RELEVANT LAWS AND RIGHTS VIOLATED
(not including my case manager making false statements in my official health care records)
Ohio Administrative Code (OAC) 5160-45-03: Consumers enrolled on an Ohio department of job and family services- (ODJFS) administered waiver in accordance with rule 5101:3-46-02, 5101:3-47-02 or 5101:3-50-02 of the Administrative Code, and/or their authorized representatives, have choice and control over the arrangement and provision of home and community-based waiver services. Consumers also have choice over the selection and control over the direction of approved waiver service providers.
Ohio Administrative Code (OAC) 5160-45-03(G)(1): The CMA shall comply with all of the requirements set forth in paragraphs (G)(1) to (G)(8) of this rule. Assure the health and welfare of the consumer while acknowledging the consumer’s right to make informed decisions and accept the resulting consequences that may impact the consumer’s life.
Ohio Administrative Code (OAC) 5160-45-03(G)(3)(c): The CMA shall comply with all of the requirements set forth in paragraphs (G)(1) to (G)(8) of this rule. Work with the consumer and/or authorized representative to do the following: Exchange information with all of the consumer’s service providers for development of the all services plan.
Ohio Administrative Code (OAC) 5160-12-02(D)(2): Consumers who receive PDN must: Participate in the development of a plan of care with the treating physician and the MCRHHA or other accredited agencies or non-agency registered nurse.
Ohio Administrative Code (OAC) 2913: THEFT AND FRAUD
The HIPAA Privacy Rule 45 CFR Part 160
“When the agency reduces, suspends, or terminates your benefits or services, it must mail you written notice at least 15 calendar days beforehand. When the agency denies your request for prior authorization, it must mail you written notice promptly.”
- Your Case Manager must issue state hearing rights for all service changes, including increases and decreases of services, as well as any denial of a waiver service you have requested.
- Be treated with dignity and respect
- Control how your services are delivered
- Self-determine and participate in developing your All Services Plan
- Address problems, concerns and issues about your services, Case Manager, and providers, and suggest changes without fear
- See any files or records related to your health care
- Case management includes, but is not limited to, the following functions: Scheduling, coordinating and facilitating meetings with you and your care team
- Case management includes, but is not limited to, the following functions: Working with you and your care team to develop your All Services Plan
- Your Case Manager develops the comprehensive All Services Plan in collaboration with your care team. Your care team members, at a minimum, include you, unpaid caregiver(s), your authorized representative (if applicable), providers, physician, and your Case Manager
- Working with your care team to resolve problems or concerns
- “…maximize your quality of life based upon your capacity and preferences
- Advocating for you
- Whom would you like to deliver your services? When, where, and how do you want your paid supports and services to be delivered? Time, place and how you want to receive services?
- “Problem Solving and Conflict Resolution” with “Mediation”