Current through all regulations passed and filed through September 16, 2024
(A)
The program
administrator may provide a consultation in person or by telephone or video
conference.
(B)
The program administrator shall offer a consultation to
any individual who contacts the program administrator to seek information about
options available to meet longterm care needs.
(C)
On application
for admission to a nursing facility or on seeking medicaid payment for a
continued stay in a nursing facility, the following apply:
(1)
The nursing
facility shall notify the program administrator of any individual that was
admitted to the nursing facility under a a categorical determination in
accordance with rule 5160-3-15.1, 5122-21-03, or
5123-14-01 of the Administrative
Code, but has since been found to need a stay in a nursing facility that will
exceed the time limits identified in those rules. The nursing facility shall
notify the program administrator no later than seventy-two hours after the
expiration of the time limit, unless rule
173-43-03 of the Administrative
Code indicates that the program administrator is not required to provide a
consultation to the individual. On being notified, the program administrator
shall determine if a consultation is required.
(2)
If the program
administrator is not required to provide a consultation to an individual under
rule 173-43-03 of the Administrative
Code, then the nursing facility shall specify the reason why the program
administrator is not required to provide a consultation in the individual's
record.
(3)
The program administrator shall provide a consultation
at a time agreed to by the program administrator and the individual, whether
before or after admission to a nursing facility.
(4)
The nursing
facility shall not deny or limit access to the facility or a resident of the
facility to any person who is attempting to provide a
consultation.
(5)
The program administrator may obtain information about
an individual who is applying to a nursing facility or seeking medicaid payment
for a continued stay in a nursing facility from the individual, the nursing
facility to which admission is being sought, the pre-admission screening and
resident review under rules
5160-3-15.1 and 5160-3- 15.2 of
the Administrative Code, or through the resident assessment instrument as
defined in rule
5160-3-43.1 of the
Administrative Code.
(6)
A nursing facility that has a provider agreement with
the department of medicaid may admit an individual as a resident only if the
nursing facility has evidence of all of the following:
(a)
The nursing
facility complied with this rule.
(b)
The nursing
facility complied with rule
173-43-03 of the Administrative
Code.
(c)
The program administrator provided a consultation to
the individual, unless rule
173-43-03 of the Administrative
Code exempted the individual.
(D)
Concurrent
assessments: The program administrator may incorporate either of the following
assessments into a consultation:
(1)
The level-of-care assessment under rule
5160-3-14 of the Administrative
Code.
(2)
The pre-admission screening and resident review under
rules 5160-3-15.1 and 5160-3- 15.2 of
the Administrative Code.
(E)
Components of
each consultation: When providing a consultation, the program administrator
shall focus on the individual's needs, circumstances, and values and provide
the individual with information about options available to meet the
individual's needs, including all of the following information:
(1)
The availability
of any long-term care options open to the individual.
(2)
Sources and
methods of both private and public payment for long-term care
services.
(3)
Factors to consider when choosing among the available
program, services, and benefits.
(4)
Opportunities and
methods for maximizing independence and self-reliance, including support
services provided by the individual's family, friends, and
community.
(5)
If the individual is a veteran, as defined in section
5901.01 of the Revised Code, or
the spouse, surviving spouse, or representative of the veteran, the following
additional information:
(a)
The availability of health care or financial benefits
through the United States department of veterans affairs.
(b)
Information about
congressionally-chartered veterans service organizations or the county veterans
service office that can assist with investigating and applying for benefits
through the United States department of veterans affairs.
(6)
Support for the individual as the individual explores the
range of options available, makes decisions about the appropriate services to
meet the individual's needs, and creates a plan of care.
(F)
At the
conclusion of the consultation, the program administrator shall provide the
individual (or the individual's representative) with a written or electronic
summary of the options and resources discussed. The information the program
administrator provides to an individual during a consultation is not binding.
The individual may choose the long-term services and supports that best meet
the individual's needs.
Replaces: 173-43-02
