Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-9 - Home and Community-Based Services Waivers › Section 5123-9-04 - Home and community-based services waivers - waiting list

Current through all regulations passed and filed through July 1, 2024
(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 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
(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 in a setting other than a hospital, an intermediate
			 care facility for individuals with intellectual disabilities, or a nursing
			 facility.
(4) "County board" means
			 a county board of developmental disabilities.
(5) "Current need" means an unmet need for
			 home and community-based services within twelve months, as determined by a
			 county board based upon assessment of the individual using the waiting list
			 assessment tool. Situations that give rise to current need include:
(a) An individual is likely to be at risk of
			 substantial harm due to:
(i) The primary
			 caregiver's declining or chronic physical or psychiatric condition that
			 significantly limits his or her ability to care for the individual;
(ii) Insufficient availability of caregivers
			 to provide necessary supports to the individual; or
(iii) The individual's declining skills
			 resulting from a lack of supports.
(b) An individual has an ongoing need for
			 limited or intermittent supports to address behavioral, physical, or medical
			 needs, in order to sustain existing caregivers and maintain the viability of
			 the individual's current living arrangement.
(c) An individual has an ongoing need for
			 continuous supports to address significant behavioral, physical, or medical
			 needs.
(d) An individual is aging
			 out of or being emancipated from children's services and has needs that cannot
			 be addressed through community-based alternative services.
(e) An individual requires waiver funding for
			 adult day services or employment- related supports that are not otherwise
			 available as vocational rehabilitation services funded under section 110 of the
			 Rehabilitation Act of 1973,
			 29 U.S.C. 730,
			 as in effect on the effective date of this rule, or as special education or
			 related services as those terms are defined in section 602 of the Individuals
			 with Disabilities Education Improvement Act of 2004,
			 20
			 U.S.C. 1401, as in effect on the effective
			 date of this rule.
(f)
										An individual is living in an intermediate care
			 facility for individuals with intellectual disabilities or a nursing facility
			 and has a viable discharge plan.
(6) "Date of request" means the earliest date
			 and time of any written or otherwise documented request for home and
			 community-based services made prior to 
									September 1,
			 2018.
(7) "Department" means
			 the Ohio department of developmental disabilities.
(8) "Home and community-based services" has
			 the same meaning as in section
			 5123.01 of the Revised
			 Code.
(9) "Immediate need" means a
			 situation that creates a risk of substantial harm to an individual, caregiver,
			 or another person if action is not taken within thirty calendar days to reduce
			 the risk. Situations that give rise to immediate need include:
(a) A resident of an intermediate care
			 facility for individuals with intellectual disabilities has received notice of
			 termination of services in accordance with rule
			 5123:2-3-05
			 of the Administrative Code.
(b) A
			 resident of a nursing facility has received thirty-day notice of intent to
			 discharge in accordance with Chapter 5160-3 of the Administrative
			 Code.
(c) A resident of a nursing
			 facility has received an adverse determination in accordance with rule
			 5123:2-14-01
			 of the Administrative Code.
(d) An
			 adult is losing his or her primary caregiver due to the primary caregiver's
			 declining or chronic physical or psychiatric condition or due to other
			 unforeseen circumstances (such as military deployment or incarceration) that
			 significantly limit the primary caregiver's ability to care for the individual
			 when:
(i) Impending loss of the caregiver
			 creates a risk of substantial harm to the individual; and
(ii) There are no other caregivers available
			 to provide necessary supports to the individual.
(e) An adult or child is engaging in
			 documented behavior that creates a risk of substantial harm to the individual,
			 caregiver, or another person.
(f)
			 There is impending risk of substantial harm to the individual or caregiver as a
			 result of:
(i) The individual's significant
			 care needs (i.e., bathing, lifting, high-demand, or twenty-four-hour care);
			 or
(ii) The individual's
			 significant or life-threatening medical needs.
(g) An adult has been subjected to abuse,
			 neglect, or exploitation and requires additional supports to reduce a risk of
			 substantial harm to the individual.
(10) Individual" means a person with a
			 developmental disability.
(11)
			 "Intermediate care facility for individuals with intellectual disabilities" has
			 the same meaning as in section
			 5124.01 of the Revised
			 Code.
(12) "Locally-funded home and
			 community-based services waiver" means the county board pays the entire
			 nonfederal share of medicaid expenditures in accordance with sections
			 5126.059 and
			 5126.0510 of the Revised
			 Code.
(13) "Nursing facility" has
			 the same meaning as in section
			 5165.01 of the Revised
			 Code.
(14) "Service and support
			 administration" means the duties performed by a service and support
			 administrator pursuant to section
			 5126.15 of the Revised
			 Code.
(15) "State-funded home and
			 community-based services waiver" means the department pays, in whole or in
			 part, the nonfederal share of medicaid expenditures associated with an
			 individual's enrollment in the waiver.
(16) "Status date" means the date on which
			 the individual is determined to have a current need based on completion of an
			 assessment of the individual using the waiting list assessment tool.
(17) "Transitional list of individuals
			 waiting for home and community-based services" means the list maintained in the
			 department's web-based individual data system which shall include the name and
			 date of request for each individual on a list of individuals waiting for home
			 and community-based services on 
									August 31, 2018 established in accordance with rule
			 5123:2-1-08
			 of the Administrative Code as that rule existed on August 31, 2018.
(18) "Waiting list assessment tool" means the
			 Ohio assessment for immediate need and current need contained in the appendix
			 to this rule, which shall be used for purposes of making a determination of an
			 individual's eligibility to be added to the waiting list for home and
			 community-based services defined in paragraph (B)(20) of this rule and
			 administered by persons who successfully complete training developed by the
			 department.
(19) "Waiting list
			 date" means, as applicable, either:
(a) The
			 date of request for an individual whose name is included on the transitional
			 list of individuals waiting for home and community-based services; or
(b) The earliest status date for an
			 individual whose name is not included on the transitional list of individuals
			 waiting for home and community-based services.
(20) "Waiting list for home and
			 community-based services" means the list established by county boards and
			 maintained in the department's web-based waiting list management system which
			 shall include the name, status date, date of request (as applicable), waiting
			 list date, and the criteria for current need by which an individual is eligible
			 based on administration of the waiting list assessment tool, for each
			 individual determined to have a current need on or after
			 
									September 1, 2018.