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additional information policy and procedures Policy #17.0 Federal Funds - Title XX Coshocton County Board of Policy Reference: Federal Funds-Title XX I. PURPOSE The purpose of this policy is to define the parameters by which the Coshocton County Board of Developmental Disabilities will utilize and carry out the Title XX Federal Grant Assistance Program. II. APPLICATION • Federal Funds Proposals and Applications: The Board will consider and authorize the applications for any state and federal grants for which it is eligible. The Superintendent evaluates federally funded programs and state grants, including their requirements, regulations, reporting and their benefits to the consumers of the program. The Superintendent reports to the Board about the worth of the programs and makes recommendations accordingly. • Compliance: The Board will comply with all requirements of state and federal programs in regards to planning, application, expenditures, and reporting. • Title XX Assistance Program: • Participating The Board elects to participate in the Title XX federal assistance program through a contract/grant agreement with the Department. The Board agrees to the terms and conditions set forth in the contract/grant agreement and in the attachments, which are deemed to be part of this contract/grant agreement. • Purpose In accordance with the applicable legislation, the Board and the Department agree to work together to carry out the grant program objectives as per the approved profile to maximize use of the Title XX federal assistance program and ensure services to individuals residing in the community with mental retardation and developmental disabilities. • Administration Requirements Administration of this contract shall include compliance with all aspects of signed contract/agreement between the Board and the Department. Documentation for billing shall incorporate records for each recipient showing the number of units provided as per the approved profile . This data will be summarized by computer and will be used as a basis for preparing quarterly reports for billing according to required format and dates. The Coshocton County Board of DD will provide Title XX funded services as approved in the latest Title XX Service Profile without regard to income. Eligibility for the Title XX funded services shall be determined using the process identified in 5123: 2-1-02 of the Ohio Administrative Code for determining eligibility for County Board of DD services. Redetermination of eligibility for Title XX funded services shall be completed no less than annually through the Individual Plan review process. • Eligibility Determination for participation in the Title XX federal assistance program will use the same process that is required in 5123: 2-1-02 of the OAC using the Ohio Eligibility Determination Instrument (OEDI) process for determining eligibility for Board services and shall be without regard to income. Redetermination of eligibility will be completed at the annual program review for each participant. Redetermination would be done if there were a change in client's needs, program goals to targeted applicant and objective of services. This process will include review of continued eligibility for Board services and benefit participation in Title XX as per the approved profile according to individual plans. • Audit The Board agrees to receive, reply to and/or comply with audit exceptions discovered in an audit relating to this contract/grant agreement and to respond accordingly. When applicable, the Board will provide the Department a written corrective action plan to correct such exceptions noted in the final audit report within the time frame allowed by OMD Circular A - 133. Coshocton County Board of Policy Reference: Internet and E-mail Use Policy I. PURPOSE The purpose of this policy is to establish employee work rules and guidelines regarding the use of Board computers, computer hardware and software, and computer communications. Use of the Internet, e-mail and online services has great potential to enhance the productivity of Coshocton County Board employees. These rules shall serve as the framework for the effective use of the rapidly expanding electronic resources available to Board employees. Employees will be held accountable for the use and misuse of government resources, including access to the Internet, e-mail and online services. The following address some, but not necessarily all, of the uses subject to abuse. The Internet and online services are to be used for Board business purposes. Uses that are illegal, interfere with the normal business activities, involve solicitation, are associated with any for-profit business activities; or could potentially embarrass the Board, are strictly forbidden. Coshocton County Board employees shall not access news groups and/or Internet relay chat groups or websites, or any stock market reports or trading vehicles unless they involve approved work-related topics. There is no expectation of privacy on Board owned/provided computer resources which include servers, PC's, workstations, connections Internet e-mail and online services. The Board, without notice to Board employees, reserves the right to routinely and randomly monitor, access, disclose and use the contents of materials on or utilizing Board owned/provided computer resources. II. SCOPE AND AUTHORITY OF COVERAGE This policy covers all employees and volunteers working under the authority of the Coshocton County Board of Commissioners, including employees of departments which report to the Board, Appointing Authorities, as well as any others authorized to use Board equipment or who supervise those utilizing Board equipment. This policy is a work rule, which serves as a standard of conduct for disciplinary purposes under Ohio Revised Code 124.34. III. DEFINITIONS (specific to this policy) A. Board Computers - This definition includes, but is not limited to, mainframes, servers, personal computers (PCs), laptop and portable computers, stand-alone workstations and networked PCs wherever the users and equipment may reside. The term "Board computer(s)" includes, but is not limited to 1) computers which are purchased or leased by a covered Appointing Authority; 2) computers owned by third parties, including the State of Ohio , and used or accessed from Board premises; or 3) computers which can be associated with any covered Appointing Authority in its official public function. B. Electronic Mail (E-mail) - E-mail is the transmission of memos and messages over electronic networks, including but not limited to, local area networks and the Internet. The sections of this policy regulating e-mail shall apply to both incoming and outgoing e-mail messages. C. Internet - The Internet is a worldwide network of computer networks connected to each other primarily using the Internet Protocol (IP). The Internet provides for the World Wide Web, file transfer, remote log-in, e-mail, news and other services. D. Online services or ISP's (Internet Service Providers) - ISP's provide access to the Internet through leased communications lines. E. Instant Messaging - "Real-time" text, voice, video and data communication network software that enables users to quickly transmit and receive text, video, audio and data messages over the Internet. IV. APPLICATION A. Security and Privacy - Board computers, including software and work product, are considered public resources and are the property of the Appointing Authority. Board computers and computer accounts are to assist employees in the performance of their jobs. Employees should not have an expectation of privacy in anything they access, view, create, send or receive on a Board computer, without the express consent of the Appointing Authority. All employees have the responsibility to use all computer resources and services in an efficient, effective, ethical and lawful manner. An employee's ability to connect to other computer systems through the network does not imply a right to connect to those systems or to make use of those systems unless specifically authorized by a policy or procedure of the employee's Appointing Authority. The Appointing Authority has the right, but not the duty, to monitor any and all aspects of the computer resources and services, including e-mail, to ensure compliance with this policy. This includes the right to perform manual or automated audits. The Board and covered Appointing Authority respect the individual privacy of their employees. However, employee privacy does not extend to the employee's work-related conduct, including the use of Board computers, equipment or supplies. Employees have no expectations of privacy when they use Board computer equipment, including, but not limited to, files, e-mail, and Internet browsing. Employees are expected to be vigilant in maintaining system security. Employees may not break into or exceed authorized limits when accessing any computer networks. The entry or distribution of any self-replicating code, any file which may cause damage to any computer system, or any computer "virus" is prohibited. No outside software may be installed on any Board computer system without prior approval of the appropriate supervisor. No employee shall log-in to any system with any identification or password other than that assigned to the employee. Employees shall also follow all account authorization processes, log-in procedures and password protection features established by the appropriate supervisor in the department. Any employee who suspects or detects a breach of security shall immediately notify the appropriate supervisor in the department. The e-mail system is installed to facilitate effective communication between licensed users. While each user has an individual mailbox and password, the system in its entirety belongs to the Coshocton County Board of Commissioners and/or specific Appointing Authority. Users do not have any expectation of privacy using the e-mail system. B. Management's Right to Access Information - The Appointing Authority, through the appropriate supervisor in the department, reserves the right to review contents of employees' e-mail communications at any time, for any reason, without prior notification . Employees should also be aware that e-mail messages may be considered public record and therefore subject to the Appointing Authority's record retention schedule and possible disclosure to the general public. Employees should not assume that e-mail messages are confidential. Employees should also note that "deletion" of an e-mail message does not necessarily ensure that the message is not later retrievable. C. Passwords - All passwords must be recorded with the appropriate supervisor in the department. Employees may not intentionally intercept, eavesdrop, record, read, alter or receive another person's e-mail messages without proper authorization. Other than the appropriate supervisor in the department or specific employees designated by the Appointing Authority, an employee shall not use the password of another employee. No encryption programs may be used without the express authorization of the Appointing Authority. If encryption is used, then the method to decipher the encryption must be made available to the appropriate supervisor in the department prior to its use. V. VIOLATION OF POLICY Any suspected violations of this policy shall be reported immediately to a supervisor. Coshocton County Board employees who are found to have violated this policy are subject to discipline up to and including removal or other disciplinary action as appropriate under an applicable collective bargaining agreement. Violation of this policy may also result in criminal prosecution. Employees are expected to read and comply with the terms and provisions of this policy and supplemental materials established by the employee's Appointing Authority. Employees are to report computer malfunctions and other technical problems to the appropriate supervisor in the department. Employees are to report work rule and disciplinary issues to their supervisor. VI. AUTHORIZATION TO DEVELOP OF PROCEDURES A. The Board authorizes the Superintendent to develop and implement written procedures consistent with Board policy and applicable rules, regulations and statues that apply. Coshocton County Board of Policy Reference: Internet and E-mail Use Procedures I. PROCEDURES A. General E-Mail and Internet Employees are expected to communicate in a professional manner, which will reflect positively on themselves, their Appointing Authority and Coshocton County Board. Restraint shall be exercised regarding the amount of time spent accessing the Internet. E-mail should be written in a businesslike manner. E-mail shall not be used to send insulting, disruptive or offensive messages to other persons or messages which tend to be harmful to morale. Forbidden e-mail messages include, but are not limited to, profane or vulgar language, discriminatory, insulting or defamatory remarks, sexually explicit messages, cartoons or jokes; solicitation of funds, commercial interests, personal or religious causes; political campaign materials; any messages that encourages violation of the Appointing Authority's policies, procedures, rules and/or regulations. Coshocton County Board employees shall not use the Internet, e-mail or online services to access, distribute or solicit sexually oriented messages or images. Board employees shall not use the Internet, or online services for operating a business for personal gain, accessing or trading on the stock market, sending chain letters or soliciting money for religious or political causes. Coshocton County Board employees shall not use the Internet, e-mail or online services to disseminate offensive, harassing, vulgar, obscene, or threatening statements, including disparagement of others based on their race, national origin, gender, sexual orientation, age, marital status, pregnancy, disability religion or political beliefs. Coshocton County Board employees shall not use the Internet, e-mail or online services to distribute or print materials (including articles and software) in violation of copyright or trademark laws. Use of e-mail shall be viewed no differently than the use of other Board equipment (e.g. telephone, fax or copier). Coshocton County Board employees shall not use the Internet, e-mail or online services to provide access to and/or disclosure of confidential information. Coshocton County Board employees shall not use the Internet, e-mail or online services to provide access to public information without following the existing rules and procedures of the custodial agency for dissemination. Coshocton County Board employees shall not use an Internet, e-mail or online service account or signature line other than their own. Coshocton County Board employees shall take all reasonable precautions to prevent the inadvertent distribution of anyone else's information via the Internet, e-mail or online services. B. Instant Messaging Policy Users granted access to instant messaging communications software are asked to do so responsibly. As proprietary public networks like ICQ, AIM, Yahoo Instant Messenger and MSN Messenger often do not employ data encryption, strict HIPAA regulations prohibit the transmission of PHI (Protected Health Information) over IM (Instant Messaging). All PHI must be transferred via email or phone. II. SECURITY Due to strict regulations like HIPAA (Health and Information Privacy Accessibility Act), the management of private information is a responsibility for all technology users. Security procedures in the form of unique user sign-on identification and passwords have been provided to control access to Coshocton County Board of DD's local or host computer system and networks. In addition, security facilities have been provided to restrict access to certain documents and files for the purpose of safeguarding sensitive information. The following activities, which present security risks, should be avoided: • Passwords should not be shared between users. If written down, passwords should be kept in locked drawers or other places not easily accessible. • All users' PC's should be locked when users step away from their computers. Persons using Windows XP or higher can lock their PC's down faster by pressing the Windows key (Window flag icon located next to the Alt key) and the "L" key simultaneously. This is also done by simultaneously pressing the CTRL, ALT and DELETE keys to evoke the Windows Security menu and selecting the Lock Computer option. • Document libraries of other users should not be browsed unless there is a legitimate business reason to do so. • Changes or modifications to the hardware configuration of computer equipment should never be made by individual users. Requests for such changes should be directed to the Systems Administrator. • Users should not attempt to boot PCs from all matter of floppy diskettes, CD's or any other removable, extendable media. This practice risks the introduction of a worm or computer virus. When starting or restarting a PC, please remove all removable media from their drives (such as floppy disks, CD's and Zip disks). III. IMPORTANT USAGE PRACTICES There are a number of practices which individual users should adopt that will foster a higher level of security. Among them are the following: • Lock your workstation (PC) when you must step away from it. For Windows XP users, simultaneously press the Windows and "L" keys. Windows 2000 users, simultaneously press the CTRL, ALT and DELETE keys then choose Lock Computer. • Turn off your personal computer when you are leaving your work area or office for an extended period of time. IV. FILE NAMING CONVENTION In order to better organize files for future access, a file naming convention should be used when creating new documents. The samples listed below show type, suggested format and a hypothetical filename (in bold). • Memos: Memo - <recipient(s)> - <subject> Memo - School Staff - Museum Field Trip • Letters: Letter - <recipient(s)> - <subject> Letter - Parents - Student Progress Reports • Newsletters: News - <date> - <headline> News - 2004-11-24 - Thanksgiving Festivities • Charts: Chart - <subject> Chart - 2004 Quarter II Usage • Spreadsheet: Sheet - <recipient> - <subject> Sheet - Superintendent - 2005 Budget • Databases: Data - <subject> Data - 2004 Client Database .etc. Coshocton County Board of Policy: HIPAA Privacy Policy HIPAA PRIVACY POLICYThe Health Insurance Portability and Accountability Act of 1996 (HIPAA) grants individuals the right to receive notice of the uses and disclosures of their protected health information that may be made by the Coshocton County Board of DD, and sets forth the individual's rights and the Coshocton County Board of DD's legal obligations with respect to protected health information. The purpose of this policy is to assist the Coshocton County Board of DD in complying with the HIPAA privacy standards, to ensure that individuals receive adequate notice of the Coshocton County Board of DD's practices with regard to the dissemination and use of protected health information, and to protect the confidentiality and integrity of protected health information. Definitions
For the purposes of this policy, the following definitions shall apply: Individually Identifiable Health Information is a subset of health information, including demographic information collected from an individual and is created or received by a health care provider, health plan, employer, or health care clearinghouse; relates to past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual; and identifies the individual, or with respect to which there is a reasonable basis to believe the information can be used to identify the individual. Protected Health Information is individually identifiable health information that is transmitted by electronic means; maintained in any electronic medium, such as magnetic tape, disc, or optical file; or transmitted or maintained in any other form or medium, such as paper, verbal, email, or fax. Covered Functions means those functions of the Coshocton County Board of DD the performance of which makes the Coshocton County Board of DD a health plan, health care provider, or health care clearinghouse. Designated Record Set is a group of records maintained by or for the Coshocton County Board of DD that is medical records and billing records about individuals; the enrollment, payment, claims adjudication, and case or medical management systems; or used in whole or in part by the Coshocton County Board of DD to make decisions about individuals. Business Associate is a person or entity that provides certain functions, activities, or services for or on behalf of the Coshocton County Board of DD involving the use and/or disclosure of protected health information. Confidentiality of Individually Identifiable Health Information The Coshocton County Board of DD and its officers, employees, and agents will not use or disclose an individual's protected health information for any purpose without the properly documented consent or authorization of the individual or his/her authorized representative unless required or authorized to do so under state or federal law or this policy, unless an emergency exists, or unless the information has been sufficiently de-identified that the recipient of the information would be unable to link the information to a specific individual. All officers, employees, and agents of the Coshocton County Board of DD are expected to comply with and cooperate fully with the administration of this policy. The Coshocton County Board of DD will not tolerate any violation of the HIPAA privacy or security standards or this policy. Any such violation shall constitute grounds for disciplinary action up to and including termination of employment. Any officer, employee, or agent of the Coshocton County Board of DD who believes that there has been a breach of these privacy and security policies and procedures or a breach of the integrity or confidentiality of any person's protected health information shall immediately report such breach to his or her immediate supervisor or the Privacy/Security Officer. The Privacy/Security Officer shall conduct a thorough and confidential investigation of any reported breach and notify the complainant of the results of the investigation and any corrective action taken. The Coshocton County Board of DD will not retaliate or permit reprisals against any employee who reports a breach to the integrity or confidentiality of protected health information. Any employee involved in retaliatory behavior or reprisals against another individual for reporting an infraction of this policy shall be subject to disciplinary action up to and including termination of employment. Security Provisions
Mitigating the Effects of Unauthorized Use or Disclosure Use or Disclosure of Personal Health Information
Prior to releasing any protected health information for the purposes set forth above, the Coshocton County Board of DD representative disclosing the information shall verify the identity and authority of the individual to whom disclosure is made. This verification may include the examination of official documents, badges, driver's licenses, workplace identity cards, credentials, or other relevant forms of identification or verification. Authorization
To be valid, an authorization shall contain at least the following elements:
In addition to the requirements set forth above, authorization requested by the Coshocton County Board of DD for its own use of protected health information that it maintains, must comply with the following additional requirements:
The Coshocton County Board of DD shall provide the individual with a copy of the signed authorization. An authorization for the use or disclosure of protected health information may not be combined with any other document to create a compound authorization. An authorization is not valid if the document submitted has any of the following defects: A. The expiration date has passed or the expiration event is known to have occurred;
Rights Related to Protected Health Information
Business Associates will assist the Coshocton County Board of DD in complying with its duties to provide individuals with access to health information about them and a history of certain disclosures. The Coshocton County Board of DD shall disclose protected health information to a business associate for the sole purpose of assisting the District in completing healthcare functions, not for the independent use by the business associate. The Coshocton County Board of DD shall enter into a contract with each business associate, which shall be a document separate from the service agreement. The Privacy/Security Officer shall be responsible for managing all business associate contracts and ensuring that they are current and in compliance with the requirements of this policy and the HIPAA privacy rule. Under the contract, the business associate shall be obligated to notify the Privacy/Security Officer when unauthorized uses and/or disclosures of protected health information have occurred in the business associate's organization. The Privacy/Security Officer will take appropriate steps to address the violation up to and including termination of the business associate contract. However, the Coshocton County Board of DD shall not be liable for privacy violations of a business associate, and the Coshocton County Board of DD is not required to actively monitor or oversee the means by which a business associate carries out safeguards or the extent to which a business associate abides by the requirements of the contract. Privacy/Security Officer Complaint Procedure Step 1 - A written complaint must be submitted to the Privacy/Security Officer. A complaint can also be made directly to the Secretary of Health and Human Services. Upon receipt of a complaint, the Privacy/Security Officer will review the complaint, conduct any necessary investigation, and provide the complainant with a written disposition within ten working days. Step 2 - The disposition of the Privacy/Security Officer may be appealed by the complainant to the Superintendent or designee within ten working days of receipt of the disposition of the Privacy/Security Officer. The Superintendent or designee shall meet within ten school days with the complainant, the Privacy/Security Officer, and any other necessary individuals. The Superintendent or designee will respond in writing to the complainant within ten working days following the meeting. Step 3 - If the complaint is not satisfactorily resolved, a written appeal may be made to the Board of Education within ten school days of receipt of the Superintendent's decision. The Board of Education will meet with the complainant at its next regular meeting, and provide a written response to the complaint no later than the following regular meeting. Notice A. Request restrictions on certain uses and disclosures of protected health information;
Training Documentation Procedures to Implement this Policy Coshocton County Board of Policy Reference: HIPAA Procedures NOTICE OF PRIVACY PRACTICES Effective Date: April 14, 2003 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. If you have any questions about this notice, please contact, Jill Lahna, Treasurer, at 740-622-2032. Who Will Follow the Requirement of This Notice? This notice describes the Coshocton County Board of DD's practices and those of its employees and business associates. The Coshocton County Board of DD, its employees, and its business associates may share medical information with each other for the purposes of treatment, payment, or other operations of the Coshocton County Board of DD as described in this notice. Privacy of Health Information. We understand that medical information about you and your health is personal. This notice will tell you about the ways in which we may use and disclose medical information about you. We will also describe your rights and certain obligations that we have regarding the use and disclosure of medical information. We are required by law to:
Use and Disclosure of Medical Information. The following describes the different ways that we may use and disclose medical information. Generally, private health information may be released without your authorization for the purposes of treatment, payment, or other healthcare operations of the Coshocton County Board of DD. Medical information may also be released for the following purposes: • As required by law.
Rights Regarding Medical Information. You have the following rights regarding medical information that we maintain about you:
Changes to This Notice. We reserve the right to make changes to this notice, and to make the revision or change applicable to medical information we already have about you. We will post a copy of the current notice in each building in the Coshocton County Board of DD. Complaints. If you believe your privacy rights have been violated, you may file a complaint with the Coshocton County Board of DD. To file a complaint, please contact Jill Lahna , Treasurer, Coshocton County Board of DD, Ohio, 740-622-2032. All complaints must be submitted in writing. You can also complain to the Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201-0004, (800) 368-1019. Other Uses of Medical Information. Other uses and disclosures of medical information not covered by this notice will be made only with your written permission. If you provide us with permission to use or disclose medical information about you, you may revoke that permission in writing at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reason covered by your written authorization. However, we will not be able to take back any disclosures that we already made during any period in which your permission was in effect. Coshocton County Board of Policy: PASRR Policy I. PURPOSE A. Pursuant to Ohio Administrative Code 5123:2-14-02, Coshocton County Board of DD Case Management Department participates in the OBRA PASRR (Pre-Admission Screening and Resident Review) Evaluation process for individuals seeking admission to a nursing home, regardless of funding source, and for those applying for the PASSPORT Waiver administered by the Ohio Department of Aging (ODA). Case Management provides this evaluation for persons who have suspected mental retardation or developmental disabilities. B. The purpose of this process is to provide information to the Ohio Department of Mental Retardation and Developmental Disabilities (ODMRDD) to determine whether the person's needs should be met in a nursing facility or elsewhere, and whether if admitted to a nursing facility, specialized services should be provided by the county board to ensure continuous active treatment, by rule definition: C. Active treatment means a continuous treatment program which includes aggressive, consistent implementation of a program of specialized and generic training treatment, health services and related services that are directed toward the following: • The acquisition of the behaviors necessary for the client to function with as much self-determination and independence as possible; and • The prevention or deceleration of regression or loss of current optimal functional status. II. APPLICATION A. Specialized Services GuidelinesTo understand what specialized services are, it is important to understand its definition and how it interacts with active treatment. 1. Administrative Rule 5101:3-3-151(B)(19) & 5123: 2-14-01 (B)(13) "Specialized Services for mental retardation and/or other developmental disabilities means the services specified by the Pre-Admission Screening and Resident Review (PASRR) determination and provided or arranged for by the Department which are integrated with services provided by the Nursing Facility (NF) or other service providers to result in continuous active treatment. Specialized services shall be made available at the intensity and frequency necessary to meet the needs of the individual". 2. Administrative Rule 5101:3-3-151(B)(1) & 5123: 2-14-01 (B)(1) "Active treatment means a continuous treatment program which includes aggressive, consistent implementation of a program of specialized and generic training, treatment, health services and related services for individuals with mental retardation and/or other developmental disabilities that are directed towards the following: • The acquisition of the behaviors necessary for the client to function with as much self-determination and independence as possible; and • The prevention or deceleration of regression or loss of current optimal functional status. B. Definition of Commonly Used Terms1. Specialized: Directed towards or concentrated on a specific/particular end. 2. Service: An act of giving assistance (advantage) to another resulting in the others benefit. (i.e., friendly help, professional aid). 3. Integrated: Made whole or complete by the adding or brining together of parts; unity created within different segments in order to establish the whole. 4. Continuous: Ongoing without interruption or break; connected. 5. Intensity: The degree of concentrated effort; magnitude. 6. Frequency: The number of times any action or occurrence is repeated in a given period. 7. Aggressive: Bold and active, pushing, full of initiative. 8. Consistent: Holding always to the same principles, practice, approach in agreement, harmony, accord. C. Specialized Services are: 1. Specified by the PASRR determination; 2. To be provided or arranged for by the county in conjunction with ODMRDD; • What is required to equip the individual with the knowledge, resources and experiences necessary to enable the individual to reach his/her maximum level of independency; 4. To be provided in each part of the individual's daily activity, as appropriate; 5. To be coordinated in such a way to unify all providers (professional, paraprofessional, nonprofessional) in design, approach and delivery of services rendered to the individual to meet his/her unique educational training needs; • To result in an uninterrupted and connected acquisition of knowledge, resources and experience by the individual through proper or appropriate interactions between all staff and the individual which are designed to meet specific Individual Plan (IP) goals and objectives; and 7. To be made available at the number of times and to the degree specified by the IP. D. Determination of Specialized Services 5123:2-14-01 (C), & (C) (3) (C) • Review of Assessments • Current medical history, physical and physician's progress notes (current within one (1) year). • Review to determine, if any, medical needs have been noted that could be addressed through Specialized Services (i.e., individual has medications administered, but is capable intellectually and cognitively to self-administer medication). • Review to determine if the individual's medical condition has deteriorated to the point that Special Services would not show any measurable benefit to the individual (i.e., individual's Alzheimer's has progressed to the point that dementia significantly effects any measurable benefit a current or proposed self medication program would have for the individual). • Review Minimum Data Set (MDS) • Review to gain insight into the individual's behaviors, receptive and expressive language skills, self-care abilities, physical restrictions and limitations, emotional stability, adaptive equipment used, special therapy or treatments currently in place, rehabilitative/restorative care and types of medication now being administered. • Use this information to assist in determining the individual's needs through appropriate assessment/evaluations, program development and implementation, and/or consultation and training. • Nursing Care Plan • Review and gain additional insight into the individual's current physical, mental and social condition as well as the facilities approach to address the various needs of the individual. • Combine this information with the MDS information to gain a mental picture of how the individual interacts, functions and copes with the world around him. Use this to assist in determining if Specialized Services would enhance the individual's capabilities towards greater independence, self-determination and/or prevention or reduction of any loss in skills the individual already possesses. • Professional Evaluations and Consultations • Review to obtain any recommendations for treatment of needs identified through the evaluation process. • Determine if the needs and recommendations are to be addressed through specialized services. E. When making recommendations for specialized services determination, the following points may be useful to apply. 1. The assessments are to be true reflection of the individual's current condition/functional status. Therefore, information that is outdated or is not reflective of the individual's current condition/functional status should not be submitted (i.e., outdated MDS, physical, social history, evaluations, nursing care plans, IP, IEP). 2. A "specialized services determination is given only to those individuals who require continuous supervision, treatment and training to address needs in each of the life areas in which functional limitations have been identified." 3. Documentation of the need for specialized services is to accompany the Individual Plan (IP). The specialized service must be of measurable benefit to the individual. • Assessments/Evaluations should give the present status of the individual, including strengths and needs, and present recommendations designed to meet the needs of the individual. • The Department may request additional information in order to address any areas that may remain unclear. F. Where are Specialized Services to be delivered and by whom?1. Specialized services are to be rendered to the individual wherever the individual is located during the daily routine of the individual. (The IP may designate that the individual is to attend the workshop or some other function provided by the County Board; then, specialized services are provided at the location of the function. However, the IP may designate that services are to be provided in the nursing facility; then the specialized services are to be provided I the facility). 2. After the individual's IP team has met: • The team is to review all evaluations/assessments to establish a list of the individual's strengths and needs, stated in behavioral terms that are based on the individual's current functional status. • The team is to state specific objectives necessary to meet the individual's needs and the planned sequence for dealing with those objectives. These objectives are to be: 1). Stated for each behavioral outcome the team intends the individual to learn; 2). Expressed in behavioral terms that can show a measurable benefit to the individual; 3). Organized to show a developmental progression appropriate to the individual; 4). Prioritized form the most to least important for implementation; 5). Addressed through written training programs that indicate: a). The method to be used; b). The schedule for use of the method; c). The person responsible for the program; d). The type of data and frequency of data collection necessary to be able to assess the benefit to the individual towards the desired objectives; and e). The individual's inappropriate behaviors, if applicable. G. Initiated and DeliveredSpecialized services should be initiated and delivered as soon as the Individual Plan (IP) programs are developed and staff is trained to provide the service in all appropriate situations. Specialized services should be monitored on an on-going basis to ascertain the benefit the individual obtains by receiving the service. • When the individual benefits from the service, the service should be continued as is. Perhaps the service should be continued with adjustments to allow the individual to receive maximum benefit. • When the individual does not benefit from the service, the service should be reviewed and adjustments made so that the benefit to the individual is established. Otherwise, the service is to be discontinued. H. Specialized Services (Benefit or Not?) To determine if the delivery and receipt of specialized services are benefiting the individual, the CCBDD must: • Evaluate the data relevant to the accomplishment of the objectives specified in the IP; and • Evaluate significant events in the individual's daily activity that relate to the individual's IP and that contribute to the overall understanding of the individual's on-going level and quality of functioning. I. Coordination of Specialized Services• Specialized services are to be coordinated by the CCMDD and documented in the IP. • The county board is to assure that training and technical assistance is made available to all service providers in order for the individual to receive the maximum benefit from services rendered. • The county board is to monitor the services being rendered to ascertain the benefit the individual is receiving from the combined efforts offered in relation to the goals and objectives state in the IP. • The ODMRDD has the ultimate responsibility to monitor the need for, delivery of individual outcomes resulting from receipt of Specialized Services. Therefore, the PASRR Specialist will provide periodic reviews. J. Refusal to Receive Specialized ServicesAn individual has the right to refuse any attempt at service delivery. When and if this occurs, the CCBDD should ensure the following: • Refusal must be persistent from the individual (individual should be asked at least on two separate occasions under different circumstances). • Refusal must be consistently documented in the individual's records and reflected as part of the IP updates. • CCBDD must document and discuss with the individual possible consequences of refusal of services. III. AUTHORIZATION TO DEVELOP PROCEDURES A. The Board authorizes the Superintendent to develop and implement written procedures consistent with Board policy and applicable rules, regulations and statues that apply. Coshocton County Board of Policy Reference: PASRR Process I. PROCESS The process of admission to a nursing home begins with the determination of nursing home need and type of nursing facility. The Area Agency on Aging makes this determination, known as level of care. During this process, if the Agency on Aging sees indications of a diagnosis of mental retardation or development disabilities, a notification is sent to ODMRDD's PASRR office, which faxes the information to the county board with a request for Further Review. The Case Management Supervisor or designee completes the OBRA PASRR Evaluation Summary form (revised October, 2000) and submits it with documentation to the Department within five days, following procedures outlined below: If the individual is not known to the county board, the case manager screens first to confirm or rule out a diagnosis of mental retardation or developmental disability using available written or verbal information from family members or other contact persons. If there is no evidence of DD diagnosis, the Rule-Out section of the form is completed and returned to the Department's PASRR unit. If the person does have an DD diagnosis, the case manager, with permission from the person or guardian, acquires the assessments needed as listed in the PAS section of the PASRR form, and sends them to the Department's PASRR unit with the completed form. If the person needs a new or updated psychological evaluation, the county board must attempt to procure that service within five days of the request from ODMRDD. An individual with DD diagnosis may be admitted to a nursing facility without this initial procedure in the following circumstances: • An emergency situation not to exceed seven days; • Respite not to exceed fourteen days; and • Convalescent care admitted directly from a hospital, and not to exceed thirty days. The individual must need treatment for the same condition for which they were hospitalized. In the above situations, Area Agency on Aging informs ODMRDD of the category of admission. At the end of the above time limits per category, the nursing facility must inform ODMRDD's PASRR unit if the person cannot be discharged. At that point, the Department requests the further review process from the county board. With this process, referred to as Resident Review on the PASRR Evaluation form, assessments are required from the nursing home in addition to the documents for PAS, and are all sent to the Department within ten days. A. Change in ConditionChange in Condition is defined as changes in mental or physical condition, with consideration made of the individual's present physical, emotional, intellectual, cognitive, adaptive and maladaptive behavioral, social, vocational, sensori-motor, and speech and language development - which may result in a change of placement. The case manager will monitor for change in conditions by periodic review of service plans of those individuals who are provided day services at the CCBDD. For individuals who are not currently provided day services at CCDD, the individual would request services from the CCBDD, and the case manager would provide a Resident Review to obtain more information about their eligibility status. If there is a change in status when the individual would improve and the individual no longer needs nursing home placement, then the case manager would ascertain from the individual what residential setting is desired, as well as taking in to account the complete medical history, physician orders, nursing care plan, current medications, and the other components entailed in a Resident Review. B. Change in Placement/Must Move Status If ODMRDD determines during the Resident Review that the level of services of a nursing facility is not needed, the individual is given a "must move" status. This is considered an emergency and the individual becomes a priority for placement by the county board in an appropriate setting with needed services and supports. The county board where the nursing facility is located or where the person desires to live is responsible to secure these supports and relocate the individual within a reasonable time frame. Upon receipt of this determination from ODMRDD, the Case Management Department refers the emergency placement need to the PASRR unit. If the Resident Review determines a more appropriate placement is desired, then the case manager would inform the individual of the various options available, such as HCBS waivers, Supported Living, ICF/MR. The case manager will review the various alternative placement options with the individual, and have the individual sign a form acknowledging such. C. Resolution of Complaints The Resolution of Complaints Policy by the CCBDD shall be used as needed for resolving disagreements in regard to any issues that may result from implementation of this policy.
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