(B)
Definitions.
(1) "Acknowledgment of
responsibility" means the document created between the Ohio department of
medicaid (ODM) or its designee and an individual enrolled in the program that
identifies the interventions recommended by the recovery manager to remedy
risks to the health and welfare of the individual.
(2)(1)
"Adult Needs and Strengths Assessment (ANSA)"
(7/2016)
(8/2021) is
an integration information assessment tool for use in the development of
individualized person-centered care plans, to monitor outcomes, and to help
design and plan systems of care for adults with behavioral health challenges.
(3) "Alert" means an incident that
must be reported to ODM due to the severity and/ or impact on the individual
enrolled in the program.
(4)(2) "Authorized
representative" means a person the individual appoints to act on his or her
behalf in accordance with rule
5160:1-1-33
5160-1-33
of the Administrative Code.
(5)(3) "Clinical record"
is a record containing written documentation that must be maintained by a
service provider.
(4)
"Health and safety action plan" means the document
created between the Ohio department of medicaid (ODM) or its designee and an
individual enrolled in the program that identifies the interventions
recommended by the recovery manager to remedy risks to the health and welfare
of the individual.
(6)(5) "Home and
community-based services (HCBS) setting" has the same meaning as set forth in
rule
5160-44-01
of the Administrative Code.
(7)(6) "Incident" means an
alleged, suspected or actual event that is not consistent with the routine care
of and/or service delivery to an individual as set forth in rule
5160-43-06
5160-44-05 of the Administrative Code. Incidents
include, but are not limited to abuse, neglect, exploitation, misappropriation,
and inappropriate service delivery.
(8)(7) "Individual" means
a person who is pending enrollment or who is enrolled in the specialized
recovery services program and therefore is directed to adhere to the rules in
Chapter 5160-43 of the Administrative Code.
(9)(8) "Individualized
placement and support - supported employment (IPS-SE)" means the implementation
of evidence-based practices allowing individuals to obtain and maintain
meaningful employment by providing training, ongoing individualized support,
and skill development to promote recovery. IPS-SE is an evidence based practice
which is integrated and coordinated with mental health treatment and
rehabilitation designed to provide individualized placement and support to
assist individuals with a severe and persistent mental illness to obtain,
maintain, and advance within competitive community integrated employment
positions.
(10)(9) "Legally
responsible family member" means an individual's spouse, or in the case of a
minor, the individual's birth or adoptive parent.
(11)(10) "Peer recovery
support" means a service that provides community-based supports to an
individual with a mental illness with individualized activities that promote
recovery, self-determination, self-advocacy, well-being and independence
through a relationship that supports the person's ability to promote his or her
own recovery. Peer recovery supporters use their own experiences with mental
illness to help individuals reach their recovery goals.
(12)(11)
"Person-centered
care
service plan" means a
person-centered plan
document that identifies goals, objectives, and
interventions selected by the individual. The plan identifies and addresses the
assessed needs, services, and supports of the individual and is developed in
accordance with
42 CFR
441.725(a) (as in effect on
October 1, 2020).
(13)(12) "Provider" means
a person or entity who has a provider agreement with ODM and who delivers a
specialized recovery services program service, any other service provider that
is directed to adhere to this rule, and all of their respective staff who have
direct contact with individuals.
(14)(13) "Provider
occurrence" means any alleged, suspected or actual performance or operational
issue by a provider furnishing program services that does not meet the
definition of an incident as set forth in this rule. Provider occurrences
include, but are not limited to, alleged violations of provider eligibility
and/or service specification requirements, and billing issues including
overpayments and medicaid fraud.
(15)(14) "Recovery
management" means the coordination of all specialized recovery services program
services received by an individual and assisting him or her in gaining access
to needed medicaid services, as well as medical, social, educational, and other
resources, regardless of funding source.
(16)(15)
"Recovery manager" means the person responsible for performing the needs-based
assessment and monitoring the provision of services included in the
person-centered
care
service plan to ensure the individual's needs,
preferences, health and welfare are supported as described in rule
5160-43-04
of the Administrative Code.
(17)(16) "Significant
change" means a variation in the health, care or needs of an individual that
warrants further evaluation to determine if changes to the type, amount or
scope of services are needed.
(18)(17) "Specialized
recovery services" means recovery management, peer recovery support and
IPS-SE.
(19)(18) "Specialized
recovery services program" means the home and community-based services (HCBS)
program jointly administered by ODM and the Ohio department of mental health
and addiction services (OhioMHAS) or only
adminstered
administered by ODM to provide services to individuals
with qualifying diagnoses of severe and persistent mental illness or diagnosed
chronic conditions.
(20)(19)
"Trans-disciplinary care team" or "care team" means the group of persons freely
chosen by the individual to assist and support him or her in the collaboration
of creating and implementing a person-centered
care
service plan. The
team is led by the individual where possible and must include a recovery
manager. It may also include, but is not limited to, the individual's friends,
family and natural supports, the physician(s) and other professionals and
providers.