FREQUENTLY ASKED QUESTIONS
| GENERAL QUESTIONS | PROVIDER QUESTIONS | INDIVIDUALS QUESTIONS |
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1. What is Clearwater COG? Clearwater COG is an acronym for the “Clearwater Council of Governments". Developed in accordance with the Ohio Revised Code Chapter 167 pursuant to Council of Governments, COG. The Clearwater COG membership consists of nine (9) County Boards of Developmental Disabilities, CBDD. Clearwater COG was formed by an agreement between these Boards. Currently, Clearwater COG includes the following counties: Crawford, Erie, Huron, Marion, Morrow, Ottawa, Sandusky, Seneca and Wyandot CBDD. Clearwater COG was originally organized in 1996. Generally, councils of governments may perform any activities, which its member organizations are authorized to carry out. However, a COG may not exceed the scope of the authority possessed by its member organizations. Clearwater COG currently has been delegated four major areas from all or a combination of its members CBDD: · The administration of residential supports through Supported Living and Medicaid Waivers. Counties included: Crawford, Erie, Huron, Marion, Morrow, Ottawa, Sandusky, Seneca and Wyandot. · Abuse and Neglect investigation, through its Investigative Agent. Counties included: Crawford, Huron, Marion, Morrow, Ottawa, Sandusky and Wyandot. · Quality Assurance services for Supportive Living and Medicaid Waivers. Counties included: Crawford, Erie, Huron, Marion, Morrow, Ottawa and Seneca. · Quality Assurance services for Management of Medication Administration and Health Related tasks. Counties included: Crawford, Erie, Huron, Marion, Ottawa, Sandusky and Seneca. Clearwater COG also provides/contracts for the following services: · Public Relations · Behavior Support · OEDI/COEDI Assessments and PASRR Reviews |
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2. Why does the COG do Quality Assurance reviews? Per DODD Rule 5123: 2-12-01, Quality Assurance was developed as a process to ensure that individuals receiving supported living are empowered to exercise choice and enhance the quality of their lives. The rule states that County Boards shall conduct QA as a continuous process. Seven of Clearwater’s nine County Boards contract with the COG to conduct these reviews. Supported living is the philosophy that people are supported by services in order for them to reside in their community not an ICFMR, not the supported living funding source provided by County Boards. |
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3. How often does the COG do Quality Assurance reviews? Per the above rule, “all individuals receiving supported living in a county shall be reviewed at least once every three years.” |
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4. What should I expect during a Quality Assurance review? The quality assurance staff will be conducting a home visit with the individual, a review of the County Board’s file on the individual being reviewed, and review all provider(s) documentation. If the individual is on a waiver and receives any day supports or vocational habilitation, the quality assurance staff will also visit the day services provider's location. |
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5. Who needs to be available for a Quality Assurance review? Input for the Quality Assurance review will be gathered from the individual, their guardian if applicable, their family if the individual chooses, all provider direct care staff, and the County Board Service and Support Administrator. All of these people do not have to be available the day of the QA visit. Those attending the QA home visit will depend on the abilities of the individual. |
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6. What type of information does the COG need to complete a PAWS form? An approved Individual Support Plan or Revision to the Individual Support Plan, including signatures, must be submitted to the Clearwater COG. Information contained in the Level of Service Section of the plan is used to complete the PAWS form. Billing codes, ratios, hours, and effective dates must be included in order for the PAWS to be processed. |
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7. What is a Major Unusual Incident (MUI) Investigation? An MUI investigation is an administrative investigation that is conducted by a certified Investigative Agent (IA). These investigations are conducted to determine the cause of the incident, the contributing factors of the incident, and to develop a prevention plan in order to reduce the likelihood of future occurrences. |
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8. What is the difference between a protocol investigation and a non-protocol investigation? A protocol investigation is conducted when any type of abuse (including prohibited sexual relations), neglect, misappropriation, exploitation, or death is reported to have occurred with a consumer. Also included in protocol investigations are reports of peer-to-peer acts, rights code violations, and a staff person's failure to report an incident. Protocol cases require formal interviews, written statements of involved parties, and a case disposition (substantiated/unsubstantiated) and usually involve a PPI (Primary Person Involved). A non-protocol investigation is conducted for "lower level cases" such as attempted suicides, missing individuals, law enforcement involvement, medical emergencies, unapproved behavior supports, hospitalizations, and known and unknown injuries. Although serious, these cases do not always warrant conducting formal interviews and obtaining written statements. |
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9. What is a PPI and how do I know if I am listed as a PPI? A PPI, or primary person involved, is generally the name of the person who has been reported as the responsible person in the incident. If you are named a PPI in an alleged incident, the IA will interview you and explain the allegations to you. |
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10. If I am named a PPI in an allegation, what rights do I have? If you are a named a PPI in an alleged incident, you will receive a written and/or verbal notification of the case disposition (whether the case against you was substantiated or unsubstantiated). You will not be permitted to have any other facts of the case due to the Ohio laws that regulate the investigations of MUIs. |
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11. What is the difference between substantiated and unsubstantiated? A finding of "substantiated" means that the preponderance of the evidence collected during the investigation indicates that the incident occurred. A finding of “unsubstantiated/ insufficient evidence" means that the evidence collected during the investigation indicates there was not a preponderance of the evidence to support the allegation or that the evidence collected during the investigation was conflicting or inconclusive. A finding of "unsubstantiated/ unfounded" means that the evidence collected during the investigation indicates that the allegation did not or could not have occurred. |
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12. If I am named a PPI in an allegation, will I be placed on administrative leave? If you are named as a PPI in an alleged incident, the decision to place you on administrative leave rests with your employer. Your employer must ensure the consumer's health and safety, as well as protect you from being named in further allegations. |
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13. If I am named a PPI and the investigation results in a substantiated allegation, what happens next? Depending on the seriousness of the allegation, most employers have a disciplinary process that they follow when an employee's actions infract their policy. |
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14. If I am named a PPI and the investigation is substantiated, does this mean I will be placed on the "Abuser Registry"? ODMRDD reviews substantiated allegations and they determine which cases will be reviewed for possible placement on the abuser registry. |
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15. If the Department determines a case should move forward for placement on the registry, will the staff person be notified? The Department will make every effort/attempt to notify the staff person of upcoming hearings and the registry process. |
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How long does an MUI investigation generally take? The MUI Rule indicates that an investigation should be completed within thirty working days of the initial report; however, depending on the nature of the case, the investigation could reasonably take longer. |
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17. When is law enforcement involved in MUI investigations? Anytime an allegation could possibly be criminal in nature (abuse, misappropriation, exploitation, etc...) law enforcement will be notified and a formal police report will be submitted. |
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18. Can I refuse to cooperate in an MUI investigation? The MUI Rule (5123:2-17-02) requires that all DD staff shall cooperate with MUI investigations. |
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19. What is done when a Major Unusual Incident (MUI) is discovered? Typically when an MUI is discovered, a report is made to the county board via a written incident report. The county board will then contact the Investigative Agent (IA) to report the incident. The IA then reports the incident to DODD via an online system (ITS). Depending on the nature of the alleged incident, the IA will conduct interviews, obtain written statements and provide the county board with a written report of the findings of the investigation. |
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20. Who do I contact regarding MUI"s? MUI's need to be reported to the representative county board of that individual. |
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1. How do I become a Certified Provider? A “provider” of services to persons with developmental disabilities may be either a licensed provider or a certified provider of Supported Living services. An individual or organization may become certified as a Supported Living provider to provide Medicaid and/or non-Medicaid funded services to individuals with developmental disabilities living in their own homes. There is no limit to the number of supported living providers that can become certified. A licensed provider operates a residential facility (group home) and is licensed to operate the facility for a specific number of people at a specific location. The State of Ohio established a maximum number of beds that it will allow to be licensed in residential facilities. The Ohio Department of Developmental Disabilities is currently at that maximum number. Therefore, the department is not issuing any new licenses for residential facilities. The Ohio Department of Developmental Disabilities must certify agencies and or individuals that provide Supported Living services. Applications are reviewed on an individual basis, and must include documentation that the applicant meets all qualifications and standards to become certified. An individual or agency is prohibited from providing any service until certification is obtained from the Ohio Department of Developmental Disabilities. For more information, contact Certification Services at 1 (877) 289-3636 or email at provider.certification@dmr.state.oh.us. All necessary forms for certification process can be downloaded from www.dodd.ohio.gov. On the home page, there is a section titled “For Providers” and under that a link “How to Become a Provider” that will offer basic information and necessary paperwork to be completed. If you have questions, you may contact Michelle Wells, Provider Support Specialist, at Clearwater Council of Governments at (567) 262-3154. She can forward necessary information/forms to you that will need to be completed for your certification. |
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2. How does the provider selection process work? See the “Free Choice of Provider” flow chart on the forms page. |
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3. When I have waiver billing questions or problems who do I call for assistance? The Ohio Department of Developmental Disabilities (DODD) website, www.dodd.ohio.gov. contains a tab for waiver billing instructions. The Waiver Billing and the Provider Support Service Units work together to assure that the DODD provider community is paid in a timely manner. If there is a problem with your billing or reimbursement, please call Provider Support Services at (800) 617-6733 or e-mail provider.support@dmr.state.oh.us to get any issues resolved. When contacting Provider Support Services, please provide your full name, agency name (if applicable), your DODD contract billing number, phone number including area code where you can be reached between 8:00 a.m. and 4:30 p.m. and a brief description of the problem (include individual name, Medicaid number, billing codes, billing dates, errors codes and dates of service). Their goal is to return your call or e-mail as soon as they are able to. They aim for a 48 hour turnaround. Please note: When leaving a message, speak clearly and slowly. Make sure to give all information requested in order for timely assistance. If providers wish to speak to someone in person to discuss billing issues, please be aware that HIPPA regulations require that they see providers by appointment only. They will not be available to see providers on a "drop-in" basis. Making an appointment also enables them to pull your records in advance so that they can serve you more effectively. If you are still having difficulty after contacting the state, you may contact Michelle Wells, Provider Support Specialist, at Clearwater Council of Governments at 419-898-8264. |
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4. When I have supported living billing questions, whom do I call for assistance? If the supported living bills are sent to the Clearwater COG, contact Amy Rife at 567-262-3153 with any questions. If the supported living bills are sent to the county board, contact the county board. |
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5. Now that I am a certified provider what is the next step? Once you have received your Initial and Final Certification letters from DODD, you must forward them to Barb Tatlock at Clearwater COG. She will add you to our provider pool and request any additional information that may be needed. |
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6. How does the COG communicate with providers? Each new provider completes a “Provider Information and Interest” form that includes their contact information. The COG has several mechanisms we use to keep the lines of communication open. Newsletters, informational notices and training brochures are sent electronically. In addition, we conduct provider meetings every other month. These meetings are centrally located in the COG area (Tiffin) every other month (even numbered months). The COG surveys providers annually in regard to the services the COG provides. Please be sure to let the administrative assistant know if your contact information changes. The administrative assistant can be reached by telephone at 419 898-8264 #3 or via e-mail at btatlock@clearwatercog.org |
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7. How does the COG assist providers in obtaining training? The COG offers a northern and southern provider training for small provider agencies and individual providers annually. This training includes Incidents Adversely Affecting Health and Safety (MUI/UI), Individual Rights training as well as covering other timely training needs. We offer initial training to new independent providers once they are selected by an individual. In addition, the COG provides trainings 3-4 times per year on current pertinent areas. These trainings are open to county board and provider staff. Agency specific training requests are considered on an individual basis. |
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8. What are the required elements for provider documentation sheets? See the forms page for a listing of required documentation by category. |
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7. What documentation does the Quality Assurance staff look at during a Quality Assurance review? · Daily documentation sheets (typically a check sheet) · Sign in and sign out information of direct care staff assisting those individuals not on a daily rate · Transportation documentation · Location of service documentation · Skill development written programs · Skill development documentation · Medication administration reports · Financial tracking/ledgers · Fire drills, if in the ISP for the past year · Medical appointments, if in the ISP as a service for the past year · All incident reports for the past year · Any MUIs for the past year · Any weather training, if in the ISP · Any other documentation that is identified in the ISP such as weekly menus · Any other services that you provide according to the ISP · Assessments and ISPs in the county board file. |
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1. How can the COG help me find a provider? The COG is part of the “Free Choice of Provider” process. The free choice of provider flow chart can be found on the forms page of our website. The COG sends information about you, without using your name, to providers letting them know you are looking for a provider. You will need to give this information to your SSA so they can write it on a RFI (Request for Interest) form for the COG. Then, the COG will send the RFI out to all interested providers. Providers respond with their interest in providing services to you to your SSA. Your SSA then will assist you setting up interviews. |
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2. How can the COG help if I am not satisfied with my provider? If you are dissatisfied with a provider, you should let the provider know what you don’t like about the way they are providing services. The first step is to work together with the provider to try and fix the problems. If you have already done this and know you want to change providers, then you will go through the “Free Choice of Provider” process. Your SSA should be able to help you with this. If you still need help, then you can call the COG office and we can help you or your SSA. The COG also maintains a provider pool, which contains names of providers who have contacted the COG and wish to provide services for individuals in each county we serve. In addition, the Ohio Department of Developmental Disabilities has the names of all certified providers on their website. |
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3. What services are available through the Individual Options (I/O) Waiver? Individual Options Waiver is for any person disabled before turning age 22 who would otherwise require the services of an intermediate care facility for people with mental retardation. I/O
Waiver can pay for: To apply, contact your County Board of Developmental Disabilities (DD). There is a waiting list for this waiver. |
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4. What services are available through the Level One Waiver? Level I Waiver services include: · Homemaker/Personal Care · Formal and Informal Respite · Transportation · Specialized Medical Equipment and Supplies · Personal Emergency Response Systems Installation and Maintenance · Environmental Accessibility Adaptations · Day Services Array |
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5. How do I find a provider? The COG has a list of providers that have said they would like to work in your county. You may call us to obtain a copy of the list. Your county board also has a copy of the list. Certified providers may also be found on the Ohio Department of Developmental Disabilities website, www.dodd.ohio.gov. There is a provider search tab on the home page that will take you to the correct page. See question number 1 for additional information. |
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6. How do I assist an individual in changing providers? If you are assisting an individual to change providers, please contact their SSA as they need to be in the loop. The “Free Choice of Provider” process should be used unless the individual already knows someone they would like to have as a provider. Keep in mind all providers must be certified by the Ohio Department of Developmental Disabilities prior to delivering services. |