BEST PRACTICE MANUAL
1. Initial Services
    A. Initial Contact for Services ? Supported Living Services ? Seven (7) Quality Indicators ? Waiver Services ? Official Waiver File Information
    B. File Review Checklist
    C. Waiver Assurances Checklist
    D. How do I know an Individual will be on a Waiver?
 
2.  Who Goes on a Waiver?
    A. Why Choose a Waiver?
    B. Ohio Department of DD “W is for Waiver” booklet
 
3.  Initial Waiver Enrollment
    A. Why Enroll Someone on a Waiver?
    B. Initial Waiver Enrollment Intro ? HCBS Waiver Enrollment
    C. Freedom of Choice Form
    D. Intake/Transfer Checklist Fair Hearing Requirements
    E. File Review Checklist
    F. JFS Form 02399 Instructions
    G. JFS Form 02399
    H. JFS Form 07200 and Instructions
 
4.  Choosing a provider
    A. Choosing a Provider
    B. Annual Notification of Free Choice of Provider form
    C. Provider Selection Flow Chart
    D. Request for Provider Interest (RFI) ? Individual Profile Form
    E. Sample RFI and Individual Profile Forms
    F. Service Provider Interview Guide
    G. Comparing Service Providers
 
5.  Becoming a Provider
    A. Introduction
    B. Letter from Ohio DODD re: New Provider Certification Process/Rule
    C. Certification Renewal Form
    D. https://doddportal.dodd.ohio.gov/forms/Pages/defaults.aspx
    E. http://www.dodd.ohio.gov/rules/Pages/defaults.aspx
 
6.  Assessments
    A. Assessments
    B. ODDP …What, Why and How
    C. ODDP Handbook
    D. ODDP Instructions
    E. ODDP Profile
    F. Safety Assessment `     – Alone Time at Home
    G. Situational Safety Assessment
    H. Employability Assessment
    I. Functional Assessment
    J. Behavioral Risk Assessment: Transportation
    K. Acuity Assessment Instrument
    L. Remote Monitoring Assessment
 
7.  Level of Care
    A. Completion of LOC Packet ? Protective Level of Care Summary and Rule Cite PLOC Worksheet
    B. Functional Assessment – Ages 6-8
    C. Functional Assessment – Ages 9-11
    D. Functional Assessment – Ages 12-15
    E. Functional Assessment – Ages 16+
    F. Medical Evaluation
    G. Psychological Evaluation
    H. Freedom of Choice Form
    I. Initial LOC Application
    J. LOC Date Change Worksheet
    K. No Significant Change Form
    L. Significant Change Form
    M. Form 02399 – HCBS Referral
    N. Form JFS 07200 – Request for Cash, Food Stamps, Medical Assistance
    O. JFS Form 04074 – Notice of Approval Form
    P. Sample LOC Approval Letter
    Q. Redetermination Simplification & Efficiency Memo, dated 06-17-2009
 
8.  Payment Authorization for Waiver Services (PAWS)
    A. PAWS Process ? Helpful Hints for Residential Providers ? Helpful Hints for County Boards of DD
    B. Sample PAS Form
    C. Sample PAWS Confirmation Form
    D. Waiver Service Titles, Service Codes, Billing Units Tables - Individual Options Waiver
    E. Waiver Service Titles, Service Codes, Billing Units Tables - Level One Waiver
    F. Waiver Service Titles, Service Codes, Billing Units Tables - Adult Day Services
 
9.  Ohio DODD Administrative Rules
    A. Administrative Rules Introduction
    B. Administrative Rules Table of Contents
 
10.  Ohio DODD Contact Information
    A. Technical Assistance
    B. Electronic Resources and Support
    C. Eligibility Unit Contact Information
    D. Memo RE Communications Update from MDA dated 08-29-2008
    E. Waiver Assignments Spreadsheet
 
11.  Developing the ISP and Making Revisions
    A. ISP Description and Required Elements  ? Financial Information for ISPs ? Level of Service ISP Entry Examples ? ISP Level of Service Helpful Hints ? Billing Codes ? Quick Check for a Person-Centered Plan ? Quick Check for Person-Centered Agencies ? The ISP Meeting ? Guardian Consent DODD  ? Revisions ? ISP Revision Tips
  1. Due Process
  2. Due Process Overview
  3. Due Process Scenarios
  4. 4065 Decrease in HPC
  5. 7334 Denial of Increased Services
  6. 7334 Denial of Increased Services above Range
  7. 7334 Denial of Emergency Services
  8. 7334 Denial No Slots
    B. ISP Process Flowchart
    C. Self Determination Means…
    D. General Guidance/Revisions to ISP Memo from Ohio DODD
    E. Redetermination/Significant Change Procedures Memo from Ohio DODD
    F. Medical Add-On Assessment
 
12.  Skill Developments
    A. Skill Developments
    B. Skill Development Program form
    C. Skill Development Documentation Sheet (front and back)
 
13.  Adaptive and Assistive Equipment/Environmental Modificaitons
    A. Adapt and Assist Equip and Environmental Modifications
    B. Roster of Services Delivered form
    C. Verification of Environmental Modifications form
 
14.  Individual's Rights
    A. Individual Rights Introduction
    B. Bill of Rights
 
15.  Monitoring
    A. Monitoring of Services ? Why Monitor? ? How to Monitor ? Helpful Hints for Monitoring ? Quality Assurance Reviews
    B. ISP and Monitoring Procedure
    C. COG Quality Assurance and Provider Compliance Policy
    D. Universal ISP Monitoring Form (UMT)
    E. UMT - With Duplicated Pages
    F. UMT – Day Services Array
    G. Ten Day Check Form
    H. UMT – Limited Services
    I. Blank Main QA Report
    J. Blank ISP BSP Compliance Report
    K. Blank Limited QA Report
    L. Blank Individual Response to SSA Report
    M. Family-Guardian Survey
    N. Service and Support Administrator Survey
    O. Residential Provider Survey
    P. Blank ADS Vocational Habilitation QA Report
    Q. Blank Supported Employment QA Report
    R. Day Services Individual Satisfaction Survey
    S. Day Services Supervisor Survey
    T. Supported Employment Individual Satisfaction Survey

    U.

Daily Representative Survey
 
16.  Unusual Incidents/Major Unusual Incidents (UI/MUI)
    A. Clearwater COG Investigative Procedure Flowchart
    B. COG UUI/MUI Procedures Policy
    C. Ohio DODD Possible or Determined MUI Report Form
    D. Tips to Remember When Conducting MUI Analysis
    E. Blank Agency Provider Annual Analysis
    F. Sample Unusual Incident Log
 
17.  Behavior Supports
    A. Behavior Supports Introduction
    B. 5123:2-1-02 (J) Behavior Supports Policies and Procedures
    C. Basic Principles of Behavior Support
    D. Power Types
    E. Behavior Management Checklist
    F. Good Behavioral Assessments
    G. Aversive Interventions
    H. Behavior Support Resources List
    I. Behavior Support QA Survey
    J. Commonly Prescribed Psychotropic Medications
    K. Information Notice 08-11-03 RE: Prone Restraint
    L. Information Notice 08-11-04 RE: Prone Restraint for Licensed Residential Facilities, including ICF’s/MR
    M. Behavior Support Rate Modification fact sheet
 
18.  Notification of Individual Change in Status (NICS)
    A. NICS
    B. NICS Instructions
    C. NICS Form, Part 1
    D. NICS Form, Part 2
    E. Prior Notice of Right to a State (JFS Form 4065)
 
19.  Provider Billing
    A. Provider Billing Services FAQ ?  How do I Bill? ? How long will it take to get paid? ? Error ? PAWS over limit ? taxes ? restarting provider billing
    B. Security Affidavit Instructions
    C. Provider Billing Information at a Glance
    D. Verify Environmental Modifications form and Instructions
    E. Billing form for Environmental Modifications and Adaptive/Assistive Equipment
    F. JFS Denied Claims
    G. Rejected Claims FAQ
    H. Patient Liability Adjustments
    I. Various Adjustments Explanation
    J. Billing Agents List
    K. Billing Agents Request Form
    L. Change of Information Form
    M. Direct Deposit Form and Instructions
    N. Medicaid Waiver Billing Manual
    O. Billing Procedure/Supported Living Individual
  
20.  Room and Board
    A. Room and Board Explanation and Examples
    B. Clearwater COG Room and Board Guidelines  Rev 4/2011
    C. Individual Costs Paid by Room and Board ISP Attachment
 
21.  Adult Day Services Array
    A. Adult Day Support ? Vocational Habilitation ? Supported Employment ? Acuity Assessment Instrument (AAI) ?  Staff Intensity Ratio (SIR) ? Budget Limitations ? Helpful Hints
 
22.  Glossary of Acronyms
    A. Glossary/Acronyms Introduction
    B. Glossary of Acronyms
 
23.  Quality Assurance for Medication Administration and Health Related Activities
    A. List of Chapter Attachments
    B. Policy and Procedure for Quality Assessment and Compliance
    C. Notification for Referral form
    D. Blank Quality Assessment tool
    E. List of Documents Needed for RN QA Review
    F. Sample Medication Administration Record (MAR)
    G. Health Related Activities
    H. List of Nurses Who Can Provide Classes
    I. Family Delegation form
    J. Physician Visit form
    K. Blank Self-Administration Assessment form - General
    L. Blank Self-Administration Assessment form - G/J Tube
    M. Blank Self-Administration Assessment form - Glucometer

    N.

Blank Self-Administration Assessment form - Insulin Injections
    O. Memo from Ohio DODD 07-25-2008 re: Support for Medication Administration Rules
 
24.  Money Management
    A. Money Management Best Practices
    B. Sample Policy from Provider
    C. Cash on Hand Ledger
    D. Checkbook Ledger & Receipt Log
    E. Receipt Ledger for Food Stamps
    F. Gift Card Ledger
    G. House Account Ledger
    H. Daily Cash Ledger (begin)
    I. Daily Cash Count (end)
    J. Ohio DODD Alert Notice #50-12-08 re: Rewards Cards
    K. Ohio DODD Notice 03-03-04 re: Gift Cards
    L. Individual Inventory Record
    M. Individual Gift Card Account
    N. Individual Funds Transaction Record
 
 
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