Federal surveys are the primary tool used by the Centers for Medicare & Medicaid Services (CMS) to ensure that Intermediate Care Facilities comply with the federal Conditions of Participation as outlined in 42 CFR 483.400–483.480. In Ohio, these reviews:

• Are conducted by the Ohio Department of Health on behalf of CMS every 12-15 months;
• Are typically unannounced and may include a recertification review, focused fundamental survey,
complaint investigation, follow-up visit, or federal validation review.
• Are based on Exhibit 355 which serves as a guide for both the surveyor and provider.

State
(DODD)

DODD’s Office of Compliance conducts reviews of licensed facilities and waiver providers as well as oversight reviews of County Boards and Councils of Government (COGs). These reviews:

• Are conducted by DODD’s Office of Compliance at least once during each certification period or term of accreditation or licensure;
• Are announced at least 90 days prior to the review being conducted;
• Are based on a DODD provided Compliance Review Tool and a list of required documents. There are
different review tools available depending upon the service being provided.

Providers who are accredited through a national accreditation entity (CARF, CQL, etc.) may request an ABBREVIATED REVIEW by submitting a written request to the Department.

Settings
(ODM)

Settings reviews ensure that people receiving Medicaid-funded Home and Community-Based Services (HCBS) are supported in environments that meet the HCBS Settings Rule. These reviews confirm that waiver-funded residential, employment, and day service settings promote individual choice, community inclusion, and autonomy – helping Ohio maintain federal Medicaid eligibility. These reviews:

• Are conducted by the Ohio Department of Medicaid (ODM) or their contractor, in coordination with
DODD and occur when a new waiver setting is established and typically every 1-3 years thereafter although there is no set schedule.
• Are announced to the provider in advance of review; reviews occur when new waiver setting is established and typically every 1-3 years thereafter.
• Are based on a Compliance Toolkit that includes Exploratory Questions designed to assist providers with the review process.

Nursing QA

Nursing (RN) QA reviews are evaluations to assess quality and compliance of nursing services and are
conducted in settings where medication or treatment is provided with DODD-approved certification and without nursing delegation. These reviews:

• Are conducted by DODD or a Council of Government (COG) typically every 1-3 years;
• Are typically announced with providers receiving 30-60 days’ notice prior to the review.
• The RN Quality Assessment Form provides an overview of the specific areas reviewed.

Organize and align your team. Ensure plans, data, and documentation are current, consistent, and accurate. Review incident reports and confirm follow-up has been addressed. Review staff understanding of person-centered planning, settings, active treatment, infection control, fire and evacuation, etc. Confirm all required committees have recent and accurate minutes.

Stay ready. Greet the review team and provide any requested documents promptly. Ensure the review team has workspace available. Designate a “point person” for reviewer communication and coordination. Remind yourself and staff to stay calm, be transparent, and focus on the individuals served—not the survey process.

For more information or resources on types of surveys or survey processes, please contact Rachel Hayes, Director of Residential Resources, at rhayes@opra.org.

Introduces 2 different processes based on the type of incident.

Category A and B MUIs require an administrative investigation, ensuring serious or high-risk incidents get the attention they need.

Category C MUIs (Law Enforcement, Unanticipated Hospitalization, Unapproved Behavior Support) now require an administrative review, a more efficient and less intensive process. 

New appendix forms for Category C Administrative Reviews promote consistent documentation and focus on key risk and prevention areas.

 Appendix C  = Law Enforcement
 Appendix D  = Unanticipated Hospitalization
 Appendix E  = Unapproved Behavior Support.

Other important updates include changes regarding Notifications, Reviews, and Removal of a DD Employee.

The timeline to notify the Director of Operations or Administrator of MUIs involving misappropriation, neglect, or abuse is now 1 working day (reduced from 2).

Providers must continue to keep and review a monthly UI log for trend/patterns. However, they are now only required to submit it to the County Board if requested. Logs will still be reviewed during compliance surveys/reviews.

Adds procedure for removing a DD employee during abuse investigations, including a
designated contact for employee questions.

More opportunities for training include:
• Conducting a Quality Investigation
• DODD Webinar Catalog

For more information or resources on the updated MUI rule or to explore OPRA led MUI training opportunities,  please contact Rachel Hayes, Director of Residential Resources, at rhayes@opra.org.