Ohio Administrative Code|Rule 5101:2-5-37 | Additional requirements for an agency that acts as a representative of ODJFS in recommending medically fragile foster homes for certification.

                                                
(A)  The recommending agency shall not
		  allow a medically fragile child to be placed in a foster home unless the foster
		  caregiver(s) has been certified to operate a medically fragile foster home
		  pursuant to this rule and rule 5101:2-7-17 of the Administrative Code. The
		  recommending agency shall document in the homestudy of the caregiver's
		  file how a foster caregiver for medically fragile children meets the
		  requirements in paragraph (A) of rule 5101:2-7-16 of the Administrative
		  Code.
(B)  The recommending agency shall assign
		  a treatment team to each medically fragile child placed in a medically fragile
		  foster home. A licensed physician, licensed nurse practitioner or a registered
		  nurse shall supervise the medical aspects of the child's service
		  plan.
(C) A service plan shall be developed by
		  the treatment team in accordance with the following requirements:
(1) An initial service
			 plan shall be completed by the treatment team for each medically fragile child
			 placed in a medically fragile foster home no later than thirty days after
			 placement.
(2) The service plan
			 shall be reviewed and revised, if necessary, at least once every sixty days
			 thereafter.
(3) Service plan approval
			 and any revisions shall be completed by the individual assigned under paragraph
			 (B) of this rule who is supervising the medical aspects of the child's
			 service plan and approved by the treatment team leader's
			 supervisor.
(4) All treatment team
			 members shall be notified in advance of each treatment team meeting and invited
			 to participate. Documentation of the invitations shall be maintained in the
			 child's record.
(D) The service plan for a medically
		  fragile child placed in a medically fragile foster home shall
		  include:
(1) A nursing treatment
			 plan signed by a licensed physician. The nursing treatment plan shall be
			 reviewed and approved by a licensed physician at least every sixty days. The
			 nursing treatment plan shall list all of the following:
(a) Any special instructions for the care of the
				child.
(b) The child's medications including instructions for
				administering the medications and potential side effects.
(c) The child's nursing needs.
(2) Treatment goals,
			 clinical and/or rehabilitative services and other necessary interventions for
			 the child and his family.
(3) The method by which
			 the goals, rehabilitative services, and other necessary interventions will be
			 attained and progress evaluated.
(4) The projected length
			 of the child's stay in the foster home.
(5) The criteria to be
			 met for the child's reunification with his or her parent(s)/family or
			 guardian or the projected post-treatment setting into which the child will be
			 placed upon attainment of the treatment goals
(6) Aftercare services to
			 be provided or arranged.
(7) How the child's
			 permanency plan for family reunification, adoption, independent living or other
			 permanent living arrangement, as specified in the custodial agency's case
			 plan, will be attained.
(E) If the service plan developed by the
		  treatment team recommends any special needs for the child that would conflict
		  with any rule in Chapter 5101:2-7 of the Administrative Code, the service plan
		  shall be followed.
(F) The recommending agency shall develop an individual plan for
		  respite care for each medically fragile child placed in a medically fragile
		  foster home. The use of respite care shall comply with the agency's
		  respite care policy prepared pursuant to rule 5101:2-5-13 of the Administrative
		  Code. A copy of the individual plan for respite care for each medically fragile
		  child placed in a medically fragile foster home shall be included in the
		  child's case record.
(G) The agency shall ensure that a member of the agency's
		  professional staff shall be on-call for foster caregivers for medically fragile
		  children and each medically fragile child placed in a medically fragile foster
		  home on a twenty-four hour, seven day a week basis.
(H) The agency shall ensure that foster caregivers for medically
		  fragile children are provided with a manual containing all policies, procedures
		  and other information related to the program not later than the date the
		  individual becomes certified as a foster caregiver for medically fragile
		  children. The agency shall provide foster caregivers for medically fragile
		  children copies of any revisions to the manual within thirty days of the
		  revision.
(I) The agency shall coordinate with the agency holding custody
		  of a medically fragile child or the child's parent or guardian for the
		  provision of all rehabilitative services and other necessary interventions
		  contained in the child's service plan and any revisions thereto. The
		  agency shall also implement those aspects of the child's service plan that
		  are its responsibility.
(J) The agency shall ensure that a discharge summary is prepared
		  pursuant to rule 5101:2-5-17 of the Administrative Code for each child
		  discharged from a medically fragile foster home. This paragraph does not apply
		  to a child who is receiving respite services other than as a direct
		  placement.
(K)  The recommending agency shall ensure the caregiver is
		  provided written step-by-step instructions for each skilled procedure required
		  to be performed for each medically fragile child placed in the home.
		  Documentation of the receipt of this information shall be maintained in the
		  caregiver's record and in the child's record.
(L) At the following times the agency shall disclose to the
		  foster caregiver for medically fragile children all information available to
		  the agency about the child and his family pursuant to rule 5101:2-42-90 of the
		  Administrative Code:
(1) At the time of a
			 child's placement in a medically fragile foster home.
(2) Whenever additional
			 information becomes available.
(M) The agency shall ensure that all professional treatment staff
		  required to be licensed shall be appropriately licensed. Professional treatment
		  staff shall demonstrate to the employing or contracting agency that the
		  training required for professional licensure shall be in topics appropriate to
		  medically fragile foster care. Documentation of the training topics shall be
		  maintained in the child's record.
(N) All professional treatment staff shall be appropriately
		  licensed and shall annually complete at least fifteen hours of training in
		  specific issues addressing the needs of medically fragile children and the
		  mission of the agency.
(O) The agency shall ensure that all professional treatment staff
		  are provided with a manual of all policies and procedures relevant to the
		  program at the beginning of their employment with the agency.
(P) The agency shall not prohibit foster caregivers for medically
		  fragile children from participation in any formal or informal support groups
		  organized for the purpose of supporting foster caregivers.
(Q)  The recommending agency shall ensure a certified foster
		  caregiver for medically fragile children complies with the following occupancy
		  limits:
(1) With the exception of
			 the provisions of paragraph (Q)(1)(c) of this rule, a foster caregiver for
			 medically fragile children may provide foster care for not more than five
			 foster children, two of whom may have intensive needs as described in rule
			 5101:2-47-18 of the Administrative Code requiring their placement in a
			 medically fragile foster home.
(a) Any exception to the number of medically fragile foster
				children placed in the home shall be only with specific justification in
				accordance with the agency's policy for matching medically fragile foster
				children and caregivers developed pursuant to rule 5101:2-5-13 of the
				Administrative Code.
(b) The justification, which may include the need to place a
				sibling group, or the abilities of a particular family in relation to the
				intensive needs of a particular child, shall be documented in the child's
				case record and in the medically fragile foster home record.
(c) A foster caregiver for medically fragile children who
				is also an appropriately trained and licensed professional may provide care for
				not more than five medically fragile foster children placed in the
				caregiver's home. An appropriately trained and licensed professional is
				considered one of the following:
(i) A registered
				  nurse.
(ii) A licensed practical
				  nurse.
(iii) A licensed
				  emergency medical technician.
(iv) A physician
				  assistant.
(v) A licensed
				  physician.
(d) The recommending agency of a medically fragile foster
				home shall notify, within seventy-two hours, all agencies holding custody of
				any other children placed in the home if more than two medically fragile
				children are placed in a medically fragile foster home.
(2) Children placed in a foster home on
			 or prior to March 31, 2005 shall not be moved to another placement solely to
			 meet the requirements of paragraph (Q)(1) of this rule.
(R) The agency shall ensure that professional treatment staff
		  shall have consultation at least every two weeks and at least monthly
		  face-to-face contact with the foster caregiver for medically fragile children
		  or at least one member of a foster caregiver for medically fragile children
		  couple or co-parents serving an intensive needs child. At least one of the
		  face-to-face contacts every two months shall take place in the medically
		  fragile foster home.
(S) The agency shall ensure that professional treatment staff
		  shall have face-to-face meetings with each intensive needs child placed in a
		  medically fragile foster home at least every two weeks. At least one of the
		  face-to-face meetings each month shall take place in the medically fragile
		  foster home.
(T) For each medically fragile child placed in a medically
		  fragile foster home, the agency shall assure that the foster caregivers for
		  medically fragile children keep a written record of the child's emotional
		  response to treatment and progress towards achieving the treatment goals
		  identified in the child's service plan.
(1) The written record
			 shall include signed documents of treatment provided by any health care
			 professional providing services to the child, as well as records of any
			 hospitalizations and hospital emergency room or urgent medical care
			 visits.
(2) All documentation
			 shall be maintained current and kept in the manner prescribed by the
			 agency.
(U) The agency shall assure that foster caregivers for medically
		  fragile children are aware of the potential side effects of any prescribed
		  medication for children placed in their home.
(V) If a child with special or exceptional needs is placed in a
		  medically fragile foster home, the provisions of rule 5101:2-5-36 of the
		  Administrative Code shall apply for that child.