Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-8 - Developmental Disabilities Level of Care › Section 5123-8-01 - Developmental disabilities level of care

Current through all regulations passed and filed through July 1, 2024
(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;
(c) Abuse, neglect, or exploitation of 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.