Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-43 - Specialized Recovery Services Program › Section 5160-43-01 - Specialized recovery services program definitions

Current through all regulations passed and filed through July 1, 2024
(A) This rule contains the definitions used
			 in Chapter 5160-43 of the Administrative Code applicable to the specialized
			 recovery services program.
(B)
			 Definitions.
(1)
			 "Adult Needs and Strengths Assessment (ANSA)" (8/2021) is
			 an integration information assessment tool for use in the development of
			 individualized person-centered care plans, to monitor outcomes, and to help
			 design and plan systems of care for adults with behavioral health challenges.
(2) "Authorized
			 representative" means a person the individual appoints to act on his or her
			 behalf in accordance with rule 5160-1-33
			 of the Administrative Code.
(3) "Clinical record"
			 is a record containing written documentation that must be maintained by a
			 service provider.
(4)
									"Health and safety action plan" means the document
			 created between the Ohio department of medicaid (ODM) or its designee and an
			 individual enrolled in the program that identifies the interventions
			 recommended by the recovery manager to remedy risks to the health and welfare
			 of the individual.
(5) "Home and
			 community-based services (HCBS) setting" has the same meaning as set forth in
			 rule
			 5160-44-01
			 of the Administrative Code.
(6) "Incident" means an
			 alleged, suspected or actual event that is not consistent with the routine care
			 of and/or service delivery to an individual as set forth in rule
			 5160-44-05 of the Administrative Code. Incidents
			 include, but are not limited to abuse, neglect, exploitation, misappropriation,
			 and inappropriate service delivery.
(7) "Individual" means
			 a person who is pending enrollment or who is enrolled in the specialized
			 recovery services program and therefore is directed to adhere to the rules in
			 Chapter 5160-43 of the Administrative Code.
(8) "Individualized
			 placement and support - supported employment (IPS-SE)" means the implementation
			 of evidence-based practices allowing individuals to obtain and maintain
			 meaningful employment by providing training, ongoing individualized support,
			 and skill development to promote recovery. IPS-SE is an evidence based practice
			 which is integrated and coordinated with mental health treatment and
			 rehabilitation designed to provide individualized placement and support to
			 assist individuals with a severe and persistent mental illness to obtain,
			 maintain, and advance within competitive community integrated employment
			 positions.
(9) "Legally
			 responsible family member" means an individual's spouse, or in the case of a
			 minor, the individual's birth or adoptive parent.
(10) "Peer recovery
			 support" means a service that provides community-based supports to an
			 individual with a mental illness with individualized activities that promote
			 recovery, self-determination, self-advocacy, well-being and independence
			 through a relationship that supports the person's ability to promote his or her
			 own recovery. Peer recovery supporters use their own experiences with mental
			 illness to help individuals reach their recovery goals.
(11)
			 "Person-centered service plan" means a document that identifies goals, objectives, and
			 interventions selected by the individual. The plan identifies and addresses the
			 assessed needs, services, and supports of the individual and is developed in
			 accordance with
			 42 CFR
			 441.725(a) (as in effect on
			 October 1, 2020).
(12) "Provider" means
			 a person or entity who has a provider agreement with ODM and who delivers a
			 specialized recovery services program service, any other service provider that
			 is directed to adhere to this rule, and all of their respective staff who have
			 direct contact with individuals.
(13) "Provider
			 occurrence" means any alleged, suspected or actual performance or operational
			 issue by a provider furnishing program services that does not meet the
			 definition of an incident as set forth in this rule. Provider occurrences
			 include, but are not limited to, alleged violations of provider eligibility
			 and/or service specification requirements, and billing issues including
			 overpayments and medicaid fraud.
(14) "Recovery
			 management" means the coordination of all specialized recovery services program
			 services received by an individual and assisting him or her in gaining access
			 to needed medicaid services, as well as medical, social, educational, and other
			 resources, regardless of funding source.
(15)
			 "Recovery manager" means the person responsible for performing the needs-based
			 assessment and monitoring the provision of services included in the
			 person-centered service plan to ensure the individual's needs,
			 preferences, health and welfare are supported as described in rule
			 5160-43-04
			 of the Administrative Code.
(16) "Significant
			 change" means a variation in the health, care or needs of an individual that
			 warrants further evaluation to determine if changes to the type, amount or
			 scope of services are needed.
(17) "Specialized
			 recovery services" means recovery management, peer recovery support and
			 IPS-SE.
(18) "Specialized
			 recovery services program" means the home and community-based services (HCBS)
			 program jointly administered by ODM and the Ohio department of mental health
			 and addiction services (OhioMHAS) or only administered by ODM to provide services to individuals
			 with qualifying diagnoses of severe and persistent mental illness or diagnosed
			 chronic conditions.
(19)
			 "Trans-disciplinary care team" or "care team" means the group of persons freely
			 chosen by the individual to assist and support him or her in the collaboration
			 of creating and implementing a person-centered service plan. The
			 team is led by the individual where possible and must include a recovery
			 manager. It may also include, but is not limited to, the individual's friends,
			 family and natural supports, the physician(s) and other professionals and
			 providers.