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H. B. No. 405 As IntroducedAs Introduced
127th General Assembly | Regular Session | 2007-2008 |
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Cosponsors:
Representatives Setzer, Zehringer, Hughes, McGregor, J., Wagoner, Fessler, Evans, Boyd
A BILL
To amend sections 5126.042 and 5126.055 of the
Revised Code to
eliminate the requirement that
each county board
of mental retardation and
developmental
disabilities maintain a service
substitution list
and long-term service planning
registry and revise the law governing county
boards' waiting lists.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 5126.042 and 5126.055 of the Revised
Code be
amended to read as follows:
Sec. 5126.042. (A) As used in this section, "emergency:
(1) "Emergency"
means any situation that creates for an
individual with mental
retardation or developmental disabilities
a
risk of
substantial
self-harm or substantial harm to others if
action is not taken
within thirty days. An
"emergency" may
include
one or more of the
following
situations:
(1)(a) Loss of present residence for any reason, including
legal
action;
(2)(b) Loss of present caretaker for any reason, including
serious
illness of the caretaker, change in the caretaker's
status, or inability of
the caretaker to perform effectively for
the individual;
(3)(c) Abuse, neglect, or exploitation of the individual;
(4)(d) Health and safety conditions that pose a serious risk
to
the
individual or others of immediate harm or death;
(5)(e) Change in the emotional or physical condition of the
individual that necessitates substantial accommodation that cannot
be
reasonably provided by the individual's existing caretaker.
(2) "Service substitution list" means a service substitution
list established by a county board of mental retardation and
developmental disabilities before the effective date of this
amendment pursuant to division (B) of this section as this section
existed on the day immediately before the effective date of this
amendment.
(B) If a county board of mental
retardation and
developmental
disabilities determines that
available resources are
not
sufficient to meet the needs of all
individuals who request
programs and services and may be offered
the programs and
services, it shall establish waiting lists for
services. The
board
may establish priorities for making placements on its
waiting
lists according to an individual's emergency
status
and
shall
establish priorities in accordance with divisions
(D) and (E) of
this
section.
The individuals who may be placed on a waiting list include
individuals
with a need for services on an emergency
basis and
individuals who
have requested services for which
resources are
not available.
Except for an individual who is to receive priority for
services pursuant to division (D)(3) of this section, an
individual who currently receives a service but would like
to
change
to another service shall not be placed on a waiting list
but shall be placed
on a service substitution list. The
board
shall work with the individual,
service providers, and all
appropriate entities to facilitate the change in
service as
expeditiously as possible. The board may establish priorities for
making placements on its service substitution lists
according to
an
individual's emergency
status.
In addition to maintaining waiting lists and service
substitution lists,
a board shall maintain a long-term
service
planning registry for individuals
who wish to record their
intention
to request in the future a service they are not
currently receiving. The
purpose of the registry is to enable
the
board to document requests and to plan appropriately. The board
may not
place an individual on the registry who meets the
conditions for receipt of
services on an emergency
basis.
An individual placed on a county board's service substitution
list before the effective date of this amendment for the purpose
of obtaining home and community-based services shall be deemed to
have been placed on the county board's waiting list for home and
community-based services on the date the individual was placed on
the service substitution list.
(C) A county board shall establish a separate waiting list
for each of the following categories of services, and may
establish separate waiting lists within the waiting lists:
(1) Early childhood services;
(2) Educational programs for preschool and school age
children;
(4)
Service and support
administration;
(5) Residential services and supported living;
(6) Transportation services;
(7) Other services determined necessary and appropriate
for
persons with
mental retardation or a developmental disability
according to their
individual habilitation or service plans;
(8) Family support services provided under section 5126.11
of
the Revised
Code.
(D)
Except as provided in division
(G) of this section, a
county board shall do, as priorities, all of the following in
accordance with the
assessment component, approved under section
5123.046 of the Revised Code, of the
county
board's plan
developed
under section
5126.054 of the Revised
Code:
(1) For the purpose of obtaining additional federal
medicaid
funds for home and community-based services and medicaid
case
management services, do
both of
the following:
(a) Give an individual who is eligible for home and
community-based services and meets both of the following
requirements priority over any other individual on a waiting list
established under division (C) of this section for home and
community-based services that include supported living,
residential services, or family support services:
(i) Is twenty-two years of age or older;
(ii) Receives supported living or family support services.
(b) Give an individual who is eligible for home and
community-based services and meets both of the following
requirements priority over any other individual on a waiting list
established under division (C) of this section for home and
community-based services that include adult services:
(i) Resides in the individual's own home or the home of the
individual's family and will continue to reside in that home after
enrollment in home and community-based services;
(ii) Receives adult services from the county board.
(2) As federal medicaid funds become available pursuant to
division (D)(1) of this section,
give an
individual who is
eligible for home and community-based services
and meets any of
the following requirements priority for such services over any
other individual on a waiting list established under division (C)
of this section:
(a) Does not receive residential services or supported
living, either needs services in the individual's current living
arrangement or will need services in a new living arrangement, and
has a primary caregiver who is sixty years of age or older;
(b) Is less than twenty-two years of age and has at least
one
of the following
service needs that are
unusual in scope or
intensity:
(i) Severe behavior problems for
which a behavior support
plan is needed;
(ii) An emotional disorder for which anti-psychotic
medication is needed;
(iii) A medical condition that leaves the individual
dependent on life-support medical technology;
(iv) A condition affecting multiple body systems for which
a
combination of specialized medical, psychological, educational,
or
habilitation services are needed;
(v) A condition the county board determines to be
comparable
in severity to any condition described in divisions
(D)(2)(b)(i)
to
(iv) of this section and places the individual at
significant
risk
of institutionalization.
(c) Is twenty-two years of age or older, does not receive
residential services or supported living, and is determined
by
the
county board to have intensive needs for
home and
community-based
services
on an in-home or out-of-home basis.
(3) In fiscal years 2002 and 2003, give an individual who
is
eligible for home and community-based services, resides in an
intermediate care facility for the
mentally retarded or nursing
facility, chooses to move to
another
setting with the help of
home
and community-based services, and has been determined by the
department of mental retardation and developmental
disabilities to
be capable of residing in
the other setting, priority over any
other individual on a waiting list established under division (C)
of this section for home and community-based services who does not
meet these criteria. The department of mental retardation and
developmental disabilities shall identify the individuals to
receive priority under division (D)(3) of this section, assess the
needs of the individuals, and notify the county boards that are to
provide the individuals priority under division (D)(3) of this
section of the individuals identified by the department and the
individuals' assessed needs.
(E) Except as provided in division (G) of this section and
for a number of years and beginning on a date specified in rules
adopted under division (K) of this section, a county board shall
give an individual who is eligible for home and community-based
services, resides in a nursing facility, and chooses to move to
another setting with the help of home and community-based
services, priority over any other individual on a waiting list
established under division (C) of this section for home and
community-based services who does not meet these criteria.
(F)
If two or more individuals on a waiting list established
under division (C) of this section for home and community-based
services have priority for the services pursuant to division
(D)(1) or (2) or (E) of this section, a county board may use,
until
December 31, 2009, criteria specified in rules adopted
under
division (K)(2) of this section in determining the order in
which
the individuals with priority will be offered the services.
Otherwise, the county board shall offer the home and
community-based services to such individuals in the order they are
placed on the waiting list.
(G)(1) No individual may receive priority for services
pursuant to division (D) or (E) of this section over an individual
placed
on a waiting list established under division (C) of this
section
on an emergency status.
(2) No more than
four hundred individuals in the state
may
receive priority for services during
the
2008 and
2009
biennium
pursuant to division (D)(2)(b) of this
section.
(3) No more than a total of
seventy-five individuals in the
state may
receive priority for
services during state fiscal years
2002 and
2003 pursuant to
division (D)(3) of this section.
(4) No more than forty individuals in the state may receive
priority for services pursuant to division (E) of this section for
each year that priority category is in effect as specified in
rules adopted under division (K) of this section.
(H) Prior to establishing any waiting list under this
section, a county board shall develop and implement a policy for
waiting lists that complies with
this section and rules
adopted
under division (K) of this
section.
Prior to placing an individual on a waiting list, the county
board
shall assess the service needs of the individual in
accordance
with all applicable state and federal laws. The county
board
shall place the individual on the appropriate waiting list
and
may place the individual on more than one waiting list.
The
county board shall notify the individual of the individual's
placement and position on each waiting list on which the
individual is placed.
At least annually, the county board shall reassess the
service needs of each individual on a waiting list. If it
determines that an individual no longer needs a program or
service, the county board shall remove the individual from
the
waiting list. If it determines that an individual needs a program
or
service other than the one for which the individual is on the
waiting list,
the county board shall provide the program or
service to the
individual or place the individual on a waiting
list for the
program or service in accordance with the board's
policy for waiting lists.
When a program or service for which there is a waiting list
becomes available, the county board shall reassess the service
needs of the individual next scheduled on the waiting list to
receive that program or service. If the reassessment
demonstrates
that the individual continues to need the program or
service, the
board shall offer the program or service to the
individual. If it
determines that an individual no longer needs a program or
service, the county board shall remove the individual from the
waiting list.
If it determines that an individual needs a program
or service other than the
one for which the individual is on the
waiting list, the
county board shall provide the program or
service to the
individual or place the individual on a waiting
list for the program or
service in accordance with the board's
policy for waiting lists.
The county board shall notify the
individual of the individual's placement and position on the
waiting list on which the individual is placed.
(I) A child subject to a determination made pursuant to
section
121.38 of the Revised Code who requires the home
and
community-based services provided through a
medicaid component
that the department of
mental retardation and developmental
disabilities administers
under
section 5111.871 of the
Revised
Code shall
receive services through
that
medicaid component. For
all other services, a child subject
to a
determination
made
pursuant to section 121.38 of the Revised Code
shall
be
treated as
an emergency by the county boards and shall
not be
subject to a
waiting list.
(J) Not later than the fifteenth day of
March of each
even-numbered year, each county board
shall prepare and submit to
the director of mental
retardation and developmental disabilities
its recommendations for the funding
of services for individuals
with mental retardation and developmental
disabilities and its
proposals for reducing the waiting lists for services.
(K)(1) The department of mental retardation and
developmental
disabilities shall adopt rules in accordance with
Chapter 119. of
the Revised Code governing waiting lists
established under this
section. The rules shall include procedures
to be followed to
ensure that the due process rights of
individuals placed on
waiting lists are not violated.
(2) As part of the rules adopted under this division, the
department shall adopt rules
establishing criteria a county board
may use under division (F) of
this section in determining the
order in which individuals with
priority for home and
community-based services will be offered
the
services. The rules
shall also specify conditions under which
a
county board, when
there is no individual with priority for home
and community-based
services pursuant to division (D)(1) or (2) or (E) of
this section
available and appropriate for the services,
may offer
the services
to an individual on a waiting list for the
services
but not given
such priority for the services. The rules
adopted
under division
(K)(2) of this section shall cease to have
effect
December 31,
2009.
(3) As part of the rules adopted under this division, the
department shall adopt rules specifying both of the following for
the priority category established under division (E) of this
section:
(a) The number of years, which shall not exceed five, that
the priority category will be in effect;
(b) The date that the priority category is to go into effect.
(L) The following shall take precedence over the
applicable
provisions of this section:
(1) Medicaid rules and regulations;
(2) Any specific requirements that may be contained within a
medicaid
state plan amendment or waiver program that a county
board has authority to
administer or with respect to which it has
authority to provide services,
programs, or supports.
Sec. 5126.055.
(A) Except as provided in
section
5126.056
of the Revised Code, a county board of
mental retardation
and
developmental disabilities
has medicaid local
administrative
authority to, and shall,
do all of the following
for an individual
with mental retardation
or other developmental
disability who
resides in the county that
the county board serves
and seeks or
receives home and
community-based services:
(1) Perform assessments and evaluations of the individual.
As
part of the
assessment and evaluation process, the county board
shall do all
of the following:
(a) Make a recommendation to the department of mental
retardation and developmental disabilities on whether the
department should approve or deny the individual's application for
the services, including on the basis of whether the individual
needs the level of care an intermediate care facility for the
mentally retarded provides;
(b) If the individual's application is denied because of the
county board's recommendation and the individual requests a
hearing under section 5101.35 of the Revised Code, present, with
the department of mental retardation and developmental
disabilities or department of job and family services, whichever
denies the application, the reasons for the recommendation and
denial at the hearing;
(c) If the individual's application is approved, recommend
to
the departments of mental retardation and developmental
disabilities and job and family services the services that should
be included in the individual's individualized service plan and,
if either department approves, reduces, denies, or terminates a
service
included in the individual's individualized service plan
under
section 5111.871 of the Revised Code because of the county
board's
recommendation, present, with the department that made the
approval, reduction, denial, or termination, the reasons for the
recommendation and approval, reduction, denial, or termination at
a hearing
under section 5101.35 of the Revised Code.
(2) If the individual has been identified by the department
of mental retardation and developmental disabilities as an
individual to receive priority for home and community-based
services pursuant to division (D)(3) of section 5126.042 of the
Revised Code, assist the department in expediting the transfer of
the individual from an intermediate care facility for the mentally
retarded or nursing facility to the home and community-based
services;
(3)
In accordance with the rules adopted under section
5126.046 of the Revised Code, perform the county board's duties
under that section regarding assisting the individual's right to
choose a qualified and willing provider of the services and, at a
hearing under section 5101.35 of the Revised Code, present
evidence of the process for appropriate assistance in choosing
providers;
(4)(3) If the county board is certified under section
5123.161
of
the Revised Code to provide the services and agrees
to
provide
the
services to the individual and the individual
chooses
the
county
board to provide the services, furnish, in
accordance
with
the
county board's medicaid provider agreement
and for the
authorized
reimbursement rate, the services the
individual
requires;
(5)(4) Monitor the services provided to the individual and
ensure the individual's health, safety, and welfare. The
monitoring shall include quality assurance activities. If the
county board provides the services, the department of mental
retardation and developmental disabilities shall also monitor the
services.
(6)(5) Develop, with the individual and the provider of the
individual's services, an effective individualized service plan
that includes coordination of services, recommend that the
departments of mental retardation and developmental disabilities
and job and family services approve the plan, and implement the
plan unless either department disapproves it;
(7)(6) Have an investigative agent conduct investigations
under
section 5126.313 of the Revised Code that concern the
individual;
(8)(7) Have a service and support administrator perform the
duties under division (B)(9) of section 5126.15 of the Revised
Code that concern the individual.
(B) A county board shall perform its medicaid local
administrative
authority under this section in accordance with all
of the
following:
(1) The county board's plan that the department of mental
retardation and developmental disabilities approves under section
5123.046 of the Revised Code;
(2) All applicable federal and state laws;
(3) All applicable policies of the departments of mental
retardation and developmental disabilities and job and family
services and the United States department of health and human
services;
(4) The department of job and family services' supervision
under its authority under section 5111.01 of the Revised Code to
act as the single state medicaid agency;
(5) The department of mental retardation and developmental
disabilities' oversight.
(C) The departments of mental retardation and developmental
disabilities and job and family services shall communicate with
and provide training to county boards regarding medicaid local
administrative authority granted by this section. The
communication and training shall include issues regarding audit
protocols and other standards established by the United States
department of health and human services that the departments
determine appropriate for communication and training. County
boards shall participate in the training. The departments shall
assess the county board's compliance against uniform standards
that the departments shall establish.
(D) A county board may not delegate its medicaid local
administrative authority granted under this section but may
contract with a person or government entity, including a council
of governments, for assistance with its medicaid local
administrative
authority. A county board that enters into such a
contract shall
notify the director of mental retardation and
developmental
disabilities. The notice shall include the tasks
and
responsibilities that the contract gives to the person or
government entity. The person or government entity shall comply
in
full with all requirements to which the county board is subject
regarding the person or government entity's tasks and
responsibilities under the contract. The county
board remains
ultimately responsible for the tasks and responsibilities.
(E) A county board that has medicaid local administrative
authority
under this section shall, through the departments of
mental
retardation and developmental disabilities and job and
family
services, reply to, and cooperate in arranging compliance
with, a
program or fiscal audit or program violation exception
that a
state or federal audit or review discovers. The department
of job
and family services shall timely notify the department of
mental
retardation and developmental disabilities and the county
board of
any adverse findings. After receiving the notice, the
county
board, in conjunction with the department of mental
retardation
and developmental disabilities, shall cooperate fully
with the
department of job and family services and timely prepare
and send
to the department a written plan of correction or
response to the
adverse findings. The county board is liable for
any adverse
findings that result from an action it takes or fails
to take in
its implementation of medicaid local administrative
authority.
(F) If the department of mental retardation and
developmental
disabilities or department of job and family
services determines
that a county board's implementation of its
medicaid local
administrative authority under this section is
deficient,
the
department that makes the determination shall
require that
county
board do the following:
(1) If the deficiency affects the health, safety, or
welfare
of an individual with mental retardation or other
developmental
disability, correct the deficiency within
twenty-four hours;
(2) If the deficiency does not affect the health, safety,
or
welfare of an individual with mental retardation or other
developmental disability, receive technical assistance from the
department or submit a plan of correction to the
department that
is acceptable to the department within sixty days
and correct the
deficiency within the time required by the plan of
correction.
Section 2. That existing sections 5126.042 and 5126.055 of
the
Revised Code
are hereby repealed.
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