior to the agency provider's application for initial certification, the director of operations will successfully complete the training specified in appendix A to this rule.

(3) On an annual basis, the director of operations will successfully complete the training specified in appendix A to this rule.

(4) The director of operations will undergo a background investigation in accordance with rule 5123-2-02 of the Administrative Code and consent to be enrolled by the department in the Ohio attorney general's retained applicant fingerprint database (also known as "Rapback").

(5) A person may not serve as the director of operations for an agency provider if the person is:

(a) The parent of a minor child served by the agency provider; or

(b) The spouse of an individual served by the agency provider.

(I) Required actions and notifications regarding director of operations

(1) An agency provider will notify the department via the provider services management system, if the director of operations is formally charged with, is convicted of, pleads guilty to, or is found eligible for intervention in lieu of 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 within fourteen calendar days after the date of such charge, conviction, guilty plea, or finding.

(2) An agency provider will notify the department via the provider services management system, within fourteen calendar days of determining that the director of operations is or has become a related party of a person or government entity for which the department refused to issue or renew or revoked certification pursuant to section 5123.166 of the Revised Code.

(3) An agency provider will notify the department via the provider services management system, within fourteen calendar days of determining that the director of operations has had a professional registration, certification, or license (other than a driver's license) suspended or revoked.

(4) An agency provider will update its record in the provider services management system, within fourteen calendar days when a director of operations leaves or joins the agency provider's employ.

(5) When the director of operations leaves an agency provider's employ, the agency provider will report within fourteen calendar days via the provider services management system, the agency provider's plan for identifying a new director of operations and to whom executive authority has been delegated in the interim period.

(6) A person newly appointed or employed as director of operations of an agency provider will complete the department-provided web-based orientation for directors of operations described in appendix A to this rule within thirty calendar days of appointment or hire.

(7) A director of operations will inform the department via the provider services management system, if the director of operations serves as director of operations for more than one agency provider.

(8) A director of operations will inform the department via the provider services management system, if the director of operations is or was the director of operations of an agency provider at a point in time within the last five years when the agency provider had its provider certification revoked or not renewed.

(9) A director of operations will designate in writing a staff member to whom executive authority has been delegated in the temporary absence of the director of operations.

(J) Requirements for direct support professionals

(1) An agency provider will ensure that each direct support professional:

(a) Is at least eighteen years of age.

(b) Is able to read, write, and understand English at a level sufficient to comply with all requirements set forth in administrative rules governing the services provided by the direct support professional.

(2) An agency provider will ensure that each direct support professional, except for direct support professionals exempted as specified in appendix B to this rule, holds and maintains:

(a) Valid "American Red Cross" or equivalent certification in first aid which included an in-person skills assessment completed with an approved trainer; and

(b) Valid "American Red Cross" or equivalent certification in cardiopulmonary resuscitation which included an in-person skills assessment completed with an approved trainer.

(3) An agency provider will ensure that each direct support professional, except for direct support professionals exempted as specified in appendix B to this rule, successfully completes the training specified in appendix C to this rule.

(K) Requirements for supervisory staff

An agency provider will ensure that each staff member who supervises direct support professionals:

(1) Meets the requirements set forth in paragraphs (J)(1) to (J)(3) of this rule; and

(2) Has successfully completed training regarding all relevant duties and responsibilities of being a supervisor for the agency provider within ninety calendar days of becoming a supervisor.

(L) Requirements for direct support assistants

(1) An agency provider may employ persons who are sixteen or seventeen years of age to perform limited duties as direct support assistants.

(2) A person employed as a direct support assistant will, at all times, work in the company of an employee of the agency provider who is:

(a) Physically present at the location where the direct support assistant is providing services; and

(b) A direct support professional who meets the requirements of paragraph (J) of this rule or a supervisor of direct support professionals who meets the requirements of paragraph (K) of this rule.

(3) An agency provider will ensure that each direct support assistant:

(a) Undergoes a background investigation for employment in accordance with rule 5123-2-02 of the Administrative Code.

(b) Meets the training requirements for direct support professionals set forth in appendix C to this rule.

(c) Is able to read, write, and understand English at a level sufficient to comply with all requirements set forth in administrative rules governing the services provided by the direct support assistant.

(4) A person employed as a direct support assistant will not, under any circumstances:

(a) Provide intimate personal care such as dressing, showering, bathing, toileting, or changing undergarments;

(b) Operate a vehicle to transport an individual receiving services;

(d) Provide any care or perform any task for an individual expressly forbidden by the individual (e.g., provide assistance with eating); or

(e) Implement any restrictive measure as defined in rule 5123-2-06 of the Administrative Code.

(5) An agency provider will not assign a direct support assistant to provide services to an individual who does not consent to having services provided by a direct support assistant.

(M) Requirements for volunteers

(1) An agency provider may engage volunteers to provide supplementary services. An agency provider will not bill for services provided by volunteers.

(2) An agency provider will ensure that volunteers are at all times under supervision of paid supervisory staff of the agency provider.

(3) An agency provider will ensure that volunteers do not provide intimate personal care (such as dressing, showering, bathing, toileting, or changing undergarments), administer medication, or perform health-related activities.

(4) An agency provider will ensure that volunteers who provide more than forty hours of service working directly with individuals served by the agency provider during a calendar year:

(a) Receive training in:

(i) The role of a volunteer in supporting individuals served by the agency provider including the national alliance for direct support professionals code of ethics and the rights of individuals set forth in section 5123.62 of the Revised Code;

(ii) Recognizing and reporting major unusual incidents and unusual incidents; and

(iii) An overview of emergency procedures.

(b) Undergo background investigations.

(i) The background investigation for a volunteer will include:

(a) Requiring the volunteer to submit a statement to the agency provider with the volunteer's signature attesting that the volunteer has not been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of 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.

(b) Requiring the volunteer to sign an agreement under which the volunteer agrees to notify the agency provider within fourteen calendar days if the volunteer is formally charged with, is convicted of, pleads guilty to, or is found eligible for intervention in lieu of 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. The agreement will provide that failure to make the notification may result in termination of the volunteer's services.

(c) Checking each of the databases described in paragraph (C)(2) of rule 5123-2-02 of the Administrative Code to determine if the volunteer is included.

(d) Obtaining a criminal records check conducted by the Ohio bureau of criminal identification and investigation. If the volunteer does not present proof that the volunteer 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 will include information from the federal bureau of investigation.

(ii) The agency provider will, at a frequency of no less than once every five years, conduct a background investigation in accordance with paragraph (M)(4)(b)(i) of this rule for each volunteer.

(iii) The agency provider will not engage or continue to engage a volunteer who:

(a) Is included in one or more of the databases described in paragraphs (C)(2)(a) to (C)(2)(f) of rule 5123-2-02 of the Administrative Code; or

(b) Has a conviction for, pleads guilty to, or is found eligible for intervention in lieu of 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 5123-2-02 of the Administrative Code has not elapsed.

(N) Procedure for obtaining initial agency provider certification

(1) An applicant for initial agency provider certification will submit an application via the provider services management system, for supported living services and the specific home and community-based services the applicant seeks to provide in accordance with procedures prescribed by the department. The application will include required signatures and supporting documentation to demonstrate that standards are met as required by this rule and rules in Chapter 5123-9 of the Administrative Code for the specific home and community-based services the applicant seeks to provide including, but not limited to:

(a) A certificate of good standing from the Ohio secretary of state demonstrating the agency provider's status as a for-profit corporation, nonprofit corporation, limited liability company, or limited liability partnership.

(b) Proof of an unencumbered line of credit in the agency provider's name in an amount of at least ten thousand dollars or proof of a bank account in the agency provider's name with a daily balance of at least ten thousand dollars during the past ninety days.

(c) A certificate of general liability insurance in an amount of at least one million dollars which includes coverage for individuals' losses due to theft or property damage.

(d) Proof that the agency provider employs a director of operations who meets the requirements set forth in this rule.

(e) Proof that in addition to employing a director of operations, the agency provider employs at least one other person for the purpose of providing services.

(f) An employer identification number from the internal revenue service.

(g) A certificate of policy from the Ohio bureau of workers' compensation.

(h) The name, country of birth, date of birth, and social security number for any person having a financial interest of five per cent or more in the agency provider (including a direct, indirect, security, or mortgage financial interest).

(i) Written policies and procedures that address the agency provider's management practices regarding:

(i) Confidentiality of individuals' records;

(ii) Management of individuals' funds;

(iii) Reporting and investigation of major unusual incidents and unusual incidents; and

(iv) Documentation and billing for services.

(j) The application fee specified in paragraph (R) of this rule except when, based on the specific home and community-based services to be provided, the applicant is exempted from paying an application fee in accordance with appendix D to this rule.

(k) The criminal records check by the Ohio bureau of criminal identification and investigation, and when applicable by the federal bureau of investigation, for the director of operations.

(2) The department will review an application within thirty calendar days of receipt of all required components to determine if the applicant meets the standards for the requested certification.

(a) If the department determines an applicant seeking to provide home and community-based services meets the standards for the requested certification, the department will initiate the process for the applicant to obtain a medicaid provider agreement from the Ohio department of medicaid. The applicant may be subject to an on-site visit by the Ohio department of medicaid or its designee in accordance with rule 5160-1-17.8 of the Administrative Code; successful completion of the on-site visit is required prior to issuance of the medicaid provider agreement by the Ohio department of medicaid and certification issued by the department.

(b) If, upon review of the application, the department determines that supporting documentation does not demonstrate that the applicant meets the standards for the requested certification, the department will notify the applicant by electronic mail and advise that the applicant has thirty calendar days to submit components needed to demonstrate that the applicant meets the standards for the requested certification.

(i) When the department receives components needed to demonstrate that the applicant meets the standards for the requested certification within the specified thirty calendar days, the application will be advanced for processing.

(ii) When an applicant fails to submit components needed to demonstrate that the applicant meets the standards for the requested certification within the specified thirty calendar days, the department will take no further action with respect to the application.

(3) When the department has determined the applicant meets the standards for the requested certification and, when applicable, after the Ohio department of medicaid has issued a medicaid provider agreement to an applicant seeking to provide home and community-based services, the department will notify the applicant by electronic mail that certification is approved. The notification will specify the effective date and expiration date of the certification and the specific services for which the applicant is certified.

(4) The department's review of an application may extend beyond thirty calendar days when:

(a) One or more of the submitted documents requires verification; or

(b) The director of operations:

(i) Has a conviction or notation on the criminal records check by the Ohio bureau of criminal identification and investigation or the federal bureau of investigation;

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

(iii) Is the primary person involved in a major unusual incident;

(iv) Is under consideration for placement on the abuser registry; or

(v) Is a related party to an agency provider or an independent provider whose certification has been suspended or revoked or is proposed for revocation.

(5) When the department determines an applicant does not meet the standards for the requested certification, the department will notify the applicant in accordance with paragraph (T)(3) of this rule that the certification is denied. The notification will specify the reason for denial.

(O) Procedure for obtaining certification to provide additional home and community-based services during the term of existing department-issued certification

(1) A certified agency provider seeking to provide additional home and community-based services will submit an application via the provider services management system, for the additional home and community-based services the agency provider seeks to provide including:

(a) Required signatures and supporting documentation to demonstrate that standards are met as required by this rule and rules in Chapter 5123-9 of the Administrative Code for the specific home and community-based services the applicant seeks to provide.

(b) The application fee specified in paragraph (R) of this rule except when, based on the specific home and community-based services to be provided, the applicant is exempted from paying an application fee in accordance with appendix D to this rule.

(2) The department will review an application within thirty calendar days of receipt of all required components to determine if the applicant meets the standards for the requested certification. If, upon review of the application, the department determines that supporting documentation does not demonstrate that the applicant meets the standards for the requested certification, the department will notify the applicant by electronic mail and advise that the applicant has thirty calendar days to submit components needed to demonstrate that the applicant meets the standards for the requested certification.

(a) When the department receives components needed to demonstrate that the applicant meets the standards for the requested certification within the specified thirty calendar days, the application will be advanced for processing.

(b) When an applicant fails to submit components needed to demonstrate that the applicant meets the standards for the requested certification within the specified thirty calendar days, the department will take no further action with respect to the application.

(3) When the department determines the applicant meets the standards for the requested certification, the department will notify the applicant by electronic mail that certification is approved. The notification will specify the effective date and expiration date of the certification and the specific services for which the applicant is certified.

(4) When the department determines the applicant does not meet the standards for the requested certification, the department will notify the applicant in accordance with paragraph (T)(3) of this rule that the certification is denied. The notification will specify the reason for denial.

(P) Procedure for obtaining renewal agency provider certification

(1) The department will notify an agency provider by electronic mail to the address in the provider services management system, of required certification renewal no later than ninety calendar days prior to the date the agency provider's certification expires. The notification will describe the procedures for submitting the certification renewal application in accordance with this rule.

(2) The agency provider will submit the certification renewal application via the provider services management system including:

(c) The criminal records check by the Ohio bureau of criminal identification and investigation, and when applicable by the federal bureau of investigation, for the director of operations, unless the director of operations has been enrolled without interruption in the Ohio attorney general's retained applicant fingerprint database (also known as "Rapback") for the entire previous certification term and has been a resident of Ohio without interruption for the past five years.

(3) The department will review an application within thirty calendar days of receipt of all required components to determine if the applicant meets the standards for the requested certification.

(a) If the department determines an applicant meets the standards for the requested certification, the department will notify the applicant by electronic mail that certification is approved. The notification will specify the effective date and expiration date of the certification and the specific services for which the applicant is certified.

(4) The department's review of an application may extend beyond thirty calendar days when:

(a) One or more of the submitted documents requires verification; or

(b) The director of operations:

(i) Has a conviction or notation on the criminal records check by the Ohio bureau of criminal identification and investigation or the federal bureau of investigation;

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

(iii) Is the primary person involved in a major unusual incident;

(iv) Is under consideration for placement on the abuser registry; or

(v) Is a related party to an agency provider or an independent provider whose certification has been suspended or revoked or is proposed for revocation.

(6) When an agency provider submits an application for renewal certification prior to certification expiration that demonstrates the applicant meets the standards for the requested renewal certification, the agency provider's certification will be renewed without lapse.

(7) When an agency provider submits an application for renewal certification fewer than forty-five calendar days in advance of certification expiration that demonstrates the applicant meets the standards for the requested renewal certification, the agency provider may experience a gap in its ability to bill for services provided between the date of certification expiration and the date the renewal certification is approved. Once the renewal certification is approved, however, the agency provider may bill for services provided during that period.

(8) When an agency provider submits an application for renewal certification after certification expiration, there will be a lapse of certification from the date of certification expiration to the date the department receives an application for renewal certification that demonstrates the applicant meets the standards for the requested renewal certification. The agency provider will not provide services nor be reimbursed for provision of services during the lapse.

(9) An agency provider will not provide services nor submit claims for reimbursement for services provided subsequent to expiration of the agency provider's certification.

(Q) Application for certification subsequent to expiration

(1) An applicant whose certification has been expired for less than one year will be required to apply for and meet the requirements for renewal certification.

(2) An applicant whose certification has been expired for one year or more will be required to apply for and meet the requirements for initial certification.

(R) Application fees

(1) Applicants seeking certification to provide services, other than those exempted in accordance with appendix D to this rule, will submit an application fee at the time of application for initial certification, application for certification to provide additional home and community-based services during the term of existing department-issued certification, and application for renewal certification.

(a) Application fees for initial certification and renewal certification

(i) The application fee for a small agency provider (i.e., one that serves or plans to serve fifty or fewer individuals) seeking initial certification or renewal certification is eight hundred dollars.

(ii) The application fee for a large agency provider (i.e., one that serves or plans to serve fifty-one or more individuals) seeking initial certification or renewal certification is one thousand six hundred dollars.

(b) Application fees for certification to provide additional home and community-based services during the term of existing department-issued certification

(i) The application fee for a small agency provider (i.e., one that serves or plans to serve fifty or fewer individuals) seeking certification to provide additional home and community-based services is seventy-five dollars.

(ii) The application fee for a large agency provider (i.e., one that serves or plans to serve fifty-one or more individuals) seeking certification to provide additional home and community-based services is one hundred fifty dollars.

(2) Applicants will pay application fees by electronic check or credit card.

(3) Application fees are non-refundable.

(4) The department will invalidate a certification issued to an applicant whose application fees cannot be collected due to non-sufficient funds available or for any other reason. An agency provider whose certification is invalidated in accordance with this paragraph will be required to initiate and submit an entirely new application via the provider services management system.

(S) Certification terms

(1) Initial certification will be issued for a term of three years.

(2) Renewal certification will be issued for a term of three years.

(3) Certification to provide additional home and community-based services will be issued for the remainder of the term of the applicant's existing certification.

(T) Denial, suspension, or revocation of certification

(1) Agency providers are subject to monitoring and compliance reviews as set forth in rules promulgated by the department. Failure to comply with this rule or other rules governing services provided by the agency provider may result in corrective action by the department, up to and including suspension, summary suspension, denial, or revocation of certification.

(2) The department may deny, suspend, or revoke an agency provider's certification for good cause pursuant to section 5123.166 of the Revised Code.

(3) When denying, suspending, or revoking certification pursuant to this rule, the department will comply with the notice and hearing requirements of Chapter 119. of the Revised Code and section 5123.166 of the Revised Code.

(4) When the department denies an application for renewal certification, the agency provider will comply with the department's adjudication order within thirty calendar days of the date of the mailing of the order.

(U) Department's authority to waive provisions of this rule

(1) For good cause, the department may waive a provision of this rule. The department's decision to waive a provision of this rule will not be contrary to the rights, health, or safety of individuals served.

(2) An agency provider or applicant for agency provider certification may initiate a request for the department to waive a provision of this rule by submitting the request with justification in writing.

(a) The department may ask for input regarding the request from individuals served, individuals' guardians, or county boards.

(b) The department will grant or deny a request within fourteen calendar days of receipt of the request or within such longer period of time as the department deems necessary and may put whatever conditions on approval as determined to be necessary.

View AppendixView AppendixView AppendixView Appendix

Last updated September 30, 2024 at 8:35 AM

History

Effective: September 29, 2024
Promulgated Under: 119.03

Ohio Adm.Code 5123-2-09 Provider certification - independent providers.

(A) Purpose

This rule establishes procedures and standards for certification of independent providers of supported living services, including home and community-based services provided in accordance with section 5123.045 of the Revised Code.

(B) Definitions

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

(1) "Abuser registry" has the same meaning as in rule 5123-17-03 of the Administrative Code.

(2) "Agency provider" means an entity that directly employs at least one person in addition to a director of operations for the purpose of providing services for which the entity is certified in accordance with rule 5123-2-08 of the Administrative Code.

(3) "Certificate of high school equivalence" has the same meaning as in section 3301.80 of the Revised Code and includes the equivalent of a certificate of high school equivalence described in division (C) of that section.

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

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

(6) "Health-related activities" has the same meaning as in rule 5123:2-6-01 of the Administrative Code.

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

(8) "Independent provider" means a self-employed person who provides services for which the person must be certified in accordance with this rule and does not employ, either directly or through contract, anyone else to provide the services.

(9) "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, the person's guardian in accordance with section 5126.043 of the Revised Code or other person authorized to give consent.

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

(11) "Major unusual incident" has the same meaning as in rule 5123-17-02 of the Administrative Code.

(12) "Provider network management module" means a component of the Ohio medicaid enterprise system platform, maintained by the Ohio department of medicaid at its website (medicaid.ohio.gov), used by providers of services to initiate applications for certification and access the provider services management system to submit required information and documents.

(13) "Provider services management system" means the electronic portal, maintained by the department at its website (dodd.ohio.gov), used by providers of services to apply for certification and submit required information and documents.

(14) "Related party" has the same meaning as in section 5123.16 of the Revised Code.

(15) "Related to" means the independent provider is the individual's:

(a) Parent or stepparent;

(b) Sibling or stepsibling;

(d) Grandchild;

(e) Aunt, uncle, nephew, or niece;

(f) Cousin; or

(g) Child or stepchild.

(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 as set forth in section 5126.15 of the Revised Code and who holds the appropriate certification in accordance with rule 5123-5-02 of the Administrative Code.

(17) "Supported living" has the same meaning as in section 5126.01 of the Revised Code.

(18) "Unusual incident" has the same meaning as in rule 5123-17-02 of the Administrative Code.

(1) An independent provider will:

(a) Have a valid birth certificate.

(b) Be at least eighteen years of age.

(d) Meet one of the following:

(i) Hold a high school diploma;

(ii) Hold a certificate of high school equivalence;

(iii) On September 30, 2009, held independent provider certification issued by the department; or

(iv) On September 30, 2009, was employed by or under contract with an agency provider certified by the department.

(e) Be able to read, write, and understand English at a level sufficient to comply with all requirements set forth in administrative rules governing the services provided by the independent provider.

(f) Undergo a background investigation in accordance with rule 5123-2-02 of the Administrative Code and consent to be enrolled by the department in the Ohio attorney general's retained applicant fingerprint database (also known as "Rapback").

(g) Comply with the requirements of this rule and other standards and assurances established in Chapter 5123. of the Revised Code and rules adopted pursuant to that chapter.

(h) Participate as requested by the department in service delivery system data collection initiatives.

(2) An independent provider of home and community-based services must obtain and maintain a medicaid provider agreement with the Ohio department of medicaid.

(D) Training requirements for independent providers

(1) An independent provider will successfully complete the training specified in appendix A, appendix B, appendix C, or appendix D to this rule, as applicable.

(2) An independent provider of home and community-based services will comply with service-specific training required by rules in Chapter 5123-9 of the Administrative Code for the specific services provided.

(3) After being selected by an individual to provide services and prior to providing services to that individual, an independent provider will meet with a representative of the county board to discuss:

(a) The independent provider's responsibilities;

(b) Requirements set forth in the individual service plan regarding what is important to the individual and what is important for the individual (e.g., health and safety, community integration, employment goals, behavioral support strategy, management of the individual's funds, or medication administration/delegated nursing needs);

(d) Billing for services.

(E) Standards of service provision

(1) An independent provider will:

(a) Provide services only to individuals whose needs the independent provider can meet;

(b) Communicate effectively with each individual for whom the independent provider provides services;

(c) Be knowledgeable in the individual service plan for each individual served prior to providing services to the individual;

(d) Implement services in accordance with the individual service plan and in a person-centered manner;

(e) Comply with the requirements of rule 5123-2-06 of the Administrative Code; and

(f) Take all reasonable steps necessary to prevent the occurrence or recurrence of major unusual incidents and unusual incidents.

(2) An independent provider may not:

(a) Provide services to the independent provider's minor child;

(b) Provide services to the independent provider's spouse;

(c) Provide services to an individual for whom the independent provider serves as guardian unless the independent provider is related to the individual and has been approved by the probate court to provide the services;

(d) Engage in sexual conduct or have sexual contact with an individual for whom the independent provider provides services;

(e) Administer medication or perform health-related activities for individuals who receive services unless the independent provider meets the applicable requirements of Chapters 4723., 5123., and 5126. of the Revised Code and rules adopted pursuant to those chapters; or

(f) Use or be under the influence of the following while providing services:

(i) Alcohol;

(ii) Illegal drugs;

(iii) Illegal chemical substances; or

(iv) Controlled substances that may adversely affect the independent provider's ability to furnish services.

(F) Required notifications to be made by independent providers

(1) An independent provider will:

(a) Provide and maintain in the provider services management system and the provider network management module, the independent provider's current physical address, telephone number, and electronic mail address.

(b) Notify the department via the provider services management system if the independent provider is formally charged with, is convicted of, pleads guilty to, or is found eligible for intervention in lieu of 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 within fourteen calendar days after the date of such charge, conviction, guilty plea, or finding.

(c) Notify the department via the provider services management system within fourteen calendar days of determining that the independent provider is or has become a related party of a person or government entity for which the department has refused to issue or renew or revoked certification pursuant to section 5123.166 of the Revised Code.

(d) Notify the department via the provider services management system within fourteen calendar days if the independent provider has had a professional registration, certification, or license (other than a driver's license) suspended or revoked.

(2) An independent provider, upon realization that the independent provider may be unable to continue to effectively provide services to an individual, will immediately engage the individual and the individual's service and support administrator to consider alternative strategies for serving the individual that ensure the health and safety of the individual.

(3) An independent provider will notify, in writing, an individual and the individual's service and support administrator in the event that the independent provider intends to cease providing services to the individual no less than thirty calendar days prior to termination of services. If, however, an independent provider intends to cease providing services to an individual because the health or safety of the independent provider is at immediate risk of serious harm, the independent provider will immediately notify the individual's service and support administrator or if after business hours, the county board's twenty-four hour emergency telephone number, and other appropriate authorities (e.g., law enforcement). An independent provider will convey documents and records to the individual's service and support administrator as requested.

(G) Procedure for obtaining initial independent provider certification

(1) An applicant for initial independent provider certification will submit an application via the provider services management system, for supported living services and the specific home and community-based services the applicant seeks to provide in accordance with procedures prescribed by the department including:

(b) The application fee specified in paragraph (K) of this rule except when, based on the specific home and community-based services to be provided, the applicant is exempted from paying an application fee in accordance with appendix E to this rule; and

(c) The applicant's criminal records check by the Ohio bureau of criminal identification and investigation and when applicable, by the federal bureau of investigation.

(2) The department will review an application within thirty calendar days of receipt of all required components to determine if the applicant meets the standards for the requested certification.

(a) When the department determines an applicant seeking to provide home and community-based services meets the standards for the requested certification, the department will initiate the process for the applicant to obtain a medicaid provider agreement from the Ohio department of medicaid.

(ii) When the applicant fails to submit components needed to demonstrate that the applicant meets the standards for the requested certification within the specified thirty calendar days, the department will take no further action with respect to the application.

(3) When the department determines the applicant meets the standards for the requested certification and, when applicable, after the Ohio department of medicaid has issued a medicaid provider agreement to an applicant seeking to provide home and community-based services, the department will notify the applicant by electronic mail that certification is approved. The notification will specify the effective date and expiration date of the certification and the specific services for which the applicant is certified.

(4) The department's review of an application may extend beyond thirty calendar days when:

(a) One or more of the submitted documents requires verification; or

(b) The applicant:

(i) Has a conviction or notation on the criminal records check by the Ohio bureau of criminal identification and investigation or the federal bureau of investigation;

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

(iii) Is the primary person involved in a major unusual incident;

(iv) Is under consideration for placement on the abuser registry; or

(v) Is a related party to an agency provider or an independent provider whose certification has been suspended or revoked or is proposed for revocation.

(5) When the department determines an applicant does not meet the standards for the requested certification, the department will notify the applicant in accordance with paragraph (M)(3) of this rule that certification is denied. The notification will specify the reason for denial.

(H) Procedure for obtaining certification to provide additional home and community-based services during the term of existing department-issued certification

(1) A certified independent provider seeking to provide additional home and community-based services will submit an application via the provider services management system, for the additional home and community-based services the independent provider seeks to provide including:

(b) When the applicant fails to submit components needed to demonstrate that the applicant meets the standards for the requested certification within the specified thirty calendar days, the department will take no further action with respect to the application.

(4) When the department determines an applicant does not meet the standards for the requested certification, the department will notify the applicant in accordance with paragraph (M)(3) of this rule that certification is denied. The notification will specify the reason for denial.

(I) Procedure for obtaining renewal independent provider certification

(1) The department will notify an independent provider by electronic mail to the address in the provider services management system of required certification renewal no later than ninety calendar days prior to the date the independent provider's certification expires. The notification will describe the procedures for submitting the certification renewal application in accordance with this rule.

(2) An independent provider will submit the certification renewal application via the provider services management system including:

(c) The applicant's criminal records check by the Ohio bureau of criminal identification and investigation and when applicable, by the federal bureau of investigation, unless the applicant has been enrolled without interruption in the Ohio attorney general's retained applicant fingerprint database (also known as "Rapback") for the entire previous certification term and has been a resident of Ohio without interruption for the past five years.

(3) The department will review an application within thirty calendar days of receipt of all required components to determine if the applicant meets the standards for the requested certification.

(a) When the department determines the applicant meets the standards for the requested certification, the department will notify the applicant by electronic mail that certification is approved. The notification will specify the effective date and expiration date of the certification and the specific services for which the applicant is certified.

(4) The department's review of an application may extend beyond thirty calendar days when:

(a) One or more of the submitted documents requires verification; or

(b) The applicant:

(i) Has a conviction or notation on the criminal records check by the Ohio bureau of criminal identification and investigation or the federal bureau of investigation;

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

(iii) Is the primary person involved in a major unusual incident;

(iv) Is under consideration for placement on the abuser registry; or

(v) Is a related party to an agency provider or an independent provider whose certification has been suspended or revoked or is proposed for revocation.

(5) When the department determines an applicant does not meet the standards for the requested certification, the department will notify the applicant in accordance with paragraph (M)(3) of this rule that certification is denied. The notification will specify the reason for denial.

(6) When an independent provider submits an application for renewal certification prior to certification expiration that demonstrates the applicant meets the standards for the requested renewal certification, the independent provider's certification will be renewed without lapse.

(7) When an independent provider submits an application for renewal certification fewer than forty-five calendar days in advance of certification expiration that demonstrates the applicant meets the standards for the requested renewal certification, the independent provider may experience a gap in ability to bill for services provided between the date of certification expiration and the date the renewal certification is approved. Once the renewal certification is approved, however, the independent provider may bill for services provided during that period.

(8) When an independent provider submits an application for renewal certification after certification expiration, there will be a lapse of certification from the date of certification expiration to the date the department receives an application for renewal certification that demonstrates the applicant meets the standards for the requested renewal certification. The independent provider may not provide services nor be reimbursed for provision of services during the lapse.

(9) An independent provider may not provide services nor submit claims for reimbursement for services provided subsequent to expiration of the independent provider's certification.

(J) Application for certification subsequent to expiration

(1) An applicant whose certification has been expired for less than one year will be required to apply for and meet the requirements for renewal certification.

(2) An applicant whose certification has been expired for one year or more will be required to apply for and meet the requirements for initial certification.

(K) Application fees

(1) Applicants seeking certification to provide services, other than those exempted in accordance with appendix E to this rule, will submit an application fee at the time of application for initial certification, application for certification to provide additional home and community-based services during the term of existing department-issued certification, and application for renewal certification.

(a) The application fee for an independent provider seeking initial certification or renewal certification is one hundred twenty-five dollars.

(b) The application fee for an independent provider seeking certification to provide additional home and community-based services during the term of existing certification is twenty-five dollars.

(2) Applicants will pay application fees by electronic check or credit card.

(3) Application fees are non-refundable.

(4) The department will invalidate a certification issued to an applicant whose application fees cannot be collected due to non-sufficient funds available or for any other reason. An independent provider whose certification is invalidated in accordance with this paragraph will be required to initiate and submit an entirely new application via the provider network management system.

(L) Certification terms

(1) Initial certification will be issued for a term of three years.

(2) Renewal certification will be issued for a term of three years.

(3) Certification to provide additional home and community-based services will be issued for the remainder of the term of the applicant's existing certification.

(M) Denial, suspension, or revocation of certification

(1) Independent providers are subject to monitoring and compliance reviews as set forth in rules promulgated by the department. Failure to comply with this rule or other rules governing services provided by the independent provider may result in corrective action by the department, up to and including suspension, summary suspension, denial, or revocation of certification.

(2) The department may deny, suspend, or revoke an independent provider's certification for good cause pursuant to section 5123.166 of the Revised Code.

(4) When the department denies an application for renewal certification, the independent provider will comply with the department's adjudication order within thirty calendar days of the date of the mailing of the order.

(N) Department's authority to waive provisions of this rule

(2) An independent provider or applicant for independent provider certification may initiate a request for the department to waive a provision of this rule by submitting the request with justification in writing.

(a) The department may ask for input regarding the request from individuals served, individuals' guardians, or county boards.

View AppendixView AppendixView AppendixView AppendixView Appendix

Last updated January 2, 2024 at 9:42 AM

History

Effective: January 1, 2024
Promulgated Under: 119.03

Chapter 5123-3 Licensed Residential Facilities

Ohio Adm.Code 5123-3-01 Licensed residential facilities - administration and operation.

(A) Purpose

This rule sets forth requirements for administration and operation of residential facilities licensed in accordance with section 5123.19 of the Revised Code.

(B) Definitions

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

(1) "Abuser registry" has the same meaning as in rule 5123-17-03 of the Administrative Code.

(3) "Administrator" means the person responsible for administration of the residential facility who is directly and actively involved in the day-to-day operation of the residential facility and oversees provision of services by the residential facility.

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

(6) "Direct support assistant" means a person who is sixteen or seventeen years of age employed by a residential facility to provide limited duties while in the company of a direct support professional.

(7) "Direct support professional" means a person who is at least eighteen years of age employed in a "direct services position" as that term is defined in section 5123.081 of the Revised Code.

(8) "Health-related activities" has the same meaning as in rule 5123-6-01 of the Administrative 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.

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

(12) "License" means written approval by the department to a licensee to operate a residential facility.

(13) "Licensee" has the same meaning as in section 5123.19 of the Revised Code.

(14) "Operator" means the entity responsible for management of and provision of services at the residential facility.

(15) "Person-centered planning" has the same meaning as in rule 5123-3-03 of the Administrative Code.

(16) "Related party" has the same meaning as in section 5123.16 of the Revised Code.

(17) "Residential facility" has the same meaning as in section 5123.19 of the Revised Code.

(18) "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 an entity is providing specialized services, an operator may request that the director of the department make a determination. The director's determination is not subject to appeal. Programs or services available to the general public are not specialized services.

(19) "Supervisory staff" means employees of the residential facility who provide direction or exercise supervision over one or more direct support professionals.

(20) "Support staff" means employees of the residential facility who are not direct support professionals or direct support assistants, such as those in human resources positions, secretaries, clerks, housekeepers, maintenance workers, and laundry workers.

(21) "Volunteer" means a person who donates time, effort, and/or talent to meet a need or advance the mission of a residential facility and who is not paid or otherwise remunerated by the residential facility. "Volunteer" does not include a family member, guardian, friend, or other associate of an individual simply interacting with that individual.

(1) A residential facility must be licensed by the department in accordance with section 5123.19 of the Revised Code. The license to operate a residential facility is not transferable and is valid only for the licensee, the premises named on the license, the number of individuals specified on the license, and the term specified on the license. The license will be available at the residential facility and shown to anyone upon request.

(2) A licensee will serve as operator of the residential facility or contract with another entity to serve as operator of the residential facility. When a licensee contracts with another entity to serve as operator:

(a) The licensee and operator will enter into a written agreement that establishes the operator's responsibility to provide the licensee all information necessary to comply with paragraphs (C)(4)(a) to (C)(4)(h) of this rule.

(b) The licensee remains responsible for ensuring compliance with all rules and regulations governing the residential facility.

(3) When home and community-based services are provided at a residential facility, the licensee or the operator, as applicable, will submit an application for approval to provide home and community-based services in accordance with procedures established by the department, obtain and maintain a medicaid provider agreement with the Ohio department of medicaid, and comply with rules in Chapter 5123-9 of the Administrative Code for the specific home and community-based services provided.

(4) A licensee will:

(a) Electronically notify the department if the licensee, operator, or administrator has been or is formally charged with, is convicted of, pleads guilty to, or is found eligible for intervention in lieu of 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 within fourteen calendar days after the date of such charge, conviction, guilty plea, or finding.

(b) Electronically notify the department within fourteen calendar days if the licensee, operator, or administrator is or becomes a related party of a person or government entity for which the department refused to issue or renew or revoked a supported living certificate pursuant to section 5123.166 of the Revised Code.

(c) Electronically notify the department within fourteen calendar days of occurrence, and provide the name, date of birth, and social security number for any person newly acquiring a financial interest of five per cent or more in the residential facility (including a direct, indirect, security, or mortgage financial interest).

(d) Provide and maintain on file with the department, the licensee's and the operator's current physical address, telephone number, and electronic mail address.

(e) At the point of application for licensure and upon request by the department, provide proof of a:

(i) Continuing line of credit in the licensee's name in an amount of at least ten thousand dollars; or

(ii) Bank account in the licensee's name with a daily balance of at least ten thousand dollars for the most recent ninety days.

(f) At the point of application for licensure and upon request by the department, provide a certificate of a continuing policy of general liability insurance in an amount of at least one million dollars which includes coverage for individuals' losses due to theft or property damage.

(g) Electronically notify the department within seven calendar days of any bankruptcy petition for which the licensee or operator is the subject and provide related documents to the department upon request.

(h) Electronically notify the department within fourteen calendar days of determining that the administrator has had a professional registration, certification, or license (other than a driver's license) suspended or revoked.

(5) An operator will:

(a) Comply with rules in Chapter 5123-3 of the Administrative Code, rules in other chapters of the Administrative Code adopted by the department to license or regulate the operation of residential facilities, and all applicable federal, state, and local regulations including but not limited to, the Americans with Disabilities Act, fire safety code, wage and hour, workers' compensation, unemployment compensation, and withholding taxes.

(b) Have written policies and procedures that address management practices regarding:

(i) Person-centered planning and self-determination;

(ii) Individuals' satisfaction with services delivered;

(iii) Internal monitoring and evaluation procedures to improve services delivered;

(iv) Supervision of staff;

(v) The training plan described in paragraph (D)(7) of this rule;

(vi) Service delivery;

(vii) Background investigations for employment in accordance with rule 5123-2-02 of the Administrative Code; and

(viii) Volunteers (when the residential facility engages volunteers).

(i) Residential facilities in accordance with rules in Chapter 5123-3 of the Administrative Code;

(ii) Background investigations and appropriate actions in accordance with rule 5123-2-02 of the Administrative Code, for its administrator, licensee, operator, supervisors of direct support professionals, direct support professionals, direct support assistants, and volunteers;

(iii) Service delivery, service documentation, and billing for services in accordance with Chapter 5123. of the Revised Code and rules adopted pursuant to that chapter for supported living services and the specific home and community-based services provided; and

(iv) Management of individuals' funds.

(d) Participate as requested by the department in service delivery system data collection initiatives.

(e) Ensure the operator and its employees interact with individuals in a way to safeguard the rights of individuals enumerated in sections 5123.62 and 5123.65 of the Revised Code.

(f) Meet the requirements established under sections 5123.63 and 5123.64 of the Revised Code.

(6) When a residential facility is governed by a board of directors, board members will:

(a) Ensure the fiscal integrity of the residential facility by reviewing and approving the residential facility's annual audit, if otherwise required, or annual financial statements and by monitoring the residential facility's financial status including trends and challenges;

(b) Review and evaluate all compliance review reports by the department or the Ohio department of health and the operator's response, including the plan of correction;

(c) Monitor the effectiveness of the operator's internal compliance program described in paragraph (C)(5)(c) of this rule; and

(d) Promote the delivery of high-quality services.

(D) Staffing

An operator will:

(1) Conduct background investigations and take appropriate actions in accordance with rule 5123-2-02 of the Administrative Code for the administrator, supervisors of direct support professionals, direct support professionals, direct support assistants, and volunteers. The administrator will consent to be enrolled in the Ohio attorney general's retained applicant fingerprint database (also known as "Rapback"). When the licensee and/or operator is a natural person, the licensee and/or operator will be subject to background investigations in accordance with the requirements for candidates set forth in rule 5123-2-02 of the Administrative Code and consent to be enrolled in the Ohio attorney general's retained applicant fingerprint database (also known as "Rapback").

(2) Annually notify in writing, each of its staff members 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 a supervisor of direct support professionals, a direct support professional, or a direct support assistant to report in writing to the operator, if the staff member is formally charged with, is convicted of, pleads guilty to, or is found eligible for intervention in lieu of 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 within fourteen calendar days after the date of such charge, conviction, guilty plea, or finding.

(3) Be current in payment of payroll taxes, workers' compensation premiums, and unemployment compensation premiums.

(4) Ensure that staff are on duty on the basis of the needs of individuals being served. Staff schedules will be prepared in advance and available for review at each residential facility.

(5) Provide sufficient support staff so that direct support professionals are not required to perform support services to the extent that these duties interfere with the exercise of their primary duties.

(6) Maintain personnel records for each employee in accordance with the residential facility's personnel policies.

(7) Develop and implement a written training plan for its administrator, supervisors of direct support professionals, direct support professionals, direct support assistants, support staff, and volunteers that:

(a) Is consistent with the needs of individuals served, best practice, and the requirements set forth in appendix A, appendix B, appendix C, and appendix D to this rule.

(b) Describes the method (e.g., written test, skills demonstration, or documented observation by supervisor) that will be used to establish competency in areas of training.

(c) Is updated at least once every twelve months and identifies who is responsible for arranging or providing the training and projected timelines for completion of the training.

(8) Maintain a written record of training completed by the administrator, supervisors of direct support professionals, direct support professionals, direct support assistants, support staff, and volunteers that includes a description of the training completed, the date of training, the duration of training, and when applicable, the instructor's name.

(E) Requirements for administrator

(1) An operator will employ an administrator. When the operator is a natural person, the operator may serve as the administrator provided the operator meets the requirements for administrators set forth in this rule.

(2) An administrator will:

(a) Have a valid birth certificate.

(b) Be at least twenty-one years of age.

(d) Be able to read, write, and understand English at a level sufficient to comply with all requirements set forth in administrative rules governing the services provided.

(e) Have at least:

(i) One year of full-time (or equivalent part-time) paid work experience in the provision of specialized services; or

(ii) Four years of experience providing care to a family member (i.e., parent, child, or sibling) with a developmental disability.

(f) Have at least one year of full-time (or equivalent part-time) paid work experience in:

(i) Supervision of employees;

(ii) Development, oversight, and/or supervision of programs or services; and

(iii) Financial management of an organization.

(g) Except for a person who, on September 30, 2016, was employed by or under contract with a residential facility as the administrator, hold either:

(i) A bachelor's degree from an accredited college or university; or

(ii) A high school diploma or certificate of high school equivalence and have at least:

(a) Four years of full-time (or equivalent part-time) paid work experience as a supervisor of specialized services; or

(b) Four years of experience providing care to a family member (i.e., parent, child, or sibling) with a developmental disability.

(h) Successfully complete the training specified in appendix A to this rule in accordance with the stipulated timelines.

(3) An operator will designate in writing a staff member to whom executive authority has been delegated in the temporary absence of the administrator.

(4) An operator will electronically notify the department within fourteen calendar days when the administrator leaves or joins the residential facility's employ.

(a) When the administrator leaves a residential facility's employ, the operator will provide the operator's plan for identifying a new administrator and identify the person to whom executive authority has been delegated in the interim period.

(b) A person newly appointed or employed as administrator will complete the department-provided web-based orientation for administrators of residential facilities described in appendix A to this rule within thirty calendar days of appointment or hire.

(5) An administrator will electronically notify the department if the administrator:

(a) Serves as administrator for more than one licensee.

(b) Is or was the administrator of a residential facility at a point in time within the last five years when the residential facility had its license revoked or not renewed.

(F) Requirements for direct support professionals

An operator will ensure that each direct support professional:

(1) Is at least eighteen years of age.

(2) Is able to read, write, and understand English at a level sufficient to comply with all requirements set forth in administrative rules governing the services provided.

(3) Obtains within sixty calendar days of hire and thereafter maintains valid "American Red Cross" or equivalent certification in first aid which includes an in-person skills assessment completed with an approved trainer. Until such time that certification in first aid is obtained, the direct support professional may provide direct services only when there is another staff member who holds valid certification in first aid present.

(4) Obtains within sixty calendar days of hire and thereafter maintains valid "American Red Cross" or equivalent certification in cardiopulmonary resuscitation which includes an in-person skills assessment completed with an approved trainer. Until such time that certification in cardiopulmonary resuscitation is obtained, the direct support professional may provide direct services only when there is another staff member who holds valid certification in cardiopulmonary resuscitation present.

(5) Successfully completes the training specified in appendix B to this rule in accordance with the stipulated timelines.

(G) Requirements for supervisory staff

An operator will ensure that each staff member who supervises direct support professionals:

(1) Meets the requirements set forth in paragraph (F) of this rule; and

(2) Has successfully completed training regarding all relevant duties and responsibilities of being a supervisor for the residential facility within ninety calendar days of becoming a supervisor.

(H) Requirements for support staff

An operator will ensure that support staff successfully complete the training specified in appendix C to this rule in accordance with the stipulated timelines.

(I) Requirements for direct support assistants

(1) A residential facility may employ persons who are sixteen or seventeen years of age to perform limited duties as direct support assistants.

(2) A person employed as a direct support assistant will, at all times, work in the company of an employee of the residential facility who is:

(a) Physically present at the location where the direct support assistant is providing services; and

(b) A direct support professional who meets the requirements of paragraph (F) of this rule or a supervisor of direct support professionals who meets the requirements of paragraph (G) of this rule.

(3) An operator will ensure that each direct support assistant:

(a) Undergoes a background investigation for employment in accordance with rule 5123-2-02 of the Administrative Code.

(b) Meets the training requirements for direct support professionals set forth in appendix B to this rule.

(4) A person employed as a direct support assistant will not, under any circumstances:

(a) Provide intimate personal care such as dressing, showering, bathing, toileting, or changing undergarments;

(b) Operate a vehicle to transport an individual receiving services;

(d) Provide any care or perform any task for an individual expressly forbidden by the individual (e.g., provide assistance with eating); or

(e) Implement any restrictive measure as defined in rule 5123-2-06 of the Administrative Code.

(5) An operator will not assign a direct support assistant to provide services to an individual who does not consent to having services provided by a direct support assistant.

(J) Requirements for volunteers

(1) A residential facility may engage volunteers to provide supplementary services.

(2) An operator will ensure that volunteers:

(a) Are at all times under supervision of paid supervisory staff of the residential facility.

(b) Do not provide intimate personal care (such as dressing, showering, bathing, toileting, or changing undergarments), administer medication, or perform health-related activities.

(3) An operator will ensure that each volunteer who provides more than forty hours of service working directly with residents during a calendar year:

(a) Successfully completes the training specified in appendix D to this rule.

(b) Undergoes a background investigation which includes:

(i) Requiring the volunteer to submit a statement to the operator with the volunteer's signature attesting that the volunteer has not been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of 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.

(ii) Requiring the volunteer to sign an agreement under which the volunteer agrees to notify the operator within fourteen calendar days if the volunteer is formally charged with, is convicted of, pleads guilty to, or is found eligible for intervention in lieu of 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. The agreement will provide that failure to make the notification may result in termination of the volunteer's services.

(iii) Checking each of the databases described in paragraph (C)(2) of rule 5123-2-02 of the Administrative Code to determine if the volunteer is included.

(iv) Obtaining a criminal records check conducted by the Ohio bureau of criminal identification and investigation. If the volunteer does not present proof that the volunteer 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 will include information from the federal bureau of investigation.

(4) An operator will, at a frequency of no less than once every five years, conduct a background investigation in accordance with paragraph (J)(3)(b) of this rule for each volunteer who provides more than forty hours of service working directly with residents during a calendar year.

(5) An operator will not engage or continue to engage a volunteer who:

(a) Is included in one or more of the databases described in paragraphs (C)(2)(a) to (C)(2)(f) of rule 5123-2-02 of the Administrative Code; or

View AppendixView AppendixView AppendixView Appendix

Last updated September 30, 2024 at 8:36 AM

History

Effective: September 29, 2024
Promulgated Under: 119.03

Ohio Adm.Code 5123-3-02 Licensed residential facilities - physical environment standards, fire safety, and emergency response planning.

(A) Purpose

This rule establishes minimum physical environment and safety standards to ensure that individuals living in residential facilities licensed in accordance with section 5123.19 of the Revised Code are provided a safe, healthy, and homelike living environment that meets their specific needs.

(B) Definitions

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

(1) "Adult" means an individual age eighteen and older.

(2) "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.

(3) "Child" means an individual less than age eighteen.

(4) "Fire safety drill" means a documented simulation of the actions to be taken in response to a fire emergency.

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

(6) "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.

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

(8) "Operator" means the entity responsible for management of and provision of services at the residential facility.

(9) "Physical evacuation" means that the individuals residing in the residential facility physically leave the facility or, in the case of a facility that is classified as I-1 or I-2 occupancy pursuant to section 308 of the Ohio building code, individuals residing in the facility are moved to a separate fire area within the facility that is separated by a two-hour rated firewall.

(10) "Residential facility" has the same meaning as in section 5123.19 of the Revised Code.

(11) "State/local authority" means:

(a) For fire safety, the state fire marshal's office or the local fire department; or

(b) For emergency response, a chapter of the "American Red Cross" or the county emergency management agency.

(1) The interior, exterior, and grounds of the residential facility will be configured in a manner so that the residential facility:

(a) Is accessible to residents;

(b) Can accommodate the assessed needs and degree of ability of residents; and

(2) All areas of the interior, exterior, and grounds of the residential facility and all electrical, plumbing, and heating systems of the residential facility will be maintained in a clean and sanitary manner and in good repair at all times and adequate to meet the needs of the individuals.

(3) All solid waste will be disposed of immediately after production or stored in leak-proof containers with tight-fitting covers which provide protection from animals, rodents, and insects until time of disposal. Such waste will be disposed of through a public disposal service, a private contract service, or otherwise in accordance with the requirements of the Ohio department of health and any local regulations, rules, codes, or ordinances.

(4) Disinfectants, pesticides, poisons, and other toxic substances will be properly labeled and stored separate from food products. All substances defined as "hazardous substances" or which are labeled "warning," "caution," or "danger" will be used in a manner that ensures the health and safety of individuals served in the residential facility.

(5) Gasoline, kerosene, paints, and other flammable materials and liquids will be stored in a safe manner and in accordance with the manufacturer's label. Storage of combustible and non-combustible materials will not produce conditions that create a fire, safety, or health hazard.

(6) No part of the residential facility will be off limits to individuals except for office areas used exclusively by staff, staff quarters, bathrooms located in or adjacent to staff quarters, bedrooms of other individuals unless consent is given, and mechanical and boiler rooms or other areas of the facility that present a health or safety risk to an individual as identified in the individual service plan.

(7) The residential facility must have two means of egress remote from each other for each floor level, except basements which are not used as activity or program areas and are limited to laundry use and storage.

(8) Each building or part of a building and all utilities, sanitary facilities, and appliances will be designed, constructed, and installed in compliance with applicable rules of the Ohio building code, the Ohio sanitary code, the Ohio fire code, and any county or municipal building, safety, and fire regulations or codes.

(9) The residential facility will have parking spaces, curb cuts, walkways, exit/entry ramps, toilets, showers, tubs, sinks, doorways, and other features that facilitate accessibility.

(10) Only lead-free paints and finishes will be used in the residential facility.

(11) The residential facility will have sufficient rooms, offices, and other space, including storage space, needed by the operator, administrator, and staff to carry out the functions of the residential facility.

(12) The residential facility's address number will be clearly visible from the street.

(13) The grounds and buildings of the residential facility will not include any sign which labels the functions of the residential facility or the individuals who reside therein.

(14) The names of residential facilities and descriptions of the individuals residing in those facilities will not convey treatment, body parts, illness, disability, or inactivity. A residential facility will not use the words "hospital," "nursing home," or "rest home" in its name or letterhead.

(15) If the residential facility has an outside play area and serves children six years of age and younger who are ambulatory, the outside play area will be enclosed by a fence with a height sufficient to prevent egress from the area.

(16) Swimming pools on the grounds of residential facilities, including residential facilities in apartment complexes, will:

(a) Meet local and state requirements regarding construction, operation, and sanitation.

(b) Be used by individuals only in the presence of a person who holds "American Red Cross" or equivalent lifeguarding certificate or shallow water lifeguarding certificate if the pool is less than five feet deep, unless otherwise specified in the individual service plan.

(17) An operator shall:

(a) Annually obtain a fire inspection and if applicable, a water and sewer inspection, and provide the inspection to the department upon request.

(b) Maintain the heating system, and cooling system if applicable, of the residential facility in safe operating condition. The residential facility will be maintained at a comfortable and healthy temperature based on the individuals' needs and desires.

(c) Take measures to eliminate and prevent the presence of insects, rodents, and other vermin in and around the residential facility. Opened doors and windows will be screened. The extermination of insects, rodents, and other vermin will be done in such a manner as not to create a fire or other safety or health hazard.

(d) Ensure sidewalks, escape routes, and entrances are free of obstacles and ice and snow.

(e) If the residential facility has a gas furnace and/or gas water heater, maintain a carbon monoxide detector in accordance with the manufacturer's specifications.

(D) Space requirements and usage

(1) Living area

(a) The residential facility will have a minimum of eighty square feet of living area for each individual.

(b) Living area includes, but is not limited to, living rooms, dining rooms, recreation or family rooms, and portion of kitchen floor space available for individual use.

(c) Living area does not include bedrooms, bathrooms, laundry rooms, closets, corridors, hallways, garages, and unfinished basements.

(2) Bedrooms

(a) No bedroom will be occupied by more than two individuals.

(b) No bedroom will be occupied by individuals of the opposite sex unless both occupants are consenting adults or both occupants are less than age six.

(d) Each bedroom occupied by one individual will have a minimum of eighty square feet.

(e) Each bedroom occupied by two individuals will have a minimum of one hundred twenty square feet.

(f) If the bedroom is below the grade level of the residential facility, the room must have two means of egress, one of which may be a window provided the individual using the room can safely evacuate through the window.

(g) Living rooms, dining rooms, entryways, closets, corridors, hallways, outside porches, unfinished attics, and unfinished basements will not be used as bedrooms.

(h) Each bedroom will be adequately ventilated and have at least one outside window complete with a window treatment to provide adequate privacy for the individual.

(i) Each bedroom occupied by individuals who are non-ambulatory will be located on the first floor unless the residential facility has an automatic fire extinguishing system.

(j) Bedrooms will not be used as throughways to and from other areas of the residential facility.

(k) An operator shall provide each individual with:

(i) A bed or crib that is clean, comfortable, sturdy, safe, and in good condition and appropriate for the individual's age and ability.

(a) Hideaway beds, roll away beds, sleeper sofas, and futons will not be used.

(b) Cribs may be used only for individuals less than age five. An individual needing to sleep in a crib will sleep in a crib which is at least six inches longer than the individual's extended length.

(d) No individual will sleep on an exposed mattress or on an exposed mattress cover. Waterproof mattress covers will be provided for infants and individuals who are incontinent.

(e) Linens and bedding for each bed or crib will be appropriate for the weather and climate and maintained to provide clean and sanitary sleeping accommodations for each individual.

(ii) Closet and drawer space in the individual's bedroom for in-season clothing and personal possessions with racks and shelves accessible to the individual.

(3) Kitchen and dining

(a) The residential facility will have at least one area accessible to individuals used for the preparation and serving of food under sanitary conditions.

(b) Each area used for dining will have a minimum of fifteen square feet for each individual in the residential facility, not including the area generally recognized as counter and appliance space necessary for the normal preparation of meals.

(4) Bathroom and laundry

(a) The residential facility will provide bathrooms and plumbing fixtures, including grab rails where needed, appropriate for the age and degree of ability of the individuals.

(b) All bathrooms and plumbing fixtures will be in compliance with applicable state and local regulations, rules, codes, and ordinances.

(c) The residential facility will provide for toilet and bathing facilities at a minimum ratio of one to four, appropriate in size and design to meet the needs of the individuals. Toilet and bathing facilities will be provided on each floor with bedrooms.

(d) The residential facility will provide for individual privacy in toilets, bathtubs, and showers.

(e) Lavatories and bathing facilities will be supplied with hot and cold running water maintained at a comfortable level for each individual to prevent injury.

(f) Laundry services will be accessible to the individuals and adequate to meet their needs.

(E) Furnishings, equipment, and supplies

An operator shall:

(1) Provide the residential facility with safe, sanitary, comfortable, and homelike equipment, furniture, and appliances in good repair and appropriate for the age and ability of individuals.

(2) Provide a means (e.g., telephone, wireless telephone, or computer) for communicating with others to which individuals have free access at all times and in a manner that affords an individual privacy.

(3) Ensure a sufficient supply of soap and basic toiletries (i.e., deodorant, shampoo, oral hygiene items, and feminine hygiene products), toilet paper, clean towels and washcloths, and first aid supplies is available to meet the need of the individuals.

(F) Fire safety and emergency response

(1) Each residential facility will have a fire safety and emergency response plan approved by the state/local authority that at a minimum, addresses the actions to be taken in the event of a fire, tornado, or other natural disaster.

(a) The fire safety and emergency response plan will include, but is not limited to:

(i) A policy that addresses smoking regulations and the storage of combustible materials;

(ii) A fire safety training program that includes provisions for rescue, alarm, containment, and evacuation;

(iii) Designation of a tornado shelter or safe area in the residential facility and the procedure for accessing the area;

(iv) Responses to fires, weather-related emergencies, or other disasters when relocation of individuals is not required;

(v) Responses to fires, weather-related emergencies, or other disasters when relocation of individuals is required, including designation of a pre-arranged place to meet in case of a physical evacuation of the residential facility; and

(vi) A procedure for permitting re-entry to the residential facility following a fire safety drill and/or physical evacuation.

(b) The residential facility will share the fire safety and emergency response plan with the county board of developmental disabilities.

(2) A current graphic floor plan will be posted unobstructed on each floor of the residential facility and in an area most appropriate for the posting of staff information. The graphic floor plan will include, but is not limited to:

(a) A primary and secondary means of exit from each floor;

(b) The location of pull stations and fire control system panels, when applicable;

(d) The telephone number of the local fire department or "911";

(e) Designated tornado shelter or safe area; and

(f) Designated meeting places in case of fire.

(3) No exit, stairway, corridor, ramp, elevator, fire escape, or other means of exit from a building will be used for storage purposes or be otherwise obstructed from use.

(4) A fire extinguisher approved by the state/local authority will be located on each floor and in the natural path of escape from a fire, at readily accessible and visible points which are not likely to be obstructed.

(5) Each residential facility with six or more individuals will be equipped with:

(a) An automatic sprinkler system meeting the requirements of "National Fire Protection Association" 13-D, "Sprinkler Systems in One and Two Family Dwellings." The sprinkler system will be interconnected with the smoke and fire detection and alarm system.

(b) An automatic sprinkler system meeting the requirements of "National Fire Protection Association" 13, "Standard for the Installation of Sprinkler Systems," when a residential facility has seventeen or more individuals, or when a residential facility with six to sixteen individuals cannot be physically evacuated in twelve minutes or less. The sprinkler system will be interconnected with the smoke and fire detection and alarm system. A new residential facility with six to sixteen individuals classified as I-1 occupancy pursuant to section 308 of the Ohio building code on or after May 18, 1995, will be required to have a sprinkler system meeting the requirements of "National Fire Protection Association" 13-R, "Installation of Sprinkler Systems in Residential Occupancies Up to Four Stories in Height."

(c) A smoke and fire detection and alarm system meeting the requirements of "National Fire Protection Association" 72, "National Fire Alarm Code," depending upon the nature of the physical facility involved and such other standards as required by the appropriate building and fire officials.

(d) Fire alarm pull stations near each main exit and in the natural path of escape from a fire, at readily accessible and visible points which are not likely to be obstructed.

(6) Each residential facility with five or fewer individuals will be equipped with:

(a) At least a single station smoke detector on each floor of the facility. Each smoke detector will be mounted on the ceiling or wall at a point centrally located in the corridor or area giving access to rooms used for sleeping. Where sleeping rooms are on an upper level, the smoke detector will be placed at the center of the ceiling directly above the stairway. All smoke detectors will be installed and maintained in accordance with the manufacturer's recommendations. When the smoke detectors are wall-mounted, they will be located within twelve inches, but no closer than four inches, of the ceiling. Installation will not interfere with the operating characteristics of the smoke detector. When activated, the smoke detector will provide an alarm audible in the residential facility.

(b) An approved fire alarm system, which includes bells, sirens, horns, lights, or other equipment as may be appropriate, when services are provided to individuals who are visually and/or hearing impaired.

(c) An automatic sprinkler system meeting the requirements of "National Fire Protection Association" 13-D, "Sprinkler Systems in One and Two Family Dwellings," and a smoke detection system as required by paragraph (F)(6)(a) of this rule when the residential facility cannot be physically evacuated in three minutes or less.

(7) The operator shall ensure that all sprinkler systems, fire alarms, extinguishing systems, and other safety equipment are properly maintained.

(8) The department may utilize the "National Fire Protection Association 101: Life Safety Code" (2021 edition) to determine if additional life safety requirements are needed.

(9) The operator shall conduct and document at least three fire safety drills in a twelve-month period with one conducted during the morning, one conducted during the afternoon or evening, and one conducted during the time when individuals are routinely asleep.

(10) The operator shall conduct and document at least one tornado drill in a twelve-month period.

(11) Fire safety drills and tornado drills may be announced or unannounced and will be conducted in accordance with the assessed needs of individuals as identified in their individual service plans.

(12) Residential facility staff will be trained in fire safety, operation of fire safety equipment and warning systems, and the residential facility's fire safety and emergency response plan in accordance with rule 5123-3-01 of the Administrative Code.

(13) Each individual will participate in documented training of the residential facility's fire safety and emergency response plan within thirty calendar days of residency and at least once during every twelve-month period thereafter. The training will be appropriate for the individual's needs based on the results of an assessment.

(14) Except at an intermediate care facility for individuals with intellectual disabilities, individuals may be trained to assist one another in case of fire or other emergency to the extent their abilities permit without additional personal risk and as indicated in their individual service plans.

(15) An operator shall:

(a) Report to the department within one business day any fire to which a local fire department responded.

(b) Notify each individual's family member or guardian, as applicable, as soon as possible when an emergency requires the operator to relocate individuals from the residential facility.

(c) Report to the department and the county department of job and family services within one business day when an emergency requires the operator to relocate individuals from the residential facility. When the residential facility is an intermediate care facility for individuals with intellectual disabilities, the department will notify the Ohio department of health district office and the Ohio department of medicaid.

(d) Provide weekly updates to the department about individuals who have been relocated due to an emergency until the individuals return to the residential facility or permanently relocate to another residential setting.

Last updated June 25, 2025 at 5:53 PM

History

Effective: December 1, 2022
Promulgated Under: 119.03

Ohio Adm.Code 5123-3-03 Licensed residential facilities - person-centered planning.

(A) Purpose

This rule ensures that services for individuals living in residential facilities licensed in accordance with section 5123.19 of the Revised Code are delivered pursuant to an individual service plan that is developed through person-centered planning.

(B) Definitions

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

(1) "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.

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

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

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

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

(7) "Informed consent" means a documented written agreement to allow a proposed action, treatment, or service after full disclosure provided in a manner an individual or the individual's guardian understands, of the relevant facts necessary to make the decision. Relevant facts include the risks and benefits of the action, treatment, or service; the risks and benefits of the alternatives to the action, treatment, or service; and the right to refuse the action, treatment, or service. The individual or the individual's guardian, as applicable, may withdraw informed consent at any time.

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

(9) "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.

(10) "Person-centered planning templates" means the department-required formats (i.e., the assessment template and the individual service plan template) that an intermediate care facility for individuals with intellectual disabilities will use to conduct assessments and develop individual service plans for its residents.

(11) "Qualified intellectual disability professional" has the same meaning as in 42 C.F.R. 483.430.

(12) "Residential facility" has the same meaning as in section 5123.19 of the Revised Code.

(13) "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 5123-5-02 of the Administrative Code.

(14) "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.

(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 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 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 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 will not be construed to 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) Assessment of an individual

(1) Assessment of an individual who resides in a residential facility other than an intermediate care facility for individuals with intellectual disabilities will be coordinated by a service and support administrator in accordance with rule 5123-4-02 of the Administrative Code.

(2) Assessment of an individual who resides in an intermediate care facility for individuals with intellectual disabilities will be coordinated by a qualified intellectual disability professional in accordance with this paragraph.

(a) With the active participation of the individual and members of the team, including the individual's guardian when applicable, the qualified intellectual disability professional will use the department's person-centered planning template to conduct an assessment of the individual.

(b) The assessment will take into consideration:

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

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

(iii) Known and likely risks;

(iv) The individual's place on the path to community employment described in rule 5123-2-05 of the Administrative Code; and

(v) The individual's skills and abilities.

(i) Communication (expressing oneself and understanding others);

(ii) Advocacy and engagement (valued roles and making choices; responsibility and leadership);

(iii) Safety and security (safety and emergency skills; behavioral well-being; emotional well-being; supervision considerations);

(iv) Social and spirituality (personal networks, activities, and faith; friends and relationships);

(v) Daily life and employment (school and education; employment; finance);

(vi) Community living (life at home; getting around); and

(vii) Healthy living (medical and dental care; nutrition; wellness).

(E) Development of individual service plans

(1) The individual service plan for an individual who resides in a residential facility other than an intermediate care facility for individuals with intellectual disabilities will be developed by a service and support administrator in accordance with rule 5123-4-02 of the Administrative Code.

(2) The individual service plan for an individual who resides in an intermediate care facility for individuals with intellectual disabilities will be developed by a qualified intellectual disability professional in accordance with this paragraph.

(a) Person-centered planning is the foundation for development of individual service plans. What is important to the individual and what is important for the individual as expressed directly by the individual, and as applicable, by an adult authorized by the individual or the individual's guardian will drive development of the individual service plan.

(b) The services, supports, and activities described in the individual service plan will reflect what is important to the individual and what is important for the individual to achieve a more independent, secure, and enjoyable life.

(i) The qualified intellectual disability professional shall:

(a) Coordinate development of the individual service plan with the individual and the team within thirty calendar days after the individual's admission and at least annually thereafter.

(b) Describe, annually and upon request, the supports and services available to an individual residing in an intermediate care facility for individuals with intellectual disabilities and the supports and services available to an individual enrolled in a home and community-based services waiver.

(c) Ensure that development of the initial individual service plan and each subsequent individual service plan reflects meaningful planning for:

(i) The individual's discharge from the intermediate care facility for individuals with intellectual disabilities that:

(A) Identifies supports and services necessary for the individual's successful transition to an integrated community setting and specifies who is responsible for ensuring necessary supports and services are provided; and

(B) Includes strategies or methods for meeting the challenges for a successful transition to an integrated community setting.

(ii) The individual's unique strengths, interests, abilities, preferences, resources, and desired outcomes as they relate to community employment in accordance with rule 5123-2-05 of the Administrative Code.

(d) With the active participation of the individual and members of the team, including the individual's guardian when applicable, use the department's person-centered planning template to develop an individual service plan that:

(i) Identifies a continuous active treatment program;

(ii) Identifies opportunities for independence, choice, and self-management;

(iii) Identifies needed developmental, behavioral, and health interventions and supports;

(iv) Identifies and promotes opportunities for community participation; and

(v) Identifies and supports preservation and development of interpersonal relationships (e.g., social contacts, relationships, and emotional supports).

(e) Review and revise the individual service plan as needed or upon request.

(f) Review implementation of the individual service plan at least quarterly and revise as needed.

(g) Coordinate the services, supports, and activities being provided to the individual with service providers, as identified in the individual service plan.

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

(ii) The qualified intellectual disability professional shall document performance of the tasks described in paragraph (E)(2)(b)(i) of this rule and secure informed consent for the individual service plan from the individual, adult authorized by the individual, or the individual's guardian, as applicable.

(iii) The qualified intellectual disability professional shall attempt to address concerns when informed consent is refused or withdrawn by presenting alternative services or activities to the individual.

(iv) The individual service plan will be provided to the individual, adult authorized by the individual, or individual's guardian, as applicable; to all parties responsible for implementation of the individual service plan; and to authorized regulatory agents. The individual service plan will not be released to other persons without the informed consent of the individual, adult authorized by the individual, or individual's guardian, as applicable.

(c) Upon request by the department, an intermediate care facility for individuals with intellectual disabilities will provide an individual's completed person-centered planning templates as soon as possible but no later than within three business days of the request.

Last updated August 27, 2026 at 8:00 AM

History

Effective: August 27, 2026
Promulgated Under: 119.03

Ohio Adm.Code 5123-3-04 Licensed residential facilities - admission of residents, provision of services, and maintenance of service records.

(A) Purpose

This rule establishes standards to ensure that services provided in residential facilities licensed in accordance with section 5123.19 of the Revised Code focus on achievement of outcomes that are important to and important for individuals served, individuals are involved in development and delivery of their services, the confidentiality of individuals' records is maintained, and individuals' records are readily accessible for service delivery and for review by the department.

(B) Definitions

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

(1) "Administrator" means the person responsible for administration of the residential facility who shall be directly and actively involved in the day-to-day operation of the residential facility and oversee provision of services by the residential facility.

(2) "Community participation" means engagement of an individual in daytime and evening activities that:

(a) Are available to the general public (such as employment, clubs, meetings, and advocacy groups);

(b) Are important to the individual;

(d) Create opportunities for the individual to develop meaningful relationships in the local community as is typical of other citizens of that community.

(3) "Direct support professional" means a person who is employed in a "direct services position" as that term is defined in section 5123.081 of the Revised Code.

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

(6) "Informed consent" means a documented written agreement to allow a proposed action, treatment, or service after full disclosure provided in a manner the individual or the individual's guardian understands, of the relevant facts necessary to make the decision. Relevant facts include the risks and benefits of the action, treatment, or service; the alternatives to the action, treatment, or service; and the right to refuse the action, treatment, or service. The individual or the individual's guardian, as applicable, may withdraw informed consent at any time.

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

(8) "Licensee" has the same meaning as in section 5123.19 of the Revised Code.

(9) "Major unusual incident" has the same meaning as in rule 5123-17-02 of the Administrative Code.

(10) "Modified texture or therapeutic diets" means diets that are altered in any way to enable an individual to eat (e.g., food is chopped or pureed) or diets that are intended to correct or prevent a nutritional deficiency or health problem.

(11) "Operator" means the entity responsible for management of and provision of services at the residential facility.

(12) "Residential facility" has the same meaning as in section 5123.19 of the Revised Code.

(13) "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.

(14) "Unusual incident" has the same meaning as in rule 5123-17-02 of the Administrative Code.

(15) "Virtual support" means the provision of services by direct support professionals at a distant site who engage with an individual using interactive technology that has the capability for two-way, real time audio and video communication.

(1) Admission to a residential facility is voluntary, requiring informed consent.

(2) An operator shall:

(a) Admit as residents only individuals whose service needs can be met by the residential facility.

(b) When reviewing an application for admission, consider its ability to maintain adequate services to all residents of the residential facility.

(c) Notify the individual and referring party in writing of the outcome of the admission decision within thirty calendar days of receiving an application for services and referral information.

(d) Notify the county board of developmental disabilities in writing within fourteen calendar days of admitting a new resident, after securing informed consent to provide the notification.

(D) Standards of service provision

(1) The operator, administrator, and staff of a residential facility shall:

(a) Provide services in a person-centered manner.

(b) Be able to effectively communicate with each individual receiving services.

(d) Implement services in accordance with the individual service plan.

(e) Take all reasonable steps necessary to prevent the occurrence or recurrence of major unusual incidents and unusual incidents.

(f) Comply with the requirements of rule 5123-2-06 of the Administrative Code regarding development and implementation of behavioral support strategies.

(2) An operator shall ensure that a direct support professional does not:

(a) Provide services to the direct support professional's minor child.

(b) Provide services to the direct support professional's spouse.

(d) Provide services to the spouse of the administrator.

(e) Administer medication to or perform health-related activities for individuals who receive services unless the direct support professional meets the applicable requirements of Chapters 4723., 5123., and 5126. of the Revised Code and rules adopted under those chapters.

(f) Use or be under the influence of the following while providing services:

(i) Alcohol;

(ii) Illegal drugs;

(iii) Illegal chemical substances; or

(iv) Controlled substances that may adversely affect the direct support professional's ability to furnish services.

(E) Health care

(1) Self-administration or assistance with self-administration of prescribed medication will be conducted in accordance with rule 5123:2-6-02 of the Administrative Code.

(2) Delegation of nursing tasks, excluding the provision of health-related activities, will be conducted in accordance with rule 5123-6-06 of the Administrative Code and Chapter 4723-13 of the Administrative Code.

(3) Administration of prescribed medication pursuant to sections 5123.42 to 5123.46 of the Revised Code will be conducted in accordance with Chapters 5123-6 and 5123:2-6 of the Administrative Code.

(4) An operator will comply with the requirements for reporting medication/treatment errors in accordance with rules 5123-6-07 and 5123-17-02 of the Administrative Code.

(5) An operator shall develop and implement written procedures for the disposal of prescribed medication which require:

(a) Disposal of prescribed medication to be verified and recorded by two staff members or by an independent external entity.

(b) Dangerous drugs to be disposed in accordance with rule 4729-9-06 of the Administrative Code.

(6) In the event of termination of services pursuant to rule 5123-3-05 of the Administrative Code, an operator shall ensure:

(a) A written accounting of prescribed medication is completed no later than the last day of the individual's residency and verified by two staff members.

(b) A plan is developed for transfer of prescribed medication to the individual or the individual's guardian, as applicable.

(7) In the event of the death of an individual, an operator shall ensure:

(a) A written accounting of prescribed medication is completed immediately and no later than twenty-four hours following the death and verified by two staff members.

(b) The operator and staff of the residential facility cooperate with any investigation conducted by a legally authorized entity.

(c) Disposal of prescribed medication occurs in accordance with the written procedures described in paragraph (E)(5) of this rule, unless an investigation calls for the disposal to be delayed.

(F) Transportation

An operator shall:

(1) Provide or arrange for transportation of individuals residing in the residential facility in accordance with each resident's individual service plan.

(2) Ensure each employee providing transportation holds a valid driver's license as specified in Ohio law.

(3) Ensure each employee providing transportation is covered by valid personal or corporate liability insurance as specified in Ohio law.

(4) Obtain, for each employee providing transportation, a driving record prepared by the bureau of motor vehicles no earlier than fourteen calendar days prior to the date of initial employment as a driver and at least once every three years thereafter. A person having six or more points on the person's driving record is prohibited from providing transportation.

(5) Require each employee providing transportation to immediately notify the operator in writing if the employee accumulates six or more points on the employee's driving record or if the employee's driver's license is suspended or revoked.

(6) Develop and implement written policies and procedures regarding vehicle accessibility, vehicle maintenance, and requirements for vehicle drivers.

(G) Food

(1) An operator shall offer daily meals and snacks that meet an individual's nutritional needs and preferences as identified by the individual.

(2) Modified texture or therapeutic diets shall be prepared and served in accordance with the instructions of a physician or licensed dietitian. An operator shall maintain instructions regarding modified texture or therapeutic diets in accordance with paragraph (J) of this rule.

(3) Meals shall provide for variety, substitutions, and accommodation of individuals' personal preferences and religious beliefs. Individuals shall participate in meal planning and preparation to the extent of their interest and ability to do so.

(4) Fresh food supplies sufficient for three days and staple food supplies sufficient for at least five days shall be available in the residential facility at all times.

(5) Food shall be prepared and stored properly and in accordance with health codes to protect it against contamination and spoilage. Food products shall be stored separately from potentially harmful non-food items, particularly cleaning and laundry compounds.

(H) Clothing and personal belongings

(1) An operator shall ensure each individual has an adequate amount of personal clothing in good repair, well-fitting, and comparable in style to that worn by age peers in the community. The team shall ensure the clothing needs of an individual who does not have personal funds available to cover needed items are met. All clothing shall be clean and appropriate for the season and the activities in which the individual is engaged.

(2) An operator shall encourage each individual to select, purchase, and maintain the individual's own clothing and to dress as independently as possible.

(3) When an individual has been assessed to need assistance with management of personal possessions, the operator shall record the individual's clothing and personal belongings within fourteen calendar days of admission and update the record at least annually thereafter. Any single item with a purchase price of fifty dollars or more purchased by or on behalf of an individual who has been assessed to need assistance with management of personal possessions, shall be added to the record when acquired and deleted from the record when discarded or lost.

(4) An operator shall not discard an individual's clothing or personal belongings without the consent of the individual or the individual's guardian, as applicable.

(5) If operation of a residential facility is transferred from one operator to another, the outgoing operator shall convey individuals' clothing and personal belongings to the incoming operator.

(I) Community participation for individuals who reside in an intermediate care facility for individuals with intellectual disabilities

(1) The operator of an intermediate care facility for individuals with intellectual disabilities shall ensure that each individual:

(a) Has opportunities to access age-appropriate activities, engage in meaningful employment and non-work activities, and pursue activities with persons of the individual's choosing.

(b) Routinely has information in formats the individual understands about activities and programs related to community employment in accordance with rule 5123:2-2-05 of the Administrative Code offered by other providers as well as opportunities to explore and experience community participation in accordance with the individual service plan and the individual's desired outcomes.

(c) Participates in activities that foster community participation unless the individual service plan indicates why, based on evaluations and assessments, such participation is medically contraindicated.

(d) Has access to a variety of activities that reflect what is important to the individual and what is important for the individual.

(2) The activities and programs described in paragraph (I)(1) of this rule shall not be provided in an intermediate care facility for individuals with intellectual disabilities or within two hundred feet of an intermediate care facility for individuals with intellectual disabilities except that:

(a) An intermediate care facility for individuals with intellectual disabilities that was providing day activities in or on the grounds of the intermediate care facility for individuals with intellectual disabilities prior to July 1, 2005 in accordance with paragraph (H)(4) of rule 5123:2-3-04 of the Administrative Code in effect on the day immediately prior to the effective date of this rule, may continue to provide day activities at that same location.

(b) An individual may choose to participate in activities and programs through virtual support under the following conditions:

(i) Virtual support does not have the effect of isolating the individual from the community or preventing the individual from interacting with people with or without disabilities;

(ii) The use of virtual support has been agreed to by the individual and the individual's team and is specified in the individual service plan; and

(iii) The use of virtual support complies with applicable laws governing the individual's right to privacy and the individual's protected health information.

(J) Individuals' service records

(1) An operator shall ensure:

(a) The following current records for each individual are maintained at the residential facility:

(i) A photograph of the individual.

(ii) Legal status of the individual.

(iii) Individual service plan, including documentation of informed consent for services, supports, and activities provided.

(iv) A signed authorization to seek medical treatment or documentation to demonstrate that attempts to secure such authorization were unsuccessful.

(v) Medication and/or treatment records which indicate the person who prescribed the medication and/or treatment and the date, time, and person who administered the medication and/or treatment.

(b) The following records for each individual are maintained by the operator in an accessible location and provided upon request to the department for review at the residential facility or at another location mutually agreed upon by the operator and the department:

(i) Former versions of records specified in paragraph (J)(1)(a) of this rule.

(ii) Admission and referral records.

(iii) All service documentation including notations of progress.

(iv) Records of all medical and dental examinations and immunization records as appropriate based upon the individual's age.

(v) Records of major unusual incidents and unusual incidents.

(vi) Major unusual incident investigation files.

(vii) Reconciliations of the individual's account transaction record as described in rule 5123-2-07 of the Administrative Code.

(viii) Records of negotiable items owned by the individual which can be transferred or converted to cash (such as bonds or promissory notes).

(ix) Records of clothing and personal belongings for individuals who have been assessed to need assistance with management of personal possessions.

(x) A written accounting prepared within thirty calendar days following termination of an individual's residency at the residential facility that documents:

(a) Circumstances of termination of residency (e.g., the individual moved to another residential setting, the individual died, or the operator terminated services in accordance with rule 5123-3-05 of the Administrative Code);

(b) The individual's new address;

(d) Disposition of the individual's clothing and personal belongings; and

(e) Release or disposition of the individual's personal funds in accordance with rule 5123-2-07 of the Administrative Code.

(2) If operation of a residential facility is transferred from one operator to another, the outgoing operator shall convey the records specified in paragraph (J)(1) of this rule to the incoming operator.

(3) All information contained in an individual's records shall be considered confidential. Records will be maintained in accordance with state and federal regulations and in such a manner to ensure their confidentiality and protect them from unauthorized disclosure.

(4) An operator shall develop a records retention schedule for all records in accordance with applicable state and federal requirements.

Last updated June 26, 2025 at 8:57 AM

History

Effective: December 1, 2022
Promulgated Under: 119.03

Ohio Adm.Code 5123-3-05 Licensed residential facilities - transfer and termination of services.

(A) Purpose

This rule establishes uniform policies for transfer and termination of services of individuals living in residential facilities licensed in accordance with section 5123.19 of the Revised Code other than a department-operated intermediate care facility for individuals with intellectual disabilities.

(B) Definitions

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

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

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

(3) "Director" means the director of the department or a person designated by the director of the department.

(4) "Emergency" means a situation in which either:

(a) Despite the operator's documented attempts to provide, obtain, and/or coordinate the services necessary to ensure the health and safety of the resident, other residents, and/or staff of the residential facility, there still exists a significant risk of substantial harm to the resident, other residents, or staff that cannot be met in the current environment such that action must be taken immediately; or

(b) Through a level of care determination in accordance with rule 5123-8-01 of the Administrative Code or a preadmission screening for developmental disabilities in accordance with rule 5123-14-01 of the Administrative Code, the individual is determined to require a level of services provided in another type of setting (e.g., a nursing facility).

(5) "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, the person's guardian in accordance with section 5126.043 of the Revised Code or other person authorized to give consent.

(6) "Informed consent" means a documented written agreement to allow a proposed action, treatment, or service after full disclosure provided in a manner the individual understands, of the relevant facts necessary to make the decision. Relevant facts include the risks and benefits of the action, treatment, or service; the risks and benefits of the alternatives to the action, treatment, or service; and the right to refuse the action, treatment, or service. The individual may withdraw informed consent at any time.

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

(8) "Operator" means the entity responsible for management of and provision of services at the residential facility.

(9) "Residential facility" has the same meaning as in section 5123.19 of the Revised Code.

(10) "Termination of services" means an action initiated by an operator to cause a resident to move to another residence that is not under the jurisdiction of the operator. Termination of services does not include a temporary absence from an intermediate care facility for individuals with intellectual disabilities described in section 5124.34 of the Revised Code.

(11) "Transfer" means an action initiated by an operator to cause a resident to move, on a temporary or permanent basis, between residential facilities under the jurisdiction of the operator.

(1) An operator will allow each resident to remain in the residential facility and shall not initiate a transfer or termination of services unless:

(a) The transfer or termination of services is necessary for the resident's welfare and the resident's needs can no longer be met without imposing an undue hardship on the operation of the residential facility;

(b) The resident no longer needs or wants the services provided by the residential facility or chooses to move to another residence;

(c) The resident is creating a significant risk of substantial harm to self, other residents, or staff in the residential facility;

(d) Nonpayment for the stay in the residential facility, including nonpayment of medicaid or other third-party payer;

(e) The residential facility permanently reduces its capacity; or

(f) The residential facility ceases to operate.

(2) An operator shall not unlawfully discriminate because of disability, race, color, religion, national origin or ancestry, sex, or age including but not limited to, failing to make reasonable accommodation to a person's physical, mental, or behavioral support needs to the extent required by law unless the operator can demonstrate that the accommodation would impose an undue hardship on the operation of the residential facility including an unreasonable risk of harm to residents or staff in the residential facility.

(3) Before initiating a transfer or termination of services, an operator shall:

(a) Notify in writing via certified mail, the individual and the county board of the transfer or termination of services. The notice will contain:

(i) The reason for the transfer or termination of services;

(ii) The effective date of the transfer or termination of services;

(iii) A summary of the action taken by the operator, including working with the county board, to try to meet the resident's needs;

(iv) The individual's right to appeal the transfer or termination of services and the process to do so; and

(v) The telephone number and address of disability rights Ohio.

(b) Explain the transfer or termination of services and appeal rights to the individual in a manner the individual understands; and

(4) The notice of transfer or termination of services must be made at least thirty calendar days before the transfer or termination of services, except when an emergency exists. If at any time prior to the expiration of the thirty-day period the operator determines that the conditions that constituted the emergency no longer exist, the subject of the transfer or termination of services may return to the residential facility.

(5) If an individual requests a hearing regarding the transfer or termination of services, the residential facility must maintain services or the availability of services until a decision is rendered after the hearing unless an emergency exists.

(6) If after receiving notice of the transfer or termination of services, the individual waives in writing the individual's rights to appeal, the operator is not required to maintain services or the availability of services.

(D) Administrative review process

(1) An individual who wishes to appeal a transfer or termination of services shall first appeal in writing to the governing board or administrator of the residential facility within seven calendar days of the receipt of the notice of transfer or termination of services.

(2) The governing board or administrator shall review the decision and notify the individual in writing of the outcome of the review within five calendar days of the request for the review. The notice to the individual will be sent by certified mail and, if the appeal is denied, include the contact information for the director and an explanation in a manner the individual understands that the individual has five calendar days from receipt of the notice to appeal to the director.

(3) An individual who wishes to appeal to the director shall submit the appeal in writing to the director within five calendar days from receipt of the notice from the governing board or administrator. Upon request, department staff will assist the individual to understand the appeal process and find resources to help the individual with preparation of the appeal.

(E) Mediation process

(1) The individual and the operator shall attend a mediation meeting to try to achieve resolution regarding the transfer or termination of services prior to initiation of the hearing process described in paragraph (F) of this rule. Legal representation is not permitted in the mediation meeting.

(2) The department will provide the mediator.

(3) The mediation meeting will be conducted within fifteen calendar days of receipt of the appeal. Timelines may be extended if mutually agreed upon in writing by all parties.

(4) The mediator may hold the mediation open when the parties do not dispute the proposed transfer or termination of services and need additional time for the individual to transition to another residence.

(5) Unless all parties agree in writing to abide by the recommendations of the mediator, the mediation will be nonbinding.

(6) Statements made during the mediation process cannot be used as evidence in any subsequent hearings or court proceedings.

(F) Hearing process

(1) The department will grant an opportunity for a hearing to any individual who has received a transfer or termination of services notice, has attended a mediation meeting in accordance with paragraph (E) of this rule, and requests a hearing in accordance with this rule.

(2) The department will deny or dismiss a request if:

(a) The request is not filed in a timely manner;

(b) The individual fails to attend a scheduled hearing unless there is good cause for the absence; or

(3) The department will appoint a hearing officer to hear the appeal. The hearing officer will not be the same person as the mediator in any given case.

(4) The hearing officer shall select a time and place for the hearing and attempt to select a time for the hearing that is mutually agreeable to all parties. The hearing will be conducted within thirty calendar days of conclusion of the mediation meeting described in paragraph (E) of this rule. The hearing officer has discretion to determine whether a court reporter or transcript of the hearing will be required.

(5) The individual and the operator shall have the opportunity to present evidence at the hearing. The operator may have legal representation. The individual may have legal representation and/or an authorized representative.

(6) The burden of proof will be on the operator to show that the transfer or termination of services was in accordance with this rule.

(7) The hearing officer shall review the evidence presented and determine if the requirements of this rule have been followed.

(8) The hearing officer shall issue a written recommendation to the director within ten calendar days of the conclusion of the hearing or when applicable, receipt of the transcript of the hearing, whichever is later.

(9) The director will issue a written decision to the parties within five calendar days of receipt of the hearing officer's recommendation. The director may impose conditions on the transfer or termination of services.

(10) Timelines in paragraph (F)(1), (F)(4), (F)(8), or (F)(9) of this rule may be extended if mutually agreed upon in writing by all parties.

(G) Adverse actions

If an operator fails to follow the requirements of this rule or fails to follow the decision of the director, the operator may be subject to adverse actions in accordance with rule 5123-3-06 of the Administrative Code.

Last updated December 1, 2022 at 10:46 AM

History

Effective: December 1, 2022
Promulgated Under: 119.03

Ohio Adm.Code 5123-3-06 Licensed residential facilities - compliance reviews, issuance of licenses, and adverse actions.

(A) Purpose

This rule sets forth processes for reviews conducted by the department to ensure compliance by residential facilities licensed in accordance with section 5123.19 of the Revised Code, the issuance of licenses for residential facilities operating in accordance with Chapters 5123. and 5124. of the Revised Code, and adverse actions for residential facilities not operating in accordance with Chapters 5123. and 5124. of the Revised Code.

(B) Definitions

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

(1) "Administrator" means the person responsible for administration of the residential facility who is directly and actively involved in the day-to-day operation of the residential facility and oversees provision of services by the residential facility.

(2) "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.

(3) "Compliance review" means a review of a residential facility conducted by the department or its designee for the purpose of determining compliance with applicable requirements in order to ensure the health, safety, and welfare of individuals served. The department may, based upon a compliance review, issue a citation and require immediate corrective action when it determines that a violation poses an immediate and substantial risk to the health and safety of residents.

(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" has the same meaning as in section 5123.01 of the Revised Code.

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

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

(9) "License" means written approval by the department to a licensee to operate a residential facility. For purposes of this rule, "license" does not include an interim license issued in accordance with rule 5123-3-08 of the Administrative Code.

(10) "Licensee" has the same meaning as in section 5123.19 of the Revised Code.

(11) "Major unusual incident" has the same meaning as in rule 5123-17-02 of the Administrative Code.

(12) "Operator" means the entity responsible for management of and provision of services at the residential facility.

(13) "Residential facility" has the same meaning as in section 5123.19 of the Revised Code.

(1) The department will conduct a compliance review of a residential facility at least once during the term of the license and may conduct additional compliance reviews as determined by the department.

(2) There are three types of compliance reviews:

(a) Routine compliance reviews conducted so that each residential facility is reviewed once during the term of its license.

(b) Abbreviated compliance reviews conducted so that each residential facility is reviewed once during the term of its license for a residential facility that holds accreditation by a national accrediting entity. An abbreviated compliance review focuses on individuals served and their health and safety, examines fewer policies, and relies on smaller sample sizes of staff and individuals served.

(i) A residential facility that is accredited by a national accrediting entity may be eligible for an abbreviated compliance review when the standards of the national accrediting entity:

(a) Meet or exceed the department's standards;

(b) Are compatible with the centers for medicare and medicaid services home and community-based services core set of quality measures, when applicable;

(d) Ensure the health and safety of individuals served.

(ii) An abbreviated compliance review will examine the residential facility's compliance with applicable requirements regarding:

(a) Background investigations of the licensee and/or operator and background investigations and training of the residential facility's administrator and employees;

(b) Behavioral support strategies;

(d) Major unusual incidents; and

(e) Service delivery.

(iii) To be eligible for an abbreviated compliance review, the residential facility will submit a written request to the department that includes a copy of the most recent survey/review of the residential facility by the national accrediting entity.

(iv) The residential facility will notify the department in writing within ten calendar days if the residential facility's accreditation by the national accrediting entity is amended, suspended, terminated, or not renewed and provide a copy of related correspondence from the national accrediting entity.

(v) An abbreviated compliance review may not be available when:

(a) The residential facility has not yet received an initial routine compliance review by the department;

(b) The residential facility has had multiple or significant substantiated major unusual incidents since the most recent compliance review by the department or survey/review by the national accrediting entity;

(c) The operator's management team or the residential facility's administrator has changed since the most recent compliance review by the department or survey/review by the national accrediting entity; or

(d) The residential facility's accreditation by the national accrediting entity has been amended or suspended.

(c) Special compliance reviews conducted in response to a complaint, a major unusual incident, or any situation where there is reason to believe that the residential facility is not being operated in compliance with Chapters 5123. and 5124. of the Revised Code or rules adopted under those chapters.

(i) Special compliance reviews may be announced or unannounced.

(ii) Upon receipt of a complaint, department staff will:

(a) Take necessary measures to ensure that any conditions that pose a risk to the health or welfare of the individual have been corrected;

(b) Determine whether a special compliance review will be conducted;

(c) Determine if the complaint should be referred to law enforcement, a county board, or another unit or entity internal or external to the department in accordance with rule 5123-11-02 of the Administrative Code; and

(d) Send a written response to the complainant describing actions taken by the department to address the complaint.

(D) Compliance review procedures

(1) The department will maintain a protocol for compliance reviews which includes, but is not limited to:

(a) The method for selecting residential facilities to be reviewed;

(b) The types and scope of reviews that may be conducted;

(d) The elements of compliance which will be based on the applicable requirements;

(e) The elements of a written compliance review summary to a residential facility that will include an explanation of any citations, the process to develop and implement a plan of correction, and an explanation of the due process afforded to a residential facility;

(f) The criteria for conducting announced and unannounced reviews; and

(g) Any forms or methods of documentation approved by the department.

(2) The department will make the protocol for compliance reviews available at its website (https://dodd.ohio.gov).

(E) Compliance review summary, appeal, and plan of correction when no adverse action is being initiated

(1) Within ten calendar days of conclusion of a compliance review, the department will issue to the residential facility, a written compliance review summary or a written explanation of the reason for delay in issuance of the written compliance review summary.

(b) A written explanation of the reason for delay in issuance of the written compliance review summary will include the date by which the department will issue a written compliance review summary, which will not be more than twenty calendar days of conclusion of the compliance review.

(2) Within fourteen calendar days of receipt of a compliance review summary that includes one or more citations, the residential facility will submit to the department, a written appeal or a written plan of correction for each citation. If the residential facility does not submit a written appeal within fourteen calendar days, the compliance review summary will be final and not subject to appeal by the residential facility.

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

(b) If the appeal is disallowed, the residential facility will submit a written plan of correction for the citation to the department within fourteen calendar days.

(c) The written plan of correction for a citation will include action steps and timelines for remediation. The department will approve or disapprove the plan of correction within twenty calendar days of receipt. When the department disapproves a plan of correction, the residential facility will work with the department to develop an acceptable plan of correction.

(F) Issuance of license

(1) Following routine compliance reviews and abbreviated compliance reviews that do not result in adverse action, the department will issue a three-year license to the licensee within twenty calendar days of determining that the residential facility is in compliance with all requirements, an approved plan of correction has been implemented, and/or compliance with specific requirements has been waived in accordance with rule 5123-3-10 of the Administrative Code; and collection of the licensure fee specified in paragraph (J) of this rule.

(2) Following routine compliance reviews and abbreviated compliance reviews that result in adverse action that requires a plan of correction, the department will issue a one-year license to the licensee within twenty calendar days of determining that the residential facility is in compliance with all requirements, an approved plan of correction has been implemented, and/or compliance with specific requirements has been waived in accordance with rule 5123-3-10 of the Administrative Code; and collection of the licensure fee specified in paragraph (J) of this rule.

(3) A license will remain valid until the end of its term unless the license is revoked, extended, or terminated by the department or voluntarily surrendered by the licensee.

(G) Adverse actions

(1) If the department determines that a residential facility is not being operated in accordance with Chapters 5123. and 5124. of the Revised Code or rules adopted under those chapters, the department may initiate a suspension of admissions, order placement of a monitor, initiate proceedings to refuse to renew the license, and/or initiate proceedings to revoke the license.

(a) Initiate a suspension of admissions

(i) The department may initiate a suspension of admissions when the department:

(a) Determines the residential facility has demonstrated a pattern of serious noncompliance or a violation poses a substantial risk to the health and safety of residents; or

(b) Is ordering placement of a monitor or initiating proceedings to refuse to renew or revoke the license in accordance with, as applicable, paragraph (G)(1)(b), (G)(1)(c), or (G)(1)(d) of this rule.

(ii) When a suspension of admissions is ordered before providing an opportunity for adjudication pursuant to Chapter 119. of the Revised Code, the process set forth in section 5123.19 of the Revised Code will be followed.

(iii) The department will send a copy of the order suspending admissions to the county board where the residential facility is located.

(iv) The licensee will send written notice to each individual served at the residential facility, the individual's guardian if the individual is an adult for whom a guardian has been appointed, or the individual's parent or guardian if the individual is a minor, within three business days of notification from the department that a suspension of admissions has been imposed on the facility. The notice will contain information regarding the reason for suspension of admissions and how the individual, parent, or guardian can obtain additional information regarding the suspension of admissions. The licensee will send a copy of the notice to the department.

(v) Provided the suspension of admissions is not imposed in conjunction with proceedings to revoke the license, the licensee may submit a plan of correction in accordance with the process set forth in paragraph (E)(2) of this rule.

(vi) The department may lift the suspension of admissions when the department determines that the citation that formed the basis for the order has been corrected.

(b) Order placement of a monitor

(i) The department may order placement of a monitor in a residential facility (i.e., on-site monitoring provided or arranged by the department whenever an individual is in the residential facility and up to twenty-four hours per day) when the department determines the situation requires ongoing oversight to facilitate necessary corrective action.

(ii) The department will send a copy of the order for placement of a monitor to the county board where the residential facility is located.

(iii) The licensee will send written notice to each individual served at the residential facility, the individual's guardian if the individual is an adult for whom a guardian has been appointed, or the individual's parent or guardian if the individual is a minor, within three business days of notification from the department that a monitor has been placed in the facility. The notice will contain information regarding the reason for placement of a monitor and how the individual, parent, or guardian can obtain additional information regarding the placement of a monitor. The licensee will send a copy of the notice to the department.

(i) The department may initiate proceedings to refuse to renew the license of a residential facility upon expiration when the department determines the residential facility has demonstrated a pattern of serious noncompliance or a violation poses a substantial risk to the health and safety of residents.

(ii) If such a determination is made, the department will send a letter to the licensee in accordance with section 119.05 of the Revised Code. The letter will list the citations identified during the compliance review that are the basis for refusal to renew the license and include as an attachment, the compliance review summary. The department will send a copy of the letter to the county board where the residential facility is located and, if the residential facility is an intermediate care facility for individuals with intellectual disabilities, to the Ohio department of health and the Ohio department of medicaid.

(iii) The licensee will have fourteen calendar days from the date the letter is served to submit an appeal or plan of correction for each citation in accordance with the process set forth in paragraph (E)(2) of this rule.

(iv) Within twenty calendar days following an on-site visit to verify that the licensee has implemented the approved plan of correction, the department will either:

(a) Determine the plan of correction has been satisfactorily implemented and issue a one-year license to the licensee after collection of the licensure fee specified in paragraph (J) of this rule; or

(b) Determine the licensee remains in serious noncompliance or a citation continues to pose a substantial risk to the health and safety of residents and send a letter to the licensee in accordance with section 119.05 of the Revised Code, affirming the department's decision to refuse to renew the license upon expiration and advising that the licensee must cease operation within thirty calendar days of receipt of the letter or the license expiration date, whichever is later. The letter will inform the licensee of the licensee's right to request a hearing on the proposed refusal to renew the license pursuant to Chapter 119. of the Revised Code. The licensee will have thirty calendar days from the date the letter is served to request a hearing which, if timely requested, will be held in accordance with Chapter 119. of the Revised Code.

(v) If the licensee does not request a hearing within thirty calendar days, an adjudication order will be rendered pursuant to Chapter 119. of the Revised Code. The department will send a copy of the adjudication order to the county board where the residential facility is located and, if the residential facility is an intermediate care facility for individuals with intellectual disabilities, to the Ohio department of health and the Ohio department of medicaid. The department will arrange for a letter or a copy of the adjudication order to be sent to each individual served at the residential facility, the individual's guardian if the individual is an adult for whom a guardian has been appointed, or the individual's parent or guardian if the individual is a minor.

(vi) If the licensee requests a hearing and the hearing process extends beyond the expiration date of the residential facility's license, the license will continue to be valid for thirty calendar days after the date the department's decision, pursuant to Chapter 119. of the Revised Code, is rendered.

(d) Initiate proceedings to revoke the license

(i) The department may initiate proceedings to revoke the license of a residential facility when the department determines the residential facility has demonstrated a pattern of serious noncompliance or a violation poses a substantial risk to the health and safety of residents.

(ii) If such a determination is made, the department will send a letter to the licensee in accordance with section 119.05 of the Revised Code. The letter will list the citations identified during the compliance review that are the basis for revocation of the license and include as an attachment, the compliance review summary. The letter will inform the licensee of the licensee's right to request a hearing on the proposed revocation of the license pursuant to Chapter 119. of the Revised Code. The licensee will have thirty calendar days from the date the letter is served to request a hearing which, if timely requested, will be held in accordance with Chapter 119. of the Revised Code.

(iii) When the department initiates proceedings to revoke the license, the department will arrange for notification in writing to each individual served at the residential facility, the individual's guardian if the individual is an adult for whom a guardian has been appointed, the individual's parent or guardian if the individual is a minor, the county board where the residential facility is located and, if the residential facility is an intermediate care facility for individuals with intellectual disabilities, to the Ohio department of health and the Ohio department of medicaid.

(iv) Once the department initiates proceedings to revoke the license, no opportunity for submitting a plan of correction will be given.

(2) In proceedings initiated to refuse to renew or revoke a license, the department may refuse to renew or revoke the license regardless of whether some or all of the citations that prompted the proceedings have been corrected at the time of the hearing.

(H) Termination of license

(1) The department may terminate a license if more than twelve consecutive months have elapsed since the residential facility was last occupied by an individual or when the licensee failed to provide notice of modification in accordance with rule 5123-3-08 of the Administrative Code.

(2) If such a determination is made, the department will send a letter to the licensee in accordance with section 119.05 of the Revised Code. The letter will explain the basis for termination of the license and inform the licensee of the licensee's right to request a hearing on the proposed termination of the license pursuant to Chapter 119. of the Revised Code. The licensee will have thirty calendar days from the date the letter is served to request a hearing which, if timely requested, will be held in accordance with Chapter 119. of the Revised Code.

(I) Effect of refusal to renew, revocation, termination, or voluntary surrender of license

(1) When the department refuses to renew, revokes, or terminates a license or when a licensee voluntarily surrenders a licensee, the licensed beds revert to the department.

(2) When the department refuses to renew, revokes, or terminates a license or when a licensee voluntarily surrenders a license and the department determines that the licensed beds are needed to provide services to individuals who resided in the residential facility in which the beds were located, the department may authorize the county board in the county where the residential facility is located to develop a request for proposal for the purpose of recommending a licensee.

(a) The department will establish and make available the format, procedure, timelines, and criteria for evaluation for the request for proposal process to be used by a county board.

(b) The county board will solicit proposals from any interested applicants and ensure all interested applicants are afforded an equal opportunity to respond to the request for proposal. Written notice will be provided to the general public and to all interested licensees as prescribed by the department.

(c) The county board will submit all proposals and its recommendation to the department within ten calendar days after completing its review of the proposals.

(d) The department will consider the county board's recommendation and notify in writing, the county board and all applicants of its decision within thirty calendar days after receiving the county board's recommendation. The department will provide each applicant its rationale in selecting or choosing not to select a particular licensee.

(J) Licensure fees

(1) Licensure fees will be paid by electronic check or credit card in advance of issuance of a license by the department.

(2) Licensure fees are non-refundable.

(3) Licensure fees are based on the term of the license and the number of licensed beds at the residential facility.

(a) The licensure fee for a three-year license is:

(i) Three hundred dollars for a residential facility with fifteen or fewer beds; and

(ii) One thousand five hundred dollars for a residential facility with sixteen or more beds.

(b) The licensure fee for a one-year license is:

(i) One hundred dollars for a residential facility with fifteen or fewer beds; and

(ii) Five hundred dollars for a residential facility with sixteen or more beds.

Last updated November 9, 2023 at 8:21 AM

History

Effective: November 9, 2023
Promulgated Under: 119.03

Ohio Adm.Code 5123-3-07 Licensed residential facilities - immediate removal of residents.

(A) Purpose

This rule establishes a process by which the director may order the immediate removal of a resident of a residential facility licensed in accordance with section 5123.19 of the Revised Code.

(B) Definitions

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

(1) "Compliance review" has the same meaning as in rule 5123-3-06 of the Administrative Code.

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

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

(4) "Director" means the director of the department or a person designated by the director of the department.

(5) "Immediate removal" means the process initiated upon issuance of an order by the director, for removing a resident of a residential facility when:

(a) Conditions at the residential facility present an immediate danger of physical or psychological harm to the resident; and

(b) All other available interventions have proved ineffective or infeasible.

(6) "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, the person's guardian in accordance with section 5126.043 of the Revised Code or other person authorized to give consent.

(7) "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.

(8) "Licensee" has the same meaning as in section 5123.19 of the Revised Code.

(9) "Major unusual incident" has the same meaning as in rule 5123-17-02 of the Administrative Code.

(10) "Operator" means the entity responsible for management of and provision of services at the residential facility.

(11) "Residential facility" has the same meaning as in section 5123.19 of the Revised Code.

(1) When a county board, on the basis of its investigation of a major unusual incident, determines that the physical or psychological health or safety of a resident of a residential facility is in immediate danger, the county board shall contact the director to request immediate removal. The request will include a description of the major unusual incident and/or circumstances which led to the conditions at the residential facility presenting an immediate danger of physical or psychological harm to the resident.

(2) Upon receipt of an allegation that the physical or psychological health or safety of a resident of a residential facility is in danger, the department may investigate or request a county board to investigate the allegation.

(3) When a county board requests immediate removal in accordance with paragraph (C)(1) of this rule, or when the department becomes aware of an allegation that the physical or psychological health or safety of a resident of a residential facility is in immediate danger from any other source (e.g., an individual, a compliance review, or the media), the director will determine whether the resident will be removed from the residential facility based upon information obtained by the department which may be provided by the county board or any other source including the operator if, in the opinion of the director, such communication with the operator does not threaten the health or safety of the resident.

(4) When the director determines that conditions at the residential facility present an immediate danger of physical or psychological harm to the resident and all other available interventions have proved ineffective or infeasible, the director will issue an order for immediate removal and notify:

(a) The county board;

(b) Disability rights Ohio;

(c) The operator if, in the opinion of the director, the act of notification does not threaten the health or safety of the resident; and

(d) The individual if, in the opinion of the director, the act of notification does not threaten the health or safety of the resident.

(D) Effecting immediate removal

(1) After the county board receives an order for immediate removal issued by the director, the county board shall attempt to notify the individual prior to the actual immediate removal if the department has not already done so.

(2) The county board shall be responsible for removing the resident and for arranging transportation, placement, and services in the least restrictive alternative available. The county board shall assist the individual to secure long-term housing. The county board shall ensure implementation of all components of the individual service plan, as applicable. The department will assist in facilitating placement into the least restrictive alternative available.

(E) Additional actions by director or department

(1) The department may initiate suspension of admissions or revocation of the residential facility's license in accordance with rule 5123-3-06 of the Administrative Code when a resident has been subject to immediate removal pursuant to this rule.

(2) The director, upon receipt of written information from the county board or any other reliable source indicating that the circumstances which led to the immediate removal no longer exist, may permit the resident to return to the residential facility. The director will notify the county board and disability rights Ohio when a resident returns to the residential facility following an immediate removal.

(3) When the licensee is a county board or when there are circumstances that are determined by the department to potentially present a conflict of interest, the department may investigate allegations that the physical or psychological health or safety of a resident of a residential facility is in immediate danger or may request that an investigation be conducted by another county board, a council of governments, or any other entity authorized to conduct such investigations.

Last updated June 25, 2025 at 5:53 PM

History

Effective: December 1, 2022
Promulgated Under: 119.03

Ohio Adm.Code 5123-3-08 Licensed residential facilities - development and renovation.

(A) Purpose

This rule establishes uniform standards and procedures governing the development and renovation of residential facilities subject to licensure in accordance with section 5123.19 of the Revised Code.

(B) Definitions

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

(1) "Adult" means an individual age eighteen and older.

(2) "Applicant" means a person, as defined in section 1.59 of the Revised Code, or government agency submitting a proposal and seeking approval from the department for development of licensed beds.

(3) "Child" means an individual less than age eighteen.

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

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

(6) "Development" means an applicant's plan for the operation of a licensed residential facility including a plan for modification which is subject to approval of the department.

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

(8) "Initial license" means written approval by the department to a licensee to operate a residential facility for a period of one year.

(9) "Interim license" means written approval by the department to a licensee to operate a residential facility for a period not to exceed one hundred eighty calendar days.

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

(11) "Licensed bed" means a bed in a residential facility licensed by the department pursuant to section 5123.19 of the Revised Code.

(12) "Licensee" has the same meaning as in section 5123.19 of the Revised Code.

(13) "Modification" means:

(a) A change in the identity of the licensee or operator;

(b) A significant change in ownership of a licensed residential facility that occurs as the result of an acquisition, sale of a majority interest, merger, or when a family member is added to or removed from a license held by a family-owned business;

(d) An increase or decrease in the number of licensed beds operated at a specific address;

(e) The rebuilding of a licensed residential facility at the same address;

(f) The rebuilding of a licensed residential facility at a different address; or

(g) A change in the type or source of funding of a licensed residential facility.

(14) "Operator" means the entity responsible for the management of and provision of services at the residential facility.

(15) "Renovation" means a permanent change in the physical structure of a residential facility that results in a change in the use of the facility and/or a change in its floor plan since the most recent issuance of the facility's license.

(16) "Residential facility" has the same meaning as in section 5123.19 of the Revised Code.

(1) No person or government agency may apply for a license to operate a residential facility without first obtaining development approval in accordance with this rule.

(2) The department will not approve a proposal for the development of licensed beds or issue a license under section 5123.19 of the Revised Code if the approval or issuance will cause the number of licensed beds to exceed the number of licensed beds permitted by section 5123.196 of the Revised Code.

(3) A residential facility may continue to operate at the capacity for which it is licensed as of the effective date of this rule.

(4) An applicant who has obtained approval for a development proposal will be permitted to proceed with development in accordance with the terms of the approval granted by the department.

(5) The number of licensed beds in an intermediate care facility for individuals with intellectual disabilities will not exceed six unless the department determines, based upon documentation provided by the operator, that the intermediate care facility for individuals with intellectual disabilities requires capacity greater than six to be financially viable, in which case the department may approve a capacity that is not greater than eight.

(6) The number of licensed beds in a residential facility that is not an intermediate care facility for individuals with intellectual disabilities will not exceed four.

(7) Licensed residential facilities will not exist on adjoining property sites except that licensed residential facilities operating on adjoining property sites on the effective date of this rule may continue to so operate.

(8) No more than one distinct and separate physical structure may be licensed on the same property site except that licensed residential facilities with more than one distinct and separate physical structure licensed on the same property site on the effective date of this rule may continue to so operate.

(9) Notwithstanding paragraph (C)(7) or (C)(8) of this rule, multiple apartments within an apartment building or complex of apartment buildings on the same property site may be licensed individually when the apartments serve as the best alternative for maximizing community integration.

(10) A county board may not assume ownership of a residential facility.

(D) Development proposal process

(1) An applicant shall electronically submit a development proposal to the department prior to the date of the proposed modification. The proposal will:

(a) Identify the owner of the license to operate the facility, the operator of the facility if different from the owner, the lessor of the facility if any, and any related party as defined in section 5165.01 of the Revised Code to the owner or operator of the facility.

(b) Describe the modification accurately and completely.

(i) A change in the address of some or all of the licensed beds;

(ii) An increase or decrease in the number of licensed beds operated at a specific address;

(iii) The rebuilding of a licensed residential facility at the same address;

(iv) The rebuilding of a licensed residential facility at a different address; or

(v) A change in the type or source of funding.

(d) Be submitted no less than sixty calendar days in advance when the licensee proposes to make a modification involving:

(i) A change in the address of some or all of the licensed beds;

(ii) The rebuilding of a licensed residential facility at the same address; or

(iii) The rebuilding of a licensed residential facility at a different address.

(2) In reviewing a development proposal, the department will consider:

(a) The extent to which the development proposal supports integration into the community;

(b) The objective of reducing the number of beds at a single site;

(d) The outcome of prior compliance reviews;

(e) The need for services in the local community;

(f) The need for capital improvements at the residential facility;

(g) For licensed beds in a residential facility that is not an intermediate care facility for individuals with intellectual disabilities, compatibility with home and community-based character set forth by the centers for medicare and medicaid services;

(h) The provider's ability to meet the financial requirements of the development proposal; and

(i) The county board's recommendation regarding the development proposal.

(3) The department will electronically notify the applicant of the approval or disapproval of the development proposal together with a statement of reason within sixty calendar days of receipt of a complete application. The department will maintain on its website a list of development proposals and action taken thereon.

(4) The department will establish specific timelines for implementation of a development proposal at the time of development approval.

(a) Failure to meet established timelines may result in withdrawal of development approval.

(b) Revisions or extensions to established timelines require prior written approval by the department.

(E) Feasibility analysis

(1) The department will conduct a feasibility analysis prior to issuance of an initial or modified license for:

(a) A change in the address of some or all of the licensed beds;

(b) An increase in the number of licensed beds operated at a specific address;

(d) The rebuilding of a residential facility at a different address.

(2) A person or government agency shall, after obtaining development approval in accordance with paragraph (D)(3) of this rule, electronically notify the department to initiate scheduling of the feasibility analysis.

(3) The department will confirm the date for the feasibility analysis which may be conducted in-person or remotely using technology.

(4) The feasibility analysis will include a review of the physical environment and configuration of the facility to ensure the facility is in compliance with requirements set forth in rule 5123-3-02 of the Administrative Code.

(5) Any findings of non-compliance identified during the feasibility analysis will be corrected by the licensee prior to issuance of an initial or modified license.

(F) Issuance of license

(1) A person or government agency desiring to operate a residential facility shall, after obtaining development approval pursuant to this rule and establishing the facility, notify the department in writing to request issuance of the initial license no less than thirty calendar days prior to the date of the planned opening of the facility.

(2) The department will issue the initial license to the licensee within twenty calendar days of determining the residential facility is in compliance with all requirements and collection of the licensure fee which:

(a) Is based on the number of licensed beds at the residential facility, that is:

(i) One hundred dollars for a residential facility with fifteen or fewer beds; and

(ii) Five hundred dollars for a residential facility with sixteen or more beds.

(b) Will be paid by electronic check or credit card.

(3) The department may issue an interim license when it determines initiation or continuation of services at the residential facility is appropriate pending completion of the development process (e.g., while a licensee is awaiting certification by the Ohio department of health as an intermediate care facility for individuals with intellectual disabilities).

(4) A person or government agency submitting a development proposal to place a licensed bed on hold for future development will have three hundred sixty-five calendar days from the date of approval of the development proposal to apply for a license for the residential facility. The application for a license will be submitted to the department no less than sixty calendar days prior to the date of the planned opening of the facility.

(5) The applicant may appeal the decision of the department regarding a development proposal in accordance with rule 5123:2-17-01 of the Administrative Code.

(G) Renovation proposal process

(1) When the licensee proposes to make a renovation to a residential facility, the licensee shall electronically notify the department no less than thirty calendar days in advance of beginning such renovation.

(2) The licensee shall provide any information required by the department in order for the department to determine whether new inspections and/or a compliance review is required following the renovation.

(3) The department will electronically notify the licensee of the approval or disapproval of the licensee's renovation proposal within fourteen calendar days after receiving all the information it needs to determine whether new inspections and/or a licensure compliance review is required following the renovation.

Last updated June 25, 2025 at 5:53 PM

History

Effective: December 1, 2022
Promulgated Under: 119.03

Ohio Adm.Code 5123-3-09 Licensed residential facilities - standards for evaluating potential receivers.

(A) Purpose

This rule establishes standards for evaluating potential receivers of residential facilities licensed in accordance with section 5123.19 of the Revised Code.

(B) Definitions

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

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

(2) "Major unusual incident" has the same meaning as in rule 5123-17-02 of the Administrative Code.

(3) "Receiver" means a person who takes possession of and operates a residential facility when conditions existing at the residential facility present a substantial risk of physical or mental harm to residents and no other remedies at law are adequate to protect the health, safety, and welfare of the residents.

(4) "Residential facility" has the same meaning as in section 5123.19 of the Revised Code.

To be considered for inclusion on a list of potential receivers maintained by the department, a person must have at least five years of experience as a provider licensed to operate a residential facility in Ohio in accordance with section 5123.19 of the Revised Code.

(D) Standards for evaluating potential receivers

The standards to be considered by the department for evaluating persons to be included on a list of potential receivers include, but are not limited to:

(1) Substantial compliance with requirements for previous or existing residential facilities operated by the potential receiver over the past five years under any corporate name.

(2) Involvement of one or more key employees of the potential receiver in prior licensure revocation, receivership, immediate removal, or suspension of admissions.

(3) Fiscal solvency of the potential receiver.

(4) Pending and prior investigations of major unusual incidents within the past five years, which includes the scope and nature of the incidents, the analysis, and any findings involving individuals being served by the potential receiver.

(5) The experience of the potential receiver in the provision of services to individuals with developmental disabilities including, but not limited to:

(a) Characteristics of individuals served;

(b) Geographic areas served;

(d) Specialized services offered; and

(e) A table of organization that identifies key employees or positions and their qualifications.

Last updated June 26, 2025 at 4:30 AM

History

Effective: December 1, 2022
Promulgated Under: 119.03

Ohio Adm.Code 5123-3-10 Licensed residential facilities - procedures to waive rule requirements.

(A) Purpose

This rule sets forth procedures for the director to waive a condition or specific requirement of a rule in Chapter 5123-3 of the Administrative Code or a rule in another chapter of the Administrative Code adopted by the department to license or regulate the operation of residential facilities.

(B) Definitions

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

(1) "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.

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

(3) "Director" means the director of the Ohio department of developmental disabilities or that person's designee.

(4) "Licensee" has the same meaning as in section 5123.19 of the Revised Code.

(5) "Residential facility" has the same meaning as in section 5123.19 of the Revised Code.

(1) For good cause, the director may waive a condition or specific requirement of a rule in Chapter 5123-3 of the Administrative Code or a rule in another chapter of the Administrative Code adopted by the department to license or regulate the operation of residential facilities. The director's decision to waive a condition or specific requirement shall not be contrary to the rights, health, or safety of individuals living in a residential facility.

(2) A licensee may initiate a request for the director to waive a condition or specific requirement by submitting the request in writing.

(a) The director may require or solicit input regarding the licensee's request from individuals living in the residential facility, the individuals' guardians, or the county board of developmental disabilities for the county in which the residential facility is located.

(b) The director shall grant or deny a request submitted by a licensee within ten business days of receipt of the request or within such longer period of time as the director deems necessary.

(d) The director's decision to grant or deny a request is not subject to appeal.

Last updated August 27, 2026 at 8:00 AM

History

Effective: August 27, 2026
Promulgated Under: 119.03

Ohio Adm.Code 5123-3-11 Licensed residential facilities - room and board.

(A) Purpose

This rule identifies components of room and board and establishes standards and procedures for determining the amount of earned income and unearned income retained by an individual as personal funds and the amount of room and board for which an individual is responsible when residing in a residential facility licensed in accordance with section 5123.19 of the Revised Code other than an intermediate care facility for individuals with intellectual disabilities.

(B) Definitions

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

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

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

(3) "Earned income" means wages and net earnings from employment or self-employment.

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

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

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

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

(8) "Licensee" has the same meaning as in section 5123.19 of the Revised Code.

(9) "Patient liability" means the individual's financial obligation toward the medicaid cost of care. Patient liability will be satisfied in accordance with rule 5160:1-6-07.1 of the Administrative Code.

(10) "Personal funds" means earned income and unearned income retained by an individual after satisfying obligations such as rent, individual-specific expenses, or medical co-payments; satisfying state requirements including patient liability and/or monthly premiums for services funded by a home and community-based services waiver; and satisfying federal requirements including adherence to income restrictions necessary to maintain medicaid eligibility.

(11) "Residential facility" has the same meaning as in section 5123.19 of the Revised Code, except that for purposes of this rule, "residential facility" does not include an intermediate care facility for individuals with intellectual disabilities.

(12) "Room and board" means items, costs, and/or expenses, which are not reimbursable through medicaid or another payer, incurred by the licensee in order to provide needed supports and services to an individual residing in a residential facility. Room and board reflects the licensee's actual and reasonable costs and includes individual-specific expenses based on the support provided to each individual who resides in the residential facility to implement the individual's individual service plan and residential facility costs.

(a) Individual-specific expenses include:

(i) Adaptive minor equipment, routine medical supplies, and over-the-counter medications.

(ii) Healthcare-related expenses and medical equipment such as dental services, eyeglasses, wheelchairs, and catheters.

(iii) Personal hygiene supplies such as hair and nail care items, lotions, powder, dental hygiene supplies, shaving items, and the cost of haircuts.

(iv) The cost of recreational and/or social activities such as an admission ticket and travel (but never staff wages) for an individual and for staff, as specified in the individual service plan, necessary to accompany the individual to recreational and/or social activities.

(v) An individual's clothing.

(vi) Atypical supplies required for the protection of an individual and staff while performing procedures that involve potential contact with bodily fluids including, but not limited to, gowns, goggles, and eye wash.

(b) Residential facility costs include:

(i) Administrative overhead expenses directly related to property management of the residential facility.

(ii) Utilities including fuel oil, natural and propane gas, metered electrical service, water and sewage expenses, local and long distance telephone service, equipment purchased or leased for use by residents, and the cost of security services provided for the benefit of residents.

(iii) The cost of basic television and internet services provided for the benefit of residents.

(iv) The cost of food, after food stamps and other available resources are expended, including all raw, prepackaged, and prepared food (meals and/or snack items) eaten inside or outside the home (e.g., at restaurants) by the residents and like expenses for staff if consumed while providing supervision or services to the residents.

(v) Rental or lease costs for building and land limited to the lesser of actual cost or fair market value and insurance on contents.

(vi) Depreciation for a residential facility owned by the licensee (excluding the value of the land) using the straight line method of depreciation over forty years and interest expense as incurred, real property taxes, and insurance on contents and property. Excludes amortization expense over the life of state property grants received by the licensee for renovations.

(vii) Maintenance and repair of the residential facility including, but not limited to, lawn care, trash removal, pest control, carpet cleaning, and repair to minor equipment or structure.

(viii) Depreciation and current interest expense of residential facility equipment, furniture, and other furnishings that meet the licensee's capitalization policy, using the straight line method of depreciation. Guidelines established by the internal revenue service will be used to determine the number of years of useful life of the asset to be depreciated.

(ix) Lease or rental of residential facility equipment, furniture, and other furnishings and/or the cost of equipment, furniture, and other furnishings under the capitalization policy of the licensee.

(x) Major maintenance to a residential facility owned by the licensee to improve and/or maintain the structural integrity of the facility and to maintain a safe and healthy living environment including, but not limited to, roof replacement; repairs to the foundation, walls, floors, electrical, heating and cooling, plumbing, or septic and sewer systems; additions or renovations that benefit the residents; and interest expense if funds were borrowed to complete the work. The straight line method of depreciation will be used for depreciating all improvements. Improvements will be depreciated over a period not less than the remaining useful life of the property and not more than the useful life of the improvement as determined by the internal revenue service.

(xi) Non-food supplies and minor equipment used in the storage, preparation, serving, and delivery of food such as dishes, dish washing detergent, cooking utensils, silverware, wraps and containers to preserve food, and propane gas for grills.

(xii) Household costs including, but not limited to, trash cans and bags, general household cleaning supplies, paper products, towels, bedding, laundry, and minor equipment used for laundry and housekeeping.

(13) "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.

(1) For the purposes of this rule, earned income and unearned income will be considered in the month it is received.

(2) A county board is permitted to recoup earned income and unearned income received by an individual from a non-routine event (e.g., social security back payment, tax refund, or inheritance) for payment of past room and board, not to exceed twelve months. An individual will not be charged for prepayment of future room and board as a result of receiving earned income or unearned income from a non-routine event.

(3) The total amount of room and board available to support residents of residential facilities in a county will align with the plan and priorities established by the county board in accordance with section 5126.04 of the Revised Code and be based upon available resources of the county board.

(4) When a licensee operates more than one residential facility in a county, the individual-specific expenses component of room and board and/or the residential facility costs component of room and board may be determined separately for each facility or by aggregating costs across all facilities to arrive at an average. The county board and licensee shall jointly establish which method will be used. The total room and board rate may vary among facilities based on identified individual-specific expenses.

(5) The amount of room and board to be paid to a licensee by a county board will be identified in a written contract between the licensee and the county board which will be made available upon request by the department. Room and board costs will be reviewed by the county board and the licensee at least annually and amended as necessary.

(6) A county board and licensee shall share information as necessary for determination of reasonable and appropriate room and board. The county board and licensee shall work together to resolve differences regarding room and board.

(D) Personal funds retained by the individual

(1) Each individual shall retain as personal funds the first one hundred dollars per month from the individual's earned income plus one-half of the individual's earned income in excess of one hundred dollars.

(2) Each individual shall retain as personal funds at least one hundred dollars per month from the individual's unearned income. Food stamps, although unearned income, will not be applied toward the personal funds to be retained by the individual.

(3) When the sum of an individual's earned income and unearned income is less than one hundred dollars per month, the county board shall provide the individual with the difference, up to one hundred dollars, for the individual to retain as personal funds.

(E) Responsibilities of the county board

(1) The county board shall identify assets of the individual, resources, and alternatives to assist the individual to meet room and board. Unusual or atypical room and board expenses, resources, and responsible entities will be identified in the individual service plan.

(2) The county board is responsible for paying the licensee the amount owed to the licensee for room and board based on the contract established in accordance with paragraph (C)(5) of this rule, adjusted for earned income and unearned income of the individual as calculated in accordance with paragraph (D) of this rule.

(F) Responsibilities of the licensee

The licensee is responsible for calculating and documenting the sum of the individual's earned income and unearned income available for room and board as determined in accordance with paragraph (D) of this rule and shall compare it to the room and board amount identified in the contract established in accordance with paragraph (C)(5) of this rule.

(1) If the sum of the individual's earned income and unearned income minus the amount the individual is entitled to retain in accordance with paragraph (D) of this rule is less than the contracted room and board for the month, the entire amount of the individual's earned income and unearned income minus the amount the individual is entitled to retain will be paid to the licensee. The balance of the room and board cost will be billed to the county board by the licensee in accordance with the contract.

(2) If the sum of the individual's earned income and unearned income minus the amount the individual is entitled to retain in accordance with paragraph (D) of this rule is greater than the contracted room and board for the month, the individual shall pay the entire cost of the room and board to the licensee. An individual shall retain as personal funds any earned income and unearned income that exceeds the individual's obligation for room and board.

(G) Responsibilities of the individual, guardian, and/or payee

(1) The individual, guardian, or payee of the individual, as applicable, is responsible for providing the licensee and county board with information pertaining to the individual's earned income and unearned income in order to determine the individual's obligation to pay for room and board.

(2) The individual, guardian, or payee of the individual, as applicable, is responsible for paying the licensee the amount owed to the licensee for room and board in a timely manner and in accordance with the residency agreement required pursuant to rule 5123-9-02 of the Administrative Code.

Last updated December 1, 2022 at 10:47 AM

History

Effective: December 1, 2022
Promulgated Under: 119.03

Chapter 5123-4 County Boards of Developmental Disabilities

Ohio Adm.Code 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

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

(1) "Accreditation term standards" means the method developed by the department for determining the term of accreditation issued to a county board following an accreditation review conducted in accordance with paragraph (Q) of this rule. The department will notify county boards at least sixty calendar days prior to modifying the accreditation term standards.

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

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

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

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

(a) For children birth through age two, developmental delay will be established in accordance with part C of the Individuals with Disabilities Education Act and rules promulgated by the Ohio department of children and youth.

(b) For children age three through age five, developmental delay will be established in accordance with part B of the Individuals with Disabilities Education Act and rules promulgated by the Ohio department of education and workforce.

(6) "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;

(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 in one or more of the following areas of development: physical development, cognitive development, communication development, social or emotional development, and adaptive development; 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 the person's 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.

(7) "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 of the Individuals with Disabilities Education Act, 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.

(8) "Early intervention system" means Ohio's statewide, coordinated, comprehensive, interagency system for which the Ohio department of children and youth 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 of the Individuals with Disabilities Education Act.

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

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

(11) "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, the person's guardian in accordance with section 5126.043 of the Revised Code.

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

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

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

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

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

(17) "Specialized transportation" means transportation services which:

(a) Are arranged or provided by a county board to meet the needs of an individual who is eligible for county board services;

(b) Are not funded through a home and community-based services waiver; and

(1) A county board will 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 advocacy for and 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;

(d) Planning and setting priorities based on available resources to meet the needs of children and adults with developmental disabilities residing in the county;

(e) Increasing the number of individuals of working age engaged in competitive integrated employment;

(f) Taking measures to recruit and sustain a sufficient number of providers of services to meet the needs of individuals receiving services in the county; and

(g) Identifying and addressing gaps noted in services.

(2) The strategic plan will be made readily available to individuals and families who receive services, employees of the county board, citizens of the county, and anyone else who requests a copy.

(3) A county board will prepare a strategic plan progress report at least once per year. The strategic plan progress report will be made readily available to individuals and families who receive services, employees of the county board, citizens of the county, and anyone else who requests a copy.

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

(D) Eligibility determination for county board services

(1) A county board will determine whether a person has a developmental disability and is therefore eligible for county board services in accordance with the definition of "developmental disability" in paragraph (B)(6) of this rule, except that:

(a) Eligibility for service and support administration will be determined in accordance with rule 5123-4-02 of the Administrative Code.

(b) A county board may establish eligibility for county board services for a child age three through age five with a disability who is eligible for services under section 3323.02 of the Revised Code and whose disability is not attributable solely to mental illness as defined in section 5122.01 of the Revised Code.

(2) For a person age sixteen or older, a substantial functional limitation in an area of major life activity is determined through completion of the Ohio eligibility determination instrument (available at https://dodd.ohio.gov/county-boards/assessments/assessments-coedi) and application of criteria found therein.

(3) For a person age six through age fifteen, a substantial functional limitation in an area of major life activity is determined through completion of the children's Ohio eligibility determination instrument (available at https://dodd.ohio.gov/county-boards/assessments/assessments-coedi) and application of criteria found therein.

(4) The Ohio eligibility determination instrument and the children's Ohio eligibility determination instrument will be administered by employees of county boards or regional councils of governments formed under section 5126.13 of the Revised Code by two or more county boards who have successfully completed department-provided training in administration of the instruments.

(5) For a person age three through age five, the evaluation completed by an evaluation team comprised of the person's parents and a group of qualified professionals or the individual education program team and other qualified professionals may be used for eligibility determination.

(6) For a person birth through age two, the eligibility report completed by or for the early intervention system will be used for eligibility determination.

(7) A county board will complete eligibility determination within forty-five calendar days of the request for services or receipt of all necessary information and documents from the referring party or applicant unless extenuating circumstances related to the individual prevent completion within forty-five calendar days. The county board will document extenuating circumstances that delay completion of eligibility determination.

(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 retains eligibility. The new county board, however, may review the person's eligibility. During the review, the person continues to be eligible to receive services. The new county board will assign a service and support administrator to a person who is enrolled in a home and community-based services waiver within thirty calendar days after becoming aware that the person has moved to the county.

(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, will 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, will 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 will be referred, with their consent, to other agencies or sources of services.

(12) All persons determined ineligible for county board services will be informed of the process for resolution of complaints and appeals of adverse action in accordance with rule 5123-4-04 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 will 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 will not be established for early intervention services to eligible children and their families.

(2) Due process in accordance with rule 5123-4-04 of the Administrative Code will 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, in accordance with rule 5123-4-04 of the Administrative Code, attempt to informally resolve the matter. An attempt to informally resolve the matter will not affect the individual's right to due process.

(3) A county board will, in the manner specified in rule 5123-4-04 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 will document that such notice was given and the content of the notice.

(4) Upon the department's request, a county board will 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 will carry out its duties and responsibilities in accordance with Chapter 5126. of the Revised Code. If a county board operates child care or special education programs, the county board will be licensed by the Ohio department of children and youth or the Ohio department of education and workforce, as applicable.

(G) Medicaid local administrative authority

(1) A county board with medicaid local administrative authority will 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 will oversee medicaid local administrative authority activities to ensure compliance with applicable laws and the federally-approved waiver documents. 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 (F) 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 will 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 federal centers for medicare and medicaid services. A county board may challenge a disallowance by the department in accordance with rule 5123-11-02 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 will assist the department in expediting the enrollment.

(5) A county board shall not provide home and community-based services.

(H) 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 will 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 will be provided pursuant to section 5126.01 of the Revised Code and rule 5123-2-05 of the Administrative Code.

(3) A person engaged in the direct provision of adult services to individuals who are not enrolled in home and community-based services waivers will meet the training requirements for a person engaged in the direct provision of comparable home and community-based services as set forth in rules of the department including, but not limited to:

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

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

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

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

(I) Specialized transportation services

(1) Specialized transportation will be provided in compliance with applicable laws including, but not limited to, rule 3301-51-10 of the Administrative Code and Chapter 3301-83 of the Administrative Code.

(2) A provider of specialized transportation will:

(a) Ensure that each driver holds a valid driver license as specified by Ohio law.

(b) Ensure that each driver is covered by valid liability insurance as specified by Ohio law.

(c) Obtain, for each driver, a driving record prepared by the bureau of motor vehicles no earlier than fourteen calendar days prior to the date of initial employment as a driver and at least once every three years thereafter. A person whose driving record includes six or more points charged within the preceding twenty-four months is prohibited from transporting individuals.

(d) Require each driver to immediately notify the provider of specialized transportation in writing, if the driver accumulates six or more points charged within the preceding twenty-four months on the driver's driving record or has a driver license suspended or revoked.

(e) Develop and implement written policies and procedures regarding vehicle accessibility, vehicle maintenance, and requirements for vehicle drivers.

(3) Information about an individual receiving specialized transportation will be available to vehicle drivers to the degree that such information might affect safe transportation and the individual's medical well-being. The information will be maintained in a confidential manner.

(4) An individual, while receiving specialized transportation, will not travel in a vehicle on a regularly scheduled route more than ninety minutes one way on any day.

(J) Early intervention services

(1) A county board providing early intervention services will do so in accordance with part C of the Individuals with Disabilities Education Act and rules promulgated by the Ohio department of children and youth.

(2) A county board providing early intervention services will adopt a written policy describing the county board's role in the county's comprehensive system for early intervention services. The policy will 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 will 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;

(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 of the Individuals with Disabilities Education Act and rules promulgated by the Ohio department of children and youth.

(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 will adopt a written policy governing provision of family support services. The policy will:

(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;

(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 applicants will be required 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 will 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 (also known as "Rapback").

(2) A county board will 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 the staff member is formally charged with, is convicted of, pleads guilty to, or is found eligible for intervention in lieu of 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 within fourteen calendar days after the date of such charge, conviction, guilty plea, or finding.

(M) Volunteers

(1) A county board may engage volunteers to provide supplemental services.

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

(3) A county board will 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 section 5123.62 of the Revised Code;

(c) The requirements of rule 5123-17-02 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 will 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 will include:

(i) Requiring the volunteer to submit a statement to the county board with the volunteer's signature attesting that the volunteer has not been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of 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.

(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, pleads guilty to, or is found eligible for intervention in lieu of 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. The agreement will provide that failure to make the notification may result in termination of the volunteer's services.

(iii) Checking each of the databases described in paragraph (C)(2) of rule 5123-2-02 of the Administrative Code to determine if the volunteer is included.

(b) A county board will, 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.

(i) Is included in one or more of the databases described in paragraphs (C)(2)(a) to (C)(2)(f) of rule 5123-2-02 of the Administrative Code; or

(ii) Has a conviction for, pleads guilty to, or is found eligible for intervention in lieu of 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 5123-2-02 of the Administrative Code has not elapsed.

(N) Cost reports

A county board will:

(1) 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.

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

(3) 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.

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

(3) A county board will 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, and as applicable, the Family Educational Rights and Privacy Act, 20 U.S.C. 1232g.

(4) A county board will maintain records used to determine eligibility for county board services of all persons who apply on or after July 1, 1991.

(a) Records used to determine eligibility for county board services pertaining to a person determined ineligible for county board services will be maintained for five years after such determination is made.

(b) Records used to determine eligibility for county board services pertaining to a person determined eligible for county board services will be maintained for the duration of the person's lifespan.

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

(6) A county board will submit information and reports as directed by the department.

(7) A county board will 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 will be in conformance with all applicable laws, including the Americans with Disabilities Act and Section 504 of the Rehabilitation Act of 1973.

(2) Each facility owned, leased, or operated by a county board will 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 will be present.

(4) A county board will 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 will be available to all county board personnel, volunteers, individuals served, parents, and guardians.

(Q) County board accreditation

(1) The department will 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 will 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 determined in accordance with the accreditation term standards:

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

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

(c) The department will hold accreditation in abeyance for a county board that is in significant noncompliance with applicable statutes and rules. The department will 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 will not enroll individuals in home and community-based services waivers.

(3) The department will 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 will 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 will 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) Within ten calendar days of conclusion of the on-site review, the department will issue, to the president of the county board or the president's designee, the superintendent of the county board, and the county board's designated contact for the accreditation review, a written accreditation review summary or a written explanation of the reason for delay in issuance of the written accreditation review summary.

(a) A written accreditation review summary will be objective in terms of observations and citations, relying upon documentation that clearly addresses the standards reviewed.

(b) A written explanation of the reason for delay in issuance of the written accreditation review summary will include the date by which the department will issue a written accreditation review summary, which will be no more than twenty calendar days after conclusion of the accreditation review.

(6) Within fourteen calendar days of receipt of a written accreditation review summary that includes one or more citations, the county board will submit via the department's web-based review data system, 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 will be final and not subject to appeal by the county board.

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

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

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

(ii) Implementation date of corrective action.

(d) The department will not issue the accreditation term until the county board's written plan of correction is approved. When a county board's accreditation is in abeyance, the accreditation term will not be issued until the department has verified the written plan of correction has been implemented.

(7) When a county board fails to submit a plan of correction in accordance with this rule, or when a county board fails to implement a plan of correction approved by the department, the department may deny accreditation.

(8) The department will recognize a county board's achievement of outstanding results or development of successful services and programs for individuals served.

(R) Providing applicable statutes and rules

A county board will, 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 will 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.

(S) Residential options resources

A county board will:

(1) Post, at the county board's website, a link to the department's residential options counseling pamphlet (https://dodd.ohio.gov/forms-and-rules/forms/pamphlet-options-counseling) and provide the pamphlet to individuals in accordance with guidance issued by the department.

(2) Post, at the county board's website, a link to the department's search tool for intermediate care facilities for individuals with intellectual disabilities (https://dodd.ohio.gov/your-family/community-living/icf_search_map).

(T) Procedure to waive rule requirements

(1) For good cause, the director of the department may waive a condition or specific requirement of a rule in Chapter 5123-4 of the Administrative Code. The director's decision to waive a condition or specific requirement will not be contrary to the rights, health, or safety of individuals served.

(2) A county board may initiate a request for the director of the department to waive a condition or specific requirement by submitting the request in writing.

(a) The director may require or solicit input regarding the county board's request from individuals receiving services, individuals' guardians, or other persons.

(b) The director will grant or deny a request submitted by a county board within ten business days of receipt of the request or within such longer period of time as the director deems necessary.

(d) The director's decision to grant or deny a request is not subject to appeal.

Last updated April 17, 2026 at 8:04 AM

History

Effective: April 17, 2026
Promulgated Under: 119.03

Ohio Adm.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 each individual who receives 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 an 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) "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.

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

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

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

(8) "Homemaker/personal care" has the same meaning as in rule 5123-9-30 of the Administrative Code.

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

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

(11) "Informed consent" means a documented written agreement to allow a proposed action, treatment, or service after full disclosure provided in a manner an individual or the individual's guardian understands, of the relevant facts necessary to make the decision. Relevant facts include the risks and benefits of the action, treatment, or service; the risks and benefits of the alternatives to the action, treatment, or service; and the right to refuse the action, treatment, or service. The individual or the individual's guardian, as applicable, may withdraw informed consent at any time.

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

(13) "Natural supports" means the personal associations and relationships typically developed in the community that enhance the quality of an individual's life. 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 development of the individual service plan.

(14) "Participant-directed homemaker/personal care" has the same meaning as in rule 5123-9-32 of the Administrative Code.

(15) "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.

(16) "Person-centered planning templates" means the department-required formats (i.e., the assessment template and the individual service plan template) that a county board will use to conduct assessments and develop individual service plans for individuals enrolled in home and community-based services waivers.

(17) "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.

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

(19) "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 5123-5-02 of the Administrative Code.

(20) "Targeted case management" has the same meaning as in rule 5160-48-01 of the Administrative Code.

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

(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.

(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. A service and support administrator will arrange an initial meeting with an eligible individual within thirty calendar days of the request for service and support administration. The service and support administrator will document extenuating circumstances related to the individual that delay scheduling of the initial meeting.

(E) Determination of eligibility for county board services

(1) A service and support administrator shall determine an individual's eligibility for county board services in accordance with rule 5123-4-01 of the Administrative Code.

(2) 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 will be shared with the service and support administrator who is the primary point of coordination for the individual to ensure coordination of services and supports.

(3) A county board will share results of the eligibility determination 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 who will be the primary point of coordination for each individual receiving service and support administration.

(2) A county board shall give an individual the opportunity to request a different service and support administrator.

(G) Assessment of an individual

(1) With the active participation of an individual and members of the team, the service and support administrator shall coordinate the initial assessment of the individual.

(a) The initial assessment will take into consideration:

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

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

(iii) Known and likely risks; and

(iv) The individual's skills and abilities.

(b) The initial assessment will identify the individual's needs in the following domains:

(i) Communication (expressing oneself and understanding others);

(ii) Advocacy and engagement (valued roles and making choices; responsibility and leadership);

(iii) Safety and security (safety and emergency skills; behavioral well-being; emotional well-being; supervision considerations);

(iv) Social and spirituality (personal networks, activities, and faith; friends and relationships);

(v) Daily life and employment (school and education; employment; finance);

(vi) Community living (life at home; getting around); and

(vii) Healthy living (medical and dental care; nutrition; wellness).

(c) The initial assessment will be conducted in person at a time and place convenient to the individual and the individual's guardian, as applicable. The individual, when able, will be the primary respondent.

(2) With the active participation of an individual and members of the team including the individual's guardian when applicable, the service and support administrator shall coordinate reassessment of the individual at least once every twelve months.

(a) The annual reassessment will address areas or domains described in paragraphs (G)(1)(a) and (G)(1)(b) of this rule that have changed or for which the individual or the individual's guardian has expressed an interest or concern.

(b) The annual reassessment will be conducted in person except when the individual or the individual's guardian, as applicable, and the service and support administrator agree that extenuating circumstances necessitate virtual participation. The service and support administrator will document the extenuating circumstances.

(3) With the active participation of an individual and members of the team, the service and support administrator shall coordinate assessment of the individual at other times throughout the year as indicated, including when the individual's needs or circumstances change or upon request of the individual or the individual's guardian. Assessment will be tailored to the individual and may be conducted through administration of department-required assessments as well as through conversations or meetings conducted in person or by telephone, electronic mail, or other modes of technology.

(4) A county board will use the department's person-centered planning template to conduct the assessment for each individual enrolled in a home and community-based services waiver.

(H) Development of the individual service plan

(1) Using person-centered planning, the service and support administrator will develop, review, and revise the individual service plan and ensure the individual service plan:

(a) Reflects results of the assessment.

(b) Includes services and supports that:

(i) Ensure health and welfare;

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

(iii) Reflect the individual's place on the path to competitive integrated employment described in rule 5123-2-05 of the Administrative Code;

(iv) Support community connections and networking with people with and without disabilities;

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

(vi) Ensure advancement or 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; and

(vii) Address identified risks and include supports to prevent or minimize risks.

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

(d) Identifies at least one outcome important to the individual to be advanced or achieved within the next twelve months.

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

(2) The service and support administrator will ensure an individual service plan is updated throughout the year as needed to meet the individual's needs in accordance with paragraph (K)(4) of this rule.

(3) A county board will use the department's person-centered planning template to develop the individual service plan for each individual enrolled in a home and community-based services waiver.

(I) Budget for services

(1) The service and support administrator will 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.

(2) When an individual receives self-directed home and community-based services, the service and support administrator will support the individual, the individual's support broker, and/or a person exercising budget authority on the individual's behalf, as applicable, in determining the budgeted dollar amount for each service and making decisions about the acquisition of services that are authorized in the individual service plan.

(J) Selection and support of providers of services

(1) The service and support administrator will, through objective facilitation, assist the individual in choosing providers by:

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

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

(2) The service and support administrator will:

(a) Secure commitments from providers to support the individual in advancement or achievement of the individual's desired outcomes.

(b) 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;

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

(iii) Is finalized and agreed to in writing, with the informed consent of the individual or the individual's guardian, as applicable, and signed by all people and providers responsible for its implementation.

(c) 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.

(3) The service and support administrator will 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.

(K) Individual service plan coordination

(1) The service and support administrator will facilitate effective communication and coordination among the individual and members of the team.

(2) The service and support administrator will ensure an 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 members of the team 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 members of the team.

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

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

(3) The service and support administrator will provide ongoing individual service plan coordination to ensure services and supports are delivered in accordance with the individual service plan and to the benefit and satisfaction of the individual and the individual's guardian, as applicable. Ongoing individual service plan coordination will:

(a) Occur with the active participation of the individual and members of the team.

(b) Focus on achievement of the individual's desired outcomes.

(d) Examine service satisfaction (i.e., what is working and what is not working).

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

(4) The service and support administrator will review and revise the individual service plan at least once every twelve months and more frequently under the following circumstances:

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

(b) Whenever the individual's assessed needs, situation, circumstances, or status changes.

(d) As a result of monitoring conducted in accordance with paragraph (N) of this rule.

(e) Identified trends and patterns of unusual incidents or major unusual incidents.

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

(5) The service and support administrator is responsible for all service and support administration functions and communication of any decisions to the individual or the individual's guardian, as applicable.

(6) The service and support administrator will take actions necessary to remediate any immediate concerns regarding an individual's health and welfare.

(L) Additional requirements for medicaid-funded services

(1) The service and support administrator will explain to an individual or the individual's guardian, as applicable:

(a) 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:

(i) Services and service setting options available to the individual in accordance with paragraph (C)(3) of rule 5123-9-02 of the Administrative Code;

(ii) The individual's or guardian's due process and appeal rights; and

(iii) The individual's or guardian's right to choose any qualified and willing provider.

(b) At the time the individual is recommended for enrollment in a home and community-based services waiver:

(i) 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

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

(2) The service and support administrator will provide an individual or the individual's guardian, as applicable, with written notification and explanation of the individual's or guardian's due process and appeal rights 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 will be provided in accordance with section 5101.35 of the Revised Code.

(3) Prior to enrolling an individual in a home and community-based services waiver, the service and support administrator will 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.

(4) When an individual service plan includes medicaid-funded services, the service and support administrator will explain to the the individual or the individual's guardian, as applicable, 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 or the individual's guardian about this action.

(5) The individual service plan of an individual enrolled in a home and community-based services waiver will be driven by the individual and developed with the individual and the individual's guardian, as applicable, and in conformance with 42 C.F.R. 441.725.

(6) A county board will use the department's person-centered planning templates to conduct the assessment and develop the individual service plan for each individual enrolled in a home and community-based services waiver. The person-centered planning templates will be completed in compliance with applicable federal and state requirements. Upon request by the department, a county board will provide an individual's completed person-centered planning templates as soon as possible but no later than within three business days of the request.

(M) Administrative resolution of complaints related to services that are not funded by medicaid

(1) The service and support administrator will provide an individual or the individual's guardian, as applicable, with written notification and explanation of the individual's or guardian'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 that is not funded by medicaid. Such written notice and explanation will also be provided to an individual or the individual's guardian if the individual service plan process results in an approved service that the individual or guardian does not want to receive, but is necessary to ensure the individual's health, safety, and welfare. Notice will be provided in accordance with rule 5123-4-04 of the Administrative Code.

(2) The service and support administrator will advise members of the team of their right to file a complaint in accordance with rule 5123-4-04 of the Administrative Code.

(N) Monitoring implementation of individual service plans

(1) The service and support administrator will monitor implementation of individual service plans.

(a) Monitoring will be tailored to the individual and based on information provided by the individual and the team.

(b) The scope, type, and frequency of monitoring will be specified in the individual service plan. Monitoring will include, but is not limited to:

(i) In-person visits occurring at a time convenient for the individual, in the setting where the individual receives services, and in a manner that does not disrupt community-integrated activities; and

(ii) Contact via telephone, electronic mail, or other appropriate means as needed.

(c) The service and support administrator may also monitor services through unscheduled visits to settings where an individual receives services.

(i) Unscheduled visits to a family home where an individual receives services may occur only:

(a) When multiple documented attempts to contact a family have failed and the service and support administrator has documented substantiated concerns related to the health and welfare of the individual receiving services; or

(b) At the request of an individual or the individual's guardian.

(ii) A service and support administrator may request entry to the home but may not enter without the consent of the family, individual, or guardian, as applicable. If consent is denied, the service and support administrator will document denial and, if health or welfare concerns persist, refer the matter to the appropriate protective authorities.

(d) The service and support administrator will determine whether the frequency of monitoring needs to be increased when:

(i) The individual has intensive behavioral support or medical needs;

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

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

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

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

(vi) The individual receives services in a manner or setting that has been determined to be out of compliance with requirements regarding home and community-based services set forth in rule 5123-9-02 of the Administrative Code;

(vii) 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

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

(2) When an individual is enrolled in a home and community-based services waiver, monitoring of the individual's services will include:

(a) At least one in-person visit to the setting where the individual resides every six months.

(b) At least one in-person visit to the setting where the individual receives adult day or employment services every twelve months.

(3) The service and support administrator shall share results of monitoring 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.

(4) If the monitoring 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.

(5) Nothing in this rule will be construed to limit a county board's responsibility to protect health and welfare of at-risk individuals in accordance with rule 5123-17-02 of the Administrative Code.

(O) Emergency response system

(1) 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.

(2) Persons who are available for the on-call emergency response system shall:

(a) 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.

(b) 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.

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

(d) Notify the county board's investigative agent as determined necessary by the nature of the emergency.

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

(P) Records

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

(a) Identifying data.

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

(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 monitoring activities.

(p) Documentation that the individual was afforded due process in accordance with paragraph (Q) 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.

(Q) Due process

Due process 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 or pursuant to rule 5123-4-04 of the Administrative Code for services that are not funded by medicaid.

(R) Department monitoring and technical assistance

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

(S) Ohio department of medicaid monitoring of targeted case management

The Ohio department of medicaid retains final authority to monitor the provision of targeted case management.

Last updated July 1, 2026 at 8:12 AM

History

Effective: July 1, 2026
Promulgated Under: 119.03

Ohio Adm.Code 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

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

(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 section 5126.021 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 that person's 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.

(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, ethics laws of the state of Ohio, and requirements of rule 5123-17-02 of the Administrative Code. 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.

(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

(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 including:

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

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

(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.

Last updated January 12, 2026 at 10:23 AM

History

Effective: January 8, 2026
Promulgated Under: 119.03

Ohio Adm.Code 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 a contracting entity of 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 processes 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. All administrative remedies set forth in this rule must be exhausted before commencing a civil action.

(2) This rule is not applicable to:

(a) Education services arranged by the local education agency. Complaints or appeals concerning such services shall follow rules adopted by the Ohio department of education and workforce.

(b) Services provided under part C of the Individuals with Disabilities Education Act. Complaints or appeals concerning such services shall follow rules adopted by the Ohio department of children and youth.

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

(d) Performance of health-related activities and administration of medication by developmental disabilities personnel pursuant to section 5123.42 of the Revised Code or compliance with Chapter 5123-6 of the Administrative Code. Complaints or appeals concerning such matters shall be made to the department using the process established in rule 5123-11-02 of the Administrative Code.

(e) 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 a 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.

For the purposes of this rule, the following definitions 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.

(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 that person's designee.

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

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

(9) "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.

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

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

(12) "Qualified medical professional" means a person who is specially trained and licensed by the respective state of practice to examine patients; conduct or refer for diagnostic testing; diagnose health conditions; treat illnesses, diseases, and conditions; and prescribe as applicable.

(13) "Targeted case management" has the same meaning as in rule 5160-48-01 of the Administrative Code.

(14) "Working day" means Monday, Tuesday, Wednesday, Thursday, or Friday, except when that day falls on a holiday as defined in section 1.14 of the Revised Code.

(D) General provisions

(1) Complaints and appeals of adverse action must 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 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 timelines 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 resolution of a complaint or appeal of an adverse action at any point, as long as the outcome is mutually agreed upon in writing by all parties involved.

(7) When a county board and an individual agree that another Ohio eligibility determination instrument or children's Ohio eligibility determination instrument will be administered, the results of the original administration of the instrument will be discarded and the process for a complaint or appeal arising from the subsequent administration or outcome of the instrument will begin anew at step one of the formal process described in paragraph (G)(1) of this rule.

(8) Service of notices and responses made pursuant to this rule is deemed to have occurred upon:

(a) For an individual or person who has selected electronic mail as the preferred method of communication, the date electronic mail was sent to the most recent electronic mail address provided by the individual or person;

(b) Personal delivery to an individual or person; or

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

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

(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. The county board will maintain documentation confirming the individual received the "Complaint or Appeal of Adverse Action Explanation Form" as required by this paragraph, including evidence of the date the individual received the form.

(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 and how the assessment results or documents specifically support the county board's decision to deny, reduce, suspend, or terminate services;

(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 the appeal prior to the effective date for the adverse action to keep the individual's 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 the appeal; and

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

(b) The county board shall maintain a copy of the notice and written evidence that the notice was provided to the affected individual.

(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;

(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 will 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 will 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 maintain a copy of the notice and written evidence that the notice was provided to the affected individual.

(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

(1) A county board will adopt a written policy describing an informal process that takes no longer than thirty calendar days for resolution of complaints and appeals of adverse action.

(2) The informal process shall not be used in a manner that discourages individuals or persons from exercising their legal rights under the formal process set forth in paragraph (G) of this rule, nor unnecessarily delays the resolution of a matter beyond the timeline of the formal process.

(3) An individual or person and the county board may mutually agree to waive the informal process and initiate the formal process.

(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 in writing 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 in writing 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 described 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 will notify the superintendent of the county board (or the superintendent's designee) that a complaint or appeal has been filed within two working days of receipt of the complaint or appeal.

(d) The supervisor or manager of the county board shall conduct an investigation of the complaint or appeal which includes meeting with the individual or person who filed the complaint or appeal and gathering and analyzing information related to the complaint or appeal.

(i) When the complaint or appeal is related to the county board's determination that an individual does not have a qualifying diagnosis used to establish a "developmental disability" as defined in section 5126.01 of the Revised Code, and the individual claims to have a diagnosis that if confirmed would constitute a qualifying diagnosis, the county board will consult with a qualified medical professional selected by the county board at the county board's expense.

(ii) When the complaint or appeal is related to the administration or outcome of the Ohio eligibility determination instrument or the children's Ohio eligibility determination instrument, the supervisor or manager will convene a committee of no less than three persons. The committee will review and ensure the county board conducted the eligibility determination in accordance with rule 5123-4-01 of the Administrative Code and the "Children's Ohio Eligibility Determination Instrument and Ohio Eligibility Determination Instrument User Guide" (available at dodd.ohio.gov). At least two of the committee members reviewing the complaint or appeal must have successfully completed department-provided training in administration of the instruments.

(e) Within thirty calendar days of receipt of the complaint or appeal, the supervisor or manager of the county board shall issue, 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 will be reviewed and signed by the superintendent of the county board (or the superintendent's designee) prior to being issued to the individual or person who filed the complaint or appeal. The written report and decision will 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. When the complaint or appeal is denied, the written report and decision will include a justification that clearly demonstrates how the decision complies with applicable rules and is based on accurate and current information. The county board will maintain a copy of the written report and decision and written evidence that the written report and decision was issued to the affected individual or person.

(2) Step two: 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)(1) of this rule, the individual or person may file a complaint or appeal with the president of the county board.

(b) The individual or person must file the complaint or appeal of adverse action in writing with the president of the county board within ten calendar days of notice of the decision of the supervisor or manager of the county board which has been reviewed and signed by the superintendent of the county board or the superintendent's designee.

(c) The president of the county board shall ensure 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 full 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 president of 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 contracting entity of the county board providing any service other than that of hearing officer. The hearing officer need not be an attorney, but must possess qualifications to be able to make neutral and informed decisions about the complaint or appeal. The president of 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) When the full county board or a committee of two or more county board members appointed by the president of the county board hears the complaint or appeal, members of the county board will preside over the hearing. Participation of the superintendent and staff of the county board will be limited to the presentation of evidence at their allotted time.

(e) The president of the county board shall ensure the individual or person filing the complaint or appeal has access to all records and materials related to the complaint or appeal no less than ten calendar days before the hearing.

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

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

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

(i) The individual or person requesting the hearing has 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. The president of the county board will inform the individual of this right in writing upon receipt of the notice of appeal.

(j) The president of the county board shall ensure the hearing is recorded by electronic transcription, 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. Upon request, the county board shall provide at no cost, one copy of an accurate written transcript to the individual or person requesting the hearing.

(k) In making its decision, the county board may:

(i) Request or consider additional information with notice to all affected parties;

(ii) Request a presentation in writing and/or in person from each party; or

(iii) Take other action necessary to make a determination.

(l) When the president of the county board appoints a committee of two or more county board members or a hearing officer to hear the complaint or appeal, the county board must review and formally accept, reject, or modify the resulting report and recommendation.

(m) Within thirty 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 the president's designee shall provide notice of the county board's decision to the individual or person who requested the hearing. The notice 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. If the matter was heard by a county board-appointed committee or a hearing officer, the notice must explicitly state whether the county board accepted, rejected, or modified the resulting report and recommendation. The notice must specifically identify how evidence presented at the hearing was considered and how the county board's final position aligns with the Administrative Code. If the decision deviates from a hearing officer's recommendation, the rationale for deviation will be documented in detail. The county board will maintain a copy of the notice and written evidence that the notice was provided to the affected individual or person.

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

(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 director.

(b) The individual or person must file the complaint or appeal of adverse action in writing with the director within fifteen calendar days of notice of the decision 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 the president's designee shall send the director a complete record of the complaint or appeal within fifteen calendar days.

(i) A complete record includes any written determinations provided to the individual, an accurate written transcript of the county board hearing, copies of any exhibits, and a copy of the county board's decision.

(ii) When the complaint or appeal is related to eligibility determination, the complete record also includes the "Children's/Ohio Eligibility Determination Instrument" and answer sheets.

(e) Upon request by an affected party or at the director's initiation, the director may:

(i) Request or consider additional information with notice to all affected parties;

(ii) Request a presentation in writing and/or in person from each party; or

(iii) Take other action necessary to make a determination.

(f) Within forty-five calendar days of receipt of a complete record of the complaint or appeal in accordance with paragraph (G)(3)(d) of this rule, the director shall provide notice with a copy of the director's decision to all affected parties. The director's decision shall include the rationale for the decision.

(i) The director will uphold the decision of the county board if the director determines the county board provided notice and conducted the appeal in accordance with the process set forth in this rule and when applicable, the decision is in accordance with the "Children's Ohio Eligibility Determination Instrument and Ohio Eligibility Determination Instrument User Guide" and the "Life Activity Areas User Guide."

(ii) The director may remand a complaint or appeal back to the county board if the director determines the county board failed to comply with the process set forth in this rule or the "Children's Ohio Eligibility Determination Instrument and Ohio Eligibility Determination Instrument User Guide."

(a) The remand order may instruct the county board to:

(i) Re-administer the Ohio eligibility determination instrument or children's Ohio eligibility determination instrument with technical assistance from the department, if necessary;

(ii) Contract with another county board to independently administer the Ohio eligibility determination instrument or children's Ohio eligibility determination instrument;

(iii) Conduct a new hearing before the county board; or

(iv) Receive technical assistance from the department.

(b) When the director remands a complaint or appeal back to the county board, the county board will submit written documentation to the director within forty-five calendar days demonstrating that the county board has complied with the remand order.

(H) Failure of a county board to issue a notice or decision in accordance with this rule

(1) An individual or person may file a request for review with the director if a county board fails to:

(a) Issue a notice required by paragraph (E)(2) or (E)(3) of this rule or if an issued notice does not contain the required information to sufficiently inform an individual of the individual's legal rights; or

(b) Issue a decision in accordance with paragraph (G)(1)(e) or (G)(2)(m) of this rule.

(2) The individual or person must file the request for review in writing with the director within twenty-five calendar days after the day the county board failed to issue the notice or decision as required by this rule.

(3) Upon receipt of a request for review submitted in accordance with paragraphs (H)(1) and (H)(2) of this rule, the director will review the relevant information. When the director determines the county board failed to issue the notice or decision, the director may issue an order requiring the county board to:

(a) Issue or reissue the notice containing all required information and give the individual the opportunity to appeal the decision within ninety calendar days of the issued/reissued notice; or

(b) Permit the individual to reapply for county board services.

(I) 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 the satisfaction of the individual or person. This rule is not intended to provide any right or cause of action that does not exist absent this rule.

View Appendix

Last updated March 23, 2026 at 7:47 AM

History

Effective: March 19, 2026
Promulgated Under: 119.03

Ohio Adm.Code 5123-4-05 Ensuring the solvency of a county board of developmental disabilities.

(A) Purpose

This rule establishes standards to ensure a county board of developmental disabilities is able to meet its financial obligations and sets forth processes for measuring financial risk, identifying required actions to be taken, and requesting financial assistance from the department.

(B) Definitions

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

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

(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.

(4) "Scorecard risk assessment" means an objective tool administered by the department that identifies indicators and assigns a score to a county board's level of financial risk based on information from the five-year projection of revenues and expenditures submitted by a county board in accordance with section 5126.053 of the Revised Code. Administration of the scorecard risk assessment results in assignment of a county board to one of four designations based on the final score: "healthy," "watch," "warning," or "emergency."

(1) Following a county board's submission of the five-year projection of revenues and expenditures in accordance with section 5126.053 of the Revised Code, the department will administer the scorecard risk assessment and notify the county board of the results in writing.

(2) When, based on results of the scorecard risk assessment, a county board is assigned a designation of "warning" or "emergency," the county board will complete and submit a plan of action to the department within sixty calendar days. The plan of action will:

(a) Be completed in the format prescribed by the department.

(b) Identify methods the county board will employ to improve its financial situation and/or eliminate conditions that led to its financial situation.

(i) By written request, seeking financial assistance through the county commissioners, including but not limited to, advancement of a new levy, levy renewal, or restoration of a levy that has been rolled back;

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

(iii) Exploring shared funding opportunities with other local agencies such as school districts, regional transit authorities, or area agencies on aging;

(iv) Seeking third-party consultation; and

(v) Adopting a resolution to request assistance from the department.

(d) Be approved by resolution adopted by the county board.

(3) The department may prescribe additional actions when, based on results of the scorecard risk assessment, a county board is assigned a designation of "warning" or "emergency," which may include submitting a request to the department for assistance in accordance with paragraph (D) of this rule.

(D) Process for requesting assistance from the department

(1) When, based on results of the scorecard risk assessment, a county board is assigned a designation of "warning" or "emergency," or in any other event that may place a county board in unexpected fiscal strain (e.g., 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) When requesting assistance, a county board will submit to the department:

(a) A description of the actions described in paragraph (C)(2)(b) of this rule the county board has taken and the results of those actions;

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

(d) Most recent annual financial statements;

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

(f) A detailed explanation of how the fiscal strain is affecting the ability of the county board to provide services and support positive outcomes for individuals with developmental disabilities and what actions the county board will take if the department does not provide assistance; and

(g) A copy of the resolution adopted by the county board requesting assistance from the department.

(E) Department 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;

(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 and benefits of employees of the county board to other local agencies and to other similar county boards;

(h) The county board's most recent strategic plan;

(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 situation 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.

(F) Department decision

(1) The department will 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;

(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 will be at its sole discretion.

(3) If the department decides that assistance will be made available to the county board, the department will also decide whether the assistance will be in the form of paying the nonfederal share of medicaid expenditures for home and community-based services, 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 will 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;

(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 in 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 will 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.

(G) Monitoring

(1) Upon the grant of assistance, or as determined by the plan of action submitted by a county board assigned a designation of "warning" or "emergency" based on results of the scorecard risk assessment, the county board will submit to the department on a quarterly basis, or at an interval otherwise determined by the department:

(a) Financial statements;

(b) Updated projection of revenues and expenditures;

(d) Plans and strategy for an operating levy.

(2) The department will 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 will 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.

Last updated September 9, 2024 at 8:50 AM

History

Effective: September 9, 2024
Promulgated Under: 119.03

Chapter 5123-5 Certification Standards for Employees of County Boards of Developmental Disabilities

Ohio Adm.Code 5123-5-02 Service and support administration certification standards.

(A) Purpose

This rule establishes minimum qualifications through certification standards that apply to persons, directly providing or supervising the provision of service and support administration, who are employed by county boards of developmental disabilities and entities under contract with county boards of developmental disabilities to provide or supervise the provision of service and support administration.

(B) Definitions

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

(2) "Continuing professional education" means training approved by the department or a superintendent required for renewal of service and support administration certification.

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

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

(5) "Service and support administration" has the same meaning as in rule 5123-4-02 of the Administrative Code.

(6) "Superintendent" means a person certified by the department in accordance with rule 5123-5-03 of the Administrative Code and employed in that capacity by a county board or for purposes of issuing certification and/or approving continuing professional education in accordance with this rule, a person who is authorized in writing by the superintendent to perform those functions.

There are two levels of service and support administration certification:

(1) Service and support administrator

(a) A superintendent may issue service and support administrator certification for an initial period of five years to an applicant who holds an associate's degree, bachelor's degree, or graduate-level degree from an accredited college or university. Pursuant to sections 5126.15 and 5126.201 of the Revised Code, a person holding an associate's degree will be a conditional status service and support administrator and perform the duties of service and support administration only under the supervision of a management employee who is a service and support administration supervisor.

(b) A superintendent will ensure that service and support administrators successfully complete, no later than thirty calendar days after hire, department-provided web-based training in:

(i) Empowering individuals served through development of person-centered individual service plans;

(ii) Coordinating services;

(iii) Enhancing team effectiveness;

(iv) Understanding medicaid;

(v) Overview of intermediate care facilities for individuals with intellectual disabilities;

(vi) Overview of department-administered home and community-based services waivers including self-directed services, budget authority, and employer authority;

(vii) Targeted case management; and

(viii) Employment navigation.

(c) A superintendent will ensure that service and support administrators successfully complete, no later than sixty calendar days after hire, department-provided web-based training in using the department's person-centered planning templates to conduct assessments and develop individual service plans.

(d) A superintendent will ensure that service and support administrators successfully complete, no later than ninety calendar days after hire, an orientation program of at least eight hours that addresses, but is not limited to:

(i) Organizational background of the county board or contracting entity, including:

(a) Mission, vision, values, and organizational structure;

(b) Policies, procedures, and work rules;

(d) Avoiding conflicts of interest.

(ii) Components of quality care for individuals served, including:

(a) Interpersonal relationships and trust;

(b) Trauma-responsive care;

(d) Effective communication;

(e) Roles and responsibilities of team members; and

(f) Record-keeping, including progress notes and incident/accident reports.

(iii) Health and safety, including:

(a) Signs and symptoms of illness or injury and procedure for response;

(b) Building/site-specific emergency response plans; and

(iv) Requirements for development and implementation of behavioral support strategies in accordance with rule 5123-2-06 of the Administrative Code.

(v) Crisis intervention techniques.

(vi) Services that comprise service and support administration.

(e) A superintendent will ensure that service and support administrators (other than those who have at least one year of experience as a service and support administrator at the point of hire) successfully complete, no later than one year after hire, training specific to the provision of service and support administration that includes, but is not limited to:

(i) Eligibility determination;

(ii) Establishing individual budgets;

(iii) Effective service coordination;

(iv) Management of individuals' funds and related documentation requirements; and

(v) Self-determination which includes assisting an individual to develop self-advocacy skills, to exercise civil rights, to exercise choice and control over the services received, and to acquire skills that support becoming more independent, productive, and integrated within the community.

(f) A superintendent may renew the service and support administrator certification for a second period of five years provided the applicant has successfully completed:

(i) The department-provided web-based training described in paragraph (C)(1)(b) of this rule;

(iii) The orientation program described in paragraph (C)(1)(d) of this rule;

(iv) Training specific to the provision of service and support administration described in paragraph (C)(1)(e) of this rule; and

(v) At least sixty hours of continuing professional education during the period of the initial service and support administrator certification. The training described in paragraphs (C)(1)(b), (C)(1)(c), (C)(1)(d), (C)(1)(e), and (D) of this rule may be counted toward the sixty hours.

(g) A superintendent may renew the service and support administrator certification for subsequent periods of five years provided the applicant has successfully completed:

(i) The department-provided web-based training described in paragraph (C)(1)(b) of this rule prior to application to renew the service and support administrator certification;

(ii) The department-provided web-based training in using the department's person-centered planning templates to conduct assessments and develop individual service plans described in paragraph (C)(1)(c) of this rule prior to application to renew the service and support administrator certification; and

(iii) At least sixty hours of continuing professional education during the period of the preceding service and support administrator certification. The training described in paragraphs (C)(1)(b), (C)(1)(c), and (D) of this rule may be counted toward the sixty hours.

(2) Service and support administration supervisor

(a) A superintendent may issue service and support administration supervisor certification for an initial period of five years to an applicant who:

(i) Holds a bachelor's degree or graduate-level degree from an accredited college or university; and

(ii) Has at least four years of full-time (or equivalent part-time), supervised, paid work experience in programs or services for individuals with developmental disabilities.

(b) A superintendent will ensure that service and support administration supervisors successfully complete, no later than thirty calendar days after hire, the department-provided web-based training described in paragraph (C)(1)(b) of this rule.

(c) A superintendent will ensure that service and support administration supervisors successfully complete, no later than sixty calendar days after hire, the department-provided web-based training in using the department's person-centered planning templates to conduct assessments and develop individual service plans described in paragraph (C)(1)(c) of this rule.

(d) A superintendent will ensure that service and support administration supervisors successfully complete, no later than ninety calendar days after hire, the orientation program described in paragraph (C)(1)(d) of this rule.

(e) A superintendent will ensure that service and support administration supervisors (other than those who have at least one year of experience as a service and support administration supervisor at the point of hire) successfully complete, no later than one year after hire, training specific to the supervision of service and support administration that includes, but is not limited to, the topics set forth in paragraph (C)(1)(e) of this rule.

(f) A superintendent may renew the service and support administration supervisor certification for a second period of five years provided the applicant has successfully completed:

(i) The department-provided web-based training described in paragraph (C)(1)(b) of this rule;

(iii) The orientation program described in paragraph (C)(1)(d) of this rule;

(iv) Training specific to the supervision of service and support administration described in paragraph (C)(2)(e) of this rule; and

(v) At least seventy-five hours of continuing professional education during the period of the initial service and support administration supervisor certification. The training described in paragraphs (C)(2)(b), (C)(2)(c), (C)(2)(d), (C)(2)(e), and (D) of this rule may be counted toward the seventy-five hours.

(g) A superintendent may renew the service and support administration supervisor certification for subsequent periods of five years provided the applicant has successfully completed:

(i) The department-provided web-based training described in paragraph (C)(1)(b) of this rule prior to application to renew the service and support administration supervisor certification;

(iii) At least seventy-five hours of continuing professional education during the period of the preceding service and support administration supervisor certification. The training described in paragraphs (C)(1)(b), (C)(1)(c), and (D) of this rule may be counted toward the seventy-five hours.

(D) Annual training requirements

A superintendent will ensure that service and support administrators and service and support administration supervisors annually complete training, in accordance with standards established by the department, in:

(1) The rights of individuals set forth in section 5123.62 of the Revised Code; and

(2) The requirements of rule 5123-17-02 of the Administrative Code including a review of health and welfare alerts issued by the department since the previous year's training.

(E) Application fees

A superintendent may compel applicants for service and support administration certification to pay an application fee.

(1) The application fee for service and support administrator certification will not exceed fifty dollars.

(2) The application fee for service and support administration supervisor certification will not exceed seventy-five dollars.

(F) Reciprocity

(1) A superintendent will accept as valid service and support administration certification issued in accordance with this rule by the superintendent of another county board.

(2) A superintendent will accept as valid continuing professional education approved by the department or the superintendent of another county board in accordance with this rule.

(G) Renewal of expired service and support administration certification

(1) Service and support administration certification which has been expired for less than one year may be renewed upon completion of all renewal requirements of the expired certification.

(2) Service and support administration certification which has been expired for one year or more will not be renewed; the applicant will be required to meet the requirements for initial service and support administrator certification or service and support administration supervisor certification, as applicable, pursuant to paragraph (C) of this rule.

(H) Administrative review

An applicant for service and support administration certification whose application is disapproved based upon the applicant's failure to meet the requirements of this rule, may request in writing, within thirty calendar days of the rejection, an administrative review by the superintendent or the superintendent's designee.

(I) Denial, suspension, or revocation

Service and support administration certification is subject to denial, suspension, or revocation in accordance with rule 5123-5-04 of the Administrative Code.

Last updated August 27, 2026 at 8:00 AM

History

Effective: August 27, 2026
Promulgated Under: 119.03

Ohio Adm.Code 5123-5-03 Certification standards for superintendents of county boards of developmental disabilities.

(A) Purpose

This rule establishes minimum qualifications through certification standards for superintendents of county boards of developmental disabilities. These standards apply to persons who are employed or under contract in the position of superintendent of a county board of developmental disabilities.

(B) Definitions

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

(2) "Advanced curriculum for administrators in Ohio's developmental disabilities service delivery system" means department-approved instruction of at least one hundred hours that addresses, but is not limited to, the following topics:

(a) Budgeting/finance for governmental entities;

(b) Communication and public relations;

(d) Information technology management;

(e) Intergovernmental relations;

(f) Legal environment of public administration;

(g) Medicaid home and community-based services waivers;

(h) Public sector human resources management;

(i) Quality assurance;

(j) Self-advocacy; and

(k) Strategic planning, management, and implementation.

(3) "Continuing professional education" means department-approved training required for renewal of superintendent certification.

(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 department or that person's designee.

(1) Initial certification

(a) There are two alternatives for obtaining initial superintendent certification:

(i) Alternative one

The department may issue initial superintendent certification for a term of three years to an applicant who:

(a) Has an offer of employment in the position of superintendent, as evidenced by a resolution adopted by the employing county board;

(b) Holds a master's degree, a doctorate degree, or a juris doctorate degree from an accredited college or university;

(c) Has successfully completed five years of full-time (or equivalent part-time), supervised, paid work experience in administration, supervision, instruction, or habilitation of individuals with developmental disabilities, including three years in a management or supervisory capacity; and

(d) Has submitted to the department in the format prescribed by the department, an application and supporting documentation sufficient to establish that the applicant meets the requirements set forth in this rule.

(ii) Alternative two

The department may issue initial superintendent certification for a term of five years to an applicant who:

(a) Holds a master's degree, a doctorate degree, or a juris doctorate degree from an accredited college or university;

(b) Has successfully completed five years of full-time (or equivalent part-time), supervised, paid work experience in administration, supervision, instruction, or habilitation of individuals with developmental disabilities, including three years in a management or supervisory capacity;

(c) Has successfully completed an advanced curriculum for administrators in Ohio's developmental disabilities service delivery system; and

(b) When requested by a resolution adopted by a county board and with accompanying rationale, the director may waive the requirement set forth in paragraph (C)(1)(a)(i)(c) of this rule. The director's decision to grant or deny a request is not subject to appeal.

(c) When requested in writing by an applicant and with accompanying rationale, the director may waive the requirement for the applicant to complete one or more topics of the advanced curriculum for administrators in Ohio's developmental disabilities service delivery system set forth in paragraph (B)(2) of this rule. The director's decision to grant or deny a request is not subject to appeal. The director's decision to grant a request does not relieve the applicant of the requirement to complete an advanced curriculum for administrators in Ohio's developmental disabilities service delivery system of at least one hundred hours of instruction.

(2) First renewal of certification

(a) The department may renew the superintendent certification of an applicant who received initial superintendent certification in accordance with paragraph (C)(1)(a)(i) of this rule for a term of five years provided the applicant successfully completed an advanced curriculum for administrators in Ohio's developmental disabilities service delivery system during the effective dates of the initial superintendent certification and has submitted to the department in the format prescribed by the department, an application and supporting documentation sufficient to establish that the applicant meets the requirements set forth in this rule.

(b) The department may renew the superintendent certification of an applicant who received initial superintendent certification in accordance with paragraph (C)(1)(a)(ii) of this rule for a term of five years provided the applicant successfully completed one hundred twenty hours of continuing professional education on or after the effective date of the initial superintendent certification and has submitted to the department in the format prescribed by the department, an application and supporting documentation sufficient to establish that the applicant meets the requirements set forth in this rule.

(3) Subsequent renewal of certification

The department may subsequently renew an applicant's superintendent certification for a term of five years provided the applicant successfully completed one hundred twenty hours of continuing professional education on or after the effective date of the superintendent certification being renewed and has submitted to the department in the format prescribed by the department, an application and supporting documentation sufficient to establish that the applicant meets the requirements set forth in this rule.

(D) Professional development plan

Each superintendent of a county board will have a professional development plan which sets forth time lines for completing an advanced curriculum for administrators in Ohio's developmental disabilities service delivery system and/or continuing professional education, as applicable. The professional development plan will require that continuing professional education be completed across the span of the superintendent's certification. The employing county board will approve the superintendent's initial professional development plan within ninety calendar days of the superintendent's hire. Thereafter, the employing county board will review, update, and approve the superintendent's professional development plan at least once per year.

(E) Renewal of expired superintendent certification

(1) Superintendent certification which has been expired for less than one year may be renewed upon completion of all renewal requirements of the expired certification.

(2) Superintendent certification which has been expired for one year or more will not be renewed; the applicant will be required to meet the requirements for initial superintendent certification in accordance with paragraph (C)(1)(a)(ii) of this rule.

(F) Administrative review

An applicant for superintendent certification whose application is disapproved based upon the applicant's failure to meet the requirements set forth in this rule, may request in writing, within thirty calendar days of the rejection, an administrative review by the director.

(G) Denial, suspension, or revocation

(1) The director will deny, suspend, or revoke superintendent certification if the director finds, pursuant to an adjudication conducted in accordance with Chapter 119. of the Revised Code, that the applicant for or holder of superintendent certification has engaged in an immoral act, incompetence, negligence, or conduct that is unbecoming to the applicant's or holder's position.

(2) Except as provided in paragraph (G)(3) of this rule, the director will deny or revoke superintendent certification if the director finds, pursuant to an adjudication conducted in accordance with Chapter 119. of the Revised Code, that the applicant for or holder of superintendent certification:

(a) Has been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for any of the disqualifying offenses listed or described in paragraph (E)(1)(a) of rule 5123-2-02 of the Administrative Code;

(b) Has been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for any of the disqualifying offenses listed or described in paragraph (E)(1)(b) of rule 5123-2-02 of the Administrative Code if a period of ten years has not elapsed from the date the applicant was fully discharged from imprisonment, probation, and parole;

(c) Has been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for any of the disqualifying offenses listed or described in paragraph (E)(1)(c) of rule 5123-2-02 of the Administrative Code if a period of seven years has not elapsed from the date the applicant was fully discharged from imprisonment, probation, and parole;

(d) Has been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for any of the disqualifying offenses listed or described in paragraph (E)(1)(d) of rule 5123-2-02 of the Administrative Code if a period of five years has not elapsed from the date the applicant was fully discharged from imprisonment, probation, and parole;

(e) Has been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for multiple disqualifying offenses if the applicable period of time in accordance with paragraph (E)(2) of rule 5123-2-02 of the Administrative Code has not elapsed from the date the applicant was fully discharged from imprisonment, probation, and parole; or

(f) Has been included in one or more of the databases described in paragraphs (C)(2)(a) to (C)(2)(f) of rule 5123-2-02 of the Administrative Code.

(3) A conviction of or plea of guilty to a disqualifying offense listed or described in paragraphs (E)(1)(a) to (E)(1)(d) of rule 5123-2-02 of the Administrative Code will not constitute grounds for the denial or revocation of superintendent certification if the requirements contained in paragraph (F) of rule 5123-2-02 of the Administrative Code are met.

(4) An applicant for or holder of superintendent certification must disclose a conviction that has been sealed.

Last updated December 2, 2024 at 9:03 AM

History

Effective: December 1, 2024
Promulgated Under: 119.03

Ohio Adm.Code 5123-5-04 Denial, suspension, and revocation of adult services, business manager, and service and support administration registration and certification.

(A) Purpose

This rule establishes the grounds and procedure for superintendents of county boards of developmental disabilities to deny, suspend, and revoke business manager and service and support administration certification issued in accordance with section 5126.25 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.

(2) "Disqualifying offense" means any of the offenses listed or described in divisions (A)(3)(a) to (A)(3)(e) of section 109.572 of the Revised Code.

(3) "Superintendent" means a person certified by the department in accordance with rule 5123-5-03 of the Administrative Code and employed in that capacity by a county board.

(1) A superintendent will deny, suspend, or revoke a certification if the superintendent finds, pursuant to an adjudication, that the applicant for or holder of the certification has engaged in an immoral act, incompetence, negligence, or conduct that is unbecoming to the applicant's or holder's position.

(2) Except as provided in paragraph (C)(3) of this rule, a superintendent will deny or revoke a certification if the superintendent finds, pursuant to an adjudication, that the applicant for or holder of the certification:

(b) Has been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for any of the disqualifying offenses listed or described in paragraph (E)(1)(b) of rule 5123-2-02 of the Administrative Code if a period of ten years has not elapsed from the date the applicant or holder was fully discharged from imprisonment, probation, and parole;

(c) Has been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for any of the disqualifying offenses listed or described in paragraph (E)(1)(c) of rule 5123-2-02 of the Administrative Code if a period of seven years has not elapsed from the date the applicant or holder was fully discharged from imprisonment, probation, and parole;

(d) Has been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for any of the disqualifying offenses listed or described in paragraph (E)(1)(d) of rule 5123-2-02 of the Administrative Code if a period of five years has not elapsed from the date the applicant or holder was fully discharged from imprisonment, probation, and parole;

(e) Has been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for multiple disqualifying offenses if the applicable period of time in accordance with paragraph (E)(2) of rule 5123-2-02 of the Administrative Code has not elapsed from the date the applicant or holder was fully discharged from imprisonment, probation, and parole; or

(f) Has been included in one or more of the databases listed in paragraphs (C)(2)(a) to (C)(2)(f) of rule 5123-2-02 of the Administrative Code.

(3) A conviction of or a plea of guilty to a disqualifying offense listed or described in paragraphs (E)(1)(a) to (E)(1)(d) of rule 5123-2-02 of the Administrative Code will not constitute grounds for the denial or revocation of a certification if the requirements in paragraph (F) of rule 5123-2-02 of the Administrative Code are met.

(D) Requirement to disclose conviction

Applicants for or holders of certification must disclose a conviction for a disqualifying offense, including a conviction that has been sealed.

(E) Adjudication procedure

(1) The superintendent will notify an applicant for or holder of certification in writing if the superintendent intends to deny, suspend, or revoke the applicant's or holder's certification. The notice will contain the following information:

(a) The right of the applicant for or holder of certification to request a hearing within thirty calendar days of the date of the notice.

(b) A statement that the applicant for or holder of certification may appear in person or through an attorney.

(i) Present the applicant's or holder's position, arguments, or contentions entirely in writing; or

(ii) If a hearing is requested, at the hearing may present evidence and examine witnesses appearing for and against them.

(d) That the failure to request a hearing will result in the denial, suspension, or revocation of the certification.

(2) If the applicant for or holder of certification timely requests a hearing, the superintendent will appoint a hearing examiner to conduct the hearing. The hearing examiner will not be an employee of the county board. The hearing examiner will be admitted to the practice of law in Ohio and possessed of such qualifications as to be able to render a neutral and informed decision.

(3) The hearing examiner will notify the applicant for or holder of certification of the time, date, and place of the hearing. If the applicant for or holder of certification is unable to attend the hearing as scheduled, the applicant or holder may request that the hearing be rescheduled. The hearing examiner will determine if rescheduling the hearing is warranted and make efforts to schedule the hearing at a time, date, and place mutually convenient.

(4) At least fifteen calendar days prior to the date set for the hearing upon request by either party, the superintendent and the applicant for or holder of certification will exchange witness lists and lists of exhibits to be introduced at the hearing. The hearing examiner may extend the time for good cause shown.

(5) Both parties may be present at the hearing, be represented by counsel, require witnesses to be under oath, cross-examine witnesses, take a record of the proceedings, and require the presence of witnesses in their behalf upon subpoena to be issued by the superintendent. The superintendent will provide for a complete stenographic record of the proceedings, and upon request, a copy of the record will be furnished to the applicant for or holder of certification at no cost.

(6) The hearing examiner will issue a written report and recommendation setting forth findings of fact, conclusions of law, and a recommendation for the superintendent within ten calendar days of the hearing. Within five calendar days of receipt of the report and recommendation, the superintendent will serve the report and recommendation upon the applicant for or holder of certification or the applicant's or holder's attorney.

(7) Within ten calendar days of receipt of the report and recommendation, the applicant for or holder of certification may file written objections with the superintendent. The superintendent will issue a decision and serve the decision upon the applicant for or holder of certification and the applicant's or holder's attorney. The superintendent's decision is final.

Last updated December 2, 2024 at 9:03 AM

History

Effective: December 1, 2024
Promulgated Under: 119.03

Ohio Adm.Code 5123-5-07 Investigative agent certification standards.

(A) Purpose

This rule establishes minimum qualifications through certification standards that apply to staff working in investigative agent positions at county boards of developmental disabilities and persons or employees of government entities under contract with a county board of developmental disabilities to provide investigative agent services.

(B) Definitions

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

(2) "Continuing professional education" means department-approved training required for renewal of investigative agent certification.

(a) Training related to major unusual incidents or investigations, conducted by the department, the office of the attorney general, the Ohio peace officer training academy, a public children services agency, the Ohio department of health, the Ohio department of job and family services, the Ohio department of medicaid, a law enforcement agency, or an entity with statutory authority to conduct civil or criminal investigations, will be considered continuing professional education.

(b) An investigative agent who develops and conducts training approved by the department for continuing professional education may receive double the credit toward renewal of investigative agent certification, for up to a total of six hours during each year of the effective period of the certification.

(c) An investigative agent is not required to, but may, repeat the foundational investigative agent training as continuing professional education.

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

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

(5) "Director" means the director of the Ohio department of developmental disabilities or that person's designee.

(6) "Foundational investigative agent training" means training provided by the department that includes, but is not limited to:

(a) Civil and criminal investigatory practices.

(b) Rule 5123-17-02 of the Administrative Code.

(c) Trauma informed care as the basis for interacting with individuals with developmental disabilities, families, guardians, direct support professionals, and others during the course of an investigation.

(d) The role of an investigative agent in creating a culture that fosters trust through open communication, universal accountability, learning, and fair treatment of all persons involved.

(7) "Investigative agent" means a person, regardless of title, who conducts investigations pursuant to section 5126.313 of the Revised Code.

(8) "Major unusual incident" has the same meaning as in rule 5123-17-02 of the Administrative Code.

(1) The department may issue initial investigative agent certification for a five-year period to an applicant who meets the following requirements:

(a) The applicant is at least eighteen years of age.

(b) The applicant holds a high school diploma or certificate of high school equivalence.

(i) Holds a bachelor's degree or graduate-level degree from an accredited college or university; or

(ii) Holds an associate's degree from an accredited college or university or has achieved at least junior year standing at an accredited college or university and has successfully completed two years full-time (or part-time equivalent), supervised, paid work experience in conducting administrative, civil, and/or criminal investigations; or

(iii) Holds an associate's degree from an accredited college or university or has achieved at least junior year standing at an accredited college or university and has successfully completed two years full-time (or part-time equivalent), supervised, paid work experience in administration, supervision, instruction, or habilitation of individuals with developmental disabilities; or

(iv) Has successfully completed Ohio peace officer basic training or a comparable program that prepares a person to be a peace officer or a law enforcement officer and has successfully completed two years full-time (or part-time equivalent), supervised, paid work experience in conducting administrative, civil, and/or criminal investigations; or

(v) Has successfully completed four years full-time (or part-time equivalent), supervised, paid work experience in conducting administrative, civil, and/or criminal investigations.

(d) The applicant has submitted to the department in the format prescribed by the department, an application and supporting documentation sufficient to establish that the requirements set forth in this rule are met.

(2) The investigative agent will successfully complete foundational investigative agent training within the first one hundred eighty days of employment as an investigative agent. An investigative agent who fails to successfully complete foundational investigative agent training within the first one hundred eighty days of employment is ineligible to perform the duties of an investigative agent until the training has been completed.

(3) The department may renew investigative agent certification for a five-year period for an applicant who has:

(a) Successfully completed foundational investigative agent training.

(b) Successfully completed fifty hours of continuing professional education subsequent to the effective date of the preceding investigative agent certification, of which at least ten hours are related to:

(i) Conducting investigations; and/or

(ii) Trauma informed care as the basis for interacting with individuals with developmental disabilities, families, guardians, direct support professionals, and others during the course of an investigation.

(c) Submitted to the department in the format prescribed by the department, an application and supporting documentation sufficient to establish that the requirements set forth in this rule are met.

(D) Investigative agent certifications issued prior to the effective date of this rule

(1) Investigative agent certifications issued prior to the effective date of this rule will remain in effect until their assigned expiration dates.

(2) A person holding level one investigative agent certification, level two investigative agent certification, or professional grade investigative agent certification on the day immediately prior to the effective date of this rule will be eligible for five-year investigative agent certification provided:

(a) The person's investigative agent certification has not expired.

(b) The person has successfully completed foundational investigative agent training.

(i) The renewal requirements for the investigative agent certification issued to the person prior to the effective date of this rule; or

(ii) Fifty hours of continuing professional education subsequent to the effective date of the investigative agent certification issued to the person prior to the effective date of this rule, of which at least ten hours are related to:

(a) Conducting investigations; and/or

(b) Trauma informed care as the basis for interacting with individuals with developmental disabilities, families, guardians, direct support professionals, and others during the course of an investigation.

(d) The person has submitted to the department in the format prescribed by the department, an application and supporting documentation sufficient to establish that the requirements set forth in this rule are met.

(3) Investigative agent certifications issued prior to the effective date of this rule that have expired will not be renewed; applicants will be required to meet the requirements for five-year investigative agent certification in accordance with paragraph (C) of this rule.

(E) Renewal of expired investigative agent certifications issued on or after the effective date of this rule

(1) Investigative agent certifications issued on or after the effective date of this rule which have been expired for less than one year may be renewed upon completion of all renewal requirements of the expired certification.

(2) Investigative agent certifications issued on or after the effective date of this rule which have been expired for one or more years may be renewed upon completion of all renewal requirements of the expired certification and completion of fifteen additional hours of continuing professional education.

(F) Administrative review

An applicant for investigative agent certification whose application is disapproved based upon the applicant's failure to meet the requirements set forth in this rule, may request in writing, within thirty calendar days of the rejection, an administrative review by the director.

(G) Standards of conduct

(1) An investigative agent will, during the course of an investigation, act in a professional manner and treat all parties involved, including individuals with developmental disabilities, families, guardians, direct support professionals, and others, with courtesy and respect.

(2) A superintendent of a county board or an executive director of a regional council of governments formed pursuant to section 5126.13 of the Revised Code by two or more county boards will notify the department in writing within seventy-two hours of becoming aware that a holder of or applicant for investigative agent certification:

(a) Is guilty of serious intemperate, immoral, or conduct unbecoming to the investigative agent position or serious incompetence or negligence within the scope of investigative agent duties;

(c) Has been included in one or more of the databases described in paragraphs (C)(2)(a) to (C)(2)(g) of rule 5123-2-02 of the Administrative Code.

(H) Denial, suspension, or revocation

(1) The director will deny, suspend, or revoke investigative agent certification if the director finds, pursuant to an adjudication conducted in accordance with Chapter 119. of the Revised Code, that the applicant for or holder of investigative agent certification has engaged in an immoral act, incompetence, negligence, or conduct that is unbecoming to the applicant's or holder's position.

(2) Except as provided in paragraph (H)(3) of this rule, the director will deny or revoke investigative agent certification if the director finds, pursuant to an adjudication conducted in accordance with Chapter 119. of the Revised Code, that the applicant for or holder of investigative agent certification:

(b) Has been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for any of the disqualifying offenses listed or described in paragraph (E)(1)(b) of rule 5123-2-02 of the Administrative Code if a period of ten years has not elapsed from the date the applicant or holder was fully discharged from imprisonment, probation, and parole;

(c) Has been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for any of the disqualifying offenses listed or described in paragraph (E)(1)(c) of rule 5123-2-02 of the Administrative Code if a period of seven years has not elapsed from the date the applicant or holder was fully discharged from imprisonment, probation, and parole;

(d) Has been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for any of the disqualifying offenses listed or described in paragraph (E)(1)(d) of rule 5123-2-02 of the Administrative Code if a period of five years has not elapsed from the date the applicant or holder was fully discharged from imprisonment, probation, and parole;

(e) Has been convicted of, pleaded guilty to, or been found eligible for intervention in lieu of conviction for multiple disqualifying offenses if the applicable period of time in accordance with paragraph (E)(2) of rule 5123-2-02 of the Administrative Code has not elapsed from the date the applicant or holder was fully discharged from imprisonment, probation, and parole; or

(f) Has been included in one or more of the databases described in paragraphs (C)(2)(a) to (C)(2)(f) of rule 5123-2-02 of the Administrative Code.

(3) A conviction of or plea of guilty to a disqualifying offense listed or described in paragraphs (E)(1)(a) to (E)(1)(d) of rule 5123-2-02 of the Administrative Code will not constitute grounds for the denial or revocation of investigative agent certification if the requirements contained in paragraph (F) of rule 5123-2-02 of the Administrative Code are met.

(4) An applicant for or holder of investigative agent certification must disclose a conviction that has been sealed.

Last updated June 24, 2024 at 7:55 AM

History

Effective: June 23, 2024
Promulgated Under: 119.03

Ohio Adm.Code 5123-5-08 Certification standards for business managers of county boards of developmental disabilities.

(A) Purpose

This rule establishes minimum qualifications through certification standards for persons employed by or under contract with county boards of developmental disabilities as business managers in accordance with section 5126.054 of the Revised Code. Persons serving as business managers of county boards of developmental disabilities will hold certification in accordance with this rule.

(B) Definitions

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

(2) "Business manager" means a person employed by or under contract with a county board who is responsible for budgeting, financial reporting, preparing cost reports, and advancing informed and strategic decision-making by the county board.

(3) "Certified public accountant" means a person holding a certificate issued pursuant to section 4701.06 or 4701.061 of the Revised Code that is not revoked or suspended.

(4) "Continuing professional education" means training, approved by the department or a superintendent, required for renewal of business manager certification.

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

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

(7) "Superintendent" means a person certified by the department in accordance with rule 5123-5-03 of the Administrative Code and employed in that capacity by a county board.

(1) A superintendent may issue business manager certification for an initial period of one year to an applicant who:

(a) Holds a bachelor's degree or a master's degree from an accredited college or university in accounting, business administration, finance, public administration, or a related field of study;

(b) Holds a bachelor's degree or a master's degree from an accredited college or university in any field of study and has at least two years of full-time (or equivalent part-time), supervised, paid work experience with demonstrated competency in accounting, financial management, and budgeting; or

(2) A superintendent will ensure the business manager successfully completes, no later than ninety calendar days after hire, an orientation program of at least eight hours that addresses, but is not limited to:

(a) Overview of the county board, including:

(i) Mission, vision, values, and organizational structure;

(ii) Policies, procedures, and work rules;

(iii) Ethical and professional conduct and practice; and

(iv) Avoiding conflicts of interest.

(b) Serving individuals with developmental disabilities, including:

(i) Person-centered philosophy and practice;

(ii) The rights of individuals with developmental disabilities set forth in section 5123.62 of the Revised Code; and

(iii) The requirements of rule 5123-17-02 of the Administrative Code.

(c) The department-provided orientation program in cost report preparation described in paragraph (O)(4)(a) of rule 5123-4-01 of the Administrative Code.

(3) A superintendent will ensure the business manager successfully completes, no later than one year after hire, forty hours of continuing professional education that includes, but is not limited to:

(a) Budgeting;

(b) Financial forecasting;

(d) Day-to-day fiscal operations of county boards; and

(e) Financial audits of county boards.

(D) First renewal of certification

A superintendent may renew the business manager certification issued in accordance with paragraph (C) of this rule for a period of five years provided the applicant has successfully completed:

(1) The eight-hour orientation program described in paragraph (C)(2) of this rule; and

(2) The continuing professional education described in paragraph (C)(3) of this rule.

(E) Subsequent renewal of certification

A superintendent may renew the business manager certification issued in accordance with paragraph (D) of this rule for subsequent periods of five years provided the applicant has successfully completed at least one hundred hours of continuing professional education on or after the effective date of the preceding business manager certification. The training described in paragraph (F) of this rule may be counted toward the one hundred hours.

(F) Annual training requirements

(1) A superintendent will ensure the business manager annually completes the department-provided annual training in cost report preparation described in paragraph (O)(4)(b) of rule 5123-4-01 of the Administrative Code.

(2) A superintendent will ensure the business manager annually completes training, in accordance with standards established by the department, in:

(a) The rights of individuals with developmental disabilities set forth in section 5123.62 of the Revised Code; and

(b) The requirements of rule 5123-17-02 of the Administrative Code including a review of health and welfare alerts issued by the department since the previous year's training.

(G) Application fee

A superintendent may compel an applicant for business manager certification to pay an application fee to the county board which will not exceed seventy-five dollars.

(H) Reciprocity

(1) A superintendent will accept as valid, business manager certification issued in accordance with this rule by the superintendent of another county board.

(2) A superintendent will accept as valid, continuing professional education approved by the department or the superintendent of another county board in accordance with this rule.

(I) Renewal of expired business manager certification

(1) Business manager certification which has been expired for less than one year may be renewed upon completion of all renewal requirements of the expired certification.

(2) Business manager certification which has been expired for one year or more will not be renewed; the applicant will be required to meet the requirements for initial business manager certification, pursuant to paragraph (C) of this rule.

(J) Administrative review

An applicant for business manager certification whose application is disapproved based upon the applicant's failure to meet the requirements of this rule, may request in writing, within thirty calendar days of disapproval, an administrative review by the superintendent or the superintendent's designee.

(K) Denial, suspension, or revocation

Business manager certification is subject to denial, suspension, or revocation in accordance with rule 5123-5-04 of the Administrative Code.

Last updated June 25, 2025 at 6:27 PM

History

Effective: August 19, 2024
Promulgated Under: 119.03

Chapter 5123-6 Performance of Health-Related Activities and Administration of Medication

Ohio Adm.Code 5123-6-01 Definitions of terms used in Chapter 5123-6 of the Administrative Code.

The following definitions apply to Chapter 5123-6 of the Administrative Code:

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

(B) "Annually" means within a three hundred sixty-five-day span of time.

(C) "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.

(D) "Certified home and community-based services provider" means a person or government entity certified pursuant to section 5123.045 of the Revised Code.

(E) "Certified supported living provider" means a person or government entity certified pursuant to section 5123.161 of the Revised Code.

(F) "Contact hour" has the same meaning as in Chapter 4723-14 of the Administrative Code.

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

(H) "Delegable nursing task" means a nursing task, which a licensed nurse has determined meets the provisions listed in Chapter 4723-13 of the Administrative Code.

(I) "Delegating nurse" means the licensed nurse who transfers the responsibility for performance of selected nursing tasks and/or medication administration to developmental disabilities personnel who have been trained and/or certified to do so, while retaining accountability of outcome. The delegating nurse determines the level of supervision required to ensure adequate oversight of developmental disabilities personnel to perform nursing tasks and/or administer medication. The delegating nurse is not necessarily the same nurse as the nurse who trains developmental disabilities personnel to perform or administer the functions set forth in paragraphs (LL)(1) to (LL)(8) of this rule.

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

(K) "Department-approved curriculum" means the standards for instruction, training, and performance approved by the Ohio department of developmental disabilities.

(L) "Developmental disabilities personnel" means the workers who provide specialized services to individuals with developmental disabilities:

(1) Through direct employment with the Ohio department of developmental disabilities or a county board;

(2) Through an entity under contract with the Ohio department of developmental disabilities or a county board;

(3) Through direct employment or being under contract with private entities, including private entities that operate residential facilities; or

(4) As an independent provider.

(M) "Director" means the director of the Ohio department of developmental disabilities or that person's designee.

(N) "Drug" has the same meaning as in section 4729.01 of the Revised Code.

(O) "Employer oversight" means the monitoring of developmental disabilities personnel and ensuring developmental disabilities personnel perform health-related activities and administer medication in accordance with this chapter.

(P) "Family member" means a parent, sibling, spouse, son, daughter, grandparent, aunt, uncle, cousin, or guardian of an individual with a developmental disability if the individual with a developmental disability lives with the person and is dependent on the person to the extent that, if the supports were withdrawn, another living arrangement would have to be found.

(Q) "Family support services" has the same meaning as in section 5126.01 of the Revised Code.

(R) "Health-related activities" means only:

(1) Taking vital signs (i.e., temperature, pulse, respiration, and blood pressure);

(2) Application of clean dressings that do not require health assessment;

(3) Basic measurement of bodily intake and output;

(4) Oral suctioning;

(5) Use of glucometers;

(6) External urinary catheter care;

(7) Emptying and replacing ostomy bags;

(8) Obtaining pulse oximetry reading;

(9) Use of continuous positive airway pressure machines, including biphasic positive airway pressure machines;

(10) Application of percussion vests;

(11) Use of cough assist devices and insufflators;

(12) Application of prescribed compression hosiery; and

(13) Collection of specimens by noninvasive means.

(S) "Independent provider" has the same meaning as in section 5123.16 of the Revised Code.

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

(U) "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.

(V) "Individual-specific training" means training provided to developmental disabilities personnel by a licensed nurse or by an employer of developmental disabilities personnel through employer oversight, which addresses:

(1) The unique needs of the individual being served;

(2) A summary of the individual's relevant health care information; and

(3) Implementation of the individual's health care plan as part of the individual service plan.

(W) "Licensed health professional authorized to prescribe drugs" has the same meaning as in section 4729.01 of the Revised Code.

(X) "Licensed nurse" means a registered nurse or a licensed practical nurse who holds a current valid license to practice nursing in Ohio pursuant to Chapter 4723. of the Revised Code.

(Y) "Major unusual incident" has the same meaning as in rule 5123-17-02 of the Administrative Code.

(Z) "Medicaid" has the same meaning as in section 5162.03 of the Revised Code.

(AA) "Medication/treatment error" means:

(1) Wrong prescribed medication/treatment administered or performed;

(2) Medication/treatment administered or performed at the wrong time;

(3) Medication/treatment administered or performed by a route not prescribed or in the case of over-the-counter medication, not as indicated by the manufacturer;

(4) Incorrect dose or amount of medication/treatment administered or performed;

(5) Expired medication/treatment administered or performed;

(6) Contaminated medication/treatment administered or performed;

(7) Improperly stored medication/treatment administered or performed;

(8) Medication/treatment, other than over-the-counter medication authorized in accordance with section 5123.42 of the Revised Code, administered or performed without corresponding order from a licensed health professional authorized to prescribe drugs;

(9) Not performing or administering a prescribed medication/treatment during the prescribed time, including but not limited to, failure to ensure the medication/treatment, equipment, or supplies needed to administer or perform the medication/treatment are available at the prescribed time or declination of a prescribed medication/treatment by an individual;

(10) Not documenting a medication/treatment that was administered or performed;

(11) Administration or performance of prescribed medication/treatment by developmental disabilities personnel without certification or whose certification has expired;

(12) Administration of over-the-counter medication authorized in accordance with section 5123.42 of the Revised Code by developmental disabilities personnel without required training; and

(13) Administration or performance of medication/treatment without nursing delegation when nursing delegation is required.

(BB) "Mentally alert" means the ability of an individual to cognitively understand and communicate specific information pertaining to the individual's health, safety, and medication.

(CC) "Metabolic glycemic disorders" means medical conditions specifically related to metabolism of glucose such as diabetes, pre-diabetes, and metabolic syndrome.

(DD) "Metered dose inhaled medication" means a pre-measured medication administered by inhalation using a hand-held dispenser or aerosol nebulizer.

(EE) "Nursing delegation" means the process established in rules adopted by the Ohio board of nursing pursuant to Chapter 4723. of the Revised Code under which a registered nurse or licensed practical nurse acting at the direction of a registered nurse transfers responsibility for the performance of a particular nursing activity, task, or prescribed medication administration to another person who is not otherwise authorized to perform the activity, task, or prescribed medication administration.

(FF) "Nursing task" means those activities that constitute the practice of nursing as a licensed nurse and may include but is not limited to, assistance with activities that are performed to maintain or improve an individual's wellbeing when the individual is unable to perform those activities without assistance.

(GG) "Oral prescribed medication" means any prescribed medication that can be ingested through the mouth.

(HH) "Over-the-counter medication" means a drug that may be sold and purchased without a prescription, but that unless specifically authorized in division (B)(1)(c) of section 5123.42 of the Revised Code, requires a prescription for administration by unlicensed personnel to a person who is not able to self-administer.

(II) "Prescribed medication" means a drug that is to be administered according to the instructions of a licensed health professional authorized to prescribe drugs.

(JJ) "Qualified intellectual disability professional" has the same meaning as in 42 C.F.R. 483.430.

(KK) "Quality assessment registered nurse" means a registered nurse who is a registered nurse instructor or registered nurse trainer employed by or under contract with a county board and who assists with consultation and quality assessment oversight as set forth in rule 5123-6-07 of the Administrative Code.

(LL) "Registered nurse instructor" means a registered nurse who is certified by the Ohio department of developmental disabilities in accordance with rule 5123-6-04 of the Administrative Code to plan, develop, coordinate, and deliver the registered nurse train-the-trainer program to prepare other registered nurses to train developmental disabilities personnel to:

(1) Perform health-related activities;

(2) Administer oral prescribed medication;

(3) Administer topical prescribed medication;

(4) Administer topical over-the-counter musculoskeletal medication;

(5) Administer oxygen and metered dose inhaled medication;

(6) Administer prescribed medication through gastrostomy and jejunostomy tubes, if the tubes being used are stable and labeled;

(7) Administer prescribed insulin through subcutaneous injection, inhalation, and insulin pump; and

(8) Administer prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection.

(MM) "Registered nurse trainer" means a registered nurse who is certified by the Ohio department of developmental disabilities in accordance with rule 5123-6-04 of the Administrative Code to train developmental disabilities personnel to perform or administer the functions set forth in paragraphs (LL)(1) to (LL)(8) of this rule.

(NN) "Residential facility" has the same meaning as in section 5123.19 of the Revised Code.

(OO) "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 5123-5-02 of the Administrative Code.

(PP) "Specialized services" has the same meaning as in section 5123.50 of the Revised Code.

(QQ) "Task" means a task that is prescribed, ordered, delegated, or otherwise directed by a health care professional acting within the scope of professional practice.

(RR) "Topical over-the-counter musculoskeletal medication" means an over-the-counter medication that is applied topically or passes through the skin to provide relief from discomfort in the muscles, joints, or bones.

(SS) "Topical prescribed medication" means any prescribed medication that is applied to the outer skin and drops applied to the eye, ear, or nose. "Topical prescribed medication" may include transdermal prescribed medication or vaginal or rectal suppositories.

(TT) "Unusual incident" has the same meaning as in rule 5123-17-02 of the Administrative Code.

Last updated August 13, 2026 at 8:23 AM

History

Effective: August 13, 2026
Promulgated Under: 119.03

Ohio Adm.Code 5123-6-02 Self-administration or assistance with self-administration of prescribed medication.

(A) Purpose

This rule sets forth the right of an individual who can safely self-administer prescribed medication or receive assistance with self-administration of prescribed medication to do so, establishes procedures for determining whether an individual can safely self-administer or receive assistance with self-administration or is unable to self-administer with or without assistance, and defines parameters for providing assistance with self-administration of prescribed medication.

(B) Right to self-administer or receive assistance with self-administration of prescribed medication

An individual who can safely self-administer prescribed medication or receive assistance with self-administration of prescribed medication has the right to self-administer or receive assistance with self-administration.

(1) Prior to restricting an individual's right to self-administer prescribed medication, the service and support administrator or qualified intellectual disability professional, as applicable, will ensure the department-approved self-administration assessment is completed for an individual who requires prescribed medication administration.

(2) Based on the outcome of the self-administration assessment, the individual service plan will document when the individual cannot safely self-administer prescribed medication or receive assistance with self-administration of prescribed medication.

(3) The service and support administrator or qualified intellectual disability professional, as applicable, will:

(a) Review the self-administration assessment annually to confirm the individual's level of support with self-administration;

(b) Complete a self-administration assessment when there is a change that affects the individual's medication routine (such as a change in medication route, service setting, service provider, or health status); and

(4) Each individual service plan will indicate the results of the self-administration assessment, including:

(a) When the individual is able to safely self-administer medication independently;

(b) When the individual is able to safely self-administer medication with assistance; and

(c) When the individual is not able to successfully self-administer medication with or without assistance and include a statement of how medication administration will be completed.

(5) When the self-administration assessment indicates an individual cannot safely self-administer prescribed medication or receive assistance with self-administration of prescribed medication:

(a) Further assessment will be conducted to determine exactly what specific steps of self-administration of medication the individual is able to safely complete. The individual will participate in these steps under the supervision of developmental disabilities personnel who have current certification in health-related activities and prescribed medication administration and have received individual-specific training.

(b) The details of the individual's specific abilities and the specific necessary support from licensed or certified personnel to complete medication administration will be noted in the individual service plan.

(D) Providing assistance with self-administration

(1) Developmental disabilities personnel may, under section 5123.651 of the Revised Code, provide the assistance described in paragraphs (D)(2)(a) to (D)(2)(c) of this rule. To provide assistance with self-administration of prescribed medication, developmental disabilities personnel are not required to be trained or certified in accordance with section 5123.42 of the Revised Code and rules 5123-6-05 and 5123-6-06 of the Administrative Code.

(2) When assisting in the self-administration of prescribed medication, developmental disabilities personnel will take only the following actions as needed and identified in the individual service plan:

(a) Remind an individual when to take the medication and observe the individual to ensure the individual follows the directions on the container;

(b) Assist an individual by taking the medication in its container from the area where it is stored, handing the container with the medication in it to the individual, and opening the container, if the individual is physically unable to open the container; or

(c) Assist, on request by or with the consent of, a physically impaired but mentally alert individual, with removal of oral prescribed medication or topical prescribed medication from the container and physically assist with the individual's taking or applying of the medication. If an individual is physically unable to place a dose of oral prescribed medication to the individual's mouth without spilling or dropping it, developmental disabilities personnel may place the dose in another container and place that container to the individual's mouth.

(3) When an individual has been assessed as able to safely self-administer prescribed medication or self-administer prescribed medication with assistance, developmental disabilities personnel are not authorized to verify the accuracy of medication being taken by the individual on a routine basis unless specified in the individual service plan. When there is reason to question the individual's self-administration skills, a new self-administration assessment will be completed.

Last updated August 13, 2026 at 8:23 AM

History

Effective: August 13, 2026
Promulgated Under: 119.03

Ohio Adm.Code 5123-6-03 Authorization of developmental disabilities personnel to perform health-related activities and administer prescribed medication.

(A) Purpose

This rule sets forth conditions under which developmental disabilities personnel may perform health-related activities and administer prescribed medication.

(B) Individuals for whom developmental disabilities personnel may perform health-related activities and administer prescribed medication

Developmental disabilities personnel who are not authorized by other provisions of the Revised Code to perform health-related activities or administer prescribed medication may do so pursuant to section 5123.42 of the Revised Code and rules adopted by the department under this chapter as part of the specialized services the developmental disabilities personnel provide to individuals who receive:

(1) Early intervention, preschool, and school age services offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code;

(2) Adult services offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code in a setting where seventeen or more individuals have been authorized to receive services;

(3) Adult services offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code in a setting where sixteen or fewer individuals have been authorized to receive services;

(4) Family support services offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code;

(5) Services from certified supported living providers, if the services are offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code;

(6) Residential support services from certified home and community-based services providers, if the services are received in a community living arrangement that includes not more than four individuals and the services are offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code;

(7) Services not described in paragraphs (B)(1) to (B)(6) of this rule that are offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code;

(8) Services while residing in a residential facility with five or fewer beds; or

(9) Services while residing in a residential facility with six or more beds.

(C) Authorization of developmental disabilities personnel to activate a vagus nerve stimulator, administer prescribed epinephrine either by autoinjector or intranasally, and administer topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces

In the case of individuals receiving services described in paragraphs (B)(1) to (B)(9) of this rule, developmental disabilities personnel, without nursing delegation and without certification issued in accordance with rule 5123-6-06 of the Administrative Code, may:

(1) Activate a vagus nerve stimulator if all provisions of paragraph (C) of rule 5123-6-05 of the Administrative Code are being followed.

(2) Administer prescribed epinephrine either by autoinjector or intranasally for urgent or emergency treatment of allergic reaction and anaphylaxis if all provisions of paragraph (D) of rule 5123-6-05 of the Administrative Code are being followed.

(3) Administer topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces provided that:

(a) The topical over-the-counter medication is not being applied to an open wound;

(b) The topical over-the-counter medication is not being applied for specific treatment of a condition that requires a medical diagnosis including fungal infections; and

(D) Authorization of developmental disabilities personnel to perform health-related activities and administer prescribed medication

(1) When an individual receives services described in paragraph (B)(1) of this rule, trained and certified developmental disabilities personnel may, with nursing delegation:

(a) Perform health-related activities;

(b) Administer oral prescribed medication, administer topical prescribed medication, and administer topical over-the-counter musculoskeletal medication;

(d) Administer prescribed medication through gastrostomy and jejunostomy tubes, if the tubes being used are stable and labeled;

(e) Administer prescribed insulin through subcutaneous injection, inhalation, and insulin pump; and

(f) Administer prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection.

(2) When an individual receives services described in paragraphs (B)(2), (B)(7), and (B)(9) of this rule, trained and certified developmental disabilities personnel may, with nursing delegation:

(a) Perform health-related activities;

(b) Administer oral prescribed medication, administer topical prescribed medication, and administer topical over-the-counter musculoskeletal medication;

(d) Administer prescribed medication through gastrostomy and jejunostomy tubes, if the tubes being used are stable and labeled;

(e) Administer prescribed insulin through subcutaneous injection, inhalation, and insulin pump; and

(f) Administer prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection.

(3) When an individual receives services described in paragraphs (B)(3), (B)(4), (B)(5), (B)(6), and (B)(8) of this rule:

(a) Without nursing delegation, trained and certified developmental disabilities personnel may:

(i) Perform health-related activities;

(ii) Administer oral prescribed medication, administer topical prescribed medication, and administer topical over-the-counter musculoskeletal medication; and

(iii) Administer oxygen and metered dose inhaled medication.

(b) With nursing delegation, trained and certified developmental disabilities personnel may administer:

(i) Prescribed medication through gastrostomy and jejunostomy tubes, if the tubes being used are stable and labeled;

(ii) Prescribed insulin through subcutaneous injection, inhalation, and insulin pump; and

(iii) Prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection.

(4) When an individual living in a family home receives services from an unlicensed in-home care worker, a family member living in the home may be able to authorize health care tasks according to the provisions of section 5123.47 of the Revised Code. All requirements in section 5123.47 of the Revised Code must be met for family authorization to occur.

(5) A family member acting as paid developmental disabilities personnel may administer medication or perform health-related activities as described in section 5123.42 of the Revised Code without nursing delegation or a certificate issued under section 5123.45 of the Revised Code.

(E) Requirements that apply when developmental disabilities personnel activate a vagus nerve stimulator, administer prescribed epinephrine either by autoinjector or intranasally, or administer topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces pursuant to section 5123.42 of the Revised Code

(1) Developmental disabilities personnel will successfully complete, initially and annually thereafter, a training course or courses as specified in rule 5123-6-05 of the Administrative Code.

(2) Developmental disabilities personnel may activate a vagus nerve stimulator, administer prescribed epinephrine either by autoinjector or intranasally, or administer topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces only as authorized by the training courses completed and according to manufacturer's instructions and individual-specific indications.

(3) If an employer of developmental disabilities personnel or a county board believes the developmental disabilities personnel have not or will not safely activate a vagus nerve stimulator or administer prescribed epinephrine either by autoinjector or intranasally, the employer or county board will prohibit the developmental disabilities personnel from continuing or commencing to do so and make appropriate arrangements for emergency interventions by another means.

(4) If an employer of developmental disabilities personnel or a county board believes the developmental disabilities personnel have not or will not safely administer topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces, the employer or county board will prohibit the developmental disabilities personnel from continuing or commencing to do so.

(5) Developmental disabilities personnel will not engage in an action that has been prohibited by their employer or a county board.

(F) Requirements that apply when developmental disabilities personnel perform health-related activities and administer prescribed medication pursuant to section 5123.42 of the Revised Code

(1) To perform health-related activities; administer oral prescribed medication; administer topical prescribed medication; administer topical over-the-counter musculoskeletal medication; administer oxygen and metered dose inhaled medication; administer prescribed medication through stable labeled gastrostomy and jejunostomy tubes; administer prescribed insulin though subcutaneous injection, inhalation, and insulin pump; and administer prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection for individuals in the categories specified in paragraphs (B)(1) to (B)(9) of this rule and in accordance with paragraph (D) of this rule, developmental disabilities personnel will:

(a) Obtain the certification or certifications required by the department and issued in accordance with rule 5123-6-06 of the Administrative Code;

(b) Perform health-related activities and administer prescribed medication only as authorized by the certification or certifications held;

(c) Not perform health-related activities or administer prescribed medication for any individual for whom they have not received individual-specific training; and

(d) Not act without nursing delegation or act in a manner that is inconsistent with nursing delegation when nursing delegation is required in accordance with paragraph (D) of this rule.

(2) Prior to delegating to developmental disabilities personnel and in accordance with all standards and conditions set forth in Chapter 4723-13 of the Administrative Code, the delegating nurse will:

(a) Assess the individual and complete an evaluation of the conditions under which the delegated tasks or delegated prescribed medication administration will be done.

(b) Select developmental disabilities personnel that, as applicable:

(i) Are certified pursuant to rule 5123-6-06 of the Administrative Code; and

(ii) Comply with all standards and conditions set forth in Chapter 4723-13 of the Administrative Code.

(c) Ensure developmental disabilities personnel have received individual-specific training for each individual for whom they perform health-related activities or administer medication.

(d) Document the assessment of the individual and individual-specific training.

(e) Comply with all standards and conditions for nursing delegation in accordance with Chapter 4723-13 of the Administrative Code.

(3) When delegating nursing tasks that are not taught as part of the curriculum specified in rule 5123-6-06 of the Administrative Code, the delegating nurse will train and verify the skills of developmental disabilities personnel in accordance with Chapter 4723-13 of the Administrative Code.

(4) The employer of developmental disabilities personnel, or the county board for independent providers, will ensure that developmental disabilities personnel have received individual-specific training for each individual for whom they perform health-related activities or administer prescribed medication. Developmental disabilities personnel will not perform health-related activities or administer prescribed medication for any individual for whom they have not been specifically trained.

(5) When nursing delegation is required, the delegating nurse will ensure that developmental disabilities personnel have received individual-specific training provided by the delegating nurse or by another licensed nurse in coordination/communication with the delegating nurse for each individual for whom the developmental disabilities personnel perform health-related activities or administer prescribed medication.

(6) If the employer of developmental disabilities personnel believes or is notified by the county board, the department, a delegating nurse, or the quality assessment registered nurse that developmental disabilities personnel have not safely performed or will not safely perform health-related activities, or have not safely administered or will not safely administer prescribed medication, the employer will:

(a) Prohibit the action from commencing or continuing;

(b) Immediately make other staffing arrangements so that performance of health-related activities or administration of prescribed medication are completed as prescribed and in compliance with the requirements of this chapter;

(c) If applicable, immediately notify the county board via the major unusual incident reporting system pursuant to rule 5123-17-02 of the Administrative Code; if applicable, the county board will notify the quality assessment registered nurse;

(d) If applicable, immediately notify the delegating nurse; and

(7) If the employer of developmental disabilities personnel discovers or is notified by the county board, the department, a delegating nurse, or the quality assessment registered nurse that developmental disabilities personnel have committed a medication/treatment error, the employer will:

(a) Prohibit the action that contributed to the medication/treatment error from commencing or continuing by identifying the causes and contributing factors that led to the medication/treatment error and creating a concise, written plan of improvement that addresses the causes and contributing factors to ensure safe and accurate performance of health-related activities and administration of prescribed medication;

(b) If applicable, immediately make other staffing arrangements so that performance of health-related activities and administration of prescribed medication are completed as prescribed and in compliance with the requirements of this chapter;

(d) If applicable, immediately notify the delegating nurse; and

(e) Enter a notation in the certification record of the developmental disabilities personnel in the medication administration information system database described in rule 5123-6-07 of the Administrative Code except when the medication/treatment error is not related to the actions of the developmental disabilities personnel (e.g., an individual declines medication).

(8) If the delegating nurse believes that developmental disabilities personnel have not safely performed or will not safely perform health-related activities, or have not safely administered or will not safely administer prescribed medication, the delegating nurse will:

(a) Prohibit the action from commencing or continuing;

(b) Immediately notify the employer of the developmental disabilities personnel;

(d) Enter a notation in the certification record of the developmental disabilities personnel in the medication administration information system database described in rule 5123-6-07 of the Administrative Code.

(9) Developmental disabilities personnel will not engage in an action that has been prohibited by their employer or the delegating nurse.

(10) A registered nurse will reassess nursing delegation and the needs of the individual on an ongoing basis, but at least annually. The frequency of reassessment is determined by the delegating registered nurse. The reassessment will include a determination that:

(a) Nursing delegation continues to be necessary;

(b) The individual and circumstances continue to adhere to standards and conditions for nursing delegation in accordance with Chapter 4723-13 of the Administrative Code; and

(c) The developmental disabilities personnel continue to demonstrate the skill to accurately perform the nursing tasks, health-related activities, and prescribed medication administration being delegated.

Last updated August 13, 2026 at 8:23 AM

History

Effective: August 13, 2026
Promulgated Under: 119.03

Ohio Adm.Code 5123-6-04 Qualifications, training, and certification of registered nurse instructors and registered nurse trainers.

(A) Purpose

This rule establishes requirements for registered nurse instructors and registered nurse trainers as well as the curriculum for the registered nurse train-the-trainer program.

(B) Requirements for registered nurse instructors

(1) Only a registered nurse certified by the department as a registered nurse instructor may develop, coordinate, and deliver the registered nurse train-the-trainer program that prepares registered nurses to train developmental disabilities personnel to:

(a) Perform health-related activities;

(b) Administer oral prescribed medication;

(d) Administer topical over-the-counter musculoskeletal medication;

(e) Administer oxygen and metered dose inhaled medication;

(f) Administer prescribed medication through stable labeled gastrostomy and jejunostomy tubes;

(g) Administer prescribed insulin through subcutaneous injection, inhalation, and insulin pump; and

(h) Administer prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection.

(2) Only a registered nurse who meets the following requirements may be certified as a registered nurse instructor:

(a) Current, valid licensure as a registered nurse authorized to practice nursing in Ohio pursuant to Chapter 4723. of the Revised Code and rule 4723-3-01 of the Administrative Code.

(b) A minimum of sixty months full-time (or equivalent part-time) experience in the practice of nursing as a registered nurse, of which at least twenty-four months have been in the field of developmental disabilities.

(c) Knowledge of the current laws and rules which regulate the practice of nursing, sections 5123.41 to 5123.47 of the Revised Code, and this chapter.

(d) Knowledge of and experience with the principles of adult education.

(e) Current certification with a minimum of sixty months of experience as a registered nurse trainer.

(f) The department may conduct an audit of a registered nurse's training of developmental disabilities personnel to determine compliance with rule 5123-6-06 of the Administrative Code to determine eligibility for registered nurse instructor certification.

(g) Successful completion of the department-provided registered nurse instructor orientation program and maintenance of registered nurse instructor certification.

(3) The department will certify a registered nurse who meets the requirements of this rule as a registered nurse instructor for a period of up to two years. When the certification is first issued by the department on or after September first of an odd-numbered year, that certification will be current through August thirty-first of the next odd-numbered year.

(4) Registered nurse instructors will make entries in the medication administration information system database described in rule 5123-6-07 of the Administrative Code in accordance with procedures established by the department for renewal of registered nurse instructor certification.

(1) Only a registered nurse certified by the department as a registered nurse trainer may develop, coordinate, and train developmental disabilities personnel to perform or administer the functions set forth in paragraphs (B)(1)(a) to (B)(1)(h) of this rule.

(2) Only a registered nurse who meets the following requirements may be certified as a registered nurse trainer:

(a) Current, valid licensure as a registered nurse authorized to practice nursing in Ohio pursuant to Chapter 4723. of the Revised Code and rule 4723-3-01 of the Administrative Code.

(b) A minimum of eighteen months full-time (or equivalent part-time) experience in the practice of nursing as a registered nurse.

(d) Computer and internet access and computer literacy sufficient for entering data in the medication administration information system database described in rule 5123-6-07 of the Administrative Code; receiving and sending electronic mail; and creating, saving, and sending electronic file attachments.

(e) Successful completion of a registered nurse train-the-trainer program that has been authorized by an Ohio board of nursing continuing education approver unit. Successful completion of the registered nurse train-the-trainer program requires the registered nurse to:

(i) Submit a completed application to the registered nurse instructor;

(ii) Attend the entire registered nurse train-the-trainer program;

(iii) Participate in registered nurse train-the-trainer program class discussions and activities;

(iv) Successfully complete the post-program requirements to demonstrate core knowledge and preparedness for teaching; and

(v) Submit a completed program evaluation to the registered nurse instructor.

(3) The department will certify a registered nurse who meets the requirements of this rule as a registered nurse trainer for a period of up to two years. When the certification is first issued by the department on or after September first of an odd-numbered year, that certification will be current through August thirty-first of the next odd-numbered year.

(4) To maintain certification as a registered nurse trainer, the registered nurse will, during the effective period of the certification complete, at a minimum, four contact hours of continuing education approved by the Ohio board of nursing related to information addressed in the registered nurse train-the-trainer program or that will enhance the role of the registered nurse trainer. Training in cardiopulmonary resuscitation, first aid, or universal precautions for infection control will not count toward the four contact hours. The four contact hours may be part of the continuing education required by the Ohio board of nursing to maintain licensure as a registered nurse.

(5) The department may conduct an audit of proof of completion of continuing education to ensure compliance with paragraph (C)(4) of this rule. When a registered nurse fails to meet or cannot show proof of meeting the requirements set forth in paragraph (C)(4) of this rule, the registered nurse will be required to repeat the registered nurse train-the-trainer program in its entirety. Until such time that the registered nurse successfully repeats the registered nurse train-the-trainer program in its entirety, the registered nurse will not develop or coordinate the program of instruction for developmental disabilities personnel to perform or administer the functions set forth in paragraphs (B)(1)(a) to (B)(1)(h) of this rule.

(D) Minimum curriculum for the registered nurse train-the-trainer program

(1) The registered nurse train-the-trainer program will be at a minimum eight hours; one hour equals sixty minutes of classroom instruction. The registered nurse train-the-trainer program will address:

(a) Review of sections 4723.071 and 5123.41 to 5123.47 of the Revised Code, rules adopted under this chapter, and other applicable sections of the Revised Code and rules of the Administrative Code pertaining to the functioning of a county board, nursing delegation, and developmental disabilities personnel.

(b) Review of all components required when teaching developmental disabilities personnel to perform or administer the functions set forth in paragraphs (B)(1)(a) to (B)(1)(h) of this rule.

(d) Documentation requirements for licensed nurses and developmental disabilities personnel.

(e) Principles of developmental disabilities personnel certification and nursing delegation including:

(i) The scope of authority granted to developmental disabilities personnel by certification and the responsibilities of developmental disabilities personnel to acquire and maintain certification for medication administration;

(ii) Direct and indirect supervision and determination of the appropriate type of supervision pursuant to this chapter;

(iii) Explanation that nursing delegation requires developmental disabilities personnel to receive individual-specific training for each individual served; and

(iv) Explanation that nursing delegation is expressly authorized for a specific individual served and does not confer nursing delegation authority to or for another individual.

(f) How to provide indirect supervision, including methods for remaining accessible and training developmental disabilities personnel how and when to access help.

(g) How to evaluate the skills of developmental disabilities personnel, including developing and using a skills check list that addresses the functions set forth in paragraphs (B)(1)(a) to (B)(1)(h) of this rule.

(h) Responsibility and accountability pursuant to rule 5123-6-07 of the Administrative Code related to the use of the medication administration information system database and prohibition of actions by developmental disabilities personnel who the registered nurse or employer believes have not or will not safely perform or administer the functions set forth in paragraphs (B)(1)(a) to (B)(1)(h) of this rule.

(i) Responsibility and accountability pursuant to Chapter 4723-4 of the Administrative Code relating to standards of competent nursing practice including but not limited to, demonstration of competence and accountability in all areas of practice in which the nurse is engaged.

(j) General principles of adult basic education.

(k) Instruction that health-related activities and medication administration certification applies only while providing services in settings under the administrative oversight of the department and that such certification does not confer authority or apply in any other setting or course of medication administration.

(l) Information and instruction regarding the medication administration information system database described in rule 5123-6-07 of the Administrative Code, including required entry of data regarding developmental disabilities personnel trained.

(m) Instruction that only a department-approved curriculum will be used to train developmental disabilities personnel to perform or administer the functions set forth in paragraphs (B)(1)(a) to (B)(1)(h) of this rule.

(2) A registered nurse instructor may engage other licensed health care professionals to assist with instruction of the registered nurse train-the-trainer program as long as the other licensed health care professionals have received instruction on the material and are acting within the scope of their professional practice as outlined in the Revised Code.

Last updated August 13, 2026 at 8:23 AM

History

Effective: August 13, 2026
Promulgated Under: 119.03

Ohio Adm.Code 5123-6-05 Qualifications and training of developmental disabilities personnel to activate a vagus nerve stimulator; administer prescribed epinephrine either by autoinjector or intranasally; and administer topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces.

(A) Purpose

This rule establishes requirements for developmental disabilities personnel to activate a vagus nerve stimulator; administer prescribed epinephrine either by autoinjector or intranasally; and administer topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces.

(B) Basic requirements

(1) To be eligible to receive the training described in this rule, developmental disabilities personnel must be able to read, write, and understand English at a level sufficient to comply with all requirements set forth in administrative rules governing the services provided.

(2) Only a licensed nurse or developmental disabilities personnel with current health-related activities and prescribed medication administration certification in accordance with rule 5123-6-06 of the Administrative Code may provide the training described in this rule.

(1) Developmental disabilities personnel will complete department-approved training prior to activating a vagus nerve stimulator and at least annually thereafter that includes:

(a) Signs and symptoms of seizure;

(b) Seizure first aid;

(d) Ensuring availability of the stimulator magnet at all times;

(e) Reporting potential side effects and seizure-related problems to a healthcare professional; and

(f) Documentation of seizure activity and stimulator magnet use.

(2) Developmental disabilities personnel will demonstrate the skills and information on the department-approved skills checklist prior to activation of a vagus nerve stimulator and annually thereafter.

(3) Developmental disabilities personnel will complete individual-specific training about an individual for whom the developmental disabilities personnel are going to activate a vagus nerve stimulator, including individual-specific indications for use of the stimulator magnet, seizure first aid, and the information on the individual-specific training guidelines for an individual with an implanted vagus nerve stimulator prior to activating a vagus nerve stimulator for that individual.

(D) Qualifications for developmental disabilities personnel to administer prescribed epinephrine either by autoinjector or intranasally for urgent or emergency treatment of allergic reaction and anaphylaxis

(1) Developmental disabilities personnel will complete department-approved training prior to administering prescribed epinephrine either by autoinjector or intranasally for urgent or emergency treatment of allergic reaction and anaphylaxis and at least annually thereafter that includes:

(a) Signs and symptoms of allergic reaction;

(b) Correct care and use of the epinephrine autoinjector and epinephrine nasal spray;

(d) Medical follow-up after use of an epinephrine autoinjector or epinephrine nasal spray; and

(e) Documentation of major unusual incidents and unusual incidents involving use of an epinephrine autoinjector or epinephrine nasal spray in accordance with rule 5123-17-02 of the Administrative Code.

(2) Developmental disabilities personnel will demonstrate the skills and information on the department-approved skills checklist prior to administering prescribed epinephrine either by autoinjector and intranasally and annually thereafter.

(3) Developmental disabilities personnel will complete individual-specific training about an individual for whom the developmental disabilities personnel are going to administer prescribed epinephrine either by autoinjector or intranasally, including individual-specific indications for known allergens and symptoms associated with personal history of allergic reactions and the information on the individual-specific training guidelines for an individual who has been prescribed an epinephrine autoinjector or epinephrine nasal spray prior to administering prescribed epinephrine to that individual.

(4) Developmental disabilities personnel who have documentation of having received training in the use of an epinephrine autoinjector or epinephrine nasal spray as part of another recognized certification training (such as "American Red Cross" first aid) may use an epinephrine autoinjector or epinephrine nasal spray according to that certification while that certification is in effect without the training specified in paragraph (D)(1) of this rule.

(E) Qualifications for developmental disabilities personnel to administer topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces

(1) Developmental disabilities personnel will complete department-approved training prior to administering topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces and at least annually thereafter that includes:

(a) That topical over-the-counter medication is not to be applied to an open wound;

(b) That topical over-the-counter medication is not to be applied for specific treatment of a condition that requires a medical diagnosis including but not limited to, fungal infection;

(c) That an individual's known allergies must be confirmed as not present in the topical over-the-counter medication each time before the topical over-the-counter medication is administered;

(d) That the manufacturer's label directions for amount and frequency must be followed unless a prescription to administer at an alternate amount or frequency has been provided by a licensed health professional authorized to prescribe drugs;

(e) That over-the-counter medication for oral consumption requires a prescription from a licensed health professional authorized to prescribe drugs and will only be administered by developmental disabilities personnel with health-related activities and prescribed medication administration certification in accordance with rule 5123-6-06 of Administrative Code and section 5123.42 of the Revised Code;

(f) That topical over-the-counter medication for any purpose other than cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces may be applied only by developmental disabilities personnel with health-related activities and prescribed medication administration certification in accordance with rule 5123-6-06 of Administrative Code and section 5123.42 of the Revised Code; and

(g) Appropriate documentation of the use of topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces.

(2) Developmental disabilities personnel will demonstrate the skills and information on the department-approved skills checklist prior to administration of topical over-the-counter medication and annually thereafter.

(3) Developmental disabilities personnel will complete individual-specific training about an individual for whom the developmental disabilities personnel are going to administer topical over-the-counter medication including individual-specific allergies and history of the use of topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces and the information on the individual-specific training guidelines for an individual for whom developmental disabilities personnel will be administering topical over-the-counter medication without a prescription prior to administering topical over-the-counter medication to that individual.

Last updated August 17, 2026 at 9:08 AM

History

Effective: August 13, 2026
Promulgated Under: 119.03

Ohio Adm.Code 5123-6-06 Qualifications, training, and certification of developmental disabilities personnel who perform health-related activities and administer prescribed medication.

(A) Purpose

This rule sets forth eligibility and requirements for three types of training programs and resulting certification held by developmental disabilities personnel:

(1) Health-related activities and prescribed medication administration;

(2) Prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation; and

(3) Administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation.

(B) Eligibility to take a training program required to perform health-related activities and administer prescribed medication

(1) To be eligible to take a training program described in paragraph (C) of this rule, developmental disabilities personnel will:

(a) Be at least eighteen years of age;

(b) Have evidence of a high school diploma or certificate of high school equivalence; and

(c) Be able to read, write, and understand English at a level sufficient to comply with all requirements set forth in administrative rules governing the services provided.

(2) Prior to permitting developmental disabilities personnel to enroll in a training program described in paragraph (C) of this rule, the registered nurse trainer will:

(a) Secure an attestation from the employer of developmental disabilities personnel that the developmental disabilities personnel has been subject to a completed background check conducted in accordance with rule 5123-2-02 of the Administrative Code with results received; or

(b) Verify that the developmental disabilities personnel holds independent provider certification issued by the department.

(1) Health-related activities and prescribed medication administration training program

(a) A health-related activities and prescribed medication administration training program provided pursuant to this rule, to prepare developmental disabilities personnel to perform health-related activities, administer oral prescribed medication, administer topical prescribed medication, administer topical over-the-counter musculoskeletal medication, and administer oxygen and metered dose inhaled medication, will be at a minimum a fourteen-hour course; one hour equals sixty minutes of classroom instruction. Relevant agency-specific and/or facility-specific material may be added to the department-approved curriculum described in paragraph (C)(1)(c) of this rule only with additional corresponding classroom instruction time beyond the fourteen-hour course.

(b) The department may authorize a registered nurse trainer to provide a portion of the health-related activities and prescribed medication administration training program by audio-visual distance learning. The department's authorization will be based upon review and approval of a training program syllabus and supporting documentation submitted by the registered nurse trainer that demonstrate the audio-visual distance learning meets the following requirements:

(i) The registered nurse trainer will develop a syllabus that:

(a) Outlines specific content and number of hours of the training program to be conducted by audio-visual distance learning and by in-person classroom instruction;

(b) Describes methods for providing students with training manuals and materials;

(d) Includes interactive learning activities to achieve student engagement with the registered nurse trainer and other students;

(e) Describes methods to be used by the registered nurse trainer to verify student comprehension of information and skills;

(f) Sets forth that a student will complete the return demonstration of proficiency, including transcription, described in paragraph (E)(1)(c) of this rule, the written examination described in paragraph (E)(1)(d) of this rule, and the evaluation of the training program described in paragraph (E)(1)(e) of this rule during the in-person classroom instruction portion of the training program; and

(g) Provides sufficient detail to demonstrate how the requirements set forth in paragraphs (C)(1)(b)(ii) and (C)(1)(b)(iii) of this rule will be met.

(ii) Audio-visual distance learning will be conducted using conferencing software that provides for:

(a) Two-way audio and video interactive capability by all participants;

(b) All participants to see one another including each participant's face and upper body from the desktop and above;

(d) A private chat feature that enables a student to chat with the registered nurse trainer and ask questions if muted;

(e) Authenticated log-on by participants;

(f) An enabled waiting room so that the registered nurse trainer controls admission of students;

(g) The registered nurse trainer to track a student's attendance and presence in the meeting room;

(h) Prevention of anyone other than the registered nurse trainer from recording the training program; and

(i) The registered nurse trainer to control and disable a student's audio and video capability and remove a student when necessary.

(iii) The registered nurse trainer is responsible for ensuring:

(a) A student's video monitor is large enough to allow clear visualization of the registered nurse trainer, the presented materials, and demonstrations. Neither a student nor the registered nurse trainer is permitted to participate in the audio-visual distance learning via a hand-held cellular telephone.

(b) The class size is such that the registered nurse trainer clearly visualizes each student on the registered nurse trainer's video monitor.

(c) A student experiencing technical difficulties with the audio-visual conferencing software is not considered in attendance for that portion of the training program.

(i) A review of an individual's right to self-administer medication, self-administer medication with assistance, and participate in steps of medication administration when not able to self-administer medication or self-administer medication with assistance.

(ii) Concepts of person-centered planning relevant to an individual's consent or declination of prescribed medication.

(iii) Universal precautions for infection control. The registered nurse trainer may waive the universal precautions for infection control instruction material and instruction time of the program if the developmental disabilities personnel can document training on that topic within the previous year.

(iv) A review of applicable federal and state drug laws and rules.

(v) Information and instruction on the concepts underlying each step for correctly administering oral prescribed medication, administering topical prescribed medication, administering topical over-the-counter musculoskeletal medication, and administering oxygen and metered dose inhaled medication according to current standards of safe practice, procedures, and techniques.

(vi) Information and instruction to train the developmental disabilities personnel to administer the right medication, at the right dose, to the right individual, by the right route, at the right time and with the right documentation.

(vii) Written step-by-step directions on how to administer oral prescribed medication, administer topical prescribed medication, administer topical over-the-counter musculoskeletal medication, and administer oxygen and metered dose inhaled medication.

(viii) Instruction in safe storage and transport of oxygen.

(ix) Instruction in taking vital signs (i.e., temperature, pulse, respiration, and blood pressure).

(x) Instruction in application of clean dressings that do not require health assessment.

(xi) Instruction in basic measurement of bodily intake and output.

(xii) Instruction in oral suctioning.

(xiii) Instruction in use of glucometers.

(xiv) Instruction in external urinary catheter care.

(xv) Instruction in emptying and replacing ostomy bags.

(xvi) Instruction in application of prescribed compression hosiery.

(xvii) Instruction in collection of specimens by noninvasive means.

(xviii) Instruction in the use of pulse oximetry to accurately record an individual's oxygen saturation as prescribed by a licensed health professional authorized to prescribe drugs.

(xix) Instruction in the use of continuous positive airway pressure machines, including biphasic positive airway pressure machines, for the intermittent delivery of continuous positive airway pressure to treat obstructive sleep apnea or sleep-related hypoventilation as prescribed by a licensed health professional authorized to prescribe drugs.

(xx) Instruction in the application of percussion vests to promote airway secretion clearance as prescribed by a licensed health professional authorized to prescribe drugs.

(xxi) Instruction in the use of cough assist devices and insufflators to promote the removal of airway secretions in those with respiratory muscle weakness as prescribed by a licensed health professional authorized to prescribe drugs.

(xxii) Instruction in the use of metered dose inhaled medication administered by a hand-held dispenser and the use of an aerosol nebulizer to administer a pre-measured medication for the treatment of asthma or other respiratory condition as prescribed by a licensed health professional authorized to prescribe drugs.

(xxiii) Information and instruction in responsibility of developmental disabilities personnel for following the step-by-step procedures for administration of all medication and performance of health-related activities and completing additional training before attempting any action for which the developmental disabilities personnel is not competent.

(xxiv) Information and instruction in responsibility of developmental disabilities personnel for knowing the purpose of medication and health-related activities being performed or administered and facilitating the reporting of problems, including lack of effectiveness and potential side effects, to a healthcare professional.

(xxv) Instruction in quality measures, including but not limited to, procedures for reporting and documenting medication/treatment errors that may occur when performing health-related activities, administering oral prescribed medication, administering topical prescribed medication, administering topical over-the-counter musculoskeletal medication, and administering oxygen and metered dose inhaled medication.

(xxvi) Procedures to be followed in case of medication emergency including when, why, and how to contact the employer of developmental disabilities personnel or designee, a healthcare professional, or the supervising licensed nurse when medication is administered or a nursing task is performed pursuant to nursing delegation.

(xxvii) Information about what developmental disabilities personnel may be authorized to perform with respect to administering oral prescribed medication, administering topical prescribed medication, administering topical over-the-counter musculoskeletal medication, or administering oxygen and metered dose inhaled medication.

(xxviii) Limitations with respect to "as needed" (or "PRN") prescribed medication, which state that developmental disabilities personnel will not administer a prescribed medication ordered by a physician or other licensed health professional authorized to prescribe drugs when the prescribed medication is to be administered as needed, unless the order is written with specific parameters which preclude independent judgment.

(xxix) Limitations with respect to over-the-counter medication which include the need for a prescription from a licensed health professional authorized to prescribe drugs to administer all over-the-counter medication not authorized for administration by developmental disabilities personnel pursuant to section 5123.42 of the Revised Code.

(xxx) The requirement for specialized training pursuant to this rule for the administration of topical over-the-counter medication for the purpose of cleaning, protecting, or comforting the skin, hair, nails, teeth, or oral surfaces.

(xxxi) Instruction in the use of topical over-the-counter musculoskeletal medication.

(xxxii) Information about what developmental disabilities personnel are prohibited from administering, which includes but is not limited to:

(a) An intramuscular injection;

(b) An intravenous injection;

(c) A subcutaneous injection, except a subcutaneous injection of insulin or prescribed medication for the treatment of metabolic glycemic disorders, provided the developmental disabilities personnel are trained and hold administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation certification in accordance with this rule and the subcutaneous injection of insulin or prescribed medication for the treatment of metabolic glycemic disorders is delegated to a specific person by a licensed nurse pursuant to section 5123.42 of the Revised Code and this chapter;

(d) Any prescribed medication administered through a nasogastric tube or an unstable or unlabeled gastrostomy tube or an unstable or unlabeled jejunostomy tube; and

(e) Any debriding agent used in the treatment of a skin condition or minor abrasion.

(xxxiii) Instruction in the use of commercially packaged rectal diazepam gel for the treatment of epilepsy as prescribed by a licensed health professional authorized to prescribe drugs.

(xxxiv) Instruction in the use of commercially packaged glucagon for the treatment of hypoglycemia as prescribed by a licensed health professional authorized to prescribe drugs. Teaching must be completed and nursing delegation must be in place prior to administration of glucagon.

(xxxv) Instruction in potential drug reactions, including known side effects, interactions, and the proper course of action if a side effect occurs, and sources for prescribed medication information (such as pharmacist, physician, nurse, or poison control center).

(xxxvi) The requirements for documentation of prescribed medication administered, missed, held, or declined to, by, or for each individual.

(xxxvii) The definition of a medication/treatment error and requirements for documentation and notification of unusual incidents and major unusual incidents related to medication/treatment errors.

(xxxviii) Information regarding the appropriate and secure storage and care of prescribed medication.

(xxxix) Instruction that in settings where developmental disabilities personnel are administering prescribed medication, with or without nursing delegation, medication may be administered only from pharmacy-labeled or manufacturer-labeled containers and only by the person who prepared the dosage from those containers.

(xl) Information and instruction about who may receive and who may transcribe physician orders and prescriptions on to a medication administration record or treatment administration record specific to each category pursuant to rule 5123-6-03 of the Administrative Code.

(xli) Performance of a successful return demonstration for each route of prescribed medication administration in which developmental disabilities personnel are trained.

(xlii) Performance of a successful return demonstration for each health-related activity in which developmental disabilities personnel are trained.

(xliii) Information that health-related activities are performed only pursuant to nursing delegation except for individuals:

(a) Receiving family support services or services from certified supported living providers, if the services are offered or provided pursuant to Chapter 5123. or Chapter 5126. of the Revised Code;

(b) Receiving residential support services from certified home and community-based services providers, if the services are received in a community living arrangement that includes no more than four individuals;

(d) Receiving adult day services in a setting where sixteen or fewer individuals have been authorized to receive services.

(xliv) Information and instruction on the concepts underlying each step for performing health-related activities according to current standards of safe practice, including instruction in the correct and safe practices, procedures, and techniques for performing health-related activities.

(xlv) Instruction in the usual parameters of health-related activities and instruction in the course of action to be taken when parameters of health-related activities are above or below those taught.

(xlvi) Completion of written examination pursuant to paragraph (E)(1)(d) of this rule.

(xlvii) Requirements for individual-specific training which will occur after certification and prior to administration of prescribed medication or performance of health-related activities. The employer of developmental disabilities personnel, the delegating nurse, or the county board will ensure developmental disabilities personnel receive individual-specific training.

(2) Prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation training program

(a) A prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation training program provided pursuant to this rule to prepare developmental disabilities personnel to administer prescribed medication through stable labeled gastrostomy and jejunostomy tubes will be at a minimum a four-hour course; one hour equals sixty minutes of classroom instruction. Relevant agency-specific and/or facility-specific material may be added to the department-approved curriculum described in paragraph (C)(2)(b) of this rule only with additional corresponding classroom instruction time beyond the four-hour course. Developmental disabilities personnel will successfully complete the health-related activities and prescribed medication administration training program described in paragraph (C)(1) of this rule prior to participating in the prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation training program.

(b) The prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation training program will address:

(i) Correct and safe practices, procedures, and techniques for administering prescribed medication through stable labeled gastrostomy and jejunostomy tubes, including possible signs and symptoms of gastrostomy or jejunostomy tube malfunction or tube problems, complication or intolerance of prescribed medication by the individual, and appropriate response to a gastrostomy or jejunostomy tube that becomes dislodged.

(ii) Requirements for documentation of prescribed medication administered, missed, held, or declined to, by, or for each individual through stable labeled gastrostomy or jejunostomy tube.

(iii) Requirements for documentation and notification of prescribed medication errors through stable labeled gastrostomy or jejunostomy tube.

(iv) Information regarding the proper storage, care, and preparation of prescribed medication to be administered through stable labeled gastrostomy or jejunostomy tube.

(v) Information regarding the proper storage and care of gastrostomy and jejunostomy tubes.

(vi) Requirements for nursing delegation of prescribed medication administration through stable labeled gastrostomy and jejunostomy tubes.

(vii) Instruction that only the delegating nurse or a licensed nurse in coordination/communication with the delegating nurse will receive prescriptions for prescribed medication to be administered through stable labeled gastrostomy or jejunostomy tube and only the delegating nurse or a licensed nurse in coordination/communication with the delegating nurse will transcribe these prescriptions on to a medication administration record or treatment administration record.

(viii) Performance of successful return demonstration of proficiency in administering prescribed medication through stable labeled gastrostomy and jejunostomy tubes.

(ix) Completion of written examination pursuant to paragraph (E)(1)(d) of this rule.

(x) Requirements for individual-specific training which will occur after certification and prior to administration of prescribed medication through stable labeled gastrostomy or jejunostomy tube. The delegating nurse is responsible for the individual-specific training.

(3) Administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation training program

(a) An administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation training program provided pursuant to this rule to prepare developmental disabilities personnel to administer insulin through subcutaneous injection, inhalation, and insulin pump and administer prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection by nursing delegation will be a minimum a four-hour course; one hour equals sixty minutes of classroom instruction. Relevant agency-specific and/or facility-specific material may be added to the department-approved curriculum described in paragraph (C)(3)(b) of this rule only with additional corresponding classroom instruction time beyond the four-hour course. Developmental disabilities personnel will successfully complete the health-related activities and prescribed medication administration training program described in paragraph (C)(1) of this rule prior to participating in the administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation training program.

(b) The administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation training program will address:

(i) Information on the basic pathophysiology of metabolic glycemic disorders.

(ii) Correct and safe practices, procedures, and techniques for administering insulin and subcutaneous injections, possible signs and symptoms of subcutaneous injection complication, and instruction in safe handling and disposal of sharps.

(iii) The requirements for documentation of subcutaneous injections administered, missed, held, or declined to, by, or for each individual.

(iv) Requirements for documentation and notification of prescribed medication errors and subcutaneous injection errors.

(v) Information regarding the proper storage, care, and preparation of insulin or prescribed medication for treatment of metabolic glycemic disorders to be administered by subcutaneous injection.

(vi) Signs and symptoms of hypoglycemia and hyperglycemia and procedure for intervention and notification of nurse, physician, or emergency medical services.

(vii) Instruction in the use of commercially packaged glucagon for the treatment of hypoglycemia as prescribed by a licensed health professional authorized to prescribe drugs. Teaching must be completed and nursing delegation must be in place prior to administration of glucagon.

(viii) Instruction that only the delegating nurse or a licensed nurse in coordination/communication with the delegating nurse will transcribe a prescription for insulin or prescribed medication for treatment of metabolic glycemic disorders on to a medication administration record.

(ix) Performance of successful return demonstration of proficiency in administering insulin and subcutaneous injections.

(x) Completion of written examination pursuant to paragraph (E)(1)(d) of this rule.

(xi) Requirements for nursing delegation of administration of insulin through subcutaneous injection, inhalation, and insulin pump and administration of prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection.

(xii) Requirements for individual-specific training which will occur after certification and prior to administration of insulin through subcutaneous injection, inhalation, and insulin pump and administration of prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection. The delegating nurse is responsible for the individual-specific training.

(D) Requirements for training programs

(1) Training programs described in this rule will be developed and delivered by a registered nurse trainer certified by the department in accordance with rule 5123-6-04 of the Administrative Code. The registered nurse trainer will ensure training programs are conducted in accordance with requirements set forth in this chapter.

(2) A registered nurse trainer will use only a department-approved curriculum for a training program described in this rule.

(3) A registered nurse trainer will personally conduct the majority of a training program but may utilize other licensed health professionals to assist with conducting the training program as long as the other licensed health professionals have received instruction on the material and are acting within their professional scope of practice as outlined in the Revised Code.

(4) A registered nurse trainer will maintain for a period of seven years, the following training documentation:

(a) Completed developmental disabilities personnel certification course applications;

(b) Attendance verification sign-in sheets; and

(5) A registered nurse trainer will comply with a request for training documentation from the department.

(E) Initial certification of developmental disabilities personnel

(1) To receive initial certification in health-related activities and prescribed medication administration, prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation, or administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation, developmental disabilities personnel will:

(a) Attend the entire applicable training program.

(b) Actively participate in the training program class discussions and activities.

(d) Complete the closed book final written examination for the training program with a score of at least eighty per cent. Developmental disabilities personnel scoring less than eighty per cent on the final written examination will retake the training program in its entirety to be eligible to retake the final written examination. The final written examination developed and maintained by the department will be the only final written examination used.

(e) Complete and submit to the registered nurse trainer the evaluation of the training program.

(2) Certification in health-related activities and prescribed medication administration is a prerequisite for certification in prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation or certification in administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation.

(3) The registered nurse trainer will ensure developmental disabilities personnel meet all requirements for initial certification before indicating so in the medication administration information system database.

(F) Maintenance of developmental disabilities personnel certification

(1) To maintain certification, developmental disabilities personnel will annually complete continuing education that will enhance the role of developmental disabilities personnel who have completed the training program as determined by the registered nurse trainer. Developmental disabilities personnel will provide documentation of completion of the required continuing education to the registered nurse trainer.

(a) To maintain certification in health-related activities and prescribed medication administration, developmental disabilities personnel will annually complete at least two hours of continuing education that relates to the information taught in the health-related activities and prescribed medication administration training program (as determined by the registered nurse trainer) and perform a successful return demonstration of skills.

(b) To maintain certification in prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation, developmental disabilities personnel will annually complete at least one hour of continuing education that relates to the information taught in the prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation training program (as determined by the registered nurse trainer) and perform a successful return demonstration of skills. The continuing education required in this paragraph is in addition to the two hours of continuing education required for health-related activities and prescribed medication administration certification and, if applicable, the one hour of continuing education required for administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation certification.

(c) To maintain certification in administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation, the developmental disabilities personnel will annually complete at least one hour of continuing education that relates to the information taught in the administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation training program (as determined by the registered nurse trainer) and perform a successful return demonstration of skills. The continuing education required in this paragraph is in addition to the two hours of continuing education required for health-related activities and prescribed medication administration certification and, if applicable, the one hour of continuing education required for prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation certification.

(2) Training in cardiopulmonary resuscitation, first aid, activation of a vagus nerve stimulator, administration of prescribed epinephrine either by autoinjector or intranasally, administration of topical over-the-counter medication, or universal precautions for infection control will not count toward continuing education required by paragraph (F)(1)(a), (F)(1)(b), or (F)(1)(c) of this rule.

(3) Maintaining certification in health-related activities and prescribed medication administration is required to maintain certification in prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation and certification in administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation.

(4) When developmental disabilities personnel fail to complete the required continuing education and return demonstration of skills by the annual certification expiration date, the certification of the developmental disabilities personnel will be temporarily inactive for a maximum period of sixty calendar days, during which time the developmental disabilities personnel will complete the required continuing education and return demonstration of skills. If the developmental disabilities personnel fail to complete the required continuing education and return demonstration of skills within the sixty-day suspension period, the developmental disabilities personnel will be required to repeat each training program in its entirety to become recertified.

(5) While the certification of developmental disabilities personnel is temporarily inactive in accordance with paragraph (F)(4) of this rule, the developmental disabilities personnel will not:

(a) Perform health-related activities;

(b) Administer oral prescribed medication;

(d) Administer topical over-the-counter musculoskeletal medication;

(e) Administer oxygen or metered dose inhaled medication;

(f) Administer prescribed medication through gastrostomy or jejunostomy tubes;

(g) Receive nursing delegation to administer prescribed medication through gastrostomy or jejunostomy tubes;

(h) Administer prescribed insulin through subcutaneous injection, inhalation, or insulin pump;

(i) Receive nursing delegation to administer prescribed insulin through subcutaneous injection, inhalation, or insulin pump;

(j) Administer prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection; or

(k) Receive nursing delegation to administer prescribed medication for the treatment of metabolic glycemic disorders through subcutaneous injection.

(6) The registered nurse trainer will ensure developmental disabilities personnel meet all requirements for renewal certification before indicating so in the medication administration information system database.

(G) For adequate reasons and when requested in writing, the director may waive a condition or specific requirement of this rule. Approval to waive a condition or specific requirement will not be contrary to the rights, health, or safety of individuals served. The decision to grant or deny a rule waiver is not subject to appeal.

(H) The standards established by the Ohio board of nursing pursuant to Chapter 4723-13 of the Administrative Code will apply when an unlicensed person is performing delegable nursing tasks that are not defined as health-related activities.

Last updated August 13, 2026 at 8:23 AM

History

Effective: August 13, 2026
Promulgated Under: 119.03

Ohio Adm.Code 5123-6-07 General provisions and compliance for performance of health-related activities and administration of prescribed medication.

(A) Purpose

This rule sets forth requirements for the medication administration information system database, documentation of performance of health-related activities and administration of medication, compliance and quality assessment, and actions that may be taken by the department regarding certification issued pursuant to Chapter 5123-6 of the Administrative Code.

(B) Medication administration information system database

(1) The department will operate and maintain the medication administration information system database of registered nurse instructors and registered nurse trainers holding valid certification issued in accordance with rule 5123-6-04 of the Administrative Code and developmental disabilities personnel holding valid certification issued in accordance with rule 5123-6-06 of the Administrative Code in health-related activities and prescribed medication administration, prescribed medication administration through gastrostomy and jejunostomy tube by nursing delegation, and administration of insulin and medication for the treatment of metabolic glycemic disorders by nursing delegation.

(2) The department will provide read and write access to the medication administration information system database to all registered nurse instructors. Each registered nurse instructor will enter in the database initial information about each registered nurse the registered nurse instructor trained to be a registered nurse trainer in accordance with rule 5123-6-04 of the Administrative Code.

(3) The department will provide read and write access to the medication administration information system database to all registered nurse trainers. Each registered nurse trainer will enter in the database current information about developmental disabilities personnel the registered nurse trainer trained in accordance with rule 5123-6-06 of the Administrative Code at the time of certification and recertification of the developmental disabilities personnel.

(4) Registered nurse trainers will enter in the medication administration information system database:

(a) Information about themselves at the time of their recertification and thereafter, within sixty calendar days of any change of information.

(b) Information required for renewal of their registered nurse trainer certification prior to expiration of the certification.

(5) The department will provide read only access to the medication administration information system database to the public.

(C) Documentation of performance of health-related activities and administration of prescribed medication by developmental disabilities personnel

(1) All prescribed medication administered pursuant to this chapter will be administered according to the written directions of a licensed health professional authorized to prescribe drugs and according to the training received by developmental disabilities personnel in accordance with rule 5123-6-06 of the Administrative Code.

(2) Performance of health-related activities and administration of prescribed medication and treatments will be documented in a medication/treatment administration record indicating the completion of prescribed orders, including the signature or initials of the developmental disabilities personnel administering the prescribed medication or treatment, date, time, and when appropriate, observations or difficulties noted. This written documentation is required for all prescribed medication and treatments performed, administered, missed, held, or declined, including:

(a) Routine and as-needed prescribed medication and treatments;

(b) Health-related activities; and

(c) Administration of insulin and subcutaneous injections of prescribed medication for the treatment of metabolic glycemic disorders.

(3) Medication/treatment administration records will include at a minimum:

(a) Name of individual served;

(b) All allergies of individual served;

(d) Name of drug or treatment;

(e) Complete dosage and frequency of prescribed medication;

(f) Route of prescribed medication administration;

(g) Scheduled/prescribed time or intervals for administration;

(h) Any special instructions regarding each medication administration or treatment as provided by the pharmacy, physician, or prescriber; and

(i) Parameters provided by the physician or licensed health professional for ordered health-related activities.

(4) The employer of developmental disabilities personnel will maintain a means of identifying signatures and initials of developmental disabilities personnel making entries in the medication/treatment administration record. Identification will be included in the medication/treatment administration record or by using a separate master signatures/initials log.

(5) Certified developmental disabilities personnel transcribing any information in a medication/treatment administration record or checking the accuracy of information transcribed in the medication/treatment administration record will document when transcription and/or check has been completed, including the date and signature or initials.

(a) Only a licensed nurse or developmental disabilities personnel with health-related activities and prescribed medication administration certification may transcribe information in a medication/treatment administration record or check the accuracy of information transcribed in the medication/treatment administration record.

(b) Checking the accuracy of transcriptions will include:

(i) Verifying changes are transcribed as specified by the prescriber;

(ii) Verifying special instructions are indicated as instructed by pharmacy or prescriber directives; and

(iii) Ensuring the availability of equipment and/or supplies required to administer medication or perform the task in the setting.

(6) With any change to medication and/or treatment orders, the employer of developmental disabilities personnel or delegating nurse will ensure the medication/treatment administration record has been checked.

(7) Employers of developmental disabilities personnel and independent providers will ensure documentation, including the date, time, and signature or initials of certified developmental disabilities personnel who sign the medication/treatment administration record is completed in accordance with this rule.

(D) Requirements for developmental disabilities personnel to report medication/treatment errors

(1) Any medication/treatment error in the performance of health-related activities or administration of medication that results in physical harm to the individual will be immediately reported to an appropriate licensed health care professional. The requirement to immediately report medication/treatment errors applies to errors involving prescribed medication, treatments, over-the-counter medication, and health-related activities.

(2) Any medication/treatment error will be reported in accordance with rule 5123-17-02 of the Administrative Code when the medication/treatment error meets the definition of major unusual incident or unusual incident.

(3) All medication/treatment errors will be documented in an unusual incident report in accordance with rule 5123-17-02 of the Administrative Code. Developmental disabilities personnel who observe, identify, or become aware of a medication/treatment error will report to the delegating nurse and/or supervisory staff immediately in accordance with the employer's written policy and procedure.

(4) The employer of developmental disabilities personnel will train developmental disabilities personnel in accordance with the employer's written policy and procedure that medication/treatment errors and related plans of prevention will be documented in an unusual incident report.

(E) Compliance and quality assessment

(1) Each county board will employ or enter into a contract with a registered nurse instructor or a registered nurse trainer who will serve as a quality assessment registered nurse to assist with consultation and quality assessment oversight.

(2) Quality assessment reviews will be conducted when certified developmental disabilities personnel perform health-related activities, administer oral prescribed medication, administer topical prescribed medication, administer topical over-the-counter musculoskeletal medication, administer oxygen, or administer metered dose inhaled medication for individuals who:

(a) Receive services from certified supported living providers;

(b) Receive residential support services from certified home and community-based services providers, if the services are received in a community living arrangement that includes not more than four individuals;

(d) Reside in residential facilities of five or fewer beds, excluding intermediate care facilities for individuals with intellectual disabilities.

(3) The quality assessment registered nurse will complete quality assessment reviews so that a review of each provider location in the county where certified developmental disabilities personnel perform health-related activities, administer oral prescribed medication, administer topical prescribed medication, administer topical over-the-counter musculoskeletal medication, administer oxygen, or administer metered dose inhaled medication is conducted at least once every three years. The quality assessment registered nurse may conduct more frequent reviews if the quality assessment registered nurse, county board, provider, or department determines there are issues to warrant such.

(4) In the settings described in paragraph (E)(2) of this rule, the employer of developmental disabilities personnel or the independent provider, as applicable, will:

(a) Agree to schedule and participate in the quality assessment review and provide the required documentation;

(b) Submit a written plan of improvement within thirty calendar days of receipt of the quality assessment review report; and

(c) Implement the written plan of improvement within sixty calendar days of receipt of the quality assessment registered nurse's approval of the plan.

(5) Quality assessment reviews will be completed in a format prescribed by the department.

(6) Quality assessment reviews will include, but are not limited to:

(a) In-person observation of performance of health-related activities and administration of prescribed medication. A virtual observation may be arranged only when an in-person observation could adversely impact the health and safety of the individual served.

(b) Review of the system of communication and supports related to performance of health-related activities and administration of prescribed medication for the provider location being assessed to ensure complete and accurate administration of health care directives given by health care professionals for the individuals being served at the provider location.

(c) Review of documentation of performance of health-related activities and administration of prescribed medication for completeness of documentation and for documentation of appropriate actions taken based on parameters provided in the health-related activities and prescribed medication administration training program described in rule 5123-6-06 of the Administrative Code.

(d) Review of all medication/treatment errors from the past twelve months.

(e) Review of the system of processes and procedures used by the employer of developmental disabilities personnel or independent provider to monitor and document completeness and correct techniques used during performance of health-related activities, administration of oral prescribed medication, and administration of topical prescribed medication.

(7) The quality assessment registered nurse will evaluate for patterns of failure to comply or maintain compliance with this chapter.

(8) The quality assessment registered nurse will provide a copy of the quality assessment review report to the county board and the provider of services within ten business days of the quality assessment review. The quality assessment review report will identify findings specific to provisions of this chapter and may recommend to the county board and the provider of services steps to be taken to improve the systems and procedures used by the provider to support the functioning of the trained developmental disabilities personnel and suggestions for improving quality related to performance of health-related activities and administration of prescribed medication and maintaining compliance with this chapter.

(9) The quality assessment registered nurse will maintain a copy of each quality assessment review performed in accordance with paragraph (E)(3) of this rule.

(10) The quality assessment registered nurse will coordinate with, as applicable, the county board, the employer of developmental disabilities personnel, or independent provider to ensure that safety concerns are immediately addressed.

(11) The employer of developmental disabilities personnel or the independent provider, as applicable, will submit a written plan of improvement to the quality assessment registered nurse that addresses specific rule violations identified in the quality assessment review within thirty calendar days of receipt of the quality assessment review report.

(a) The written plan of improvement will address all areas that identified a lack of process, an incomplete process, or an ineffective process.

(b) The employer of developmental disabilities personnel or the independent provider, as applicable, will implement a written plan of improvement that addresses specific rule violations identified in the quality assessment review within sixty calendar days of receipt of the quality assessment registered nurse's approval of the plan.

(12) The quality assessment registered nurse will notify the county board and the department when the employer of developmental disabilities personnel or the independent provider fails to:

(a) Participate in or cooperate with the requirements of the review;

(b) Provide required documentation within thirty calendar days of receipt of the request;

(c) Submit a written plan of improvement within sixty calendar days of receipt of the quality assessment review report; or

(d) Successfully implement the written plan of improvement within sixty calendar days of receipt of the quality assessment registered nurse's approval of the plan.

(13) The quality assessment registered nurse will serve as a resource for the county board and providers of services concerning health management issues and may assist in expanding health care services in the community.

(F) Prohibition on performance of health-related activities and administration of prescribed medication by developmental disabilities personnel

(1) If an employer of developmental disabilities personnel believes or is notified by the county board, the department, a delegating nurse, or the quality assessment registered nurse that developmental disabilities personnel have not or will not safely perform health-related activities or administer prescribed medication, the employer will prohibit the action from continuing or commencing. Developmental disabilities personnel will not engage in the action or actions subject to an employer's prohibition.

(2) When the employer prohibits the action from continuing or commencing, the employer will:

(a) Notify the developmental disabilities personnel of the prohibition and immediately make other staffing arrangements so that the needs of individuals served are met in a manner that ensures compliance with the requirements of this chapter;

(b) Immediately notify the department by making a notation regarding the prohibition of the developmental disabilities personnel in the medication administration information system database;

(c) If applicable, immediately notify the county board via the major unusual incident reporting system in accordance with rule 5123-17-02 of the Administrative Code; the county board, as applicable, will notify the quality assessment registered nurse; and

(d) If applicable, immediately notify the delegating nurse.

(3) The employer will ensure corrective action is taken prior to allowing the developmental disabilities personnel to resume the performance of health-related activities or the administration of prescribed medication.

(4) The employer will notify the department by making an entry regarding the corrective action and end of prohibition of the developmental disabilities personnel in the medication administration information system database and, as applicable, the county board, the quality assessment registered nurse, and/or the delegating nurse of the corrective action taken.

(G) Denial, suspension, or revocation of certification issued pursuant to this chapter

(1) The department may deny, suspend, or revoke a certificate holder's certification issued pursuant to this chapter for good cause including:

(a) Misfeasance;

(b) Malfeasance;

(d) Substantiated abuse or neglect;

(e) A violation of sections 5123.41 to 5123.45 of the Revised Code or rules adopted pursuant to this chapter;

(f) The conviction or plea of guilty to a disqualifying offense as set forth in paragraph (E) of rule 5123-2-02 of the Administrative Code and the corresponding exclusionary period has not elapsed;

(g) Other conduct the department determines to be injurious to individuals being served; or

(h) The board of nursing has taken disciplinary action against a certificate holder pursuant to Chapter 4723. of the Revised Code.

(2) When denying, suspending, or revoking certification pursuant to this rule, the department will comply with the notice and hearing requirements of Chapter 119. of the Revised Code and section 5123.452 of the Revised Code.

(3) The department will notify the Ohio board of nursing when the department determines to deny, suspend, or revoke the certification of a registered nurse issued pursuant to this chapter.

(H) Procedures for accepting complaints and conducting investigations

(1) Any complaint regarding the performance of health-related activities or administration of prescribed medication by developmental disabilities personnel pursuant to the authority granted pursuant to section 5123.42 of the Revised Code or compliance with rules adopted pursuant to this chapter will be made to a county board or the department. This paragraph will not be construed to allow developmental disabilities personnel, a representative of developmental disabilities personnel, or an employee organization as defined in Chapter 4117. of the Revised Code to make a complaint to a county board or the department regarding a personnel action.

(2) Any complaints related to the scope of nursing practice will be referred to the Ohio board of nursing.

(3) Any complaints regarding registered nurses related to training of developmental disabilities personnel will be referred to the department.

(4) The department may conduct an audit of a registered nurse's training of developmental disabilities personnel to determine compliance with the requirements set forth in this chapter. When issues are identified, the department may:

(a) Work with the registered nurse trainer to provide technical assistance;

(b) Require a corrective action plan; or

(c) Deny, suspend, or revoke the registered nurse trainer's certification for good cause in accordance with paragraph (G)(1) of this rule.

(5) When a quality assessment registered nurse receives a complaint or identifies concerns based on a quality assessment review conducted pursuant to paragraph (E) of this rule related to the performance or qualifications of developmental disabilities personnel, the quality assessment registered nurse will conduct an initial investigation which includes a discussion with the developmental disabilities personnel and the employer. After completing the initial investigation, the quality assessment registered nurse will contact and work with the department's designee to ensure that the cases are handled in a consistent manner statewide.

(I) Immunity from liability

Developmental disabilities personnel who perform health-related activities or administer medication pursuant to the authority granted pursuant to section 5123.42 of the Revised Code and rule 5123-6-03 of the Administrative Code are not liable for any injury caused by performing the health-related activity or administering the medication when:

(1) The developmental disabilities personnel acted in accordance with the methods taught in training completed in compliance with section 5123.42 of the Revised Code and rules 5123-6-05 and 5123-6-06 of the Administrative Code; and

(2) The developmental disabilities personnel did not act in a manner that constitutes wanton or reckless misconduct.

Last updated August 13, 2026 at 8:24 AM

History

Effective: August 13, 2026
Promulgated Under: 119.03

Chapter 5123-7 Intermediate Care Facilities for Individuals with Intellectual Disabilities

Ohio Adm.Code 5123-7-01 Intermediate care facilities for individuals with intellectual disabilities - definitions.

For the purposes of rules in Chapter 5123-7 of the Administrative Code, the following definitions apply:

(A) "Allowable costs" are those costs incurred for certified beds in an ICFIID as determined by the department to be reasonable, as defined in paragraph (K) of this rule, and do not include recoupments, fines, penalties, or interest paid in accordance with sections 5124.41, 5124.42, 5124.523, and 5124.99 of the Revised Code. Unless otherwise enumerated in Chapter 5123-7 of the Administrative Code, allowable costs are also determined in accordance with the following reference material, in the following priority:

(1) 42 C.F.R. Chapter IV, as in effect on the effective date of this rule;

(2) The centers for medicare and medicaid services provider reimbursement manual (publications 15-1 and 15-2, available at https://www.cms.gov/regulations-and-guidance/guidance/manuals/paper-based-manuals.html); and

(3) Generally accepted accounting principles in accordance with standards prescribed by the "American Institute of Certified Public Accountants" (available at https://www.aicpa.org).

(B) "Date of licensure," for an ICFIID originally licensed as a nursing home under Chapter 3721. of the Revised Code, means the date specific beds were originally licensed as nursing home beds under that chapter, regardless of whether they were subsequently licensed as residential facility beds. For an ICFIID originally licensed as a residential facility, "date of licensure" means the date specific beds were originally licensed as residential facility beds under that section.

(1) If nursing home beds licensed under Chapter 3721. of the Revised Code or residential facility beds licensed under section 5123.19 of the Revised Code were not required by law to be licensed when they were originally used to provide nursing home or residential facility services, "date of licensure" means the date the beds first were used to provide nursing home or residential facility services, regardless of the date the present provider obtained licensure.

(2) If a facility adds nursing home or residential facility beds, or in the case of an ICFIID with more than eight beds or a nursing facility, it extensively renovates the facility after its original date of licensure, it will have a different date of licensure for the additional beds or for the extensively renovated facility, unless, in the case of the addition of beds, the beds are added in a space that was constructed at the same time as the previously licensed beds but was not licensed under Chapter 3721. or section 5123.19 of the Revised Code at that time. The licensure date for additional beds or facilities which extensively renovate will be the date the beds are placed into service.

(D) "Fiscal year" means the fiscal year of this state, as specified in section 9.34 of the Revised Code.

(E) "Inpatient days" means all days during which a resident, regardless of payment source, occupies a bed in an ICFIID that is included in the ICFIID's certified capacity under Title XIX of the Social Security Act, 49 stat. 620 , 42 U.S.C.A. 301, as in effect on the effective date of this rule. Bed-hold days determined in accordance with rule 5123-7-08 of the Administrative Code are considered inpatient days proportionate to the percentage of the ICFIID's per resident per day rate paid for those days.

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

(G) "Owner" means any person or government entity that has at least five per cent ownership or interest, either directly, indirectly, or in any combination, in an ICFIID.

(H) "Provider" means a person or government entity that operates an ICFIID under a provider agreement.

(I) "Provider agreement" means a contract between the Ohio department of medicaid and an operator of an ICFIID for the provision of ICFIID services under the medicaid program. The signature of the operator or the operator's authorized agent binds the operator to the terms of the agreement.

(J) "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.

(K) "Reasonable" means that a cost is an actual cost that is appropriate and helpful to develop and maintain the operation of an ICFIID and resident activities, including normal standby costs, and that does not exceed what a prudent buyer pays for a given item or service. Reasonable costs may vary from provider to provider and from time to time for the same provider.

(L) "Related party" means an individual or organization that, to a significant extent, has common ownership with, is associated or affiliated with, has control of, or is controlled by, the provider.

(1) An individual who is a relative of an owner is a related party.

(2) Common ownership exists when an individual or individuals possess significant ownership or equity in both the provider and the other organization. Significant ownership or equity exists when an individual or individuals possess five per cent ownership or equity in both the provider and a supplier. Significant ownership or equity is presumed to exist when an individual or individuals possess ten per cent ownership or equity in both the provider and another organization from which the provider purchases or leases real property.

(3) Control exists when an individual or organization has the power, directly or indirectly, to significantly influence or direct the actions or policies of an organization.

(4) An individual or organization that supplies goods or services to a provider will not be considered a related party if all of the following conditions are met:

(a) The supplier is a separate bona fide organization;

(b) A substantial part of the supplier's business activity of the type carried on with the provider is transacted with others than the provider and there is an open, competitive market for the types of goods or services the supplier furnishes;

(c) The types of goods or services are commonly obtained by other ICFIID from outside organizations and are not a basic element of resident care ordinarily furnished directly to residents by the ICFIID; and

(d) The charge to the provider is in line with the charge for the goods or services in the open market and no more than the charge made under comparable circumstances to others by the supplier.

(M) "Relative of an owner" means a person who is related to an owner of an ICFIID by one of the following relationships:

(1) Spouse;

(2) Natural parent, child, or sibling;

(3) Adopted parent, child, or sibling;

(4) Stepparent, stepchild, stepbrother, or stepsister;

(5) Father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law;

(6) Grandparent or grandchild; or

(7) Foster parent, foster child, foster brother, or foster sister.

(N) "Representative" means a person acting on behalf of an individual who is applying for or receiving medicaid. A representative may be a family member, guardian, attorney, hospital social worker, ICFIID social worker, or any other person chosen to act on the individual's behalf.

Last updated July 1, 2024 at 4:48 PM

History

Effective: July 1, 2024
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-02 Intermediate care facilities for individuals with intellectual disabilities - provider agreement and other essential requirements.

(A) Purpose

This rule sets forth requirements for an intermediate care facility for individuals with intellectual disabilities (ICFIID) to be eligible for initial and continued participation in the Ohio medicaid program and to receive payment for ICFIID services to eligible residents.

(B) Definitions

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

(1) "Certification" means the process by which the Ohio department of health certifies its findings to the federal centers for medicare and medicaid services or the Ohio department of medicaid with respect to a facility's compliance with health and safety requirements of divisions (a), (b), (c), and (d) of section 1919 of the Social Security Act, 42 U.S.C. 1396r.

(2) "Certified beds" means beds that are counted in a facility that meets medicaid standards. A count of facility beds may differ depending on whether the count is used for certification, licensure, eligibility for medicaid payment formulas, eligibility for waivers, or other purposes.

(3) "Change of operator" has the same meaning as in section 5124.01 of the Revised Code.

(4) "Facility closure" has the same meaning as in section 5124.01 of the Revised Code.

(5) "Operator" means the individual, partnership, association, trust, corporation, or other legal entity that operates an ICFIID.

(6) "Residential respite" has the same meaning as in rule 5123-9-34 of the Administrative Code.

(7) "Voluntary termination" has the same meaning as in section 5124.01 of the Revised Code.

(1) To participate in the Ohio medicaid program an operator must:

(a) Operate a residential facility licensed by the department in accordance with section 5123.19 of the Revised Code and rules adopted to implement that section.

(b) Operate a facility certified by the Ohio department of health as being in compliance with applicable federal regulations for medicaid participation as an ICFIID with a minimum of four certified beds. A facility's certification as an ICFIID by the Ohio department of health governs the types of services the facility may provide.

(2) An operator will:

(a) Execute the provider agreement in the format provided by the Ohio department of medicaid.

(b) Apply for and maintain a valid license issued by the department.

(d) Open all records relating to the costs of its services for inspection and audit by the department and the Ohio department of medicaid.

(e) Supply to the department and the Ohio department of medicaid such information as the department or the Ohio department of medicaid requests concerning services to individuals who have applied for or been determined to be eligible for medicaid.

(f) Permit access to the ICFIID and its records for inspection by the department, the Ohio department of medicaid, the Ohio department of health, the county department of job and family services, and any other state or local government entity having authority to inspect, to the extent of that entity's authority.

(g) In the case of a change of operator, adhere to the following procedures:

(i) The exiting operator or owner and entering operator must provide a written notice to the department and the Ohio department of medicaid, as provided in section 5124.51 of the Revised Code, at least forty-five calendar days prior to the effective date of any actions that constitute a change of operator, but at least ninety calendar days prior to the effective date if residents are to be relocated. An exiting operator that does not give proper notice is subject to the penalties specified in section 5124.42 of the Revised Code.

(ii) The entering operator must submit documentation of any transaction (e.g., sales agreement, contract, or lease) as requested by the department or the Ohio department of medicaid to determine whether a change of operator has occurred.

(iii) The entering operator will submit an application for participation in the medicaid program and a written statement of intent to abide by rules of the department and the Ohio department of medicaid, the provisions of the assigned provider agreement, and any centers for medicare and medicaid services "Statement of Deficiencies and Plan of Correction" forms (CMS-2567) submitted by the exiting operator.

(iv) An entering operator is subject to the same survey findings as the exiting operator unless the entering operator does not accept assignment of the exiting operator's provider agreement. Refusal to accept assignment results in termination of certification on the last day of the exiting operator's participation in medicaid. An entering operator who refuses assignment may reapply for medicaid participation and must undergo a complete initial certification survey by the Ohio department of health. There may be gaps in medicaid coverage at the facility.

(h) Comply with Title VI of the Civil Rights Act, 42 U.S.C. 2000d, Title VII of the Civil Rights Act, 42 U.S.C. 2000e, and the Americans with Disabilities Act of 1990, 42 U.S.C. 12101, and will not discriminate against any resident on the basis of race, color, age, sex, gender, sexual orientation, creed, national origin, ancestry, religion, or disability.

(i) Provide written notice to the department within five calendar days of any bankruptcy or receivership pertaining to the provider. The written notice will be sent by electronic mail to licensuredevelopmentapps@dodd.ohio.gov or by United States mail to "Ohio Department of Developmental Disabilities, Division of Medicaid Administration, 30 East Broad Street, 13th Floor, Columbus, Ohio 43215-3414."

(j) Provide the department, the Ohio department of medicaid, the resident or guardian (as applicable), and anyone designated by the resident or guardian written notice at least ninety calendar days prior to a facility closure or voluntary termination from the medicaid program in accordance with section 5124.50 of the Revised Code. An operator that does not issue the proper notice is subject to the penalties specified in section 5124.42 of the Revised Code.

(3) An operator will not:

(a) Charge, to an individual or applicant who is eligible for medicaid:

(i) A fee for the application process;

(ii) An admission fee; or

(iii) An advance deposit.

(b) Directly bill its residents for or directly pass through to its residents the franchise permit fee.

(c) Require a third party to accept personal responsibility for paying the ICFIID charges. An operator, however, may require a representative who has legal access to an individual's income or resources available to pay for ICFIID services to sign a contract, without incurring personal financial liability, to provide payment from the individual's income or resources if the individual's medicaid application is denied and if the individual's cost of care is not being paid by medicare or another third-party payor. A third-party guarantee is not the same as a third-party payor (i.e., an insurance company), and this provision does not preclude the operator from obtaining information about medicare and medicaid eligibility or the availability of private insurance. The prohibition against third-party guarantees applies to all residents and prospective residents of an ICFIID regardless of payment source. This provision does not prohibit a third party from voluntarily making payment on behalf of an individual.

(D) Effective dates of provider agreements

(1) Effective dates of initial provider agreements generally are assigned by the Ohio department of health on the basis of findings of compliance or substantial compliance with standards of certification.

(2) If a provider agreement is involuntarily terminated by the centers for medicare and medicaid services as the result of a look behind survey, re-entry into the medicaid program requires satisfaction of the reasonable assurance period as set forth in the centers for medicare and medicaid services "Medicaid State Operations Manual," chapter 2, section 2016F (publication 100-07) available at https://www.cms.gov/medicare/regulations-guidance/manuals/internet-only-manuals-ioms.

(E) Conditional provider agreements and cancellation clauses

(1) If the Ohio department of health determines that an ICFIID is in substantial compliance with medicaid standards but has deficiencies that must be corrected, the Ohio department of medicaid may execute a conditional provider agreement for a term of up to twelve full calendar months, subject to an automatic cancellation clause.

(2) The ICFIID must correct deficiencies within sixty calendar days following the scheduled date of correction as established by the Ohio department of health.

(3) If deficiencies are corrected before the cancellation date, the Ohio department of health may rescind the cancellation notice, and will notify the department and the Ohio department of medicaid in writing of its decision.

(4) If deficiencies are not corrected before the cancellation date, the Ohio department of health may propose termination of the provider agreement.

(5) If deficiencies are not corrected, the Ohio department of medicaid may cancel the provider agreement in accordance with section 5164.38 of the Revised Code, unless the Ohio department of health:

(a) Finds that all required corrections have been made and notifies the department and the Ohio department of medicaid; or

(b) Determines that substantial progress has been made in carrying out a plan of correction that has been submitted to and accepted by the Ohio department of health.

(F) Termination, suspension, denial, or non-renewal of provider agreement

(1) At the request of the department or upon its own initiative, the Ohio department of medicaid may terminate, suspend, or not enter into the provider agreement upon thirty calendar days written notice to the provider for a violation of Chapter 5123., 5124., or 5160. of the Revised Code or rules adopted pursuant to those chapters and if applicable, subject to Chapter 119. of the Revised Code.

(2) In accordance with section 5164.33 of the Revised Code, a provider agreement may be terminated, suspended, denied, or not revalidated if the Ohio department of medicaid determines such an agreement is not in the best interests of the state or medicaid recipients.

(3) The Ohio department of medicaid will terminate, deny, or not revalidate a provider agreement when any of the situations set forth in division (E) of section 5164.38 of the Revised Code occur.

(G) Waiver of licensed capacity

(1) To accommodate persons in emergency need of ICFIID services, the department may issue an operator a waiver of licensed capacity. A waiver of licensed capacity is time-limited and temporarily permits the operator to exceed the maximum number of licensed beds.

(2) A waiver of licensed capacity may be made specifically in order to provide residential respite as a prior-authorized service to a person enrolled in a home and community-based services waiver. Beds designated for residential respite for persons enrolled in home and community-based services waivers will not be included in the provider agreement.

(H) Beds subject to certification survey

(1) All beds in a medicaid-participating ICFIID that are not designated for residential respite for persons enrolled in home and community-based services waivers will be surveyed to determine compliance with the applicable certification standards.

(2) If the beds are certifiable, they will be included in the provider agreement.

(3) Beds authorized through a waiver of licensed capacity in accordance with paragraph (G)(1) of this rule that are used to provide ICFIID services will be included in the provider agreement.

(4) The only other basis for allowing non-participation of a portion of an Ohio ICFIID is certification of noncompliance by the Ohio department of health.

(I) Requirements for out-of-state providers of ICFIID services

To participate in the Ohio medicaid program and receive payment for ICFIID services to eligible Ohio residents, an operator of a facility located outside Ohio must:

(1) Hold a valid state-required license, registration, or equivalent from the respective state that specifies the level of care the facility is qualified to provide;

(2) Hold a medicaid provider agreement from the respective state as an ICFIID provider type;

(3) Hold a medicaid provider agreement with the Ohio department of medicaid; and

(4) Obtain resident-specific and date-specific prior authorization in accordance with rules 5160-1-11 and 5160-1-31 of the Administrative Code.

Last updated June 30, 2025 at 7:43 AM

History

Effective: June 30, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-03 Intermediate care facilities for individuals with intellectual disabilities - peer group 6.

(A) Purpose

This rule sets forth requirements for intermediate care facilities for individuals with intellectual disabilities (ICFIID) in peer group 6 and the manner in which the payment rate for peer group 6 is determined. ICFIID in peer group 6 serve youth in need of intensive behavioral support services primarily for short-term stays and secondarily for longer-term stays, with the goal of youth returning to their family home or other community-based home upon discharge.

(B) Definitions

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

(2) "Aftercare services" means individualized, intensive, post-discharge services driven by input from a youth and the youth's team, provided by a discharging ICFIID to the youth and the youth's family or other caregivers, as applicable.

(3) "Cost report" has the same meaning as in rule 5123-7-12 of the Administrative Code.

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

(6) "Longer-term stay" means an arrangement pre-approved by the department, for a resident of an ICFIID in peer group 6 to remain at the ICFIID for an additional period of up to one hundred eighty days.

(7) "Major unusual incident" has the same meaning as in rule 5123-17-02 of the Administrative Code.

(8) "Peer group 6" has the same meaning as in section 5124.01 of the Revised Code.

(9) "Short-term stay" means an arrangement pre-approved by the department, for a youth to be admitted to an ICFIID in peer group 6 for one hundred eighty or fewer days with the intended outcome that the youth will be discharged and return to the youth's family home or another community-based setting.

(10) "Short-term stay rate add-on" means a per diem payment of one hundred dollars to an ICFIID in peer group 6 approved by the department to serve a youth admitted for a short-term stay.

(11) "Unusual incident" has the same meaning as in rule 5123-17-02 of the Administrative Code.

(12) "Youth" means persons in middle to late childhood, generally age ten through twenty.

(1) To be assigned to peer group 6, an ICFIID will:

(a) Have a medicaid-certified capacity not exceeding six, which will be used exclusively to serve youth in need of intensive behavioral support services.

(b) Complete and submit an application to the department. 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.

(c) Submit a best practices protocol for serving youth in need of intensive behavioral support services. The department will evaluate the protocol to determine if it is approved.

(d) Enter into an agreement with the department for the provision of services for youth in need of intensive behavioral support services that includes a provision for the department to approve all admissions to the ICFIID.

(e) Agree to serve youth in need of intensive behavioral support services for short-term stays.

(f) Agree to cooperate with the department's oversight of services to youth in need of intensive behavioral support services.

(2) An ICFIID whose license has been suspended and/or revoked by the department within the past twenty-four months is not eligible for peer group 6.

(3) The department may deem an ICFIID that was approved to receive the intensive behavioral support rate add-on described in rule 5123-7-28 of the Administrative Code on the day immediately prior to the effective date of this rule, eligible for peer group 6.

(D) General requirements for ICFIID in peer group 6

(1) An ICFIID in peer group 6 will have:

(a) Adequate bedrooms so that each youth served is the sole occupant of a bedroom.

(b) Ample space inside and outside to accommodate the spatial needs of youth served.

(2) An ICFIID in peer group 6 will ensure:

(a) Nursing services are available twenty-four hours per day.

(b) Psychiatric services are available twenty-four hours per day and each youth's clinical status is reviewed at least once every ninety calendar days.

(c) Intensive and specialized therapies (e.g., occupational, physical, speech, audiology, and applied behavior analysis) as well as non-traditional therapies (e.g., art, music, and recreation) are made available to each youth in accordance with the youth's individual service plan.

(d) Family therapy is made available to each youth and the youth's family in accordance with the youth's individual service plan.

(3) An ICFIID in peer group 6 will ensure staff have adequate experience and training to effectively carry-out their duties.

(a) Staff who conduct assessments, develop individual service plans, and/or train others to implement individual service plans will:

(i) 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; or

(ii) Hold a certificate to practice as a certified Ohio behavior analyst pursuant to section 4783.04 of the Revised Code; or

(iii) 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.

(b) Staff who supervise the day-to-day provision of intensive behavioral support services to youth as well as staff who directly provide the services will, prior to supervising or providing the services, successfully complete training required by paragraphs (F) and (G) of rule 5123-3-01 of the Administrative Code as well as training in:

(i) Orientation to provision of intensive behavioral support services, including the rights of persons with developmental disabilities set forth in section 5123.62 of the Revised Code and the requirements of rule 5123-2-06 of the Administrative Code;

(ii) Accepted best practices and innovative approaches, as set forth in the ICFIID's best practices protocol for serving youth in need of intensive behavioral support services;

(iii) Department-provided training in comprehensive supports for youth with complex behavioral support needs;

(iv) Crisis intervention training in a curriculum selected by the ICFIID; and

(v) The specific needs of, and supports to be provided to, each resident.

(E) Process and timelines for admission of youth

(1) The department will identify youth to be served by an ICFIID in peer group 6 when the department determines, based on a comprehensive review of a youth conducted in collaboration with the youth's home county board, the youth needs intensive behavioral support services.

(2) Referral of a youth to the department for a comprehensive review will be initiated by the youth's home county board. The referral will be signed by the superintendent of the county board and electronically submitted to the department. A referral of a youth will include:

(a) The most recent waiting list assessment for the youth completed by the youth's home county board.

(b) Identification of the necessary supports for the youth to return to the youth's family home or other community-based home and the plan for securing those supports, including consideration of a home and community-based services waiver.

(d) Name and contact information for the designated point of contact from the school district in the youth's home county and a copy of the youth's current individualized education program.

(e) A description of services and supports that have been offered to and accessed by the youth and the youth's family and an explanation of why those services and supports did not meet the youth's needs.

(f) When applicable, a commitment from the public children services agency to remain engaged while the youth resides at the ICFIID and to collaborate with the youth's home county board to ensure successful transition planning for the youth.

(3) Within fourteen calendar days of receipt of a referral of a youth by the youth's home county board, the department will conduct a comprehensive review of the youth that includes input from the youth and the youth's team and considers:

(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 the "Child and Adolescent Needs and Strengths" decision-making tool which has been administered within the most recent ninety calendar days.

(b) Positive supports and interventions that have been found effective in meeting the youth's needs (e.g., successful visual and environmental supports).

(4) When, based on the comprehensive review of a youth described in paragraph (E)(3) of this rule, the department determines to refer the youth to an ICFIID, the department will notify the ICFIID in writing. The notice will include related documentation to inform the ICFIID's consideration of the referral.

(5) Within seven calendar days of receipt of a referral of a youth from the department, an ICFIID will electronically notify the department of its initial decision to consider admission of the youth or decline the referral. The ICFIID will provide an explanation when a referral is declined. While the ICFIID is considering admission of a youth, the department will invite the ICFIID to meet with the youth and the youth's team.

(6) Within twenty-one calendar days of receipt of a referral of a youth from the department, an ICFIID will electronically notify the department of its final decision to accept or decline the referral. The ICFIID will provide an explanation when a referral is declined.

(7) An ICFIID will take measures to admit a youth within fourteen calendar days of its final decision to accept the referral of the youth from the department. The ICFIID will alert the department via electronic mail to icfyouth@dodd.ohio.gov if delays in admission are encountered.

(F) Requesting a short-term stay rate add-on

(1) An ICFIID that has agreed to admit a youth for a short-term stay will electronically submit a request for the short-term stay rate add-on to the department.

(2) The payment approval date for the short-term stay rate add-on will be the latter of the date of approval for payment of the short-term stay rate add-on or the date of admission to the ICFIID, but will not be earlier than the effective date of a youth's developmental disabilities level of care determination.

(3) The short-term stay rate add-on will be billed and paid in addition to an ICFIID's typical per diem rate.

(4) An ICFIID will not bill the short-term stay rate add-on for a youth who is using bed-hold days in accordance with rule 5123-7-08 of the Administrative Code.

(5) Payment of the short-term stay rate add-on may be denied for any service not rendered in accordance with Chapters 5123-3, 5123-7, and 5160-3 of the Administrative Code.

(6) Payment of the short-term stay rate add-on will not exceed one hundred eighty days for a specific youth.

(G) Requesting an extension of a youth's stay

(1) The department may approve a longer-term stay for a youth initially admitted for a short-term stay.

(2) To ensure continuity, an ICFIID will electronically submit a request for an extension of a youth's stay at least thirty calendar days prior to the last day of the approved period.

(3) 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 or documentation deemed relevant by the department.

(4) Within seven calendar days of receipt of a request for an extension of a youth's stay, including any additional information or documentation requested by the department, the department will respond to the ICFIID in writing. The department will provide an explanation when a request is denied.

(5) When the department denies a request for an extension of a youth's stay, the department may allow the youth to continue to reside at the ICFIID while discharge planning occurs. The department may specify additional steps to be taken to ensure a successful transition.

(H) Meeting a youth's needs

(1) An ICFIID in peer group 6 will develop an individual service 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.

(2) An ICFIID in peer group 6 serving a youth for a short-term stay will conduct, at a minimum, bi-weekly meetings to review the youth's care and progress.

(a) The ICFIID will invite the following persons to the bi-weekly meetings:

(i) The youth;

(ii) The youth's parent or guardian, as applicable, and/or other family representative designated by the youth's parent or guardian;

(iii) A representative of the youth's home county board;

(iv) A representative of the care management entity designated by the Ohio resilience through integrated systems and excellence ("OhioRISE") program described in Chapter 5160-59 of the Administrative Code;

(v) A representative of the youth's home school district;

(vi) A representative of the school district serving the youth while the youth resides at the ICFIID; and

(vii) A representative of the department.

(b) The ICFIID will conduct the bi-weekly meetings so that invited persons may participate via technology from remote locations.

(3) An ICFIID in peer group 6 serving a youth for a longer-term stay will conduct, at a minimum, monthly meetings to update the youth's discharge plan.

(a) The ICFIID will invite the persons described in paragraphs (H)(2)(a)(i) to (H)(2)(a)(vii) of this rule to the monthly meetings.

(b) The ICFIID will conduct the monthly meetings so that invited persons may participate via technology from remote locations.

(4) An ICFIID in peer group 6 will collaborate with a youth's home county board to transition a youth who no longer needs intensive behavioral support services to an appropriate alternative setting within ninety calendar days.

(5) An ICFIID in peer group 6 will, in collaboration with a youth's home county board and the department, provide three months of aftercare services upon the youth's discharge.

(I) Determination of the payment rate for an ICFIID in peer group 6

(1) The total per medicaid day payment rate that the department will pay to an ICFIID in peer group 6 will be calculated in accordance with section 5124.15 of the Revised Code.

(2) The department will determine the per medicaid day capital component rate for an ICFIID in peer group 6 in the manner established in section 5124.17 of the Revised Code for peer group 4.

(3) The department will determine the per medicaid day direct care costs component rate for an ICFIID in peer group 6 in the manner established in section 5124.19 of the Revised Code for peer group 4.

(4) The department will determine the per medicaid day indirect care costs component rate for an ICFIID in peer group 6 in the manner established in section 5124.21 of the Revised Code for peer group 4.

(5) The department will determine the per medicaid day other protected costs component rate for an ICFIID in peer group 6 in the manner established in section 5124.23 of the Revised Code for peer group 4.

(J) Submission of cost reports

(1) An ICFIID that becomes newly assigned to peer group 6 will file an initial cost report covering the period that begins with the day that the ICFIID is assigned to peer group 6 and ends on the last day of the last month of the first three full months of operation as peer group 6.

(2) An ICFIID that files a cost report in accordance with paragraph (J)(1) of this rule is not required to file a cost report for the calendar year if the ICFIID's initial cost report covers a period that begins after the first day of October of that calendar year.

(K) Department oversight

(1) The department will oversee the provision of intensive behavioral support services to youth. 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 youth's team.

(b) Facilitating collaboration between the ICFIID and the youth's home county board.

(2) The department may withdraw approval of an ICFIID's eligibility for peer group 6 based on:

(a) The ICFIID's failure to provide services in accordance with this rule or its agreement with the department for the provision of services for youth in need of intensive behavioral support services.

(b) A pattern of refusing to serve youth referred to the ICFIID by the department.

(c) A pattern of requests to involuntarily discharge youth 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.

(3) The department will notify an ICFIID in writing of withdrawal of approval of the ICFIID's eligibility for peer group 6 no less than thirty calendar days in advance.

(4) The department will reassign an ICFIID that is no longer eligible for peer group 6 to the appropriate peer group.

Last updated July 1, 2026 at 8:13 AM

History

Effective: July 1, 2026
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-04 Intermediate care facilities for individuals with intellectual disabilities - payment during the Ohio department of medicaid administrative appeals process for termination of a provider agreement.

(A) Purpose

This rule clarifies conditions under which payment may be made to an intermediate care facility for individuals with intellectual disabilities (ICFIID) during proposed termination and upon termination of the ICFIID's provider agreement by the Ohio department of medicaid.

(B) Payment during the appeals process

When the Ohio department of medicaid is required to provide an adjudicatory hearing pursuant to Chapter 119. of the Revised Code, payment will continue for medicaid-covered services provided to eligible residents during the appeal of and the proposed termination of an ICFIID's provider agreement. Payment will not be made under this provision for services rendered on or after the effective date of the issuance of a final order of adjudication pursuant to Chapter 119. of the Revised Code, except as provided in paragraph (C)(1) of this rule.

(1) Payment may be provided up to thirty calendar days following the effective date of termination of an ICFIID's provider agreement or after an administrative hearing decision that upholds the termination action. Payment will be available if both of the following conditions are met:

(a) Payment is for residents admitted to the ICFIID before the effective date of termination; and

(b) The ICFIID cooperates with federal, state, and local entities in the effort to transfer residents to other facilities or community programs that can meet the residents' needs.

(2) When the Ohio department of medicaid acts under instructions from the United States department of health and human services, payment ends on the termination date specified by that agency.

Last updated June 30, 2025 at 7:43 AM

History

Effective: June 30, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-05 Intermediate care facilities for individuals with intellectual disabilities - payment during the Ohio department of health administrative appeals process for termination or non-renewal of medicaid certification.

(A) Purpose

This rule clarifies conditions under which payment may be made to an intermediate care facility for individuals with intellectual disabilities (ICFIID) during proposed termination or non-renewal and upon termination or non-renewal of the ICFIID's medicaid certification by the Ohio department of health.

(B) Definitions

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

(1) "Effective date of termination" means the date set by the Ohio department of health or the United States department of health and human services for the termination of medicaid certification.

(2) "Informal reconsideration" is the process by which an ICFIID may refute in writing, prior to the termination or non-renewal of medicaid certification, the Ohio department of health's findings on which the termination or non-renewal is based. The ICFIID must receive a written response to the informal reconsideration request which either affirms or reverses the survey decisions. Informal reconsideration is a process independent of the formal appeal. An ICFIID may or may not choose to utilize informal reconsideration.

In addition to or in conjunction with the appeals process, an ICFIID may request informal reconsideration. If informal reconsideration results in an affirmation of the original survey findings, the appeals process moves forward to the administrative hearing if one was requested. If informal reconsideration results in a reversal of the original survey findings, the Ohio department of health's termination or non-renewal action, based on those original findings, is dismissed.

(D) Payment during the appeals process

(1) During the appeals process provided by the Ohio department of health in accordance with rule 3701-63-01 of the Administrative Code for the proposed termination or non-renewal of medicaid certification, payment under regulations for covered services provided to eligible residents will continue through the earlier of:

(a) The date of issuance of a final order of adjudication that upholds the Ohio department of health's termination or non-renewal action; or

(b) The one hundred twentieth calendar day after the effective date of termination of the ICFIID's provider agreement.

(2) Payment may be provided up to an additional thirty calendar days following either the cessation of payment on the one hundred twentieth calendar day post termination or non-renewal, or after the issuance of an adjudication order that upholds the termination or non-renewal action. Payment will be available if both of the following conditions are met:

(a) Payment is for residents admitted to the ICFIID before the effective date of termination or non-renewal; and

(b) The ICFIID cooperates with federal, state, and local entities in the effort to transfer residents to other facilities or community programs that can meet the residents' needs.

(E) Payment following termination of medicaid certification

(1) When the Ohio department of medicaid acts under instructions from the United States department of health and human services, payment ends on the termination date specified by that agency.

(2) When the Ohio department of health certifies that there is jeopardy to residents' health and safety by issuing an order under Chapter 5165. of the Revised Code, or when the Ohio department of health fails to certify that there is no jeopardy, payment will end on the effective date of termination.

(F) Termination of provider agreement

When an ICFIID's medicaid certification is terminated or not renewed, the Ohio department of medicaid will terminate the ICFIID's provider agreement.

Last updated June 30, 2025 at 7:44 AM

History

Effective: June 30, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-08 Intermediate care facilities for individuals with intellectual disabilities - bed-hold days.

(A) Purpose

This rule establishes requirements and procedures for an intermediate care facility for individuals with intellectual disabilities (ICFIID) to be reimbursed for reserving a bed for a resident who is temporarily absent.

(B) Definitions

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

(1) "Admission" occurs when an individual who was not being counted in the census of any Ohio medicaid-certified ICFIID becomes a resident of an ICFIID. An admission may be a new admission or a return admission after a discharge.

(2) "Advanced practice registered nurse" has the same meaning as in section 4723.01 of the Revised Code.

(3) "Bed-hold day" means a day for which a bed is reserved for a resident of an ICFIID through medicaid reimbursement while the resident is temporarily absent from the ICFIID for hospitalization, therapeutic leave, or a visit with friends or relatives. Reimbursement for bed-hold days may be made only if the resident has the intent and ability or may have cause to return to the same ICFIID. A resident on bed-hold day status is not considered discharged because the ICFIID is reimbursed to hold the bed while the resident is on temporary leave.

(4) "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.

(5) "Discharge" means the full release of a resident from an ICFIID so that he or she is no longer counted in the ICFIID's census. Reasons for discharge include, but are not limited to, the resident's move to another ICFIID, decision to reside in a community-based setting, or death. The day of discharge is not counted as a bed-hold day or an occupied day except when discharge and admission occur on the same day, in which case the day is considered a day of admission and counts as one occupied day.

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

(7) "Hospital" has the same meaning as in rule 3701-59-01 of the Administrative Code.

(8) "Hospitalization" means a resident is temporarily absent from an ICFIID for the purpose of receiving services or being treated in a hospital.

(9) "Institution for mental disease" has the same meaning as in rule 5160-3-16.4 of the Administrative Code.

(10) "Occupied day" means either:

(a) A day of admission; or

(b) A day during which a medicaid-eligible resident's stay in an ICFIID is eight or more hours. A day begins at twelve a.m. and ends at eleven fifty-nine p.m.

(11) "Readmission" occurs when a resident returns to the same ICFIID following use of bed-hold days.

(12) "Skilled nursing facility" means a nursing facility certified to participate in the medicare program.

(13) "Therapeutic leave" means a resident is temporarily absent from an ICFIID, and is in a residential setting other than a long-term care facility, hospital, or other entity eligible to receive federal, state, or county funds to maintain a resident, for the purpose of receiving a regimen of therapeutic services or visiting a potential new residential setting.

(1) The department shall not make payment to an ICFIID to reserve a bed for a medicaid-eligible prospective resident.

(2) An ICFIID shall not accept preadmission payment to reserve a bed from a medicaid-eligible prospective resident or from any other source on the prospective resident's behalf as a precondition for admission.

(D) Limits and reimbursement for bed-hold days

(1) For a medicaid-eligible resident of an ICFIID, except those excluded in accordance with paragraph (H) of this rule, the department may reimburse the ICFIID to reserve a bed only for as long as the resident has a developmental disabilities level of care determination and intends or may have cause to return to the same ICFIID, but not for more than thirty days in any calendar year unless additional days have been authorized by the department in accordance with paragraph (E) of this rule.

(2) Reimbursement for bed-hold days shall be paid at one hundred per cent of the ICFIID's per diem rate.

(3) Reimbursement for bed-hold days may be made for the following reasons:

(a) Hospitalization

Bed-hold days used for hospitalization may be reimbursed only until:

(i) The day the resident's anticipated level of care at time of discharge from the hospital changes to a level of care that the ICFIID is not certified to provide;

(ii) The day the resident is discharged from the hospital, including discharge resulting in transfer to the ICFIID, a nursing facility, or a skilled nursing facility;

(iii) The day the resident decides to go to another ICFIID upon discharge from the hospital and notifies the first ICFIID; or

(iv) The day the hospitalized resident dies.

(b) Therapeutic leave

(i) A plan to use bed-hold days for therapeutic leave for the purpose of receiving a regimen of therapeutic services must be approved in advance by a physician or an advanced practice registered nurse and documented in the resident's medical record. The documentation shall be available for viewing by the department.

(ii) A plan to use bed-hold days for therapeutic leave for the purpose of visiting a potential new residential setting must be approved in advance by a physician, an advanced practice registered nurse, or a qualified intellectual disability professional and documented in the resident's medical record or individual plan. The documentation shall be available for viewing by the department.

(iii) An ICFIID shall make arrangements for the resident to receive required care and services while on approved therapeutic leave. Medicaid funding, however, shall not be used for state plan home health services, durable medical equipment, and/or private duty nursing on days for which the ICFIID receives reimbursement for bed-hold days.

(i) A plan to use bed-hold days to visit with friends or relatives must be approved in advance by a physician, an advanced practice registered nurse, or a qualified intellectual disability professional and documented in the resident's medical record or individual plan. The documentation shall be available for viewing by the department.

(ii) An ICFIID shall make arrangements for the resident to receive required care and services while on approved visits. Medicaid funding, however, shall not be used for state plan home health services, durable medical equipment, and/or private duty nursing on days for which the ICFIID receives reimbursement for bed-hold days.

(iii) The number of days per visit is flexible within the maximum bed-hold days, allowing for differences in the resident's physical condition, the type of visit, and travel time.

(4) The number and frequency of bed-hold days used shall be considered in evaluating the continuing need of a resident for care in an ICFIID.

(E) Requests for additional bed-hold days

(1) Additional bed-hold days beyond the original thirty days in a calendar year require prior authorization except in the event of an emergency situation. In the event of an emergency situation, authorization may be requested after the fact if the request is submitted no later than one business day following the first additional bed-hold day. A maximum of thirty additional consecutive bed-hold days may be authorized per request.

(2) An ICFIID shall submit a request for additional bed-hold days to the department electronically via the department's website. The request shall be consistent with the goals of the resident's individual plan and medical records and include:

(a) Reason for bed-hold days (i.e., hospitalization, therapeutic leave, or visit with friends or relatives);

(b) Projected dates of absence; and

(3) The department shall review the request for additional bed-hold days and send notice within five business days of approval or denial to the ICFIID.

(a) When a request is approved, the notice shall specify the time period during which the bed-hold days may be used.

(b) When a request is denied, the notice shall specify the reason for denial and explain the individual's right to a state hearing in accordance with section 5101.35 of the Revised Code.

(4) The department shall review requests for additional bed-hold days on a case-by-case basis. Conditions under which a request may be denied include, but are not limited to, visits with friends or relatives exceeding thirty consecutive days or forty-five total days in a calendar year.

(5) An approved request for additional bed-hold days is for the specified period of time only. Unused bed-hold days from an approved request shall not be used at a later time. A new request must be submitted if additional bed-hold days are required during that same calendar year.

(6) Bed-hold days beyond the original thirty days used without prior authorization by the department may result in an adjustment to the ICFIID's reimbursement.

(F) Readmission

An ICFIID shall readmit a resident upon depletion of approved bed-hold days or at any time prior to depletion of approved bed-hold days upon the resident's request for readmission.

(G) Residents eligible for bed-hold days

(1) Medicaid reimbursement for bed-hold days is available under the provisions specified in this rule if a resident:

(a) Is eligible for medicaid services and has met the patient liability and financial eligibility requirements set forth in Chapter 5160:1-6 of the Administrative Code;

(b) Requires a developmental disabilities level of care; and

(2) If a resident meets all of the criteria in paragraph (G)(1) of this rule and is pending approval of a medicaid application and requires bed-hold days, medicaid reimbursement shall be made retroactive to the date the resident became medicaid-eligible and approved for medicaid vendor reimbursement through the date the resident returns from a leave or until the maximum number of bed-hold days are exhausted.

(H) Exclusions

Bed-hold days are not available to a medicaid-eligible resident of an ICFIID who is:

(1) Enrolled in a medicare or medicaid hospice program;

(2) Over age twenty-one and under age sixty-five and becomes a patient of an institution for mental disease;

(3) Enrolled in a home and community-based services waiver;

(4) In a period of restricted medicaid coverage because of an improper transfer of resources as set forth in rule 5160:1-6-06.5 of the Administrative Code; or

(5) Relocating due to anticipated closure of an ICFIID, an ICFIID's voluntary withdrawal from participation in the medicaid program, or other events that result in termination of an ICFIID's medicaid provider agreement except when the ICFIID becomes a downsized ICFIID as defined in section 5124.01 of the Revised Code or converts beds from ICFIID services to home and community-based services in accordance with section 5124.60 or 5124.61 of the Revised Code. No span of bed-hold days shall be approved that ends on an ICFIID's date of closure or termination from participation in the medicaid program.

(I) Compliance

(1) Without limiting such other remedies provided by law for noncompliance with this rule:

(a) The Ohio department of medicaid may terminate the ICFIID's provider agreement; or

(b) The department may require the ICFIID to submit and implement a corrective action plan on a schedule specified by the department.

(2) An ICFIID shall cooperate with any investigation and shall provide copies of any records requested by the department or the Ohio department of medicaid.

Last updated October 15, 2021 at 8:29 AM

History

Effective: October 15, 2021
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-09 Intermediate care facilities for individuals with intellectual disabilities - personal needs allowance accounts.

(A) Purpose

This rule establishes requirements and procedures regarding personal needs allowance accounts of residents of an intermediate care facility for individuals with intellectual disabilities (ICFIID).

(B) Definitions

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

(1) "Patient liability" means an individual's financial obligation toward the medicaid cost of care.

(2) "Personal needs allowance" means a required deduction in the computation of patient liability for needs of a resident of an ICFIID.

(3) "Personal needs allowance account" means an account or petty cash fund that holds the personal needs allowance funds of a resident of an ICFIID and is managed for the resident by the ICFIID.

(1) An ICFIID will allow residents to manage their financial affairs and teach them to do so to the extent of their capabilities in accordance with 42 C.F.R. 483.420.

(2) An ICFIID will hold, safeguard, manage, account for, and convey a resident's funds in accordance with rule 5123-2-07 of the Administrative Code.

(D) Personal needs allowance account

(1) A medicaid-eligible resident of an ICFIID may retain a personal needs allowance account in the amount set forth in section 5163.33 of the Revised Code.

(2) A personal needs allowance account is the exclusive property of the resident, who may use the funds as the resident chooses in any lawful manner.

(3) An ICFIID will not require a resident to deposit personal needs allowance funds with the ICFIID; a resident wishing to do so will submit a request to the ICFIID in writing.

(4) An ICFIID will explain both verbally and in writing to a resident or the resident's representative, as applicable, that personal needs allowance funds are for the resident to use as the resident chooses. If a resident's representative is the payee for the resident's personal needs allowance account, the resident's representative is responsible for ensuring that the funds are used to meet the personal needs of the resident.

(E) Notification of certain balances and transactions that may affect medicaid eligibility

(1) When the funds in a personal needs allowance account of a medicaid-eligible resident reach two hundred dollars less than the resource limit set forth in rule 5160:1-3-05.1 of the Administrative Code or section 5163.092 of the Revised Code, as applicable, the ICFIID will:

(a) Give written notice to the resident or the resident's representative, as applicable, that the resident may lose medicaid eligibility if the amount in the personal needs allowance account, in addition to the value of other nonexempt resources, exceeds the resource limit and retain a copy of the written notice in the resident's file; and

(b) Work with the resident or the resident's representative, as applicable, and the county department of job and family services to coordinate a spenddown plan.

(2) An ICFIID will report to the county department of job and family services any personal needs allowance account balance in excess of the resource limit. The county department of job and family services will apply the excess amount to the routine cost of the resident's ICFIID services.

(3) If a resident is considering using personal needs allowance funds to purchase life insurance, grave space, a burial account, or other item that may be considered a countable resource, the ICFIID will refer the resident or the resident's representative, as applicable, to the county department of job and family services for an explanation of the effect the purchase may have on the resident's medicaid eligibility.

(F) Limitations on charges to the personal needs allowance account

(1) An ICFIID will not charge a resident's personal needs allowance account for items and services that the ICFIID is required to furnish in order to participate in the medicaid program and that are included in medicaid payments made to the ICFIID. An ICFIID will provide or arrange for, at no charge to a resident, any item or service that is ordered by a physician, determined medically necessary by the resident's team, and does not conflict with any state or federal regulations.

(2) Items and services that may not be purchased with personal needs allowance account funds include, but are not limited to:

(a) Nursing services;

(b) Dietary services;

(d) Room and board maintenance services;

(e) Routine personal hygiene items and services required to meet the needs of the resident, including but not limited to, hair hygiene supplies, comb, brush, bath soap, disinfecting soap or specialized cleansing agents when indicated to treat special skin problems or to fight infection, razor, shaving cream, toothbrush, toothpaste, denture adhesive, denture cleaner, dental floss, moisturizing lotion, tissues, cotton balls, deodorant, incontinence care supplies, feminine hygiene products, towels, washcloths, hospital gowns, over-the-counter medication, hair and nail hygiene services, and basic personal laundry;

(f) Medically related social services;

(g) Medical supplies such as irrigation trays, catheters, drainage bags, syringes, and needles;

(h) Durable medical equipment;

(i) Air conditioners or charges to resident for the use of electricity;

(j) Therapy or podiatry services; and

(k) Charges for telephone consultation by physicians or other personnel.

(G) Resident requests for items and services

(1) A resident's personal needs allowance account funds may be used to purchase only those items and services requested by the resident.

(2) When a resident requests an item or service for which a charge to the resident's personal needs allowance account will be made, the ICFIID will inform the resident that there will be a charge and the amount of the charge.

(3) An ICFIID will not require a resident to request an item or service as a condition for admission to, or continued stay in, the ICFIID.

(H) Items and services that may be charged to the personal needs allowance account

(1) An ICFIID will accept medicaid payment as payment in full for items and services that are covered by the medicaid program. If a resident clearly expresses a desire for a particular brand or item not available from the ICFIID, the resident's personal needs allowance funds may be used as long as a comparable item of reasonable quality is available from the ICFIID at no charge.

(2) Items and services that may be charged to a resident's personal needs allowance account include, but are not limited to:

(a) Telephone, television, or radio for the resident's exclusive use;

(b) Personal comfort items, including smoking materials, notions, novelties, and confections;

(d) Personal reading material;

(e) Stationary or stamps;

(f) Personal clothing in excess of that required by paragraph (H)(1) of rule 5123-3-04 of the Administrative Code;

(g) Specialty laundry services such as dry cleaning, mending, or hand-washing;

(h) Flowers or plants;

(i) Gifts the resident purchases for others;

(j) Social events or entertainment offered outside the scope of the ICFIID's activities program; and

(k) Burial plots.

(I) Monitoring

The county department of job and family services will monitor personal needs allowance accounts in accordance with section 5163.33 of the Revised Code. At least once a quarter, a designated employee of the county department of job and family services will determine if an ICFIID is following the provisions of this rule and report any questions concerning inappropriate use or inadequate record keeping of personal needs allowance funds to the department and to the Ohio department of health for further action. Inappropriate use of personal needs allowance funds by a payee or an ICFIID does not, however, reduce the scope or duration of medicaid benefits for a medicaid recipient.

(J) Disposition of personal needs allowance account funds in the event of a resident's death

(1) A department-operated ICFIID that has possession of a resident's personal needs allowance account funds at the time of the resident's death will dispose of the funds in accordance with section 5123.28 of the Revised Code.

(2) An ICFIID other than a department-operated ICFIID that has possession of a resident's personal needs allowance account funds at the time of the resident's death will dispose of the funds in accordance with paragraphs (J)(2)(a) to (J)(2)(c) of this rule, as applicable.

(a) If funeral or burial expenses for a deceased resident have not been paid and the only resource left to pay those expenses is the resident's personal needs allowance account funds, or all other resources of the resident are inadequate to pay the full amount, the resident's personal needs allowance account funds will be used to pay the expenses.

(b) If, within sixty calendar days after the resident's death, letters testamentary or letters of administration are issued, or an application for release from administration is filed under section 2113.03 of the Revised Code concerning the resident's estate, the ICFIID will transfer the resident's personal needs allowance account funds and a final accounting of those funds to the administrator, executor, commissioner, or person who filed the application for release from administration.

(c) If, within sixty calendar days after the resident's death, letters testamentary or letters of administration are not issued, or an application for release from administration is not filed under section 2113.03 of the Revised Code concerning the resident's estate, and if the resident was a recipient of medicaid benefits, the ICFIID will transfer the resident's personal needs allowance account funds to the Ohio department of medicaid no earlier than sixty calendar days and no later than ninety calendar days after the resident's death, with the exception of the amount used for funeral or burial expenses in accordance with paragraph (J)(2)(a) of this rule. Personal needs allowance account funds transferred to the Ohio department of medicaid will be accompanied by a completed Ohio department of medicaid form 09405, "Personal Needs Allowance Account Remittance Notice," in accordance with the instructions on the form.

Last updated June 30, 2025 at 7:44 AM

History

Effective: June 30, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-11 Intermediate care facilities for individuals with intellectual disabilities - relationship of other covered medicaid services.

(A) Purpose

This rule identifies covered services generally available to individuals who are eligible for medicaid and describes the relationship of such services to those provided to residents of an intermediate care facility for individuals with intellectual disabilities (ICFIID) other than a department-operated ICFIID. Reimbursement of services through the "ICFIID cost report mechanism" referenced in this rule is governed by rule 5123-7-12 of the Administrative Code.

(B) Dental services

All covered dental services provided by licensed dentists are reimbursed directly to the provider of the dental services in accordance with Chapter 5160-5 of the Administrative Code. Personal hygiene services provided by staff or contracted personnel of the ICFIID are reimbursed through the ICFIID cost report mechanism.

Costs incurred for the purchase and administration of tuberculin tests, and for drawing specimens and forwarding specimens to a laboratory, are reimbursed through the ICFIID cost report mechanism. All laboratory and x-ray procedures covered under the medicaid program are reimbursed directly to the laboratory or x-ray provider in accordance with Chapter 5160-11 of the Administrative Code.

(D) Medical supplier services

(1) Medical supplier services that are reimbursed through the ICFIID cost report mechanism include:

(a) Costs incurred for "needed medical and program supplies," defined as items that have a very limited life expectancy. Such items include atomizers, nebulizers, bed pans, catheters, electric pads, hypodermic needles, syringes, incontinence pads, splints, and disposable ventilator circuits.

(b) Costs incurred for the purchase and repair of "needed medical equipment," defined as items that can stand repeated use, are primarily and customarily used to serve a medical purpose, are not useful to a person in the absence of illness or injury, and are appropriate for use in the ICFIID. Such items include hospital beds, wheelchairs, and intermittent positive-pressure breathing machines, except as noted in paragraph (D)(2) of this rule.

(c) Costs of equipment associated with oxygen administration such as carts, regulators, humidifiers, cannulas, masks, and demurrage.

(2) Medical supplier services that are reimbursed directly to the medical supplier provider in accordance with Chapter 5160-10 of the Administrative Code include:

(a) Certain durable medical equipment items, specifically, ventilators and custom-made wheelchairs that have parts which are actually molded to fit the resident.

(b) "Prostheses," defined as devices that replace all or part of a body organ to prevent or correct physical deformity or malfunction. Such devices include artificial arms or legs, electro-larynxes, and breast prostheses.

(c) "Orthoses," defined as devices that assist in correcting or strengthening a distorted part. Such devices include arm braces, hearing aids and batteries, abdominal binders, and corsets.

(d) Contents of oxygen cylinders or tanks including liquid oxygen, except emergency stand-by oxygen which is reimbursed through the ICFIID cost report mechanism.

(e) Oxygen-producing machines (concentrators) for specific use by an individual resident.

(E) Pharmaceuticals

(1) Over-the-counter drugs covered in accordance with rule 5160-9-03 of the Administrative Code and nutritional supplements are reimbursed through the ICFIID cost report mechanism.

(2) Pharmaceuticals reimbursed directly to the pharmacy provider are subject to the limitations in Chapter 5160-9 of the Administrative Code, the limitations established by the Ohio state board of pharmacy, and the following conditions:

(a) When new prescriptions are necessary following expiration of the last refill, the new prescription may be ordered only after the physician examines the resident.

(b) A copy of all records regarding prescribed drugs for a resident of an ICFIID will be retained by the dispensing pharmacy for at least six years. A receipt for drugs delivered to an ICFIID will be signed by a representative of the ICFIID at the time of delivery and a copy retained by the pharmacy.

(F) Therapy services

(1) Costs incurred for physical therapy, occupational therapy, speech therapy, and audiology services provided by licensed therapists or therapy assistants that are covered for residents of an ICFIID by medicaid are reimbursed through the ICFIID cost report mechanism.

(2) Costs incurred for psychology services provided by licensed psychologists or psychology assistants that are covered for residents of an ICFIID by medicaid are reimbursed through the ICFIID cost report mechanism. No reimbursement for psychology services will be made to a provider other than the ICFIID or a community mental health center certified by the Ohio department of mental health and addiction services. Services provided by an employee of the community mental health center will be billed directly to medicaid by the community mental health center.

(3) Costs incurred for respiratory therapy services provided by licensed respiratory care professionals that are covered for residents of an ICFIID by medicaid are reimbursed through the ICFIID cost report mechanism. No reimbursement for respiratory therapy services will be made to a provider other than the ICFIID.

(4) Reasonable costs for rehabilitative, restorative, or maintenance therapy services rendered to residents of an ICFIID by staff or contracted personnel of the ICFIID and the overhead costs to support the provision of such services are reimbursed through the ICFIID cost report mechanism.

(G) Physician services

(1) A physician may be directly reimbursed for providing the following services to a resident of an ICFIID:

(a) All covered diagnostic and treatment services in accordance with Chapter 5160-4 of the Administrative Code.

(b) All medically necessary physician visits in accordance with rule 5160-4-06 of the Administrative Code.

(c) All required physician visits as described in this rule when the services are billed in accordance with rule 5160-4-06 of the Administrative Code.

(i) Physician visits provided to a resident of an ICFIID are considered timely if they occur no later than ten calendar days after the date the visit was requested.

(ii) For reimbursement of the required physician visits, the physician shall:

(a) Review the resident's total program of care including medications and treatments at each visit required by this rule;

(b) Write, sign, and date progress notes at each visit;

(d) Personally visit the resident except as provided in paragraph (G)(1)(c)(iii) of this rule.

(iii) At the option of the physician, required visits after the initial visit may be delegated in accordance with paragraph (G)(1)(c)(iv) of this rule and alternate between physician and visits by a physician assistant or certified nurse practitioner.

(iv) A physician may delegate tasks to a physician assistant (in accordance with Chapter 4730. of the Revised Code and Chapter 4730-1 of the Administrative Code) or a certified nurse practitioner (in accordance with Chapter 4723. of the Revised Code and Chapter 4723-4 of the Administrative Code) provided the physician assistant or certified nurse practitioner is acting within the scope of practice and is under supervision and employment of the billing physician. A physician will not delegate a task when regulations specify that the physician must perform it personally or when delegation is prohibited by state law or the ICFIID's policies.

(2) Services directly reimbursed to the physician will be:

(a) Based on medical necessity, as defined in rule 5160-1-01 of the Administrative Code, and requested by the resident of the ICFIID with the exception of the required visits described in paragraph (G)(1)(c) of this rule.

(b) Documented by entries in the resident's medical record along with any symptoms and findings that are signed and dated by the physician.

(3) Services provided in the capacity of overall medical direction are reimbursed only to an ICFIID and will not be directly reimbursed to a physician.

(H) Podiatry services

Covered services provided by licensed podiatrists are reimbursed directly to the authorized podiatric provider in accordance with Chapter 5160-7 of the Administrative Code.

(I) Transportation services

Costs incurred by the ICFIID for transporting residents by means other than covered ambulance or ambulette services are reimbursed through the ICFIID cost report mechanism. Payment is made directly to authorized providers for covered ambulance and ambulette services as set forth in Chapter 5160-15 of the Administrative Code.

(J) Vision care services

All covered vision care services, including examinations, dispensing, and the fitting of eyeglasses, are reimbursed directly to authorized vision care providers in accordance with Chapter 5160-6 of the Administrative Code.

Last updated April 27, 2023 at 8:43 AM

History

Effective: April 27, 2023
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-12 Intermediate care facilities for individuals with intellectual disabilities - cost report and chart of accounts.

(A) Purpose

This rule sets forth standards and requirements for an intermediate care facility for individuals with intellectual disabilities (ICFIID), other than a department-operated ICFIID, to submit cost reports to the department and maintain supporting documents and records.

(B) Submission of cost reports

(1) An ICFIID will utilize the medicaid information technology system maintained by the Ohio department of medicaid to submit a cost report to the department in accordance with sections 5124.10, 5124.101, and 5124.522 of the Revised Code.

(2) For good cause, an ICFIID may request and the department may grant an extension of fourteen calendar days for submitting a cost report. An ICFIID will request an extension in writing via email to cr-icf@dodd.ohio.gov, explain the circumstances resulting in the need for an extension, and submit the request no later than ninety calendar days after the end of the reporting period.

(1) For purposes of the cost report, an ICFIID will use the chart of accounts in the appendix to this rule and classify costs in accordance with applicable guidance and directives issued by the centers for medicare and medicaid services.

(a) When an account has sub-accounts, the sub-accounts will be used to capture the information for cost reporting purposes. For example:

(i) When revenue accounts appear by payor type, charges will be reported by payor type as applicable; and

(ii) When salary accounts differentiate between "supervisory" and "other," this level of detail will be reported as applicable.

(b) While the chart of accounts facilitates the level of detail necessary for cost reporting purposes, an ICFIID may maintain records in a manner that allows for greater detail.

(c) The chart of accounts allows for a range of account numbers for a specified account. For example, account 1001 is for petty cash, with the next account, cash in bank, beginning at account 1010. An ICFIID may delineate sub-accounts 1010.1 to 1010.7 as separate cash accounts. An ICFIID need only use the applicable sub-accounts.

(d) Within the expense section (i.e., tables 5, 6, and 7), accounts identified as "salary" accounts are only to be used to report wages for employees of the ICFIID. Wages are to include wages for sick pay, vacation pay, and other paid time off, as well as any other compensation to be paid to an employee.

(e) Expense accounts identified as "contract" accounts are only to be used to report costs incurred for services performed by contracted personnel engaged by the ICFIID to perform a service that would otherwise be performed by personnel on the ICFIID's payroll.

(f) Expense accounts identified as "purchased nursing services" are only to be used to report costs incurred for personnel acquired through a nursing pool agency.

(g) Expense accounts designated as "other" may be used to report any appropriate non-wage expenses, including contract services and supplies.

(h) Completion of the cost report requires that the number of hours paid be reported (depending on ICFIID type of control, on an accrual or cash basis) for all salary expense accounts. An ICFIID's record keeping will include accumulating hours paid consistent with the salary accounts included within the chart of accounts.

(i) Expenses related to a technology solution, acquired or implemented as a result of the person-centered assessment and planning process described in rule 5123-2-01 of the Administrative Code are to be reported in the appropriate account or sub-account unless they are directly covered by the medicaid state plan.

(2) Cost reports submitted by a county-operated ICFIID may be completed on accrual basis accounting and generally accepted accounting principles unless otherwise specified in Chapter 5123-7 or 5160-3 of the Administrative Code.

(3) All depreciable equipment valued at five hundred dollars or more per item with a useful life of at least two years, is to be reported in the capital cost component set forth in rule 5123-7-18 of the Administrative Code. The costs of equipment (including vehicles) acquired by an operating lease executed before December 1, 1992, may be reported in the indirect care cost component if the costs were reported as administrative and general costs on the ICFIID's cost report for the reporting period ending December 31, 1992, until the current lease term expires. The costs of any equipment leases executed before December 1, 1992 and reported as capital costs, will continue to be reported under the capital cost component. The costs of any new leases for equipment executed on or after December 1, 1992, will be reported under the capital cost component. Operating lease costs for equipment, which result from extended leases under the provision of a lease option negotiated on or after December 1, 1992, will be reported under the capital cost component.

(4) Costs of ownership

(a) The desk-reviewed, actual, allowable, per diem costs of ownership are based upon certified beds for property costs and equipment for the calendar year preceding the fiscal year in which the rate will be paid and include:

(i) The costs of ownership directly related to purchasing or acquiring capital assets including:

(a) Except as otherwise required by paragraph (C)(4)(e) of this rule, depreciation expense for the cost of buildings equal to the actual cost depreciated in accordance with rule 5123-7-18 of the Administrative Code. The provider is not to change the accumulated depreciation that has been previously reported. This accumulated depreciation will be carried forward as previously reported and audited. The current depreciation will then be added to accumulated depreciation as recognized.

(b) Except as otherwise required by paragraph (C)(4)(e) of this rule, depreciation expense for major components of property and fixed equipment equal to the actual cost depreciated in accordance with rule 5123-7-18 of the Administrative Code. The provider is not to change the accumulated depreciation that has been previously reported. This accumulated depreciation will be carried forward as previously reported and audited. The current depreciation will then be added to accumulated depreciation as recognized.

(c) Except as otherwise required by paragraph (C)(4)(e) of this rule, depreciation expense for major movable equipment equal to the actual cost depreciated in accordance with rule 5123-7-18 of the Administrative Code. The provider is not to change the accumulated depreciation that has been previously reported. This accumulated depreciation will be carried forward as previously reported and audited. The current depreciation will then be added to accumulated depreciation as recognized.

(d) Interest expense incurred on money borrowed for construction or the purchase of real property, major components of that property, and equipment.

(e) Depreciation expense for costs paid or reimbursed by any government agency, if that part of the prospective per diem rate is used to reimburse the government agency and a loan provides for repayment over a time-limited period.

(f) Amortization expense of financing costs.

(ii) The costs of ownership directly related to renting or leasing capital assets.

(iii) The costs of ownership directly related to the amortization of leasehold improvements. These costs will be expensed over the lesser of the remaining life of the lease, but not less than five years, or the useful life of the improvement as specified in rule 5123-7-18 of the Administrative Code. If the useful life of the improvement is less than five years, it may be amortized over its useful life. Options on leases will not be considered. Lessees who report leasehold improvements and who leave the program before the minimum amortization period is complete will not receive reimbursement for the balance of unamortized costs.

(b) The costs of ownership directly attributable to the purchase, rent, or lease of property and equipment costs from one related party to another through common ownership or control will be based upon the lesser of the actual purchase, rent, or lease of property and equipment costs or the actual costs of the related party.

(i) If a provider leases or transfers an interest in an ICFIID to another provider who is a related party, the related party's allowable costs of ownership will include the lesser of:

(a) The annual lease expense or actual costs of ownership, whichever is applicable; or

(b) The reasonable cost to the lessor or provider making the transfer.

(ii) If a provider leases or transfers an interest in an ICFIID to another provider who is a related party, regardless of the date of the lease or transfer, the related party's allowable costs of ownership will include the annual lease expense or actual costs of ownership, whichever is applicable, if all of the following conditions are met:

(a) The related party is a relative of the owner.

(b) In the case of a lease, if the lessor retains any ownership interest, it is, except as provided in paragraph (C)(4)(b)(ii)(d)(i)(B) of this rule, in only the real property and any improvements to the real property.

(c) In the case of a transfer, the provider making the transfer retains, except as provided in paragraph (C)(4)(b)(ii)(d)(ii)(B) of this rule, no ownership interest in the ICFIID.

(d) The department determines that the lease or transfer is an arm's length transaction when:

(i) In the case of a lease:

(A) Once the lease goes into effect, the lessor has no direct or indirect interest in the lessee or, except as provided in paragraph (C)(4)(b)(ii)(b) of this rule, the ICFIID itself, including interest as an owner, officer, director, employee, independent contractor, or consultant, but excluding interest as a lessor.

(B) The lessor does not reacquire an interest in the ICFIID except through the exercise of a lessor's rights in the event of a default. If the lessor reacquires an interest in the ICFIID in this manner, the department will treat the ICFIID as if the lease never occurred when the department calculates its reimbursement rates for capital costs.

(ii) In the case of a transfer:

(A) Once the transfer goes into effect, the provider that made the transfer has no direct or indirect interest in the provider that acquires the ICFIID or in the ICFIID itself, including interest as an owner, officer, director, employee, independent contractor, or consultant, but excluding interest as a creditor. If the provider making the transfer maintains an interest as a creditor, the interest rate of the creditor will not exceed the lesser of:

(1) The prime rate, as published by the "Wall Street Journal" on the first business day of the calendar year plus four per cent; or

(2) Fifteen per cent.

(B) The provider that made the transfer does not reacquire an interest in the ICFIID except through the exercise of a creditor's rights in the event of a default. If the provider reacquires an interest in the ICFIID in this manner, the department will treat the ICFIID as if the transfer never occurred when the department calculates its reimbursement rates for capital costs.

(e) Except in the case of hardship caused by a catastrophic event, as determined by the department, or in the case of a lessor or provider making the transfer who is at least sixty-five years of age, not less than twenty years have elapsed since, for the same ICFIID, allowable costs of ownership was determined most recently.

(c) A provider proposing to lease or transfer an interest in an ICFIID to a related party will provide the department with a certified appraisal for each ICFIID to be leased or transferred at least ninety calendar days prior to the actual change of the provider agreement. The certified appraisal will be conducted no earlier than one hundred eighty calendar days prior to the actual change of the provider agreement for each ICFIID leased or transferred to a related party.

(d) A provider proposing to lease or transfer an interest in an ICFIID to a related party will notify the department in writing and supply sufficient documentation demonstrating compliance with the provisions of this rule at least ninety calendar days prior to the anticipated date of completion of the transfer or lease. A provider that fails to supply the required documentation will not qualify for a rate adjustment. The department will issue a written decision determining whether the lease or transfer meets the requirements of this rule within sixty calendar days after receiving complete information as determined by the department.

(e) Reporting of accumulated depreciation

(i) Upon the sale of an ICFIID, the allowable capital asset cost basis, depreciation expense, and interest expense for the new provider/buyer of the ICFIID will be the new provider's/buyer's actual depreciation and interest expense subject to the ceilings set forth in section 5124.171 of the Revised Code. If the operating rights are separately identified and valued in a sale that includes both the building and the operating rights, the operating rights will be considered to be a part of the building for purposes of determining the allowable capital asset cost basis under this paragraph. If a new provider/buyer purchases only the operating rights to the ICFIID and uses the operating rights to create a new ICFIID or add beds to an existing ICFIID, the purchase price of the operating rights will be added to the capital asset cost basis of the new ICFIID building or the additional beds.

(ii) Upon the sale of an ICFIID, the initial accumulated depreciation for the new provider/buyer of the ICFIID will be recalculated starting at zero.

(5) Except for the employer's share of payroll taxes, workers' compensation, employee benefits, and home office costs, allocation of commonly shared expenses across cost centers is not allowed. Wages and benefits for staff, including related parties who perform duties directly related to functions performed in more than one cost center which would be expended under separate cost centers if performed by separate staff, may be expended to separate cost centers based upon documented hours worked, provided the ICFIID maintains adequate documentation of hours worked in each cost center. For example, the salary of an aide who is assigned to bathing and dressing chores in the early hours but works in the kitchen as a dietary aide for the remainder of the shift may be expended to separate cost centers provided the ICFIID maintains adequate documentation of hours worked in each cost center.

(6) The cost of purchasing resident transport vehicles is reported under the capital cost component. The cost of maintaining and repairing these vehicles is reported under the indirect care cost component.

(7) As part of its cost report, an ICFIID may complete the addendum for disputed costs to defend costs the ICFIID believes may be disputed by the department. The costs stated on the addendum are to have been applied to the other schedules and attachments for the reporting period in question (either in the reimbursable or the nonreimbursable cost centers). Any costs reported on the addendum may be considered by the department in establishing the ICFIID's prospective rate.

(8) The following costs are not reimbursable to an ICFIID through the prospective reimbursement cost reporting mechanism, except as otherwise specified in Chapter 5123-7 of the Administrative Code:

(a) Recoupments, fines, penalties, or interest paid in accordance with sections 5124.41, 5124.42, 5124.523, and 5124.99 of the Revised Code.

(b) Disallowances made during an audit of the ICFIID's cost report which are sanctioned through adjudication in accordance with Chapter 119. of the Revised Code.

(d) Cost of ancillary services (e.g., physicians, legend drugs, radiology, laboratory, oxygen, or resident-specific medical equipment) rendered to residents of the ICFIID by providers who bill medicaid directly.

(e) Cost per case mix units in excess of the applicable peer group ceiling for direct care cost.

(f) Expenses in excess of the applicable peer group ceiling for indirect care cost.

(g) Expenses in excess of the capital costs limitations.

(h) Expenses associated with lawsuits filed against the department or the Ohio department of medicaid which are not upheld by the courts.

(i) Cost of meals sold to visitors or the public (e.g., meals on wheels).

(j) Cost of supplies or services sold to persons who do not reside at the ICFIID.

(k) Cost of operating a gift shop.

(D) Required disclosures

As a component of the cost report, providers will identify:

(1) Each known related party.

(2) Each known individual, group of individuals, or organization not otherwise publicly disclosed that owns or has common ownership in whole or in part, in any mortgage, deed of trust, property, or asset of the ICFIID. When the ICFIID or the common owner is a publicly owned and traded corporation, this information beyond basic identifying criteria is not required as part of the cost report but must be available within two weeks when requested. Publicly disclosed information must be available at the time of an audit.

(3) Each corporate officer or director, if the provider is a corporation.

(4) Each partner, if the provider is a partnership.

(5) Each provider, whether participating in the medicare or medicaid program or not, which is part of an organization which is owned, or through any other device controlled, by the organization of which the provider is a part.

(6) Any director, officer, manager, employee, individual, or organization having direct or indirect ownership or control of five per cent or more, or who has been convicted of or pleaded guilty to a civil or criminal offense related to his or her involvement in programs established by Title XVIII, Title XIX, or Title XX of the Social Security Act, as in effect on the effective date of this rule. The amount of indirect ownership is determined by multiplying the percentage of ownership interest at each level (e.g., forty per cent interest in corporation "A" which owns fifty per cent of corporation "B" results in a twenty per cent indirect interest in corporation "B").

(7) Any individual currently employed by or under contract with the provider, or a related party in a managerial, accounting, auditing, legal, or similar capacity who was employed by the department, the Ohio department of medicaid, the Ohio department of health, the Ohio attorney general, the Ohio department of aging, the Ohio department of commerce, or the industrial commission of Ohio within the previous twelve months.

(E) Contracts for service

A provider will provide upon request, each contract for service in effect during the reporting period for which the cost of the service from any subcontractor, individual, or organization is ten thousand dollars or more in a twelve-month period or for the services of a sole proprietor or partnership where there is no cost incurred and the imputed value of the service is ten thousand dollars or more in a twelve-month period. For the purposes of this paragraph:

(1) "Contract for service" is defined as the component of a contract that details services provided exclusive of supplies and equipment. It includes any contract which details services, supplies, and equipment to the extent the value of the service component is ten thousand dollars or more within a twelve-month period.

(2) "Subcontractor" is defined as any entity, including an individual or individuals, who contract with a provider to supply a service, either to the provider or directly to the beneficiary, where medicaid reimburses the provider for the cost of the service. This includes organizations related to the subcontractor that have a contract with the subcontractor for which the cost or value is ten thousand dollars or more in a twelve-month period.

(F) Preliminary determination by the department

(1) The department will conduct a desk review of each cost report it receives. The desk review is an analysis of the cost report to determine its adequacy, completeness, and accuracy and reasonableness of the data contained therein. It is a process of reviewing information pertaining to the cost report without detailed verification and is designed to identify problems warranting additional review.

(2) Based on the desk review, the department will make a preliminary determination of whether the reported costs are reasonable and allowable costs. "Reasonable and allowable costs" means costs established in accordance with the centers for medicare and medicaid services provider reimbursement manual (publications 15-1 and 15-2, available at https://www.cms.gov/regulations-and-guidance/guidance/manuals/paper-based-manuals.html). Before issuing the preliminary determination, the department will notify the provider of any information in the cost report that requires additional support. The provider will submit any documentation or other information requested by the department and may submit any information that it believes supports the reported costs. The department will notify each provider of any costs preliminarily determined not to be reasonable and allowable costs and provide the reasons for the determination.

(3) A provider may revise the cost report within sixty calendar days after the original due date without the revised information being considered an amended cost report.

(4) The cost report is considered accepted after the department has completed the desk review process.

(5) After final rates have been issued, a provider who disagrees with a preliminary determination based on the desk review may request a rate reconsideration in accordance with rule 5123-7-27 of the Administrative Code.

(G) Amending a cost report

(1) Except as provided in paragraph (G)(2) of this rule and not later than three years after a provider files a cost report with the department, the provider may amend the cost report if the provider discovers a material error in the cost report or additional information to be included in the cost report. The department will review the amended cost report for accuracy and notify the provider of its determination.

(2) A provider may amend a cost report except when the Ohio department of medicaid has notified the provider that an audit of the cost report or a cost report of the provider for a subsequent cost reporting period is to be conducted under section 5124.109 of the Revised Code. The provider may, however, provide the Ohio department of medicaid information that affects the costs included in the cost report to be audited. Such information may be provided prior to the adjudication of the final settlement of the cost report.

(3) The department will not charge interest under division (B) of section 5124.41 of the Revised Code based on any error or additional information that is not required to be reported under this rule. The department will review the amended cost report for accuracy and notify the provider of its determination in accordance with section 5124.107 of the Revised Code.

(H) Retention of records

(1) Financial, statistical, and medical records supporting the cost reports or claims for services rendered to residents will be:

(a) Available to the department, the ohio department of medicaid, and the United States department of health and human services and other federal agencies; and

(b) Retained for the greater of seven years after the cost report is filed if the Ohio department of medicaid issues an audit report, or six years after all appeal rights relating to the audit report are exhausted.

(2) Failure to retain the required financial, statistical, or medical records to the extent that filed cost reports are unauditable renders the provider liable for monetary damages of the greater amount:

(a) One thousand dollars per audit; or

(b) Twenty-five per cent of the amount by which the undocumented cost increased the medicaid payments to the provider during the fiscal year.

(3) Providers whose records have been found to be unauditable will be allowed sixty calendar days to provide the necessary documentation. If, at the end of the sixty calendar days, the required records have been provided and are determined auditable, the proposed penalty will be withdrawn. If the Ohio department of medicaid, after review of the documentation submitted during the sixty-day period, determines that the records are still unauditable, the department will impose the penalty as specified in paragraph (H)(2) of this rule.

(4) Refusing access to financial, statistical, or medical records will result in a penalty as specified in paragraph (H)(2) of this rule for outstanding medicaid services until such time as the requested information is made available to the department or the Ohio department of medicaid.

(5) All requested financial, statistical, and medical records supporting the cost reports or claims for services rendered to residents will be available at a location in the state of Ohio for an ICFIID certified for participation in the medicaid program by this state within at least sixty calendar days after request by the state or its subcontractors. The preferred Ohio location is the ICFIID itself, but may be a corporate office, an accountant's office, or an attorney's office elsewhere in Ohio. This requirement, however, does not preclude the state or its subcontractors from the option of conducting the audit and/or a review at the site of such records if outside of Ohio.

View Appendix

Last updated July 1, 2024 at 4:48 PM

History

Effective: July 1, 2024
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-14 Intermediate care facilities for individuals with intellectual disabilities - debt estimation, debt summary report, and successor liability agreements for change of operator, facility closure, involuntary termination, or voluntary termination.

(A) Purpose

This rule sets forth procedures for estimating the debt an exiting operator of an intermediate care facility for individuals with intellectual disabilities (ICFIID) owes the department and the federal centers for medicare and medicaid services at the time of a change of operator, facility closure, involuntary termination, or voluntary termination.

(B) Definitions

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

(1) "Change of operator" has the same meaning as in section 5124.01 of the Revised Code.

(2) "Exiting operator" has the same meaning as in section 5124.01 of the Revised Code.

(3) "Facility closure" has the same meaning as in section 5124.01 of the Revised Code.

(4) "Involuntary termination" has the same meaning as in section 5124.01 of the Revised Code.

(5) "Voluntary termination" has the same meaning as in section 5124.01 of the Revised Code.

(1) The Ohio department of medicaid will use the debt estimation methodology set forth in this rule to estimate an exiting operator's actual and potential debts to the department and the centers for medicare and medicaid services under the medicaid program.

(2) The Ohio department of medicaid will total the value of all of the following that are determined applicable in calculating the debt estimate:

(a) Overpayments due to the department pursuant to section 5124.41 of the Revised Code, including:

(i) Overpayments owed for adjudicated final fiscal audit periods.

(ii) Overpayments identified in proposed adjudication orders that have been issued but not adjudicated.

(iii) Overpayment amounts for any outstanding periods where a final fiscal audit has not yet been issued. Such amounts are estimated by generating preliminary reports of amounts owed by the exiting operator for the applicable periods.

(b) Monies owed to the department and the centers for medicare and medicaid services resulting from penalties authorized by federal and state law, including but not limited to:

(i) Penalties assessed pursuant to section 5124.42 of the Revised Code for:

(a) Lack of proper notice of a change of operator, facility closure, or voluntary termination from the medicaid program; or

(b) Failure to furnish invoices or other documentation that the department requests during an audit.

(ii) Late cost report filing penalties assessed pursuant to rule 5123-7-12 of the Administrative Code.

(c) Penalties assessed pursuant to section 5124.99 of the Revised Code for violation of cost reporting provisions or provider agreement obligations.

(d) Interest monies owed to the department pursuant to section 5124.41 of the Revised Code and to the centers for medicare and medicaid services pursuant to 42 C.F.R. 488.442.

(e) Monies owed to the department and the centers for medicare and medicaid services pursuant to sections 5124.52 and 5124.525 of the Revised Code, including a final fiscal audit for the last fiscal year or portion thereof that the exiting operator participated in the medicaid program.

(f) Franchise permit fee owed to the department pursuant to section 5168.63 of the Revised Code which will include unpaid franchise permit fee for:

(i) Amounts due for periods assessed or to be assessed but for which payment is not yet required pursuant to section 5168.63 of the Revised Code.

(ii) Amounts due that are certified to the Ohio attorney general's office for collection, including penalties assessed pursuant to section 5168.63 of the Revised Code for failure to pay the full amount when due.

(g) Monies owed for recapture of excess depreciation.

(h) Monies owed due to a credit balance.

(i) Monies owed pursuant to successor liability or assumption of liability agreements the exiting operator entered into.

(j) Other amounts the department determines are applicable.

(3) The sum of the amounts determined owed, or estimated to be owed, to the department and the centers for medicare and medicaid services pursuant to paragraphs (C)(2)(a) to (C)(2)(j) of this rule will be the total estimated debt.

(4) The Ohio department of medicaid may release a portion of funds withheld pursuant to division (A) of section 5124.521 of the Revised Code if the funds withheld are materially greater than the debt calculated by the department in the initial debt summary report issued pursuant to section 5124.525 of the Revised Code.

(D) Provision of debt estimate

For the purposes of division (C) of section 5124.52 of the Revised Code, the debt estimate is considered provided by the Ohio department of medicaid on the date of mailing or date of personal service.

(E) Initial debt summary report

(1) Whenever the Ohio department of medicaid issues an initial debt summary report pursuant to section 5124.525 of the Revised Code, the Ohio department of medicaid will give notice to the affected party informing the affected party of the affected party's right to request a review. Notice will be served in the same manner as notices issued under rule 5160-70-03 of the Administrative Code and include:

(a) A statement informing the affected party that the affected party is entitled to request a review of the initial debt summary report.

(b) A statement informing the affected party that if a request for review of the initial debt summary report is not submitted on or before thirty calendar days after issuance of the initial debt summary report, the initial debt summary report becomes the final debt summary report thirty-one calendar days after the mailing of the initial debt summary report, and that the affected party may request, in accordance with Chapter 119. of the Revised Code, an adjudication hearing regarding a finding in the final debt summary report that pertains to an audit or alleged overpayment made under the medicaid program to the exiting operator. The adjudication will be consolidated with any other uncompleted adjudication that concerns a matter addressed in the final debt summary report.

(2) Any request for a review made as the result of notice of an initial debt summary report issued pursuant to this rule must be made in writing and mailed or delivered to the Ohio department of medicaid office and address identified in the initial debt summary report within thirty calendar days of notice given.

(3) If a request for review is mailed to the Ohio department of medicaid office and address identified in the initial debt summary report, the request is deemed to have been made:

(a) If the request for review is mailed by certified mail, as of the date stamped by the United States postal service on its receipt form.

(b) If the request for review is mailed by regular United States mail, as of the date of the postmark appearing upon the envelope containing the request.

(c) If the request for review is mailed by regular United States mail and the postmark is illegible or fails to appear on the envelope, as of the date of its receipt by the Ohio department of medicaid office identified in the initial debt summary report as evidenced by that office's date and time stamp.

(4) If a request for review is made by electronic mail to the office identified in the initial debt summary report, the request is deemed to have been made as of the date of its receipt as evidenced by the date of receipt shown in the source code of the electronic mail received by the office identified in the initial debt summary report.

(5) If a request for review is mailed, personally delivered, or made by electronic mail to a party or address other than the proper office identified in the initial debt summary report, the request is deemed to have been made as of the date of its receipt by the office identified in the initial debt summary report as evidenced by that office's date and time stamp.

(6) If a request for review is personally delivered to the office identified in the initial debt summary report, the request is deemed to have been made as of the date of its receipt as evidenced by that office's date and time stamp.

(7) All requests for review must clearly identify both the affected party involved and the initial debt summary report that is being contested.

(F) Revised debt summary report

(1) Whenever the Ohio department of medicaid issues a revised debt summary report pursuant to section 5124.525 of the Revised Code, the Ohio department of medicaid will give notice to the affected party informing the affected party of the affected party's right to submit additional information. Notice will be served in the same manner as notices issued under rule 5160-70-03 of the Administrative Code and include:

(a) A statement informing the affected party that the affected party is entitled to submit additional information.

(b) A statement informing the affected party that if additional information is not submitted on or before thirty calendar days after the issuance of the revised debt summary report, the revised debt summary report becomes the final debt summary report thirty-one calendar days after the mailing of the revised debt summary report, and that the affected party may request, in accordance with Chapter 119. of the Revised Code, an adjudication hearing regarding a finding in the final debt summary report that pertains to an audit or alleged overpayment made under the medicaid program to the exiting operator. The adjudication will be consolidated with any other uncompleted adjudication that concerns a matter addressed in the final debt summary report.

(2) Any submission of additional information made as the result of notice of a revised debt summary report issued pursuant to this rule must be made in writing and mailed or delivered to the Ohio department of medicaid office and address identified in the revised debt summary report within thirty calendar days of notice given.

(3) If a submission of additional information is mailed to the Ohio department of medicaid office and address identified in the revised debt summary report, the request is deemed to have been made:

(a) If the submission of additional information is mailed by certified mail, as of the date stamped by the United States postal service on its receipt form.

(b) If the submission of additional information is mailed by regular United States mail, as of the date of the postmark appearing upon the envelope containing the request.

(c) If the submission of additional information is mailed by regular United States mail and the postmark is illegible or fails to appear on the envelope, as of the date of its receipt by the Ohio department of medicaid office identified in the revised debt summary report as evidenced by that office's date and time stamp.

(4) If a submission of additional information is made by electronic mail to the office identified in the revised debt summary report, the submission is deemed to have been made as of the date of its receipt as evidenced by the date of receipt shown in the source code of the electronic mail received by the office identified in the revised debt summary report.

(5) If a submission of additional information is mailed, personally delivered, or made by electronic mail to a party or address other than the proper office identified in the revised debt summary report, the submission is deemed to have been made as of the date of its receipt by the office identified in the revised debt summary report as evidenced by that office's date and time stamp.

(6) If a submission of additional information is personally delivered to the office identified in the revised debt summary report, the submission is deemed to have been made as of the date of its receipt as evidenced by that office's date and time stamp.

(7) All submissions of additional information must clearly identify both the affected party involved and the revised debt summary report that is being contested.

(G) Final debt summary report

Rule 5101:6-50-03 of the Administrative Code applies if an affected party timely submits a request for review and additional information in response to a revised debt summary report, and the Ohio department of medicaid issues a final debt summary report pursuant to section 5124.525 of the Revised Code. An adjudication on a final debt summary report will be conducted only with respect to findings in the final debt summary report that pertain to an audit or alleged overpayment made under the medicaid program to the exiting operator. The adjudication will be consolidated with any other uncompleted adjudication that concerns a matter addressed in the final debt summary report.

(H) Computation of time deadlines

Section 1.14 of the Revised Code controls the computing of time deadlines imposed by section 5124.525 of the Revised Code.

(I) Successor liability agreements

(1) Successor liability agreements entered into pursuant to section 5124.521 of the Revised Code are subject to approval by the Ohio department of medicaid.

(2) Successor liability agreements must be signed by the exiting operator, the Ohio department of medicaid, and the entity assuming liability pursuant to section 5124.521 of the Revised Code.

Last updated June 30, 2025 at 7:44 AM

History

Effective: June 30, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-15 Intermediate care facilities for individuals with intellectual disabilities - claim submission.

(A) Purpose

This rule establishes procedures for an intermediate care facility for individuals with intellectual disabilities (ICFIID) to submit claims and be paid for services rendered.

(B) Submission of claims for payment for services included in the ICFIID per diem rate

(1) An ICFIID shall:

(a) Submit claims for payment to the Ohio department of medicaid in accordance with rule 5160-1-19 of the Administrative Code.

(b) Submit claims for payment either directly or through a "trading partner" as that term is defined in rule 5160-1-20 of the Administrative Code.

(2) A single claim will include days of service provided, including qualifying leave days, for a single resident within a single calendar month and will not cross calendar months. If an ICFIID determines that a claim that has been paid should have included additional per diem service days, the ICFIID shall timely submit an adjustment claim correcting the entire calendar month's claim information.

(3) When a medicaid-eligible resident of an ICFIID has a patient liability obligation, the entire monthly amount of patient liability, as determined in accordance with rule 5160:1-6-07 of the Administrative Code, will be reported by the ICFIID on the resident's monthly claim. When a resident is admitted, discharged, or transfers to another facility mid-month, the entire monthly amount of patient liability will be reported on the claim for that month. The patient liability will be applied as an offset against the amount medicaid would otherwise reimburse for the claim. When the patient liability exceeds the amount medicaid would reimburse, the claim will be processed with a payment of zero dollars.

(4) The treatment of lump sum payments and their disposition regarding medicaid eligibility are addressed in rule 5160:1-3-05.8 of the Administrative Code; if however, the county department of job and family services and the medicaid-eligible resident determine that the lump sum will be assigned to the ICFIID as payment for past per diem services received by the resident, the ICFIID shall submit adjustment claims for as many prior months as necessary to fully offset the amount of the lump sum payment that was assigned to the ICFIID. When there are lump sum monies remaining after adjusting all prior payments, the ICFIID shall apply the remaining lump sum balance to current and future claims. When the resident is discharged or passes away prior to exhausting the lump sum payment, the ICFIID shall return the balance to the individual or the individual's estate.

Last updated June 25, 2025 at 6:50 PM

History

Effective: April 27, 2023
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-18 Intermediate care facilities for individuals with intellectual disabilities - capital assets and depreciation.

(A) Purpose

This rule establishes requirements for determining when an asset of an intermediate care facility for individuals with intellectual disabilities (ICFIID) is capitalized and depreciated.

(B) Capitalization of assets

For purposes of determining when an asset is capitalized, an ICFIID will use the following guidelines:

(1) Any item that costs five hundred or more dollars and has a useful life of two or more years will be capitalized and depreciated over the asset's useful life.

(2) An ICFIID that has a capitalization policy in effect on the effective date of this rule to capitalize items that cost less than five hundred dollars will continue to follow its policy and will obtain prior approval from the department to change its policy.

For purposes of determining the useful life of a capital asset, an ICFIID will use:

(1) The internal revenue service publication 946, "How to Depreciate Property," available at https://www.irs.gov/publications/p946;

(2) The American hospital association's "Estimated Useful Lives of Depreciable Hospital Assets" (2023);

(3) The appendix to rule 5123:2-7-18 of the Administrative Code as it existed on December 15, 2019; or

(4) Another method approved by the department.

(D) Depreciation

(1) Depreciation on buildings, components of a building, and medical equipment used in the provision of resident care that is not reimbursable directly to the medical equipment supplier in accordance with rule 5123-7-11 of the Administrative Code is an allowable cost.

(2) For purposes of calculating depreciation expense, an ICFIID will use the following guidelines:

(a) All capital assets will be depreciated using the straight-line method of depreciation.

(b) In the month that a capital asset is placed into service, no depreciation expense is recognized as an allowable expense. A full month's depreciation expense is recognized in the month following the month the asset is placed into service.

(c) In the month that a capital asset is disposed, if the capital asset is not fully depreciated, the allowable depreciation expense is recognized as it is defined in section 132 of the centers for medicare and medicaid services publication 15-1, "The Provider Reimbursement Manual - Part 1," available at https://www.cms.gov/regulations-and-guidance/guidance/manuals/paper-based-manuals-items/cms021929. At no time will a capital asset be depreciated more than its adjusted basis.

(d) An ICFIID will maintain, and provide to the department upon request, detailed depreciation schedules to verify each individual capital asset placed in service.

(E) Salvage value

For purposes of determining the salvage value of a capital asset, an ICFIID will use the following guidelines:

(1) An ICFIID will maintain, and provide to the department upon request, documentation demonstrating the salvage value for any capital asset determined to have a salvage value of less than ten per cent.

(2) When an ICFIID determines that a capital asset does not have a salvage value, the ICFIID will record a salvage value of zero dollars in its asset ledger.

(3) If an ICFIID previously recorded a ten per cent salvage value for a capital asset that is still in use and that has a salvage value of less than ten per cent, the salvage value may be added to the capital asset and expensed over the remaining useful life of the capital asset. The ICFIID may revise unaudited cost reports accordingly for years where final cost settlement has not occurred.

Last updated June 30, 2025 at 7:44 AM

History

Effective: June 30, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-21 Intermediate care facilities for individuals with intellectual disabilities - compensation cost limits for owners and relatives of owners.

(A) Purpose

This rule establishes limits, applicable to the cost report of an intermediate care facility for individuals with intellectual disabilities (ICFIID), for the amount of compensation that may be claimed for owners or relatives of owners of the ICFIID.

(B) Calculating compensation cost limits for owners and relatives of owners serving in positions for which comparable positions exist

Compensation cost limits for owners and relatives of owners are based upon compensation costs for persons who hold comparable positions but who are not owners or relatives of owners, as reported on the ICFIID's cost report from the calendar year preceding the fiscal year in which the rate is paid. As used in this rule, "comparable position" means the position that is held by the owner or relative of an owner, if that position is listed separately on the ICFIID's cost report, or if the position is not listed separately, the group of positions that is listed on the ICFIID's cost report and that includes the position held by the owner or relative of an owner. The compensation cost limits for owners and relatives of owners who function in positions listed on attachment 6 of the cost report are based upon the wage and hour equivalents which are calculated as follows:

(1) The compensation cost limits for owners and relatives of owners are calculated from:

(a) Cost reports with a December thirty-first end date; and

(b) Desk-reviewed and preliminarily determined to be allowable costs.

(2) For each wage and hour chart of account number from attachment 6 of the cost report, calculate the compensation cost limits as follows:

(a) Calculate the total non-owner wages paid by summing the total non-owner wages paid (column E) for all providers that have amounts reported in columns (E) and (H) of attachment 6.

(b) Calculate the total non-owner hours paid by summing the total non-owner hours paid (column H) for all providers that have amounts reported in columns (E) and (H) of attachment 6.

(c) Calculate the average hourly rate by dividing the total non-owner wages paid as calculated in accordance with paragraph (B)(2)(a) of this rule by the total non-owner hours paid as calculated in accordance with paragraph (B)(2)(b) of this rule.

(d) Calculate the compensation cost limit by multiplying the average hourly rate as calculated in accordance with paragraph (B)(2)(c) of this rule by two thousand eighty hours.

(C) Calculating compensation cost limits for owners and relatives of owners serving in positions for which comparable positions do not exist

Compensation cost limits for owners and relatives of owners who serve the ICFIID in a capacity such as corporate officer, for which no comparable position or group of positions is listed on attachment 6 of the cost report are based upon the civil service equivalents established in accordance with rule 123:1-7-15 of the Administrative Code. Compensation for owners and relatives of owners that are corporate officers is allowable for managerial, administrative, professional, and other services related to the operation of the ICFIID and rendered in connection with resident care. The compensation cost limit for an owner or relative of an owner who functions in a corporate position is based upon the civil service equivalents as listed below. In the case of an owner or relative of an owner who functions as proprietor or partner, one of the below-listed civil service equivalents will be applied based upon the duties performed:

(1) Corporate president

(a) Business administrator 3, classification 63317, for facilities with a combined bed total of one to ninety-nine;

(b) Business administrator 4, classification 63318, for facilities with a combined bed total of one hundred to one hundred ninety-nine;

(c) Senior financial manager, classification 66587, for facilities with a combined bed total of two hundred to two hundred ninety-nine;

(d) Director 1, classification 61111, for facilities with a combined bed total of three hundred to five hundred ninety-nine;

(e) Director 2, classification 61112, for facilities with a combined bed total of six hundred to one thousand one hundred ninety-nine; or

(f) Director 3, classification 61113, for facilities with a combined bed total of one thousand two hundred or more.

(2) Corporate vice-president

(a) Program administrator 2, classification 63123, for facilities with a combined bed total of one to ninety-nine;

(b) Program administrator 3, classification 63124, for facilities with a combined bed total of one hundred to one hundred ninety-nine;

(c) Assistant director 1, classification 61211, for facilities with a combined bed total of two hundred to two hundred ninety-nine;

(d) Assistant director 2, classification 61212, for facilities with a combined bed total of three hundred to five hundred ninety-nine;

(e) Assistant director 3, classification 61213, for facilities with a combined bed total of six hundred to one thousand one hundred ninety-nine; or

(f) Assistant director 4, classification 61214, for facilities with a combined bed total of one thousand two hundred or more.

(3) Corporate treasurer

(a) Accountant/examiner 3, classification 66113, for facilities with a combined bed total of one to ninety-nine;

(b) Senior financial analyst, classification 66563, for facilities with a combined bed total of one hundred to one hundred ninety-nine;

(c) Financial analyst supervisor, classification 66566, for facilities with a combined bed total of two hundred to two hundred ninety-nine;

(d) Financial program manager, classification 66585, for facilities with a combined bed total of three hundred to five hundred ninety-nine;

(e) Financial manager, classification 66586, for facilities with a combined bed total of six hundred to one thousand one hundred ninety-nine; or

(f) Senior financial manager, classification 66587, for facilities with a combined bed total of one thousand two hundred or more.

(4) Board secretary/member

(a) Administrative professional 1, classification 16871, for facilities with a combined bed total of one to ninety-nine;

(b) Office professional supervisor, classification 12145, for facilities with a combined bed total of one hundred to one hundred ninety-nine;

(c) Administrative professional 4, classification 16874, for facilities with a combined bed total of two hundred to two hundred ninety-nine;

(d) Program administrator 2, classification 63123, for facilities with a combined bed total of three hundred to five hundred ninety-nine;

(e) Board/commission secretary 1, classification 62111, for facilities with a combined bed total of six hundred to one thousand one hundred ninety-nine; or

(f) Board/commission secretary 2, classification 62112, for facilities with a combined bed total of one thousand two hundred or more.

(5) For those owners and relatives of owners who serve the ICFIID in the capacity of a corporate officer, proprietor, or partner as specified in paragraphs (C)(1) to (C)(4) of this rule, the formula for determining the compensation cost limits is as follows:

(a) The civil service equivalent hourly rate as published by the Ohio department of administrative services for those positions specified in paragraphs (C)(1) to (C)(4) of this rule will be multiplied by two thousand eighty hours to arrive at an annual salary screen for each step in the position. If the civil service equivalent hourly rate changes during the reporting period, the civil service equivalent hourly rate will be the hourly rate that is in effect at the end of the cost reporting period.

(b) The appropriate job step within those civil service classifications as specified in paragraphs (C)(1) to (C)(4) of this rule will be based upon the owner's years of service in the health care field plus one.

(D) Determining reasonable costs and disallowances

Reasonable costs for compensation and compensation disallowances for owners and relatives of owners are the ICFIID's desk-reviewed, actual, allowable costs reported on schedule C-2 of the cost report subject to the applicable compensation cost limits and audit by the department. For each owner or relative of an owner that has reported compensation on schedule C-2 of the cost report, the medicaid information system will perform the following steps.

(1) Calculate the "time slice" for each owner and relative of an owner, which is defined as either:

(a) When there is no overlap of an employment period for an owner or relative of an owner working in a related ICFIID and the functions have the same position number, the number of days employed; or

(b) When there is an overlap of an employment period for an owner or relative of an owner working in a related ICFIID and the functions have the same position number:

(i) The number of days employed for the overlap of an employment period when the owner or relative of an owner is working in the related ICFIID during the same period of time; plus

(ii) The number of days employed preceding the overlapping employment period; plus

(iii) The number of days employed subsequent to the overlapping employment period.

(2) For each time slice of an owner or relative of an owner, calculate the following:

(a) Acquire the number of certified beds for the ICFIID as of the end of the cost reporting period from schedule A, line 2, column 1 of the cost report.

(b) Acquire the number of certified beds for related facilities that the owner or relative of an owner worked in during the time slice, as of the end of the cost reporting period.

(c) Calculate the total number of certified beds by adding the number of certified beds for the ICFIID as determined in accordance with paragraph (D)(2)(a) of this rule and the number of certified beds for any related facilities that the owner or relative of an owner worked in as determined in accordance with paragraph (D)(2)(a) of this rule.

(d) For an owner or relative of an owner who received compensation as a corporate officer, acquire the appropriate corporate duty job step as calculated in accordance with paragraph (C)(5)(b) of this rule.

(e) Determine the applicable compensation cost limit based on the position the owner or relative of an owner worked as follows:

(i) For an owner or relative of an owner who performs duties that are included on attachment 6 of the cost report, acquire the appropriate compensation cost limit as calculated in accordance with paragraph (B)(2)(d) of this rule subject to the following criteria:

(a) Compensation is allowable only for duties performed by an owner or relative of an owner which otherwise would require the employment of another person; and

(b) In order to qualify as a supervisor for positions listed on attachment 6 of the cost report, a supervisor must supervise at least two persons in an ICFIID with fifty or more beds. In an ICFIID with fewer than fifty beds, a supervisor may supervise one person.

(ii) For an owner or relative of an owner who perform duties which otherwise would have required the employment of another person and received compensation as a corporate officer, acquire the appropriate compensation cost limit as calculated in accordance with paragraph (C)(5) of this rule.

(iii) For purposes of determining the compensation cost limits, an owner or relative of an owner is overtime exempt. There will be no upward adjustment to the applicable compensation cost limit to accommodate circumstances where such persons work in excess of forty hours per week.

(f) Calculate the total number of days employed for each owner or relative of an owner by subtracting the beginning date from the ending date for each time slice and adding one.

(g) Determine the total days in the calendar year.

(h) Calculate the per cent of days allowed by dividing the number of days in the time slice as calculated in accordance with paragraph (D)(2)(f) of this rule by the total days in the calendar year as determined in accordance with paragraph (D)(2)(g) of this rule.

(i) Calculate the time slice adjusted compensation cost limit by multiplying the per cent of days allowed as calculated in accordance with paragraph (D)(2)(h) of this rule by the adjusted compensation as calculated in accordance with paragraph (D)(2)(e) of this rule.

(j) Acquire the weekly hours in the time slice for the appropriate time period from schedule C-2 of the cost report.

(k) Acquire the related weekly hours in the time slice for the appropriate time period from the related ICFIID's schedule C-2 of the cost report.

(l) Calculate the total weekly hours in the time slice by adding the weekly hours in the time slice as determined in accordance with paragraph (D)(2)(j) of this rule and the related weekly hours in the time slice as determined in accordance with paragraph (D)(2)(k) of this rule.

(m) Calculate the maximum weekly hours:

(i) If the total weekly hours in the time slice as calculated in accordance with paragraph (D)(2)(l) of this rule is less than thirty-five hours per week then the maximum weekly hours in the time slice is forty; or

(ii) If the total weekly hours in the time slice as calculated in accordance with paragraph (D)(2)(l) of this rule is greater than or equal to thirty-five hours per week then the maximum weekly hours in the time slice is the total weekly hours in the time slice.

(n) Calculate the hours allocation percentage by dividing the weekly hours in the time slice as calculated in accordance with paragraph (D)(2)(j) of this rule by the maximum weekly hours as calculated in accordance with paragraph (D)(2)(m) of this rule.

(o) Calculate the final time slice adjusted compensation cost limit by multiplying the time slice adjusted compensation cost limit as calculated in accordance with paragraph (D)(2)(i) of this rule by the hours allocation percentage as calculated in accordance with paragraph (D)(2)(n) of this rule.

(p) Calculate a daily salary amount for each owner and relative of an owner by dividing the compensation amount by the number of days employed as reported on schedule C-2 of the cost report. For each time slice, calculate the prorated amount for each owner and relative of an owner by multiplying the daily salary amount for each owner and relative of an owner by the number of days in the time slice as calculated in accordance with paragraph (D)(2)(f) of this rule.

(q) Calculate the compensation disallowance for each owner and relative of an owner by subtracting the final time slice adjusted compensation cost limit as calculated in accordance with paragraph (D)(2)(o) of this rule from the prorated amount for each owner and relative of an owner as calculated in accordance with paragraph (D)(2)(p) of this rule. The result cannot be less than zero.

Last updated June 30, 2025 at 7:44 AM

History

Effective: June 30, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-22 Intermediate care facilities for individuals with intellectual disabilities - compensation cost limits for administrators who are not owners or relatives of owners.

(A) Purpose

(B) Calculating compensation cost limits

Compensation cost limits for administrators are based upon compensation costs for administrators who are not owners or relatives of owners, as reported on the ICFIID's cost report for the calendar year preceding the fiscal year in which the rate is paid. The compensation cost limits for administrators, excluding owners and relatives of owners who are administrators, are calculated as follows:

(1) The compensation cost limits for administrators are calculated from:

(a) Cost reports with a December thirty-first end date; and

(b) Desk-reviewed and preliminarily determined to be allowable costs.

(2) For each administrator, calculate the hourly rate from schedule C-1 of the cost report as follows:

(a) Calculate the number of days employed by subtracting the employment period beginning date from the employment period ending date. Add one day to the number of days calculated to account for total days worked as reported on the cost report;

(b) Calculate the number of weeks worked by dividing the number of days employed by seven as calculated in accordance with paragraph (B)(2)(a) of this rule;

(c) Calculate the weekly compensation amount by dividing the compensation amount as reported on the cost report by the number of weeks worked as calculated in accordance with paragraph (B)(2)(b) of this rule; and

(d) Calculate the hourly rate by dividing the weekly compensation amount as calculated in accordance with paragraph (B)(2)(c) of this rule by the weekly hours as reported on the cost report.

(3) Exclude any administrator's hourly rate as calculated in accordance with paragraph (B)(2) of this rule that is less than the federal minimum wage rate in effect at the end of the cost reporting period.

(4) Excluding administrators described in paragraph (B)(3) of this rule, calculate the average annual administrator salary for each facility from schedule C-1 of the cost report as follows:

(a) For each administrator, calculate the hours worked by multiplying the weekly hours as reported on the cost report by the number of days employed as calculated in accordance with paragraph (B)(2)(a) of this rule;

(b) For all administrators as reported for each ICFIID, total the following:

(i) Number of days employed as calculated in accordance with paragraph (B)(2)(a) of this rule;

(ii) Compensation amounts as reported on the cost report; and

(iii) Hours worked as calculated in accordance with paragraph (B)(4)(a) of this rule;

(c) Calculate a weighted facility average weekly hours by dividing the sum of the weighted weekly hours as calculated in accordance with paragraph (B)(4)(b)(iii) of this rule by the total number of days employed as calculated in accordance with paragraph (B)(4)(b)(i) of this rule;

(d) Calculate the weighted facility compensation amount:

(i) If the weighted facility average weekly hours as calculated in accordance with paragraph (B)(4)(c) of this rule is less than thirty-five hours per week, multiply the total compensation amount as calculated in accordance with paragraph (B)(4)(b)(ii) of this rule by forty; or

(ii) If the weighted facility average weekly hours as calculated in accordance with paragraph (B)(4)(c) of this rule is thirty-five hours or more per week, multiply the total compensation amount as calculated in accordance with paragraph (B)(4)(b)(ii) of this rule by the weighted facility average weekly hours as calculated in accordance with paragraph (B)(4)(c) of this rule;

(e) Calculate the total salary per year by dividing the weighted facility compensation amount as calculated in accordance with paragraph (B)(4)(d) of this rule by the weighted facility average weekly hours as calculated in accordance with paragraph (B)(4)(c) of this rule; and

(f) Calculate the average annual administrator salary by multiplying the total salary per year as calculated in accordance with paragraph (B)(4)(e) of this rule by the number of days in a calendar year and dividing the product by the total number of days employed as calculated in accordance with paragraph (B)(4)(b)(i) of this rule.

(5) Group the average annual administrator salary for each ICFIID calculated in accordance with paragraph (B)(4)(f) of this rule into the following bed size categories based on certified beds at the end of the cost reporting period:

(a) One to forty-nine;

(b) Fifty to ninety-nine; or

(6) For each bed size category in accordance with paragraph (B)(5) of this rule, calculate the compensation cost limit by summing the average annual administrator salary as calculated in accordance with paragraph (B)(4)(f) of this rule and dividing the total sum of all average annual administrator salary by the number of records summed.

Reasonable costs for compensation and compensation disallowances for administrators are the ICFIID's desk-reviewed, actual, allowable costs reported on schedule C-1 of the cost report subject to the applicable compensation cost limits and audit by the department.

(1) For each administrator that has reported compensation on schedule C-1 of the cost report, the medicaid information system will perform the following steps:

(a) Calculate the "time slice" for each administrator, which is defined as either:

(i) When there is no overlap of an employment period for an administrator working in a related ICFIID, the number of days employed; or

(ii) When there is an overlap of an employment period for an administrator working in a related ICFIID;

(a) The number of days employed for the overlap of an employment period when the administrator is working in the related ICFIID during the same period of time; plus

(b) The number of days employed preceding the overlapping employment period; plus

(b) For each time slice of an administrator, calculate the following:

(i) Acquire the number of certified beds for the ICFIID as of the end of the cost reporting period from schedule A, line 2, column 1 of the cost report.

(ii) Acquire the number of certified beds for related facilities that the administrator worked in during the time slice as of the end of the cost reporting period.

(iii) Calculate the total number of certified beds by adding the number of certified beds for the ICFIID as determined in accordance with paragraph (C)(1)(b)(i) of this rule and the number of certified beds for any related facilities that the administrator worked in as determined in accordance with paragraph (C)(1)(b)(ii) of this rule.

(iv) Acquire the appropriate compensation cost limit as follows:

(a) If the administrator does not work in four or more related facilities, use the total number of certified beds determined in accordance with paragraph (C)(1)(b)(ii) of this rule to determine the appropriate compensation cost limit determined in accordance with paragraph (B)(6) of this rule; or

(b) If the administrator works in four or more related facilities, the compensation cost limit is the maximum for the bed size category determined in accordance with paragraph (B)(6) of this rule.

(v) Acquire the allowance percentage from schedule C-1 of the cost report which will not exceed one hundred-fifty per cent.

(vi) Calculate the adjusted compensation cost limit by multiplying the compensation cost limit determined in accordance with paragraph (C)(1)(b)(iv) of this rule by the allowance percentage determined in accordance with paragraph (C)(1)(b)(v) of this rule.

(vii) Calculate the total number of days employed for each administrator by subtracting the beginning date from the ending date for each time slice and adding one.

(viii) Determine the total days in the calendar year.

(ix) Calculate the per cent of days allowed by dividing the number of days in the time slice as calculated in accordance with paragraph (C)(1)(b)(vii) of this rule by the total days in the calendar year as determined in accordance with paragraph (C)(1)(b)(viii) of this rule.

(x) Calculate the time slice adjusted compensation cost limit by multiplying the per cent of days allowed as calculated in accordance with paragraph (C)(1)(b)(ix) of this rule by the adjusted compensation as calculated in accordance with paragraph (C)(1)(b)(vi) of this rule.

(xi) Acquire the weekly hours in the time slice for the appropriate time period from schedule C-1 of the cost report.

(xii) Acquire the related weekly hours in the time slice for the appropriate time period from the related ICFIID's schedule C-1 of the cost report.

(xiii) Calculate the total weekly hours in the time slice by adding the weekly hours in the time slice as determined in accordance with paragraph (C)(1)(b)(xi) of this rule and the related weekly hours in the time slice as determined in accordance with paragraph (C)(1)(b)(xii) of this rule.

(xiv) Calculate the maximum weekly hours:

(a) If the total weekly hours in the time slice as calculated in accordance with paragraph (C)(1)(b)(xiii) of this rule is less than thirty-five hours per week, the maximum weekly hours in the time slice is forty; or

(b) If the total weekly hours in the time slice as calculated in accordance with paragraph (C)(1)(b)(xiii) of this rule is greater than or equal to thirty-five hours per week, the maximum weekly hours in the time slice is the total weekly hours in the time slice.

(xv) Calculate the hours allocation percentage by dividing the weekly hours in the time slice as calculated in accordance with paragraph (C)(1)(b)(xi) of this rule by the maximum weekly hours as calculated in accordance with paragraph (C)(1)(b)(xiv) of this rule.

(xvi) Calculate the final time slice adjusted compensation cost limit by multiplying the time slice adjusted compensation cost limit as calculated in accordance with paragraph (C)(1)(b)(x) of this rule by the hours allocation percentage as calculated in accordance with paragraph (C)(1)(b)(xv) of this rule.

(xvii) Calculate a daily salary amount for each administrator by dividing the compensation amount by the number of days employed as reported on schedule C-1 of the cost report. For each time slice, calculate the prorated administrator compensation amount by multiplying the daily salary amount for each administrator by the number of days employed in each time slice as calculated in accordance with paragraph (C)(1)(b)(vii) of this rule.

(xviii) Calculate the administrator compensation disallowance by subtracting the final time slice adjusted compensation cost limit as calculated in accordance with paragraph (C)(1)(b)(xvi) of this rule from the adjusted prorated administrator compensation amount as calculated in accordance with paragraph (C)(1)(b)(xvii) of this rule. The result cannot be less than zero.

(xix) Calculate the final adjusted prorated administrator compensation amount by subtracting the administrator compensation disallowance as calculated in accordance with paragraph (C)(1)(b)(xviii) of this rule from the adjusted prorated administrator compensation amount as calculated in accordance with paragraph (C)(1)(b)(xvii) of this rule.

(2) For each ICFIID, determine the overall facility administrator aggregate compensation disallowance for reporting costs in excess of the adjusted compensation cost limit as follows:

(a) Acquire the number of certified beds for the ICFIID as of the end of the cost reporting period from schedule A, line 2, column 1 of the cost report.

(b) Acquire the appropriate compensation cost limit for the bed size category using the total number of certified beds determined in accordance with paragraph (C)(2)(a) of this rule and the compensation cost limit determined in accordance with paragraph (B)(6) of this rule.

(d) Calculate the adjusted compensation cost limit by multiplying the compensation cost limit determined in accordance with paragraph (C)(2)(b) of this rule by the allowance percentage determined in accordance with paragraph (C)(2)(c) of this rule.

(e) Calculate the total administrator allowable compensation by summing the compensation reported on schedule C-1 of the cost report for all administrators and subtracting any disallowances calculated in accordance with paragraph (C)(1)(b)(xviii) of this rule.

(f) Calculate the overall facility administrator aggregate compensation disallowance by subtracting the adjusted compensation cost limit as calculated in accordance with paragraph (C)(2)(d) of this rule from the total administrator allowable compensation as calculated in accordance with paragraph (C)(2)(e) of this rule. The result cannot be less than zero.

(D) Administrators serving in direct care positions

(1) If an administrator works in one or more of the following direct care cost center positions, the compensation earned for performing such duties may be expensed directly to the direct care cost center.

(a) Medical director;

(b) Director of nursing;

(d) Registered nurse;

(e) Licensed practical nurse;

(f) Recreational therapist;

(g) Psychologist;

(h) Respiratory therapist;

(i) Qualified intellectual disability professional;

(j) Licensed social worker/counselor;

(k) Chaplain;

(l) Charge nurse - registered nurse; or

(m) Charge nurse - licensed practical nurse.

(2) Compensation for an administrator performing a direct care cost center function is allowable only for duties which otherwise would require the employment of another person. The portion of the administrator's total compensation paid by the ICFIID that may be reported in the direct care cost center is determined by multiplying the total compensation by the percentage of time the administrator spends performing the direct care cost center duties.

(3) The ICFIID must maintain records documenting the allocation of the administrator's time to the direct care cost center duties. Time studies conducted in accordance with the centers for medicare and medicaid services publication 15-1, "The Provider Reimbursement Manual - Part 1," available at https://www.cms.gov/regulations-and-guidance/guidance/manuals/paper-based-manuals-items/cms021929, will be considered sufficient documentation of the allocation of time. If the department finds that the ICFIID has not sufficiently documented the allocation of time, the cost associated with the undocumented time will be reclassified back to the indirect cost center.

Last updated June 30, 2025 at 7:45 AM

History

Effective: June 30, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-23 Intermediate care facilities for individuals with intellectual disabilities - method for establishing the other protected costs component of the prospective rate.

(A) Purpose

This rule sets forth the method for establishing the other protected costs component of the prospective rate paid to an intermediate care facility for individuals with intellectual disabilities (ICFIID).

(B) Calculation of per diem rate

Each eligible ICFIID will be paid a per diem for each resident for other protected costs. This component of the rate will be established prospectively each fiscal year. This per diem is calculated by dividing the desk-reviewed, actual, allowable other protected costs total except for the franchise permit fee (account 6091) by the inpatient days. This information will come from the year-end cost report preceding the fiscal year in which the rate will be paid. This per diem will then be inflated by the estimated inflation rate as calculated in accordance with paragraph (C) of this rule and added to the per diem for the franchise permit fee as calculated in accordance with paragraph (D) of this rule to determine the total other protected costs component of the prospective rate.

The department will estimate the rate of inflation for the eighteen-month period using the consumer price index for all urban consumers for nonprescription drugs and the consumer price index for all urban consumers for medical supplies, as published by the United States bureau of labor statistics. The estimated inflation rate is calculated by taking the value of the indexes as of the thirty-first day of December in the fiscal year the rate will be paid, divided by the value of the indexes as of the first day of July in the immediately preceding calendar year. If the estimated inflation rate for the eighteen-month period is different from the actual inflation rate for that period, the difference will be added to or subtracted from the inflation rate estimated for the following fiscal year.

(D) Franchise permit fee

Notwithstanding the method for reimbursement for other protected costs as set forth in rule 5123-7-12 of the Administrative Code, the franchise permit fee rate in the amount equal to the assessment specified in section 5168.61 of the Revised Code will be included in the other protected costs center per diem rate for each ICFIID subject to the franchise permit fee assessment as specified in section 5168.61 of the Revised Code. The ICFIID will not receive reimbursement for the franchise permit fee if there is no assessment. The franchise permit fee rate is not subject to the inflation factor that is allowed for costs reported in the other protected costs center in accordance with paragraph (C) of this rule.

Last updated June 30, 2025 at 7:45 AM

History

Effective: June 30, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-24 Intermediate care facilities for individuals with intellectual disabilities - costs of ownership payment.

(A) Purpose

This rule sets forth conditions necessary for an intermediate care facility for individuals with intellectual disabilities (ICFIID) to receive a costs of ownership payment. This rule applies only to the capital rate calculation prescribed in section 5124.17 of the Revised Code.

(B) Definitions

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

(1) "Costs of ownership" means the actual expense incurred for:

(a) Depreciation and interest on any items capitalized including:

(i) Buildings;

(ii) Building improvements;

(iii) Equipment;

(iv) Extensive renovation;

(v) Transportation equipment; and

(vi) Replacement beds.

(b) Amortization and interest on land improvements and leasehold improvements.

(d) Lease and rent of land, building, and equipment.

(2) "Extensive renovation" means a renovation that costs more than sixty-five per cent and no more than eighty-five per cent of the cost of constructing a new bed and that extends the useful life of the assets for at least ten years. To calculate the per-bed cost of a renovation project for purposes of determining whether it is an extensive renovation, the allowable cost of the project will be divided by the number of beds in the facility certified for participation in the medicaid program, even if the project does not affect all medicaid-certified beds. Allowable extensive renovations are considered an integral part of costs of ownership.

(a) The cost of constructing a new bed will be considered to be forty thousand dollars, adjusted for inflation from January 1, 1993 to the end of the calendar year during which the renovation is completed using the consumer price index for shelter costs for all urban consumers for the midwest region, as published by the United States bureau of labor statistics.

(b) The department may treat a renovation that costs more than eighty-five per cent of the cost of constructing new beds as an extensive renovation if the department determines that the renovation is more prudent than construction of new beds.

(3) "Nonextensive renovation" has the same meaning as in rule 5123-7-25 of the Administrative Code.

(4) "Replacement beds" are beds which are relocated to a new building or portion of a building attached to and/or constructed outside of the original licensed structure of an ICFIID. Replacement beds may originate from within the licensed structure of an ICFIID or from another ICFIID. Replacement beds are eligible for the costs of ownership efficiency incentive ceiling which corresponds to the period in which the beds were replaced.

(1) For an ICFIID that has dates of licensure or that has been granted project authorization by the department on or after July 1, 1993, for which substantial commitments of funds were not made before July 1, 1993, costs of ownership payments will not exceed the ceilings established in section 5124.17 of the Revised Code, if the department gives prior approval for construction of the ICFIID.

(a) Prior to commencement of construction, the provider must submit a request in writing to the department that includes:

(i) The projected completion date for the new ICFIID.

(ii) A projected budget for the new ICFIID that includes a projected three-month cost report that contains all cost centers and inpatient days so that an overall rate can be calculated. For beds relocated from an existing ICFIID, the same information must be received for the existing ICFIID and the ICFIID to which the beds are to be relocated.

(b) The department will review the request and the projected budget, comparing the projected cost per diem to the rate currently associated with the beds for cost neutrality to the Ohio medicaid program. Cost neutrality will be evaluated across beds transferred to the new ICFIID and the beds remaining in the existing ICFIID.

(c) Approval for the increased costs of ownership payments will be granted contingent upon the receipt by the department of the provider's filed actual cost report for the first three months of operation confirming cost neutrality to the Ohio medicaid program. Until a final determination is made by the department with regard to the request for increased costs of ownership payments, the lower costs of ownership ceiling will be effective.

(d) Written approval or denial of the preliminary request will be made by the department within sixty calendar days of the date the initial request was made and the required documentation was received. Written documentation of the final determination will be provided by the department within sixty calendar days from the date the new ICFIID's actual three-month cost report is received.

(e) If the project continues to satisfy the cost neutrality standard, the higher costs of ownership ceiling will be implemented retroactively to the first day the new ICFIID's provider agreement was effective. If the request is denied, the provider will continue to receive the lower costs of ownership ceiling.

(2) An ICFIID that completes extensive renovations will receive a per diem for costs of ownership based upon the costs as specified in paragraph (C)(1) of this rule.

(a) The date of licensure for an extensively renovated ICFIID will be considered to be the date of completion of the extensive renovation.

(b) The current limits as calculated in accordance with section 5124.17 of the Revised Code will be assigned to the extensively renovated ICFIID using the date of licensure.

(c) An extensively renovated ICFIID that obtains new ceilings in accordance with this rule, will not be permitted any reimbursement for nonextensive renovation under rule 5123-7-25 of the Administrative Code made prior to the extensive renovation project which resulted in the new ceilings. Thereafter, the cost and accumulated depreciation of the nonextensive renovation will be included in costs of ownership.

(d) An extensively renovated ICFIID will not be permitted to receive any reimbursement for nonextensive renovation under rule 5123-7-25 of the Administrative Code for a period of five years after the completion of the extensive renovations, with the exception of those nonextensive renovation projects necessary to meet the requirements of federal, state, or local statutes, ordinances, rules, or policies.

Last updated July 1, 2024 at 4:49 PM

History

Effective: July 1, 2024
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-25 Intermediate care facilities for individuals with intellectual disabilities - nonextensive renovation.

(A) Purpose

This rule defines nonextensive renovation and sets forth the process for calculating the per-bed cost of a nonextensive renovation project at an intermediate care facility for individuals with intellectual disabilities (ICFIID).

(B) Definitions

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

(1) "Extensive renovation" has the same meaning as in rule 5123-7-24 of the Administrative Code.

(2) "Nonextensive renovation" means a project, approved by the department prior to July 8, 2018 in accordance with rule 5123:2-7-25 of the Administrative Code as it existed on July 7, 2018, for the betterment, improvement, or restoration of an ICFIID beyond its current functional capacity through a structural change that costs at least five hundred dollars per bed. To calculate the per-bed cost of a renovation project for purposes of determining whether it is a nonextensive renovation, the allowable cost of the project will be divided by the number of beds in the ICFIID certified for participation in the medicaid program, even if the project does not affect all medicaid-certified beds. "Nonextensive renovation" may include betterment, improvement, restoration, or replacement of assets that are affixed to the building and have a useful life of at least five years. "Nonextensive renovation" may include costs that otherwise would be considered maintenance and repair expenses if they are included as part of the nonextensive renovation project and are an integral part of the structural change that makes up the nonextensive renovation project. "Nonextensive renovation" does not mean construction of additional space for beds that will be added to an ICFIID's licensed or certified capacity. Allowable nonextensive renovation projects are not considered costs of ownership.

(1) The desk-reviewed actual, allowable, per diem cost of nonextensive renovation is based upon certified beds for property costs and assets affixed to the building for the calendar year preceding the fiscal year in which the rate will be paid. The desk-reviewed actual, allowable, per diem cost of nonextensive renovation includes:

(a) The cost of purchasing or acquiring capital assets that meet the requirements of nonextensive renovation in accordance with this rule which includes:

(i) Depreciation expense for the cost of buildings equal to the actual cost depreciated in accordance with rule 5123-7-18 of the Administrative Code for nonextensive renovation. The provider is not to change the accumulated depreciation that has been previously reported. This accumulated depreciation will be carried forward as previously reported and audited. The current depreciation will then be added to accumulated depreciation as recognized.

(ii) Depreciation expense for major components of property and fixed equipment equal to the actual cost depreciated in accordance with rule 5123-7-18 of the Administrative Code for nonextensive renovation. The provider is not to change the accumulated depreciation that has been previously reported. This accumulated depreciation will be carried forward as previously reported and audited. The current depreciation will then be added to accumulated depreciation as recognized.

(iii) Interest expense incurred on money borrowed for capital assets that qualify for nonextensive renovation.

(iv) Depreciation expense for costs paid or reimbursed by any government agency, if that part of the prospective per diem rate is used to reimburse the government agency and a loan provides for repayment over a time-limited period. These capital assets must qualify for nonextensive renovation.

(v) Amortization expense of financing costs.

(b) The cost of nonextensive renovation directly related to the amortization of leasehold improvements that meet the criteria for nonextensive renovation in accordance with this rule. These costs will be expensed over the lesser of the remaining life of the lease, but not less than five years, or the useful life of the improvement as specified in rule 5123-7-18 of the Administrative Code. If the useful life of the improvement is less than five years, it may be amortized over its useful life. Options on leases will not be considered. Lessees who report leasehold improvements and who leave the program before the minimum amortization period is complete will not receive reimbursement for the balance of unamortized costs.

(2) The cost of nonextensive renovation directly attributable to the purchase of property and equipment costs from one related party to another through common ownership or control will be based upon the lesser of the actual purchase of property and equipment costs or the actual costs of the related party.

(D) Criteria for treatment as a nonextensive renovation

(1) The following will apply in order to determine if a project qualifies for treatment as a nonextensive renovation.

(a) The project meets the definition of nonextensive renovation set forth in paragraph (B)(2) of this rule.

(b) The project does not increase the number of licensed beds.

(c) If the ICFIID relocates beds within the current structure of the building, the construction for the relocated beds will be considered a nonextensive renovation if it meets the other criteria specified in this rule unless the project meets the requirements of extensive renovation.

(d) The ICFIID obtained approval of the project as a nonextensive renovation from the department prior to July 8, 2018.

(e) The ICFIID has satisfied all requirements for notice to the department upon completion of the project as set forth in paragraph (F) of this rule.

(2) A nonextensive renovation project will be started within six months after the date the department grants approval. For the purposes of this rule, "started" means the physical work has begun on the project at the site of the ICFIID. Preliminary work such as planning, agency approval, feasibility surveys, and architectural drawings are not considered "started."

(3) A nonextensive renovation project will be completed within eighteen months after it is started. The total cost of all portions of the nonextensive renovation project completed within eighteen months after it is started must satisfy the per-bed cost requirement set forth in paragraph (B)(2) of this rule.

(4) Failure to satisfy the conditions set forth in paragraphs (D)(1) to (D)(3) of this rule will result in the costs of the project being reported as costs of ownership in lieu of nonextensive renovation.

(E) Additional notice requirements

Additional notice to the department is required during the course of the construction of the approved nonextensive renovation if:

(1) The completion of the nonextensive renovation project is delayed or accelerated by more than four months from the estimated date of completion.

(2) The actual cost of construction exceeds the approved cost by the greater of ten per cent or two thousand dollars.

(a) Upon receiving notice of the increase in the cost of construction, the department may approve the additional project costs for inclusion as a nonextensive renovation. In reviewing a project for approval under this paragraph, the department will apply the criteria specified in paragraph (D) of this rule.

(b) If the department does not approve the additional cost of construction, expenses related to all costs of construction in excess of the approved amount will be reported as costs of ownership.

(c) If the provider fails to provide notice to the department of the increase in the cost of construction, expenses related to all costs of construction in excess of the approved amount will be reported as costs of ownership.

(3) The actual amount financed exceeds the approved amount financed by the greater of ten per cent or two thousand dollars.

(a) Upon receiving notice of the increase in the amount financed, the department may approve the increase in the amount financed for inclusion as a nonextensive renovation. In reviewing a project for approval under this paragraph, the department will apply the criteria specified in paragraph (D) of this rule.

(b) If the department does not approve the additional amount financed, interest expense related to all amounts financed in excess of the approved amount will be reported as costs of ownership.

(c) If the provider fails to provide notice to the department of the increase in the amount financed, interest expense related to all amounts financed in excess of the approved amount will be reported as costs of ownership.

(4) The actual interest rate exceeds the projected interest rate by two or more percentage points.

(a) Upon receiving notice of the increase in the interest rate, the department may approve the interest expense associated with the increased interest rate for inclusion as a nonextensive renovation. In reviewing a project for approval under this paragraph, the department will apply the criteria specified in paragraph (D) of this rule.

(b) If the department does not approve the increased interest rate, the interest expense associated with the incremental increase in the approved interest rate will be reported as costs of ownership.

(c) If the provider fails to provide notice to the department of the increase in the interest rate, the interest expense associated with the incremental increase in the approved interest rate will be reported as costs of ownership.

(5) There is any increase or decrease in the scope of the nonextensive renovation project.

(a) Upon receiving notice of the change in the scope of the nonextensive renovation project, the department may approve the project as revised if the change in scope bears a reasonable relationship to the approved nonextensive renovation project.

(b) If the department does not approve the project as revised, the additional costs associated with the change in scope will be reported as costs of ownership.

(c) If the provider fails to provide notice to the department of the change in the scope of the project, the additional costs associated with the change in scope will be reported as costs of ownership.

(6) Any change of cost causes the project to exceed the threshold for being considered an extensive renovation or to fall below the threshold for being considered a nonextensive renovation.

(F) Reporting a nonextensive renovation project on the cost report

(1) Before a nonextensive renovation or portion thereof can be reported on the cost report, notice of completion must be submitted to the department. The notice of completion will include:

(a) The date the project or portion thereof was placed in service;

(b) Detailed depreciation and amortization schedules and a narrative explanation of any material differences between the expenses stated on the schedules and the estimated costs submitted for the project and prior-approved by the department; and

(c) A detailed reconciliation of actual financing cost to the projected financing cost in the request for approval of a nonextensive renovation.

(2) A nonextensive renovation may be reported on the cost report as each portion of the project is placed into service as long as the anticipated completion of the portions of the project is still within the period set forth in paragraphs (D)(2) and (D)(3) of this rule and in the aggregate satisfy the per-bed cost requirement set forth in paragraph (B)(2) of this rule.

(3) If the total cost of all the portions of the entire project that have been placed into service within the period set forth in paragraphs (D)(2) and (D)(3) of this rule do not satisfy the per-bed cost requirement set forth in paragraph (B)(2) of this rule, the costs and related expenses for all the portions of the project that have been reported as a nonextensive renovation will be reported as costs of ownership.

Last updated July 1, 2024 at 4:49 PM

History

Effective: July 1, 2024
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-27 Intermediate care facilities for individuals with intellectual disabilities - request for rate reconsideration.

(A) Purpose

This rule establishes a process for an intermediate care facility for individuals with intellectual disabilities (ICFIID) or a group or association of ICFIID providers to request reconsideration of an ICFIID's per diem payment rate pursuant to section 5124.38 of the Revised Code.

(B) Submission of request

(1) An ICFIID will submit a request for reconsideration of the ICFIID's per diem payment rate in writing via email to cr-icf@dodd.ohio.gov. The request will indicate the basis for rate reconsideration.

(2) In addition to the circumstances described in section 5124.38 of the Revised Code, an ICFIID may request reconsideration of the ICFIID's per diem payment rate on the basis of:

(a) A possible error in the calculation of the rate, in which case the request will:

(i) Be submitted to the department within thirty calendar days after the later of the initial payment of the rate or the receipt of the rate-setting calculation.

(ii) Include a detailed explanation of the possible error and the proposed corrected calculation and references to the relevant sections of the Revised Code and/or rules of the Administrative Code, as applicable.

(b) Actual allowable costs that are significantly higher than those recognized by the ICFIID's current per diem payment rate and the ability of the ICFIID to deliver necessary care and active treatment is severely jeopardized, in which case the request will include:

(i) A detailed explanation of the current hardship and the impact on delivery of necessary care and active treatment.

(ii) A cost report for at least three full months of operation.

(1) The department will respond in writing within sixty calendar days of receiving a written request for rate reconsideration. If the department requests additional information to determine whether a rate adjustment is warranted, the ICFIID will respond in writing and provide additional supporting documentation within thirty calendar days of receipt of the request for additional information. The department will respond in writing within sixty calendar days of receiving the additional information.

(2) If the department grants a rate adjustment due to an error in the calculation of the rate, the adjustment will be implemented retroactively to the initial service date for which the rate is effective.

(3) If the department grants a rate adjustment due to actual allowable costs that are significantly higher than those recognized by the ICFIID's current per diem payment rate and the ability of the ICFIID to deliver necessary care and active treatment is severely jeopardized, the adjustment will be implemented the first day of the first month after the the request is approved.

(4) If the department grants a rate adjustment to an ICFIID that subsequently undergoes a change of operator, the adjusted rate will remain in place as though a change of operator had not occurred.

(5) The department's decision at the conclusion of the rate reconsideration process is not subject to any administrative proceedings under Chapter 119. or any other provision of the Revised Code.

Last updated July 1, 2024 at 4:50 PM

History

Effective: July 1, 2024
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-29 Intermediate care facilities for individuals with intellectual disabilities - ventilator services.

(A) Purpose

This rule sets forth requirements for an intermediate care facility for individuals with intellectual disabilities (ICFIID) to provide and be reimbursed for providing services to residents who are dependent on invasive mechanical ventilators.

(B) Definitions

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

(1) "Adult" means a person twenty-two years of age or older.

(2) "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.

(3) "Designated outlier coordinator" means a department staff member who coordinates the general operations of the ICFIID outlier services program. The designated outlier coordinator works with providers of outlier services, individuals requesting and receiving outlier services, other persons whom individuals have identified, other service agencies, and other department staff. The designated outlier coordinator's duties include, but are not limited to:

(a) Assisting with the initial approval and ongoing monitoring of an ICFIID providing outlier services;

(b) Coordinating the processing of pre-admission and continued stay prior authorization requests for individuals; and

(4) "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.

(5) "Invasive mechanical ventilator" means a ventilator that is interfaced directly with the individual via an artificial airway (e.g., tracheostomy tube). Invasive mechanical ventilators (volume and/or pressure) are life support devices designed specifically for invasive mechanical ventilation applications and must accommodate direct current backup power supply and include disconnect, high pressure, low pressure, and power loss alarms.

(6) "Nurse" means a person authorized by Chapter 4723. of the Revised Code to engage in the practice of nursing as a registered nurse or a licensed practical nurse.

(7) "Outlier services" means those clusters of services that have been determined by the department to have reimbursement rates established pursuant to section 5124.152 of the Revised Code when delivered by qualified providers to individuals who have been prior-authorized to receive a category of service identified as an outlier service by the department in accordance with Chapter 5123-7 of the Administrative Code.

(8) "Pediatric ventilator services" means services provided by an ICFIID in accordance with rule 5123:2-7-29 of the Administrative Code as it existed on January 17, 2018.

(9) "Physician" means a person authorized by Chapter 4731. of the Revised Code to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery.

(10) "Plan of correction" means a corrective action plan prepared by an ICFIID in response to deficiencies cited by the department or the Ohio department of health which conforms to regulations and guidelines and includes information that describes how the deficiency will be corrected, when it will be corrected, how other residents that may be affected by the deficiency will be identified, and how the ICFIID will ensure that compliance is maintained upon correction.

(11) "Prior authorization assessment for ventilator services" means an evaluation to determine if an individual meets the eligibility criteria to receive ventilator services set forth in paragraphs (C)(3) to (C)(6) of this rule that will take place only after the individual is determined to meet the financial eligibility and level of care requirements set forth in paragraphs (C)(1) and (C)(2) of this rule.

(12) "Prior authorization for ventilator services" means department approval obtained by an ICFIID to provide ventilator services to a specific individual for specific time-limited initial or continued stay periods. Prior authorization for ventilator services is required for the ICFIID to be authorized by the department to provide ventilator services and to receive reimbursement for services rendered to the individual. Reimbursement may be denied for any service not rendered in accordance with Chapters 5160-3 and 5123-7 of the Administrative Code.

(13) "Registered nurse" has the same meaning as in section 4723.01 of the Revised Code.

(14) "Respiratory care professional" means a person who is licensed under Chapter 4761. of the Revised Code to practice the full range of respiratory care services described in division (A) of section 4761.01 of the Revised Code.

(15) "Ventilator services" means services provided by an ICFIID that holds an effective provider agreement with the Ohio department of medicaid and that is approved by the department to deliver outlier services to individuals who are dependent on invasive mechanical ventilators.

To receive prior authorization for ventilator services, an individual must:

(1) Have been determined by the county department of job and family services to meet the medicaid financial eligibility standards for institutional care.

(2) Have obtained a developmental disabilities level of care determination from the department within the last thirty calendar days, or, at the time of prior authorization assessment for ventilator services, be determined by the department to meet the criteria for a developmental disabilities level of care in accordance with rule 5123-8-01 of the Administrative Code.

(3) Require the use of an invasive mechanical ventilator.

(4) Have been either:

(a) An adult resident of an ICFIID approved to provide pediatric ventilator services on January 17, 2018; or

(b) An inpatient, for at least ninety days within the past twelve months, in an acute care hospital for treatment of a life-threatening or complex medical condition. If the individual has been an inpatient in an acute care hospital for treatment of a life-threatening or complex medical condition within the past twelve months but for less than ninety days, an ICFIID may submit to the department, and the department may approve, a written request to waive the ninety-day requirement. The request will include a description of the clinical services the individual continues to require and an attestation by the ICFIID that it is able to meet the individual's needs.

(5) Have achieved a stabilized medical condition so that the immediate services of an acute care hospital, including daily physician visits, are not medically necessary.

(6) Require monitoring by a nurse twenty-four hours per day and professional assessment by a registered nurse on a daily basis.

(D) ICFIID eligibility criteria

(1) An ICFIID will complete and electronically submit to the department an application for approval to provide ventilator services. The application is available at the department's website (https://dodd.ohio.gov). The ICFIID will provide any additional information requested by the department and may be subject to documentation review and on-site visits by department personnel.

(2) To be approved to provide ventilator services and qualify for enhanced payment for provision of ventilator services to prior-authorized individuals, an ICFIID will:

(a) Be an Ohio medicaid-certified ICFIID and agree to cooperate with the department's oversight of ventilator services.

(b) Meet the requirements set forth in rule 5123-7-02 of the Administrative Code in order to obtain and maintain a provider agreement.

(c) Fully meet all standards for residential facilities licensed in accordance with section 5123.19 of the Revised Code or have an approved and implemented plan of correction and have not demonstrated a pattern of repeat deficiencies.

(d) Fully meet all standards for Ohio medicaid ICFIID certification or meet the medicaid program requirements of a facility for which the Ohio department of health found deficiencies, have an approved and implemented plan of correction, and have not demonstrated a pattern of repeat deficiencies.

(e) Have:

(i) An emergency action plan in place in the event of a power failure;

(ii) An on-site backup generator service for all equipment including suction lines, oxygen lines, and emergency power to ventilators;

(iii) Sufficient backup ventilators on-site and available in the event of mechanical failure as well as any other equipment necessary to meet the needs of individuals in the event of an emergency; and

(iv) An emergency response plan in place in the event of natural or human-made disasters that provides for the safe transport of individuals to a safe area with appropriate resources available to ensure the health and safety of the individuals.

(f) Schedule direct care staff to ensure that adequately trained staff are present and on duty twenty-four hours per day, every day of the year. Staffing will be sufficient to ensure that urgent, emergent, and routine resident needs are identified appropriately and in a timely manner and are met through the implementation of intervention strategies reflected in each resident's individual service plan. Absences of staff for breaks and meals will not compromise this staffing arrangement.

(g) Ensure that staff who manage ventilator services have evidence of at least two years of work experience with individuals who have complex medical conditions.

(h) Address through staff training programs, the specific medical domains a staff member must master for a thorough understanding and demonstration of competency in order to meet the specialized needs of residents requiring ventilator services. Initial and continuing direct care staff training will include:

(i) Orientation to the ICFIID's status as a provider of ventilator services, including the individual eligibility criteria set forth in paragraph (C) of this rule and the ICFIID eligibility criteria set forth in paragraph (D) of this rule;

(ii) Information about the specific health care needs of the current residents of the ICFIID who receive ventilator services;

(iii) Accepted best practices and innovative approaches to meet residents' needs;

(iv) Training to ensure nursing care competence for residents, including specialized training on developmental needs that improve an individual's overall functional status; and

(v) Due to the increased risk of infection for residents of ICFIID who receive ventilator services, steps to be taken to minimize risk of transmission of contagious or infectious diseases.

(i) Agree to furnish or arrange to have furnished all medically necessary services to individuals who are dependent on invasive mechanical ventilators, regardless of whether the services are reimbursable through the ICFIID cost report mechanism or directly to the provider of such services.

(i) Physician services will be available twenty-four hours per day.

(ii) A physician will complete an assessment of the individual at least once every thirty calendar days for the first ninety calendar days and at least once every ninety calendar days thereafter if the individual maintains a stable status with no acute complications related to ventilator support. If acute care needs requiring hospitalization present upon return to the ICFIID, a physician will complete an assessment of the individual at least once every thirty calendar days for the first ninety calendar days and at least once every ninety calendar days thereafter.

(iii) Respiratory care services will be available twenty-four hours per day. Medically necessary respiratory care services will be provided by a respiratory care professional or by a nurse who the ICFIID has determined has the training, knowledge, skill, and ability to complete the services in coordination with the respiratory care professional, and as ordered by a physician.

(iv) The ICFIID, in consultation with a physician and a respiratory care professional, will develop a facility plan for providing care to individuals who are dependent on invasive mechanical ventilators which addresses:

(a) Maintenance of ventilators;

(b) Required modification and maintenance of facilities; and

(c) Special accommodations required to ensure that all needs, including but not limited to, hygiene, bathing, dietary, social, and transportation, of individuals who are dependent on invasive mechanical ventilators, are met.

(v) Services by registered nurses will be available twenty-four hours per day.

(vi) Nursing care and any personal care that may be required for the health, safety, and wellbeing of the individuals served will be available twenty-four hours per day. Nursing personnel will be sufficient to ensure prompt recognition of any adverse change in an individual's condition and to facilitate nursing, medical, or other appropriate interventions, up to and including transfers to an acute care hospital.

(vii) The need for physical, occupational, and/or speech therapy services will be assessed and services will be provided as needed by therapists licensed to practice in Ohio.

(viii) If an individual is receiving enteral feedings and there is a complication of medical status secondary to the nutritional status, a dietary consultation by a person licensed to practice dietetics in Ohio will be made available to that individual.

(j) Prior to admission of an individual who requires ventilator services, arrange for a suitable school or day program for the individual and submit the plan for such program to the designated outlier coordinator or other department designee.

(k) Prior to admission of an individual who requires ventilator services, develop and submit to the designated outlier coordinator or other department designee accurate assessments or reassessments by an interdisciplinary team that address the individual's health, social, psychological, educational, vocational, and chemical dependency needs. Health information will include a copy of the medical assessment completed by a physician who has knowledge of and experience with the individual, a clinical summary, need for invasive mechanical ventilation (including viability and plan for weaning), detailed therapy assessment with recommended therapy plan, medication needs, and any other medical information relevant to the individual's care needs.

(l) Ensure that a registered nurse submits a written summary of clinical status to the primary care physician on a monthly basis. The physician will review and sign the summary and place it in the individual's medical record.

(m) Due to the complex and intensive needs of individuals who require ventilator services, develop a transitional plan prior to admission of an individual to ensure that the ICFIID is able to meet the individual's health, safety, and behavioral support needs from the day of admission. The transitional plan will address major concerns and be provided to the designated outlier coordinator or other department designee upon request.

(n) Within thirty calendar days after admission, develop accurate assessments or reassessments by an interdisciplinary team that address the individual's health, social, psychological, educational, vocational, and chemical dependency needs in order to supplement the preliminary evaluation described in paragraph (D)(2)(k) of this rule, which was conducted prior to admission. The ICFIID will provide the assessments or reassessments to the designated outlier coordinator or other department designee upon request.

(o) Develop a comprehensive individual service plan within thirty calendar days of an individual's admission, with input from the individual, the individual's parent, the individual's guardian, or other person whom the individual has identified, as applicable. The ICFIID will provide a copy of the individual service plan to the designated outlier coordinator or other department designee upon request.

(i) The individual service plan will be reviewed by the appropriate program staff at least quarterly and revised as necessary with input from the individual, the individual's parent, the individual's guardian, or other person whom the individual has identified, as applicable.

(ii) The ICFIID will notify the designated outlier coordinator or other department designee whenever an individual experiences a significant change in medical status, including hospitalization.

(iii) The ICFIID will prepare a quarterly report in a format approved by the department that summarizes the resident's individual service plan, progress, changes in treatment, current status relative to discharge goals, and any updates to the discharge plan, including referrals made and anticipated time frames. The ICFIID will provide a copy of the quarterly report to the designated outlier coordinator or other department designee upon request.

(iv) The designated outlier coordinator or other department designee may visit the ICFIID at any time. The ICFIID will provide any documents or information requested by the designated outlier coordinator or other department designee.

(p) Within thirty calendar days after admission, develop a written discharge plan with the interdisciplinary team in conjunction with the individual and others concerned with the individual's welfare which describes targeted medical/health status indicators that would signify the resident could be safely discharged. The ICFIID will provide a copy of the discharge plan to the designated outlier coordinator or other department designee upon request.

(q) Accept payment for the provision of services at the non-outlier ICFIID reimbursement rate if prior authorization for ventilator services requested for an individual already residing in the ICFIID is denied.

(E) Outlier per diem rate

(1) An ICFIID's per diem rate will be set in accordance with Chapter 5124. of the Revised Code and applicable rules in Chapter 5123-7 of the Administrative Code. An outlier per diem rate for ventilator services, determined and applied in accordance with paragraph (H) of this rule, will be added to the ICFIID's per diem rate.

(2) With the exception of any specific items that are direct-billed in accordance with rule 5123-7-11 of the Administrative Code, the ICFIID will agree to accept as payment in full the per diem rate established for ventilator services in accordance with this rule, and to make no additional charge to the individual, to any member of the individual's family, or to any other source for covered ventilator services.

(F) Prior authorization for services

(1) Payment for ventilator services covered by the medicaid program will be available only upon prior authorization by the department for each individual in accordance with the procedures set forth in this rule. The prior authorization procedures set forth in this rule are in addition to the developmental disabilities level of care review process set forth in rule 5123-8-01 of the Administrative Code.

(a) Unless the individual is seeking a change of payer, prior authorization for ventilator services will occur prior to admission to the ICFIID.

(b) In the case of requests for continued stay, prior authorization for ventilator services will occur no later than the final day of the previously authorized ventilator services stay.

(2) A request for prior authorization for ventilator services will be electronically submitted to the department.

(3) It is the responsibility of the ICFIID to ensure that all required information is provided to the department as requested. An initial request for prior authorization for ventilator services is considered complete when:

(a) A request has been accurately completed and electronically submitted;

(b) A developmental disabilities level of care has been issued in accordance with rule 5123-8-01 of the Administrative Code and a determination regarding the feasibility of community-based care has been made; and

(c) The designated outlier coordinator has received supporting documentation exhibiting evidence that the applicant meets the eligibility criteria set forth in paragraphs (C)(3) to (C)(6) of this rule. Supporting documentation may include, but is not limited to, the preliminary evaluation, assessments, and transitional plan required prior to admission as set forth in paragraph (D) of this rule.

(4) The department's determination will be based on the completed initial stay request and any additional information or documentation necessary to make the determination of eligibility for ventilator services, which may include a face-to-face visit by at least one department representative with the individual and, if applicable, the individual's parent, the individual's guardian, or other person whom the individual has identified and, to the extent possible, the individual's formal and informal care givers, to review and discuss the individual's care needs and preferences.

(5) Based upon a comparison of the individual's condition, service needs, and the requested placement site with the eligibility criteria set forth in paragraph (C) of this rule, the department will conduct a review of the application, assessment report, and supporting documentation about the individual's condition and service needs to determine whether the individual is eligible for ventilator services.

(6) The department will issue a notice of determination within thirty calendar days of receipt of a complete request for prior authorization indicating approval or denial of the request to the individual, the individual's parent, the individual's guardian, or other person whom the individual has identified, as applicable, and the ICFIID.

(a) When a request for prior authorization for ventilator services is denied, the notice will specify the reason for denial and explain the individual's right to a state hearing in accordance with section 5101.35 of the Revised Code.

(b) When a request for prior authorization for ventilator services is approved, the notice will include an assigned prior authorization number, the number of days for which ventilator services are authorized, and the date on which payment is authorized to begin. The notice will also include the name and email address of the department staff member who is assigned to monitor the individual's progress at the ICFIID.

(i) Individuals who are determined to have met the eligibility criteria set forth in paragraph (C) of this rule may be approved for an initial stay of a maximum of one hundred eighty-four days. The number of days prior-authorized for each eligible individual will be based upon the submitted application materials, consultation with the individual's attending physician, and/or any additional consultations or materials required by the assessor to make a reasonable estimation regarding the individual's probable need for ventilator services.

(ii) Continued stay determinations will be based on reports from the ICFIID submitted to the designated outlier coordinator regarding critical events and the status of the individual's condition and discharge planning options, face-to-face assessments conducted by the department, and/or other information determined by the department. When the department determines that the individual continues to meet the eligibility criteria set forth in paragraph (C) of this rule, and the ICFIID submits a request for continued stay in accordance with paragraph (F)(8) of this rule, continued stays may be approved for maximum increments of one hundred eighty-four days.

(7) An individual is expected to be discharged to the setting specified in the individual's discharge plan at the end of the prior-authorized initial or continued stay, and progress toward that end will be monitored by the department or its designee throughout the individual's stay in the ICFIID.

(8) Ventilator services may be extended beyond the previously approved length of stay if the ICFIID electronically submits a request to the department proving that it is not possible to implement the individual's discharge plan. Such requests will be submitted at least thirty calendar days prior to the last day of the previously authorized stay, unless there is a significant change of circumstances within the week preceding the expected discharge date that prevents implementation of the discharge plan.

(G) Payment authorization

The payment authorization date will be one of the following, but will not be earlier than the effective date of the individual's developmental disabilities level of care determination:

(1) The date of admission to the ICFIID; or

(2) The date of prior authorization for ventilator services approval, if the individual was already a resident of an ICFIID that provides ventilator services but was using another payer source.

(H) Initial and subsequent contracted rates

(1) The department will establish the initial and subsequent contracted rates in accordance with Chapter 5124. of the Revised Code. All rate adjustments determined in accordance with this rule will be effective on the payment authorization date determined in accordance with paragraph (G) of this rule through the date of discharge from the ICFIID or until the date the individual no longer meets the eligibility criteria set forth in paragraph (C) of this rule.

(2) An ICFIID may bill the ventilator services revenue code for each individual whose initial or continued stay prior authorization has been approved in accordance with paragraph (F) of this rule.

(3) An ICFIID will not bill the ventilator services revenue code for individuals who are using bed-hold days in accordance with rule 5123-7-08 of the Administrative Code.

(4) The ICFIID will notify the designated outlier coordinator or other department designee no later than by the close of the next business day following the discharge of an individual or point at which the individual no longer meets the eligibility criteria established in paragraph (C) of this rule to ensure processing time for recalculation and application of the ventilator services outlier per diem rate to the ICFIID per diem rate.

(5) The ventilator services outlier per diem rate is specific to the individual approved to receive ventilator services.

(a) The ventilator services outlier per diem rate is three hundred dollars for services rendered on or before June 30, 2023.

(b) The ventilator services outlier per diem rate is nine hundred dollars for services rendered on or after July 1, 2023.

Last updated June 25, 2025 at 6:50 PM

History

Effective: August 13, 2023
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-32 Intermediate care facilities for individuals with intellectual disabilities - administration of the Ohio developmental disabilities profile.

(A) Purpose

This rule sets forth a requirement and process for administration of the Ohio developmental disabilities profile to residents of an intermediate care facility for individuals with intellectual disabilities (ICFIID).

(B) Definitions of terms used in this rule

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

(1) "Certified assessor" means a person authorized by the department to administer the Ohio developmental disabilities profile. In order to become a certified assessor, a person is required to complete training conducted or approved by the department and successfully perform a post-training demonstration.

(2) "Ohio developmental disabilities profile" means the instrument used to assess the needs and circumstances of an individual with developmental disabilities relative to other individuals with developmental disabilities.

(3) "Reporting period" means one of the four quarters of the calendar year, that is:

(a) January through March;

(b) April through June;

(d) October through December.

(4) "Reporting period end date" means the last day of the last month in a reporting period.

(5) "Significant change of condition" means that an individual has experienced a change in physical or mental condition or functional abilities which may result in a change in the individual's support needs.

(1) Only a certified assessor may administer the Ohio developmental disabilities profile or attest that the most recent Ohio developmental disabilities profile is still valid for a resident of an ICFIID.

(2) A certified assessor of the department will administer the Ohio developmental disabilities profile to a new resident of an ICFIID (other than a resident who transfers from another ICFIID) within thirty calendar days of the resident's admission, regardless of the resident's payment source or anticipated length of stay. Within seven calendar days of administration of the Ohio developmental disabilities profile, the department will electronically notify the ICFIID of the results.

(3) When a resident of an ICFIID transfers to another ICFIID, the resident's most recent Ohio developmental disabilities profile will transfer with the resident.

(4) When a resident of an ICFIID, regardless of the resident's payment source or anticipated length of stay, experiences a significant change of condition, a certified assessor of the ICFIID shall administer the Ohio developmental disabilities profile and electronically submit the results to the department with supporting documentation for the significant change of condition within fifteen calendar days of the significant change of condition. Within seven calendar days of receipt of the ICFIID's electronic submission, the department will make a determination on a question-by-question basis and electronically notify the ICFIID that:

(a) The department accepts the results of the Ohio developmental disabilities profile administered by the ICFIID;

(b) The department requires additional supporting documentation to make a determination which will be submitted by the ICFIID within seven calendar days; or

(c) The department does not accept the results of the Ohio developmental disabilities profile administered by the ICFIID and provide the department's rationale for not accepting the results.

(5) An ICFIID that disputes the results of an Ohio developmental disabilities profile administered by the department in accordance with paragraph (C)(2) of this rule or the department's determination in accordance with paragraph (C)(4)(c) of this rule may submit a request for reconsideration within fifteen calendar days of receiving notification of the results or determination. The ICFIID shall electronically submit the request for reconsideration to the department with a detailed explanation of why the ICFIID disputes the results or determination, relevant supporting documentation, and a proposed resolution. When an ICFIID submits a request for reconsideration in response to the department's determination in accordance with paragraph (C)(4)(c) of this rule, a certified assessor of the department will re-administer the entire Ohio developmental disabilities profile to the resident. The department will electronically respond to the ICFIID within fifteen calendar days of receiving the request for reconsideration. The department's decision regarding a request for reconsideration is final and not subject to further appeal.

(D) Quarterly certification of Ohio developmental disabilities profile data

(1) For each reporting period, a certified assessor of the ICFIID shall attest that the most recent Ohio developmental disabilities profile is still valid for each resident of the ICFIID on the reporting period end date, regardless of a resident's payment source or anticipated length of stay.

(a) The following will be considered residents of the ICFIID on the reporting period end date:

(i) Residents admitted or transferred to the ICFIID prior to or on the reporting period end date and physically residing in the ICFIID on the reporting period end date; and

(ii) Residents temporarily absent on the reporting period end date but for whom the ICFIID is receiving payment from any source to hold a bed for the resident during a hospital stay, visit with friends or relatives, or participation in therapeutic programs outside the facility in accordance with rule 5123-7-08 of the Administrative Code.

(b) The following will not be considered residents of the ICFIID on the reporting period end date:

(i) Residents discharged from the ICFIID prior to or on the reporting period end date;

(ii) Residents transferred to another ICFIID prior to or on the reporting period end date; and

(iii) Residents who die prior to or on the reporting period end date.

(2) A certified assessor of the ICFIID shall electronically certify the Ohio developmental disabilities profile data on behalf of the entire ICFIID no later than fifteen calendar days following the reporting period end date. The certification will include the name of the certified assessor who verified that an Ohio developmental disabilities profile has been administered and attested that the most recent Ohio developmental disabilities profile is still valid for each resident of the ICFIID on the reporting period end date and the name and contact information of a staff member should department staff have questions about the data.

(E) Summary and correction of Ohio developmental disabilities profile data

(1) The department will electronically notify an ICFIID of a missing or incomplete certification of Ohio developmental disabilities profile.

(2) The department will process and summarize the ICFIID's Ohio developmental disabilities profile data for the reporting period and electronically provide a summary of the data to the ICFIID.

(3) An ICFIID may correct errors or omissions identified by either the department or the ICFIID by electronically submitting corrections along with an amended certification of Ohio developmental disabilities profile data no later than forty-five calendar days following the reporting period end date. Timeliness of the submission will be determined by the electronic submission date.

(4) An ICFIID shall ensure that corrections made to the Ohio developmental disabilities profile data submitted to the department are consistent with the Ohio developmental disabilities profiles maintained at the ICFIID.

Last updated April 27, 2023 at 8:43 AM

History

Effective: April 27, 2023
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-33 Intermediate care facilities for individuals with intellectual disabilities - resident assessment classification system based on administration of the Ohio developmental disabilities profile.

(A) Purpose

This rule sets forth a method and process for determining the per resident/per day rate paid to an intermediate care facility for individuals with intellectual disabilities (ICFIID) for direct care costs using the Ohio developmental disabilities profile pursuant to sections 5124.19 to 5124.193 of the Revised Code.

(B) Definitions

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

(1) "Annual facility average case mix score" means the ICFIID's average case mix score of all qualifying quarters in a calendar year.

(2) "Case mix score" means the measure of the relative direct care resources needed to provide care and rehabilitation to a resident of an ICFIID using the Ohio developmental disabilities profile.

(3) "Correction submission due date" means the deadline for an ICFIID to submit corrected Ohio developmental disabilities profile data to the department. The correction submission due date applies to corrections submitted in electronic format for facility level errors and resident record changes.

(4) "Cost per case mix unit" is calculated by dividing an ICFIID's desk-reviewed, actual, allowable, per diem direct care costs for the calendar year preceding the fiscal year in which the rate will be paid by the annual facility average case mix score for the calendar year preceding the fiscal year in which the rate will be paid.

(5) "Facility level errors" means errors which must be corrected before a facility average case mix score can be calculated and include:

(a) Failure to electronically submit the certification of Ohio developmental disabilities profile data by the filing date; and

(b) Incomplete or inaccurate changes to a resident's assessment data are submitted to the department.

(6) "Filing date" means the deadline for initial quarterly electronic submission and certification of an ICFIID's Ohio developmental disabilities profile data, which is the fifteenth calendar day following the reporting period end date.

(7) "Ohio developmental disabilities profile" means the instrument used to assess the needs and circumstances of an individual with developmental disabilities for the purpose of calculating an ICFIID's direct care component rate pursuant to sections 5124.19 to 5124.193 of the Revised Code.

(8) "Peer group" means one of the following groups of ICFIID:

(a) "Peer group 1" includes each ICFIID with a medicaid-certified capacity exceeding sixteen.

(b) "Peer group 2" includes each ICFIID with a medicaid-certified capacity exceeding eight but not exceeding sixteen.

(d) "Peer group 4" includes each ICFIID with a medicaid-certified capacity not exceeding six, other than an ICFIID that is in peer group 5.

(e) "Peer group 5" includes each ICFIID to which all of the following apply:

(i) The ICFIID is first certified as an ICFIID after July 1, 2014;

(ii) The ICFIID has a medicaid-certified capacity not exceeding six;

(iii) The ICFIID has a contract with the department that is for fifteen years and includes a provision for the department to approve all admissions to, and discharges from, the ICFIID; and

(iv) The ICFIID's residents are admitted to the ICFIID directly from a department-operated ICFIID or have been determined by the department to be at risk of admission to a department-operated ICFIID.

(f) "Peer group 6" includes each ICFIID to which all of the following apply:

(i) The ICFIID has submitted a best practices protocol for providing services to youth up to twenty-one years of age in need of intensive behavioral support services that has been approved by the department;

(ii) The ICFIID, or a distinct unit of the ICFIID, has a medicaid-certified capacity not exceeding six;

(iii) The ICFIID has a contract with the department that includes a provision for the department to approve all admissions to the ICFIID; and

(iv) The ICFIID has agreed to be reimbursed in accordance with the reimbursement methodology established under the rules authorized by section 5124.03 of the Revised Code.

(9) "Processing quarter" means the quarter that follows the reporting quarter and is the quarter in which the department receives the Ohio developmental disabilities profile data for the reporting quarter.

(10) "Quarterly facility average case mix score" means the facility average case mix score based on Ohio developmental disabilities profile data submitted for one reporting quarter.

(11) "Record" means a resident's Ohio developmental disabilities profile data processed by the department.

(12) "Relative resource weight" means the measure of the relative costliness of caring for residents in one case mix classification versus another, indicating the relative amount and cost of staff time required on average for defined job types to care for residents in a single case mix classification.

(13) "Reporting period end date" means the last day of each calendar quarter.

(14) "Reporting quarter" means the quarter which precedes the processing quarter.

(15) "Resident assessment classification system" means the system for classifying residents of an ICFIID into case mix classifications that reflect clusters of residents, defined by resident characteristics, determined using data from the Ohio developmental disabilities profile, that explain resource use.

(16) "Resident case mix score" means the relative resource weight for the classification to which a resident is assigned based on data elements from the resident's Ohio developmental disabilities profile.

(1) The department will use the resident assessment classification system to classify residents of an ICFIID based on the data from the Ohio developmental disabilities profile. Using point values assigned to responses to questions on the Ohio developmental disabilities profile as set forth in the appendix to this rule, the Ohio developmental disabilities profile for each resident will be scored in three distinct domains:

(a) Medical;

(b) Behavioral; and

(2) The department will calculate a resident's assessment score for each of the medical, behavioral, and adaptive skills domains and assign points:

(a) If the resident's assessment score for the domain is more than one standard deviation above the mean assessment score for the domain for all ICFIID residents as of December 31, 2017, one point;

(b) If the resident's assessment score for the domain is more than one-half standard deviation above the mean assessment score for the domain for all ICFIID residents as of December 31, 2017, and not more than one standard deviation above that mean, two points;

(c) If the resident's assessment score for the domain is more than the mean assessment score for the domain for all ICFIID residents as of December 31, 2017, and not more than one-half standard deviation above that mean, three points;

(d) If the resident's assessment score for the domain is not more than the mean assessment score for the domain for all ICFIID residents as of December 31, 2017, and not more than one-half standard deviation below that mean, four points;

(e) If the resident's assessment score for the domain is more than one-half standard deviation below the mean assessment score for the domain for all ICFIID residents as of December 31, 2017, and not more than one standard deviation below that mean, five points; and

(f) If the resident's assessment score for the domain is more than one standard deviation below the mean assessment score for the domain for all ICFIID residents as of December 31, 2017, six points.

(3) The department will determine the weighted sum of the points assigned in accordance with paragraph (C)(2) of this rule to each of the resident's domain assessment scores and round the weighted sum to the nearest whole number:

(a) Points assigned to the resident's assessment score for the medical domain will be weighted at thirty-five per cent;

(b) Points assigned to the resident's assessment score for the behavioral domain will be weighted at thirty per cent; and

(c) Points assigned to the resident's assessment score for the adaptive skills domain will be weighted at thirty-five per cent.

(4) The department will place the resident into an acuity group:

(a) If the resident's weighted sum of points is five or lower, group one;

(b) If the resident's weighted sum of points is at least six and not more than eight, group two;

(d) If the resident's weighted sum of points is eleven or twelve, group four;

(e) If the resident's weighted sum of points is at least thirteen and not more than fifteen, group five; and

(f) If the resident's weighted sum of points is sixteen or higher, group six.

(D) Relative resource weights

(1) Analysis of staff time and resident assessment data, collected in a work measurement study of Ohio medicaid-certified ICFIID for the purpose of establishing common staff times associated with all resident classifications that are standard across residents, staff, facilities, and units, determined that the job classifications listed in paragraphs (D)(1)(a) to (D)(1)(h) of this rule are job types that perform activities that vary by case mix classification established using the Ohio developmental disabilities profile. Job types determined not to be positions participating in activities that vary by case mix classification are not used to calculate the relative resource weights described in paragraph (D)(2) of this rule.

(a) Habilitation specialists consisting of nurse aides and habilitation staff;

(b) Licensed practical nurses;

(d) Program specialists;

(e) Qualified intellectual disability professionals;

(f) Registered nurses;

(g) Social workers/counselors; and

(h) Speech therapists.

(2) Each of the six resident acuity groups is assigned a relative resource weight. The relative resource weight indicates the relative amount and cost of staff time required on average for the job types listed in paragraphs (D)(1)(a) to (D)(1)(h) of this rule to deliver care to residents in that classification. The relative resource weight was calculated using the average minutes of care per job type per classification as determined during the work measurement study, and the averages of the wages by job type as reported on the cost report. By setting the wage weight at one for the job type receiving the lowest hourly wage, wage weights for the other job types are calculated by dividing the lowest wage into the wage of each of the other job types. To calculate the total weighted minutes for each classification, the wage weight for each job type is multiplied by the average number of minutes staff of that job type spend caring for a resident in that classification, and the products are summed. The classification with the lowest total weighted minutes receives a relative resource weight of one. Relative resource weights are calculated by dividing the total weighted minutes of the lowest classification into the total weighted minutes of each classification. Weight calculations are rounded to the second decimal place. Relative resource weights for the resident acuity groups are:

(a) Resident acuity group one = 2.75.

(b) Resident acuity group two = 1.86.

(d) Resident acuity group four = 1.31.

(e) Resident acuity group five = 1.12.

(f) Resident acuity group six = 1.00.

(3) Except as provided in paragraph (D)(3)(a) of this rule, relative resource weights may be recalibrated using wage weights based on three-year statewide averages of wages of the job types listed in this rule as reported on the cost report, and minutes of care per job type per resident assessment classification.

(a) The department may recalibrate the relative resource weights no more often than every three years, using the minutes of care per job type per classification from the most current work measurement study and the wages per job type per hour, to be effective at the beginning of the next state fiscal year. When recalibrating the relative resource weights, the department will use cost report wage data from the most recent three calendar years available ninety calendar days prior to the start of the fiscal year.

(b) The department may recalibrate relative resource weights more frequently if significant variances in wage ratios between job types occur.

(c) The department may rebase the relative resource weights through the deletion or addition of job types or with revised minutes of care per job type by conducting a new work measurement study, if significant changes in the job types or work roles of the job types occur, or following a change in state policy which would significantly affect statewide case mix of the ICFIID population.

(d) After recalibrating or rebasing relative resource weights in accordance with paragraph (D)(3)(a), (D)(3)(b), or (D)(3)(c) of this rule, the department will use the recalibrated or rebased relative resource weights to recalculate the annual facility average case mix score for the calendar year preceding the fiscal year.

(4) The annual facility average case mix score is used in conjunction with the lesser of the ICFIID's cost per case mix unit or the maximum allowable cost per case mix unit, adjusted by the inflation rate, to establish the direct care rate, as outlined in sections 5124.19 to 5124.193 of the Revised Code. The ICFIID's cost per case mix unit is calculated using the annual facility average case mix score. The method for determining the annual facility average case mix score is described in paragraph (F) of this rule.

(E) Quarterly facility average case mix score

(1) The department will establish each ICFIID's rate for direct care costs annually pursuant to sections 5124.19 to 5124.193 of the Revised Code. To set the rate, the department will:

(a) Calculate the ICFIID's cost per case mix unit;

(b) Multiply the lesser of the ICFIID's cost per case mix unit or the maximum cost per case mix unit for the ICFIID's peer group determined pursuant to division (C) of section 5124.19 of the Revised Code by the ICFIID's case mix score for the calendar quarter ending March thirty-first of the calendar year in which the fiscal year for which the rate is set begins; and

(c) Multiply the amount determined in accordance with paragraph (E)(1)(b) of this rule by the inflation factor specified in division (D) of section 5124.19 of the Revised Code.

(2) The quarterly facility average case mix score for an ICFIID that submitted Ohio developmental disabilities profile data and modifications timely, and has no facility level errors is calculated by:

(a) Adding together all residents' relative resource weights for the quarter; and

(b) Dividing the sum of relative resource weights by the total number of residents.

(3) The department will assign a quarterly facility average case mix score or cost per case mix unit used to establish an ICFIID's rate for direct care costs if the ICFIID fails to correct facility level errors. Before taking such action, the department will permit the ICFIID a reasonable period of time to correct the information, in accordance with rule 5123-7-32 of the Administrative Code.

(a) The department may assign a quarterly facility average case mix score that is five per cent less than the ICFIID's quarterly facility average case mix score for the preceding calendar quarter instead of using the quarterly facility average case mix score calculated based on the ICFIID's submitted information as described in paragraph (E)(2) of this rule. If the ICFIID was assigned a quarterly facility average case mix score for the preceding calendar quarter, the assigned quarterly facility average case mix score will be the score that is five per cent less than that score assigned for the preceding quarter.

(b) The department may assign a cost per case mix unit that is five per cent less than the ICFIID's calculated or assigned cost per case mix unit for the preceding calendar year if the ICFIID has fewer than two acceptable quarterly facility average case mix scores as described in paragraph (F)(1)(b) of this rule.

(F) Annual facility average case mix score

(1) The annual facility average case mix score is used pursuant to section 5124.19 of the Revised Code to compute the cost per case mix unit for the ICFIID and the peer group maximum cost per case mix unit. Ohio developmental disabilities profile data for all four quarters of the calendar year will be used to calculate the annual facility average case mix score:

(a) The department-assigned facility average case mix scores will be omitted from the ICFIID's annual average case mix score calculation.

(b) The annual facility average case mix score will be calculated from no fewer than two acceptable quarterly facility average case mix scores. Acceptable quarterly facility average case mix scores will be summed and divided by the total number of quarters of acceptable scores. Acceptable quarterly facility average case mix scores for the purposes of calculating the annual facility average case mix score and for paragraph (E)(3) of this rule include quarterly facility average case mix scores calculated based on the ICFIID's submitted information as described in paragraph (E)(2) of this rule.

(2) If at least two acceptable quarterly facility average case mix scores are not available, the department will assign the cost per case mix unit in accordance with paragraph (E)(3)(b) of this rule.

View Appendix

Last updated July 1, 2024 at 4:50 PM

History

Effective: July 1, 2024
Promulgated Under: 119.03

Ohio Adm.Code 5123-7-34 Intermediate care facilities for individuals with intellectual disabilities - quality indicators and the quality incentive payment program.

(A) Purpose

This rule sets forth a method and process for determining the quality incentive payment that may be paid to an intermediate care facility for individuals with intellectual disabilities (ICFIID) for achieving quality indicators pursuant to section 5124.24 of the Revised Code.

(B) Definitions

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

(1) "Change of operator" has the same meaning as in section 5124.01 of the Revised Code.

(2) "Cost report" has the same meaning as in rule 5123-7-12 of the Administrative Code.

(3) "Direct care staff" means activity staff, habilitation staff, habilitation supervisors, nurse aides, nurses, and qualified intellectual disability professionals.

(5) "Inpatient days" has the same meaning as in section 5124.01 of the Revised Code.

(6) "Quality incentive payment" means a rate enhancement, available beginning with fiscal year 2022, that is a component of an ICFIID's per diem rate, available to an eligible ICFIID that chooses to achieve quality indicators and meets the requirements set forth in this rule.

(7) "Quality indicator" means one of the five standards set forth in paragraph (D) of this rule.

(1) Participation in the quality incentive payment program is voluntary. An ICFIID that chooses to participate may elect to do so for one or more quality indicators.

(2) To be eligible for participation in the quality incentive payment program, an ICFIID is to have been in operation for at least three months prior to the last day of the calendar year for which it is submitting a cost report.

(3) In the case of a change of operator, an entering operator may be eligible for the quality incentive payment determined only for a cost report period commencing after the effective date of the change of operator.

(4) An ICFIID whose license has been suspended, proposed for revocation, or revoked at any time during a cost report period is ineligible for a quality incentive payment for the following fiscal year.

(D) Quality indicators

Five quality indicators have been established for purposes of the quality incentive payment program:

(1) The ICFIID has developed and implemented a written policy to annually conduct satisfaction surveys for residents of the ICFIID. The policy is to set forth that:

(a) The survey will address, at a minimum:

(i) The degree to which a resident feels happy and safe living in the ICFIID;

(ii) Staff interactions;

(iii) The level to which a resident and/or his or her guardian are involved in person-centered planning;

(iv) Community activities; and

(v) Medical care.

(b) The ICFIID will ensure and document that the satisfaction survey is completed by or offered to each resident and/or the resident's guardian, family member, or advocate.

(c) The ICFIID will summarize the survey results and share the summarized survey results with residents, guardians, family members, and advocates.

(d) The ICFIID will develop a plan to respond to any concerns identified through administration of the survey.

(2) The ICFIID has developed and implemented a written policy to ensure individual service plans are person-centered. At a minimum, the policy will:

(a) Set forth a process for obtaining input from residents, guardians, and direct care staff.

(b) Address the six essential elements of person-centered planning:

(i) Language in the individual service plan is descriptive, respectful, empowering, and uses everyday words that the resident, persons important to the resident, and direct care staff understand;

(ii) The individual service plan uses a trauma-responsive approach and identifies the resident's strengths learned through life experiences;

(iii) Important ideas are organized and interwoven through the individual service plan so that it is clear that outcomes and services flow from information outlined elsewhere in the individual service plan;

(iv) What is important for the resident and what is important to the resident is specific, detailed, and reflected in outcomes and services;

(v) Outcomes are clear and action steps describe how progress will be measured; and

(vi) The individual service plan includes a clear description of services and supports necessary to address the resident's needs and preferred method for delivery.

(3) The ICFIID has developed and implemented a written policy to ensure that each resident has opportunities to experience community integration on a person-centered basis.

(4) The ICFIID has developed and implemented a written policy to ensure all direct care staff successfully complete, on an annual basis, at least one hour of training specific to resident or staff needs that is above and beyond the training described in paragraph (C) of appendix B to rule 5123-3-01 of the Administrative Code. The training may vary among staff.

(5) The ICFIID has developed and implemented a written policy for staff retention that includes measuring staff turnover.

(E) Awarding points for quality indicators

(1) Each quality indicator is associated with one point, for a maximum possible five points.

(2) An ICFIID will indicate its intent to receive the point for a quality indicator by attesting on its cost report that it has achieved the quality indicator and attaching its written policy for the quality indicator. To continue to receive the point for a quality indicator, the ICFIID will attach its written policy for the quality indicator to subsequent cost reports and indicate if the written policy has been amended since the prior submission.

(3) An eligible ICFIID will receive the point for a quality indicator when:

(a) The ICFIID attests it has achieved the quality indicator;

(b) The ICFIID attaches its written policy for the quality indicator with its cost report; and

(i) The written policy for the quality indicator fails to meet the requirements set forth in this rule; or

(ii) The ICFIID fails to implement the written policy.

(F) Calculation of the quality incentive payment

An ICFIID's per diem quality incentive payment for a fiscal year will be calculated in accordance with section 5124.24 of the Revised Code.

(G) Verifying achievement of quality indicators

(1) The department will use two methods to verify a participating ICFIID's achievement of quality indicators.

(a) Review of written policy

(i) Department staff will review each written policy for a quality indicator submitted by an ICFIID to ensure the policy meets the requirements set forth in this rule. The written policies will be reviewed as part of the desk review of the ICFIID's cost report conducted in accordance with rule 5123-7-12 of the Administrative Code.

(ii) The department will notify an ICFIID by electronic mail within fifteen calendar days of completing the desk review when the department finds that the written policy fails to meet the requirements set forth in this rule. The notice will inform the ICFIID that it is ineligible to receive the quality incentive payment for that quality indicator for the following fiscal year and should adjust its cost report accordingly.

(iii) An ICFIID may electronically submit a request for reconsideration of the department's finding that includes written justification within fifteen calendar days of receipt of the desk review finding.

(iv) The department will respond by electronic mail to the request for reconsideration within fifteen calendar days of receipt.

(b) Review of implementation of written policy

(i) Department staff will review the ICFIID's implementation of the written policy for a quality indicator during an on-site or virtual review of the ICFIID. The department will notify an ICFIID by electronic mail at least fifteen calendar days in advance of the on-site or virtual review. When an ICFIID indicates it has achieved more than one quality indicator, department staff will review implementation of at least two quality indicators.

(a) For purposes of reviewing implementation of the written policy for a quality indicator described in paragraph (D)(1), (D)(2), or (D)(3) of this rule, the department will select a random sample of residents for review. The number of residents selected will be two or twenty per cent, whichever is larger.

(b) For purposes of reviewing implementation of the written policy for the quality indicator described in paragraph (D)(4) of this rule, the department will select a random sample of direct care staff for review. The number of direct care staff selected will be two or twenty per cent, whichever is larger.

(c) For purposes of reviewing implementation of the written policy for the quality indicator described in paragraph (D)(5) of this rule, the department will examine the ICFIID's measurements or reports of staff turnover for the cost report period.

(ii) The department will notify an ICFIID by electronic mail within fifteen calendar days of completing the on-site or virtual review when the department finds that the ICFIID failed to implement the written policy. The notice will inform the ICFIID that it is ineligible to receive the quality incentive payment for that quality indicator for the following fiscal year and should adjust its cost report accordingly.

(iii) An ICFIID may electronically submit a request for reconsideration of the department's finding that includes written justification with supporting documentation within fifteen calendar days of receipt of the on-site or virtual review finding.

(iv) The department will respond by electronic mail to the request for reconsideration within fifteen calendar days of receipt.

(2) If the department determines that an ICFIID improperly attested achievement of a quality indicator on its cost report, the department will reject the cost report and the ICFIID will submit a corrected cost report in accordance with rule 5123-7-12 of the Administrative Code. The ICFIID will not receive a quality incentive payment for the quality indicator.

Last updated July 1, 2024 at 4:51 PM

History

Effective: July 1, 2024
Promulgated Under: 119.03

Chapter 5123-8 Developmental Disabilities Level of Care

Ohio Adm.Code 5123-8-01 Developmental disabilities level of care.

(A) Purpose

This rule sets forth the criteria and process used to determine whether an individual requires the level of care necessary to receive medicaid-funded services from an intermediate care facility for individuals with intellectual disabilities (ICFIID) or through enrollment in a home and community-based services waiver administered by the Ohio department of developmental disabilities.

(B) Definitions

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

(1) "Certified nurse practitioner" has the same meaning as in section 4723.01 of the Revised Code.

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

(3) "Current diagnoses" means a written determination by a qualified professional, whose scope of practice includes diagnosis, which lists the diagnosed conditions that currently impact an individual's health and functional abilities.

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

(5) "Developmental disabilities level of care" means the level of care required for admission to an ICFIID or enrollment in home and community-based services. A determination by the department that an individual meets the criteria for a developmental disabilities level of care will be valid for up to twelve months unless the individual has experienced a significant change of condition.

(6) "Developmental disabilities level of care assessment" means a standardized process approved by the Ohio department of medicaid for the purpose of determining an individual's functional capacity.

(7) "Emergency admission" means admission to an ICFIID of an individual who is facing a situation that creates for the individual a risk of substantial self-harm or substantial harm to others if action is not taken within thirty calendar days. Emergency admission may be necessitated by one or more of the following:

(a) Loss of present residence for any reason, including legal action;

(b) Loss of present caretaker for any reason, including serious illness of the caretaker, change in caretaker's status, or inability of the caretaker to effectively provide care for the individual;

(d) Health and safety conditions that pose a serious risk to the individual or others of immediate harm or death; or

(e) Change in emotional or physical condition of the individual that necessitates substantial accommodation that cannot be reasonably provided by the individual's existing caretaker.

(8) "Evaluator" means a person who coordinates or performs the evaluations and assessments of an individual to make a recommendation to the department as to whether or not the individual meets the criteria for the developmental disabilities level of care.

(a) Each evaluator will complete department-approved training prior to completing evaluations or assessments and recommending level of care.

(b) An evaluator will be a person:

(i) Employed by or under contract with a county board for the purpose of recommending level of care for an individual seeking enrollment in home and community-based services;

(ii) Employed by an ICFIID in which an individual is seeking placement or currently resides; or

(iii) Designated by the department.

(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 the purposes of giving, refusing to give, or withdrawing consent for services, the person's guardian in accordance with section 5126.043 of the Revised Code or other person authorized to give consent.

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

(12) "Physician" means a person licensed under Chapter 4731. of the Revised Code or licensed in another state as defined by applicable law, to practice medicine and surgery or osteopathic medicine and surgery.

(13) "Psychiatrist" means a physician licensed under Chapter 4731. of the Revised Code or licensed in another state as defined by applicable law, to practice psychiatry.

(14) "Psychologist" means a person licensed under Chapter 3319. or Chapter 4732. of the Revised Code or licensed in another state as defined by applicable law, to practice psychology.

(15) "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.

(16) "Significant change of condition" means that an individual has experienced a change in physical or mental condition or functional abilities which may result in a change in the individual's level of care.

(1) For an individual birth through age nine, the criteria for a developmental disabilities level of care is met when:

(a) The individual has a substantial developmental delay or specific congenital or acquired condition other than an impairment caused solely by mental illness; and

(b) In the absence of individually planned supports, the individual has a high probability of having substantial functional limitations in at least three areas of major life activities set forth in paragraphs (C)(2)(b)(i) to (C)(2)(b)(vii) of this rule later in life.

(2) For an individual age ten and older, the criteria for a developmental disabilities level of care is met when:

(a) The individual has been diagnosed with a severe, chronic disability that:

(i) Is attributable to a mental or physical impairment or combination of mental and physical impairments, other than an impairment caused solely by mental illness;

(ii) Is manifested before the individual is age twenty-two; and

(iii) Is likely to continue indefinitely.

(b) The condition described in paragraph (C)(2)(a) of this rule results in substantial functional limitations in at least three of the following areas of major life activities, as determined through use of the developmental disabilities level of care assessment:

(i) Self-care;

(ii) Receptive and expressive communication;

(iii) Learning;

(iv) Mobility;

(v) Self-direction;

(vi) Capacity for independent living; or

(vii) Economic self-sufficiency.

(c) The condition described in paragraph (C)(2)(a) of this rule reflects the individual's need for a combination and sequence of special, interdisciplinary, or generic services, individualized supports, or other forms of assistance of lifelong or extended duration that are individually planned and coordinated.

(D) Developmental disabilities level of care assessment

(1) A developmental disabilities level of care assessment will include:

(a) Current diagnoses, including an indication of whether the individual has been diagnosed with a severe, chronic disability as described in paragraph (C)(2)(a) of this rule;

(b) An in-person review of current functional capacity; and

(c) Supporting documentation which will be maintained in the individual's record and made available for state and federal quality assurance and audit purposes.

(2) When requesting an initial determination of developmental disabilities level of care, an evaluator will submit a recommendation and supporting documentation to the department for review and approval or denial. Supporting documentation will include:

(a) Verification of the presence of a substantial developmental delay or congenital condition for an individual birth through age nine as described in paragraph (C)(1)(a) of this rule or the presence of a severe, chronic disability for an individual age ten and older as described in paragraph (C)(2)(a) of this rule. The verification will be submitted in a format prescribed by the department and include:

(i) The results of a medical evaluation performed by a physician or certified nurse practitioner which includes etiology of the condition leading to a developmental disability, diagnoses, and dates of onset; or

(ii) For a child birth through age five, the results of an evaluation performed by a qualified professional using appropriate diagnostic instruments and/or procedures; or

(iii) The results of a psychological evaluation completed by a psychologist or a psychiatric evaluation completed by a psychiatrist which includes the current diagnoses as specified in the "Diagnostic and Statistical Manual of Mental Disorders" (fifth edition), axes I, II, and III.

(b) A completed developmental disabilities level of care assessment.

(3) An initial level of care recommendation for an individual seeking enrollment in home and community-based services will be submitted to the department prior to enrollment. A level of care recommendation may be submitted to the department up to ninety calendar days in advance of the proposed enrollment date.

(4) An initial level of care recommendation for an individual seeking medicaid funding for placement in an ICFIID will be submitted to the department prior to admission, unless the individual is determined to need emergency admission. A level of care recommendation for an individual seeking emergency admission will be submitted to the department no later than seven calendar days after the date of admission.

(5) A county board will send notification to the department in a format prescribed by the department within three business days when an individual determined to have a developmental disabilities level of care moves from home and community-based services to:

(a) An ICFIID;

(b) A hospital;

(d) A jail or prison; or

(e) Another institutional setting.

(6) An ICFIID will send notification to the department in a format prescribed by the department within three business days when an individual determined to have a developmental disabilities level of care moves from the ICFIID to:

(a) A hospital;

(b) A nursing facility;

(d) Another institutional setting; or

(e) Home and community-based services.

(7) Subsequent to a move described in paragraph (D)(5) or (D)(6) of this rule, a review of the individual's level of care will be completed upon the individual's return to the prior home and community-based services waiver or ICFIID. Evidence of this review will be submitted to the department in a format prescribed by the department within three business days of the individual's return in order for payment authorization to resume for the ICFIID or providers of home and community-based services.

(8) An evaluator will submit a request for redetermination of developmental disabilities level of care to the department within twelve months of the previous developmental disabilities level of care determination and whenever circumstances suggest the individual may have experienced a significant change of condition which will establish one of the following:

(a) The individual has not experienced a significant change of condition since the previous developmental disabilities level of care determination. The evaluator will submit to the department, in a format prescribed by the department, documentation verifying that the individual's condition has not changed significantly since the previous developmental disabilities level of care determination and recommend continuation of the developmental disabilities level of care. All recommendations to continue the developmental disabilities level of care will be submitted to the department at least fifteen calendar days in advance of the redetermination due date and may be submitted up to ninety calendar days in advance.

(b) The individual has experienced a significant change of condition since the previous developmental disabilities level of care determination. The evaluator will submit the verification described in paragraph (D)(2)(a) of this rule and a completed developmental disabilities level of care assessment to the department immediately upon identification of a significant change of condition.

(9) Following receipt by the department of the documentation specified in paragraph (D)(2) or (D)(8) of this rule, the department will make a determination of whether the documentation is sufficiently complete to make a determination based upon the criteria set forth in paragraph (C) of this rule.

(a) If the documentation is incomplete, the department will notify the individual and the evaluator regarding the need for additional documentation. The notice will specify the additional documentation that is required and indicate that the individual, or someone on the individual's behalf, has fifteen calendar days from the date the department mails the notice to submit additional documentation or the developmental disabilities level of care will be denied. In the event the individual, or someone on the individual's behalf, is not able to provide the necessary documentation in the time specified, the department will, upon good cause, grant an extension when the individual, or someone on the individual's behalf, requests an extension.

(b) Within thirty calendar days of receipt of all required documentation, the department will issue a level of care determination. A request for a developmental disabilities level of care will not be denied by the department for the reason that the individual does not meet the criteria, as set forth in paragraph (C) of this rule, until a qualified intellectual disability professional conducts a face-to-face assessment of the individual and reviews medical records that accurately reflect the individual's condition.

(10) Once a final level of care determination is made, the department will notify the individual. The notice will explain the individual's hearing rights, as set forth in rules 5101:6-2-02 to 5101:6-2-04 of the Administrative Code, and the time frames within which they must be exercised.

(a) If the individual submits a hearing request within the time frame specified in rule 5101:6-4-01 of the Administrative Code that requires the continuation of benefits, authorization for payment will be continued pending the issuance of a state hearing decision.

(b) If the individual does not submit a hearing request within the time frame specified in rule 5101:6-4-01 of the Administrative Code, vendor payment will automatically terminate on the date specified in the notice advising the recipient of the intent of the Ohio department of medicaid to terminate vendor payment.

(11) Federal financial participation will not be claimed for services rendered in an ICFIID or for home and community-based services delivered prior to the developmental disabilities level of care effective date.

Last updated January 2, 2024 at 9:44 AM

History

Effective: January 1, 2024
Promulgated Under: 119.03

Chapter 5123-9 Home and Community-Based Services Waivers

Ohio Adm.Code 5123-9-01 Home and community-based services waivers - enrollment, denial of enrollment, disenrollment, and reenrollment.

(A) Purpose

This rule establishes procedures for the enrollment, denial of enrollment, disenrollment, and reenrollment of individuals in home and community-based services waivers administered by the Ohio department of developmental disabilities.

(B) Definitions

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

(1) "Alternative services" means the various programs, services, and supports, regardless of funding source, other than home and community-based services, that exist as part of the developmental disabilities service system and other service systems including, but not limited to:

(a) Services provided directly by a county board;

(b) Services funded by a county board and delivered by other providers;

(d) Services provided at the state level.

(2) "County board" means a county board of developmental disabilities or a person or government entity, including a council of governments, with which a county board has contracted for assistance with its medicaid local administrative authority pursuant to section 5126.055 of the Revised Code.

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

(4) "Home and community-based services" means medicaid-funded home and community-based services provided under a medicaid component that the department administers pursuant to section 5166.21 of the Revised Code.

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

(7) "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 process.

(8) "Prior authorization" means the process to be followed in accordance with rule 5123-9-07 of the Administrative Code to authorize an individual funding level for an individual enrolled in the individual options waiver that exceeds the maximum value of the funding range.

(9) "Waiver eligibility span" means the twelve-month period following either an individual's initial waiver enrollment date or a subsequent eligibility redetermination date.

(10) "Waiver year" means the twelve-month period that begins on the date the waiver takes effect and the twelve-month period following each subsequent anniversary date of the waiver.

When an individual who is not yet enrolled in medicaid requests home and community-based services, the county board will submit or assist the individual with submission of Ohio department of medicaid form 02399, "Request for Medicaid Home and Community-Based Services Waiver," to the county department of job and family services. The department will accept notification of requests for home and community-based services waiver enrollment that are referred by the county department of job and family services. The department will notify the appropriate county board when it receives notification of a request from the county department of job and family services.

(D) Eligibility criteria for enrollment in home and community-based services waivers

To be eligible for enrollment in a home and community-based services waiver administered by the department an individual must:

(1) Be eligible for Ohio medicaid in accordance with rule 5160:1-2-03 of the Administrative Code;

(2) Have a developmental disabilities level of care in accordance with rule 5123-8-01 of the Administrative Code;

(3) Choose enrollment in a home and community-based services waiver in lieu of an opportunity to reside in an intermediate care facility for individuals with intellectual disabilities;

(4) Require, at a minimum, one waiver service;

(5) Participate in the development of the individual service plan; and

(6) Be able to have health and welfare needs met through waiver services at or below the federally-approved cost limitation, and through a combination of informal and formal supports including, but not limited to, waiver services, medicaid state plan services, private health insurance plan benefits, non-waiver services, and/or natural supports.

(E) Responsibilities for enrollment

(1) A county board will enroll individuals in home and community-based services waivers in accordance with rule 5123-9-04 of the Administrative Code.

(2) When a county board intends to enroll an individual in a home and community-based services waiver, the county board will request the department to authorize waiver capacity for the individual to be enrolled.

(3) Upon authorization by the department to enroll an individual in a home and community-based services waiver:

(a) The county board will complete the required assessments of the individual in accordance with rule 5123-8-01 of the Administrative Code and any other assessments specific to the waiver in which the individual is seeking enrollment.

(b) Within ninety calendar days of the department's authorization to enroll an individual, the county board will forward to the department all necessary enrollment information, including a request for developmental disabilities level of care determination with respect to the individual.

(c) The department will determine whether the individual meets the criteria for a developmental disabilities level of care in accordance with rule 5123-8-01 of the Administrative Code. An individual determined to have a developmental disabilities level of care who meets all other eligibility criteria for home and community-based services waivers is eligible for home and community-based services waiver enrollment.

(d) The department will send notification to the individual upon completion of the level of care determination in accordance with paragraph (J) of this rule.

(e) The county board will:

(i) Submit a payment authorization for waiver services to the department no later than the first date of any planned service within an individual's waiver eligibility span except when:

(a) A delay is caused by failure of an entity other than the county board to update an individual's record in the Ohio benefits system, in which case, no later than fourteen calendar days after the individual's enrollment in the waiver is reflected in the department's information system; or

(b) The individual funding level of an individual to be enrolled in the individual options waiver exceeds the maximum value of the funding range, in which case, no later than fourteen calendar days after prior authorization is approved by the department.

(ii) Submit an updated payment authorization for waiver services to the department no later than fourteen calendar days after authorizing a change to an individual's services or revising an individual service plan, whichever is earlier. If submission of the updated payment authorization for waiver services is rejected by the department's information system due to discrepancies between provider billing and service authorization, the payment authorization for waiver services is to be submitted no later than fourteen calendar days after the discrepancy has been successfully resolved.

(iii) Correct an error to a payment authorization for waiver services no later than fourteen calendar days after identification of the error.

(F) Continued enrollment and disenrollment

(1) The county board will submit a developmental disabilities level of care redetermination at least annually to the department in accordance with rule 5123-8-01 of the Administrative Code.

(2) Subsequent to initial enrollment of an individual in a home and community-based services waiver, the county board will evaluate the current needs and circumstances of the individual in relationship to the services and activities described in the individual's most recent individual service plan and recommend appropriate action to the department, which may include a recommendation to disenroll the individual from the home and community-based services waiver, when:

(a) There is a significant change of condition as defined in rule 5123-8-01 of the Administrative Code;

(b) The individual is admitted as an inpatient to a hospital, nursing facility, intermediate care facility for individuals with intellectual disabilities, or is incarcerated if such admission or incarceration is reasonably anticipated to exceed ninety calendar days;

(d) The individual interferes with or otherwise refuses to cooperate with the county board and such interference or refusal to cooperate renders the county board unable to perform its medicaid local administrative authority pursuant to section 5126.055 of the Revised Code;

(e) The individual ceases to meet the eligibility criteria for enrollment in the home and community-based services waiver;

(f) The individual's health and welfare cannot be assured in accordance with the requirements of paragraph (D)(6) of this rule; or

(g) The individual requests to be disenrolled from the home and community-based services waiver.

(3) When the cost of waiver services for the individual exceeds the amount authorized by the centers for medicare and medicaid services for the waiver in which the individual is enrolled, the county board will evaluate the individual, consider the measures set forth in paragraphs (F)(3)(a) to (F)(3)(e) of this rule, and submit a recommendation to the department regarding whether or not the individual can remain enrolled in the waiver and have health and welfare assured by one or more of the following measures:

(a) Adding more available natural supports;

(b) Accessing available non-waiver services, other than natural supports;

(d) Accessing private health insurance plan benefits; and/or

(e) Sharing supports and services, such as natural supports and non-waiver services, by collaborating with other systems, organizations, agencies, and people with and without disabilities.

(4) Upon receipt of a recommendation and necessary information from a county board in accordance with paragraph (F)(2) or (F)(3) of this rule, the department will within thirty calendar days, make a determination as to the individual's continued enrollment in the waiver, inform the county board accordingly, and take whatever additional actions may be required by law. If the department determines that the individual cannot continue to be enrolled in the waiver and have health and welfare assured by one or more of the measures set forth in paragraph (F)(3) of this rule, the department will propose to disenroll the individual from the waiver and provide notice in accordance with paragraph (J) of this rule.

(5) When the department proposes to disenroll an individual in accordance with paragraph (F)(2) or (F)(3) of this rule, the county board will:

(a) Offer the individual the opportunity to apply for an alternative home and community-based services waiver for which the individual is eligible that may more adequately address the needs of the individual, to the extent that such waiver openings exist; and

(b) Assist the individual in identifying and obtaining alternative services that are available and may more adequately address the needs of the individual.

(6) In the event that options set forth in paragraphs (F)(5)(a) and (F)(5)(b) of this rule do not meet the individual's needs, the county board may offer the individual an opportunity to reside in an intermediate care facility for individuals with intellectual disabilities.

(G) Suspension of medicaid waiver payment

(1) In the event an individual is admitted as an inpatient to a hospital, nursing facility, or intermediate care facility for individuals with intellectual disabilities or is incarcerated, the county board will notify the department.

(a) Upon receipt of notification, the department will suspend medicaid waiver payments for the individual for a period not to exceed ninety calendar days during the time the individual is admitted as an inpatient or is incarcerated.

(b) When the individual continues to remain admitted as an inpatient or incarcerated, the county board will, prior to the ninety-first calendar day after the date of admission as an inpatient or incarceration, submit a recommendation to the department to disenroll the individual from the home and community-based services waiver.

(2) Upon receipt of a recommendation and necessary information from a county board in accordance with paragraph (G)(1)(b) of this rule, the department will within thirty calendar days, make a determination as to the individual's continued enrollment in the waiver, inform the county board accordingly, and take whatever additional actions may be required by law, which may include, but are not limited to, proposing to disenroll the individual from the waiver and providing notice in accordance with paragraph (J) of this rule. If the department determines to disenroll an individual based on a recommendation by the county board, the county board may request reenrollment when the individual is discharged from the hospital, nursing facility, or immediate care facility for individuals with intellectual disabilities or is no longer incarcerated.

(H) Reenrollment

(1) When an individual who has been disenrolled from a home and community-based services waiver requests reenrollment within the same waiver year, the individual will be reenrolled in that waiver provided:

(a) The circumstances leading to the individual's disenrollment have been resolved; and

(b) The individual meets the eligibility criteria for enrollment in home and community-based services waivers in accordance with paragraph (D) of this rule.

(2) When an individual who has been disenrolled from a home and community-based services waiver requests reenrollment in a subsequent waiver year, the individual may be reenrolled in a waiver:

(a) Provided the individual meets the eligibility criteria for enrollment in home and community-based services waivers in accordance with paragraph (D) of this rule; and

(b) In accordance with the process set forth in paragraph (E) of this rule.

(I) Waiver capacity

In accordance with section 5126.054 of the Revised Code, a county board will annually inform the department of its waiver capacity request. Based on the county board's request, the department may authorize enrollment when the number of filled waivers for each year is less than the number of waivers approved by the centers for medicare and medicaid services for that year. The department will provide notice of waiver capacity to county boards. Within ninety calendar days from receipt of such notice from the department, a county board will submit the assessments and other necessary enrollment information pursuant to paragraph (E) of this rule. The county board may request and the department may grant for good cause, an extension of the deadline referenced in this paragraph. Failure of the county board to meet the requirements of this paragraph will result in the department providing the county board with prior notice of no less than fifteen calendar days that the authorization to enroll pursuant to this rule is to be withdrawn.

(J) Required notices

(1) The department will send written notice to an individual and the county board when the individual is enrolled in a home and community-based services waiver. The notice will include the date on which waiver services may be initiated.

(2) The department will send written notice to an individual and the county board when the individual is disenrolled from a home and community-based services waiver. The notice will be made in accordance with paragraph (J)(3) of this rule.

(3) When denial of enrollment in or disenrollment from a home and community-based services waiver is proposed, the individual will receive notice of the individual's right to a state hearing in accordance with section 5160.31 of the Revised Code and rules implementing that statute.

(a) The department will issue the notice when:

(i) Denial of enrollment is based on a determination that the individual does not meet the criteria for a developmental disabilities level of care; or

(ii) The department proposes disenrollment for any reason, including disenrollment based on the county board's recommendation made in accordance with paragraph (F)(2), (F)(3), or (G)(1)(b) of this rule.

(b) The county board will issue the notice when the county board proposes to deny enrollment based on the individual's position on the waiting list for home and community-based services waivers established in accordance with rule 5123-9-04 of the Administrative Code.

Last updated January 2, 2024 at 9:45 AM

History

Effective: January 1, 2024
Promulgated Under: 119.03

Ohio Adm.Code 5123-9-02 Home and community-based services waivers - ensuring the suitability of services and service settings.

(A) Purpose

This rule establishes standards to ensure that individuals receiving services through home and community-based services waivers administered by the Ohio department of developmental disabilities receive the services in settings that meet requirements for home and community-based services established by the centers for medicare and medicaid services.

(B) Definitions

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

(1) "Agency provider" means an entity that directly employs at least one person in addition to a director of operations for the purpose of providing services for which the entity is certified in accordance with 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) "Home and community-based services" has the same meaning as in section 5123.01 of the Revised Code.

(5) "Immediate family member" means a spouse, parent or stepparent, child or stepchild, sibling or stepsibling, grandparent, or grandchild.

(6) "Independent provider" means a self-employed person who provides services for which the person is certified in accordance with rule 5123-2-09 of the Administrative Code and does not employ, either directly or through contract, anyone else to provide the services.

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

(9) "Individual-specific expenses" means standard monthly costs other than rent (e.g., household goods and supplies, food, minor equipment, and medical equipment) that are not reimbursable through medicaid, that are paid by the individual to a residential facility or provider of shared living, and that have been identified as needed and requested by the individual to be provided by the residential facility or provider of shared living.

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

(11) "Landlord" means the owner, lessor, or agent of the owner contracted by the owner to manage the premises or to receive rent or room costs in accordance with a lease or a residency agreement meeting the requirements set forth in paragraph (F) of this rule.

(12) "Lease" means a written rental agreement meeting the requirements for rental agreements set forth in Chapter 5321. of the Revised Code.

(13) "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 process.

(14) "Provider-controlled residential setting" means a residence where the landlord is:

(a) An entity that is owned in whole or in part by the individual's independent provider;

(b) An immediate family member of the individual's independent provider;

(d) Affiliated with the individual's agency provider, meaning the landlord:

(i) Employs a person who is also an owner or a management employee of the agency provider; or

(ii) Has, serving as a member of its board, a person who is also serving as a member of the board of the agency provider;

(e) An entity that is owned in whole or in part by an owner, a management employee, or an immediate family member of the individual's agency provider; or

(f) An owner or a management employee of the individual's agency provider.

(15) "Provider-owned residential setting" means a residence where the provider is both the landlord and the residential home and community-based services provider. There are only three acceptable types of provider-owned residential settings under Ohio law:

(a) A setting where shared living is provided;

(b) A setting owned by an independent provider who is living in the setting and providing services to an individual who is living in the setting; or

(16) "Related to" means the caregiver is the individual's:

(a) Parent or stepparent;

(b) Sibling or stepsibling;

(d) Grandchild;

(e) Aunt, uncle, nephew, or niece;

(f) Cousin; or

(g) Child or stepchild.

(17) "Rent" means the standard charge to the individual to cover the individual's use of the property, living space, and structure, and where applicable, the appliances, utilities, and furniture.

(18) "Residency agreement" means a written agreement between an individual and a residential facility or provider of shared living which establishes or modifies the terms, conditions, rules, or any other provisions concerning the use and occupancy of a residence.

(19) "Residential facility" means a residential facility licensed by the department in accordance with section 5123.19 of the Revised Code other than an intermediate care facility for individuals with intellectual disabilities.

(20) "Roommate" means a person with whom one shares a bedroom.

(22) "Shared living" has the same meaning as in rule 5123-9-33 of the Administrative Code.

(1) An individual's private residence is presumed to be a suitable setting for home and community-based services when it meets the requirements set forth in paragraphs (C)(1)(a) to (C)(1)(e) of this rule. For the purposes of this rule, provider-controlled residential settings and provider-owned residential settings are not private residences.

(a) The private residence is integrated in and supports the individual's full access to the greater community.

(b) The private residence is selected by the individual from among setting options.

(c) The private residence ensures an individual's right to privacy, dignity, and respect as well as freedom from coercion and restraint.

(d) The private residence optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices.

(e) The private residence facilitates individual choice regarding services and supports, and who provides them.

(2) The purpose of home and community-based services is to support full community participation and achievement of individual-specific outcomes. An individual receiving home and community-based services will have opportunities to access age-appropriate activities, engage in meaningful employment and non-work activities, and pursue activities with persons of the individual's choosing and in settings not created exclusively for individuals with disabilities.

(3) An individual's service and support administrator will provide the individual with a description of all services and service setting options available through the waiver in which the individual is enrolled. Each individual will be afforded the opportunity to choose among services or a combination of services and settings that promote the individual's autonomy and minimize the individual's dependency on paid support staff. Services and service setting options (such as technology-based supports, intermittent or drop-in staffing, shared living, and integrated employment services) will be considered to enable the individual to live and work in settings which promote access to and participation in the broader community.

(4) Each individual will receive home and community-based services that:

(a) Are appropriate to meet the individual's assessed needs and desired outcomes identified in the individual service plan;

(b) Supplement and not supplant existing natural supports;

(d) Are not otherwise available through other resources, including:

(i) Unpaid supports;

(ii) Private insurance;

(iii) Community resources;

(iv) Special education or related services as 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;

(v) 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;

(vi) Medicare; or

(vii) The medicaid state plan.

(5) Home and community-based services funds will not be used to provide modifications to the physical structure of a residential facility unless the modifications are necessary to meet the needs of an established resident of the residential facility or the modifications are portable and clearly identified as the property of the individual.

(D) Settings presumed unsuitable for home and community-based services

(1) Home and community-based services will not be provided in provider-owned residential settings that do not meet an exception set forth in paragraph (B)(15) of this rule.

(2) Except for the provision of short-term respite services as approved by the centers for medicare and medicaid services, home and community-based services will not be provided in:

(a) Hospitals except when:

(i) Homemaker/personal care is provided to an individual in an acute care hospital in accordance with rule 5123-9-30 of the Administrative Code;

(ii) Participant-directed homemaker/personal care is provided to an individual in an acute care hospital in accordance with rule 5123-9-32 of the Administrative Code; or

(iii) Shared living is provided to an individual in an acute care hospital in accordance with rule 5123-9-33 of the Administrative Code;

(b) Institutions for mental diseases;

(d) Nursing facilities; or

(e) Other locations that have been determined by the secretary of the United States department of health and human services or the department as having the qualities of an institution and the effect of isolating individuals from the broader community.

(3) Absent a determination by the centers for medicare and medicaid services that the settings are suitable, home and community-based services will not be provided in:

(a) Settings located in a building that is a publicly-operated or privately-operated facility that also provides inpatient institutional treatment; or

(b) Settings located in a building on the grounds of or immediately adjacent to a publicly-operated facility that provides inpatient institutional treatment.

(E) Requirements for providers of home and community-based services

A provider of home and community-based services will:

(1) Meet the requirements set forth in Chapter 5123-9 of the Administrative Code for the services delivered; and

(2) Deliver services in accordance with each individual's choices, preferences, and needs and in a manner that supports each individual's full participation in the community as identified in the individual service plan.

(F) Requirements for individuals enrolled in home and community-based services waivers

An individual enrolled in a home and community-based services waiver will:

(1) Communicate, as applicable, to the independent provider and/or assigned staff of the agency provider and the agency provider management staff, personal preferences about the duties, tasks, and procedures to be performed;

(2) Communicate to the service and support administrator any significant change that may affect the provision of services or result in a need for more or fewer hours of service or different types of service;

(3) Use services in accordance with the individual service plan; and

(4) Cooperate with the county board in the county board's performance of medicaid local administrative authority in accordance with section 5126.055 of the Revised Code.

(G) Requirement for a lease or residency agreement

(1) A lease consented to by both the individual and the landlord is required when an individual lives in a provider-controlled residential setting. The lease will include:

(a) A statement that the residence is a provider-controlled residential setting and an explanation of the relationship between the landlord and the provider of home and community-based services.

(b) A statement that the individual may choose any provider to deliver home and community-based services.

(2) A residency agreement consented to by both the individual and the landlord is required when an individual lives in a residential facility or when an individual lives in a provider-owned residential setting as described in paragraph (B)(15)(a) or (B)(15)(b) of this rule and the provider is not related to the individual. The residency agreement will include:

(a) Name and contact information of the landlord.

(b) A statement that the residence is, as applicable, a residential facility or a shared living setting.

(c) An explanation of the relationship between the landlord and the provider of home and community-based services and a statement regarding whether or not the individual may choose a provider other than the residential facility or shared living provider to deliver home and community-based services.

(d) A statement that the landlord:

(i) Is responsible for maintaining in good working order all electrical, plumbing, sanitary, heating, ventilating, and air conditioning systems;

(ii) Will ensure barrier-free ingress and egress to and from the residence by individuals residing in the residence;

(iii) Is responsible for keeping the residence in a safe condition that meets local health and safety codes; and

(iv) Has a right to reasonable access to the residence in order to complete the terms of the residency agreement.

(e) Unless otherwise specified in the individual service plan and implemented in accordance with rule 5123-2-06 of the Administrative Code, a statement that the individual:

(i) Has a right to select the individual's roommates;

(ii) Has a right to privacy and security including locks and keys to the individual's bedroom;

(iii) Has a right to decorate the individual's bedroom;

(iv) Has a right to have visitors of the individual's choosing at any time;

(v) Has the freedom and support to control the individual's schedule and activities; and

(vi) Has a right to access food at any time.

(f) A statement that the individual is responsible for timely monthly payment of the rent or the individual's share of the rent, as applicable, to the landlord. When determined to be appropriate by the individual with the support of the team, the residency agreement may designate a person or responsible party to ensure timely payment to the landlord.

(g) The rent amount which:

(i) Will be reasonable and comparable to community standards;

(ii) Will be determined based upon the accommodations provided and not upon an individual's assets, resources, or ability to pay;

(iii) In a residential facility, will include the cost of providing furnishings, equipment, and supplies required by Chapter 5123-3 of the Administrative Code; and

(iv) Will not include items that are reimbursable under the medicaid program.

(h) Individual-specific expenses:

(i) Which reflect only items that are available exclusively from the landlord and determined to be needed by the individual with the support of the individual's team;

(ii) Which reflect only items that the individual has been unable to access or utilize through other available resources; and

(iii) The cost of which may be shared equally when two or more residents agree to share use of the item.

(i) A statement that the individual has a right to terminate the residency agreement:

(i) Without cause upon thirty-day advance written notice to the landlord unless the individual and the landlord mutually agree in writing to an alternative plan; or

(ii) With cause upon five-day advance written notice to the landlord if the landlord has breached an obligation or failed to satisfy required conditions under the residency agreement.

(j) In a provider-owned residential setting as described in paragraph (B)(15)(a) or (B)(15)(b) of this rule when the provider is not related to the individual, a statement that the landlord has a right to terminate the residency agreement:

(i) Without cause upon thirty-day advance written notice to the individual unless the individual and the landlord mutually agree in writing to an alternative plan; or

(ii) With cause upon five-day advance written notice to the individual if the individual has breached an obligation or failed to satisfy required conditions under the residency agreement or chooses to leave or otherwise vacates the residence (e.g., upon incarceration).

(k) In a residential facility, a statement that the residential facility will terminate services in accordance with rule 5123-3-05 of the Administrative Code.

Last updated January 26, 2024 at 7:46 AM

History

Effective: January 26, 2024
Promulgated Under: 119.03

Ohio Adm.Code 5123-9-03 Home and community-based services waivers - overtime and limit on number of hours in a work week an independent provider may provide services.

(A) Purpose

This rule sets forth procedures related to overtime worked by independent providers, places a limit on the number of hours in a work week an independent provider may provide services under a home and community-based services medicaid waiver component administered by the Ohio department of developmental disabilities, and establishes a process and the circumstances under which the limit may be exceeded.

(B) Definitions

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

(1) "Agency provider" means an entity that directly employs at least one person in addition to the director of operations for the purpose of providing services for which the entity is certified in accordance with 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) "Emergency" means an unanticipated and sudden absence of an individual's provider or natural supports due to illness, incapacity, or other cause.

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

(6) "Home and community-based services medicaid waiver component" has the same meaning as in section 5166.01 of the Revised Code.

(7) "Independent provider" means a self-employed person who provides services for which the person is certified in accordance with rule 5123-2-09 of the Administrative Code and does not employ, either directly or through contract, anyone else to provide the services.

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

(10) "Overtime" means hours worked in excess of forty in a work week.

(11) "Provider" means an agency provider or an independent provider.

(12) "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 5123-5-02 of the Administrative Code.

(13) "Waiver eligibility span" means the twelve-month period beginning with the individual's initial waiver enrollment date or a subsequent eligibility re-determination date.

(14) "Work week" means the seven consecutive days beginning on Sunday at twelve a.m. and ending on Saturday at eleven fifty-nine p.m. of each week.

The department, county boards, individuals who receive services, and independent providers will work collaboratively to efficiently use available resources and to the extent possible, reduce the need for overtime. To that end, an independent provider will inform an individual's service and support administrator of the number of persons for whom the independent provider provides any medicaid-funded services as an independent provider anywhere in the state and the number of hours of services the independent provider provides in a work week for each such person:

(1) When the independent provider is selected by an individual to provide services;

(2) When notifying the service and support administrator in accordance with paragraph (D)(3) of this rule; and

(3) At other times upon request of the service and support administrator.

(D) Limit on providing services in a work week

(1) After an independent provider has worked sixty hours in a work week providing any medicaid-funded services as an independent provider, that independent provider may provide additional units of services under a home and community-based services medicaid waiver component administered by the department as an independent provider in that work week only:

(a) When authorized by the service and support administrator for the individual for whom the additional services are provided in accordance with paragraph (D)(2) of this rule; or

(b) Due to an emergency.

(2) As part of the assessment and person-centered planning process set forth in rule 5123-4-02 of the Administrative Code, an individual and the individual's team will identify known or anticipated events or circumstances that will necessitate an individual's independent provider to exceed the limit established in paragraph (D)(1) of this rule.

(a) When known or anticipated events or circumstances will necessitate an individual's independent provider to exceed the limit, the events and circumstances, including authorization for the independent provider to exceed the limit for these specific events and circumstances, will be addressed in the individual service plan. Examples of known or anticipated events or circumstances include but are not limited to:

(i) Scheduled travel or surgery of the individual, the individual's family member, or the individual's provider;

(ii) Holidays or scheduled breaks from school;

(iii) The individual has a compromised immune system and may be put at risk by having additional providers;

(iv) The independent provider is the only provider that has been trained by a nurse on delegated tasks or trained by a behavioral specialist to implement unique behavioral support strategies; and

(v) A shortage of other available providers.

(b) When an individual requests that an independent provider be authorized to routinely exceed the limit due to a shortage of other available providers, the individual and the service and support administrator will work together to identify additional providers. When good faith efforts to identify additional providers have not been effective, the service and support administrator may authorize the independent provider to exceed the limit as specified in the individual service plan, for the duration of the individual's waiver eligibility span.

(c) When, pursuant to circumstances described in paragraph (D)(2)(a)(iv) or (D)(2)(a)(v) of this rule, the service and support administrator authorizes an independent provider to exceed the limit, the service and support administrator will work with the individual and the individual's team to develop and implement a plan to eliminate the circumstances that necessitate the independent provider to exceed the limit.

(3) When an emergency necessitates an individual's independent provider to exceed the limit established in paragraph (D)(1) of this rule, the independent provider will notify the individual's service and support administrator in accordance with the county board's written procedure described in paragraph (D)(4) of this rule, within seventy-two hours of the events or circumstances creating the emergency and report the hours the independent provider worked that exceeded the limit.

(4) A county board will adopt a written procedure for an individual's independent provider to notify the individual's service and support administrator when an emergency requires the independent provider to exceed the limit established in paragraph (D)(1) of this rule. The county board will notify independent providers at least thirty calendar days in advance of revising the written procedure.

(E) Violations of this rule

(1) An individual's right to obtain home and community-based services from any qualified and willing provider in accordance with 42 C.F.R. 431.51 as in effect on the effective date of this rule and sections 5123.044 and 5126.046 of the Revised Code will not be interpreted to permit an independent provider to violate this rule.

(2) An independent provider who violates the requirements of this rule may be subject to denial, suspension, or revocation of certification pursuant to rule 5123-2-09 of the Administrative Code.

(F) Informal complaint process

(1) If a county board receives a complaint from an individual regarding implementation of this rule, the county board will respond to the individual within thirty calendar days and provide the department with a copy of the individual's complaint and the county board's response. The department will review the complaint and the response and take actions it determines necessary.

(2) Initiation of a complaint in accordance with paragraph (F)(1) of this rule will not limit an individual's ability to exercise due process rights in accordance with paragraph (G) of this rule.

(G) Due process rights and responsibilities

(1) Applicants for and recipients of services under a home and community-based services medicaid waiver component administered by the department may use the process set forth in section 5160.31 of the Revised Code and rules implementing that statute for any purpose authorized by that statute, including being denied the choice of a provider who is qualified and willing to provide home and community-based services. The process set forth in section 5160.31 of the Revised Code is available only to applicants, recipients, and their lawfully appointed authorized representatives. Providers have no standing in an appeal under that section.

(2) Applicants for and recipients of services under a home and community-based services medicaid waiver component administered by the department will use the process set forth in section 5160.31 of the Revised Code and rules implementing that statute, for any challenge related to the type, amount, level, scope, or duration of services included in or excluded from an individual service plan. A county board's denial of authorization for an independent provider to exceed the limit established in paragraph (D)(1) of this rule does not necessarily result in a change in the level of services received by an individual.

Last updated May 15, 2026 at 1:02 AM

History

Effective: June 30, 2023
Promulgated Under: 119.03

Ohio Adm.Code 5123-9-04 Home and community-based services waivers - waiting list.

(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 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 intermittent supports to sustain existing caregivers and maintain the viability of the individual's current living arrangement because the individual requires more care than typically required for someone without developmental disabilities of the same age. This may include supports needed to supplement care provided by other caregivers for an individual in the custody of a public children services agency.

(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, 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.

(f) An individual is living in an intermediate care facility for individuals with intellectual disabilities or a nursing facility and has requested assistance to move from the facility to a community setting.

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

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

(8) "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 5123-3-05 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 5123-14-01 of the Administrative Code.

(d) An adult is losing 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 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) There is reason to believe an adult has been subjected to abuse, neglect, or exploitation and requires additional supports to reduce a risk of substantial harm to the individual.

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

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

(11) "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.

(12) "Nursing facility" has the same meaning as in section 5165.01 of the Revised Code.

(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) "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.

(15) "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.

(16) "Waiting list assessment tool" means a component of the waiting list management system which 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 and administered by persons who successfully complete training developed by the department.

(17) "Waiting list for home and community-based services" means the list established by county boards and maintained in the waiting list management system which includes the name, status date, and 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.

(18) "Waiting list management system" means the web-based information technology platform created and maintained by the department for managing the waiting list for home and community-based services. The waiting list management system includes department-validated information technology platforms maintained by county boards to manage, store, and electronically exchange information with the department's information technology platform. A county board will use the waiting list management system to capture administration of the waiting list assessment tool and to transmit all completed waiting list assessment tools to the department.

A county board 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 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

(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.

(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 and approved 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, in writing of the outcome of administration of the waiting list assessment tool within ten calendar days of completion and approval.

(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 including the person's name, title, telephone number, and electronic mail address.

(E) Waiting list for home and community-based services

(1) The county board 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 diagnosed with a severe, chronic disability 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).

(2) The county board 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 will take action necessary to ensure the immediate need is met. The county board 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 preferred setting option, the county board 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.

(3) When a county board places an individual's name on the waiting list for home and community-based services, the county board will:

(a) Record the individual's status date in the waiting list management system.

(b) Notify the individual or the individual's guardian, as applicable, in writing 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. Contact information will include the person's name, title, telephone number, and electronic mail address.

(4) Annually, a county board 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.

(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 will update the individual's record in the waiting list management system.

(F) Order for enrolling individuals in locally-funded home and community-based services waivers

(1) 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 status date 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 status date 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 status date 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 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 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.

(5) A county board will respond to the department within ten calendar days when the department requests additional information regarding an individual on the waiting list who was passed over for enrollment in a locally-funded home and community-based services waiver despite a higher placement on the waiting list. The county board will collaborate with the department to address any impediments to meeting the individual's needs.

(G) Order for enrolling individuals in state-funded home and community-based services waivers

(1) The department 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.

(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 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 will update the individual's county of residence in the waiting list management system without changing the status date 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 will assist the individual or the individual's guardian, as applicable, in identifying and accessing those services.

(I) Removal from waiting list for home and community-based services

A county board 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 (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) If the individual or the individual's guardian, as applicable, refuses to secure medicaid eligibility.

(5) If the individual or the individual's guardian, as applicable, refuses or withdraws consent for service and support administration.

(6) Upon enrollment of the individual in a home and community-based services waiver that meets the individual's needs.

(7) 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.

(8) 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 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

(9) When the county board determines the individual does not have a developmental disabilities level of care in accordance with rule 5123-8-01 of the Administrative Code.

(10) When the individual is no longer a resident of Ohio.

(11) Upon the individual's death.

(J) Due process

(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/).

(3) Due process 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.

Last updated July 1, 2025 at 8:02 AM

History

Effective: July 1, 2025
Promulgated Under: 119.03

Ohio Adm.Code 5123-9-05 Home and community-based services waivers - retention payments for direct support professionals.

(A) Purpose

This rule establishes requirements and processes for retention payments to benefit direct support professionals providing specific home and community-based services to individuals enrolled in home and community-based services waivers administered by the Ohio department of developmental disabilities.

(B) Definitions

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

(1) "Adult day support" has the same meaning as in rule 5123-9-17 of the Administrative Code.

(2) "Agency provider" has the same meaning as in rule 5123-2-08 of the Administrative Code.

(3) "Career planning" has the same meaning as in rule 5123-9-13 of the Administrative Code.

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

(5) "Direct support professional" means:

(a) An independent provider;

(b) A person who is employed by an agency provider or a residential facility in a "direct services position," as that term is defined in section 5123.081 of the Revised Code, regardless of the person's job title, and who is engaged in provision or supervision of direct support for at least fifty per cent of the hours the person worked for the employing agency provider or residential facility during the quarter used by the department for determination of the amount of a retention payment; or

(6) "Good standing" means a provider is not the subject of an action initiated by the department to deny, suspend, or revoke the provider's certification or license.

(7) "Group employment support" has the same meaning as in rule 5123-9-16 of the Administrative Code.

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

(9) "Homemaker/personal care" has the same meaning as in rule 5123-9-30 of the Administrative Code and includes on-site/on-call homemaker/personal care provided in accordance with that rule.

(10) "Homemaker/personal care daily billing unit" has the same meaning as in rule 5123-9-31 of the Administrative Code.

(11) "Independent provider" has the same meaning as in rule 5123-2-09 of the Administrative Code.

(12) "Individual employment support" has the same meaning as in rule 5123-9-15 of the Administrative Code.

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

(14) "Non-medical transportation" has the same meaning as in rule 5123-9-18 of the Administrative Code.

(15) "Participant-directed homemaker/personal care" has the same meaning as in rule 5123-9-32 of the Administrative Code.

(16) "Provider" means an independent provider, an agency provider, or a residential facility that provides one or more of the home and community-based services listed in paragraphs (B)(19)(a) to (B)(19)(k) of this rule.

(17) "Quarter" means one of four three-month spans of each calendar year, that is:

(a) January first through March thirty-first;

(b) April first through June thirtieth;

(d) October first through December thirty-first.

(18) "Residential facility" means a residential facility licensed by the department pursuant to section 5123.19 of the Revised Code, other than an intermediate care facility for individuals with intellectual disabilities.

(19) "Retention payment" means a payment intended to directly benefit direct support professionals which the department may issue on a quarterly basis to an eligible provider in an amount determined by the department based on a percentage of the provider's reimbursed claims during the preceding quarter for provision of:

(a) Adult day support;

(b) Career planning;

(d) Homemaker/personal care;

(e) Homemaker/personal care daily billing unit;

(f) Individual employment support;

(g) Non-medical transportation;

(h) Participant-directed homemaker/personal care;

(i) Shared living;

(j) Transportation; and

(k) Vocational habilitation.

(20) "Shared living" has the same meaning as in rule 5123-9-33 of the Administrative Code.

(21) "Transportation" has the same meaning as in rule 5123-9-24 of the Administrative Code.

(22) "Vocational habilitation" has the same meaning as in rule 5123-9-14 of the Administrative Code.

(1) An independent provider that has been reimbursed for provision of one or more of the home and community-based services listed in paragraphs (B)(19)(a) to (B)(19)(k) of this rule during the quarter used by the department for determination of the amount of the retention payment and that is in good standing at the time the department issues the retention payment, is eligible and will receive a retention payment. The independent provider need not take any action to participate in the retention payment program; the department will issue retention payments to eligible independent providers in accordance with paragraph (F)(1) of this rule.

(2) An agency provider or residential facility that has been reimbursed for provision of one or more of the home and community-based services listed in paragraphs (B)(19)(a) to (B)(19)(k) of this rule during the quarter used by the department for determination of the amount of the retention payment and that is in good standing at the time the department issues the retention payment, is eligible to receive a retention payment when the agency provider or residential facility:

(a) Opts to participate in the retention payment program by affirming, via the department's web-based portal for the retention payment program, on or before the fifteenth day of the first month of the quarter following the quarter used by the department for determination of the amount of the retention payment, its intent to participate and assurance that it will comply with this rule;

(b) Disburses to each of its eligible direct support professionals, the direct support professional's share of the retention payment issued by the department in accordance with paragraph (F) of this rule; and

(c) Submits, via the department's web-based portal for the retention payment program, on or before the fifteenth day of the first month of the quarter following the quarter in which the department issued the retention payment:

(i) Information requested by the department regarding the retention payment program including, but not limited to:

(a) Disbursement of the retention payment to its direct support professionals; and

(b) Any portion of a retention payment used to cover costs associated with implementation or administration of the retention payment program and therefore not disbursed directly to its direct support professionals.

(ii) An attestation that the retention payment was used and disbursed to direct support professionals in accordance with this rule.

(D) Eligibility for retention payment - direct support professionals engaged by agency providers and residential facilities

(1) A direct support professional engaged by an agency provider or a residential facility is eligible to receive a retention payment when the direct support professional:

(a) Provided or supervised provision of direct support while employed by the agency provider or residential facility or was under contract to provide shared living during the quarter used by the department for determination of the amount of the retention payment; and

(b) Is employed by the agency provider or residential facility or under contract to provide shared living on the day the agency provider or residential facility disburses the retention payment to its direct support professionals.

(2) Owners and management staff of agency providers and residential facilities (e.g., directors of operations, administrators, or operators) are not eligible to receive a retention payment unless they meet the definition of "direct support professional" in paragraph (B)(5) of this rule and the criteria set forth in paragraph (D)(1) of this rule.

(3) A direct support professional who has separated from employment with the agency provider or residential facility or is no longer under contract to provide shared living is not eligible to receive a retention payment.

(E) Use of retention payments

(1) An agency provider or residential facility is to disburse a retention payment to its eligible direct support professionals in accordance with one of the methods described in paragraph (F)(3) of this rule. At least eighty-two per cent of the retention payment is to be disbursed to direct support professionals or used to cover the employer's share of the associated payroll taxes.

(2) An agency provider or residential facility may use up to eighteen per cent of a retention payment for costs associated with implementation or administration of the retention payment program, additional employee compensation, or other activities that benefit its direct support professionals and/or improve service delivery.

(3) An agency provider or residential facility will not use a retention payment to fund a program or incentive the agency provider or residential facility had in place prior to the effective date of this rule unless the funding available for the program or incentive prior to the effective date of this rule ceases to be available.

(4) An agency provider or residential facility is to maintain records sufficient to demonstrate compliance with this rule for a period of six years from the date of receipt of a retention payment or until an initiated audit is resolved, whichever is longer.

(F) Disbursement of retention payments to direct support professionals

(1) The department will issue retention payments to eligible providers via electronic funds transfer on or before the fifteenth day of the second month of the quarter following the quarter used by the department for determination of the amount of the retention payment.

(2) An agency provider or residential facility will disburse to each eligible direct support professional, on or before the fifteenth day of the third month of the quarter following the quarter used by the department for determination of the amount of the retention payment, the direct support professional's share of the retention payment.

(3) An agency provider or residential facility is to choose from two methods for determining each direct support professional's share of the retention payment:

(a) Each eligible direct support professional receives the same percentage adjustment of total wages, including standard pay and overtime pay, or compensation for the quarter (total amount of retention payment / total wages or compensation = percentage adjustment disbursed to each eligible direct support professional); or

(b) Each eligible direct support professional receives the same dollar amount (total amount of retention payment / number of eligible direct support professionals = amount disbursed to each eligible direct support professional).

(G) Recoupment of a retention payment

(1) If the department determines that a provider received a retention payment for which it was not eligible or otherwise failed to comply with this rule, the department may initiate recoupment. When such a determination is made, the department will notify the provider by certified mail, return receipt requested. The notice will explain the amount due and the basis for the recoupment and inform the provider of the provider's right to request a hearing on the proposed recoupment pursuant to Chapter 119. of the Revised Code. The provider will have thirty days from the date the notice is mailed to request a hearing which, if timely requested, will be held in accordance with Chapter 119. of the Revised Code.

(2) When a provider does not request a hearing in accordance with paragraph (G)(1) of this rule, the amount of the recoupment is due and payable within thirty days of the provider's receipt of the notice.

(3) At the department's discretion, a provider may make repayment:

(a) In a lump sum payment to the department; or

(b) In a single deduction from the provider's next scheduled medicaid payment as long as the deduction will equal the total amount due to the department.

(4) The department may charge interest on the amount of the recoupment beginning on, as applicable:

(a) The date the recoupment is due and payable in accordance with paragraph (G)(2) of this rule; or

(b) The thirtieth day following an adjudication issued by the director of the department ordering recoupment of the retention payment.

(5) A provider that has been subject to recoupment may be ineligible to receive future retention payments.

(H) Waiving provisions of this rule

For good cause, the director of the department may waive a condition or specific requirement of this rule. The director's decision to waive a condition or specific requirement is not subject to appeal.

Last updated August 9, 2026 at 5:13 PM

History

Effective: March 23, 2023
Promulgated Under: 119.03

Ohio Adm.Code 5123-9-06 Home and community-based services waivers - administration of the individual options and level one waivers.

(A) Purpose

This rule establishes standards governing administration of the individual options and level one waivers, components of the medicaid home and community-based services program the Ohio department of developmental disabilities administers pursuant to section 5166.21 of the Revised Code.

(B) Definitions

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

(1) "Adult" means an individual who is at least twenty-two years old or an individual who is under twenty-two years old and no longer eligible for educational services based on graduation, receipt of a diploma or equivalency certificate, or permanent discontinuation of educational services within parameters established by the Ohio department of education and workforce.

(2) "Budget authority" means an individual has the authority and responsibility to manage the individual's budget for self-directed services. This authority supports the individual in determining the budgeted dollar amount for each self-directed waiver service that will be provided to the individual and making decisions about the acquisition of self-directed waiver services that are authorized in the individual service plan (e.g., negotiating payment rates to providers within the applicable range as specified in rules adopted by the department).

(3) "Child" means an individual who is under twenty-two years old and eligible for educational services.

(4) "Cost projection and payment authorization" means the process followed and the form used by county boards (including the payment authorization for waiver services) to communicate the frequency, duration, scope, and amount of payment requested for each home and community-based service that is identified in an individual service plan.

(5) "Cost projection tool" means the web-based analytical tool that is a component of the medicaid services system, developed and administered by the department, used to project the cost of home and community-based services identified in an individual service plan.

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

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

(8) "Employer authority" means an individual has the authority to recruit, hire, supervise, and direct the staff who furnish supports. The individual functions as the common law employer or the co-employer of these staff.

(9) "Fifteen-minute billing unit" means a billing unit that equals fifteen minutes of service delivery time or is greater or equal to eight minutes and less than or equal to twenty-two minutes of service delivery time. Minutes of service delivery time accrued throughout a day will be added together for the purpose of calculating the number of fifteen-minute billing units for the day.

(10) "Financial management services entity" means a governmental entity and/or another third-party entity designated by the department to perform necessary financial transactions on behalf of individuals who receive self-directed services.

(11) "Funding range" means one of the dollar ranges contained in appendix A to this rule to which individuals enrolled in the individual options waiver have been assigned for the purpose of funding services other than adult day support, career planning, group employment support, individual employment support, non-medical transportation, vocational habilitation, waiver nursing delegation, and waiver nursing. The funding range applicable to an individual is determined by the score derived from the Ohio developmental disabilities profile that has been completed by a county board employee qualified to administer the tool.

(12) "Guardian" means a guardian appointed by the probate court under Chapter 2111. of the Revised Code. If the individual is a minor, "guardian" means the individual's parents. If no guardian has been appointed for a minor under Chapter 2111. of the Revised Code and the minor is in the legal or permanent custody of a government agency or person other than the minor's natural or adoptive parents, "guardian" means that government agency or person. "Guardian" includes an agency under contract with the department for the provision of protective service in accordance with sections 5123.55 to 5123.59 of the Revised Code.

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

(14) "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, the person's guardian in accordance with section 5126.043 of the Revised Code or other person authorized to give consent.

(15) "Individual funding level," as established for each individual enrolled in the individual options waiver, means the total funds, calculated on a twelve-month basis, that result from applying the payment rates in service-specific rules in Chapter 5123-9 of the Administrative Code to the units of all waiver services other than adult day support, career planning, group employment support, individual employment support, non-medical transportation, vocational habilitation, waiver nursing delegation, and waiver nursing established by the individual service plan development process to be sufficient in frequency, duration, and scope to meet the individual's health and welfare needs. Unless prior authorization has been obtained in accordance with rule 5123-9-07 of the Administrative Code, the individual funding level for services paid in accordance with this rule will be within or below the funding range assigned to the individual as the result of administration of the Ohio developmental disabilities profile.

(16) "Individual service plan" means the written description of services, supports, and activities to be provided to an individual developed in accordance with rule 5123-4-02 of the Administrative Code.

(17) "InterRAI assessment" means the "InterRAI Intellectual Disability" or "Child and Youth Mental Health and Developmental Disability" which are validated and normed instruments proprietary to the interRAI organization. The instruments are used by the department to assess the needs, strengths, and preferences of individuals enrolled in department-administered home and community-based services waivers.

(18) "InterRAI assessor" means a person, regardless of title, employed by or under contract with a county board who is responsible for conducting interRAI assessments and who:

(a) Holds service and support administration certification in accordance with rule 5123-5-02 of the Administrative Code;

(b) Has at least eighteen months of experience conducting assessments;

(d) Has successfully completed department-approved interRAI assessor training.

(19) "Natural supports" means the personal associations and relationships typically developed in the community that enhance the quality of an individual's life. 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 development of the individual service plan.

(20) "Ohio developmental disabilities profile" means the standardized instrument used by the department to assess the relative needs and circumstances of an individual compared to others. The individual's responses are scored and the individual is linked to a funding range, which enables similarly situated individuals to access comparable waiver services paid in accordance with rules adopted by the department.

(21) "Prior authorization" means the process to be followed in accordance with rule 5123-9-07 of the Administrative Code to authorize an individual funding level for an individual enrolled in the individual options waiver that exceeds the maximum value of the funding range.

(22) "Provider" means a person or entity certified or licensed by the department that has met the provider qualification requirements to provide specific home and community-based services and holds a valid medicaid provider agreement with the Ohio department of medicaid or a person or entity that has been determined by the financial management services entity to be qualified to provide participant-directed goods and services or self-directed transportation.

(23) "Self-direction" means an individual has authority to make decisions about the individual's waiver services and accepts responsibility for taking a direct role in managing the services. Self-direction includes the exercise of budget authority and/or employer authority as set forth in paragraph (F) of this rule.

(24) "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 5123-5-02 of the Administrative Code.

(25) "Service documentation" means all records and information on one or more documents that:

(a) Are created and maintained as services are delivered and completed prior to billing for services;

(b) Are kept in a manner that fully discloses the extent of services delivered;

(c) Include the items delineated in service-specific rules in Chapter 5123-9 of the Administrative Code to validate payment for home and community-based services; and

(d) May be created or maintained in electronic software programs.

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

(27) "Waiver eligibility span" means the twelve-month period following either an individual's initial waiver enrollment date or a subsequent eligibility re-determination date.

(1) Individuals enrolled in department-administered home and community-based services waivers will participate in interRAI assessments. Assessments will be administered by interRAI assessors once every three years or when a significant change in the individual's situation occurs.

(2) The interRAI assessor will use the information technology platform designated by the department to administer the appropriate interRAI assessment based on the individual's age (i.e., "InterRAI Intellectual Disability" for individuals age eighteen and older or the "Child and Youth Mental Health and Developmental Disability" for individuals age seventeen and younger) in accordance with department-approved training. The interRAI assessor will coordinate the assessment results with the individual's service and support administrator. The individual's service and support administrator will provide the assessment results to the individual or the individual's guardian, as applicable.

(3) The service and support administrator will review outputs from the interRAI assessment and identify any changes in the individual's situation that may require updates to the individual service plan. The interRAI assessment results may be used to provide supplemental information to the annual reassessment process described in rule 5123-4-02 of the Administrative Code. Development of individual service plans will rely on current funding ranges and individual funding levels as described in paragraph (D) of this rule.

(D) Funding ranges and individual funding levels for individuals enrolled in the individual options waiver

(1) Individuals enrolled in the individual options waiver will be assigned to a funding range based on completion and scoring of the Ohio developmental disabilities profile and the cost-of-doing-business category that applies to the county in which the individual receives the preponderance of services. The funding ranges are contained in appendix A to this rule. The cost-of-doing-business categories are contained in appendix B to this rule.

(2) The funding ranges consider:

(a) The natural supports available to the individual;

(b) The individual's living arrangement;

(d) The individual's mobility;

(e) The individual's ability for self care; and

(f) Any other variable that significantly impacts the individual's needs as determined by the department through statistical analysis.

(3) The service and support administrator will ensure that an Ohio developmental disabilities profile is completed with input from the individual and the team. The service and support administrator will inform the individual, and the team with consent of the individual, of the assigned funding range at the time of enrollment and any time the Ohio developmental disabilities profile is reviewed or updated. The service and support administrator will ensure the individual, and the team with consent of the individual, have access to review the Ohio developmental disabilities profile and other assessments used in relation to completion of the Ohio developmental disabilities profile.

(4) Following assignment of a funding range, an individual service plan that assures the individual's health and welfare will be reviewed, revised, or developed with the individual. The service and support administrator will ensure that individuals share services to whatever extent practical and with the agreement of the team. Paid services should be used in conjunction with available natural supports. The service and support administrator will ensure that development or revision of the individual service plan addresses the availability of natural supports that currently exist or could be developed to meet assessed needs, including:

(a) Supports that family members provide including, but not limited to, basic personal care, performing health care activities, transportation, attending family/social/recreational activities, laundry, meal preparation, and grocery shopping; and

(b) Supports that friends, neighbors, and others in the community provide.

(5) The county board will apply rates for the units of each waiver service, other than adult day support, career planning, group employment support, individual employment support, non-medical transportation, vocational habilitation, waiver nursing delegation, and waiver nursing, resulting from completion of the individual service plan development process to calculate the individual funding level.

(6) The county board will determine whether the individual funding level is within, exceeds, or is below the assigned funding range for the individual. The service and support administrator will inform the individual of this determination in accordance with procedures developed by the department.

(7) When an individual service plan is revised and a new funding level is determined, the providers of waiver services to the individual will verify to the county board the number of units of each waiver service delivered during the individual's current waiver eligibility span so that the county board may accurately calculate the number of units of services available for the individual's use during the remainder of the waiver eligibility span.

(8) The county board will complete the cost projection and payment authorization and the service and support administrator will ensure waiver services are initiated for an individual whose funding level is within the funding range determined by the Ohio developmental disabilities profile. The service and support administrator will inform the individual in writing and in a form and manner the individual can understand of the individual's due process rights and responsibilities as set forth in section 5160.31 of the Revised Code.

(9) When the individual funding level exceeds the assigned funding range:

(a) The county board will inform the individual of the individual's right to request prior authorization to obtain services that result in an individual funding level that exceeds the funding range using the process described in rule 5123-9-07 of the Administrative Code.

(b) If, through the prior authorization process, the request for the funding level is approved, the county board will ensure the cost projection and payment authorization is completed and waiver services are initiated.

(c) If, through the prior authorization process, the request for the funding level is denied, the service and support administrator will continue the individual service plan development process to determine if an individual service plan that assures the individual's health and welfare can be developed within the individual's funding range.

(i) If an individual service plan that meets these conditions is developed, the county board will ensure the cost projection and payment authorization is completed and waiver services are initiated.

(ii) If an individual service plan that meets these conditions cannot be developed, the county board will propose to deny the individual's initial or continuing enrollment in the waiver and inform the individual of the individual's due process rights and responsibilities as set forth in section 5160.31 of the Revised Code.

(10) The department will use the twelve-month period following either an individual's initial waiver enrollment date or a subsequent waiver eligibility re-determination date to verify that cumulative payments made for waiver services remain within the approved funding range for each individual or that cumulative payments made for waiver services remain within the approved funding range when prior authorization has been granted.

(11) The department will periodically re-examine the scoring of the Ohio developmental disabilities profile and the linkage of the scores to the funding ranges.

(E) Changes to individual funding levels and funding ranges

(1) The individual funding level may increase or decrease based on the outcome of the individual service plan development process. In no instance will the individual funding level exceed the cost cap approved for the waiver in which the individual is enrolled. The county board has the authority and responsibility to make changes to individual funding levels which result from the individual service plan development process in accordance with paragraph (D) of this rule. Changes to individual funding levels are subject to review by the department.

(2) A funding range established for an individual will change only when changes in assessment variable scores on the Ohio developmental disabilities profile justify assignment of a new funding range. Any or all Ohio developmental disabilities profile variables may be revised at any time at the request of the individual or at the discretion of the service and support administrator, with the individual's knowledge.

(3) Neither the department nor the county board will recommend a change in individual funding level within the funding range or assign a new funding range after notification that the individual has requested a hearing pursuant to section 5160.31 of the Revised Code concerning the approval, denial, reduction, or termination of services.

(F) Self-direction

(1) The individual options and level one waivers support individuals who want to direct their services through exercise of budget authority and/or employment authority. The individual or the individual's guardian or the individual's designee must be willing and able to perform the duties associated with self-direction.

(2) An individual enrolled in the individual options waiver may exercise:

(a) Budget authority for:

(i) Participant-directed homemaker/personal care; and

(ii) Self-directed transportation.

(b) Employer authority for:

(i) Participant-directed homemaker/personal care; and

(ii) Self-directed transportation.

(3) An individual enrolled in the level one waiver may exercise:

(a) Budget authority for:

(i) Clinical/therapeutic intervention;

(ii) Participant-directed goods and services;

(iii) Participant-directed homemaker/personal care; and

(iv) Self-directed transportation.

(b) Employer authority for:

(i) Participant-directed homemaker/personal care; and

(ii) Self-directed transportation.

(G) Level one waiver benefit limitations

The cost of services available under the level one waiver will not exceed:

(1) Sixty-two thousand one hundred thirty-six dollars per waiver eligibility span for an adult; or

(2) Forty-one thousand four hundred twenty-four dollars per waiver eligibility span for a child.

(H) Staffing ratios

(1) In situations where more than one staff member serves more than one individual simultaneously, the individuals' needs and circumstances will determine staffing ratios, based on a unit of one staff to the portion of the total group that includes the individual. Only when it is impractical to determine staff ratios based on a unit of one staff, the provider will, as authorized in the individual service plan, use the applicable service codes and payment rates established in service-specific rules in Chapter 5123-9 of the Administrative Code to indicate both staff size and group size.

(2) Staffing ratios do not change at times when one or more individuals, for whom the staff is responsible, are not physically present, but are within verbal, visual, or technological supervision of the staff providing the service. Technological supervision includes staff contact with individuals through telecommunication and/or electronic signaling devices.

(I) Projection of the cost of an individual's services

(1) Prior to the beginning of an individual's waiver eligibility span, the individual's service and support administrator or other county board designee will prepare a projection of the annual cost of every individual options or level one waiver service that is authorized in the individual service plan for the waiver eligibility span using the cost projection tool.

(2) The cost projection will be based on staffing ratios and the total estimated number of service units the individual is expected to receive in accordance with the individual service plan during the waiver eligibility span. Staffing ratios contained in the cost projection tool will be considered a part of the individual service plan.

(3) The total number of service units will be determined with input from the individual and the individual's team as part of the individual service plan development process.

(4) The cost projection tool will project the cost of services based on the payment rates established in service-specific rules in Chapter 5123-9 of the Administrative Code.

(5) Rule 5123-9-31 of the Administrative Code will govern the circumstances when an individual receives the homemaker/personal care daily billing unit.

(6) The cost projection tool will be used to project costs based on medicaid payment rates for individuals, regardless of funding source, who share services with individuals enrolled in home and community-based services waivers.

(7) The individual's provider will have access to the cost projection tool including, but not limited to, the detail and summary information. At the request of the individual, other persons will have access to the detail and summary information in the cost projection tool.

(8) When changes occur that the team determines affect the service authorization, the county board will enter changes to the cost projection tool within ten calendar days of a recommendation from the team to change the service authorization. These changes will be made along with any necessary revisions to the individual service plan and prior authorization request (as applicable) for the individual or individuals affected by the changes.

(9) A county board will complete a cost projection using the cost projection tool when an individual is initially enrolled in an individual options or level one waiver and when an individual is annually re-determined eligible for continued enrollment in an individual options or level one waiver. The cost projection tool is the only authorized cost projection instrument.

(J) Service documentation

(1) Providers will maintain service documentation in accordance with this rule and service-specific rules in Chapter 5123-9 of the Administrative Code.

(2) Claims for payment a provider submits to the department for services delivered will not be considered service documentation. Any information contained in the submitted claim for payment may not and will not be substituted for any required service documentation information that a provider is required to maintain to validate payment for home and community-based services.

(3) Each provider will maintain all service documentation in an accessible location. The service documentation will be made available upon request for review by the department, the Ohio department of medicaid, the centers for medicare and medicaid services, a county board or regional council of governments that submits to the department payment authorization for the service, and those designated or assigned authority by the department or the Ohio department of medicaid to review service documentation.

(4) When a provider discontinues operations, the provider will, within seven calendar days, notify the county boards for the counties in which individuals for whom the provider has provided services reside, of the location where the service documentation will be stored, and provide the county board with the name and telephone number of the person responsible for maintaining the service documentation.

(K) Payment for waiver services

(1) Providers will be paid the lesser of their usual and customary rate or the payment rate for each waiver service that is delivered. The department will maintain a mechanism through which providers will communicate their usual and customary rates to the department. A single provider may charge different usual and customary rates for the same service when the service is provided in different geographic areas of the state. In this instance, the usual and customary rates charged will be declared for each cost-of-doing-business category contained in appendix B to this rule that identifies the counties in which the provider intends to provide specific services. Upon notification of a provider's usual and customary rate or change in usual and customary rate, the department will provide notice to the appropriate county board.

(2) The billing units, service codes, and payment rates for waiver services are contained in service-specific rules in Chapter 5123-9 of the Administrative Code including, but not limited to:

(a) 5123-9-12 (assistive technology under the individual options and level one waivers);

(b) 5123-9-13 (career planning under the individual options and level one waivers);

(d) 5123-9-15 (individual employment support under the individual options and level one waivers);

(e) 5123-9-16 (group employment support under the individual options and level one waivers);

(f) 5123-9-17 (adult day support under the individual options and level one waivers);

(g) 5123-9-18 (non-medical transportation under the individual options and level one waivers);

(h) 5123-9-20 (money management under the individual options and level one waivers);

(i) 5123-9-21 (informal respite under the level one waiver);

(j) 5123-9-22 (community respite under the individual options and level one waivers);

(k) 5123-9-23 (environmental accessibility adaptations under the individual options and level one waivers);

(l) 5123-9-24 (transportation under the individual options and level one waivers);

(m) 5123-9-25 (specialized medical equipment and supplies under the individual options and level one waivers);

(n) 5123-9-26 (self-directed transportation under the individual options and level one waivers);

(o) 5123-9-27 (health care assessment under the individual options and level one waivers);

(p) 5123-9-28 (nutrition services under the individual options waiver);

(q) 5123-9-29 (home-delivered meals under the individual options and level one waivers);

(r) 5123-9-30 (homemaker/personal care under the individual options and level one waivers);

(s) 5123-9-31 (homemaker/personal care daily billing unit under the individual options waiver);

(t) 5123-9-32 (participant-directed homemaker/personal care under the individual options and level one waivers);

(u) 5123-9-33 (shared living under the individual options waiver);

(v) 5123-9-34 (residential respite under the individual options and level one waivers);

(w) 5123-9-35 (remote support under the individual options and level one waivers);

(x) 5123-9-36 (interpreter services under the individual options waiver);

(y) 5123-9-37 (waiver nursing delegation under the individual options and level one waivers);

(z) 5123-9-38 (social work under the individual options waiver);

(aa) 5123-9-39 (waiver nursing under the individual options waiver);

(bb) 5123-9-41 (clinical/therapeutic intervention under the level one waiver);

(cc) 5123-9-43 (functional behavioral assessment under the level one waiver);

(dd) 5123-9-44 (vehicle modification under the individual options and level one waivers);

(ee) 5123-9-45 (participant-directed goods and services under the level one waiver);

(ff) 5123-9-46 (participant/family stability assistance under the level one waiver);

(gg) 5123-9-47 (support brokerage under the individual options and level one waivers); and

(hh) 5123-9-48 (community transition under the individual options waiver).

(3) The department will periodically collect payment information for a comprehensive, statistically valid sample of individuals from providers of home and community-based services at the time the information is collected. Based upon the department's review of the information, the department will recommend to the Ohio department of medicaid any changes necessary to assure that the payment rates are sufficient to enlist enough waiver providers so that waiver services are readily available to individuals, to the extent that these types of services are available to the general population, and that provider payment is consistent with efficiency, economy, and quality of care.

(4) Payment for home and community-based services constitutes payment in full. Payment will be made for home and community-based services when:

(a) The service is identified in an approved individual service plan;

(b) The service is recommended for payment through the cost projection and payment authorization process; and

(5) Payment for waiver services will not exceed amounts authorized through the cost projection and payment authorization for the individual's corresponding waiver eligibility span.

(L) Claims for payment for home and community-based services

(1) When home and community-based services are also available on the medicaid state plan, state plan services will be billed first. Only home and community-based services in excess of those covered under the medicaid state plan will be authorized.

(2) Claims for payment for home and community-based services will be submitted to the department in the format prescribed by the department. The department will inform county boards of the billing information submitted by providers in a manner and at a frequency necessary to assist county boards to manage the waiver expenditures being authorized.

(3) Claims for payment for home and community-based services will be submitted within three hundred fifty calendar days after the home and community-based services are provided. Payment will be made in accordance with the requirements of rule 5160-1-19 of the Administrative Code. Claims for payment will include the number of units of service.

(4) All providers of home and community-based services will take reasonable measures to identify any third-party health care coverage available to the individual and file a claim with that third party in accordance with the requirements of rule 5160-1-08 of the Administrative Code.

(5) For individuals with a monthly patient liability for the cost of home and community-based services, as described in rule 5160:1-6-07.1 of the Administrative Code, and determined by the county department of job and family services for the county in which the individual resides, payment is available only for the home and community-based services delivered to the individual that exceed the amount of the individual's monthly patient liability. Verification that patient liability has been satisfied will be accomplished as follows:

(a) The department will provide notification to the appropriate county board identifying each individual who has a patient liability for home and community-based services and the monthly amount of the patient liability.

(b) The county board will assign the home and community-based services to which each individual's patient liability will be applied and assign the corresponding monthly patient liability amount to the provider that provides the preponderance of home and community-based services. The county board will notify each individual and provider, in writing, of this assignment.

(c) Upon submission of a claim for payment, the designated provider will report the home and community-based services to which the patient liability was assigned and the applicable patient liability amount on the claim for payment using the format prescribed by the department.

(6) The department, the Ohio department of medicaid, the centers for medicare and medicaid services, and/or the auditor of state may audit any funds a provider of home and community-based services receives pursuant to this rule, including any source documentation supporting the claiming and/or receipt of such funds.

(7) Overpayments, duplicate payments, payments for services not rendered, payments for which there is no documentation of services delivered or for which the documentation does not include all of the items required in service-specific rules in Chapter 5123-9 of the Administrative Code, or payments for services not in accordance with an approved individual service plan are recoverable by the department, the Ohio department of medicaid, the auditor of state, or the office of the attorney general. All recoverable amounts are subject to the application of interest in accordance with rule 5160-1-25 of the Administrative Code.

(8) Providers of home and community-based services will maintain the records necessary and in such form to disclose fully the extent of home and community-based services provided, for a period of six years from the date of receipt of payment or until an initiated audit is resolved, whichever is longer. The records will be made available upon request to the department, the Ohio department of medicaid, the centers for medicare and medicaid services, and/or the auditor of state. Providers who fail to produce the records requested within thirty calendar days following the request are subject to denial, suspension, or revocation of certification and/or loss of their medicaid provider agreement.

(M) Due process rights and responsibilities

(1) Applicants for and recipients of waiver services administered by the department may use the process set forth in section 5160.31 of the Revised Code and rules implementing that statute for any purpose authorized by that statute. The process set forth in section 5160.31 of the Revised Code is available only to applicants, recipients, and their lawfully appointed authorized representatives. Providers have no standing in an appeal under that section.

(2) Applicants for and recipients of waiver services administered by the department will use the process set forth in section 5160.31 of the Revised Code and rules implementing that statute for any challenge related to the administration and/or scoring of the Ohio developmental disabilities profile or to the type, amount, level, scope, or duration of services included in or excluded from an individual service plan. A change in staff to waiver recipient service ratios does not necessarily result in a change in the level of services received by an individual.

(N) Ohio department of medicaid authority

The Ohio department of medicaid retains final authority to establish funding ranges for home and community-based services; to establish payment rates for home and community-based services; to review and approve each service identified in an individual service plan that is funded through a home and community-based services waiver; and to authorize the provision of and payment for home and community-based services through the cost projection and payment authorization.

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Last updated July 1, 2026 at 8:13 AM

History

Effective: July 1, 2026
Promulgated Under: 119.03

Ohio Adm.Code 5123-9-07 Home and community-based services waivers - request for prior authorization for individuals enrolled in the individual options waiver.

(A) Purpose

This rule establishes standards and procedures for prior authorization of waiver services when an individual funding level exceeds the funding range determined by the Ohio developmental disabilities profile for an individual enrolled in the individual options waiver.

(B) Definitions

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

(1) "Cost projection tool" means the web-based analytical tool that is a component of the medicaid services system, developed and administered by the department, used to project the cost of home and community-based services identified in an individual service plan.

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

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

(4) "Funding range" means one of the dollar ranges contained in appendix A to rule 5123-9-06 of the Administrative Code to which individuals enrolled in the individual options waiver have been assigned for the purpose of funding services other than adult day support, career planning, group employment support, individual employment support, non-medical transportation, vocational habilitation, waiver nursing delegation, and waiver nursing services. The funding range applicable to an individual is determined by the score derived from the Ohio developmental disabilities profile that has been completed by a county board employee qualified to administer the tool.

(6) "Individual funding level" means the total funds, calculated on a twelve-month basis, that result from applying the payment rates in service-specific rules in Chapter 5123-9 of the Administrative Code to the units of all waiver services other than adult day support, career planning, group employment support, individual employment support, non-medical transportation, vocational habilitation, waiver nursing delegation, and waiver nursing services established by the individual service plan development process to be sufficient in frequency, duration, and scope to meet the health and welfare needs of an individual enrolled in the individual options waiver.

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

(8) "Medicaid services system" means the comprehensive information system that integrates cost projection, prior authorization, daily rate calculation, and payment authorization of waiver services.

(9) "Ohio developmental disabilities profile" means the standardized instrument utilized by the department to assess the relative needs and circumstances of an individual compared to others. The individual's responses are scored and the individual is linked to a funding range, which enables similarly situated individuals to access comparable waiver services paid in accordance with rules adopted by the department.

(10) "Prior authorization" means the process to be followed in accordance with this rule to authorize an individual funding level for an individual enrolled in the individual options waiver that exceeds the maximum value of the funding range.

(11) "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 5123-5-02 of the Administrative Code.

(12) "Waiver eligibility span" means the twelve-month period following either an individual's initial waiver enrollment date or a subsequent eligibility redetermination date.

(1) The county board will inform an individual, in writing, of the individual's right to request prior authorization whenever development or proposed revision of the individual service plan results in an individual funding level that exceeds the funding range assigned to the individual.

(2) Unless a request for prior authorization has been approved in accordance with this rule, the individual funding level for services will be within or below the funding range assigned to the individual.

(3) Approval of a request for prior authorization is valid only for the duration of the individual's waiver eligibility span for which the request was made.

(4) The department will not consider a request for prior authorization submitted after the end date of the waiver eligibility span for which the request is made.

(D) Procedures

(1) A request for prior authorization will be submitted to the department during the waiver eligibility span for which the request is made and as soon as possible after development or proposed revision of the individual service plan results in an individual funding level that exceeds the funding range assigned to the individual.

(2) An individual will initiate the prior authorization process by submitting a signed and dated request to the county board. A county board will assist in the preparation of the request when the individual requests assistance.

(3) The county board will submit the request for prior authorization with the current or proposed individual service plan and supporting documentation to the department through the medicaid services system within ten business days of receiving the individual's request. Supporting documentation will provide evidence that the requested services are medically necessary in accordance with the criteria set forth in paragraph (D)(7) of this rule.

(4) When the county board is unable to support the request based on the county board's documentation that the requested services do not meet the criteria set forth in paragraph (D)(7) of this rule, the county board will provide to the department:

(a) A detailed description of the county board's efforts to develop an individual service plan that results in an individual funding level within the funding range assigned to the individual; and

(b) An alternative cost projection that ensures the health and safety of the individual, including the date the alternative cost projection was reviewed and declined by the individual; and

(c) Supporting documentation evidencing that the requested services are not medically necessary in accordance with the criteria set forth in paragraph (D)(7) of this rule.

(5) Within ten business days of receiving the request, the department will notify the county board if additional information is needed to make a determination. The county board will submit the additional information to the department within five business days of receiving notification from the department.

(6) The department will review the request and make a determination within ten business days of receiving all necessary information.

(7) When reviewing a request, the department will determine whether the waiver services for which prior authorization is requested meet the waiver service definition and are medically necessary. The department will determine the services to be medically necessary if the services:

(a) Are appropriate for the individual's health and welfare needs, living arrangement, circumstances, and expected outcomes; and

(b) Are of an appropriate type, amount, duration, scope, and intensity; and

(c) Are the most efficient, effective, and lowest cost alternative that, when combined with non-waiver services, ensure the health and welfare of the individual receiving the services; and

(d) Protect the individual from substantial harm expected to occur if the requested services are not authorized.

(8) The department may limit its review to the individual's request in the medicaid services system and the cost projection tool that produced an individual funding level that exceeds the funding range assigned to the individual when the county board supports the request and:

(a) The costs exceed the funding range solely as a result of a payment rate increase taking effect during the individual's waiver eligibility span and not as a result of a change in the type, amount, duration, scope, or intensity of services authorized; or

(b) The projected individual funding level exceeds the funding range assigned to the individual by no more than ten per cent; or

(c) The request is for an individual for whom prior authorization has been approved for a previous waiver eligibility span and the request includes an attestation by the service and support administrator that the individual's needs, waiver services, and cost of waiver services have not changed since the preceding request.

(9) Based on its review, the department will:

(a) Approve the request if it finds that the services for which prior authorization is requested meet the criteria set forth in paragraph (D)(7) of this rule; or

(b) Deny the request; or

(c) Approve the request for a partial or full waiver eligibility span for all or some of the services provided the criteria set forth in paragraph (D)(7) of this rule are met.

(10) When the department makes a determination regarding a request for prior authorization, the department will:

(a) Issue written notification to the individual which sets forth the reason for denial or reflects the total amount authorized for the current waiver eligibility span and includes the individual's right to request a hearing in accordance with section 5101.35 of the Revised Code and division 5101:6 of the Administrative Code; and

(b) Update the prior authorization status to reflect its determination in the medicaid services system.

(11) When the request for prior authorization is denied, the individual and the service and support administrator will meet to revise the individual service plan.

(12) If the individual requests a hearing in accordance with paragraph (D)(10)(a) of this rule, the county board will offer a county conference in accordance with rule 5101:6-5-01 of the Administrative Code and comply with applicable requirements of division 5101:6 of the Administrative Code.

(13) Failure by a county board or the department to comply with the timelines established in this rule will not constitute approval of a request for prior authorization.

(14) The Ohio department of medicaid reserves the right to review all requests for prior authorization submitted through the medicaid services system to ensure compliance with this rule.

Last updated January 2, 2024 at 9:45 AM

History

Effective: January 1, 2024
Promulgated Under: 119.03

Ohio Adm.Code 5123-9-11 Home and community-based services waivers - free choice of providers.

(A) Purpose

This rule establishes the responsibilities of a county board of developmental disabilities for assuring an individual's right to obtain home and community-based services from any qualified and willing provider in accordance with 42 C.F.R. 431.51 as in effect on the effective date of this rule and sections 5123.044 and 5126.046 of the Revised Code.

(B) Definitions

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

(1) "Adult day support" has the same meaning as in rule 5123-9-17 of the Administrative Code.

(3) "Career planning" has the same meaning as in rule 5123-9-13 of the Administrative Code.

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

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

(6) "Group employment support" has the same meaning as in rule 5123-9-16 of the Administrative Code.

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

(8) "Homemaker/personal care" has the same meaning as in rule 5123-9-30 of the Administrative Code.

(9) "Independent provider" means a self-employed person who provides services for which the person is certified in accordance with rule 5123-2-09 of the Administrative Code and does not employ, either directly or through contract, anyone else to provide the services.

(10) "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, the person's guardian in accordance with section 5126.043 of the Revised Code or other person authorized to give consent.

(11) "Individual employment support" has the same meaning as in rule 5123-9-15 of the Administrative Code.

(12) "Non-medical transportation" has the same meaning as in rule 5123-9-18 of the Administrative Code.

(14) "Vocational habilitation" has the same meaning as in rule 5123-9-14 of the Administrative Code.

(1) The county board will notify each individual at the time of enrollment in a home and community-based services waiver and at least annually thereafter, of the individual's right to choose any qualified and willing provider of home and community-based services. The notification will specify that:

(a) The individual may choose agency providers, independent providers, or a combination of agency providers and independent providers;

(b) The individual may choose providers from all qualified and willing providers available statewide and is not limited to those currently providing services in a given county;

(c) When a provider offers more than one service, the individual may choose to receive only one of the offered services from that provider.

(d) The individual may choose to receive services from a different provider at any time;

(e) An individual choosing to receive homemaker/personal care in a licensed residential facility is choosing both the place of residence and the homemaker/personal care provider, but maintains free choice of providers for all other home and community-based services and the right to move to another setting at any time if a new homemaker/personal care provider is desired; and

(f) The service and support administrator will assist the individual with the provider selection process if the individual requests assistance.

(2) A service and support administrator will assist an individual enrolled in a home and community-based services waiver with one or more of the following, as requested by the individual:

(a) Accessing the department's website to conduct a search for qualified and willing providers;

(b) Providing the individual with the department's guide to interviewing prospective providers;

(c) Sharing objective information with the individual about providers that includes reports of provider compliance reviews conducted in accordance with section 5123.162 or 5123.19 of the Revised Code, approved plans of correction submitted by providers in response to compliance reviews, number of individuals currently served, and any information about services offered by the provider to meet the unique needs of a specific group of individuals such as aging adults, children with autism, or individuals with intense medical or behavioral needs;

(d) Utilizing the statewide, uniform format to create a profile that includes the type of services and supports the individual requires, hours of services and supports required, the individual's essential service preferences, the funding source of services, and any other information the individual chooses to share with prospective providers;

(e) Making available to all qualified providers in the county that have expressed an interest in serving additional individuals, the individual-specific profile created in accordance with paragraph (C)(2)(d) of this rule to identify willing providers of the service;

(f) Contacting providers on the individual's behalf;

(g) Developing provider interview questions that reflect the characteristics of the individual's preferred provider; and

(h) Scheduling and participating as needed in interviews of prospective providers. If the individual chooses to interview the county board as a prospective provider, the service and support administrator will disclose to the individual that the service and support administrator is employed by the same agency. The service and support administrator may participate in this interview as directed by the individual.

(3) The county board will document the alternative home and community-based services settings that were considered by each individual and ensure that each individual service plan reflects the setting options chosen by the individual.

(4) The county board will document that each individual has been offered free choice among all qualified and willing providers of home and community-based services.

(5) If a county board receives a complaint from an individual regarding the free choice of provider process, the county board will respond to the individual within thirty calendar days and provide the department with a copy of the individual's complaint and the county board's response. The department will review the complaint and the county board's response and take actions it determines necessary to ensure that each individual has been afforded free choice among all qualified and willing providers of home and community-based services.

(6) The county board will notify the department if the county board becomes aware of a provider conditioning willingness to provide a home and community-based service to an individual on being selected by that individual to provide another service.

(D) Additional requirements that apply when a county board provides home and community-based services

(1) So long as a county board is a provider of home and community-based services, the county board will:

(a) Ensure administrative separation between county board staff doing assessments and service planning and county board staff delivering direct services.

(b) Establish and implement annual benchmarks for recruitment of sufficient providers of adult day support, career planning, group employment support, individual employment support, non-medical transportation, and vocational habilitation. Benchmarks are subject to approval by the department. The county board will report progress on achieving benchmarks to the department in accordance with the schedule and format established by the department.

(c) Refrain from providing adult day support, career planning, group employment support, individual employment support, non-medical transportation, or vocational habilitation to an individual for whom the county board was not already providing the service prior to November 19, 2020.

(2) In accordance with Ohio's home and community-based services waiver amendments approved by the federal centers for medicare and medicaid services on May 22, 2020 and 42 C.F.R. 441.301(c)(1)(vi) in effect on the effective date of this rule, a county board must cease providing home and community-based services on or before February 28, 2024.

(E) Commencement of services

The county board will adopt written procedures to ensure that home and community-based services begin in accordance with the date established in the individual service plan. The procedures will include a requirement for the county board to monitor the service commencement process and implement corrective measures if services do not begin as indicated.

(F) Department training and oversight

(1) The department will periodically provide training and assistance to familiarize county boards and individuals with the rights and responsibilities set forth in this rule.

(2) The department will investigate or cause an investigation when an individual alleges that the individual is being denied free choice of providers for home and community-based services.

(3) The department will utilize the accreditation process in accordance with rule 5123-4-01 of the Administrative Code to monitor county board compliance with requirements of this rule.

(G) Due process and appeal rights

(1) Any recipient of or applicant for home and community-based services may utilize the process set forth in section 5101.35 of the Revised Code, in accordance with division 5101:6 of the Administrative Code, for any purpose authorized by that statute and the rules implementing the statute, including being denied the choice of a provider who is qualified and willing to provide home and community-based services. The process set forth in section 5101.35 of the Revised Code is available only to applicants, recipients, and their lawfully authorized representatives.

(2) Providers may not utilize or attempt to utilize the process set forth in section 5101.35 of the Revised Code or appeal or pursue any other legal challenge to a decision resulting from the process set forth in section 5101.35 of the Revised Code.

(3) The county board will inform the individual, in writing and in a manner the individual can understand, of the individual's right to request a hearing in accordance with division 5101:6 of the Administrative Code.

(4) The county board will immediately implement any final state hearing decision or administrative appeal decision relative to free choice of providers for home and community-based services issued by the Ohio department of medicaid, unless a court of competent jurisdiction modifies such a decision as the result of an appeal by the medicaid applicant or recipient.

Last updated January 2, 2024 at 9:46 AM

History

Effective: January 1, 2024
Promulgated Under: 119.03

Ohio Adm.Code 5123-9-12 Home and community-based services waivers - assistive technology under the individual options, level one, and self-empowered life funding waivers.

(A) Purpose

This rule defines assistive technology and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service.

(B) Definitions

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

(2) "Acquisition costs" means the cost of any attachments, accessories, or auxiliary apparatus necessary to make assistive technology - equipment usable; taxes; duty; protective in-transit insurance; and freight charges.

(3) "Actual price" means the actual price that a provider of assistive technology - equipment is charged to purchase an item of equipment by the seller and that fully and accurately reflects any discount or rebate the provider receives. The provider will maintain documentation of the actual price in the form of an invoice from the seller that gives details of date, price, quantity, and type of the assistive technology - equipment or other documentation approved by the department.

(4) "Agency provider" means an entity that directly employs at least one person in addition to a director of operations for the purpose of providing services for which the entity is certified in accordance with rule 5123-2-08 of the Administrative Code.

(5) "Assistive technology" means an item, piece of equipment, device, product system, or engineered solution, or training of a service animal, that addresses an individual's needs and outcomes identified in the individual service plan and that is for the direct benefit of the individual in maintaining or improving independence, functional capabilities, vocational skills, community involvement, or physical skills. Assistive technology has four distinct components:

(a) "Assistive technology - consultation" means an evaluation of the assistive technology needs of an individual, including a functional evaluation of technologies available to address the individual's assessed needs and support the individual to achieve outcomes identified in the individual service plan.

(b) "Assistive technology - equipment" means the equipment comprising the assistive technology and may include engineering, designing, fitting, customizing, or otherwise adapting the equipment to meet an individual's specific needs. Assistive technology - equipment may include equipment used for remote support such as motion sensing system, radio frequency identification, live video feed, live audio feed, web-based monitoring, or other device that meets the requirements set forth in this rule and rule 5123-9-35 of the Administrative Code. Assistive technology - equipment may include the cost of software applications or monthly recurring fees (such as a subscription) necessary to use an item, piece of equipment, device, product system, or engineered solution. Assistive technology - equipment does not include:

(i) Items otherwise available as environmental accessibility adaptations, specialized medical equipment and supplies, or vehicle modification;

(ii) Internet service;

(iii) Items or equipment that are illegal or otherwise prohibited by federal or state statutes or regulations;

(iv) Items or equipment used solely for entertainment or recreational purposes;

(v) Items or equipment used solely for the purpose of general utility;

(vi) Replacement or repair of previously approved equipment that has been damaged as a result of confirmed misuse, abuse, or negligence; or

(vii) Purchase or rental of a personal computing device such as a desktop, laptop, or tablet that duplicates any similar equipment in the possession of, or service currently used by, the individual.

(c) "Assistive technology - service animal training" means training of an animal to perform a specific job or task for an individual. The job or task performed by the animal must be directly related to the individual's disability. An animal that provides emotional support, therapy, comfort, or companionship but does not perform a specific job or task for the individual is not a service animal for the purposes of this rule. Assistive technology - service animal training may include an annual examination and routine vaccinations of a fully-trained service animal performed or administered by a licensed veterinarian. Assistive technology - service animal training does not include:

(i) Costs of purchasing or otherwise acquiring an animal;

(ii) Veterinary care of an animal other than an annual examination and routine vaccinations of a fully-trained service animal;

(iii) Grooming of an animal;

(iv) Food, equipment, or supplies consumed or utilized by an animal;

(v) Modifications to an individual's home or vehicle necessary to accommodate an animal;

(vi) Licensing or registering an animal; or

(vii) Costs associated with delivery, transport, or boarding of an animal.

(d) "Assistive technology - support" means education and training that aids an individual in the use of assistive technology - equipment as well as training for the individual's family members, guardian, staff, or other persons who provide natural supports or paid services, employ the individual, or who are otherwise substantially involved in activities being supported by the assistive technology - equipment. Assistive technology - support may include, when necessary, coordination with complementary therapies or interventions and adjustments to existing assistive technology - equipment to ensure its ongoing effectiveness.

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

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

(8) "Environmental accessibility adaptations" has the same meaning as in rule 5123-9-23 of the Administrative Code.

(10) "Homemaker/personal care" has the same meaning as in rule 5123-9-30 of the Administrative Code.

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

(13) "Manufacturer's suggested retail price" means the current retail price of an item of assistive technology - equipment that is recommended by the item's manufacturer. If a provider of assistive technology - equipment is also the manufacturer, the provider may establish a suggested retail price if the price is equal to or less than the suggested retail price for the same or a comparable item of equipment recommended by one or more other manufacturers.

(14) "Participant-directed homemaker/personal care" has the same meaning as in rule 5123-9-32 of the Administrative Code.

(15) "Remote support" has the same meaning as in rule 5123-9-35 of the Administrative Code.

(17) "Service documentation" means all records and information on one or more documents that:

(a) Are created and maintained as services are delivered, and completed prior to billing for services;

(b) Are kept in a manner that fully discloses the extent of services delivered;

(d) May be created or maintained in electronic software programs.

(18) "Specialized medical equipment and supplies" has the same meaning as in rule 5123-9-25 of the Administrative Code.

(19) "Subscription" is a recurring payment for accessing a service (e.g., global positioning system interface or transportation tracking) related to use of assistive technology - equipment that does not involve real-time interaction with remote support staff.

(20) "Team" has the same meaning as in rule 5123-4-02 of the Administrative Code.

(21) "Useful life" means a period of two years, which serves as the standard timeframe during which waiver funds may not be used to replace an item of assistive technology - equipment, except when the item:

(a) Is defective or no longer functional; and

(b) Has not been damaged as a result of confirmed misuse, abuse, or negligence.

(22) "Vehicle modification" has the same meaning as in rule 5123-9-44 of the Administrative Code.

(23) "Waiver eligibility span" means the twelve-month period following either an individual's initial waiver enrollment date or a subsequent eligibility re-determination date.

(1) Assistive technology will be provided only by an agency provider that meets the requirements of this rule and that has a medicaid provider agreement with the Ohio department of medicaid.

(2) An applicant seeking approval to provide assistive technology will complete and submit an application and adhere to the requirements of rule 5123-2-08 of the Administrative Code.

(3) An applicant seeking approval to provide assistive technology - consultation will submit documentation to the department demonstrating that persons who deliver the service:

(a) Hold a license in occupational therapy or physical therapy issued in accordance with Chapter 4755. of the Revised Code; or

(b) Hold a license in speech-language pathology issued in accordance with Chapter 4753. of the Revised Code; or

(c) Hold assistive technology professional certification issued by the "Rehabilitation Engineering and Assistive Technology Society of North America;" or

(d) Have at least two years of full-time (or part-time equivalent), paid work experience in the developmental disabilities services delivery system and hold a bachelor's degree from an accredited college or university in:

(i) Biomedical, computer, electrical, or mechanical engineering;

(ii) Health and rehabilitation sciences including, but not limited to, occupational therapy, physical therapy, speech-language pathology, or rehabilitation counseling; or

(iii) Engineering technology, special education, or a related program.

(4) An applicant seeking approval to provide assistive technology - equipment will provide written assurance that the applicant has experience related to items, equipment, devices, product systems, or engineered solutions that directly benefit individuals in maintaining or improving independence, functional capabilities, vocational skills, community involvement, or physical skills.

(5) An applicant seeking approval to provide assistive technology - support will either:

(a) Meet the requirements set forth in paragraph (C)(3) of this rule; or

(b) Meet the requirements set forth in paragraph (C)(4) of this rule.

(6) An applicant seeking approval to provide assistive technology - service animal training will submit documentation to the department demonstrating that:

(a) Persons or entities that train service animals are reputable and experienced in providing structured training for animals to perform specific jobs or tasks for an individual that are directly related to the individual's disability.

(b) Persons who perform or administer an annual examination and routine vaccinations to a fully-trained service animal are licensed to practice veterinary medicine in accordance with Chapter 4741. of the Revised Code.

(D) Requirements for service delivery

(1) Assistive technology is intended to address an individual's assessed needs in a manner that promotes autonomy and minimizes dependence on paid support staff and should be explored prior to authorizing services that may be more intrusive, including homemaker/personal care, participant-directed homemaker/personal care, and remote support.

(2) Assistive technology will be provided pursuant to an individual service plan that conforms to the requirements of rule 5123-4-02 of the Administrative Code.

(3) In accordance with rule 5123-9-02 of the Administrative Code, waiver funds may be used for assistive technology only when no other funds or resources are available.

(4) Prior to selecting assistive technology - equipment, the individual and the team may access assistive technology - consultation by a qualified provider to assess the fit between an individual's needs and an item, piece of equipment, device, product system, or engineered solution being considered for purchase or rental.

(5) An individual and the team will select the arrangement for acquiring assistive technology - equipment that best meets the individual's needs. The terms of the arrangement will be documented in the individual service plan or in a written agreement signed by the provider of assistive technology - equipment and the individual. An individual may:

(a) Purchase equipment outright.

(b) Rent equipment from the provider of assistive technology - equipment.

(i) The period of the initial rental agreement between the provider of assistive technology - equipment and the individual will not exceed the useful life of the equipment. The rental agreement will specify whether, at the end of the rental period, the individual will own the equipment or return the equipment to the provider.

(ii) An individual and the team may choose to renew a rental agreement beyond the useful life of the equipment when such an arrangement best meets the individual's needs.

(6) Purchase or rental of assistive technology - equipment must be the least costly alternative that reasonably meets an individual's assessed needs.

(7) A provider of assistive technology - equipment is responsible for:

(a) Delivery of the assistive technology - equipment to the individual;

(b) Assembly and set-up of the assistive technology - equipment, if required;

(c) Coordinating as necessary with a provider of assistive technology - support to ensure the individual and others identified by the individual receive instruction in effective use of the assistive technology - equipment; and

(d) Maintenance, necessary repairs, and replacement of the assistive technology - equipment prior to expiration of its useful life for any reason other than misuse or damage by the individual.

(8) Assistive technology - equipment to be used for remote support will be designed so that it may be turned off by the provider of remote support when requested by a person designated in the individual service plan.

(9) Assistive technology - equipment that involves the use of audio and/or video technology by a provider of services that permits other persons to view the individual's activities and/or listen to the individual's conversations and/or record the individual's activities or conversations, will not be activated by the provider when the provider is not being paid to provide the services.

(10) Assistive technology - service animal training may be used to pay for an annual examination and routine vaccinations of a service animal only after the service animal has completed initial training which was funded by the individual's home and community-based services waiver.

(11) Assistive technology - support will not exceed forty hours per waiver eligibility span.

(12) A provider of assistive technology - support will coordinate as necessary with the provider of assistive technology - equipment to ensure that the individual and others identified by the individual receive instruction in effective use of the assistive technology - equipment.

(E) Documentation of services

(1) Service documentation for assistive technology will include each of the following to validate payment for medicaid services.

(a) Type of service (i.e., assistive technology - consultation, assistive technology - equipment, assistive technology - service animal training, or assistive technology - support).

(b) Name of individual receiving service.

(d) Name of provider.

(e) Provider identifier/contract number.

(2) In addition to the requirements set forth in paragraph (E)(1) of this rule, service documentation for assistive technology - consultation will include:

(a) A description of the functional evaluation process and technologies considered to address the individual's needs and support desired outcomes.

(b) A written recommendation that identifies the specific items and estimated cost of assistive technology - equipment necessary to meet the individual's assessed needs and advance achievement of outcomes defined in the individual service plan.

(c) The date the written recommendation was completed and submitted to the individual's service and support administrator.

(3) In addition to the requirements set forth in paragraph (E)(1) of this rule, service documentation for assistive technology - equipment will include:

(a) The address where assistive technology - equipment is installed.

(b) A list of installed assistive technology - equipment including the date each item of assistive technology - equipment is installed, modified, repaired, or removed and the reasons therefore, and associated adjustments in cost.

(4) In addition to the requirements set forth in paragraph (E)(1) of this rule, service documentation for assistive technology - service animal training will include:

(a) A description (including type of animal, date of birth, and name) of the service animal being trained or the fully-trained service animal receiving an annual examination or routine vaccinations.

(b) The date, time, duration, location, and description of the training provided, or the date, time, and description of the annual examination or routine vaccinations performed or administered.

(c) A description of the achieved training outcome (i.e., the specific job or task the service animal will perform for the individual which is directly related to the individual's disability), or an itemized statement of the annual examination or routine vaccinations performed or administered.

(5) In addition to the requirements set forth in paragraph (E)(1) of this rule, service documentation for assistive technology - support will include, as applicable:

(a) The date, time, duration, location, and description of education and training provided and the names of persons receiving the education and training.

(b) The date, time, duration, location, and description of activities necessary to coordinate assistive technology with complementary therapies or interventions.

(F) Payment standards

(1) The billing units, service codes, and payment rates for assistive technology are contained in the appendix to this rule.

(2) Claims for payment for assistive technology will be submitted to the department upon the provider's receipt of verification from the county board that the delivered services meet the requirements specified in the individual service plan.

(3) A county board will authorize payment for assistive technology - consultation within ten calendar days of receiving the written recommendation described in paragraph (E)(2)(b) of this rule.

(4) Purchase or rental of assistive technology - equipment will include, as appropriate, recurring monthly fees and the manufacturer's and seller's warranties.

(5) The cost of all components of assistive technology - equipment, including subscriptions and recurring monthly fees, will not exceed five thousand dollars per waiver eligibility span.

(6) When a provider of assistive technology - equipment leases or manufactures assistive technology - equipment, the amount billed to the department will be the lesser of the provider's usual and customary charge or the manufacturer's suggested retail price (which will be prorated over the useful life of the assistive technology - equipment) plus up to twenty-five per cent as necessary to cover the cost of the provider's responsibilities as set forth in paragraph (D)(7) of this rule.

(7) When a provider of assistive technology - equipment purchases assistive technology - equipment, the amount billed to the department will be the lesser of the provider's usual and customary charge or the actual price plus acquisition costs of the item plus up to twenty-five per cent as necessary to cover the cost of the provider's responsibilities as set forth in paragraph (D)(7) of this rule.

(8) When an individual and the team determine assistive technology - equipment that has exceeded its useful life requires repair or replacement:

(a) The individual and the team will authorize the most cost-effective approach (i.e., repair or replacement).

(b) The amount billed to the department for repair of an item will be the cost of parts plus associated labor. The total cost of parts and labor to repair an item will not exceed twenty-five per cent of the cost of replacing the item.

(c) The amount billed to the department for replacement of an item will be the lesser of the provider's usual and customary charge or the actual price plus acquisition costs of the item plus up to twenty-five per cent as necessary to cover the cost of the provider's responsibilities as set forth in paragraph (D)(7) of this rule.

(d) An individual's waiver will not pay for a service call that does not result in repair of an item.

(9) When two or more individuals share assistive technology - equipment, the cost of acquiring or repairing the equipment will be divided equally among those individuals, without regard to funding source for the service.

(10) Payment for assistive technology - service animal training is subject to the following limitations:

(a) Payment for initial training of a service animal will not exceed ten thousand dollars.

(b) Beyond initial training of a service animal, payment for additional training of the same service animal whose initial training was funded by the individual's home and community-based services waiver may occur in subsequent waiver eligibility spans. Payment for additional training will not exceed two thousand dollars per waiver eligibility span.

(c) Payment for an annual examination and routine vaccinations of a fully-trained service animal will not exceed five hundred dollars per waiver eligibility span.

View Appendix

Last updated January 5, 2026 at 8:47 AM

History

Effective: January 1, 2026
Promulgated Under: 119.03

Ohio Adm.Code 5123-9-13 Home and community-based services waivers - career planning under the individual options, level one, and self-empowered life funding waivers.

(A) Purpose

This rule defines career planning and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service. The expected outcome of career planning is the individual's achievement of competitive integrated employment and/or career advancement in competitive integrated employment.

(B) Definitions

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

(1) "Acuity assessment group" means one of four groups (i.e., group A-1, group A, group B, or group C) to which an individual is assigned based on the individual's score resulting from administration of the acuity assessment instrument in accordance with rule 5123-9-19 of the Administrative Code.

(2) "Adult day support" has the same meaning as in rule 5123-9-17 of the Administrative Code.

(3) "Agency provider" means an entity that directly employs at least one person in addition to a director of operations for the purpose of providing services for which the entity is certified in accordance with rule 5123-2-08 of the Administrative Code.

(4) "Career planning" means individualized, person-centered, comprehensive employment planning and support that provides assistance for individuals to achieve or advance in competitive integrated employment. Career planning is a focused and time-limited engagement of an individual in identification of a career direction and development of a plan for achieving competitive integrated employment and the supports needed to achieve that employment. Components of career planning include:

(a) Benefits education and analysis. Benefits education and analysis, also known as "work incentives planning," provides information to individuals, families, guardians, advocates, service and support administrators, and educators about the impact of paid employment on a range of public assistance and benefits programs, including but not limited to supplemental security income, social security disability insurance, medicaid buy-in for workers with disabilities, medicare continuation benefits, veteran's benefits, supplemental nutrition assistance program, and housing assistance. A maximum of four benefits education and analyses may be funded through the individual's waiver in a waiver eligibility span.

(b) Career discovery. Career discovery is an individualized, comprehensive process to help an individual, who is pursuing individualized integrated employment or self-employment, reveal how interests and activities of daily life may be translated into possibilities for integrated employment. Career discovery results in identification of the individual's interests in one or more specific aspects of the job market; the individual's skills, strengths, and other contributions likely to be valuable to employers or valuable to the community if offered through self-employment; and conditions necessary for the individual's successful employment or self-employment. This service culminates in development of a written career discovery profile summarizing the process, revelations, and recommendations for next steps to be used to develop the individual's vocational portfolio. A maximum of four career discovery processes may be funded through the individual's waiver in a waiver eligibility span.

(c) Career exploration. Career exploration assists an individual to interact with job holders and observe jobs and job tasks. Career exploration may include informational interviews with and/or shadowing persons who are actually performing the job duties of the identified occupation. When possible, the individual will be given an opportunity to perform actual job duties as well.

(d) Employment/self-employment plan. Employment/self-employment plan is an individualized service to create a clear plan for employment or the start-up phase of self-employment and includes a planning meeting involving the job seeker and other key people who will be instrumental in supporting the job seeker to become employed in competitive integrated employment. The service may include career advancement planning for individuals who are already employed. This service culminates in development of a written employment plan directly tied to the results of career exploration, if previously authorized, situational observation and assessment, and/or career discovery. For individuals seeking self-employment, this service culminates in development of a self-employment business plan that identifies training and technical assistance needs and potential supports and resources for those services as well as potential sources of business financing given that medicaid funds may not be used to defray the capital expenses associated with starting a business. A maximum of four employment/self-employment plans may be funded through the individual's waiver in a waiver eligibility span.

(e) Job development. Job development is an individualized service to develop a strategy to achieve competitive integrated employment. The job development strategy will reflect best practices. The service may include analyzing a job site, identifying necessary accommodations, and negotiating with an employer for customized employment. This service is intended to result in achievement of competitive integrated employment consistent with the job seeker's or job holder's personal and career goals as identified in the individual service plan, as determined through career exploration, situational observation and assessment, career discovery, and/or the employment planning process. This service will not be provided to an individual on place four of the path to competitive integrated employment as described in paragraph (D)(2)(d) of rule 5123-2-05 of the Administrative Code.

(f) Self-employment launch. Self-employment launch is support to implement a self-employment business plan and launch a business. This service is intended to result in the achievement of an integrated employment outcome consistent with the job seeker's or job holder's personal and career goals as identified in the individual service plan, as determined through career exploration, situational observation and assessment, career discovery, and/or the employment planning process. This service will not be provided to an individual on place four of the path to competitive integrated employment as described in paragraph (D)(2)(d) of rule 5123-2-05 of the Administrative Code.

(g) Situational observation and assessment. Situational observation and assessment is observation and assessment, not to exceed thirty days, of the individual's interpersonal skills, work behaviors, and vocational skills through practical, experiential, community integrated, paid work experiences related to the individual's preferences as established in the individual service plan. Information gathered through situational observation and assessment provides a context to further determine the skills or behaviors to be developed by the individual to ensure success in the individual's preferred work environment. A maximum of four situational observations and assessments may be funded through the individual's waiver in a waiver eligibility span.

(h) Worksite accessibility. Worksite accessibility includes:

(i) Time spent identifying the need for and ensuring the provision of reasonable worksite accommodations that allow the job seeker or job holder to gain, retain, and enhance employment or self-employment; and

(ii) Time spent ensuring the provision of reasonable worksite accommodations through partnership efforts with the employer and, when appropriate, the opportunities for Ohioans with disabilities agency.

(5) "Competitive integrated employment" means work (including self-employment) that is performed on a full-time or part-time basis:

(a) For which an individual is:

(i) Compensated:

(a) At a rate that is not less than the higher of the rate specified in the Fair Labor Standards Act of 1938, 29 U.S.C. 206(a)(1), as in effect on the effective date of this rule, or the rate specified in the applicable state or local minimum wage law and is not less than the customary rate paid by the employer for the same or similar work performed by other employees who do not have disabilities, and who are in similar occupations by the same employer and who have similar training, experience, and skills; or

(b) In the case of an individual who is self-employed, yields an income that is comparable to the income received by persons without disabilities, who are self-employed in similar occupations or on similar tasks and who have similar training, experience, and skills; and

(ii) Eligible for the level of benefits provided to other full-time and part-time employees;

(b) At a location where the individual interacts with persons without disabilities to the same extent as employees who are not receiving home and community-based services;

(ii) Mobile work crews comprised solely of individuals operating as a distinct unit and/or self-contained business working in several locations within the community; and

(d) That, as appropriate, presents opportunities for advancement that are similar to those for persons without disabilities who have similar positions.

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

(7) "Customized employment" means competitive integrated employment designed to meet the specific abilities of an individual with a significant disability and the business needs of an employer that is carried out through flexible strategies such as job exploration by the individual and working with an employer to facilitate placement including:

(a) Customizing a job description based on current employer needs or on previously unidentified and unmet employer needs;

(b) Developing a set of job duties, a work schedule and job arrangement, and specifics of supervision (including performance evaluation and review), and determining a job location; and

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

(10) "Group employment support" has the same meaning as in rule 5123-9-16 of the Administrative Code.

(11) "Independent provider" means a self-employed person who provides services for which the person is certified in accordance with rule 5123-2-09 of the Administrative Code and does not employ, either directly or through contract, anyone else to provide the services.

(12) "Individual" means a person with a developmental disability or for purposes of giving, refusing to give, or withdrawing consent for services, the person's guardian in accordance with section 5126.043 of the Revised Code or other person authorized to give consent.

(13) "Individual employment support" has the same meaning as in rule 5123-9-15 of the Administrative Code.

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

(15) "Mentor" means a person employed by or under contract with the agency provider who has experience providing direct services to persons with developmental disabilities and who is available on a regular basis to provide guidance to new direct support professionals regarding techniques and practices that enhance the effectiveness of the provision of career planning.

(16) "Pay stub" means a document issued by an employer that shows, for a specified period of time, an employee's gross earnings, deductions from those earnings, and net pay.

(17) "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 5123-5-02 of the Administrative Code.

(18) "Service documentation" means all records and information on one or more documents, including documents that may be created or maintained in electronic software programs, created and maintained contemporaneously with the delivery of services, and kept in a manner as to fully disclose the nature and extent of services delivered that includes the items delineated in paragraph (E) of this rule to validate payment for medicaid services.

(19) "Vocational habilitation" has the same meaning as in rule 5123-9-14 of the Administrative Code.

(20) "Waiver eligibility span" means the twelve-month period following either an individual's initial waiver enrollment date or a subsequent eligibility re-determination date.

(1) Career planning will be provided by an agency provider or an independent provider that meets the requirements of this rule and that has a medicaid provider agreement with the Ohio department of medicaid.

(2) An applicant seeking approval to provide career planning will complete and submit an application and adhere to the requirements of as applicable, rule 5123-2-08 or 5123-2-09 of the Administrative Code.

(3) An applicant seeking independent provider certification to provide career planning will have:

(a) At least one year of full-time (or part-time equivalent), paid work experience related to employment planning and support that assists individuals to achieve competitive integrated employment; or

(b) Thirty hours of formal training related to employment planning and support that assists individuals to achieve competitive integrated employment.

(4) In addition to meeting the requirements set forth in paragraph (C)(3) of this rule, an applicant seeking independent provider certification to provide some components of career planning will meet additional requirements:

(a) An independent provider of the benefits education and analysis component of career planning will have successfully completed nationally approved or accredited training in benefits education and analysis.

(b) An independent provider of the worksite accessibility component of career planning will hold an appropriate license (e.g., occupational therapist) or certification (e.g., certified professional ergonomist issued by the "Board of Certification in Professional Ergonomics"), or have successfully completed appropriate training by an accredited college or university.

(5) An agency provider will ensure that direct support professionals who provide career planning successfully complete, no later than thirty calendar days after hire, training in:

(a) Services that comprise career planning including the expectation that career planning will eventually lead to competitive integrated employment;

(b) Signs and symptoms of illness or injury and procedure for response;

(d) Program-specific transportation safely.

(6) An agency provider will ensure that:

(a) Direct support professionals who perform the benefits education and analysis component of career planning have successfully completed nationally approved or accredited training in benefits education and analysis.

(b) Direct support professionals who perform the worksite accessibility component of career planning hold an appropriate license (e.g., occupational therapist) or certification (e.g., certified professional ergonomist issued by the "Board of Certification in Professional Ergonomics"), or have successfully completed appropriate training by an accredited college or university.

(7) An agency provider will ensure that direct support professionals who provide career planning (other than those who have at least one year of experience providing career planning at the point of hire), during the first year after hire, are assigned and have access to a mentor.

(8) An agency provider will ensure that direct support professionals who provide career planning (other than those who have at least one year of experience providing career planning at the point of hire), no later than one year after hire, successfully complete at least eight hours of training specific to the provision of career planning that includes, but is not limited to:

(a) Skill building in advancement of individuals on the path to competitive integrated employment as described in rule 5123-2-05 of the Administrative Code and development of individuals' strengths and skills necessary for competitive integrated employment; and

(b) Self-determination which includes assisting the individual to develop self-advocacy skills, to exercise civil rights, to exercise control and responsibility over the services received, and to acquire skills that enable becoming more independent, productive, and integrated within the community.

(9) Failure to comply with this rule and as applicable, rule 5123-2-08 or 5123-2-09 of the Administrative Code, may result in denial, suspension, or revocation of the provider's certification.

(D) Requirements for service delivery

(1) The expected outcome of career planning is the individual's achievement of competitive integrated employment and/or career advancement in competitive integrated employment.

(2) The service and support administrator will ensure that documentation is maintained to demonstrate that the service provided as career planning to an individual enrolled in a waiver is 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.

(3) Career planning will be provided pursuant to a person-centered individual service plan that conforms to the requirements of rules 5123-4-02 and 5123-2-05 of the Administrative Code and be coordinated with other services and supports set forth in the individual service plan. An individual will be made aware of the potential impact of outcome-based payments described in paragraph (F)(6) of this rule before the job development component of career planning is authorized in the individual service plan.

(4) Career planning may be provided in a variety of settings but will not be furnished in the individual's home except when a home visit is conducted as part of the career discovery component of career planning or when the individual is self-employed and the home is the site of self-employment.

(5) Career planning will be provided at a ratio of one direct support professional to one individual.

(6) Career planning services may extend to those times when the individual is not physically present while the provider is performing career planning activities on behalf of the individual.

(7) A provider of career planning will complete reports and collect and submit data via the department's outcome tracking system in accordance with rule 5123-2-05 of the Administrative Code.

(8) A provider of career planning will recognize changes in the individual's condition and behavior as well as safety and sanitation hazards, report to the service and support administrator, and record the changes in the individual's written record.

(E) Documentation of services

(1) Service documentation for the career exploration, job development, self-employment launch, and worksite accessibility components of career planning will include each of the following to validate payment for medicaid services:

(a) Type of service.

(b) Date of service.

(d) Name of individual receiving service.

(e) Medicaid identification number of individual receiving service.

(f) Name of provider.

(g) Provider identifier/contract number.

(h) Written or electronic signature of the person delivering the service, or initials of the person delivering the service if a signature and corresponding initials are on file with the provider.

(i) Description and details of the services delivered that directly relate to the services specified in the approved individual service plan as the services to be provided.

(j) Times the delivered service started and stopped.

(k) Number of units of the delivered service.

(2) Service documentation for the benefits education and analysis, career discovery, employment/self-employment plan, and situational observation and assessment components of career planning will include each of the following to validate payment for medicaid services:

(a) Type of service.

(b) Date of service.

(d) Name of individual receiving service.

(e) Medicaid identification number of individual receiving service.

(f) Name of provider.

(g) Provider identifier/contract number.

(h) Written or electronic signature of the person delivering the service, or initials of the person delivering the service if a signature and corresponding initials are on file with the provider.

(i) Description and details of the services delivered that directly relate to the services specified in the approved individual service plan as the services to be provided. The description and details of the services delivered will be sufficient to demonstrate achievement of the desired outcomes in order to serve as the report required for payment for delivery of the services.

(F) Payment standards

(1) The billing units, service codes, and payment rates for career planning are contained in the appendix to this rule.

(2) Payment for adult day support, career planning, group employment support, individual employment support, and vocational habilitation, alone or in combination, will not exceed the budget limitations contained in appendix B to rule 5123-9-19 of the Administrative Code.

(3) The county board will authorize payment for the benefits education and analysis, career discovery, employment/self-employment plan, and situational observation and assessment components of career planning within ten calendar days of acceptance of a report required for payment for delivery of services pursuant to paragraph (E)(2)(i) of this rule.

(4) Payment rates for the career exploration, job development, self-employment launch, and worksite accessibility components of career planning will be adjusted by the behavioral support rate modification to reflect the needs of an individual requiring behavioral support upon determination by the department that the individual meets the criteria set forth in paragraph (F)(4)(a) of this rule. The amount of the behavioral support rate modification applied to each fifteen-minute billing unit of service is contained in the appendix to this rule.

(a) The department will determine that an individual meets the criteria for the behavioral support rate modification when:

(i) The individual has been assessed within the last twelve months to present a danger to self or others or have the potential to present a danger to self or others; and

(ii) A behavioral support strategy that is a component of the individual service plan has been developed in accordance with the requirements in rules established by the department; and

(iii) The individual either:

(a) Has a response of "yes" to at least four items in question thirty-two of the behavioral domain of the Ohio developmental disabilities profile; or

(b) Requires a structured environment that, if removed, will result in the individual's engagement in behavior destructive to self or others.

(b) The duration of the behavioral support rate modification is limited to the individual's waiver eligibility span, may be determined needed or no longer needed within that waiver eligibility span, and may be renewed annually.

(c) The purpose of the behavioral support rate modification is to provide funding for the implementation of behavioral support strategies by staff who have the level of training necessary to implement the strategies; the department retains the right to verify that staff who implement behavioral support strategies have received training (e.g., specialized training recommended by clinicians or the team or training regarding an individual's behavioral support strategy) that is adequate to meet the needs of the individuals served.

(5) Payment rates for the career exploration, job development, self-employment launch, and worksite accessibility components of career planning will be adjusted by the medical assistance rate modification to reflect the needs of an individual requiring medical assistance upon determination by the county board that the individual meets the criteria set forth in paragraph (F)(5)(a) of this rule. The amount of the medical assistance rate modification applied to each fifteen-minute billing unit of service is contained in the appendix to this rule.

(a) The county board will determine that an individual meets the criteria for the medical assistance rate modification when:

(i) The individual requires the administration of fluid, nutrition, and/or prescribed medication through gastrostomy and/or jejunostomy tube; and/or requires the administration of insulin through subcutaneous injection, inhalation, or insulin pump; and/or requires the administration of medication for the treatment of metabolic glycemic disorder by subcutaneous injection; or

(ii) The individual requires a nursing procedure or nursing task that a licensed nurse agrees to delegate in accordance with rules in Chapter 4723-13 of the Administrative Code, which is provided in accordance with section 5123.42 of the Revised Code, and when such procedure or nursing task is not the administration of oral prescribed medication, topical prescribed medication, oxygen, or metered dose inhaled medication, or a health-related activity as defined in rule 5123-6-01 of the Administrative Code.

(b) The duration of the medical assistance rate modification is limited to the individual's waiver eligibility span, may be determined needed or no longer needed within that waiver eligibility span, and may be renewed annually.

(6) A provider of the job development component of career planning may be eligible for an outcome-based payment following an individual's achievement of competitive integrated employment.

(a) A provider may obtain either or both of two possible outcome-based payments for each individual served:

(i) One payment when the individual achieves competitive integrated employment.

(ii) One payment when the individual achieves competitive integrated employment that:

(a) Pays at least twelve dollars per hour; and/or

(b) Employs the individual for an average of at least thirty hours per week as determined over the course of at least four weeks.

(b) To obtain an outcome-based payment, a provider will secure one or more pay stubs from the individual served sufficient to document the competitive integrated employment and/or hourly wage or average hours worked following provision of the job development component of career planning. The provider will submit the pay stub or pay stubs to the individual's service and support administrator, who will authorize the outcome-based payment in the individual service plan. When pay stubs cannot be secured, the provider will instead submit an attestation in the format prescribed by the department that the outcome has been achieved.

(c) The amount of the outcome-based payment is determined by the nature of the competitive integrated employment and the acuity assessment group assignment of the individual at the time the individual achieves competitive integrated employment.

(d) No more than two outcome-based payments will be made during an individual's waiver eligibility span.

(e) The service codes and payment rates for outcome-based payments are contained in the appendix to this rule.

View Appendix

Last updated June 25, 2025 at 5:44 PM

History

Effective: July 1, 2024
Promulgated Under: 119.03

Ohio Adm.Code 5123-9-14 Home and community-based services waivers - vocational habilitation under the individual options, level one, and self-empowered life funding waivers.

(A) Purpose

This rule defines vocational habilitation and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service.

(B) Definitions

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

(2) "Adult day support" has the same meaning as in rule 5123-9-17 of the Administrative Code.

(4) "Career planning" has the same meaning as in rule 5123-9-13 of the Administrative Code.

(5) "Competitive integrated employment" means work (including self-employment) that is performed on a full-time or part-time basis:

(a) For which an individual is:

(i) Compensated:

(a) At a rate that is not less than the higher of the rate specified in the Fair Labor Standards Act of 1938, 29 U.S.C. 206(a)(1) or the rate specified in the applicable state or local minimum wage law and is not less than the customary rate paid by the employer for the same or similar work performed by other employees who do not have disabilities, and who are in similar occupations by the same employer and who have similar training, experience, and skills; or

(ii) Eligible for the level of benefits provided to other full-time and part-time employees;

(b) At a location where the individual interacts with persons without disabilities to the same extent as employees who are not receiving home and community-based services;

(ii) Mobile work crews comprised solely of individuals operating as a distinct unit and/or self-contained business working in several locations within the community.

(d) That, as appropriate, presents opportunities for career advancement that are similar to those for persons without disabilities who have similar positions.

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

(7) "Daily billing unit" means a billing unit that may be used when between five and seven hours of vocational habilitation are delivered by the same provider to the same individual during one calendar day in accordance with the conditions specified in paragraph (F)(2) of this rule.

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

(10) "Group employment support" has the same meaning as in rule 5123-9-16 of the Administrative Code.

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

(13) "Individual employment support" has the same meaning as in rule 5123-9-15 of the Administrative Code.

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

(15) "Integrated community setting" means a place where home and community-based services are delivered in a manner that supports access to, and participation in, the broader community. An integrated community setting:

(a) Offers jobs and/or activities where people receiving home and community-based services have the opportunity to work or participate to the same extent as people not delivering or receiving home and community-based services, as evidenced by documentation;

(b) For employment services, ensures employees with disabilities are paid at least minimum wage and offered benefits consistent with employer policy and applicable wage and hour requirements, as evidenced by documentation;

(c) Is open to the public and operates in a way that is part of the broader community, following standard industry practices for similar businesses (e.g., open on weekends or during early and late hours, as applicable for the industry standard for that business), as evidenced by documentation; and

(d) Promotes access to community resources and interactions beyond the service setting, based on individual interests and goals, as evidenced by documentation.

(16) "Mentor" means a person employed by or under contract with the agency provider who:

(a) Has at least one year of experience providing direct services to persons with developmental disabilities;

(b) Has completed the training described in paragraph (C)(3) of this rule; and

(c) Is available on a regular basis to provide guidance to new direct support professionals regarding techniques and practices that enhance the effectiveness of the provision of vocational habilitation.

(17) "Natural supports" means the personal associations and relationships typically developed in the community that enhance the quality of an individual's life. 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 development of the individual service plan.

(18) "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 5123-5-02 of the Administrative Code.

(19) "Service documentation" means all records and information on one or more documents that:

(a) Are created and maintained as services are delivered and completed prior to billing for services;

(b) Are kept in a manner that fully discloses the extent of services delivered;

(d) May be created or maintained in electronic software programs.

(20) "Small group" means a service arrangement with corresponding payment rates when one direct support professional provides adult day support to no more than four participants in order to deliver more individualized and intensive services based on the participants' assessed needs.

(21) "Virtual support" means the provision of services by direct support professionals at a distant site who engage with an individual using interactive technology that has the capability for two-way, real time audio and video communication.

(22) "Vocational habilitation" means services that provide learning and work experiences, including volunteer work, where the individual develops general skills that lead to competitive integrated employment such as ability to communicate effectively with supervisors, coworkers, and customers; generally-accepted community workplace conduct and dress; ability to follow directions; ability to attend to tasks; workplace problem-solving skills and strategies; and workplace safety and mobility training. Services are expected to occur over a defined period of time with specific outcomes to be achieved determined by the individual and individual's team. Activities that constitute vocational habilitation include, but are not limited to:

(a) Ongoing support, that may be provided in-person or through virtual support, which includes direct supervision, monitoring and/or counseling, and the provision of some or all of the following supports to promote the development of general work skills:

(i) Developing a systematic plan of instruction and support, including task analyses to prepare the individual for competitive integrated employment;

(ii) Assisting the individual to perform activities that result in increasing social integration with other persons employed at the worksite;

(iii) Supporting and training the individual in the use of individualized or community-based transportation services;

(iv) Providing services and training that assist the individual with problem-solving and meeting job-related expectations;

(v) Assisting the individual to use natural supports and community resources;

(vi) Providing training to the individual to maintain current skills, enhance personal hygiene, learn new work skills, attain self-determination goals, and improve social skills;

(vii) Developing and implementing a plan to assist the individual to transition from the vocational habilitation setting to competitive integrated employment emphasizing the use of natural supports; and

(viii) Providing information about or referral to career planning services, disability benefits services, or other appropriate consultative services.

(b) Ongoing support, that may only be provided in-person, assisting the individual with self-medication or health-related activities or performing medication administration or health-related activities in accordance with Chapter 5123-6 of the Administrative Code.

(23) "Waiver eligibility span" means the twelve-month period following either an individual's initial waiver enrollment date or a subsequent eligibility re-determination date.

(1) Vocational habilitation will be provided by an agency provider that meets the requirements of this rule and that has a medicaid provider agreement with the Ohio department of medicaid.

(2) An applicant seeking approval to provide vocational habilitation will complete and submit an application and adhere to the requirements of rule 5123-2-08 of the Administrative Code.

(3) An agency provider will ensure that direct support professionals who provide vocational habilitation successfully complete, no later than thirty calendar days after hire, training in:

(a) Services that comprise vocational habilitation including the expectation that vocational habilitation will eventually lead to competitive integrated employment;

(b) Signs and symptoms of illness or injury and procedure for response;

(d) Program-specific transportation safety.

(4) An agency provider will ensure that direct support professionals who provide vocational habilitation (other than those who have at least one year of experience providing vocational habilitation at the point of hire), during the first year after hire, are assigned and have access to a mentor.

(5) An agency provider will ensure that direct support professionals who provide vocational habilitation (other than those who have at least one year of experience providing vocational habilitation at the point of hire), no later than one year after hire, successfully complete at least eight hours of training specific to the provision of vocational habilitation that includes, but is not limited to:

(D) Requirements for service delivery

(1) The expected outcome of vocational habilitation is the advancement of an individual on the path to competitive integrated employment in accordance with rule 5123-2-05 of the Administrative Code and the individual's achievement of competitive integrated employment in a job well-matched to the individual's interests, strengths, priorities, and abilities.

(2) Vocational habilitation is available to individuals who are no longer eligible for educational services based on their graduation and/or receipt of a diploma or equivalency certificate and/or their permanent discontinuation of educational services within parameters established by the Ohio department of education and workforce.

(3) The service and support administrator will ensure that documentation is maintained to demonstrate that the service provided as vocational habilitation to an individual enrolled in a waiver is not otherwise available as vocational rehabilitation services funded under section 110 of the Rehabilitation Act of 1973, 29 U.S.C. 730.

(4) Vocational habilitation will be provided pursuant to a person-centered individual service plan that conforms to the requirements of rules 5123-4-02 and 5123-2-05 of the Administrative Code and coordinated with other services and supports set forth in the individual service plan. An individual receiving vocational habilitation will have competitive integrated employment outcomes in the individual service plan; vocational habilitation activities will be designed to support the individual's competitive integrated employment outcomes.

(5) Vocational habilitation provided in-person will take place in a non-residential setting separate from any individual's home. An individual participating in vocational habilitation provided through virtual support may do so from the individual's home.

(6) Vocational habilitation may be provided through virtual support under the following conditions:

(a) Virtual support does not have the effect of isolating an individual from the individual's community or preventing the individual from interacting with people with or without disabilities.

(b) The use of virtual support has been agreed to by an individual and the individual's team and is specified in the individual service plan.

(c) The use of virtual support complies with applicable laws governing an individual's right to privacy and the individual's protected health information.

(d) Provision of vocational habilitation through virtual support does not include assisting an individual with self-medication or health-related activities or performing medication administration or health-related activities in accordance with Chapter 5123-6 of the Administrative Code.

(7) A provider of vocational habilitation will notify the department within fourteen calendar days when there is a change in the physical address (i.e., adding a new location or closing an existing location) of any facility where vocational habilitation takes place.

(8) A provider of vocational habilitation will complete reports and collect and submit data via the department's outcome tracking system in accordance with rule 5123-2-05 of the Administrative Code.

(9) Individuals receiving vocational habilitation will be compensated in accordance with applicable federal and state laws and regulations. A determination that an individual receiving vocational habilitation is eligible to be paid at special minimum wage rates in accordance with 29 C.F.R. Part 525, "Employment of Workers with Disabilities Under Special Certificates," will be based on documented evaluations and assessments.

(10) A provider of vocational habilitation will ensure that appropriate staff are knowledgeable about the Workforce Innovation and Opportunity Act program, wage and hour laws, benefits, work incentives, and employer tax credits for individuals with developmental disabilities and ensure that individuals served receive this information.

(11) A provider of vocational habilitation will comply with applicable laws, rules, and regulations of the federal, state, and local governments pertaining to the physical environment (building and grounds) where vocational habilitation is provided. A provider of vocational habilitation will be informed of and comply with standards applicable to the service setting.

(12) A provider of vocational habilitation will recognize changes in the individual's condition and behavior as well as safety and sanitation hazards, report to the service and support administrator, and record the changes in the individual's written record.

(E) Documentation of services

Service documentation for vocational habilitation will include each of the following to validate payment for home and community-based services:

(1) Type of service.

(2) Date of service.

(3) Place of service.

(4) Name of individual receiving service.

(5) Medicaid identification number of individual receiving service.

(6) Name of provider.

(7) Provider identifier/contract number.

(8) Description and details of the services delivered that directly relate to the services specified in the approved individual service plan as the services to be provided.

(9) Times the delivered service started and stopped.

(10) Number of units of the delivered service.

(11) Group size in which services were delivered.

(12) Written or electronic signature of the person delivering the service, or initials of the person delivering the service if a signature and corresponding initials are on file with the provider.

(F) Payment standards

(1) The billing units, service codes, and payment rates for vocational habilitation are contained in appendix A to this rule. Payment rates, except payment rates for vocational habilitation provided in-person to a small group in an integrated community setting for a group of four or fewer individuals, are based on individuals' acuity assessment group assignments determined in accordance with rule 5123-9-19 of the Administrative Code and the county cost-of-doing-business category. Payment rates for vocational habilitation provided in-person to a small group in an integrated community setting are based on the county cost-of-doing-business category. The cost-of-doing-business category for an individual is the category assigned to the county in which the service is actually provided for the preponderance of time. The cost-of-doing-business categories are contained in appendix B to this rule.

(2) A provider of vocational habilitation may use the daily billing unit when the provider delivers between five and seven hours of vocational habilitation in-person to the same individual during one calendar day and:

(a) The individual does not qualify for or the provider elects not to receive the behavioral support rate modification described in paragraph (F)(6) of this rule;

(b) The individual does not qualify for or the provider elects not to receive the medical assistance rate modification described in paragraph (F)(7) of this rule; and

(c) The provider does not provide vocational habilitation to the individual in multiple modes on the same day (i.e., in an integrated community setting when the individual is part of a small group and in another setting or group).

(3) A provider of vocational habilitation will use the fifteen-minute billing unit when:

(a) The provider delivers less than five hours or more than seven hours of vocational habilitation to the same individual during one calendar day;

(b) The individual being served qualifies for and the provider elects to receive the behavioral support rate modification in accordance with paragraph (F)(6) of this rule;

(c) The individual being served qualifies for and the provider elects to receive the medical assistance rate modification in accordance with paragraph (F)(7) of this rule;

(d) The provider provides vocational habilitation to the individual in multiple modes on the same day (i.e., in an integrated community setting when the individual is part of a small group and in another setting or group); or

(e) The provider provides vocational habilitation to the individual through virtual support.

(4) A provider of vocational habilitation will not bill a daily billing unit on the same day the provider bills fifteen-minute billing units for the same individual.

(5) Payment for adult day support, career planning, group employment support, individual employment support, and/or vocational habilitation, provided alone or in combination to an individual enrolled in the individual options waiver, will not exceed the budget limitations set forth in rule 5123-9-19 of the Administrative Code.

(6) Payment rates for vocational habilitation provided in-person at the fifteen-minute billing unit may be adjusted by the behavioral support rate modification to reflect the needs of an individual requiring behavioral support upon determination by the department that the individual meets the criteria set forth in paragraph (F)(6)(a) of this rule. The amount of the behavioral support rate modification applied to each fifteen-minute billing unit of service is contained in appendix A to this rule.

(a) The department will determine that an individual meets the criteria for the behavioral support rate modification when:

(i) The individual has been assessed within the last twelve months to present a danger to self or others or have the potential to present a danger to self or others; and

(ii) A behavioral support strategy that is a component of the individual service plan has been developed in accordance with the requirements in rules established by the department; and

(iii) The individual either:

(a) Has a response of "yes" to at least four items in question thirty-two of the behavioral domain of the Ohio developmental disabilities profile; or

(b) Requires a structured environment that, if removed, will result in the individual's engagement in behavior destructive to self or others.

(7) Payment rates for vocational habilitation provided in-person at the fifteen-minute billing unit may be adjusted by the medical assistance rate modification to reflect the needs of an individual requiring medical assistance upon determination by the county board that the individual meets the criteria set forth in paragraph (F)(7)(a) of this rule. The amount of the medical assistance rate modification applied to each fifteen-minute billing unit of service is contained in appendix A to this rule.

(a) The county board will determine that an individual meets the criteria for the medical assistance rate modification when:

View AppendixView Appendix

Last updated July 1, 2026 at 8:13 AM

History

Effective: July 1, 2026
Promulgated Under: 119.03

Ohio Adm.Code 5123-9-15 Home and community-based services waivers - individual employment support under the individual options, level one, and self-empowered life funding waivers.

(A) Purpose

This rule defines individual employment support and sets forth provider qualifications, requirements for service delivery and documentation of services, and payment standards for the service. The expected outcome of individual employment support is competitive integrated employment in a job well-matched to the individual's interests, strengths, priorities, and abilities that meets the individual's personal and career goals.