RVI is reaearching the use of interior and exterior cameras.
If you have a system in place at your facility, could you tell me:
What areas are covered?
The basics on how they work - do they record and if so, for how long?
What would you do differently?
Anything else I should know?
Thanks!
Brenda Smith
Riverview Industries

Question:  Is anyone billing the waiver for supported employment – community
employment with an individual who has an AAI grouping of a B?

An individual has been at a day hab site since October 2011.  He has an AAI
ratio of a B (1:6).  His span date is October 2011 – October 2012.  His day
waiver ceiling is $17,940.

He has obtained a community employment job 1 day a week for 5 hours a day and
wants to access job coaching services for the entire 5 hours.  He will be
quitting his day hab site.

Questions
1. Do the AAI groupings (A, A-1, B C) apply to someone receiving supported
employment – community employment services in which the individual WILL have a
staff with them on the job?
2. What is the budget limitation for someone receiving supported employment –
community employment services?  Is it based on the AAI rating?  The rule
5123:2-9-19 is very inconsistent about when the AAI must be applied (see
comments below)

Below are excerpts of the payment rule that I am trying to apply to this
scenario:

5123:2-9-19HCBS waivers - payment standards for adult day support, vocational
habilitation, supported employment-enclave, supported employment-community, and
non-medical transportation.

"Budget limitation" means the funding amount available to enable each individual
to receive adult day support, vocational habilitation, supported
employment-enclave, and supported employment-community services within each
waiver eligibility span (supported employment-community employment is included
in this definition).  A separate annual budget limitation amount will be
established to enable each individual to receive non-medical transportation
services to access adult day support, vocational habilitation, supported
employment-enclave, and supported employment-community services within each
waiver eligibility span.

"ODMRDD acuity assessment instrument" means the standardized instrument utilized
by the department to assess the relative needs and circumstances of an
individual compared to other adults in a non-residential setting when receiving
adult day support, vocational habilitation, and supported employment-enclave
services (does not include supported employment - community employment. Scores
resulting from administration of the ODMRDD acuity assessment instrument have
been grouped into ranges and subsequently linked with staffing intensity ratio
expectations that result in four payment rates that have been calibrated on
group size.

"Staff intensity" means the minimum portion of time, as calculated in decimals
and reflected in appendix D to this rule, that one direct services staff
position is required to provide adult day support, vocational habilitation,
and/or supported employment-enclave services to an individual (does not include
supported employment-community employment. When determining that an individual
received a sufficient number of direct services staff are available to provide
services at the staff intensity ratio indicated by his/her each individual's
ODMRDD acuity assessment score, a certified provider may use the average of the
staff to individual ratios at which each discrete waiver service was provided to
the individual during one calendar day. For purposes of determining this
average, a provider may combine the time spent providing adult day support and
vocational habilitation services to an individual during the span of service
delivery time that occurred in one calendar day aggregate the staff intensity
ratio needs for all waiver enrollees and non-waiver enrollees receiving services
in one service delivery location during one calendar day.

(E) Acuity assessments, staff intensity group assignments, and budget
limitations
(1) SSAs employed by county boards shall review and approve information
contained on the ODMRDD acuity assessment instrument for each waiver enrollee
for whom adult day support, vocational habilitation, supported
employment-enclave, or supported employment-community services have been
authorized through the individual planning process that is submitted to the
department (AAI now includes supported employment-community employment). 
Application of the ODMRDD acuity assessment instrument ensures that similarly
situated individuals have access to comparable waiver services reimbursed in
accordance with this rule on a statewide basis.

(3) The score resulting from administration of the ODMRDD acuity assessment
instrument will result in the assignment of the individual by the SSA to one of
four groups that correlate with the staff intensity ratios required. These group
assignments will be applied to determine the rates paid when individuals receive
adult day support, vocational habilitation, and/or supported employment-enclave
services only(does not include supported emplotyment-community employment). The
scores and related staffing calculations are contained in appendix D to this
rule.

(4) Following assignment of the individual to one of four staff intensity
groups, the SSA will determine the budget limitations for individuals receiving
adult day support, vocational habilitation, supported employment-enclave, or
supported employment-community services. The budget limitations are contained in
appendix B to this rule (It now includes supported employment-community
employment).

(F) Calculation of budget limitations
(1) The budget limitations for adult day support, vocational habilitation,
supported employment-enclave, and/or supported employment-community services, as
reflected in appendix B (Appendix B budget lomotations includes group A, A-1, B,
C categories AND the budget lomotations includes supported employment-community
employment)to this rule, have been determined by use of a projected service
utilization of two hundred forty days per year multiplied by 6.25 hours of
attendance each day multiplied by four fifteen-minute units per hour to obtain
the maximum base of six thousand fifteen-minute units of service that may be
received per person per twelve-month waiver eligibility span.

(2) ISPs shall indicate the staff intensity ratios at which adult day support,
vocational habilitation, and supported employment-enclave services are to be
delivered, as defined in appendix D (does not include supported
employment-community employment) to this rule . When a waiver enrollee receives
one or more of these services in a group setting with one or more individuals
who do not receive waiver services, the staff intensity ratios of the non-waiver
enrollees shall be identified through the ISP development process applicable to
them. Providers are not required to use, but may use, the ODMRDD acuity
assessment instrument to determine the staff intensity ratios of non-waiver
enrollees.

(3) The county board shall determine whether the annualized cost for adult day
support, vocational habilitation, supported employment-enclave, and/or supported
employment-community services can be met by or exceeds the assigned budget
limitation for the individual.

(I) Group size, billing units, and payment conditions
When an individual has been assigned to a staff intensity group for the purposes
of receiving adult day support, vocational habilitation, and/or supported
employment-enclave services, billing must correspond to the rates assigned for
that group (does not include supported employment-community employment).

5123:2-9-19 APPENDIX D Page 1
STAFF INTENSITY RATIOS
The ODMRDD Acuity Assessment score determines the amount (intensity) of direct
services staff time required by each individual when receiving Adult Day
Support, Vocational Habilitation, and/or Supported Employment-Enclave services
(does not include supported employment-community employment).

PAR is seeking nominations for the following award categories.

Nominations are open to anyone and they are due by the close of the day on
September 7, 2012. Awards will be given out at the PAR/OSDA conference - Synergy
on October 3-5. The nomination forms can be located at: www.par-ohio.org then go
to the forms tab, then you will see PAR Award Nominations or PAR Ohio
Scholarship applications.

Thanks

Steve Oster, PAR Executive Director

LIFETIME ACHIEVEMENT AWARD
This award is given to an individual who has dedicated their life to the field
of developmental disabilities.
Previous winners include:
2011 - Jed Morison
2010 - Gary Tonks
2009 - Jody Harris
2008 - Donna Maloney & Sara Haag
2007 - Dan Housepian
2006 - Kim Linkinhoker
2005 - Patricia Keel
2004 - Bob Morgan & Virginia Mitchell
2003 - Cheryl Phipps
2002 - Mary Mihelcic-Jones

INDIVIDUAL OF THE YEAR AWARD
This award is given to an individual with a developmental disability who has
excelled in their life and made an impact on others.
Previous winners include:
2011 - John Hannah
2010 - Christine Brown
2009 - John G. Gillespie
2008 - Bryan Grubb

PAR FOR EXCELLENCE
This award is given to a manager, supervisor or direct care staff that has
devoted their life to serving individuals in the DD field, played a role in
training of staff and has been involved with PAR during their career.
Previous winners include:
2011 - Jeannie Stahl
2010 - Nancy Richards
2009 - Bethany Schultz
2008 - Randy Shively
2007 - Jackie Rhodes
2006 - Ken Miller

YOU MAKE A DIFFERENCE AWARD
This award is given to a person that truly is making an impact or difference in
the field of Developmental Disabilities.
Previous winners include:
2011 - Winnie Hosking
2010 - Robin Trocki
2009 - Director John Martin
PAR'tnering AWARD
This award is given to an individual or organization that provides a positive
collaboration to PAR and supports PAR's mission.
Previous winners include:
2011 - Cuyahoga County Board of Developmental Disabilities & Jim Watson
2010 - Leeda NE, Inc
2009 - Summit Board of Developmental Disabilities
2008 - Hamilton County Board of Developmental Disabilities
2007 - Center for Marketing and Opinion Research

PAR MEMBER OF THE YEAR
This award is given to an individual that belongs to PAR and show a commitment
to PAR and its mission.
Previous winners include:
2011 - Gail Porter & Debra Yates
2010 - Anna Markley & Lynn Franklin
2009 - Dawn Petrick
2008 - Brenda Watts
2007 - Kelly Lebo
2006 - Barrett Nefores
2005 - Marjorie Munson
2004 - Ken Miller
2003 - Don McElvain
2002 - Pat Keel
2001 - Erick Berquist

PAR MEMORIAL SCHOLARSHIP
This award is sponsored by Champaign Residential Services, Inc. and is given to
an individual or staff person to upgrade their professional skills in the area
of developmental disabilities. Up to $200 per person can be awarded for the
scholarship and will be given after proof of the course is taken.
2011 - Theresa Vernon & Kelly Dingman
2010 - Wendy Gorrrell & Dolly Brumage
2009 - Dawn Joiner
2008 - Pat Russell
2007 - Corliss Mayle
2006 - Morgan Seymour
2004 - Jean Fish
2003 - Joelyn Karlson

We have a situation currently in which an individual has decided to remove his
g-tube and refuses to have it replaced.  He has had multiple swallowing
evaluations which indicate that eating by mouth puts him very much at risk. 
However, over time the physician has allowed him 3 very small oral feedings/day
if liquids are thickened and food pureed.  He would like to eat normal food and
liquid without these restrictions.  For now, we are operating under orders for
thickened/pureed but it is possible that he will very soon have a physican's
order for normal feedings.  Being that we provide services in a workshop
setting, under Waiver Rules, billing Medicaid,and knowing that his health is at
extreme risk (while recognizing that he is able to make this choice), what is
our liability if we allow him to eat regularly in the workshop (under
physician's order)?  Has anyone dealt with a similar situation?

Thanks!

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