(A) Disenrollment: ODA or its designee shall
disenroll an individual enrolled in the state-funded component of the assisted
living program under any one or more of the following situations:
(1) The individual no longer meets all
requirements under rule
173-51-02 of the Administrative
Code, unless the only requirement the individual no longer meets is the PETI
requirement listed in paragraph (A)(5) of that rule, during a state of
emergency declared by the governor, or during a federal public health emergency
if federal financial participation pays for all of the individual's
services.
(2) ODM's administrative
agency determined the individual meets all medicaid financial eligibility
requirements under rules
5160:1-2-03 and
5160:1-2-10 of the
Administrative Code. (If an individual meets all requirements for the
medicaid-funded component of the assisted living program, the individual would
be enrolled into the medicaid-funded component of the program and no longer
remain in the state-funded component.)
(3) ODM's administrative agency determined
the individual does not meet all financial eligibility requirements under rules
5160:1-2-03 and
5160:1-2-10 of the
Administrative Code.
(4) The
individual has been enrolled in the state-funded component of the assisted
living program for the maximum enrollment period of ninety days, unless ODA's
director approved an extended number of days.
(5) The individual voluntarily disenrolls
from the state-funded component of the assisted living program before reaching
the maximum enrollment period of ninety days, unless ODA's director approved an
extended number of days.
(B) Post-disenrollment limitations: After ODA
or its designee disenrolls an individual from the state-funded component of the
assisted living program, the following limits apply:
(1) The individual is not eligible to
re-enroll into the state-funded component of the assisted living
program.
(2) The individual is not
eligible to enroll the individual into the medicaid-funded component of the
assisted living program until ODM's administrative agency determines the
individual meets all medicaid financial eligibility requirements and ODA or its
designee determines the individual meets all non-financial eligibility
requirements in rule
5160-33-03 of the Administrative
Code.
(3) The individual is not
eligible to enroll the individual into the state-funded component of the
PASSPORT program.
(C)
Appeals: An eligible individual may appeal a decision made under this rule
pursuant to section 173.545 of the Revised Code. The
individual's appeal is timely only if the request for a hearing is received by
ODA within thirty days
after the date in which ODA mailed the notice of
opportunity for hearing.
