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Pre-Admission Counseling

Pre-Admission Counseling helps make sure that a person seeking admission to an intermediate care facility (ICF), where eight or more people live, is fully aware of the service and support options available to meet their needs while living outside of an ICF. The Pre-Admission Counseling process focuses on supporting informed choice and is not intended to deter someone from living in an ICF if they choose to.

Pre-Admission Counseling is required when an Ohio resident is seeking new admission to an ICF with eight or more beds.

Pre-Admission Counseling is not required for any of the following reasons:

  • a person is seeking admission to an ICF with seven beds or fewer,
  • out-of-state residents seek admission to an ICF,
  • a person is seeking admission to a state-operated developmental center,
  • a person is transferring from one ICF to another, including transfers between a state-operated developmental center to another ICF,
  • a person who has left an ICF for a nursing facility stay and returns to the ICF, or
  • a person is already enrolled in a waiver and seeking a short-term admission to an ICF.

Emergency Admission

Pre-Admission Counseling is required for an emergency admission; however, the process does not need to be completed prior to admission and should not prevent the admission from occurring. No later than the day of admission, the ICF will submit the Individual Consent/Pre-Admission Counseling referral to DODD. The county board must conduct the interview and submit the Pre-Admission Counseling assessment results to DODD within 5 business days. For an emergency admission, DODD will grant the ICF access to the individual’s record in order to complete an initial Level of Care (if needed) or review an existing Level of Care and submit a NICS Admission. The Level of Care/NICS Admission will not be approved until the Pre-Admission Counseling process is complete.

Pre-Admission Counseling Process

Process Initiation

The Pre-Admission Counseling process is initiated when an ICF with eight or more beds has a current vacancy or anticipates a vacancy within the next six months. If the ICF agrees to accept the person for admission, and the person agrees to accept the next opportunity for admission, the ICF must submit an Individual Consent/Pre-Admission Counseling referral form to DODD. The referral must include required signatures from the person or guardian, if applicable, and a representative from the ICF. All referrals must be submitted in DODD’s electronic Level of Care system. Incomplete referrals will not be accepted. DODD will notify the county board of developmental disabilities in the person’s county of residence that a Pre-Admission Counseling assessment is needed.

The county of residence is the county in which the person presently resides, or, for minors in the custody of Child Protective Services, the county where legal custody is maintained.

For each vacancy, the ICF may refer up to three people at a time. When more than one person is referred, the ICF must prioritize the referrals in the order in which they are to be considered for admission. The county board will schedule face-to-face interviews in the order in which the referrals are prioritized. The person with first priority will be interviewed before interviews are scheduled with the additional people who were referred.


Upon receipt of a complete referral, the county board has five business days to complete the Pre-Admission Counseling assessment and submit the results to DODD for review. The county board will include the person, legal guardian, if applicable, and anyone else chosen by the person to participate in the Pre-Admission Counseling interview. The names of all those participating must be identified on the Pre-Admission Counseling assessment results.

Using a conversational, person-centered approach, the representative will assess the person’s preferences in the areas listed on the Pre-Admission Counseling interview form. The county board representative must carefully explain the purpose of the session and clarify that the person maintains the right to seek admission to the ICF. The Residential Options Counseling Pamphlet developed by DODD must be presented to the person during this process. The pamphlet explains the general differences between home and community-based services and ICF services.

The areas in which the person currently requires support will also be identified.

  • If no assistance is required in an area, “not applicable” must be selected on the form.
  • For all areas in which supports are currently required, the county board representative will identify the resource primarily used to meet that need at this time.
  • The representative will select “yes” or “no” to indicate if an area of support is new or if additional support is needed.

The representative must also explore the strengths, resources, and barriers that may contribute to or inhibit the person’s success in a community-based setting. During this person-centered discussion, the representative is required to explain how available resources may be used to support the person in a community-based setting and to overcome historic barriers.

Complete the Referral

Upon reviewing all available options with the person, the county board representative must ask the person if he or she chooses to proceed with admission to the ICF or if a community-based option is preferred.

Once the person’s choice of service has been identified and the Pre-Admission Counseling assessment is complete, the county board representative must submit the results to DODD for review.

Within two business days of receiving the results, DODD will review the assessment to ensure accuracy and appropriateness of the Pre-Admission Counseling assessment. DODD will keep a record of the names of people who participated in the counseling process, the facilities in which they are seeking admission, and the settings they chose.


A Pre-Admission Counseling assessment remains valid for up to six months. A person who has completed the process within the past six months and is now being selected for admission to an ICF does not need to complete another interview prior to admission.

If it has been between six and 12 months since a person selected for admission to an ICF participated in Pre-Admission Counseling, the county of residence must contact the person to see if anything has changed since the last interview. If not, the person may proceed with admission to the ICF.

If there have been changes, the county board may update the assessment by gathering information by phone, face-to-face discussion, or other electronic means. All updated assessments must be submitted to DODD for review.

DODD will notify the county board and the ICF of the Pre-Admission Counseling review outcome within two business days of receipt.