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Insights you can act on from OPRA

Key Changes to the Major Unusual Incident (MUI) Rule

Ohio's updated Major Unusual Incident (MUI) Rule under OAC 5123-17-02 strengthens provider
accountability, improves protections for individuals, and modernizes investigation practices. Here’s what DD
providers need to know to stay compliant and support safety.

   
Updated Definitions
The rule updates and/or changes several definitions, including those listed below:

Unanticipated and Unexpected Death • Emotional Abuse • Missing Individual • Systems Issue • Medical Emergency • Peer-to-Peer • Unanticipated Hospitalization • Significant Injury • Program Implementation • Failure to Report
Efficiencies


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. 
Updated Appendix Forms


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.
Process Updates


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.

 

Resources

   

5123-17-02 MUI Rule

 The updated Major Unusual Incident Rule goes into effect July 1, 2025.
MUI Toolkit
A comprehensive resource for incident reporting, investigation, and management. It
includes health and welfare alerts, training and education materials, and tools for
promoting quality and compliance.
FAQs and Interpretive Guidelines
FAQs provide quick answers to the most common questions providers ask about
MUIs—what to report, when, and how. Interpretive guidelines are practical guides that break down the MUI rule and help providers understand what’s expected in everyday terms.
Health and Welfare Alerts
Initial and annual MUI training for employees must include a review of Health and Welfare
Alerts from the past year.
MyLearning Training


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

 

Rachel Hayes

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.

 

 


   The OPRA Advantage

Sonya Summers OPRA membership gives you access to the tools, training, and support you need to stay compliant and deliver high-quality services. From the Great Provider Playbook to expert policy guidance and a strong provider network, ORPA helps you stay focused on what matters most—supporting people with IDD.

To learn more about becoming a member of OPRA, please contact Sonya Summers, Member Communication Manager, at ssummers@opra.org.		 Ask OPRA Logo
 


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