Current through all regulations passed and filed through September 16, 2024
(A) Only an individual meeting all of the
following
qualifications is eligible for the state-funded
component of the assisted living program:
(1)
Consultation: The individual participated in a long-term care consultation
under section 173.42 of the Revised Code and
Chapter 173-43 of the Administrative Code.
(2) Financial requirements:
(a) The individual contacted either ODA's
designee or ODM's administrative agency to apply for the medicaid-funded
component of the assisted living program, but the application is still pending
because ODM's administrative agency has not yet made a final determination on
the individual's financial eligibility. If
ODM's administrative agency already determined the individual was eligible to
participate in the medicaid-funded component of the assisted living program,
the individual would
enroll into the medicaid-funded component of the
assisted living program. If ODM's administrative agency already determined the
individual was not financially eligible to participate in the medicaid-funded
component of the assisted living program, the individual would also not be
eligible to participate in the state-funded component of the assisted living
program.
(b) The individual agreed
that, if the individual
enrolls into the state-funded component of the
assisted living program,
and ODM's administrative agency determines the
individual is financially eligible for the medicaid-funded component of the
assisted-living program, then the individual
would transfer immediately
to the medicaid-funded
component of the assisted living program.
(c) The individual is cooperative and actively assisting ODM's
administrative agency in determining if the individual is financially eligible
to participate in the medicaid-funded component of the assisted living program
by timely providing ODM's administrative agency with information and copies of
any records ODM's administrative agency needs to make its financial eligibility
determination.
(d) ODA or its
designee
determined that ODM's administrative agency would most likely determine
that the individual meets all financial
eligibility requirements for the medicaid-funded component of the assisted
living program listed in rules
5160:1-2-03 and
5160:1-2-10 of the
Administrative Code.
(3) Non-financial requirements:
(a) ODA or its designee and the individual
entered into an enrollment agreement, and the
form indicated the individual chose to enroll in the state-funded component of
the assisted living program, named the individual's representative (if any),
and authorized ODA
or its designee to release information.
(b) ODA or its designee determined the
individual meets all non-financial eligibility requirements for the
medicaid-funded component of the assisted living program in rule
5160-33-03 of the Administrative
Code.
(c) The individual agreed to
reside in a
resident unit of
a certified RCF
while receiving assisted living services under the
state-funded component of the assisted living program that meets the requirements for resident units in rule
173-39-02.16 of the
Administrative Code.
(4) Post-eligibility treatment of income
(PETI) (i.e., patient liability or share of cost): After ODA or its designee
assessed the individual's income and resources using the methodology described
in rule
5160:1-6-07.1 of the
Administrative Code to determine if the individual should pay any share of cost
and the individual agreed to pay, and does pay, any share of cost as it becomes
due.
(B) If, at any
time, an individual enrolled in the state-funded component of the assisted
living program no longer meets all the requirements under paragraph (A) of this
rule, unless the only requirement the individual no longer meets is the PETI
requirement in paragraph (A)(5) of this rule, the individual is no longer
eligible for the state-funded component of the assisted living
program.
(C) An individual who is
eligible for the state-funded component of the assisted living program
is not
eligible to participate in the state-funded
component of the assisted living program for more than ninety days, unless
ODA's director
approved an extended number of days.
(D)
ODA's designee
may allow an individual to provide verbal agreement for intent to enroll in the
state-funded component of the assisted living program at the time of assessment
if unable to provide a unique identifier of the individual. ODA's
designee may collect the
unique identifier of the
individual for the agreements required in paragraphs (A)(2)(b),
(A)(3)(a), (A)(3) (c), and (A)(4) of this rule no
later than
thirty days after the individual's
original enrollment date.
