Ohio Administrative Code › Title 5123:2 - Community Services › Chapter 5123:2-10 - Early Intervention Services › Section 5123:2-10-01 - Early intervention services - system of payments

Current through all regulations passed and filed through July 1, 2024
(A)
								Purpose
This rule establishes a structure to
				pay for activities and expenses that are reasonable and necessary for
				implementing Ohio's early intervention system for eligible children and their
				families.
(B)
								Definitions
(1)
									"Assistive technology device" means any item, piece of
			 equipment, or product, whether acquired commercially off the shelf, modified,
			 or customized, that is used to increase, maintain, or improve the functional
			 capabilities of a child. The term does not include a medical device that is
			 surgically implanted, including a cochlear implant, or the optimization (e.g.,
			 mapping), maintenance, or replacement of that device.
(2)
									"County board"
			 means a county board of developmental disabilities.
(3)
									"Department"
			 means the Ohio department of developmental disabilities.
(4)
									"Early
			 intervention service coordinator" means a person that assists and enables an
			 eligible child and the child's family to receive the services and rights,
			 including procedural safeguards, required under part C.
(5)
									"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, 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.
(6)
									"Early
			 intervention system" means Ohio's statewide, coordinated, comprehensive,
			 interagency system for which the department is the lead agency, that promotes
			 transdisciplinary, family-centered services and supports to eligible children
			 birth through age two and their families.
(7)
									"Eligible" means
			 a child, birth through age two, who has:
(a)
										A physical or
			 mental condition with a high probability of resulting in a developmental delay
			 listed in the appendix to this rule as documented by a diagnosis signed by a
			 professional licensed to diagnose and treat physical or mental
			 conditions;
(b)
										A physical or mental condition which is not listed in
			 the appendix to this rule as documented by a diagnosis signed by a professional
			 licensed to diagnose and treat physical or mental conditions that includes the
			 name of the diagnosed physical or mental condition, and a statement of how the
			 diagnosed condition has a high likelihood of causing a developmental delay;
			 or
(c)
										A developmental delay of at least one and one-half
			 standard deviations below the mean, or the equivalent determined through
			 informed clinical opinion, in adaptive, cognitive, communication, physical, or
			 social-emotional development, as determined and documented by the "Bayley
			 Infant Scales of Development" or the "Battelle Developmental
			 Inventory."
(8)
									"Extraordinary medical expenses" means non-reimbursable
			 costs paid during the individualized family service plan year by the family of
			 the eligible child for medical and related care including, but not limited to,
			 hospital stays, physician visits, dental care, vision care, prescribed
			 medications/ supplies/therapies, health insurance
			 premiums/co-payments/deductibles, and modifications to the child's home to make
			 the home accessible when such costs constitute:
(a)
										At least one per
			 cent of the family's gross income when the family's gross income is less than
			 or equal to two hundred ten per cent of the federal poverty
			 level;
(b)
										At least two per cent of the family's gross income when
			 the family's gross income is greater than two hundred ten per cent of the
			 federal poverty level and less than or equal to two hundred twenty per cent of
			 the federal poverty level;
(c)
										At least three
			 per cent of the family's gross income when the family's gross income is greater
			 than two hundred twenty per cent of the federal poverty level and less than or
			 equal to two hundred thirty per cent of the federal poverty
			 level;
(d)
										At least four per cent of the family's gross income
			 when the family's gross income is greater than two hundred thirty per cent of
			 the federal poverty level and less than or equal to two hundred forty per cent
			 of the federal poverty level;
(e)
										At least five per
			 cent of the family's gross income when the family's gross income is greater
			 than two hundred forty per cent of the federal poverty level and less than or
			 equal to two hundred seventy per cent of the federal poverty
			 level;
(f)
										At least six per cent of the family's gross income when
			 the family's gross income is greater than two hundred seventy per cent of the
			 federal poverty level and less than or equal to three hundred per cent of the
			 federal poverty level;
(g)
										At least seven per cent of the family's gross income
			 when the family's gross income is greater than three hundred per cent of the
			 federal poverty level and less than or equal to four hundred per cent of the
			 federal poverty level; or
(h)
										At least eight per cent of the family's gross income
			 when the family's gross income is greater than four hundred per cent of the
			 federal poverty level.
(9)
									"Home and
			 community-based services medicaid waiver component" has the same meaning as in
			 section 5166.01 of the Revised
			 Code.
(10)
									"Individualized family service plan" means the written
			 plan for providing early intervention services to an eligible child and his or
			 her family. The fifty-five units of early intervention services per
			 individualized family service plan year provided at no cost to an eligible
			 child and his or her family in accordance with paragraph (C)(1)(f) of this rule
			 shall not serve to limit the team's recommendation of needed early intervention
			 services in the individualized family service plan.
(11)
									"Individualized
			 family service plan year" means the period, not to exceed three hundred
			 sixty-six calendar days or extend beyond the child's third birthday, beginning
			 on the day signatures are secured on an initial or annual individualized family
			 service plan and ending when signatures are secured on a subsequent annual
			 individualized family service plan.
(12)
									"Parent" means a
			 biological or adoptive parent of a child, a guardian, a person acting in place
			 of a parent and with whom the child lives, or an appointed surrogate
			 parent.
(13)
									"Part C" means part C of the Individuals with
			 Disabilities Education Act,
			 20 U.S.C.
			 1431 through 1445, as in effect on the
			 effective date of this rule, and 34 C.F.R. part 303, as in effect on the
			 effective date of this rule.
(14)
									"Payor of last
			 resort" means the use of federal part C funds to pay for early intervention
			 services only when all other funding sources have been exhausted. These funds
			 may be used to prevent a delay in the timely provision of early intervention
			 services, pending reimbursement from the agency or entity that has ultimate
			 responsibility for the payment.
(15)
									"Qualified
			 personnel" means persons who:
(a)
										Hold, as applicable based on the early intervention
			 services provided:
(i)
											Valid early intervention services certification issued
			 by the department in accordance with rule
			 5123:2-5-05
			 of the Administrative Code;
(ii)
											Valid license or
			 certificate issued under Title XLVII of the Revised Code; or
(iii)
											Valid license
			 or certificate issued under Chapter 3319. of the Revised Code.
(b)
										Provide early intervention services in accordance with part
			 C and rules promulgated by the department.
(c)
										Shall be subject
			 to the department's oversight of the early intervention services
			 provided.
(16)
									"Team" means the group of persons who develop the
			 individualized family service plan and includes, at a minimum, the parent of
			 the eligible child, other family members when requested by the parent, an
			 advocate or other person outside of the family when requested by the parent,
			 the early intervention service coordinator, and a person who conducted the
			 evaluation or assessment of the child.
(17)
									"Unit" means
			 either:
(a)
										Sixty minutes of early intervention services;
			 or
(b)
										One hundred dollars expended for an assistive
			 technology device.