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rights policy and procedures Policy #13.0 Administrative Resolution of Complaints and Due Process Rights Policy Coshocton County Board of Policy: A dministrative Resolution of Complaints and Due Process Rights Policy I. PURPOSE • It is the policy of the Board to provide due process protections to individuals, families guardians or complainants in the resolution of complaints involving programs, services, policies or administrative practices of the Board of any entities acting under contract with the Board. Areas subject to administrative resolution may include, but not be limited to, eligibility determination, arranging appropriate services for eligible individuals, or any denial, reduction or termination of services to individuals provided. • The Board shall adhere to the administrative resolution of complaints process as outlined in the section OAC 5123: 2-1-12 . II. APPLICATION • This policy shall apply to any person, other than an employee of the Board. Any person may file a complaint and use this policy prior to commencing a civil action regarding said complaint. • Medicaid related procedures or other processes for appeal, specific to the service or support, may be utilized independent of, or in addition to, the Board administrative resolution of complaints and informal grievance procedures for resolving disputes of individuals, families, guardians, or complainants. III. DEFINITIONS • Adverse Actions-Denial, reduction, termination of services is an adverse action. • Denial-to refuse an initial request to receive a Medicaid service; to refuse to increase the frequency and/or duration of delivery of an existing Medicaid service. • Reduction-to decrease frequency and/or duration of the current delivery level of a Medicaid service. • Termination-to stop delivery of Medicaid service. • "Case Conference or County Conference " means discussion and attempt to achieve resolution of a complaint or issue at the local level. The process for case or county conferences is outlined in the Board's informal hearing grievance process. F. "Complainant" means a person as defined in ORC 1.59 and shall include any person other than an individual as defined in this Rule, a corporation, business trust, estate, trust, partnership and association when such person has an interest with the Board through a contract or in relation to an Administrative practice of the Board. • "Board" means the Coshocton County Board of MR/DD, including Board members as an entity, the Superintendent and any person employed by or under contract with the board who has authority for Administrative or service implementation on behalf of the Board. • "Department" means the Ohio Department of Mental Retardation and Developmental Disabilities. • "Employee" means any person employed by the Board. J. "Good Cause" means circumstances which may justify delay in making a timely request for state hearing, including: death in immediate family; sudden illness or injury of the individual or a member of the individual's immediate family; other circumstances which reasonably prevented requesting the hearing within the 15 day period. • "Individual" means a person applying for, determined eligible for, denied eligibility, or enrolled in the programs, services, an supports provided or arranged in accordance with ORC 5126 and includes the parents of an individual who is a minor, any guardian, or any other legally appointed representative acting in a legal capacity on the individual's behalf. • "Prior Notice" means written notice that must be given to the individual no later than 15 calendar days prior to the effective date of the proposed action. • "Reinstatement" means reinitiating a service that was reduced or terminated. IV. NOTIFICATION OF POLICY AND DUE PROCESS RIGHTS • On an annual basis the Board shall provide notification of the availability of the policy for administrative resolution of complaints and due process rights to individuals, families, guardians, and any entity in the county that serves persons or provides or desires to provide services and/or supports under contract with the Board. The notice shall be incorporated into the individual or family planning process. Notifications may occur upon request or receipt of any complaint. The policy is also available on the board website at www.coshmrdd.org. • When an individual applies for Medicaid services the applicant is notified of their right to a state hearing as part of the comprehensive notification process of the Board. • If the Board believes the individual may have difficulty understanding the Board procedures the Board will assist the individual in identifying an authorized representative. • Providing Notice upon Receipt of Complaint: • Upon receipt of any complaint subject to this policy, the Board shall provide written notice of the right to use the Board administrative resolution of complaints and due process rights policy, to the individuals, families, guardians, or complainants. The Board shall inform the individual that a representative of the Board is available to assist the individual with utilization of the grievance or administrative resolution of complaint processes outlined in the policy. • Where circumstances permit, due process rights shall be given at least ten days prior to any action being taken. Such noticed shall be written in terms and easily understood by the individual, families, guardians, or complainants and shall include the following: a. A written detailed description of the proposed action; b. A clear statement of the reasons for the proposed actions, including the specification of any evaluative instruments or reports upon which such action is proposed; c. A statement that the complainant or individual has the right to seek administrative resolution regarding complaints about such decision; and • A copy of the administrative resolution of complaints and due process policy. • Upon notice of an individual, family, guardian or complainant's intent to evoke their due process rights all proposed actions shall halt until the issue is fully resolved to the satisfaction of all parties involved. V. RESOLVING COMPLAINTS USING THE INFORMAL GRIEVANCE PROCESS A. Informal Grievance Process: 1. The informal grievance process represents the initial effort to resolve concerns of individuals, families, guardians, or complainants. Concerns not satisfactorily addressed may result in utilization of the administrative resolution of complaints process defined in this policy. 2. The individual or authorized representative has ninety calendar days from the notice of a change in services in which to file an appeal. No reduction or termination of service shall occur without giving notice to the individual or representative not less than fifteen days prior to the effective date of the proposed action. Services shall continue if an appeal is received within fifteen days. If there no appeal, services will be terminated and payment will stop. Services will not be reinstated if the appeal is received within ninety days, but after fifteen days, unless there is a good cause for failing to request a hearing within the fifteen day period. 3. The informal grievance procedure is an informal method of resolving disputes. 4. Upon notice of a potential dispute the Superintendent shall appoint 1 or more persons to conduct an informal hearing to resolve the issue within a time frame of not more than 30 days. The Superintendent or designee shall inform the individual, family, guardian, or complainant of their right to utilization of the informal grievance process. Notice of a potential dispute may result from correspondence, memos, meetings, or phone contact with the individual, family, guardian or complainant. The filing of such grievances under this policy shall not affect the rights of the individual, family, guardian or complainant to file an appeal through the administrative resolution of complaint process within this policy B. A Program Manager will serve as the Board's representative to conduct an informal hearing of the complaint. 1. An informal hearing may be requested by the individual or complainant to discuss the complaint within five days of the complaint. 2. The individual shall contact the Program Manager of the applicable Board program from which the complaint originated. 3. Upon receipt of the request for an informal hearing, the Program Manager shall at a mutually agreeable time to all parties, schedule an informal hearing to be held within ten calendar days of the request. 4. The informal hearing shall include all persons requested to attend by the individual or complainant. 5. During the informal hearing, the Program Manager shall respond to questions, review circumstances related to the decision and provide the party initiating the request, the opportunity to present reasons as to why any decision(s) should be reconsidered. 6. The Program Manager shall issue a written decision to the individual or complainant regarding the complaint within ten days of the informal hearing. 7. Prior to the conclusion of the informal hearing, the Board representative shall provide the party initiating the request a copy of the Board administrative resolution of complaint policy. VI. RESOLVING COMPLAINTS USING THE ADMINISTRATIVE RESOLUTION OF COMPLAINTS PROCESS A. Subject to the limitations of ORC 5123:043, any request for administrative resolution of a complaint filed in accordance with this policy will not nullify any other rights to services. B. If the complaint relates to the Board requesting a termination, reduction, or changes of services for an individual, current services shall continue to be provided pending final resolution. Individual protections afforded by ODJFS for Medicaid funded services may be used in lieu of, or in addition to, the Board administrative resolution of complaints policy. • Notwithstanding any other provisions of this procedure, the appeal of any action of the Board of its employees shall begin at the level in which the decision or action was made. If there is an appeal of a decision taken by a contractor of the Board, the appeal shall begin with the contractor in place of the supervisor. • The request for administrative resolution shall be in writing and shall be filed with the supervisor/designee of the applicable service component of the Board. If an individual has difficulty reading or writing, an oral report may be accepted and documented by the Board supervisor receiving the report. An advocate who may speak on behalf of the individual may assist an individual who wishes to seek administrative resolution in accordance with this policy. 1. The Board supervisor/designee will conduct an investigation of the complaint within ten calendar days of receipt of the request for administrative resolution of the complaint. 2. Within ten calendar days of the completion of the investigation, a written report and decision will be completed and discussed with the complainant or individual. Such report shall include a description of next step in the administrative resolution or complaint process. 3. Within ten calendar days or receipt of Board supervisor's/designee's written decision, the complainant or individual may request administrative review of the supervisor's/designee's written decision. 4. Timelines may be extended if mutually agreeable to all involved parties. • If the complainant or individual desires an administrative review of the supervisor's/designee's decision, the following shall occur: 1. A request for an administrative review shall be made in writing by the complainant or individual within ten calendar days of the receipt of the supervisor's/designee's written decision. The request for administrative review shall be made to the Superintendent/designee of the Board. 2. Upon receipt of a request for administrative review of the supervisor's written decision, the Superintendent/designee shall, within ten calendar days, meet with the party initiating the request and conduct an administrative review. a. During the administrative review, the Superintendent/designee may ask questions to clarify the circumstances and facts related to the decision, and provide the party initiating the request the opportunity to present reasons as to why the decision should be reconsidered. b. Within five working days of the administrative review, the Superintendent/designee's decision shall be made known, in writing, to the complainant or individual and include a rationale for such decision, and a written description of the next step in the administrative resolution of complaints process. • Timelines may be extended if mutually agreed upon by all involved parties. • If the complainant or individual is not satisfied with the decision of the Superintendent/designee, a written appeal may be filed with the Board. The written appeal shall be filed with the Board President within ten calendar days of receipt of the Superintendent/designee's decision. 1. Upon receipt of a written request to the appeal, the Board President or designee shall conduct a hearing no sooner than seven calendar days, nor later than the next regularly scheduled Board meeting, at a time and place convenient to all parties. The Board may hear the case as a full Board or the President of the Board, with the concurrence of the Board, may establish a committee of two or more Board Members to hear such appeals. The committee shall be vested with full rights and authorities as the County Board in handling the appeal. 2. No less than seven days prior to the hearing, the complainant, or individual shall be provided access to the Board records pertaining to the specifics of the appeal. 3. The hearing shall be a closed meeting unless the complainant or individual request an open meeting. 4. During the hearing, evidence shall be presented by both parties to support their positions. 5. The complainant or individual shall be afforded the right to be represented by legal counsel or by such other representative of the party's choice and at the expense of the individual or complainant. 6. The complainant or individual shall be afforded the right to have in attendance and question any official, employee, or agent of the Board who may have evidence upon which the appeal is based. 7. The decision of the Board shall be solely based upon evidence presented at the hearing. Evidence presented at the hearing shall be recorded by stenographic and/or use of audio-electronic recording devices as the Board determines at the time of the hearing. Such record shall be made at the expense of the Board and, upon request, one copy of the verbatim transcript and/or recording shall be provided to the complainant or individual at no cost. 8. In any hearing held under the authority of the Board pursuant to the OAC 5123: 2-1-12 , the Board may appoint a hearing examiner, to conduct said hearing. The hearing examiner shall have the same powers and authority in conducting the hearing as granted to the Board, but shall not be a Board employee. The hearing examiner need not be admitted to the practice of law, but shall be possessed of such qualification as to be able to render neutral and informed decisions on matters presented in the complaint. The Director or his/her designee shall maintain a list of approved hearing examiners, which a Board may request in order to select a qualified examiner. The Board may also request the Department to certify a qualified hearing examiner. • Within five calendar days of the date the hearing is deemed closed, the hearing examiner shall issue a written report and a recommendation, setting forth findings of fact, conclusions of law, and recommendations for the disposition of the complaint. The report and recommendation shall be served upon the parties to the hearing by certified mail. • The parties to the hearing may file with the Board written objections to the report and recommendations within ten days of receipt of the report and recommendation • Within five calendar days of the hearing or within five calendar days following the Board action upon Receipt of the hearing examiner's report and any objections thereto, written notification of the Board's decision shall be sent by certified mail to the complainant or individual. Such notification shall include a rational for the Board decision and description of the next step in the process. • Timelines may be extended if it is mutually agreed upon by all parties. • In the event the complainant or individual wishes to appeal the decision of the Board, the individual/complainant shall have the right to appeal the decision of the Board to the Director of the Department. For any complaints file with the Director, the individual will be assisted by the Board to access the Department. The County Board would assist in any manner that the family requested. H. After exhausting the administrative remedies in OAC 5123:2-1-12, if the complaint is not settled to their satisfaction, a complainant or individual may either file a complaint with the Department as permitted by OAC 5123:2-17-01 or commence a civil action against the Board. I. Subject to the limitations of ORC 5123:043, the Administrative Resolution Process provided by OAC 5123:2-1-12, are in addition to any other rights an individual or the parent of minor or guardian may otherwise have pursuant to the Ohio Revised Code or any other applicable State or Federal Law. VII. RESOLVING COMPLAINTS RELATED TO MEDICAID SERVICES A. When Medicaid-funded services are denied, reduced, or terminated, the affected Medicaid-eligible individual has the right to a state hearing if they wish to appeal the decision. The Board shall be the provider agency ( HAB Center ) and the Superintendent or their designee shall be responsible for implementation of due process. B. When an individual applies for initial Medicaid services or they are denied a request to increase frequency/duration of an existing service, the applicant is notified of their right to a state hearing as part of the comprehensive notification process of the Board. C. The individual or their representative shall be given notice of the denial for initial service or increased frequency/duration of an existing service by the Board through distribution of the Ohio Department of Jobs and Family Services (ODJFS) Form 7334 ("Notice of Denial of your Application for Assistance"). D. When a decision has been made to terminate a service received or to reduce the frequency and/or duration of the Service, ODJFS Form 4065 ("Important notice about your Welfare Benefits") shall be provided to the individual. E. If the individual or their authorized representative believes the adverse action is a mistake, only the individual or their authorized representative can request the state hearing. The right to a state hearing is guaranteed in the federal statutes that govern all Medicaid-funded services. F. If a state hearing is requested by the individual or their authorized representative for a decision made by the Board, the Board shall prepare the Ohio Department of Jobs and Family Services ODJFS 4067 Form ("Appeals Summary") and defend the decision in the hearing. G. The request for a state hearing may be in writing or verbally indicated. If a verbal request is indicated, the request shall be transcribed in a written format by the Board. The written format for the request shall contain written signatures. • In order to avoid unnecessary state hearings, an individual or authorized representative may use a county conference (Board informal grievance process) to resolve the dispute if they so chose. Utilization of the county conference does not disqualify the individual or their representative to pursue the state hearing. • When an individual requests a county conference, the local agency shall convene a conference within five days presided over by the Superintendent or their designee. Both the agency and the individual may bring whoever each reasonably wants to be at the conference. The issue to be decided by the presiding person shall be whether the agency can show, by preponderance of the evidence, that its action or inaction was in accordance with ODJFS rules. If not, the presiding person shall retract the notice of adverse action and/or decide the question of the individual's entitlement to benefits, or arrange to make the determination as quickly as possible. The outcome of the county conference shall be recorded within ten days of the conference. • A state hearing will be held unless resolution is reached at the county conference and the individual withdraws the request for the state hearing in writing. Any such withdraw shall be signed and dated by both the individual and the local habilitation center representative shall clearly set forth resolution upon which the withdraw is based and shall be forwarded to the district hearings section within two working days. One copy shall be forwarded to the individual and one copy will be retained in the case file. • The individual or authorized representative has ninety calendar days from the mailing or delivery of the notice (form) in which to file an appeal. No reduction or termination of service shall occur without giving notice to the individual or representative not less than fifteen days prior to the effective date of the proposed action. Services shall continue if an appeal is received within fifteen days. If there is no appeal, services will be terminated and payment will stop. Services will not be reinstated if the appeal is received within ninety days, but after fifteen days, unless there is a good cause for failing to request a hearing within the fifteen-day period. L. If the individual or the authorized representative fails to request the hearing within the fifteen day prior notice period, but requests a hearing within ten days following the effective date of the proposed action AND has good cause for failing to request the hearing within the prior notice period, services shall be reinstated to the previous level and continued until the hearing is decided. 1. Determination of "good cause" is the responsibility of the ODJFS hearing authority, which is the hearing supervisor in the ODJFS district office with jurisdiction over the county in which the individual lives. 2. If good cause is found, the hearing authority will issue an order that services be reinstated. 3. It is the responsibility of the Department to assure that the service is reinstated and continued until the hearing decision is made. Service invoice should be submitted by the Board to the Office of Medicaid Payment and Support to recover costs related to the provision of reinstated services. 4. If there is no appeal, services will be terminated and payment will stop. M. A request for a state hearing on disagreements with the decisions of the Board shall be made to the Ohio Department of Job and Family Service in accordance with the Rules for Appeals promulgated by ODJFS under OAC 5101:6-1 to 5101:6-9. If a state hearing appeal is initiated, the following will occur: • Both the individual and the agency have the right to be represented by legal counsel at the state hearing. The Board shall provide the individual with information related to free legal services in the community. The Board may provide legal services through a social services contract. • The individual and authorized representative shall be provided reasonable time before the date of the hearing, as well as during the hearing to examine the contents of case files, as well as other records and documents to be used by the Board at the hearing except for confidential information protected from release. • If the individual or authorized representative requests case record documents that are relevant to the issue under appeal, the Board shall provide one copy of such documents at no cost. The authorized representative must provide the individuals signed authorization prior to obtaining a copy of case record material. Current program manuals shall be made available to the individual or authorized representative for review at the local Board. • The Board failure to provide or allow access to the above information shall not be the basis for postponing or continuing the hearing. • Confidential material protected from release, and other documents or records that the individual will not have an opportunity to contest or challenge, shall not be presented at the hearing nor affect the hearing officer's decision. • When the hearing involves work registration or employment and training, the individual shall also be allowed to examine employment and training component case files, except for confidential information (which may include test results) that the Board determines should be protected from release. • The Department's Community Medicaid Services unit is responsible for coordinating all aspects of the hearing process for CAFS eligible individuals. Incases where the Board decision is being appealed, the Board shall be responsible for preparing the ODJFS 4067 form and defending the decision in the hearing. A copy of the summary shall be kept on file at the Board for its defense at the requested hearing. • The appeals summary form 4067 is forwarded to the Department before the scheduled hearing date. • The actual hearing is usually held via telephone conference call. • The designated representative or individual is generally present with the hearing officer and the other relevant parties participate in the conference call. • The individual's representative will present the basis of the appeal during the hearing and the Board will present its justification or defense of the adverse action. • The hearing decision is typically not made during the hearing. The decision is made known in a written document to all relevant parties at a later date. • Individuals may use the Board's informal grievance and administrative resolution of complaints process unrelated to denial, termination, and reduction of service. VIII. RESOLVING COMPLAINTS RELATED TO DELEGATED NURSING A. The Ohio Board of Nursing (OBN) and/or the Department shall accept complaints regarding alleged violation of ORC 4723:21-01 through 4723:21-28 and/or OAC 5123:2-1-07. B. Investigations resulting from complaints related to Board workers performance of delegated nursing tasks, inclusive of qualifications of board workers to give and/or apply prescribed medications, shall be conducted by the Department utilizing the complaint resolution process as outlined OAC 5123:2-17-01. Department investigations may be conducted in conjunction with the OBN. C. Complaints related to delegated nursing practices shall be refereed to the OBN. The procedures outlined in OAC 4723:21-28 shall be used by ODN to investigate allegations. A report of the findings of the OBN Investigation shall be submitted to the Department Director. The Department Director shall notify the Superintendent of the Board in writing of the outcome of the investigation. D. If a complaint alleges circumstances, which would jeopardize health, safety or welfare of the individual, an investigation shall commence immediately. If the complaint does not allege circumstance, which would pose imminent harm to the health, safety or welfare of the individual, the investigation shall proceed within seven working days. E. Any complaints related to the scope of nursing practices shall be referred to the OBN, which regulated nursing practices in accordance to ORC 4723. IX. RESOLVING COMPLAINTS RELATED TO EARLY INTERVENTION SERVICES A. Families have a right to a state hearing with the Ohio Department of Health to resolve complaints pertaining to Early Intervention Services provided by the Board. Upon receipt of a complaint the Board shall make families aware of their right to at state hearing. Families may file a complaint when they disagree with any of the following: • Eligibility determination for services; • An evaluation or assessment for their child; • Provision of services provided in the Early Intervention program; • Payment for Early Intervention Services. B. Families may also utilize the board informal grievance and administrative resolution of complaints processes contained in this policy if they so choose. X. RESOLVING COMPLAINTS RELATED TO PRE-SCHOOL/SCHOOL AGE SERVICES Individuals receiving pre-school services shall utilize the rules governing the Local Education Agency (LEA) Contained in IDEA and rules promulgated by the Ohio Department of Education to resolve disputes and complaints. XI. RESOLVING COMPLAINTS RELATED TO SUPPORTED LIVING SERVICES A. Individuals, guardians, complainants receiving or providing supported living services under contracts with the Board or MEORC shall utilize grievance procedures contained in the contract for resolving disputes. Use of these procedures shall be specific to complaints related to the contracts for supported living services and supports. B. In the case of disputes related to the termination, reduction, or change of supported living services or supports an individual shall utilize the Board due processes contained in this policy. The individual or authorized representative has ninety calendar days from the notice in which to file an appeal. No reduction or termination of service shall occur without giving notice to the individual or representative not less than fifteen days prior to the effective date of the proposed action. Services shall continue if an appeal is received within fifteen days. If there is no appeal, services will be terminated and payment will stop. Services will not be reinstated if the appeal is received within ninety days, but after fifteen days, unless there is a good cause for failing to request a hearing within the fifteen-day period. C. Services shall continue to be provided pending the final resolution of complaint, unless an entity under contract with a county board for the provision of supported living terminates the services it is providing that individual in accordance with the terms of the contract with the county board. XII. CONFIDENTIALITY The Board shall at all times maintain confidentiality concerning the identities of individuals, families, guardians, complainants, witnesses or other involved parties who provide information unless an authorized release of information is obtained. XIII. UPDATING AND DEVELOPING POLICIES SPECIFIC TO DUE PROCESS A. The Board shall annually review policies of the Board to ensure they are current and reflect current practice. B. 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: Confidentiality of Individual Records and Protected Health Information Policy • SUBJECT: Confidentiality of Individual Records and Protected Information (PHI).II. PURPOSE: To establish the Board's policy for safeguarding confidentiality of information and individual records and PHI. III. POLICY: The Board hereby establishes a policy to safeguard each individual's right to confidentiality in the receipt of services and supports from the Board and to ensure a system exists for maintaining and protecting the confidentiality of individual records and their use applicable with all State and Federal guidelines and rules. A. The Board shall conform to all requirements for privacy and confidentiality set forth in Health Insurance Portability and Accountability Act (HIPAA) and other applicable law. The Board shall not use or disclose PHI except in accordance with applicable requirements. B. This policy shall apply whether the Board is acting as a covered health care provider or a Health Plan under HIPAA. If the Board is acting in more than one capacity, the Board shall be subject to the requirements applicable to that function and shall use or disclose PHI only for purposes related to the function being performed. IV. APPLICATION OF CONFIDENTIALITY POLICY: All information contained in an individual's records, including information contained in any automated data bank, shall be considered confidential. V. PHILOSOPHY AND USE OF CONFIDENTIAL INFORMATION: Confidentiality is the basis for all personal relationships. It involves intimacy, trust and confidence and is the key to developing successful service and/or support delivery relationships with individuals. VI. PROCEDURES TO IMPLEMENT THIS POLICY: The Board authorizes the superintendent to develop and implement written procedures consistent with Board policy and applicable rules, regulations and statutes that apply to all employees, volunteers/interns and contracted service and support providers to be implemented to ensure a system exists for maintaining confidentiality of individual records and PHI. A. Policies/procedures concerning confidentiality will be made known to all Board employees, individuals of services and supports and/or the parent of a minor, or guardian of an adult, and contract service and support providers as applicable. B. Policies and procedures specific to confidentiality shall be reviewed annually and revised as necessary to ensure systems of ensuring confidentiality are adequate for protecting individual's rights. Coshocton County Board of Policy Reference: Confidentiality of Individual Records and Protected Health Information Procedures I. Application of Confidentiality Policy A. All information contained in an individual's records, including information contained in any automated data bank, shall be considered confidential. B. Confidentiality policies and procedures shall apply to all individual records. II. Development of Procedures and Disclosure to Stakeholders A. The Board shall authorize the superintendent to develop procedures specific to confidentiality that apply to all employees, volunteers/interns and contracted service and support providers. B. Policies and procedures concerning confidentiality will be made known to all Board employees, individuals of services and supports and/or the parent of a minor, or guardian of an adult, and, as applicable, contract service and support providers. III. Definitions A. "Board" means the Coshocton County Board of Mental Retardation and Developmental Disabilities. B. "Directory Information" includes the following information relating to an individual: 1. Name, address, telephone number, date and place of service, participation in officially recognized activities, services and supports. C. "Disclosure" means permitting access or the release, transfer, or other communication of records of the individual or the personally identifiable information contained therein, orally or in writing, or by electronic means, or by any other means to a party. D. "Individual" means an eligible person receiving services and supports from the Board or a contracted entity or person under the Board's authority. E. "Parent" means either parent. If the parents are separated or divorced, "parent" means the parents as legally determined. At age eighteen the individual must act on his or her behalf, unless he/she has a court-appointed guardian. This term does not include the State, if a child is a ward of the state. F. "Personally Identifiable Data" includes: 1. Name of the individual and the individual's family members. 2. The address of the individual. 3. A personal identifier, such as the individual's date of birth, Social Security number or Medicaid and/or Medicare number. 4. A list of personal characteristics or other information that use first and last name would make it possible to identify the individual with reasonable certainty. G. "Records" mean those records that are directly related to an individual's service(s) and support(s) and are maintained by the Board or by a party acting for the Board. Record means any information or data recorded in any medium, including, but not limited to: Photographs, handwriting, prints, tapes, film, microfilm, microfiche and automated data bank. H. "Record destruction" means the physical destruction of a record or removal of personal identifiers from information so that the information is no longer personally identifiable. IV. Access Rights A. Reports made under Section 5123.61 of the Revised Code and section 5123:2-17-02 of the Administrative Code specific to Major Unusual Incidents are not public records as defined in Section 149.43 of the Revised Code. B. The individual parent or guardian has the right to inspect and review any Board record related to his or her minor son or daughter. C. If the Board's records include information on more than one individual, the guardian or individual shall have the right to inspect and review only the information relating to them or be informed of that specific information. D. An individual of legal age eighteen with no court-appointed legal guardian has the right to act in his/her own behalf in all matters related to confidentiality and records access, consent, maintenance, destruction, and dissemination. Throughout the remainder of this procedure, "individual" refers to the individual, himself/herself, when acting in his/her own behalf or to the parent as defined in Section III-E under definitions. E. The Board shall comply with the individuals' requests for access and/or copies of confidential materials without unnecessary delay. Typical response time for request for access to confidential material shall not exceed ten working days unless specific deadlines accompany the request for access or copies. Requests occurring prior to a planning meeting or hearing related to identification, evaluation, or placement of an individual shall have immediate response. F. The Board may charge a fee, of 10¢ per copy, for copies of records, which are for the individual under this procedure, if the fee does not effectively prevent the individual from exercising the right to inspect those records. V. Types of Records and Locations A. Every individual receiving services and or supports shall have access to the records maintained by the Board. All information shall be treated as confidential and shall be directly accessible only to the Board professional staff pursuant to these policies and procedures. B. An individual's record is removed from the Board's jurisdiction and safekeeping only in accordance with a court order, subpoena, or statute. Individual's records shall not be removed from the Board's jurisdiction for any other reason. C. The Board shall develop a list at each service delivery site of the types and locations of records collected, maintained, or used, and shall provide this list to individuals on request. D. The types of records maintained by the Board may include, but not limited to: • MUI Reports are kept at the MEORC/MUI Office in Byesville , Ohio and the Board. • Residential Waiver and Supported Living official files with current individual service plans, level of cares, PAWS, quality assurance reports, and service coordination notes are kept at the MEORC office located at the Board offices in Mt. Vernon . • Residential Waiver and Supported Living unofficial files with current individual service plans, level of cares, PAWS, quality assurance reports, and service coordination notes are kept in the Case Management offices of the Board. • Case Management records, TCM, and MUI Reports and Incident Reports specific to individual are kept in the Case Management offices of the Board. • Adult services official files with copies of birth certificates, social security cards, social summaries, psychological, Fed. Forms, individual plans and 90-day reviews, and incident reports are kept in the office of Hopewell Industries. • Emergency care cards for individuals are kept in the applicable service setting office and on each vehicle in case there was an accident involving one of the individuals. • Payroll records for the adults enrolled in the Hopewell Industries are kept in the payroll office in the Hopewell Industries building. • Nursing records and chart with an individual's medical and inoculation records are kept in the clinic of the applicable service setting of the Board. • Student, Preschool and Early Intervention files containing their IEP/IFSP, Multi-factor Evaluations, Birth Certificate, Social Security Care, custody and guardianship records and incident reports are kept at Hopewell School . • Family Resource Services (FRS) files are kept for those individuals who are eligible for FRS containing information about family income and other eligibility requirements. These files are kept in the Administration Offices of the Coshocton County Board of MR/DD. • Archived records are maintained at the Administration Offices of the Coshocton County Board of MRDD. E. Records shall be kept on file in a secure location to assure permanence of the records for the time during which the services are provided and for transmittal to an alternative program when alternate placement occurs. F. Reports made under Section 5123.61 of the ORC and 5123:2-17-02 of the OAC (major unusual incidents) are not public records as defined in Section 149.43 of the Revised Code and may not be deemed accessible. VI. Requests to Amend an Individual Record A. An individual who believes that information in records collected, maintained, or used under this part is inaccurate or misleading or violates the privacy or other rights of the individual may request the Board to amend the information. B. The Superintendent, or his/her designee, shall hear the request to amend the records in question within thirty days after the Board has received the request. If the decision is made not to amend the information in accordance with the request, the superintendent or designee shall inform the individual of the refusal and advise the individual of the right to a records hearing to challenge information in the records, to ensure that it is not inaccurate, misleading, or otherwise in violation of the privacy or other rights of the individual. C. A records hearing shall be set up at the individual's request and will adhere to the following: 1. The records hearing shall be held within thirty (30) calendar days after the Board has received the request, and the individual shall be given written notice of the date and time of the hearing at least ten working days in advance. 2. The records hearing will be conducted by a subcommittee appointed from members of the County Board . 3. The individual shall be afforded a full and fair opportunity to present evidence relevant to the issues and may be assisted or represented by individuals of his or her choice, at his/her expense, including an attorney. The party conducting the hearing shall make his/her decision in writing to the Board within ten (10) working days after the conclusion of the hearing. The decision shall be based solely upon the evidence presented at the hearing and shall include a summary of evidence and the reasons for the decision. VII. Results of Records Hearing A. If, as a result of the records hearing, it is decided that the information is inaccurate, misleading, or otherwise in violation of the privacy or other rights of the individual, the Board shall direct that an amendment be made to the information accordingly, and so inform the individual in writing. B. If, as a result of the records hearing, it is decided that this information is not inaccurate, misleading, or otherwise in violation of the privacy or other rights of the individual, the Board shall inform the individual of the right to place in the records maintained by the Board a statement commenting on the information or setting forth any reasons for disagreeing with the decision of the Board. C. Any explanation placed in the records of the individual under this procedure shall be maintained by the Board as part of the records of the individual, as long as the record or contested portion is maintained. If the records of the individual or the contested portion are disclosed to any party, the explanation must be disclosed to the party. VIII. Safeguards for Maintaining Confidentially of Individual Records A. The safekeeping of records and securing them against loss or use by unauthorized persons is the responsibility of the designated Director. The designated Director shall be responsible for all records under their assigned area of responsibility. It is the responsibility of the MEORC Waiver and Supported Living Project Director for the safekeeping of official files for residential records. It is the MEORC MUI Council Director's responsibility to maintain confidentiality of applicable records. B. Each employee of the Board shall act responsibly in the provision of service delivery to ensure the confidentiality of information of each individual receiving supports. C. Board personnel collecting, maintaining using, or otherwise having access to personally identifiable data shall be informed of the confidentiality policies and procedures of the Board and are responsible for implementing them. D. The Board shall maintain, for public inspection, a current listing of names and positions of those employees who have access to the personally identifiable data. The listing shall be posted near the area where the records are maintained. E. If the Board records include information on more than one individual, the individual shall have the right to inspect only the information related to them. IX. Disclosure of Confidential Information: Requiring Written Consent and Recording Procedures A. The Board shall implement procedures to obtain written consent of an individual or legal guardian before disclosing personally identifiable information and other information not otherwise authorized from the records of an individual. The written consent (ADM-01) required by this paragraph shall comply with all state and federal regulations, be signed and dated by the individual or their legal guardian giving the consent, and shall include: 1. A specification of the records to be disclosed; 2. The purpose of the disclosure; 3. The party or class of parties to whom the disclosure may be made; 4. A specific date upon which the authorization will expire; and c onsent will be valid for one year unless the authorizing individual requests that consent be revoked, which can occur at any time. 5. A statement that authorization can be revoked prior to the disclosure. B. When a disclosure is made pursuant to this procedure, the Board shall, upon request of the individual, provide a copy of the records that are disclosed to the individual or their guardian. C. Disclosure of information also includes verbal sharing (meeting, telephone conversations, etc.) which requires written individual consent, as outlined above. Record of such disclosures shall be documented. D. Information and/or documents disclosed may be via fax, mailed or certified mail. Mode of transmittal will be depending on the nature of the request. E. A release shall not exceed a time period of one year. F. Directory information will not be disclosed by the Board without the written consent of the individual. G. A record of all disclosures of information that includes the information disclosed, to whom it was disclosed, the reason and the date of the disclosure shall be maintained in the individual's record. These recording procedures shall be used for all disclosures of confidential information. X. Disclosure of Information: Written Consent Not Required and Recording Procedures A. Confidential information from the records of an individual may be disclosed without consent of the individual, if the disclosure is: 1. To other staff within the Board who have been determined by the designated program director of the board to have a legitimate interest in providing services and supports. 2. To Federal and State officials, in connection with the audit or evaluation of federally support programs or in connection with the enforcement of or compliance with the legal requirements that relate to these programs. 3. To officials or another agency who are providing, or intend to provide services to individuals under contract with the County Board . B. The Board shall keep a record (Confidentiality Record Form) of parties obtaining or given access to records collected, maintained, or used. Record of access/disclosure shall be kept on parties reviewing the files and of parties to whom information is sent, including: 1. Name of the party 2. Date access was given 3. Purpose for which the party is authorized to use the data. These recording procedures shall be used for all disclosures of information without consent. XI. Dissemination of Confidentiality Policy and Procedures A. The Board shall disseminate this confidentiality policy and procedures to all parents/legal guardians or individuals including the following information, upon request, regarding records: 1. The type of information and records that are maintained on individuals; 2. The name and position of the person responsible for maintaining individual records; 3. The name of persons with access to individual records and the purpose for which they have access; 4. The County Board's policies and procedures regarding review and destruction of information; 5. The categories of directory information; 6. All other rights and requirements of guardian/individual, including the Administrative Resolution of Complaints and Due Process Policies and Procedures. B. Methods of dissemination may include, but not be limited to, the following: 1. Through ISP, IEP, IP, IFSP meetings; 2. During the eligibility and intake process; 3. Upon request of the individual. XII. Destruction of Information A. The Board shall inform an individual in writing (ADM - 26) when personally identifiable information collected, maintained, or used is no longer needed to provide services to the individual. Such information includes, but not limited to, case notes and other documentation which shall be retained in accordance with all applicable laws and rules to ensure Medicaid related material and investigation information is maintained for a period of seven years from the date of receipt of payment for services or six years after an initial audit is completed or adjudicated, whichever is longer. After this time, if no further service has been provided or requested, the records may be destroyed. Written permission of the individual shall be obtained prior to the destruction of record information. B. Destruction of information notices shall afford the individual the opportunity to obtain a copy of any such records identified by the Board prior to destruction. The personally identifiable information of an individual may be retained permanently, unless the individual requests that it be destroyed. Individuals should be reminded that the records may be needed by the individual for Social Security benefits or other purposes. C. The information shall be destroyed at the request of the individual in writing after thirty (30) days of receipt of such a request by the individual. Medicaid related record information/fiscal data shall be maintained for a period of seven years from the date of receipt of payment or for six years after an initiated audit is completed and adjudicated, whichever is longer. However, permanent records of an individual's name, address, phone number, service(s) and support(s) provided may be maintained without time limitation. XIII. Policy and Procedure Review and Update The Board shall review, not less than once a year, the systems and safeguards employed by the Board and staff to preserve confidentiality of information. This review shall be used to maintain the confidential nature of the information. Forms used with this procedure: Confidentiality of Record Forms HS-04 CM-05 AS-02 RES-03 NUR-34
File Sign-out Forms RES-01 CM-06 NUR-11 HS-14 AS-03
ADM-01 Release of Information HS-01 Child Release Authorization HS-02 Photo Release AS-05 Photo Release ADM-26 Destruction of Data - Hopewell School ADM-27 Destruction of Data - Hopewell Industries
Authorized Personnel List Case Management Residential Hopewell School Nursing Adult Services Archived Coshocton County Board of Policy: Service and Support Administration Procedures • Eligibility for Service and Support Administration (SSA) • The Coshocton County Board of MRDD shall provide service and support administration to the following: a. Each individual, regardless of age, who is applying for or enrolled in a HCBS waiver; b. Each individual three years of age or older who is eligible for county board services, and requests or a person on the individual's behalf requests pursuant to paragraph (B) of the policy, service and support administration; c. An individual residing in an ICFMR is eligible for service and support administration related to moving the individual from the ICF/MR to a non-ICF/MR community setting. • The Coshocton County Board of MRDD shall provide service and support administration in accordance with the requirements of section 5126.15 of the Revised Code. • Only a service and support administration supervisor, a service and support administrator, or a conditional status service and support administrator who holds the appropriate certification in accordance with rule 5123:2-5-02 of the Administrative Code may provide service and support administration. • Any person who is employed to assist a service and support administration supervisor, a service and support administrator, or a conditional status service and support administrator in the performance of their duties shall have a registered service level service and support administration registration in accordance with 5123:2-5-02 of the Administrative Code • Persons employed or under subcontract as service and support administrators shall not be in the same collective bargaining unit as employees who perform duties that are not administrative. • The County Board shall provide adequate supervision to persons employed to perform the functions of SSA. A conditional status SSA shall perform duties of SSA only under the supervision of a management employee who is a SSA supervisor or a professional employee who is a SSA. • Persons employed or under subcontract as SSA's shall not be assigned responsibilities for implementing other services for individuals and shall not be employed by or serve in a decision-making or policy-making capacity for any other entity that provides programs or services to individuals. C. Notwithstanding the requirements of paragraph (B), persons employed or under subcontract with a county board who meet the requirements established by the Ohio department of health for service coordinators in the HMG system may provide SSA in accordance with the service coordination requirements of 34 C.F.R. 303.23 to an individual under three years of age for early intervention services. • Single Point of Accountability: • The County Board shall identify a SSA for each individual receiving SSA who shall be the single point of accountability for the individual and who shall perform the following duties: • Assess the individual's need for services in accordance with paragraph (F), b. Develop and revise the individual's ISP in accordance with paragraph (G), c. Establish the individual's budget for services in accordance with paragraph (H), • Assist the individual in choosing providers in accordance with paragraph (I) • Ensure that the individual's services are effectively coordinated and provided by appropriate providers in accordance with paragraph (J), • Monitor the implementation of the individual's ISP in accordance with paragraph (K), • Ensure that the individual has a designated person to provide daily representation in accordance with paragraph (L). • The single point of accountability may perform the duties set forth in paragraph (D)(1) of this rule with the assistance of appropriate others on the individual's team. In order to receive such assistance, the single point of accountability shall: a. Maintain the responsibility to ensure that activities performed on behalf of the individual are completed in accordance with the ISP and to the benefit and satisfaction of the individual, b. Ensure that the person providing assistance has a clear understanding of the expectations and desired outcomes of the task (s), c. Maintain contact with the person providing assistance as frequently as necessary to monitor the completion of the assigned task (s), • Retain responsibility for all decision-making regarding SSA functions and the communication of any such assistance. • A person who provides assistance pursuant to paragraph (D)(2) of this rule is not required to have a registered service level of SSA registration in accordance with rule 5123:2-5-02 of the Administrative Code unless the person is employed to provide such assistance. • The County Board may assign the responsibility for eligibility determinations and quality assurance reviews to a person(s) employed by or under subcontract with the county board to provide SSA who does not perform other SSA duties. In such a case, the results and information from eligibility determinations and quality assurance reviews shall be shared in a timely manner with the individual, the individual's guardian, the person designated under paragraph (M) to provide daily representation, and the SSA who is the single point of accountability for the individual in order to facilitate the coordination of services and supports. E. Eligibility Determinations The SSA shall establish an individual's eligibility for the services of the county board. The person performing this duty for an individual shall: • Establish the individual's eligibility for the services provided or administered by the county board in accordance with the rules adopted by the department. Therefore the following procedure shall be implemented when someone desires services from the county board: a. SS Secretary will take referral (or person receiving referral will give or e-mail referral to SS Secretary) b. The SS secretary will send a letter to the individual requesting the following information be sent: i. History and Physical (w/in 6 months) ii. Medicaid card (copy) • Guardianship papers (if applicable) • Certificate of Birth (copy) • Social Security card (copy) • IEP (for school age) • ETR/MFE • Assessments - optional (Psychological) c. The return information along with the original referral will be given to the SS Director. d. The SS Director will schedule and then conduct the OEDI/COEDI (within 45 days of referral) and determine the individual's eligibility. The FED will be completed and the eligibility or ineligibility determination letter will be provided to the Superintendent for signature. • Referred individual will receive a letter notifying of the results of the OEDI/COEDI. • The SS secretary will update Gatekeeper and complete the IIF form for those found eligible for services. • SS Secretary will forward IIF Form to Medicaid Compliance Officer who will update IIF on-line information. • SSC will be notified of new individual and begin initial ISP process for services to begin within 60 days of eligibility date. • Explain to the individual, in conjunction with the process of recommending eligibility determination and/or assisting in making application for enrollment in an HCBS waiver or any other Medicaid service, and in accordance with rules adopted by the department, the following; • Alternative services available to the individual, • Due process and appeal rights, • Right to choose any qualified and willing provider • At the time the individual is being recommended for enrollment in the HCBS waiver, a. Explain to the individual; i. Choice of waiver enrollment as an alternative to ICF/MR placement; ii. Feasible alternatives available upon enrollment in a HCBS waiver, and b. Make a recommendation to ODJFS or its designee, in accordance with rule 5101:3-3-15.3 of the Administrative Code, as to whether the individual meets the criteria for an ICFMR level of care in accordance with rule 5101:3-3-07 of the Administrative Code. • Assessments The SSA shall assess individual needs for services. The SSA who is the single point of accountability for an individual shall perform this duty and shall: 1. After the initial request for services and at least annually thereafter, complete or coordinate and ensure the completion of assessments. The assessment process shall include all types of assessments based upon input obtained from the individual, the individual's guardian, the person designated under paragraph (M) to provide daily representation, and the individual's team. • The information obtained shall include the individual's likes, dislikes, priorities, and desired outcomes, as well as what is important to and for the individual, including skill development, health, safety, and welfare needs, as applicable. • The completion of assessments and evaluations by licensed or certified professionals is not required annually, but shall be done at a time dictated by the needs of the individual. • Recommend to the department and ODJFS, the continued need for an ICFMR level of care for an individual enrolled in an HCBS waiver for the annual redetermination in accordance with rule 5101:3-3-15.5 of the Administrative Code. • ISP Development The SSA shall develop ISP's. If an ISP includes HCBS waiver services or Medicaid case management services, those services shall be subject to approval by the department and ODJFS. If either department approves, reduces, denies, or terminates HCBS waiver services or Medicaid case management services included in an ISP, the SSA who is the single point of accountability for the individual shall communicate with the individual to ensure compliance with paragraphs (G)(3) and (P). That person shall also; • Ensure that the development or revision of the ISP. a. Occurs with active participation of the individual served and other persons selected by the individual, and, when applicable, the provider(s) selected by the individual, b. Addresses the results of the assessment process pursuant to paragraph (F) and monitoring conducted pursuant to paragraph (K), • Focuses on the individual's strengths, interests and talents, • Integrates all sources of supports, including alternative services, available to meet the needs and desired outcomes of the individual, • Occurs in accordance with rules adopted by the department. • The following procedure shall be followed for all initial or redeterminations of the persons ISP: i. Assessment meeting is held with all stakeholders in the person's life. Goals for residential and day habilitation are developed. All providers (independent and agency) need to come to the assessment meeting with proposed goals. ii. ISP is written by SSC based upon findings from assessment. • The proposed ISP is given to SSA Director. Prior to scheduled ISP meeting, SSA Director will review, correct, and return to SSC with signed CB approval. • No less than 14 calendar days from the scheduled ISP meeting, the ISP is mailed to EVERY team member, guardian/individual. • The following instructions are attached to every ISP for team members to do the following: • Review the ISP for accuracy. • Write on the document any changes that need to be made. • All team members bring the ISP to the scheduled ISP meeting ready to discuss their issues with the document. • Come to the table ready to discuss options for best possible service for the focus person. • The SSC comes to scheduled ISP meeting with a pre-printed sign-off page and the pre-approved ISP signed off by the SSA Director. • At ISP meeting, SSC makes all changes that were brought to the team and were agreed upon on their laptops. • After all areas have been discussed and approved by guardian, and/or individual, and the team, ISP is printed off on premises, signature sheet is signed by all team members. ISP is copied and everyone is given a copy before the meeting concludes. IF the document is unable to be printed, then the document will be e-mailed to all team members by the end of business the same day as the meeting. • By Friday of the same week ISP meeting was conducted, SSC will send ISP to MEORC for QA • Upon notification from the MEORC QAS that the QA is complete; the specific pages where wording changes occurred will be mailed to the team members by Friday of that week the QA was completed. • Certify by signature and date that an ISP meets the following criteria for approval. This approval shall occur prior to implementation, a. All ISP's shall; i. Assist the individual to engage in meaningful, productive activities and develop community connections; and ii. Indicate the provider, the frequency, and the funding source for each service and activity; and iii. Specify which services will be coordinated among which providers and across all appropriate settings for the individual. b. An ISP that includes HCBS waiver services shall; i. Meet the requirements of paragraph (G)(2)(a), ii. Indicate the provider type; and iii. With respect to that portion of the ISP that pertains to HCBS waiver services, meet the requirements of paragraph (C)(2) of rule 5123:2-9-04 of the Administrative Code. • Review and revise the ISP as appropriate under any of the following circumstances; a. At the request of the individual or a member of the individual's team, b. Whenever the individual's assessed needs, circumstances or status changes, c. As a result of ongoing monitoring of ISP implementation, quality assurance reviews, and/or identified trends and patterns of unusual incidents or major unusual incidents, or d. With respect to HCBS waiver services and Medicaid case management services, if a service is reduced, denied, or terminated by the department or ODJFS. • Provide a complete copy of the ISP to the individual or his or her guardian and a copy of relevant sections of the ISP to the individual's providers. • Provide an individual with written notification and explanation of the individual's right to a Medicaid fair hearing if the ISP process results in a recommendation for the approval, reduction, or denial, or termination of an HCBS waiver service or Medicaid case management service. Notice shall be provided in accordance with section 5101.35 of the Revised Code. • Provide an individual with written notification and explanation of the individual's right to use the administrative resolution of complaint process if the ISP process results in the reduction, denial, or termination of a service other than an HCBS waiver service or Medicaid case management serviced. Such written notice and explanation shall also be provided to an individual if the ISP process results in an approved service that the individual does not want to receive, but is necessary to ensure the individual's health, safety, and welfare. Notice shall be provided in accordance with 5123: 2-1-12 of the Administrative Code. • Budget for Services The SSA shall establish budgets for services. The SSA who is the single point of accountability for the individual shall establish a recommendation for and obtain approval of budgets for services based on the ISP for the individual and the individual's assessed needs and preferred ways of meeting those needs. Funding of services for individuals enrolled in a HCBS waiver shall be subject to rule 5123: 2-9-06 for the Administrative Code. • Provider Selection The SSA shall through objective facilitation assist individuals in choosing providers. The SSA who is the single point of accountability for an individual shall perform this duty and shall: • Ensure that individuals are given the opportunity to select service providers from willing and qualified providers in accordance with applicable state and federal laws and regulations. The following procedure shall be implemented in assisting individuals with free choice of provider: a. A "private meeting" will be scheduled with the individual, guardian, and/or personal advocate. This meeting is for the purpose to discuss provider selection for the services they are requesting or are currently receiving. • No less than 14 days prior to scheduled "private meeting" to discuss FCOP, SSC mail's all brochures currently on file to guardian/individual. NOTE: This is regardless whether the guardian/individual desires to change providers or not. c.. At the private meeting the SSC will ask the guardian/individual if they had any questions about the material. If no, then the SSC will follow the established FCOP procedure (ODMRDD Appendix A Process) . If yes, the SSC will answer any questions the guardian/individual has and obtain additional info for the guardian/individual as requested as well as follow the established FCOP procedure (ODMRDD Appendix A Process) . d. The following statement shall be placed in all ISP's for individuals who are receiving an HCBS service: • Individuals have the right to choose any qualified provider of home and community based services. • Individuals, their designee and/or appointed guardian shall be responsible for making all decisions regarding free choice of provider. • The individual has the right to choose any qualified provider from those available statewide and is not limited to those who provide services in only Coshocton County . The state website is http://odmrdd.state.oh.us • Service and Support Coordinators (SSC) in Coshocton County shall follow the provider choice process for each service specified in the ISP. This process will take place for new home and community based services, annually at the time of redetermination or at any time that the individual/guardian expresses an interest or makes a request to choose a new, different or additional provider. • The SSC will support individuals by following and documenting all processes in Rule 5123: 2-9-11 Home and Community Based Service Waivers - Free Choice of Provider. A copy of the documentation will be kept in the individual's service record on file with the Coshocton County Board of MRDD. 2. Assist individuals, as necessary, to work with their provider(s) to resolve concerns involving the direct support staff assigned to work with them. J. Coordinating Services The SSA shall ensure that services are effectively coordinated and provided by providers, as identified in the ISP, by facilitating communication with the individual and among providers across all settings and systems. The person who is the single point of accountability for an individual shall perform this duty and shall directly communicate with all providers of residential and day program services through their employees who are designated as responsible for habilitation management and program management and to the designated staff of all other providers including, but not limited to, transportation service providers. Relevant sections of the ISP shall be shared with providers. Such communication, as applicable, shall include, but not be limited to, the following; 1. ISP revisions, 2. Relocation plans of the individual, including information necessary to determine the health, safety, and welfare factors of the proposed living situation, • Hospitalizations, incarcerations, or other changes in individual status that result in suspension or dis-enrollment from services including, but not limited to, services under an HCBS waiver, • Coordination activities to ensure that services are provided to individuals in accordance with their ISPs and desired outcomes, • Results of the monitoring conducted pursuant to paragraph (K). K. Monitoring ISP Implementation The SSA shall establish and implement an ongoing system of monitoring the implementation of an individual's ISP. The SSA who is the single point of accountability for an individual shall perform this duty in accordance with the following requirements; 1. The purpose of the monitoring shall be to verify; a. The health, safety, and welfare of the individual, b. Consistent implementation of services, c. Achievement of the desired outcomes for the individual as stated in the ISP; and d. That services received are those reflected in the ISP. 2. Areas to be monitored, as applicable to each individual, shall include, but not be limited to, the following; a. Behavior support • Emergency Intervention • Identified trends and patterns of unusual incidents and major unusual incidents and the development and implementation of prevention and/or risk management plans, • Results of quality assurance reviews; and • Other individual needs as determined by the assessment process conducted pursuant to paragraph (F). • Quality Assurance Reviews 1. The SSA shall conduct quality assurance reviews. The person performing this duty for an individual shall; a. Conduct quality assurance reviews in accordance with rules adopted by the department. • Conduct quality assurance reviews that result in outcomes at two levels. • Identification of areas of concerns and recommendations necessary to achieve desired outcomes for the individual as stated in the ISP. • Identification of trends and patterns common to a significant number of individuals that indicate possible need for modification of an agency and/or county board system to achieved desired outcomes for individuals. • The person performing this duty shall not conduct quality assurance reviews for an individual for whom he/she is the SSA who is the single point of accountability. 3. If a quality assurance review indicates areas of provider non-compliance with continuing certification standards for provider certified as HCBS waiver providers, the County Board shall conduct provider compliance reviews in accordance with rile 5123:2-9-08 of the Administrative Code. M. Designated Person to Provide Daily Representation 1. Each individual receiving SSA shall have a designated person to provide daily representation who is responsible on a continuing basis for providing the individual with representation, advocacy, advice and assistance related to day-to-day coordination of services in accordance with the ISP. a. The role of the person designated is to assist the individual to keep the service and support delivery system focused on his/her desired outcomes. b. The person designated shall be willing to interact regularly with the individual in order to maintain or develop a relationship that will allow him/her to fulfill this role. c. A designated person who is not legally responsible shall not receive any privileged information without consent of the individual. d. Neither the SSA who is the single point of accountability for the individual nor any other person providing SSA shall be the person designated. • The SSA who is the single point of accountability for an individual shall ensure that the individual has a person designated to provide daily representation and shall: a. Give the individual an opportunity, at least annually, to designate such person. b. Make the designation if the individual declines to do so, taking into consideration the designated person's credibility with the individual, the person's understanding of the individual's desired outcomes, and the person's reliability. If the individual has no such person involved in his/her life, actions shall be specified in the ISP that will lead to the development of a circle of support for the individual. c. Document the person designated, by name, in the individual's ISP. d. Permit an individual to change at any time the person designated to provide daily representation. • Paragraphs (M)(1)(2) of this procedure are not intended to prevent an individual for representing himself or herself or advocating on behalf of himself or herself. N. Emergency Intervention The County Board shall, in coordination with the provision of SSA, make an on-call emergency response system available 24 hours per day, seven days per week. Persons who are available for the on-call emergency response system shall; 1. Provide emergency intervention directly or through immediate linkage with the SSA who is the single point of accountability for the individual or primary provider. • Be trained and have the skills to identify the problem; determine what immediate response is needed to alleviate the emergency and ensure health and safety; and identify and contact the person(s) to take the needed action. • Notify the provider(s) and the SSA(s) who is the single point of accountability for the individual(s) to assure adequate follow-up. The County Board 's investigate agent under section 5126.221 of the Revised Code shall also be notified as determined necessary by the nature of the emergency. • Document the emergency in accordance with the County Board UI process. • Records Records shall be maintained on individuals receiving SSA and shall include, at a minimum, the following; 1. Identifying data, 2. Information identifying guardianship, trusteeship, or protectorship, 3. Date of request for services from the County Board , 4. Evidence of eligibility for County Board services, • Assessment information relevant to the request for services and the planning process for supports and services, • Current ISP, • Current budget for support and services, • Documentation of provider selection process, • Quality assurance review summary reports, • Documentation of unusual incidents, • Major unusual incident investigation summary reports, • The name of the SSA who is the single point of accountability for the individual, • The name of the person designated to provide daily representation, • Emergency information, • Personal financial information, • Release of information and consent forms, • Case notes which include coordination of services and monitoring activities. P. Due Process Due process shall be afforded to each individual receiving SSA pursuant to either 5123:2-1-12 of the Administrative Code for services other than HCBS waiver services and Medicaid case management services or section 5101.35 of the Revised Code of HCBS waiver services and Medicaid case management. • Department Monitoring The Department shall monitor compliance with the SSA rule by County Boards and their subcontract agencies in accordance with sections 5123.044 and 5126.055 of the Revised Code. R. ODJFS Monitoring of Medicaid Case Management Services For all Medicaid eligible recipients, ODJFS retains final authority to monitor the provision of Medicaid case management services in accordance with rule 5101:3- 48-01 of the Administrative Code. APPENDIX A Process to Assure Free Choice of Provider • An individual receiving I/O or Level 1 Waiver services from the Coshocton County Board of Mental Retardation and Developmental Disabilities (CCBMR/DD) shall have free choice of provider. To assure that an individual exercises this right, this process shall be utilized by the CCBMR/DD Service and Supports Coordinator (SSC). • The standards for the selection of a provider shall include, but not be limited to the following: • The choice of the individual/guardian of a provider • The provider's ability to ensure the health and safety of the individual • The budget for supports as determined by the CCBMR/DD and applicable requirements • The ability of the provider to meet applicable compliance and quality assurance standards of regulatory bodies • The certification of the provider to provide supports in accordance with standards established by the Ohio Department of Mental Retardation and Developmental Disabilities (ODMR/DD) and other applicable regulatory bodies • An individual approved for I/O or Level 1 Waiver services will generally require the selection of a provider as follows: • The individual does not have a provider and needs to choose a provider for service • The individual currently receives services from a provider but chooses to select a different provider. • The individual currently receives supports from a provider, but chooses to select an additional provider. • Prior to all aspects of developing the initial and annual ISP the CCBMR/DD staff performing Service and Support Admin istration (SSA) functions for the individual, shall assist the individual/guardian as necessary in selecting a provider of his/her choice. The SSC shall maintain documentation of the completion of this process in the individual's permanent file at the county board office. The SSC shall document the activities performed in the implementation of the provider selection process. The role of the SSC shall be as a facilitator in the provider selection process. The SSC shall adhere to timelines set forth in rule (references above). PROVIDER SELECTION PROCESS:
• The SSC reviews with the individual/guardian the need for an individual provider and/or agency provider to assure the health and safety of the individual. The individual/guardian may also choose any combination of an individual provider and/or agency provider. • SSC shall inform the individual/guardian of qualified providers in the areas of service needed. (handout "List of Providers") The SSC will tell how to find the list of providers on the ODMR/DD website and assist the person if asked. • SSC will have available any applicable Provider information (give any brochures or information provided by qualified providers.) If requested by the individual/guardian, SSC will obtain outcomes of past internal and/or external monitoring reviews of the waiver provider(s). • If the individual/guardian has already selected the provider without the SSC's assistance, the SSC will document the individual's/guardian's selection of provider, proceed with development of the ISP and arrange for commencement of services. • If the individual/guardian does not know which provider to choose, the SSC will follow the procedure outlined in OAC 5123:2-9-11, beginning at section I . (If the individual/guardian selects a provider directly from ODMR/DD's pool, it is recommended that the individual/guardian with the assistance of the SSC, conduct interviews in accordance with the guidelines for interviews of providers referenced in this procedure). • Conflict of interest/Family members as providers/Resolution of complaints • For Medicaid I.O. Waiver Recipients: An immediate family member (spouse or parent) of a minor child (minor child as defined in Ohio 's CMS approved I.O. waiver) is not eligible to provide waiver services to their minor child. • For Level 1 Medicaid Waiver Recipients: An immediate family member (spouse or parent) when the minor child (under the age of 18 years) is the waiver recipient, is not eligible to provide homemaker/personal care services to their minor child. • Any provider who may have a "conflict of interest" as defined by Chapter 102 of the Ohio Revised Code is not eligible to be a residential service provider unless determined otherwise by the CCBMR/DD. All potential "conflicts of interest" shall be submitted to the CCBMR/DD for review and resolution in accordance with Chapter 102 of the ORC. • Resolution of complaints regarding the implementation of these procedures will be addressed as follows: • For providers, including family members who are providers, complaint resolutions shall follow 5126.036 of the ORC and /or 5123: 2-9-04 (H) (3) (a-d). Ohio Admin istrative Code (OAC). • For individuals, complaint resolution shall be as follows; 5101 (6.1-6.9) OAC and/or the informal process of 5123: 2-1-12 of the OAC. F. Emergencies may warrant departure from the provider selection process. An emergency shall be defined as per ORC 5123:711: 1. The CCBMR/DD shall determine an emergency exists in accordance with ORC 5123:711. 2. If the emergency situation allows, the individual shall be afforded a choice of providers in accordance with the CCBMR/DD provider selection procedure. 3. In the event CCBMR/DD provider selection procedure cannot be used due to the nature of the emergency, the CCBMR/DD will assign a provider. Following resolution of the emergency, the individual will be afforded the opportunity to choose a provider in accordance with the provider selection process above. 4. The CCBMR/DD shall inform the provider assigned by the CCBMR/DD during the emergency situation of the temporary nature of the provider's services. Screening Questionnaire Date: _______________ Agency Name: Phone: CEO: Address:
CPR ___yes ___no First Aid ___yes ___no
If yes, please explain;
PROFESSIONAL REFERENCES : Please list three professional references Name: Title: Address: Phone: How long have you known this person? What is your relationship to this person? Name: Title: Address: Phone: How long have you known this person? What is your relationship to this person? Name: Title: Address: Phone: How long have you known this person? What is your relationship to this person? I certify that the information provided in this screening questionnaire is correct and complete to the best of my knowledge. I authorize the Coshocton County Board of Mental Retardation and Developmental Disabilities to contact references listed above, on behalf of the individual seeking services, regarding the agency's experience, qualifications and job performance. ____________________ Signature Date
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