Ohio Extraordinary Care Instrument (ODM Form 10372): Scoring and Age Rules

The Ohio Extraordinary Care Instrument is ODM Form 10372, a clinical assessment that decides whether a Medicaid waiver recipient’s needs are heavy enough that a parent or spouse may be paid to provide the care. An assessor scores the person across 22 daily-living categories on a 0–3 scale, and the standard is met when the person scores a 3 in at least three categories.¹

What the Assessment Decides

Under Ohio Administrative Code 5160-44-32, a parent of a minor child or a spouse normally cannot be paid as a home and community-based services (HCBS) provider, because the state treats that help as part of ordinary family responsibility. The extraordinary care assessment exists to identify the situations that go beyond ordinary — where the person’s needs are so far above what a family member would typically provide for someone of the same age without a disability that paid family caregiving becomes appropriate.²

Two things have to be true before the assessment even matters. There must be no other willing and qualified provider or direct care worker available; a preference for keeping care in the family is not enough.³ And the Ohio Department of Medicaid, the Ohio Department of Aging, or the Ohio Department of Developmental Disabilities (or a designee) must conclude that the person’s health and safety needs can be met in the arrangement.²

The person being cared for must already be enrolled on a qualifying HCBS waiver — including Individual Options, Level One, SELF, MyCare Ohio, Ohio Home Care, and PASSPORT. Form 10372 does not create waiver eligibility. It only answers the paid-family-caregiver question for someone who is already a waiver participant.²

How the Scoring Works

The assessing agency — typically a county board of developmental disabilities or a care management agency — fills out the form during an in-person visit. The parent or spouse does not complete it. Every one of the 22 categories must be scored, and each category gets a single rating that reflects the highest level of support the person needs for that activity.

The scale has four points:

0 — Independent, not applicable, or within an age range where the need is presumed not to apply.
1 — Needs an assistive device (wheelchair, walker, lift, communication app) but can use it without hands-on help or verbal direction.
2 — Sometimes needs hands-on help or verbal direction, but not every time.
3 — Always needs hands-on help or verbal direction when the need arises.

Only a 3 counts toward the extraordinary care threshold. Scores of 1 and 2 describe real support needs, but they describe help that could fall within what a parent or spouse ordinarily provides. The person must receive a 3 in at least three of the 22 categories for the form’s result section to be marked “Yes.” A 3 in only one or two categories does not meet the standard, and a parent or spouse cannot be authorized as a paid provider for that person.¹

No medical documentation is required to support a score on any of the assessed needs.¹

The 22 Categories

The form covers activities of daily living, instrumental activities of daily living, and medical and behavioral needs:

Feeding Assistance
Seizure Protocol
Respiratory/Pulmonary Care
Catheter or Ostomy Care
Turning/Positioning
Ambulation
Transfer Assistance
Oral Hygiene
Dressing
Toileting
Behavioral Support
Bathing
Hair, Nail, and/or Skin Care
Communication
Basic Purchases
Basic Meal Preparation
Basic Household Chores
Laundry
Accessing Transportation
Accessing Personal Funds
Cognition/Decision Making
Medication Administration

Pages two through four of the form carry the definitions the assessor uses when assigning each score.¹

Age Rules for Minor Children

Young children depend on adults for many daily activities, so the form builds in age thresholds. If the child is at or below the listed age for a category, the assessor enters a 0 regardless of what the child can actually do. A three-year-old who cannot do laundry does not have an extraordinary care need; that is age-appropriate dependence.

8 months and younger: Turning/Positioning is scored 0.
17 months and younger: Ambulation, Transfer Assistance, and Medication Administration are scored 0.
4 years and younger: Oral Hygiene, Dressing, Toileting, and Behavioral Support are scored 0.
6 years and younger: Bathing is scored 0.
9 years and younger: Hair, Nail, and/or Skin Care is scored 0.
15 years and younger: Communication, Basic Purchases, Basic Meal Preparation, Basic Household Chores, Laundry, Accessing Transportation, Accessing Personal Funds, and Cognition/Decision Making are scored 0.

The categories without an age threshold — Feeding Assistance, Seizure Protocol, Respiratory/Pulmonary Care, and Catheter or Ostomy Care — are scored at any age, because these needs are never treated as routine parental care.¹

For families with young children, the age rules do most of the work in deciding whether the threshold is reachable. A child under 15 automatically scores 0 in eight instrumental-activity categories, so the three 3s have to come from the remaining 14 — primarily medical, physical, and behavioral needs. For very young children, fewer categories are even available for scoring.

What Meeting the Standard Does and Doesn’t Do

A “Yes” on Form 10372 opens the door; it does not set the hours or the pay. The county or care management agency decides how many paid hours are appropriate based on the person’s assessed needs, as documented in the person-centered services plan (PCSP).³

Paid care from a parent or spouse is capped at 40 hours per week per person receiving services. The cap is per recipient, not per caregiver, so if two parents share paid caregiving duties for the same child, their combined paid hours cannot exceed 40. ODM, ODA, or DODD may grant exceptions when needed for the person’s health and safety.²

Respite is excluded. A parent or spouse cannot be paid to provide respite services no matter how the assessment comes out.²

How to Request the Assessment

Families do not download or complete Form 10372 themselves. The fillable PDF lives on the Ohio Department of Medicaid website, and the assessing agency uses it. To start the process, contact your care management agency or county board of developmental disabilities and ask for an extraordinary care assessment. They will schedule the in-person visit and walk through each of the 22 categories with you present.¹

1
Ohio Department of Medicaid. Ohio Extraordinary Care Instrument
2
Ohio Legislative Service Commission. Ohio Administrative Code 5160-44-32
3
Ohio Department of Developmental Disabilities. Parents as Paid Caregivers for Their Minor Children