Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-44 - Nursing Facility-Based Level of Care Home and Community-Based Services Programs
Section 5160-44-02 - Nursing facility-based level of care home and community-based services programs: person-centered planning and documentation standards
Universal Citation: OH Admin Code 5160-44-02
Current through all regulations passed and filed through September 16, 2024
(A) Person-centered planning process.
Individuals receiving home and community-based services (HCBS) through either an Ohio department of medicaid (ODM) or Ohio department of aging (ODA) - administered waiver program authorized under section 1915(c) of the Social Security Act (as in effect on January 1, 2024) or the Ohio medicaid state plan authorized under section 1915(i) of the Social Security Act (as in effect on January 1, 2024) will lead the person-centered planning process where possible. The individual's authorized representative should have a participatory role, as needed, and as defined by the individual, unless Ohio law confers decision-making authority to the legal representative. All references to individuals include the role of the individual's authorized representative. In addition to being led by the individual receiving services and supports, the person-centered planning process will:
(1) Include a team of people chosen by the
individual.
(2) Provide necessary
information and support to ensure that the individual directs the process to
the maximum extent possible and is enabled
to make informed choices and decisions.
(3) Be timely and occur at times and
locations of convenience to the individual.
(4) Reflect cultural considerations of the
individual. The process
will be conducted by providing information in
plain language and in a manner that is accessible to persons with disabilities
and persons who are limited English proficient, consistent with
42 CFR
435.905(b) (as in effect
October 1, 2023).
(5)
Include strategies for solving conflict or disagreement within the process, including clear conflict of interest guidelines for all
planning participants.
(6)
Ensure that providers of HCBS for the individual, or those who have an interest
in or are employed by a provider of HCBS for the individual
will not
provide case management, provider oversight, or develop the person-centered
services plan.
(7) Offer informed
choices to the individual regarding the services and supports he or she
receives and from whom.
(8) Include
a method for the individual to request updates to the person-centered services plan as needed. The
individual may request a person-centered services plan review at any
time.
(B) Person-centered services plan.
(1) The
person-centered services plan describes the person-centered goals, objectives
and interventions selected by the individual and team to support him or her in
his or her community of choice. The person-centered
services plan addresses the assessed needs of the individual by
identifying medically-necessary services,
natural supports,
medical and professional staff, and community
resources. The person-centered services plan
will:
(a) Identify the setting in which the
individual resides is chosen by the individual and
document the
alternative home and community-based settings that were considered by the
individual.
(b) Reflect the
individual's strengths.
(c) Reflect
the individual's preferences.
(d)
Reflect clinical and support needs as identified through the assessment
process.
(e) Include the
individual's identified goals and desired outcomes.
(f) Identify the services and supports (paid
and unpaid) that will assist the individual to achieve identified goals, and
the providers of those services and supports, including natural supports and
those services the individual elects to self-direct. This includes all services and supports provided through
private insurance, medicare, medicaid state plan, and waiver
services.
(g) Address any
risk factors and measures in place to minimize them, when needed.
(h) Include back-up plans that meet the needs
of the individual.
(i) Reflect that
the setting chosen by the individual is integrated in, and supports the full
access of individuals receiving medicaid HCBS to the greater community,
including opportunities to seek employment and work in competitive integrated
settings, engage in community life, control personal resources and receive
services in the community to the same degree of access as people not receiving
medicaid HCBS.
(2) The
person-centered services plan will document that any
modification of the additional conditions for provider-owned or controlled
residential settings set forth in rule
5160-44-01 of the Administrative
Code
is supported by a specific assessed need and justified
in the person-centered services plan. In these cases, the person-centered
services plan will:
(a) Identify a
specific and individualized assessed need;
(b) Document the positive interventions and
supports used prior to any modifications to the person-centered services
plan;
(c) Document less intrusive
methods of meeting the need that have been
attempted but
were unsuccessful;
(d) Include a
clear description of the condition that is directly proportionate to the
specific assessed need;
(e) Include
a regular collection and review of data to measure the ongoing effectiveness of
the modification;
(f) Include
established time limits for periodic reviews to determine if the modification
is still necessary or can be terminated;
(g) Include informed consent of the
individual; and
(h) Include an
assurance that interventions and supports will not cause any harm to the
individual.
(3) The
person-centered services plan will:
(a) Be
understandable to the individual receiving services and supports, and the
people important in supporting him or her. At a minimum, it
will be
written in plain language and in a manner that is accessible to persons with
disabilities and persons who are limited english proficient, consistent with
42 CFR
435.905(b) (as in effect on
October 1, 2023).
(b)
Identify the person and/or entity responsible for monitoring the
plan.
(c) Be finalized and agreed
to, with the informed consent of the individual in writing, and signed by all
people and providers responsible for its implementation. Acceptable signatures
include, but are not limited to a handwritten signature, initials, a stamp or
mark, or an electronic signature. Any accommodations to the individual's or
authorized representative's signature
will be documented on the plan.
(d) Be distributed to the individual and
other people involved in the plan.
(e) Prevent the provision of unnecessary or
inappropriate services and supports.
(f) Be reviewed and revised upon reassessment of functional need
as required by 42 CFR
441.365(e) (as in effect on
October 1, 2023), at least every twelve months, when the
individual experiences a significant change, or at the request of the
individual.
(C) Documentation standards.
(1)
Documentation standards apply to entities delegated to
perform assessments and care coordination activities for nursing facility-based
waiver programs. Assessments and care coordination activities include in-person
visits, telephone conversations, or email exchanges.
(2)
Documentation for
each assessment and care coordination activity will include the
following:
(a)
Individual's name.
(b)
Name and
relationship to the individual for all that participate.
(c)
Date of the
assessment or care coordination activity.
(d)
Location of the
assessment or care coordination activity.
(e)
Type of
assessment or care coordination activity.
(f)
Detailed
description of the assessment or care coordination activity, including the
reason for the activity, actions completed, outcome and next
steps.
(3)
Documentation of all assessments and care coordination
activities will be:
(a)
Written in a manner that is objective, accurate, and
understandable to the individual as described in paragraph (B)(3)(a) of this
rule.
(b)
Completed within three business days of the assessment
or care coordination activity.
(c)
Accessible to ODM
in the system designated by ODM.
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.
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