Commentary on Proposed ODMH Certification Standards

Commentary on Proposed ODMH Certification Standards

Presented by: The Ohio Association of Child Care Agencies

5122-24-01 Definitions

The Definitions section does contain terms that are not used in the current standards (“home- based intervention service”), and does not define terms that are used in the standards (recovery and resiliency). The rule continues to use discontinued definitions for “persons with serious emotional disturbance” and “person with severe mental disability”. The Definitions need to be reviewed for accuracy and current use.

5122-25-01Applicability

(B) Includes language for Boards to establish rules, operating procedures, standards and bylaws.

Certification is the responsibility of the Ohio Department of Mental Health and is not, nor should it be, delegated to the various community mental health boards. Section 340 of the ORC does not provide Boards the authority to regulate certification processes nor does it provide the Department the authority to delegate their authority. Item (B) of this proposed standard is inappropriate and puts Ohio at jeopardy for wide variations in quality of services and for noncompliance with the federal Medicaid requirement for “statewideness.”

5122-25-04 (F) and 5122-25-05 (C)

Both standards refer to “site-specific” certification and to services being specific to a certified site. These references could easily be interpreted to mean that crisis services, counseling and psychotherapy and CSP (Community Support Services) may be provided only at a certified site and not in the community. Currently, these three services may be provided at a client’s home, school or other community location. Policy makers have worked hard to ensure that mental health services are more available in natural, community settings. A literal interpretation of this rule would reverse this positive trend and diminish the system’s ability to respond when and where services are needed. This will create service delays, increase risks to people in need of services and eliminate key support services in the community for persons most at risk. The language must be clarified to ensure that services can continue to be provided in the community.

5122-26-13 Incident Reports

The proposed standard fails to define reportable incidents adequately: A “reportable incident” is defined in the proposed standard as “an incident that must be reported.” Also, the standard does not identify the form to be used in reporting incidents. The proposed standard states that the incident “shall be documented on standardized forms/media, as required by the department”. Form identification is critical to ensure state-wideness and HIPAA (Health Insurance Portability and Accountability Act) compliance (de-identification).

Item (C)(2) requires agencies to maintain an ongoing record of incidents for department, board and Ohio Legal Rights Service review. Under Section 340, ORC, boards are authorized to investigate allegations of abuse and neglect only. As written, this section opens and all incidents to board review. Furthermore, the recent passage of SB 179 provides protection for agency peer review functions, including incident monitoring. These protections are not reflected in the proposed standard and conflict with it.

Item (F) requires the agency to inform the client of actions taken and the resolution, if any, regarding abuse and neglect allegations. For persons under the age of 18, this requirement exceeds those in 2151.421 of the ORC and may be contraindicated for younger children.

5122-28-04 Outcomes

Item (E)(1) requires providers to “flow data through the mental health board to the department”. Serious questions regarding the provision of client identifiable outcome data to the Boards have been raised with regard to HIPAA (Health Insurance Portability and Accountability Act) requirements for “minimum necessary” disclosures. To date, these questions have not been fully answered. Furthermore, if determined to be appropriate, an agency can forward data to the mental health board but cannot control the “flow” of data from the Board to the Department.