Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-10 - Early Intervention Program › Section 5123-10-03 - Early intervention program - 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 program for eligible children and their families.
(B) Definitions
For the purposes of this rule, the following definitions
				 apply:
(1) "Assistive technology device" means any
			 item, piece of equipment, or product system, whether acquired commercially off
			 the shelf, modified, or customized, that is used to increase, maintain, or
			 improve the functional capabilities of an infant or toddler with a
			 developmental delay or disability. 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 program" means Ohio's
			 statewide system that provides coordinated services to parents of infants and
			 toddlers with delays or disabilities in accordance with part C.
(5) "Early intervention service coordinator"
			 means a person who holds an early intervention service coordinator credential
			 or an early intervention service coordination supervisor credential issued in
			 accordance with rule
			 5123-10-04 of the Administrative
			 Code and assists and enables an infant or toddler with a developmental delay or
			 disability and the child's family to receive the services and rights, including
			 procedural safeguards, required under part C.
(6) "Early intervention services" means
			 developmental services described in appendix A to rule
			 5123-10-02 of the Administrative
			 Code, selected in collaboration with a parent 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.
(7)
			 "Extraordinary medical expenses" means non-reimbursable costs paid during the
			 individualized family service plan year by the family of the eligible child for
			 medically necessary care, 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.
(8) "Home and community-based services
			 medicaid waiver component" has the same meaning as in section
			 5166.01 of the Revised
			 Code.
(9) "Individualized family
			 service plan" means the written plan for providing early intervention services
			 to an eligible child and the child's family. The 
									one
			 hundred units of early intervention services per individualized family
			 service plan year provided at no cost to an eligible child and
			 
									the
			 child's family in accordance with paragraph (C)(1)(f) of this rule
			 
									will
			 not serve to limit the team's recommendation of needed early intervention
			 services in the individualized family service plan.
(10) "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.
(11) "Medically
			 necessary care" means a procedure, item, or service that prevents, diagnoses,
			 evaluates, corrects, ameliorates, or treats an adverse health condition such as
			 an illness, injury, disease or its symptoms, emotional or behavioral
			 dysfunction, intellectual deficit, cognitive impairment, developmental delay,
			 or disability and that:
(a) Meets generally
			 accepted standards of medical practice;
(b) Is clinically appropriate in its type,
			 frequency, extent, duration, and delivery setting;
(c) Is appropriate to the adverse health
			 condition for which it is provided and is expected to produce the desired
			 outcome;
(d) Is the lowest cost
			 alternative that effectively addresses and treats the medical
			 problem;
(e) Provides unique,
			 essential, and appropriate information if it is used for diagnostic purposes;
			 and
(f) Is not provided primarily
			 for the economic benefit of the provider nor for the convenience of the
			 provider or anyone else other than the recipient.
(12) "Parent" means a biological or adoptive
			 parent of a child, a guardian, a foster parent or person acting in place of a
			 biological or adoptive parent with whom the child lives, or an appointed
			 surrogate parent, consistent with
			 34 C.F.R.
			 303.27, as in effect on the effective date of
			 this rule.
(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 the persons
			 described in appendix B to rule
			 5123-10-02 of the Administrative
			 Code.
(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.