The HRC serves as an important safeguard to ensure that any limitation on an individual’s rights is:

• Aligned with the individual's assessed needs and supported by data.
• The least restrictive option available.
• Time-limited and reviewed at regular intervals.
• Implemented with informed consent.

A strong HRC oversight process demonstrates that providers are not only identifying risks, but actively protecting the rights, dignity, health and safety of the individuals they support.

When is HRC Review Required? 

HRC review is required anytime a proposed intervention or plan may restrict or limit an individual’s rights.
This commonly includes:

• Behavior supports with aversive or restrictive measures;
• Limitations on movement, access, or personal property;
• Use of monitoring systems (as applicable under rule);
• Rights modifications or restrictions tied to individual health, safety, or mitigation of risk.

Providers must ensure that no restrictive measure is implemented without appropriate HRC review and approval. In emergency situations, staff may need to take immediate action to protect an individual or others from immediate harm, even if no approved plan is in place. In this instance, staff must immediately document the incident thoroughly. The team and committee should then meet as soon as possible to review the incident and determine if ongoing supports are needed. If additional restrictive measures are needed, this must also be submitted to the HRC for further approval.

HRC
Composition & Requirements

Regulation and survey guidance require that the HRC be structured to ensure objective, informed decision-making.
The committee must:

• Be multidisciplinary in nature. No specific disciplines required, but multiple perspectives must be represented. At least 1 member must have experience with behavior support practices.
• Include members with no ownership or controlling interest in the facility.
• Include facility staff such as a QIDP, nurse, supervisor, administrator, DSP, etc.
• Include community members not employed by the agency.
• For ICFs, federal regulation dictates that the committee must be made up of at least a “quorum”. The quorum should be defined by the facility and referenced in policy. DODD guidance states that the HRC must be at least 4 people.

Process for Restrictive Measures

Providers must follow a structured, compliance-driven process when implementing restrictive measures.

The numbered steps below have been identified by DODD as the process to follow when developing a plan with a restriction:

1. Assessment in the last 12 months identifying risk of harm
2. Strategies addressing risk of harm developed
3. Informed consent obtained
4. Individual / guardian notified of HRC meeting
5. HRC Approval or Denial
6. Restrictive Measures Notification (RMN) form completed and submitted
7. Staff trained on plan / strategies
8. Implementation of restrictive measures
9. Team review within 90 days

Compliance

Surveyors evaluate restrictions by asking key questions. Great providers can stay ahead by answering those questions before the survey ever begins.

• Was the restriction approved before implementation?
• Is it linked to the OhioISP?
• Was informed consent obtained?
• Is there data demonstrating necessity?
• Is there a plan to remove the restriction / is it time-limited?

Resources

Behavior Support Rule
DODD Behavior Strategies and Restrictive Measures
DODD Restrictive Measure and HRC Information

For More information or resources on Human Rights Committees, please contact Rachel Hayes, Director of Residential Resources, at rhayes@opra.org.

Remote Support services are defined as continuous oversight of technology with remote staff immediately
available to respond as needed — but it does not require constant video surveillance of the individual.
Effective January 1, 2026.

• Terminology has been updated. “Vendor” changed to “Remote Support Provider” and is now defined as the agency responsible for the monitoring base, remote staff, and all technology used.

• Backup support may be unpaid family/friends or a paid provider (HPC or AWC). Clear definition added for when backup is needed and who can fulfill the role.

• New provider requirements including written agreement detailing how backup is contacted, who they cover, and expectations for response.

• Remote Support now bills in 15-minute units.

Assistive Technology

Assistive Technology services enable individuals to use smart or electronic devices to increase their
independence. Effective January 1, 2026.

• Definition has been updated to include “non-electronic” items such as pencil grips, weighted pens, screen readers, and communication boards.

• Coverage details updated. May include items, equipment, engineered solutions, product systems, service-animal training, along with any required software or subscription fees needed for the device to function.

• “Subscription” is now defined as a recurring payment for services that support the use of AT equipment without involving real-time Remote Support.

• Teams may choose to purchase or rent equipment, with rental agreements documented in the ISP.

Support Broker

Support Brokerage helps a person develop skills and build confidence that will support their success and independence self-directing. The Support Broker works closely with the person until they feel confident transitioning to full independence with self-direction. Effective January 1, 2026.

• Service will now be available under both the Individual Options (IO) and Level One waivers, increasing access to self-direction support.

• Service now allows for some virtual support and travel time, expanding flexibility in how support can be delivered.

• Billing is shifting from an hourly unit to a 15-minute unit, aligning with other HCBS services.

• New Support Broker training will be released in December 2025 on DODD My Learning. Completion will be required for Support Broker certification, with current brokers and SSAs encouraged to
complete the updated curriculum.

Ohio established Vehicle Modifications as a stand-alone HCBS waiver service in July 2025. The process begins with a clinician assessment to document medical need, followed by obtaining required quotes from certified vendors and verifying vehicle ownership and insurance. Modifications must be medically necessary and cost-effective, with manual options considered before automated features. Payment is issued after the SSA confirms the work is complete, and higher-cost requests must follow the appropriate approval or prior authorization process.

For More information or resources on Waiver Amendments or upcoming changes, please contact Rachel Hayes, Director of Residential Resources, at rhayes@opra.org.

The federal 21st Century Cures Act requires states to implement EVV for Medicaid-funded personal care and home health services by January 1, 2023. States that fail to comply face phased reductions in Federal Medical Assistance Percentage (FMAP) unless a “good faith effort” to avoid delays is demonstrated.

Applicable Services

Multiple services administered by the Ohio Department of Developmental Disabilities are subject to EVV. Whether or not a service requires EVV is determined by what service is billed. The required EVV services are:

1. Homemaker/Personal Care and participant-directed HPC when billed in 15-minute units
2. Residential respite when billed in 15-minute units
3. Waiver nursing
4. Waiver nursing delegation (RN/LPN consultation)
5. Waiver nursing assessment

Claims Validation

Starting October 1, 2025, claims for above services that require EVV must have a sufficient EVV record on file with the Ohio Department of Medicaid.  To have sufficient claims, the number of logged EVV units must be equal to or greater than the number of units of billed services. Claims with fewer EVV units than billed units of service will be denied.

Claims
Denial

When a claim is denied based on insufficient EVV units, what opportunity does a provider have to get paid for the service they provided?

When a claim is denied, a provider should be able to correct their EVV visit to update the units for the visit in the system they are using for EVV (either Sandata or the provider’s alternate vendor). Once the EVV errors are cleared, the provider should be able to bill for the service.

The Ohio Medicaid EVV Program and Service Code Guide lists all services subject to EVV along with their billing codes. For DD providers, see pages 7–9 for the DODD-specific services and codes.

Guidance from DODD and ODM for providers who have multiple provider Medicaid IDs with ODM.

The EVV Provider Dashboard is a vital tool for providers that offers both insight into EVV claims as well as detailed help in navigating the Provider Dashboard. Additionally, it provides instructions for Sandata and alternate vendors to support timely error correction.

The helpdesk can assist with problems stemming for the state provided Sandata system and the Sandata aggregator.

Daily time where providers can sign up to attend virtual office hours to have individual questions answered by Sandata representatives. 

For more information or resources on EVV,
please contact Christine Touvelle, Director of Advocacy, at ctouvelle@opra.org.

Service Documentation is how providers demonstrate that Medicaid-funded services were delivered as authorized and support payment validation. It includes records created at the time
services are provided that fully disclose the nature and extent of the service. Documentation must clearly reflect:
•   What service was delivered
•   When and where the service occurred
•   Who provided the service
•   How it meets the applicable requirements in Chapter 5123-9 of the Ohio Administrative Code

Required Elements

To comply with state and federal rules, every service note must include specific, identifiable elements that clearly show who received the service, what was done, when and where it was done, who delivered the service, and how it connects back to the individual’s OhioISP. Records may be maintained in either handwritten or electronic formats but must contain all required elements. The following are common required elements for service documentation and should be present in every service note where applicable:

Scope of Service refers to the specific supports and activities authorized for delivery under a service
as identified in the OhioISP and defined by rule. Service documentation must clearly reflect that the
supports provided fall within the approved scope of the service and align with what is authorized in the
individual’s OhioISP.

Group Size

Group size refers to the total number of individuals receiving the service at the same time under the supervision of one staff member. Group size directly impacts service delivery expectations, billing units, and compliance with staffing ratios outlined in the rule. The following services require group size to be documented:

Rules Under
OAC 5123-9

Chapter 5123-9-23 of the Ohio Administrative Code governs the delivery of Home and Community-Based Services (HCBS). Under this chapter, there are specific service rules. Each rule contains a section titled, Documentation of Services. The list below highlights different service rules but is not an all-inclusive
list of services under HCBS.

For More information or resources on documentation and service delivery, please contact Rachel Hayes, Director of Residential Resources, at rhayes@opra.org.