COEDIOEDI

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COEDI/OEDI

• Authorization Training

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COEDI OEDI
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Eligibility Process isBased on Definition

• Ohio Revised Code (ORC) 5126.01
• Turn to page 4 of the User Guide.

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To determine eligibility for

• Family Resource Services
• Service Coordination
• Residential
• Adult Services
• Title XX services
• NOT SCHOOL PLACEMENT

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Flow Chart/Directions for Completion of
the OEDI Document
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INTRODUCTION

• The COEDI and OEDI 08 Users Guides contain
  information that will assist staff in determining
  an individuals eligibility for County Board of
  Mental Retardation and Developmental Disability
  (MR/DD) Programs. The two components of the
  eligibility determination process include

• 1. The Form for Eligibility Determination (FED)
  (CFED)
• 2. Eligibility Determination Instruments (OEDI
  COEDI)

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The FED CFED

• Screening Tool it is used BEFORE administering
  the C/OEDI.
• Also used to record the outcome of a C/OEDI

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The C/FED relies on the Definition

• Severe chronic disability
• Mental or Physical impairment, or combination
• Not SOLEY due to mental Illness
• Manifested before age 22
• Likely to continue indefinitely

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Prior Enrollment What the rule says

• See OAC 51232-1-02 County board administration
  Section C (10-11)
• All persons who were eligible for services and
  receiving services from programs offered by a
  county board pursuant to Chapter 5126. of the
  Revised Code on July 1, 1991, shall continue to
  be eligible for those services and to receive
  services in those programs as long as they are in
  need of services.

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Prior Enrollment (on FED)
If, on July 1, 1991, the individual was at least
age 18, and eligible for and enrolled in a county
board of mr/dd program, STOP! The person is
eligible in your county. If, on January 10,
1992, the individual was receiving case
management services only due to having mild
mental retardation with no SDD (Substantial
Developmental Disability), the person is eligible
for case management services only. If the person
wants other services, complete the FED and OEDI.
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Prior enrollment, CFED

• Look at the CFED, pgs 68-69 in the Attachments
• By January 11, 2008, Prior Enrollment criteria
  will no longer apply to current applicants age 6
  to 15.

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Does the applicant reside in your county?
Does the individual reside or plan to reside in
the county where application for service is being
made? If NO, stop. The person is not eligible in
this county.
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Diagnoses Guidelines
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Diagnosis of Mental Illness

• See page 8 in the guide
• DSM-IV Classification Diagnoses Related to
  Mental Illness
• This is a tool to help you answer question 3 on
  the C/FED

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SOLE Diagnosis of Mental Illness is

• Not a qualifying disability.
• A person who has a sole diagnosis of mental
  illness is not eligible for a county board
  program.
• BUT . . .

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Diagnosis ofMental Illness Qualifying
Disability

• If an individual has a qualifying disability
  (such as Cerebral Palsy, Mental Retardation,
  Traumatic Brain Injury, etc.) in addition to a
  mental illness, then she will satisfy this part
  of the FED.

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Hold oncan you clarify Qualifying Disability?

• What we are talking about here is really
  qualifying DIAGNOSES
• Page 7 gives a non exhaustive list of
  Acceptable diagnoses
• What about Sensory Disabilities?

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More on diagnoses..

• Unacceptable Terms are descriptions such as those
  applied by school districts or other non-medical
  sources. They are not diagnoses
• See page 7

You do not need to determine the primary
diagnosis
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Recap on diagnoses (FED)

• Its important to document all of the presenting
  physical or mental impairments the individual may
  have.
• Also, indicate who made the diagnosis.
• Individuals with a diagnosis of mental
  retardation must be diagnosed by a professional
  who is licensed or certified to administer
  individual psychological tests.

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More on diagnoses

• Diagnoses need not be recent, nor does the
  documentation of those diagnoses have to be
  current.
• The applicant is not required to have any degree
  of mental retardation to be considered, as long
  as they meet the requirements.

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Manifested before Age 22

• Was the individuals disability (ies) manifested
  before age 22? If NO, stop. The individual is
  not eligible.
• There must be recorded evidence indicating that
  the individual had some degree of limitations
  caused by any presenting disability prior to age
  22.

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Likely to continue indefinitely
Is the individuals disability likely to continue
indefinitely? If NO, stop. The individual is not
eligible.
The condition should have a reasonable likelihood
of continuing throughout life.
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Did you make it through C/FED 4 with a yes?

• Carefully re-read all of the material in the USER
  Guide and C/OEDI tools (pages 21-64) as well as
  the Attachments before you pre-plan.
• Go C/OEDI

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Design of the C/OEDI

• COEDI 6 Life Activity Areas
• OEDI 7 Life Activity Areas
• Each area contains at least ONE item
• Each item contains at least ONE sub-item

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COEDI or OEDI?

• COEDI Age 6 15
• OEDI Age 16 and older
• Neither under age 6

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Eligibility Determination

• Age 0-3 1 Delay
• Under Age 6 2 Delays
• Age 6-15 3 SFLs on the COEDI
• Age 16 3 SFLs on the OEDI

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What isDevelopmental Delay?

• Failure of a child to reach developmental
  milestones for his/her age in one or more of the
  following

• Cognitive Development
• Physical and Sensory Development, including
  vision and hearing
• Communication Development
• Social or Emotional Development
• Adaptive Development

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What isa SFL?

• SFL- Substantial Functional Limitation

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COEDI6 Life Activity Areas

• Mobility
• Self-Care
• Self-Direction
• Capacity for Independent Living
• Learning
• Receptive Expressive Language

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OEDI7 Life Activity Areas

• Mobility
• Self-Care
• Self-Direction
• Capacity for Independent Living
• Learning
• Economic Self-Sufficiency
• Receptive Expressive Language

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Eligibility Determination Tools

• Users Guide and Instrument

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Administrative GuidelinesMaterials Needed

• The reading document (page 71)
• 2.00 in change (5 pennies, 4 nickels, 5 dimes, 5
  quarters)
• Two watches (1 sweep hand and 1 digital)

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The Reading Document

• The document is used with the Life Area
  Learning
• Item 5 under Learning is on p.55 (OEDI)
• The Reading Document is on page 71, Attachments.

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Administrative GuidelinesPlanning

• Collect and review any available documentation
  (less than 1 year old) describing the
  individuals abilities.
• If necessary, arrange for involvement of
  informants who know the individual.
• Schedule an interview with the individual and/or
  informants to administer the C/OEDI.

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Administrative GuidelinesPlanning

• Plan time to watch the individual in various
  settings to better understand his/her abilities.
• This may be a stressful situation for the
  individual, so be sure to set the person at ease
  prior to beginning the interview.

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Administrative Guidelines

• Documenting Relevant Information

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Administrative GuidelinesInterview Technique

• Conversational approach
• Ask the individual to describe his/her
  performance in a specific area.
• Inquire further to direct the conversation toward
  areas that need to be addressed.

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Directions for Completing the Interview Process

• See page 14
• The interviewer shall always use the C/OEDI 08
  when completing the interview process.
• All conclusion (YES/NO) responses are recorded on
  the score sheet, along with concise comments.
• Do we need to determine which diagnosis is
  responsible for the individuals inability to
  perform an item?

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Directions for Completing the Interview Process

• C/OEDI 08 includes clarifying questions that can
  be utilized if the interviewer needs assistance
• In order to save time and be more efficient in
  the eligibility process, the interviewer may
  administer the C/OEDI in any order.

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Its time for us to take a brief look at the OEDI
Life Areas section of the USER Guide, which is
also the OEDI tool. For Adults 16, it starts on
page 21o. For Children, page 21c.
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Suggested Clarifying Questions
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Administrative GuidelinesReasonableness Standard

• Allow for some degree of interpretation (e.g., in
  the case of deciding if the individual can cut
  all of his/her own food, if he/she can do this
  with the exception of tough meats, score YES).
• Compare the individual to others of the same age.

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Consider F.E.A.S.Tat every step!

• Frequency ... of the functional limitation.
• Effort ... needed to complete the task.
• Adequacy ... of task completion.
• Safety ... in completing the task.
• Time ... needed to complete the task.

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F.E.A.S.T Reminders
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FEAST

• For purposes of eligibility determination, an
  individual might be able to accomplish certain
  tasks called for in the COEDI, but still receive
  a NO score because he/she could not accomplish
  the task without violating the principles of
  FEAST.

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Cultural Differences

• Although an attempt was made to write items in an
  unbiased manner, use the Reasonableness Standard
  to compare the individual to someone their own
  age and same culture.

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Allowable Assistive Devices

• Reliable
• Personally Owned
• Readily Accessible

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Physical/Verbal Assistance

• A YES score the individual must accomplish the
  activity independently.
• A NO score any assistance, either verbal or
  physical, should result in a NO score.

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Administrative GuidelinesSupervision vs.
Assistance

• The individual must accomplish the activity
  independently to receive a YES score.
• Any assistance, either physical or verbal, should
  result in a NO score.
• However, for children under age 12, the parent
  may be present to supervise or monitor the
  individuals performance.

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Answering, Recording, Score Sheet

• As you determine the Yes , No or
• Not Applicable (N/A) answer to each sub-item,
  and reach conclusions on each item

Uses Stairs....? Joan uses an electric
wheelchair

• Record the answers, your comments, and your
  Conclusions on the score sheet.

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Comments and Statements

• The interviewer must include a short comment or
  statement after each item on the score sheet.
  Interviewer should feel free to utilize
  quotes/statements given by the interviewee and/or
  informant.

Score sheets are located in the Attachments
section!
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Score sheet comments

• Examples include
• (Individual) states I can do that by myself.
• Parent states (individual) has no concept of
  safety and is monitored at all times.
• If an individual is independent in certain areas,
  interviewer should state independent.
• If an individual is not independent, interviewer
  should be sure to include why.
• Review recorded and collateral information,
  contact additional informants if needed.

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Cross-Referencing

• If an individual can perform an activity but
  chooses not to and understands the consequences
  of his/her decision, score YES and
  cross-reference to Self-Direction.

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More on cross-referencing to Self-Direction

• As you go through each life area, youll want to
  document any instance when a cross reference to
  Self-Direction is necessary.
• An easy way to do this is to use the designated
  space on the score sheets.
• List the cross references in the space provided.
• Consider the list when you make your final
  decision on Self-Direction

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Final Decisions

• When Conclusions for all of the items are
  complete, the rater must

• Transfer the score sheet information to the FED.

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Final Decisions

• Conclusions for each of the items are complete,
  the rater must

• Determine whether the individual meets the
  criteria of having at least 3 Substantial
  Functional Limitations.

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Streamlined Completion

• Within an item, complete the sub-items until
  criterion is reached.
• Within an area, complete information until
  criterion is reached or until criterion for the
  SFL is reached.
• All SIX/SEVEN areas of the C/OEDI must still be
  scored on the Score Sheet.

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Its time for us to get a little practice using
the OEDI tool. Please turn to page 21 in the
OEDI Users Guide. Youll see it says OEDI
Life Activity Areas MOBILITY We will be
using the tool in the context of a few
individual case scenarios.
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The county board must provide

• A copy of the completed C/OEDI upon request.
• An opportunity for the individual to discuss the
  decision with the staff person who completed the
  instrument.

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Complaint Resolution
What to include in a rejection letter

• A description of the eligibility process.
• Reasons for the denial of services (include
  C/OEDI results.)
• A description of other available alternative
  services.
• An explanation of the complaint resolution
  procedure.

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Complaint Resolution
An individual determined ineligible has the right
to

• Understand how the decision was made.
• Appeal the decision.
• Obtain copies of county board of mr/dd records
  used to determine eligibility.

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The Individuals Rights

• The right to

• Legal Representation
• Question county board staff
• Examine records
• Offer additional evidence

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REDETERMINATION GUIDELINES

• When should county board eligibility be done?
• At a minimum, eligibility should be determined at
  ages 3, 6, and 16.
• However, it is permissible for county boards to
  specify that an eligibility decision is effective
  for a one-year period, two-year period, etc.
• This is especially true in children who may be in
  the diagnostic process.
• Eligibility may be re-determined at any time.

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REDETERMINATION GUIDELINES

• County boards of MR/DD are to serve eligible
  individuals. If the individual has significant
  change in condition or functioning, it is
  appropriate to reconsider the individuals
  eligibility status.

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Below are some indicators that eligibility
should be re-determined
When the individuals life become more stable
and functioning improves. When an individual no
longer takes medication or begins taking
medication. When an individual no longer has a
qualifying diagnosis or there is a change in
diagnosis. When there is a change in medical
condition or mental health condition. When the
person turns 21 or prior to transition to
services for adults.
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Eligibility should be re-determined
At the request of a team, individual, family,
guardian, or other professional. When an
individual demonstrates through their actions or
assessments that they no longer have three
substantial functional limitations. When
someone moves from one county to another your
eligibility status may be re-determined. You will
maintain your current eligibility status until
the re-determination occurs in the new county of
residence. If there is a change in rules
governing eligibility.
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Authorization Approval

• Approval will be granted upon submission of an
  acceptable practice COEDI and/or OEDI to
• The Ohio Department of MR/DD
• Attn. Leslie Paull/Practice C/OEDI
• 35 E. Chestnut St., 5th Floor
• Columbus, Ohio 43215

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Questions?

• We are ready to answer your questions now!
• Check the Frequently Asked Questions in the
  Attachments!

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Direct Questions To

• COEDI/OEDI
• Leslie.Paull_at_dmr.state.oh.us
• 614/466-3240