Current through all regulations passed and filed through September 16, 2024
(A)
The residential
state supplement (RSS) payment to the assistance group shall be equal to the
difference between the countable income and the financial need standard for the
appropriate RSS living arrangement.
(B)
The approval
date for the RSS payment cannot precede the signature date on the JFS 07120
"Residential State Supplement Referral" (rev. 3/2003), the date of placement in
an appropriate RSS living arrangement, or the date when all financial and
resource eligibility requirements are met, whichever occurs last.
(C)
When
an individual leaves an RSS placement after the monthly RSS payment has been
made, a refund of the payment will not be made to the individual. If an
individual leaves an RSS placement and moves to another RSS living arrangement
and the monthly RSS payment has been made to the previous residence, a second
monthly RSS payment will not be made for the new residence.
(D)
When an
individual leaves an RSS placement the CDJFS must determine the individual's
continued medicaid eligibility. If an adverse action is required (e.g., a
change to delayed spenddown medicaid) the individual must be afforded hearing
rights in accordance with Chapter 5101:6-2 of the Administrative Code.
(E)
When
an individual moves from a nursing facility or a personal residence into an RSS
living arrangement the first day of the month and is otherwise eligible for
RSS, the individual is eligible for a full month's RSS payment.
(F)
When
an individual moves into an RSS living arrangement on a date other than the
first of the month and is otherwise eligible for RSS, the first month's payment
is calculated according to the following formula:
(1)
Determine the
regular monthly RSS payment in accordance with paragraph (A) of this
rule.
(2)
Divide the monthly RSS payment amount by the number of
days in the month to arrive at the daily supplement amount. Round amounts up to
the nearest dollar.
(3)
Multiply the daily supplement amount by the actual
number of days of RSS placement in the month. The actual number of days of RSS
placement in the month includes the day that the individual moves into the RSS
living arrangement through the last day of the month.
(4)
The resulting
product is the prorated RSS payment.
(G)
Impact of
temporary institutional placement.
(1)
Individuals who temporarily enter a public or medicaid
certified facility are potentially eligible to receive full uninterrupted RSS
benefits during the first three full months of institutional placement. These
RSS benefits are intended to allow the individual to maintain and pay for the
expense of the RSS living arrangement in which the individual intends to live
when discharged.
(2)
Individuals are eligible for continued RSS benefits
provided the following criteria are met:
(a)
Institutional
placement. The individual must continuously reside in one or more of the
following: a public medical institution, a public psychiatric institution, a
medicaid approved hospital, or a Title XIX certified long term care facility
(LTCF).
(b)
Recipient status. The individual must be eligible for
an RSS payment both the month prior to and the month of institutional
placement.
(c)
Physician's certification. The individual's physician
must provide a statement that the individual's period of institutional
placement is not likely to exceed ninety consecutive days, beginning the day
after the day of admission.
(d)
Need to maintain
the RSS facility placement. The individual must demonstrate the need to
continue to maintain the placement in the RSS facility during the institutional
placement, and that the RSS facility will reserve the individual's space. A
written statement from the RSS facility to this effect is necessary.
(e)
Evidence documenting that the criteria listed in paragraphs (G)(2)(a) to
(G)(2)(d) of this rule have been met must be provided by the earlier of:
(i)
Ninety days
after the date of admission to the institution; or
(ii)
The day of
release from the institution.
(f)
Individuals in
receipt of supplemental security income (SSI) must provide verification that
the social security administration (SSA) has approved continued SSI
benefits.
(3)
The CDJFS shall continue RSS payments to all
individuals meeting the criteria in paragraph (G)(2) of this rule.
(4)
RSS
payments and personal income are exempt from consideration as income in the
long term care patient liability calculation for individuals entering a
LTCF.
(a)
This
income exemption continues through the last day of the month in which the
temporary period of institutional placement ends.
(b)
Effective the
following month, if the RSS individual remains in an institutional placement,
the CDJFS must stop the RSS payment and count the individual's income in the
patient liability calculation.
(5)
Any RSS payments
made under the continued benefit provision are not overpayments if the
recipient's actual stay exceeds the expected stay of ninety days or less.
(6)
Prior
notice is not required to stop RSS payments and start vendor payments to a long
term care facility.
(H)
If the license
or certification of the RSS living arrangement expires or is suspended or
revoked, and a new alternative living arrangement is not secured for the
individual, the RSS case is terminated.
(1)
Upon
notification that the RSS living arrangement's license or certification has
expired or has been suspended or revoked, the CDJFS must provide prior notice
that the individual's RSS eligibility will be terminated because the individual
no longer resides in an RSS living arrangement.
(2)
When the living
arrangement's license or certification has been renewed, the RSS payment may be
made retroactive to the effective date of the living arrangement's
recertification, as long as all other RSS eligibility factors are met.
Replaces: 5101:1-17-05
