Ohio Administrative Code
Title 5123:2 - Community Services
Chapter 5123:2-1 - County Boards of Developmental Disabilities
Section 5123:2-1-08 - Waiting lists
Universal Citation: OH Admin Code 5123:2-1-08
Current through all regulations passed and filed through March 18, 2024
(A) Purpose This rule sets forth the requirements for waiting lists established by a county board pursuant to section 5126.042 of the Revised Code.
(B) Definitions
(1)
"Alternative
services" means the various programs, services, and supports, regardless of
funding source, other than home and community-based services, that exist as
part of the developmental disabilities service system and other service systems
including, but not limited to:
(a)
Services provided directly by a county
board;
(b)
Services funded by a county board and delivered by
other providers;
(c)
Services provided and funded outside the developmental
disabilities service system; and
(d)
Services
provided at the state level.
(2)
"County board"
means a county board of developmental disabilities.
(3)
"Date of
request" means the earliest date and time of any written or other documented
request for home and community-based services. The request, including the date
and time of request, shall be included in an individual's record maintained by
a county board. Documentation of the date of request may include the Ohio
department of medicaid form 02399, "Request for Medicaid Home and
Community-Based Services" (revised July 2014), signature date.
(4)
"Department"
means the Ohio department of developmental disabilities.
(5)
"Emergency
status" means an individual 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 status may result
from, but is not limited to:
(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 the caretaker's status, or
inability of the caretaker to perform effectively 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.
(6)
"Home and community-based services" has the same
meaning as in section
5123.01 of the Revised
Code.
(7)
"Individual" means a person with a developmental
disability or for purposes of giving, refusing to give, or withdrawing consent
for services, his or her guardian in accordance with section
5126.043 of the Revised
Code.
(8)
"Individual service plan" means the written
description of services, supports, and activities to be provided to an
individual.
(9)
"Intermediate care facility for individuals with
intellectual disabilities" has the same meaning as in section
5124.01 of the Revised
Code.
(10)
"Nursing facility" has the same meaning as in section
5165.01 of the Revised
Code.
(C) There shall be no waiting list for:
(1)
Medicaid state
plan services;
(2)
Home and community-based services for individuals
already enrolled in a home and community-based services waiver administered by
the department;
(3)
Home and community-based services for children who are
subject to a determination under section
121.38 of the Revised Code and
require the services; or
(4)
Home and community-based services for individuals who
are transferred to a home and community-based services waiver pursuant to
paragraph (D)(12) of this rule.
(D) Waiting list for home and community-based services
(1)
If a county board determines that available resources
are not sufficient to meet the needs of all individuals who request home and
community-based services, the board shall establish a waiting list for the
services.
(2)
When an individual requests home and community-based
services for which there is a waiting list, a county board shall:
(a)
With the
agreement of the individual, place the individual's name on the waiting
list;
(b)
Inform the individual, the individual's guardian, and
in accordance with section
5126.044 of the Revised Code,
the individual's family, as applicable, of the individual's position on the
waiting list and the individual's due process rights in accordance with
paragraph (F) of this rule;
(c)
Identify the
individual's immediate needs; and
(d)
Assist the
individual in identifying and obtaining alternative services that are available
to meet those needs, including applying for medicaid. An individual who accepts
alternative services may, at the individual's choice, remain on the waiting
list in his or her current position.
(3)
An individual's
date of request is the controlling date for placement on a waiting list for
home and community-based services and shall be documented at the time of any
such request.
(4)
When there is a dispute regarding an individual's date
of request, the individual or a person with legal authority to act on behalf of
the individual, may appeal under procedures set forth in paragraph (F) of this
rule.
(5)
When an individual relocates or expresses a desire to
relocate from one county to another county, any waiting list for home and
community-based services shall be reordered in the new county based on the
individual's date of request for such services.
(6)
Except as
provided in paragraph (D)(13) of this rule, when home and community-based
services for which there is a waiting list become available, a county board
shall offer the services to the individual next scheduled on the waiting list
to receive the services subject to a determination of the individual's
eligibility for the services.
(7)
Annually, a
county board shall:
(a)
Review the current status, reassess the service needs,
and notify the individual, the individual's guardian, and in accordance with
section 5126.044 of the Revised Code,
the individual's family, as applicable, of the individual's position on the
waiting list; and
(b)
Provide contact information for a person at the county
board who can provide resource information to address, to the extent possible,
immediate needs of the individual and who can respond to questions about the
notice.
(8)
If at any time it is determined that an individual on
a waiting list for home and community-based services is not eligible for home
and community-based services, the county board shall remove the individual's
name from the waiting list and shall assist the individual with contacting
other agencies/programs for which the individual may be eligible. Individuals
removed from the waiting list have a right to due process as set forth in
paragraph (F) of this rule.
(9)
Emergency status
The individuals who may be placed on a waiting list include individuals with emergency status. An individual with emergency status shall receive first priority for home and community-based services. No individual may receive priority for home and community-based services pursuant to paragraph (D)(10) of this rule over an individual placed on a waiting list with emergency status. When two or more individuals have emergency status pursuant to this paragraph, the county board shall offer the services to such individuals in the order they are placed on the waiting list based on their date of request.
(10)
Priority
categories
Except as provided in paragraph (D)(9) of this rule, a county board shall give priority on a waiting list established under paragraph (D)(1) of this rule to all of the following in accordance with the assessment component approved under section 5123.046 of the Revised Code of the county board's plan developed under section 5126.054 of the Revised Code.
(a)
Refinancing of supported living and family support
services. An individual who is eligible for home and community-based services
and meets both of the following requirements:
(i)
The individual
is eighteen years of age or older; and
(ii)
The individual
receives supported living or family support services.
(b)
Refinancing of adult services. An individual who is eligible for home and
community-based services and meets both of the following requirements:
(i)
The individual
resides in the individual's own home or the home of the individual's family and
will continue to reside in that home after enrollment in home and
community-based services; and
(ii)
The individual
receives adult services directly from the county board or from another provider
with funding from the county board.
(c)
Aging caregiver
or intensive needs. An individual who is eligible for home and community-based
services and meets either of the following requirements:
(i)
The individual
does not receive residential services or supported living, either needs
services in the individual's current living arrangement or will need services
in a new living arrangement, and has a primary caregiver who is sixty years of
age or older; or
(ii)
The individual has at least one of the following
service needs that is unusual in scope or intensity:
(a)
Severe
behavioral problems for which a behavioral support strategy is
needed;
(b)
A mental health diagnosis for which medication has
been prescribed;
(c)
A medical condition that leaves the individual
dependent on life-support medical technology;
(d)
A condition
affecting multiple body systems for which a combination of specialized medical,
psychological, educational, or habilitation services is needed; or
(e)
A
condition the county board determines to be comparable in severity to any
condition described in paragraphs (D)(10)(c)(ii)(a) to (D)(10)(c)(ii)(d) of
this rule and places the individual at significant risk of
institutionalization.
(d)
Resident of
intermediate care facility for individuals with intellectual disabilities. An
individual who is eligible for home and community-based services and resides in
an intermediate care facility for individuals with developmental
disabilities.
(e)
Resident of nursing facility. An individual who is
eligible for home and community-based services and resides in a nursing
facility.
(11)
Order for offering services to individuals within
priority categories established in paragraph (D)(10) of this rule
(a)
If two or more
individuals on a waiting list for home and community-based services have
priority for the services pursuant to paragraph (D)(10) of this rule, a county
board shall use the following criteria to determine the order in which the
individuals with priority are offered the services:
(i)
The maximization
of federal funding;
(ii)
A mix among the individuals in each of the priority
categories in paragraph (D)(10) of this rule; and
(iii)
With regard to
living arrangements, promoting:
(a)
Individuals' ability to choose other individuals with
priority under paragraph (D)(10) of this rule with whom to live if the
individuals have an existing relationship; and
(b)
Sharing of
services among any individuals with priority under paragraph (D)(10) of this
rule when the services are appropriate for the individuals.
(b)
When individuals are offered home and community-based
services in accordance with the criteria in paragraph (D)(11)(a) of this rule
and two or more individuals have equal rank, the county board shall offer the
services to such individuals in the order they are placed on the waiting list
based on their date of request.
(12)
When an
individual who is enrolled in the individual options waiver or the level one
waiver requests enrollment in the self-empowered life funding waiver, the
department may transfer the individual to the self-empowered life funding
waiver provided the individual's needs can be more appropriately met by the
self-empowered life funding waiver, the individual meets all eligibility
criteria for the self-empowered life funding waiver, and the county board
requests to enroll the individual in the self-empowered life funding waiver. At
any time within one hundred eighty calendar days of enrollment in the
self-empowered life funding waiver, at the individual's request, the county
board shall request that the individual be re-enrolled in the waiver from which
the transfer was made.
(13)
Paragraph (D)(6) of this rule shall not apply to home
and community-based services funded in whole or in part by the department if
the department directs a county board in writing to use an alternative method
for selecting individuals for enrollment in the home and community-based
services. When the department directs a county board to use an alternative
method, the county board shall offer the services to individuals in accordance
with the method.
(14)
When an individual on a waiting list established under
paragraph (D)(1) of this rule is offered home and community-based services and
refuses the services, the individual may, at the individual's choice, remain on
the waiting list in his or her current position.
(E) Waiting lists for non-medicaid programs and services
If a county board determines that available resources are not sufficient to meet the needs of all individuals who request non-medicaid programs or services, the county board shall establish one or more waiting lists for such programs or services in accordance with the county board's plan developed under section 5126.04 of the Revised Code.
(F) Due process
(1)
Due process shall
be available to an individual aggrieved by an action of a county board related
to any of the following:
(a)
The approval, denial, withholding, reduction,
suspension, or termination of a service funded by the state medicaid program;
and
(b)
The establishment or maintenance of, placement on, the
failure to offer services in accordance with, or removal from a waiting
list.
(2)
Due process shall be provided in accordance with
Chapters 5101:6-1 to 5101:6-9 of the Administrative Code when the service
involved is funded by the state medicaid program and in accordance with rule
5123:2-1-12
of the Administrative Code when the service involved is not
medicaid-funded.
(3)
If an individual is aggrieved in accordance with
paragraph (F)(1) of this rule, a county board may, if it has adopted a written
policy describing an informal process for resolution of complaints and appeals
of adverse action in accordance with rule
5123:2-1-12
of the Administrative Code, attempt to informally resolve the matter. An
attempt to informally resolve the matter shall not affect the right of the
individual to due process in accordance with paragraph (F)(1) of this
rule.
(4)
A county board shall, in the manner specified in rule
5123:2-1-12
of the Administrative Code, give notice to each individual on the waiting list,
the individual's guardian, and in accordance with section
5126.044 of the Revised Code,
the individual's family, as applicable, of the individual's due process rights.
The county board shall document that such notice was given and the content of
the notice.
(G) Upon the department's request, a county board shall submit in a format specified by the department, documentation related to its waiting list for home and community-based services and any waiting list established pursuant to paragraph (E) of this rule including, but not limited to, information regarding individuals who requested services or were removed from the waiting list.
(H) The department shall monitor compliance with this rule by county boards and their contract agencies. The department shall provide technical support upon request and through regional and statewide trainings.
(I) Nothing in this rule shall be interpreted to alter the obligation of a county board to provide a service, which it is required to provide under applicable law. Nothing in this rule shall be interpreted to create an obligation of a county board to provide a service, unless the obligation exists under applicable law.
Replaces: 5123:2-1-08
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
