1. REQUIRED PROVIDER TRAINING
FOR MEDICAID WAIVER SERVICES
(5123:2-2-01)
COMPLETION TIME: 8 HOURS
House of New Hope (revised 3/2010)
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2. Overview
 This eight-hour course covers all areas required by
5123:2-2-01 - Provider Certification. This includes:
 Understand basic concepts for serving individuals with
developmental disabilities
 Learn the rights of individuals with developmental
disabilities
 Understand the basic principles and requirements of
providing home and community-based waiver services;
 Requirements for incidents adversely affecting health and
safety; and
 Universal precautions for infection control, including hand
washing and the disposal of bodily waste.
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3. Objectives include:
 The foundation for the information that providers of Medicaid waiver services will need to
be knowledgeable about providing services and supports to individuals with disabilities,
 To gain a basic understanding of current philosophies and best practice for working with
individuals with disabilities,
 To understand the individual service plan (ISP) and the responsibility of providing service
in accordance with the plan,
 To have an understanding of MUI’s and the provider’s responsibility for reporting MUI’s,
 To be aware of what bloodborne infections are, how to prevent illness from bloodborne
pathogens and how to handle contaminated matter, and
 To understand Medicaid waivers, documentation requirements, reporting requirements and
where to find forms and additional information.
 This competency-based training requires the applicant/employee to take and pass
a multiple-choice quiz at the end of the training—100% accuracy is required. The
applicant/employee will be allowed multiple attempts to take and pass the quiz.
The quiz contains questions from all resources provided in the course.
 The course contains a narrative section and numerous required reading assignments
including articles written by experts in the field.
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4. What is Developmental Disability (DD)?
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 The term ‘developmental disability’ includes a wide array of disabilities that
includes mental retardation. Examples of other developmental disabilities include:
vision impairment, hearing impairment, cerebral palsy, autism and others.
 Developmental disabilities are defined as “severe chronic disabilities that can be
cognitive or physical or both. The disabilities appear before the age of 22 and are
likely to be life-long.”
 “Cognitive” disabilities are those disabilities that are related to thought processes
and the ability to comprehend and respond to what a person hears and sees. This
includes such disabilities as mental retardation/intellectual disability, learning
disabilities, Asperger’s syndrome, brain injury and others. A person with a cognitive
disability may not be able to process information in the same way or as quickly as
a person who does not have a cognitive disability.
 Because cognitive and physical disabilities can both affect one person, providers
will often work with people who have both types of disabilities.
 Some developmental disabilities are purely physical, such as congenital deafness or
visual impairment. These are not intellectual disabilities. Other developmental
disabilities can be caused by cerebral palsy, epilepsy, autism or other disabling
conditions. These conditions might or might not include intellectual disabilities.

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 Still other developmental disabilities can result from chromosomal disorders, such as
Down Syndrome and fragile X syndrome.
 These instances could well include intellectual disabilities—but not always. For
example, according to the Centers for Disease Control, males with fragile X
syndrome generally have mild to severe intellectual disabilities, whereas females
can have average intelligence.
 On the other hand, some causes of intellectual disabilities are not physical. These
include social & environmental factors such as the level of interaction & stimulation a
child has during the developmental period and educational factors such as the
availability of family and educational supports that promote mental development
and greater adaptive skills.
 Some disabilities are preventable. This includes fetal alcohol syndrome caused by
the mother consuming alcohol during pregnancy. FAS can cause both physical and
cognitive disabilities.

6. Required Reading
 General Info Fact Sheet
 Autism Fact Sheet
 Learning Disability Fact Sheet
 Intellectual Disability Fact Sheet
 Severe Disabilities Fact Sheet
 TBI Fact Sheet
 Epilepsy Fact Sheet
 ADHD Fact Sheet
 Down Syndrome Fact Sheet
 Cerebral Palsy Fact Sheet
 Emotional Disturbance Fact Sheet
 Hearing Loss Fact Sheet
 Visual Impairment Fact Sheet
 Speech & Language Fact Sheet
 ARC Fact Sheet
 Mental Retardation vs. Mental Illness
 Fetal Alcohol Syndrome Characteristics
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7. What is Intellectual Disability?
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 The term ‘intellectual disability’ is a fairly new term that has the same meaning as
mental retardation. You may see both terms used to mean the same thing.
 The term “mental retardation” is the term used in law and public policy to
determine eligibility for state and federal programs, including the Individuals with
Disabilities Education Act—IDEA (2004), Social Security Disability Insurance, and
Medicaid Home and Community Based Waiver.
 Also, the term ‘mental retardation’ is used for citizenship and legal status, civil and criminal
justice, early care and education, training and employment, income support, health care, and
housing and zoning.
 While Ohio still uses the term mental retardation in the Ohio Revised Code,
administrative rules and other places, in 2009, Governor Strickland signed a bill
into law removing the words “Mental Retardation” from the name of the Ohio
Department of Mental Retardation and Developmental Disabilities and from the
titles of other state and county entities, councils, commissions and various funds that
use the term. As the Ohio Department of Developmental Disabilities, S.B. 79
recognized that mental retardation was merely a subset of developmental
disabilities and had taken on an uncomplimentary connotation.

8. Definition of Intellectual Disability
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 The American Association on Intellectual and Developmental Disabilities (AAIDD)
defines ‘intellectual disability, as “a disability characterized by significant limitations
both in intellectual functioning and in adaptive behavior, which covers many
everyday social and practical skills. This disability originates before the age of 18’.
 Intellectual functioning — also called intelligence — refers to general mental capacity, such
as learning, reasoning, problem solving, and so on.
 Adaptive behavior - Adaptive Behavior includes the age-appropriate behaviors necessary
for people to live independently and to function safely and appropriately in daily life.
Adaptive behaviors include real life skills such as grooming, dressing, safety, safe food
handling, school rules, ability to work, money management, cleaning, making friends, social
skills, and personal responsibility.
 One criterion to measure intellectual functioning is an IQ test. Generally, an IQ test
score of around 70 or as high as 75 indicates a limitation in intellectual functioning.

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 Standardized tests can also determine limitations in adaptive
behavior. Adaptive behavior includes three skill types:
 Conceptual skills—includes skills such as language and literacy; money,
time, number concepts and self-direction.
 Social skills— such as interpersonal skills, social responsibility, self-
esteem, gullibility, naïveté (i.e., wariness), social problem solving, and the
ability to follow rules/obey laws and to avoid being victimized.
 Practical skills— including activities of daily living (personal care),
occupational skills, healthcare, travel/transportation, schedules/routines,
safety, use of money, use of the telephone.

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 On the basis of such many-sided evaluations, professionals can determine whether
an individual has an intellectual disability and can tailor a support plan for each
individual.
 But in defining and assessing intellectual disability, professionals must take
additional factors into account, such as the community environment typical of the
individual’s peers and culture.
 Professionals should also consider language and cultural differences in the way
people communicate, move, and behave.
 Finally, assessments must also assume that limitations in individuals often coexist with
strengths, and that a person’s level of life functioning will improve if appropriate
personalized supports are provided over a sustained period.

11. What does it Mean to Treat People
with Dignity and Respect?11
 It is important to remember that you may be a person with a
disability, but you are not a “disabled person.” You are, first
and foremost, a person. Not unlike any other person, you have
your own set of strengths and weaknesses.
 Every individual has rights, is capable of learning, working,
and being a contributing member of society.
 People with disabilities should live in a home of their choice,
participate in chosen activities, employment and life-style and
each person deserves to be treated with dignity and respect.

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 Providers and others who work and interact with individuals with disabilities must
always treat the individual with dignity and respect. A few examples include:
 Speaking to a person directly
 Speaking to individuals in a respectful manner and tone of voice
 Listening to the person, however they communicate
 Getting to know the person as an individual
 Not discussing a person in front of that person as if they are not present
 Not discussing an individual’s personal business in public where others can hear
 Not sharing information about an individual that is private or personal unless
you have permission of the individual to share specific information
 Allowing the individual to do those things independently that they are capable
of doing
 Using a person’s name when speaking to them or about them
 Avoiding derogatory terms when talking about a person – never refer to a
person based on their needs. For example, never call a person a tube feeder, or
a pooper.

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 Several important points to remember:
 Everyone can learn
 Everyone should have the opportunity to work if they choose
 Everyone should have choice in where they live
 Everyone should be treated with dignity and respect
 People with disabilities can be contributing members of their community
 People with disabilities can make their own decisions
 Providers and others are not in control of a person’s life
 Individuals with disabilities want to have control of their own lives
 Providers and others need to listen to what a person is telling you and learn how
each person communicates
 It is important to listen, support and provide what the individual wants and
needs
 Everyone should have the opportunity to be as independent as possible
 People with disabilities are not ill
 Everyone is a citizen with equal rights, whether or not they have a disability

14. Remember to Think “People First”
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 Language is a reflection of how people see each other. That's why the words we use
can hurt. It's also why responsible communicators are now choosing language that
reflects the dignity of people with disabilities-words that put the person first, rather
than the disability. Read on for a short course on using language that empowers.
 Think "people first." Say "a woman who has a developmental disability" rather than "a
developmentally disabled woman."
 Avoid words like "unfortunate," "afflicted," and "victim." Try to avoid casting a person with
a disability as a superhuman model of courage. People with disabilities are just people,
not tragic figures or demigods.
 A developmental disability is not a disease. Do not mention "symptoms," "patient" or
"treatment," unless the person you're writing about has an illness as well as a disability.
 Use common sense. Avoid terms with obvious negative or judgmental connotations, such as
"crippled," "deaf and dumb," "lame" and "defective." If you aren't sure how to refer to a
person's condition, ask. And if the disability is not relevant to your story or conversation,
why mention it at all?
 Never refer to a person as "confined to a wheelchair." Wheelchairs enable people to
escape confinement. A person with mobility impairment "uses" a wheelchair.
 Try to describe people without disabilities as "typical" rather than "normal."

15. Current Philosophy and Best Practices
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 Some of the key fundamentals in providing services and supports for
individuals with Developmental Disability include:
 Supporting the individual in having control over his/her own life
 Supporting the individual in building friendships and relationships
 Supporting the individual in working and living in their own community
 Assisting the individual establish & maintain financial control and stability
 Assuring that each person achieves and maintains an acceptable quality of
life is an important factor in providing services and supports.
 This section of the course will give a brief overview of several principles that will
help providers meet this goal. The more familiar you are with each of these
principles the better you will be able to support each individual. These principles
include self-advocacy, person-centered planning, self-determination, supported
employment and supported living. The chart below shows some of the key
elements of a quality life.

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17. Self-Advocacy
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 Self-advocacy means advocating on one's own behalf. It is the root of all social
activist movements. The self-advocacy movement was started by and for people
with developmental disabilities because they wanted to be their own advocates
rather than having others, such as professionals, parents and other family members,
and advocates with or without other disabilities, speak about their needs and
desires. As part of the broader disability rights/independent living movement, the
self-advocacy movement is first and foremost a civil rights movement. As with all
social activist movements, self-advocacy started at the grass-roots level where local
leadership was drawn upon to organize groups of people to stand up and speak
with a goal to effect social change. The national self-advocacy organization, Self-
Advocates Becoming Empowered (SABE), has defined self-advocacy in 1991 as the
following:
 " [It] is about independent groups of people with disabilities working together for justice by
helping each other take charge of our lives and fight discrimination. It teaches us how to
make decisions and choices that affect our lives so we can be more independent. It also
teaches us about our rights, but along with learning about our rights we learn responsibilities.
The way we learn about advocating for ourselves is by supporting each other and helping
each other gain confidence in ourselves so we can speak out for what we believe in." The
Research and Training Center on Community Living (RTC), The University of Minnesota

18. Person-Centered Planning
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 The concept of person-centered planning developed from the work of John O’Brien, Beth
Mount, Marsha Forest, Judith Snow and Jack Pearpoint. They wanted to change the way
families and communities looked at and planned for the futures of persons with disabilities. Up
to this point, programs had been created to serve people with disabilities and then people
were “plugged into” the program where they best fit. Many of these programs did not help
individuals succeed in community environments and did not focus on functional skills.
Traditionally, services, goals and objectives were determined by and controlled by staff and
were based on remediating a person’s deficits. Through person-centered planning the
individual and those closest to him or her control the development of the plan to help the
person live a life in the community similar to the lives of other community members and the
plan focuses on a persons strengths and choices.
 With person-centered planning, the main concept is to develop a plan to meet personal needs,
desires, dreams and choices of individuals, then find or create the services, supports and
budget to make that plan happen. The purpose of the plan is to help the person live the life of
his or her choosing in the environment of choice. Person-centered planning changed the focus
from existing services and systems to focus on the individual and each person’s individual
choices, strengths, dreams and needs. Planning focuses on personal strengths, choices and
dreams rather than on a person’s weaknesses and deficits.

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 Getting to know someone is a very important part of person-centered planning. The best way
to get to know someone is to spend enough time together doing things, talking, listening, and
watching to figure out how someone chooses to live their life, where someone wants to live, how
they want to spend time each day, who they want to spend time with, and what are their
hopes and dreams for the future. It is also important to figure out the things that get in the way
of those life choices and how to eliminate barriers.
 There have been a number of formal approaches to person–centered planning including
Personal Futures Planning, Making Action Plans or MAPS, PATH or Planning Alternative
Tomorrows with Hope, Essential Lifestyle Planning and Circle of Friends. “All person centered
planning approaches share three basic features:
1. Everyday events and activities in which the individual participates should be the focus
of planning;
2. Family and connections within the community are more important than the services
historically available; and
3. Planning must be done with the individual with the disability and a group of people
who know the person well and are committed to helping the person achieve their
goals.” (Falvey et al.,1994).

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 Some of the most important features of person-centered planning include:
 Planning must be based on the individual’s informed choices, preferences, desires, needs,
and knowing one’s options
 Being in control of one's own life
 Being accepted by other community members as a member of the community
 Being valued by the community
 Living, working and enjoying recreational opportunities in the community
 Having needed supports available
 Having friends and relationships
 Having financial resources
 Having financial stability
 Holistic planning and support occur
 Forming interdependent relationships and partnerships with others and the community is
important
 Natural supports are identified and used
 Services and supports are provided in a respectful, image enhancing manner
 Nonintrusive delivery of services and supports is essential

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 When using the person-centered planning approach, the plan results in the
commitment of many people supporting the person in reaching his or her
desired future, not just the “professionals”. The plan is not based on
traditional assessment or evaluation methods but rather on a process
effective for determining each individual’s choices, preferences and desires.
The planning process focuses on building relationships and belonging. To
implement such a plan, methods and resources for supporting choices,
community connections and support, and an agency design that enables
supporting individual’s choices are needed.
 Ohio has come a long way over the past 20 years since person-centered
planning first came to the forefront. Individual budgets, service and support
administration, new funding streams, and choice of providers have all
opened the doors to the person-centered approach.

22. Self-Determination
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 Self-determination is a belief that was applied to people,
other than those with disabilities, for many years prior to
being applied to persons with developmental disabilities.
 This belief had roots in the civil rights movements and was
often applied to Native Americans.
 Self-determination is the belief that people can and should
be in charge of their own lives to whatever degree that
person is capable.
 For a person to be self-determining, they may need
supports, opportunities for decision-making and resources to
implement their choices in all aspects of their lives.

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 The four main principles of self-determination are
freedom, authority, support and responsibility. These
have been defined as follows:
Freedom:
 The ability to make life decisions about where and with
whom one lives and what important things one undertakes
that parallels in every important way the decisions that
those without disabilities make everyday.
 People have the freedom to determine a meaningful life for
themselves with the assistance of an independent facilitator
and their chosen circle of support.

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Authority:
 The ability to control a targeted amount of public dollars
together and any available private money in order to craft
a life plan that results in the everyday freedoms that all
Americans desire and the expectations that the lives of those
with disabilities will mirror, with appropriate assistance when
necessary, the lives of others in this society.
 People have the authority to develop and control their own
individual support budget within the constraints of the
funding allocation.

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Support:
 The organization of these resources in ways that are unique
for the individual and address the support needed because
of a disability with a more holistic way of planning and
budgeting that address perennial issues often lost in the
system of traditional long term care: a place to call home,
sustained relationships, community membership and for
adults the production of private income through the world of
business and commerce.
 People set up and control the support they need to have a
meaningful life with the assistance of an independent
broker.

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Responsibility:
 The commitment for the wise use of public dollars and with
added flexibility in public funding seeking a more cost
effective way to support individuals with disabilities.
 From its very inception Self-Determination challenged the
high cost of “serving” individuals with significant disabilities
with very few discernable outcomes that would be
acceptable to a person without a disability.
 People take responsibility for managing their individual
budget with the assistance of an independent fiscal
intermediary.

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 Ohio has accomplished a number of goals toward the implementation of self-
determination including:
 the Medicaid Buy-In as a start toward allowing people to work without fear of losing their
health insurance;
 service and support administrators are now responsible for completing functional
assessment, developing individual plans, developing individual budgets and overseeing
the plan implementation;
 Medicaid Waivers have been approved;
 rules have been changed;
 new rules have been developed to help change the system in support of person-centered
planning and self-determination concepts;
 Home and Community Based Services (HCBS) waiver rules support the development of
individual budgets;
 adoption of the Core Indicators;
 and many other changes as well.

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29. Supported Employment
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 Supported employment has opened the door for many
adults with disabilities to leave sheltered work environments
and become employed in a wide variety of community jobs
with the supports needed to remain successfully employed.
 Community employment programs existed in several counties
in Ohio in the early 1980’s. These eventually evolved into
supported employment programs. Currently, one of the
sources of payment for supported employment comes from
one of Ohio’s Home and Community Based Waivers.

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 What is Supported Employment?*
 Supported employment facilitates competitive work in integrated work settings
for individuals with the most severe disabilities (i.e. psychiatric, mental
retardation, learning disabilities, traumatic brain injury) for whom competitive
employment has not traditionally occurred, and who, because of the nature and
severity of their disability, need ongoing support services in order to perform
their job. Supported employment provides assistance such as job coaches,
transportation, assistive technology, specialized job training, and individually
tailored supervision.
 Supported employment is a way to move people from dependence on a service
delivery system to independence via competitive employment. Recent studies
indicate that the provision of on-going support services for people with severe
disabilities significantly increases their rates for employment retention.
Supported employment encourages people to work within their communities and
encourages work, social interaction, and integration.
*Excerpted from: U.S. Department of Labor, Office of Disability Employment Policy

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 Definitions
 A job coach is a person who is hired by the placement agency to
provide specialized on-site training to assist the employee with a
disability in learning and performing the job and adjusting to the work
environment.
 Natural supports are support from supervisors and co-workers, such as
mentoring, friendships, socializing at breaks and/or after work,
providing feedback on job performance, or learning a new skill together
at the invitation of a supervisor or co-workers. These natural supports
are particularly effective because they enhance the social integration
between the employee with a disability and his/her co-workers and
supervisor. In addition, natural supports may be more permanent,
consistently and readily available, thereby facilitating long-term job-
retention.

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 Basic Components
 Supported employment services should achieve the following outcomes: opportunity to
earn equitable wages and other employment-related benefits, development of new skills,
increased community participation, enhanced self-esteem, increased consumer
empowerment, and quality of life. The types of supported employment services used
depend on the needs of individual consumers.
 The following are the basic components of supported employment:
 Paid Employment -- Wages are a major outcome of supported employment. Work
performed must be compensated with the same benefits and wages as other workers in
similar jobs receive. This includes sick leave, vacation time, health benefits, bonuses,
training opportunities, and other benefits. Employment must be for at least 18 hours
per week.
 Integrated Work Sites -- Integration is one of the essential features of supported
employment. Individuals with disabilities should have the same opportunities to
participate in all activities in which other employees participate and to work alongside
other employees who do not have disabilities.
 Ongoing Support -- A key characteristic which distinguishes supported employment
from other employment programs is the provision of ongoing support for individuals
with severe disabilities to maintain employment.

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 Supported Employment Models
 Several supported employment models are being used to provide the benefits of work for people with
severe disabilities.
 Individual Placement Model -- A person with a disability is placed in a job in a community business which best suits
his/her abilities and preferences. Training is provided on the job site in job skills and work related behaviors,
including social skills, by a job coach. As the employee gains skills and confidence, the job coach gradually spends
less time at the worksite. Support is never completely removed. The private or public vocational rehabilitation
agency furnishing the job coach is always available to the employer for retraining for new assignments, assisting in
dealing with challenging behaviors, supplying periodic consultations with co-workers and employer, giving
orientation and training for co-workers.
 Enclave Model -- A small group of people with disabilities (generally 5-8) is trained and supervised among
employees who are not disabled at the host company's work site. Persons in the enclave work as a team at a single
work site in a community business or industry. Initial training, supervision, and support are provided by a specially
trained on-site supervisor, who may work for the host company or the placement agency. Another variation of the
enclave approach is called the "dispersed enclave." This model is used in service industries (e.g., universities,
restaurants, and hotels). Each person works on a separate job, and the group is dispersed throughout the company.
 Mobile Work Crew -- A small crew of persons with disabilities (up to 6) works as a distinct unit and operates as a
self-contained business that generates employment for their crew members by selling a service. The crew works at
several locations within the community, under the supervision of a job coach. Examples of this type of work might
include janitorial or grounds keeping. People with disabilities work with people who do not have disabilities in a
variety of settings, such as offices and apartment buildings.
 Small Business Model -- Within a small business, there may be up to six employees with disabilities, but not more than
the number of employees without disabilities. The small business operates like any business, generating work and
paying employees from revenues received. The small business is located within the community

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 Benefits to Employers
 No fee to employer
 Thoroughly screened applicants
 Employees' abilities matched to job requirements
 On-site job training by professionals
 Additional training, as necessary
 Follow-up services for the duration of employment

35. Supported Living & Other Residential
Options35
 Supported Living
Supported Living is a way to assist individuals with mental retardation and
developmental disabilities to live as independently as possible in their own homes in
their own communities, with support from public funds. Most often, people in
supported living arrangements live with family members, with roommates or by
themselves. They may live in an apartment, condo, duplex, single family home or
any other type of housing. Supported living services may be provided in the
individual’s home regardless of the type of home.
An individual may share supported living with up to three other individuals with
disabilities in a supported living arrangement. Service providers chosen by the
individuals sharing services may not be the landlord. Services and supports are
identified on an Individual Service Plan (ISP). An individual selects a supported
living service provider from a list of certified providers.
Supported living “includes the provision of housing, food, clothing, habilitation, staff
support, professional services, and any related support services necessary to ensure
the health, safety, and welfare of the individual receiving the services”.

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 Capital Housing
The Ohio Department of Developmental Disabilities (ODDD) makes available state
capital assistance (bond) funds to assist local County Boards of DD in purchasing
housing for individuals receiving Supported Living services, or Supported Living
services funded through Home and Community Based waivers. The goal of the
program is to provide housing options in their own communities that allow people
with disabilities to be as fully integrated and independent as possible.
The process for accessing Capital Housing dollars is governed through ODDD
administrative rule. Typically, County Boards of DD establish non-profit housing
corporations to receive the funds, and match them with other funding sources.
Existing homes in the community are then purchased with these dollars for
individuals with developmental disabilities, often with their active involvement.
Capital housing dollars are allocated to counties through an established formula
based on available funds.

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 Licensed Facilities
There are many homes throughout Ohio that are licensed residential facilities for
person with mental retardation and developmental disabilities, often called group
homes. These homes are funded through waivers and ICFMR funds.
Ohio law requires the licensure of facilities that provide services to two or more
unrelated individuals with DD, unless the individuals are sharing services in a
Supported Living arrangement. In a licensed setting, a specific provider holds the
license to operate the facility for a specific number of individuals at a specific
location. Holding the license means that the provider of the housing is the same as
the provider of the services received by the individuals who live there.
Currently there are over 1,200 licensed facilities housing over 10,000 individuals.
This number of facilities has now been “capped” and will not continue to grow.

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 Intermediate Care Facility Mentally Retarded (ICFMR)
ICFMR facilities typically serve persons with the most severe disabilities and, often,
multiple disabilities. ICFMR facilities must provide "active treatment" to individuals
residing there. Active treatment is defined as a program of specialized and generic
training, treatment and health services.
Intermediate Care Facilities for the Mentally Retarded (ICFMR) are funded through
Medicaid dollars and, in Ohio, are licensed by the ODDD, to be operated by a
specific provider at a specific location. The Department of Health (DOH) certifies
the licensed facility as meeting the Federal requirements for funding as an ICFMR.
The provider is responsible for all aspects of care for the individual, including
financial matters, transportation, habilitation, and medical needs.
According to the federal regulations, an ICFMR is primarily for the diagnosis,
treatment, or rehabilitation for people with mental retardation and provides, in a
protected residential setting, ongoing evaluation, planning, 24-hour supervision,
coordination, and integration for health or rehabilitative services to help individuals
function at their greatest ability.

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Developmental Centers
 Ohio operates ten developmental centers (as of 2010) that are located
throughout the state.
 Approximately 1,660 individuals reside in these facilities.
 All developmental centers are licensed as ICFMR facilities.
 Individuals residing in these facilities typically have severe challenges and
receive comprehensive and intensive services.
 No resident is ever considered permanently placed at a developmental
center.
 In addition to providing habilitation, centers provide extensive outreach
services to county boards and other providers, including case consultation
and staff training.

40. Required Reading
 Required Reading:
 Person-Centered Planning –
CMS Definition
 Person-Centered Planning –
Renewed Interest
 Guiding Principles
 Circles of Support
 NCR Fact Sheet on Self
Determination
 Supported Living Per the ORC
40

41. Individual Planning
41
 Individuals with developmental disabilities often receive services from a
wide variety of service providers. In the past, each provider of services
developed an individual plan that contained the services and supports that
they or their agency would provide. Staff from the varying agencies often
attended each other’s team meetings and attempted to coordinate services,
sometimes very successfully and other times, not so successfully. Having more
than one plan often led to duplication of services, services that conflicted,
and service needs that were not met at all.
 With the onset of service and support administration came the requirement
for a single point of contact. This person has the overall responsibility to
focus on the individual, develop one coordinated plan rather than multiple,
discordant plans, and assure the plan is carried out in accordance with all
applicable rules and best practices. Service and support administration also
assures that quality assurance reviews are carried out and the results of
those reviews are incorporated into the individual’s plan and services.

42. 42
 One person now has the responsibility for overseeing and coordinating services, supports and
needs of an individual. This person also has the responsibility for developing one plan thereby
assuring comprehensive, coordinated planning and service delivery for and with each
individual. That responsible person is the service and support administrator. The service and
support administrator can have any assigned job title. Some examples are case manager,
case coordinator, service coordinator, service & support specialist and many other titles.
County boards are required to provide service and support administration to any individual,
regardless of age, who is applying for or enrolled in an HCBS waiver; any 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 service and support administration; and any individual
residing in an ICF/MR is eligible for service and support administration related to moving the
individual from the ICF/MR to a non-ICF/MR community setting. County boards may provide
service and support administration to any other individuals who are eligible for county board
services. Individuals with a sole diagnosis of mental illness are not eligible for county board
services.
Each individual who receives services and support administration must have a service and
support administrator who is the single point of accountability. This means that an SSA is
identified who is responsible to an individual for the development, effective implementation
and coordination of his or her ISP process.

43. Individual Plan Development
Requirements43
 Service and support administrators are responsible for developing and revising the
individual’s individual service plan (ISP). The ISP is the basis for all service delivery
and should focus on the individual’s strengths, interests, talents, choices, preferences
and dreams as well as skill development, increasing independence, and assuring
health and safety. The ISP defines the goals and objectives established by the
individual and the services needed to assist the individual in meeting his/her goals.
It also defines the type, frequency and duration of each service selected by the
individual and serves as the authorizing document for all services. For individuals on
waivers, the payment authorization form must be completed prior to commencement
of services.
SSAs must assure that the individual to be served and other persons selected by the
individual, and, when applicable, the provider(s) selected by the individual, are all
active participants in the development of the ISP. SSAs are also responsible for
integrating all sources of supports available to meet the needs and desired
outcomes of the individual including alternative services.

44. 44
 When assisting individuals with plan development, the focus should be on
such areas as helping the individual engage in meaningful, productive
activities and develop community connections; selecting the provider;
identifying the frequency of services and supports; and identifying the
funding source for each service and activity. The plan needs to specify
which services will be coordinated among which providers and across all
appropriate settings for the individual. If an ISP includes HCBS waiver
services, the plan must be in compliance with all applicable rules.
The ISP also serves as a key document to ensure that services are provided
in accordance with the plan, no matter who the service provider is, and
ensure that the health and welfare needs of the individual are met as
outlined in the plan. The ISP is also key to monitoring that the number of
Board authorized units of service are delivered.
SSAs do not “own” the plan but are the “recorders” of the plan who
document the process for the individual to achieve desired outcomes.

45. Critical Issues of Planning
45
 The ISP is the document that is the basis for not only what services and supports the individual
is to receive and what the health and welfare needs are of the individual, but the ISP is also
the means that allows for the monitoring of service providers. The plan must be sufficiently
specific to be able to document that the intent of the plan was met. It also needs to be written
to allow for adequate flexibility to meet the needs of the individual…sometimes a fine line to
walk.
Individual plans must be written in a manner that is easily understood by all concerned persons
including the individual, family members and those who will be implementing various service
and supports outlined in the plan. Plans need to contain sufficient detail to clearly define the
services to be delivered and must clearly identify health and safety concerns of the individual.
The plan must indicate how those involved in plan implementation will address those concerns.
Within the ISP, there must also be a balance between choices of the individual and the risks
incurred by those choices that may impact health and safety.
The planning process is an ongoing process. This means that the ISP will be changed and
updated as needed. This may be in response to changing desires of the individual, change in
providers, changes due to results of monitoring, changes in the individuals health or
circumstances or many other issues/occurrences.

46. Why is the ISP important?
46
 Individual service plans are important for a multitude of reasons. Some of
the most important reasons include:
 Individuals are relying on this plan to help them achieve their goals and
identified choices, preferences, desires, dreams and needs.
 Individuals are relying on this plan to develop more independence and acquire
more community connections.
 Individuals are relying on this plan to maintain their health and safety.
 Individuals are relying on this plan to develop new skills and improve existing
skills.
 Individuals are relying on this plan to develop community connections.
 Individuals are relying on providers to deliver services based on this plan.
 Providers are responsible for delivering services as outlined in the plan.
 Providers are held accountable for the proper delivery of services as outlined in
the plan.
 This is a legal document that provides a roadmap of the person’s life plan.
 Over time the ISP provides an historical view of the person’s life.

47. 47
 SSAs need to be work collaboratively with the individual and his or
her family and circle of support, be responsive to the needs and
desires of the individual and family, and be respectful, in all
interactions with the individual and family.
The individual service plan (ISP) is what provides the content and
direction for what services and support are to be provided to the
individual. The best practices discussed above are some of the many
tools, principles and philosophies that should be used in the planning
and delivery of the services and supports to assure that those
services and supports result in meeting the intent of the plan, the
expected outcomes of the plan and provide the quality of life
chosen by the individual and his/her circle of support.

48. Preparation and Quality Assurance
for the ISP48
 Planning is a critical process that drives services and
supports and involves many people and numerous steps and
processes. These typically include:
 evaluating/determining choices, preferences needs and desires
of the individual;
 meeting to develop a plan, developing a budget based on
available resources, implementing the plan;
 evaluating the outcomes of the plan through quality assurance
reviews, revising or redeveloping the plan as needed.
Each of these are briefly discussed below. These steps may differ
based on the chosen planning process and other variables.

49. 49
 Evaluation and data gathering provide the basis for the plan.
The SSA oversees the process of working with the individual and others to
gather and review information that is already available about the
individual including strengths, choices, preferences, desires and needs. The
SSA in conjunction with the team then decides if the group needs more
information to develop a plan to support the individual. If so, additional
information can be gathered using best practices.
 Collecting needed information.
The designated person gains permission to gather the needed information.
If there are guardians they must give informed, written permission.
Information can be gathered through a variety of means including formal
and informal assessments, functional assessments, circles of support, person-
centered planning, and other chosen best practices. Communication with the
individual and those who know the person best is critical to determining
what should be included in the person’s plan.

50. 50
 Developing the individual’s plan based on gathered data.
The content of the individual plan drives the services and supports the
individual will receive. This plan must be clearly and well written. It is key to
achieving the desired outcomes and assuring the health and safety of the
individual. Team meetings are commonly held to develop the plan. Meetings
are usually composed of people that the individual invites. They are person
centered and typically include many of the people that provide services
and support to the individual. During the team meeting discussions and
planning occur to help the individual achieve their desired goals in life.
 Determining how the services and supports will be funded and developing an
individual budget.
How are services and supports to be funded? Is the individual eligible for
DD and related services? What other sources of funds are available? The
team/circle of support works with the individual to identify, secure and
budget available resources.

51. 51
 Choosing a provider.
The individual has free choice of provider. The individual, with assistance as
needed, will choose the provider(s) to carry out the plan. This may include
residential providers, county boards, and a host of private providers.
 Implementation and Quality Assurance Reviews
Implementing the plan is the next essential step in providing services and supports to
assist the individual attain his or her desired outcomes. Quality assurance reviews
are periodically conducted to assure the plan is carried out in accordance with the
individual’s wishes as written in the plan and the expected outcomes are achieved.
 Revision & Redevelopment of the Plan
When it is determined that the plan needs to be revised or redeveloped the process
begins again. The plan may need to be revised, reviewed or redeveloped for
various reasons, some of which include rule requirements, changes desired by the
individual, as a result of the quality assurance review, due to a change in the
persons circumstances, or many other reason.

52. 52
 Examples of team members that may help the individual
with planning and supports:
 Guardians, family members, friends and advocates
 Providers and agencies
 Sheltered workshop personnel
 The individual’s employer
 Speech/Physical/Occupational therapists
 Service and Support Administrators
 Social Workers
 Local Transportation Agencies
 Supported Employment Staff (BVR or local employment agencies)

53. Required Reading
 Required Reading
ISP Requirements
53

54. Individual Rights: An Ohio Focus
54
 Throughout history, individuals with disabilities have often been
denied their rights that most Americans take for granted.
 Ohio has reinforced the rights of individuals with developmental
disability through statute. Section 5123.62 of the ORC Rights of
Persons with Mental Retardation or a Developmental Disabilities is
the statute that addresses these rights. Other Ohio statute and
Federal law address other aspects of rights of individuals as well.
 When interacting with individuals, including when providing services
and supports, it is imperative that you be aware of and honor each
individual’s rights. Following is information that will help you
recognize and honor those individual rights.

55. 55
 What is the Revised Code?
The Ohio Revised Code (ORC) is the law in the state of Ohio. When
a bill is passed by the state legislature and signed by the Governor,
it becomes a part of the Ohio Revised Code. It is the law.
ORC 5123.62
The Ohio legislature passed a bill that identifies the “rights for
persons with mental retardation or a developmental disability” in
1986. It remains the law in Ohio today.
Federal Law
Rights for persons with DD are also in federal law. In addition, all
U.S. citizens have the rights guaranteed them in the U.S. Constitution.
There are the basic civil rights for everyone with or without
disabilities.

56. 56
 What are ‘Rights’?
‘Rights’ are the rules that help to make everyone equal. As a
person, you have some rights when you are born. These are called
‘human rights’. In addition, you have ‘legal rights’ that are a part of
the law in this country and in this state (Ohio). It is important to know
your rights so that if people try to take them away, you can stop
them or get help to stop them.
 Differences in Adult and Children Rights
Legal rights are held by parents for their children because parents
are legal guardians unless a court has intervened. Every child has
basic human rights protected by state and federal law. A person is
“emancipated” at the age of 18 and assumes his/her legal rights.
This is true for people with or without disabilities.

57. 57
 Guardianship
Individuals with DD are their own guardian at the age of 18 unless a
court has appointed a legal guardian. Guardianship may be full or
limited to specific areas. An individual who has a court appointed
guardian maintains all rights unless a specific right has been
restricted by the court or the guardian.
 What are ‘Responsibilities’?
‘Responsibilities’ are the things that other people expect us to
do. Responsible people know what their rights are and respect the
rights of other people. Being responsible means that you care about
the rights of other people.

58. 58
 Additional Support Needed
Individuals with DD often need additional education in learning their
rights and responsibilities. Special classes and teaching materials
help people with DD learn more about their rights and how to speak
up and advocate for themselves.
 The Bill of Rights
Ohio’s law has specified ‘rights’ for individuals with mental
retardation and/or other developmental disabilities.
 It is the responsibility of all staff to assure that these rights are
granted and that each person with a developmental disability is
aware of and understands his or her rights.

59. ORC 5123.62
 The rights of persons
with a developmental
disability include, but
are not limited to, the
following:
 ORC 5123.62…
59

60. 60
 Courtesy and Respect…
 Individuals have the right to be treated at all times with courtesy
and respect and with full recognition of their dignity and
individuality.
 In simple terms… To always be treated nicely and as a person no
matter the circumstances.
 A Safe Place To Live…
 The right to an appropriate, safe, and sanitary living environment
that complies with local, state, and federal standards and
recognizes the persons’ need for privacy and independence.
 In simple terms… Have a clean safe place to live in and a place
to be alone

61. 61
 Good Nutrition…
 The right to food adequate to meet accepted
standards of nutrition.
 In simple terms… to have food that is good for you.
 Freedom of Religion…
 The right to practice the religion of their choice or to
abstain from the practice of religion.
 In simple terms… to be able to go, if you want, to any
church, temple, mosque

62. 62
 Medical Care…
 The right of timely access to appropriate medical or dental
treatment.
 In simple terms…to be able to go to a doctor or dentist when you
are sick or need a check-up.
 Ancillary Services…
 The right of access to necessary ancillary services, including, but
not limited to, occupational therapy, physical therapy, speech
therapy, behavior modification and other psychological services.
 In simple terms…To be able to have people help you with the
way you walk, talk, do things with your hands, act or feel, if you
need it.

63. 63
 Medical Treatment…
 The right to receive appropriate care and treatment in the
least intrusive manner.
 In simple terms…To be treated kindly and gently when you
receive the care you need and want.
 Privacy…
 The right to privacy, including both periods of privacy and
places of privacy.
 In simple terms…To be able to have time and a place to go
to be by yourself.

64. 64
 Communication…
 The right to communicate freely with persons of their choice
in any reasonable manner they choose.
 In simple terms… To be able to call, write letters or talk to
anyone you want about anything you want
 Personal Property…
 The right to ownership and use of personal possessions so as
to maintain individuality and personal dignity.
 In simple terms… To be able to have your own things and to
be able to use them.

65. 65
 Friendships…
 The right to social interaction with members of either sex.
 In simple terms… To be able to have men and women as
friends.
 Be All That You Can Be…
 The right of access to opportunities that enable individuals
to develop their full human potential.
 In simple terms… To be able to join in activities, have
friends, participate in community activities and do things
that will help you grow to be the best person you can be.

66. 66
 Contribute to Your Own Support…
 The right to pursue vocational opportunities that will promote and
enhance economic independence.
 In simple terms…To be able to work at a job of one’s choosing
and make money.
 Americans with Disabilities Act …
 Assures employers shall not discriminate against a qualified
individual with a disability.
 Legislation passed by the United States Congress in 1990 to
prohibit discrimination against people with disabilities and
to guarantee them equal access to employment, public
services, public accommodations, and telecommunications.

67. 67
 Equality…
 The right to be treated equally as citizens under the
law.
 In simple terms…To be treated just like everyone else.
 Free From Harm…
 The right to be free from emotional, psychological or
physical abuse.
 In simple terms…To not be hit, yelled at, cursed at or
called names that hurt you.

68. 68
 Learning, Growing, Playing…
 The right to participate in appropriate programs in
education, training, social development, and habilitation and
in programs of reasonable recreation.
 In simple terms…To be able to learn new things, make
friends, have activities to do, and go out in your community
 Freedom To Choose…
 The right to participate in decisions that affect their lives.
 In simple terms…To be able to tell people what you want
and be part of making plans or decisions about your life

69. 69
 Advocacy or Representation…
 The right to select a parent or advocate to act on their
behalf.
 In simple terms…To be able to ask someone you want to
help you, let others know how you feel or what you want.
 It’s My Money…
 The right to manage their personal financial affairs, based
on individual ability to do so.
 In simple terms…To be able to use your money to pay for
things you need and want.

70. 70
 Privacy…
 The right to confidential treatment of all information in their
personal; and medical records, except to the extent that
disclosure or release of records is permitted under sections
5123.89 and 5126.044 of the Revised Code.
 In simple terms…To be able to say yes or no before people
talk about what you do at work or home or look at your file.
 ORC 5123.89
 Confidentiality of records; disclosure.
 ORC 5126.044
 Disclosure of identity of individual or release of record or report.

71. 71
 Freedom of Speech…
 The right to voice grievances and recommend changes in policies
and services without restraint, interference, coercion,
discrimination, or reprisal.
 In simple terms…To be able to complain or ask for changes if you
do not like something without being afraid of getting in trouble.
 Freedom…
 The right to be free from unnecessary chemical or physical
restraints.
 In simple terms… Not be given medicine that you don't need or
want, nor be held down if you are not hurting yourself or others.

72. 72
 The Right to Vote…
 The right to participate in the political process.
 In simple terms…To vote, learn about laws and your
community.
 The Right To Say “NO”…
 The right to refuse to participate in medical,
psychological, or other research experiments.
 In simple terms…To say “yes” or “no” to being a part
of a study or experiment.

73. ORC 5123.62 Client Rights
73
 Every state agency, county board of mental retardation and developmental disabilities, or
political subdivision that provides services, either directly or through a contract, to persons with
a developmental disability shall give each provider a copy of the list of rights contained in
section 5123.62 of the Revised Code. Each public and private provider of services shall carry
out the requirements of this section in addition to any other posting or notification requirements
imposed by local, state, or federal law or rules.
 The provider shall make copies of the list of rights and shall be responsible for an initial
distribution of the list to each individual receiving services from the provider. If the individual is
unable to read the list, the provider shall communicate the contents of the list to the individual
to the extent practicable in a manner that the individual understands. The individual receiving
services or the parent, guardian, or advocate of the individual shall sign an acknowledgement
of receipt of a copy of the list of rights, and a copy of the signed acknowledgement shall be
placed in the individual’s file. The provider shall also be responsible for answering any
questions and giving any explanations necessary to assist the individual to understand the
rights enumerated. Instruction in these rights shall be documented.
 Each provider shall make available to all persons receiving services and all employees and
visitors a copy of the list of rights and the addresses and telephone numbers of the legal
rights service, the department of mental retardation and developmental disabilities, and the
county board of mental retardation and developmental disabilities of the county in which the
provider provides services.

74. Required Reading
 Required Reading
 ORC 5123.62 Rights
of Persons with a
Developmental
Disability.
74

75. 75
 5123.64 Enforcement duties of providers; procedure upon violation
 Every provider of services to persons a developmental disability shall establish policies
and programs to ensure that all staff members are familiar with the rights enumerated in
section 5123.62 of the Revised Code and observe those rights in their contacts with
persons receiving services.
 Any policy, procedure, or rule of the provider that conflicts with any of the rights
enumerated shall be null and void. Every provider shall establish written procedures for
resolving complaints of violations of those rights. A copy of the procedures shall be
provided to any person receiving services or to any parent, guardian, or advocate of a
person receiving services.
 Any person with mental retardation or a developmental disability who believes that the
person’s rights as enumerated in section 5123.62 of the Revised Code have been violated
may:
 Bring the violation to the attention of the provider for resolution;
 Report the violation to the department of mental retardation and developmental
disabilities, the ombudsperson section of the legal rights service, or the appropriate
county board of mental retardation and developmental disabilities;
 Take any other appropriate action to ensure compliance with sections 5123.60 to
5123.64 of the Revised Code, including the filing of a legal action to enforce rights or
to recover damages for violation of rights.

76. 76
 5123.65 Self-administration of medication.
 In addition to the rights specified in section 5123.62 of
the Revised Code, individuals with developmental
disabilities who can safely self-administer medication
or receive assistance with self-administration of
medication have the right to self-administer medication
or receive assistance with the self-administration of
medication. The department of mental retardation and
developmental disabilities shall adopt rules as it
considers necessary to implement and enforce this
section. The rules shall be adopted in accordance with
Chapter 119. of the Revised Code.

77. 77
 Remember….it is the responsibility of everyone who
works with, supports or otherwise interacts with persons
with disabilities to assure they are aware of, understand
and are afforded their rights.
 When Rights Violations Becomes an MUI
Some rights violations must be reported as a Major
Unusual Incident. A rights violation that results in
physical or emotional harm must be reported as an
MUI.

78. 78
 Restricting Rights
 Rights must never be restricted without the approval of the individual and/or his
or her guardian. Rights are often violated through the use of behavior plans,
through the mode of “not enough money” and through medication
“restraint.” Everyone who supports an individual with DD must be on guard to
guarantee and protect rights.
 Reporting Rights Violations…
 Any person with DD who believes their rights have been violated may:
 Tell their provider so it may be resolved;
 Report it to the Department of DD or the Ohio Legal Rights Service;
 Tell their Service and Support Administrator; or,
 File a legal action.
 Annual Review of Rights
 Individuals who receive services from a county board of DD must have their
rights reviewed each year and sign a statement that it was done.

79. Rights: An International Focus
79
 The United Nations Department of Economic and Social Affairs based in New York
and the Office of the High Commissioner for Human Rights in Geneva have multiple
responsibilities including:
 to support the full and effective participation of persons with disabilities in social life and
development;
 to advance the rights and protect the dignity of persons with disabilities and;
 to promote equal access to employment, education, information, goods and services.
 One of the mandates of the Secretariat for the Convention on the Rights of Persons
with Disabilities was to develop the Convention on the Rights of Persons with
Disabilities which was adopted in 2006.
 The Convention on the Rights of Persons with Disabilities and Optional Protocol
entered into force on May 3, 2008. This marked ‘a major milestone in the effort to
promote, protect and ensure the full and equal enjoyment of all human rights and
fundamental freedoms of persons with disabilities and to promote respect for their
inherent dignity’.

80. 80
 Over 130 nations have now signed the Convention agreeing to abide by its principles. There
are eight guiding principles that underlie the Convention and each one of its specific articles.
These are:
 Respect for inherent dignity, individual autonomy including the freedon to make one’s own choices, and
independence of person’s
 Non-discrimination
 Full and effective participation and inclusion in society
 Respect for difference and acceptance of persons with disabilities as part of human diversity and
humanity
 Equality of opportunity
 Accessibility
 Equality between men and women
 Respect for the evolving capacities of children with disabilities and respect for the right of children with
disabilities to preserve their identities

Monitoring occurs to assure implementation through a committee on the rights of persons with
disabilities. For more information on the Convention, visit www. un.org/disabilities.

81. Required Reading
 Required Reading
 We Have Human
Rights: A Handbook for
People with
Developmental
Disabilities
81

82. MUI: Major Unusual Incidents
82
 ORC 5123:2-17-02
Incidents Adversely Affecting Health and Safety
 What does Major Unusual Incident (MUI) mean?
Major unusual incident means the alleged, suspected, or
actual occurrence of an incident when there is reason to
believe the health or safety of an individual may be
adversely affected or an individual may be placed at
a reasonable risk of harm, if the individual is receiving
services through the DD service delivery system or will
be receiving such services as a result of the incident.

83. 83
 Why are MUI’s reported?
 MUIs are reported to protect individuals with developmental
disabilities -- to ensure their health and safety. By reporting each
and every MUI, the cause, factors or trends leading to an MUI
can more easily be identified and plans and safeguards can be
established or revised to prevent future incidents.
 Who must report an MUI?
 All providers who are contracted, certified or licensed to serve
persons with developmental disabilities are required to report
MUIs to the appropriate county board.
 All county board and ODDD staff are required to reports MUIs.
 Anyone providing Medicaid waiver services must report MUIs.

84. 84
 When must an MUI be reported?
All incidents of possible abuse, neglect, misappropriation or death
must be reported to local law enforcement and the county board or
to the public children’s service agency, when applicable, no matter
where the incident occurred.
Other categories of MUIs must be reported according to 5123:2-
17-02 when the incident occurred in a program operated by a
county board or contractor or the county board or when the
individual is being served by a licensed or certified provider.
Reporting/notification should occur as soon as possible but no later
than 4 hours after the incident occurred. Written reports are to be
submitted no later than 3 p.m. the day following the incident.

85. What is an MUI?
85
 An MUI includes, but is not limited to, the following:
Abuse
 Physical - Physical force that can reasonably be
expected to result in harm or serious physical harm.
Examples of physical abuse include hitting, slapping,
pushing, throwing objects at a person and others.
 Sexual - Unlawful sexual conduct or sexual contact as
defined in 2907.01 of the ORC. Verbal - Using words
or gestures to threaten, coerce, intimidate, harass or
humiliate an individual.

86. 86
 Physical Abuse Example
 Peter is on a homecare waiver. A staff member observed him
being hit by his care worker. If the staff person hitting caused
harm, the county board and law enforcement needs to be
notified immediately.
 Sexual Abuse Example
 Steve is well known by staff in the workshop to be a sexual
predator and is to have “eyes-on supervision.” Two staff
intervened in a behavioral episode with other clients, which gave
Steve the opportunity to slip into the bathroom and fondle Larry.
 This would be an MUI if it was unwanted, not consensual sexual
contact. Staff was failing to provide supervision. (How many
MUI’s? Two. Two victims - two primary people involved)

87. 87
 Verbal Abuse Example
 The consumer wet the bed. Staff yelled, “I’m tired
of this-this better not happen again.” The consumer
reported that her feelings were hurt.
 This would be an MUI if the consumer felt
threatened, humiliated or intimidated.

88. 88
 Attempted Suicide – Actual physical attempt –
regardless of whether harm resulted.
 Attempted Suicide Examples
 An individual attempts to commit suicide by taking a
bottle of pills. The pills turn out to be placebos and the
individual suffers no physical harm.
 An individual attempts to commit suicide by cutting their
arm. Seven stitches are required to treat the wound.

89. 89
 Death – Any cause.
 Exploitation – Unlawful or improper acts using an individual or an
individual’s resources for monetary or personal benefit, profit or
gain.
 Failure to Report – A person, who is required to report pursuant to
section 5123.61 of the Revised Code, has reason to believe that an
individual has suffered or faces a substantial risk of suffering any
wound, injury, disability, or condition of such a nature as to
reasonably indicate abuse or neglect of that individual, and such
person does not immediately report such information to a law
enforcement agency, a county board, or, in the case of an individual
living in a developmental center, either to law enforcement or the
department.

90. 90
 Known Injury – Injury from a known cause that is not considered
abuse or neglect and that requires immobilization, casting, five or
more sutures or the equivalent, second or third degree burns, dental
injuries, or any injury that provides the individual from participating
in routine daily tasks for more than two consecutive days.
 Law Enforcement – An incident that results in an arrest, filing of
charges or incarceration.
 Law Enforcement Example
 The county board should be notified immediately for abuse/neglect, theft,
accidental or suspicious death, missing person or serious injury.
 Medical Emergency – Emergency medical intervention is required to
save an individual’s life.
 Medical Emergency Example
 Heimlich maneuver, CPR, intravenous fluids given due to dehydration

91. 91
 Misappropriation – Depriving, defrauding, or obtaining by
any other means the real or personal property of an
individual by means prohibited by the ORC.
 Missing Person – The individual cannot be located for a
period of time longer than specified in the individual service
plan and the individual cannot be located after actions
specified in the individual service plan are taken and the
individual cannot be located in a search of the immediate
surrounding area; or circumstances indicate that the
individual may be in immediate jeopardy; or law
enforcement has been called to assist in the search for the
individual.

92. 92
 Neglect – When there is a duty to do so, failing to provide
an individual with any treatment, care, goods, supervision or
services necessary to maintain health and safety.
 Neglect Example
 A child at a swimming pool jumped into the deep end by
mistake. The lifeguard rescues the child.
 This would be an MUI if there was a failure to supervise and/or if a
medical emergency occurred.
 Peer-to-Peer Acts – Acts committed by one individual
against another when there is physical, verbal or sexual
abuse; any exploitation; or intentional misappropriation of
property of significant value.

93. 93
 Prohibited Sexual Relations – An employee engaging in
consensual sexual conduct/contact with an individual they
are employed to provide care at the time of the incident
and includes persons in the employee's supervisory chain of
command.
 Rights Violation – Any violation of rights that creates a
reasonable risk of harm to the person’s health or safety. Did
the act negatively create risk to the individual’s health
and/or safety?
 Rights Violation Examples:
 The individual sustains food poisoning after staff inadvertently serves
the individual moldy bologna.
 Staff padlocks the refrigerator. The individual sustains laceration
trying to break the lock.

94. 94
 Unapproved Behavior Support – The use of any aversive behavior
strategy or intervention implemented without appropriate approvals
or without informed consent.
 Unknown Injury – Any injury of an unknown or suspicious origin that
requires treatment by a physician, physician assistant, or nurse
practitioner or any injury of a known or non-suspicious origin that
has a significant impact on their physical health.
 Unscheduled Hospital Admission – Any unplanned or unscheduled
hospital admission (not expected as a part of a person’s medical
condition. Not included in ISP under specific criteria as to when
person would be admitted).

95. Notification and Reporting Requirements
for MUIs95
 All incidents of possible abuse must be reported to
local law enforcement and to the county board or to the
public children’s service agency, when applicable, no
matter where the incident occurred. The county board
has the responsibility of reporting incidents on the
ODDD on-line incident tracking system (ITS).
 All MUIs involving abuse, neglect, exploitation,
misappropriation or death must be reported/filed no
matter where the incident occurred.

96. 96
 Other categories of MUIs must be reported according to
5123:2-17-02 when the incident occurred in a program
operated by a county board or when the individual is being
served by a licensed or certified provider. The provider
must notify the County Board of DD.
 Whenever an MUI occurs, first and foremost, measures to
ensure the health and safety of the individual must be taken.
This may include:
 Medical care
 Removal of an employee from direct contact with an at-risk
individual when the employee is alleged to have been involved in
the abuse or neglect
 Any other appropriate measures to protect the health and safety
of the individual

97. MUIs must be reported to the ODDD
under any circumstances listed below97
 5123:2-17-02 (I) Department-directed Investigations
 (1) The department shall conduct the administrative investigation when the MUI includes an allegation against:
 (a) The superintendent of a county board or developmental center.
 (b) The executive director or equivalent of a regional council of governments.
 (c) A management employee who reports directly to the superintendent of the county board, the superintendent of a developmental
center, or executive director or equivalent of a regional council of governments.
 (d) An investigative agent.
 (e) A service and support administrator.
 (f) An MUI contact employed by a county board.
 (g) A current member of a county board.
 (h) A person having any known relationship with any of the persons specified in paragraph (I)(1)(a) to (I)(1)(g) of this rule when such
relationship may present a conflict of interest or the appearance of a conflict of interest.
 (i) An employee of a county board when it is alleged that the employee is responsible for an individual’s death, has committed
sexual abuse, engaged in prohibited sexual activity, or committed physical abuse or neglect resulting in emergency room treatment
or hospitalization.
 (2) A department-directed investigation or investigation review may be conducted following the receipt of a request
from a county board, developmental center, provider, individual, or guardian if the department determines that
there is a reasonable basis for the request.
 (3) The department may conduct a review or investigation of any MUI or may request that a review or investigation
be conducted by another county board, a regional council of governments, or any other governmental entity
authorized to conduct an investigation.

98. 98
If the provider has received
inquiries from the media
regarding an MUI, the
provider must immediately,
but no later than four hours
after discovery of the
incident, notify the county
board by means identified
by the county board.

99. Investigation Requirements
 All MUI’s require an investigation that meet the
requirements outlined in Appendix A or Appendix B
of 5123:2-17-02. Each county board is required to
employ at least one investigative agent or contract
with a person or governmental entity for the
services of an investigative agent. This person must
be appropriately certified by ODDD.
99

100. Required Reading
 Required Reading
General Investigation
Requirements
100

101. Investigation Closure
 Written Summaries
 Must be submitted five calendar days after recommendation made that the report
be closed. This must include:
 Allegations
 Facts & findings
 Whether or not the case was substantiated
 Preventive measures required, if applicable
 The summary is to be provided to:
 The individual or his or her legal guardian or an advocate selected by the individual
 The licensed or certified provider
 The service and support administrator or other person chosen by the individual to coordinate
services
101

102.  In the case of death, the written summary is to be given to the family, upon request
 The summary is NOT to be given to the PPI, the PPI’s spouse, or the PPI’s significant
other.
 The PPI is to be notified as to whether the MUI was substantiated, unsubstantiated
due to insufficient information or unsubstantiated due to being unfounded
 If no SSA is assigned to the individual, a county board designee is to be
assigned responsibility for ensuring any preventive measures in the summary
are implemented unless the individual resides in an ICF/MR.
 Any findings in the report may be disputed by following the guidelines
found in 5123:2-17-02.
102

103. Review of MUIs
 County boards and agency providers must have a written procedure in
place for internal review of all MUIs and for reasonable steps to prevent
MUIs.
 An individual’s team is required to collaborate to develop preventive
measures for future MUIs.
 The ODDD has the responsibility to review and close reports submitted by
the county board or developmental center for such incidents as abuse,
death, neglect and others as required by rule 5123:2-17-02.
 The county board has the responsibility to review and close reports for
incidents such as attempted suicide, medical emergencies and others as
required by rule 5123:2-17-02.
103

104.  The department and the county board both use the following criteria when
determining whether or not to close a case:
 Have sufficient reasonable measures have been taken to ensure the health and safety of any at-risk
individual
 Has a thorough investigation has been conducted consistent with the standards for protocol and non-
protocol investigations
 Has the team, including the county board and provider, collaborated on developing preventive
measures to address the causes and contributing factors
 Has the county board ensured that the preventive measures have been implemented to prevent
reoccurrence
 Is the incident part of a pattern or trend or does it require some additional action
 Have all requirements in statute or rule been satisfied.
 No later than five days after a case is closed, the county board is to notify the
provider that the case was closed.
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105. Patterns and Trends
 County boards are required to conduct quarterly and annual reviews of
MUIs to look for trends and patterns, analyze the data and develop
preventive measures to address any identified trends or patterns to prevent
reoccurrence.
 This analysis is submitted to the ODDD twice a year, per rule. Any trends or
patterns related to any individual must also be addressed in that person’s
individual plan.
 Each county board must have a committee that reviews trends and patterns
and to identify areas for improving the quality of life of individuals
supported in the county.
105

106. Unusual Incidents
What does Unusual Incident (UI) mean?
 An unusual incident is an event or occurrence involving an individual that is
not consistent with routine operations, policies and procedures, or the care
or individual service plan of the individual, but is not an MUI. Unusual
incidents include, but are not limited to:
 Medication errors
 Falls
 Peer-to-peer incidents that are not MUIs
 Overnight relocation of an individual due to fire, natural disaster, or mechanical
failure
 Any injury to an individual that is not an MUI
106

107.  Each agency provider and county board must develop and implement a
policy and procedure that:
 Identifies what is to be reported as a UI including those defined by rule
 Requires anyone who becomes aware of a UI to report it to the person designated
by the provider who can initiate proper action
 Requires the report to be made no later than twenty-four hours after the occurrence
of the incident
 Requires appropriate actions be taken to protect the health and safety of any at-risk
individuals
 Staff are to be trained and knowledgeable regarding the policy and
procedure. Notification procedures and timelines are to be followed by
staff.
107

108.  UIs are to be reviewed as necessary, but no less than monthly, to ensure
appropriate preventive measures have been implemented and trends and
patterns identified and addressed as appropriate. A log of all UIs must be
maintained and must include, but not be limited to, the name of the
individual, a brief description of the incident, any injuries, time, date,
location, and preventive measures. These logs are to be reviewed at least
monthly by the appropriate agency per rule 5123:20-17-02 guidelines.
 UI reports, documentation of identified trends and patterns, and corrective
action must be available to the county board and ODDD upon request.
 The ODDD conducts reviews of county boards and providers as necessary
to ensure the health and safety of individuals and compliance with the
requirements of this 5123:2-17-02.
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109. Training Regarding MUIs and UIs
 All staff of agency providers and county boards are to be trained regarding the
identification and reporting of MUIs and UIs and other requirements of 5123:2-17-02, in
accordance with all provisions of 5123:2-17-02, prior to unsupervised contact with any
individual and in all cases, no later than thirty calendar days after employment. Thereafter, all
employees are to receive training during each calendar year which includes a review of
health and safety alerts released since the previous calendar year’s training.
 All agency providers and county boards are to ensure that all staff responsible for
administrative compliance with this rule receive training on all applicable requirements of this
rule at the time of employment or no later than ninety calendar days from the time of
employment and each calendar year thereafter.
 The county board is to ensure that staff responsible for conducting investigations receive initial
and annual department-approved training. The department provides technical assistance and
training to providers and county boards as necessary. The department will periodically
monitor compliance with the provisions of this rule.
109

110. MUI/UI Summary
 MUIs and UIs are reported to protect individuals with developmental
disabilities -- to ensure their health and safety. By reporting each and
every MUI and UI, the cause, factors or trends leading to an incident can
more easily be identified. Plans and safeguards can then be established or
revised to prevent future incidents.
 It is the responsibility of all staff who work with persons with mental
retardation and developmental disabilities to be able to recognize and
identify MUIs and UIs and to know what actions they are required to follow
to report such incidents. When in doubt that an incident is a UI or MUI
document the incident as if it is a UI or MUI.
 Review your agencies policies and procedures on MUIs and UIs and become
familiar with reporting procedures and forms.
110

111. Required Reading
 Required Reading
 5123:2-17-02 Incidents
adversely affecting
health and safety.
111

112. Overview of Individual Options
and Level One Waivers
 What is a Waiver?
A waiver is a part of a state’s Medicaid State Plan. It is an exception to the Medicaid
legislation that is granted to a state by the federal Centers for Medicare and Medicaid
Services allowing the state to waive some of the requirements of Medicaid. To gain approval,
waivers must be cost effective, efficient, and consistent with the objectives of the Medicaid
program. Waivers serve people who are elderly, who have mental retardation and/or
developmental disabilities and/or who have physical disabilities. The purpose of waivers is to
keep people living in their own homes rather than moving to more expensive options such as
nursing homes or intermediate care facilities.
Waivers are one of the optional benefits that states may choose to offer through the Medicaid
State Plan as an alternative to institutional care. Through this option, Ohio’s State Plan offers
Home and Community-Based Services Waivers (HCBS). These waiver programs provide
alternatives to living in facility-based care settings such as a nursing home or intermediate
care facility for the mentally retarded (ICFMR). Because this type of care can be costly, Ohio's
Medicaid program can help Medicaid-eligible Ohioans pay for their long-term care.
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113.  Waiver programs were first authorized in 1981 under section 1915c of the Social
Security Act. The first time these waivers became available in Ohio was July 1991.
This first waiver was called the Individual Options waiver and is one of the two
waivers available today in Ohio. The second waiver to become available is the
Level One waiver that began in 2003. Waivers are available on a limited basis,
based on available funds and meeting eligibility requirements.
 Since waivers are a part of Medicaid, they are administered by the same agencies
as the overall Medicaid program. At the Federal level, Medicaid is administered by
the U.S. Department of Health and Human Services, Centers for Medicare and
Medicaid Administration (CMS). In Ohio, the Medicaid program is administered by
the Department of Jobs and Family Services (ODJFS). Other agencies administer
specific Medicaid programs through interagency operating agreements with ODJFS.
ODJFS applies for all HCBS waivers and sets parameters for waiver programs.
113

114.  The ODDD Eligibility Unit, Division of Medicaid Administration and
development processes all waiver applications and determines level of care
for HCBS waivers. County Boards of DD administer HCBS waivers as
defined in ORC Section 5126.055. There is an annual renewal process for
continued waiver services and individuals enrolled on waivers must meet
Medicaid eligibility requirements every month.
 Before waiver services can be provided an authorization for waiver
services must be secured. This process authorizes the ISP and associated
payment. Why is authorization of waiver services important? The result
specifies how much of what services an individual will receive, when, and
according to what parameters. The process associated with the
authorization of waiver services includes allocation of state and local
resources for the reimbursement of services provided.
114

115.  Individuals who have been approved to receive waiver services will choose their service
provider through the Free Choice of Provider Process. It is the responsibility of the service and
support administrator to assist individuals in the selection of service providers. Service
providers must be certified through the ODDD. Per 5123:2-9-11 of the Ohio Administrative
Code, which has details about the Free Choice of Provider Process, “An individual shall be
responsible for making all decisions regarding free choice of providers unless the individual
has a guardian, in which case the guardian shall be responsible for making such decisions.
Individuals, including those with guardians, have the right to participate in decisions regarding
the free choice of providers. An individual who does not have a guardian or an individual's
guardian may designate another person, including a member of the individual's family, to
participate in the process of making decisions regarding free choice of providers…”
 Other details available in this rule include such areas as the requirement for ODDD to
maintain a current provider list and details on the requirement that SSAs must utilize this list to
assist individuals when selecting providers.
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116. Individual Options Waiver
(IO Waiver)
 Waiver services provide certain Ohio citizens the training and support that they need in
addition to the Medicaid State Plan services that they can receive. Medicaid State Plan
services are often called ‘Medicaid Card’ services and include prescription medication,
hospital care, physician visits and other healthcare services.
 Waiver services allow a limited number of people who meet certain conditions to stay in their
own homes and receive services there and in the community instead of living in an
Intermediate Care Facility for the Mentally Retarded (ICF/MR). To receive IO waiver services,
an individual must be eligible for Medicaid and have an ICF/MR Level of Care approved by
the Department of Job and Family Services.
 As of 2008, all 88 counties have individuals enrolled on the IO waiver with approximately
12,000 individuals enrolled across the state.
 The average cost in 2008 of Individual Options waiver services per person is approximately
$47,000 while the
average cost of ICF/MR services per person is approximately $90,000. Not only does an
individual benefit from staying in their own home, but a significant cost savings can be gained.
116

117.  Service and Support Administrators (SSAs) who work in each county board of
mental retardation and developmental disabilities will assist individuals to apply for
Medicaid and complete their Level of Care paperwork. Through the individual
planning process, with help from the SSA and input from professionals and service
providers, each individual, his/her family and advocates will determine which
services are needed, how often they are needed, where they will be provided and
who will provide them.
 The funding ranges and payment amounts that will be available to an individual for
the IO waiver funded portion of these services are based on the needs of each
individual as measured by the Ohio Developmental Disabilities Profile (ODDP). The
Acuity Assessment (AAI) is also used to determine a waiver budget amount if an
adult needs out of home day services through the waiver.
117

118. The IO waiver provides the
following services:
 Adult Day Services
These services are available to individuals who are not eligible to receive
educational services. Adult Day Services include:
 Adult Day Support
These services are provided separate from any home or facility in which an individual
resides, focus on non-work activities, and include five components:
 Assessment -- may be formal or informal, for the purpose of developing an Individual Service Plan
(ISP)
 Personal care -- includes personal hygiene, eating, communication, mobility, toileting, and dressing
 Skill reinforcement -- includes implementing behavioral intervention plans, and help with the use of
communication and mobility devices
 Training in self-determination -- includes developing self-advocacy skills and acquiring skills that
enable an individual to become more independent
 Recreation and leisure -- includes supports identified in the ISP that are therapeutic, and help to
develop and maintain social relationships and family contacts
118

119.  Vocational Habilitation
These services teach and reinforce concepts related to work
such as:
 * Responsibility
 * Attendance
 * Task completion
 * Problem Solving
 * Social Interaction
 * Motor skill development
 * Safety
119

120.  Supported employment
 Supported Employment – Community
 This service provides job coaches, supervision and training to help individuals
find and keep paying community jobs at places where persons without
disabilities are employed and to work side-by-side with them.
 Supported Employment – Enclave
 This service provides job coaches, supervision and training to help individuals
who work as a team to find and keep paying jobs at one or more work sites
of the ‘host’ community business.
 Non-Medical Transportation
This service pays for transportation needed by an individual to get to and from
places where he/she receives Supported-Employment – Community, Supported
Employment – Enclave, Adult Day Services and/or Vocational Habilitation
waiver services.
120

121.  Environmental Accessibility Adaptations
 This service includes changes to the individual’s home that help him/her to be more
independent. The modifications may include widening doorways, building ramps into
the home, changing bathrooms for individuals who use wheelchairs or other aids to
walk, and installing special electric or plumbing changes needed to operate medical
equipment.
 Home Delivered Meals
 Preparation and delivery of up to two meals each day, seven days per week is
provided for individuals who are unable to make their own meals or get healthy
meals for themselves in some other way.
121

122.  Homemaker/Personal Care
Services are provided to increase the independence of the individual within his/her home or
the community and may include:
 Basic personal care and grooming such as bathing, hair care and help dressing;
 Assisting the individual going to and/or using the bathroom;
 Help with household chores for the individual, such as changing bed linens and doing the
laundry, so the individual remains in good health and is comfortable;
 Helping the individual take his/her medication or perform health-related tasks that have
been delegated by the individual’s physician and a licensed nurse;
 Helping the individual to prepare shopping lists, to make meals, to shop in the community
for food and clothing;
 Assisting the individual to go to medical appointments, to use community services, to take
walks and participate in recreational activities inside and outside the home;
 Cooking meals with the individual or for the individual;
 Assisting the individual to get to and from work and other vocational activities;
 Running errands on behalf of the individual, such as picking up medication from the drug
store.
122

123.  Interpreter Services
People who provide this service help the individual to communicate his/her
messages and feelings and understand the messages of others.
 Nutrition Service
A nutritionist provides direction to individuals who are at risk because they a not
eating the right kinds of foods to stay healthy. The service can be used to prepare
a plan for healthy eating and can also be used to teach the individual, family or
others who help with meals.
 Respite Care
Services are provided to individuals for a short period of time in an ICF/MR and/or
other home licensed by the Department of DD in order to give persons who care for
them a break. Respite services are also available when caregivers are unable to
provide care because of their illness or absence
123

124.  Social Work & Counseling
Professional help is provided to assist individuals and their families to solve
problems and gain social skills that will help the individual to have a better life in
the community.
 Specialized Adaptive or Assistive Equipment and Supplies
Services include devices, controls, appliances, supplies and/or other equipment that
an individual needs to do everyday activities or to communicate his/her needs. The
waiver pays for items that cannot be paid for through the Medicaid State Plan.
 Supported Employment – Adaptive Equipment
Payment can be made to buy or modify equipment that will be owned by an
individual who is receiving Supported Employment – Community or Supported
Employment – Enclave and that the individual needs to get and/or keep his/her
job.
 Non-Medical Transportation
Payment can be used to help individuals get to and from waiver services or other
community services, activities or resources.
124

125. Level One Waiver
 The Level I Waiver is for people with developmental disabilities. Like the IO
waiver, this waiver is also intended to allow people to stay in their own
homes rather than live in an ICFMR.
 This waiver is for people who require the care given in an Intermediate
Care Facility for the Mentally Retarded (ICFMR) but want to live at home
and who have a network of families, friends, neighbors and professionals
who can safely and effectively provide the needed care.
 The cost for this help cannot be more than the Level I Waiver allows.
125