Current through all regulations passed and filed through September 16, 2024
(A) This rule sets
forth the eligibility criteria for a state plan home and community-based
services (HCBS) benefit authorized under section 1915(i) of the Social Security
Act (as in effect on October 1, 2017). Section 1915(i) of the act allows states the
flexibility to provide HCBS to individuals who require less than an
institutional level of care (LOC) and who would, therefore, not be eligible for
HCBS under the more restrictive criteria of section 1915(c) waivers. The
specialized recovery services (SRS) program provides targeted services to the
following individuals described in rule
5160-43-02
of the Administrative Code:
(1) Individuals
with severe and persistent mental illness (SPMI); or
(2) Individuals who are active on the solid
organ or soft tissue waiting list; or
(3) Individuals with certain diagnosed
chronic conditions.
(B)
Eligibility for the SRS program state plan HCBS benefit. An individual
shall meet all
of the following criteria to be eligible for the SRS program state plan HCBS
benefit:
(1) Be at least twenty-one
years of age.
(2) Have
been determined to meet the definition of disability used by the social
security administration (SSA) for purposes of supplemental security income
(SSI) or social security disability insurance (SSDI) benefits.
(a)
A disability
determination is not required for individuals over the age of sixty-five years
old who are active on the solid organ or soft tissue waiting list, or who have
certain diagnosed chronic conditions.
(b)
A disability
determination is not required for individuals under age sixty-five years old
who are enrolled in the medicare end-stage renal disease program.
(3) Meet the clinical diagnostic, needs assessment,
and risk criteria described in rule
5160-43-02
of the Administrative Code.
(4) Reside in a home
and community-based setting consistent with the qualities identified in
42
C.F.R. 441.710 (as in effect on October 1,
2017).
(5) Meet the financial
and nonfinancial eligibility requirements of one of the following groups:
(a) Group one.
(i) Be in receipt of
medical
assistance, as described in Chapters 5160:1-1 to 5160:1-5 of the
Administrative Code; and
(ii) Have
countable income that does not exceed one hundred fifty
per
cent of the federal poverty level (FPL), as determined using the same
rules used for determining the individual's medical
assistance eligibility.
(b) Group two.
(i) Meet the conditions of eligibility
outlined in rule
5160:1-2-10
of the Administrative Code; and
(ii) Not be otherwise eligible for
medical
assistance; and
(iii) For the
purpose of determining whether an individual is income eligible for the SRS
program, the administrative agency shall compare the individual's countable income to one
hundred fifty per cent of the FPL, as determined in accordance with Chapter
5160:1-3 of the Administrative Code.
(a) If
the individual's countable income exceeds one hundred fifty
per
cent of the FPL, apply additional disregards in the following order:
(i) Twenty dollar personal needs disregard;
then
(ii) Disregard income in the
amount of the difference between one hundred fifty per cent of the FPL for an
individual and three hundred per cent of the current supplemental security
income (SSI) federal benefit rate (FBR) for an individual.
(b) If the amount determined in paragraph
(B)(5)(b)(iii) of this rule is no more than one hundred
fifty per cent of the FPL, the individual meets the income eligibility
requirement for the SRS program.
(iv) There is no resource limit for
individuals described in paragraph (B) (5)(b) of this
rule.
(C) There is no retroactive eligibility for
the SRS program state plan HCBS benefit. Coverage under this rule cannot begin
prior to the first day of the month in which all financial, nonfinancial, and
programmatic criteria are met.
(D)
An individual who is receiving the state plan HCBS benefit cannot be
concurrently enrolled in another HCBS authority, such as a section 1915(c)
waiver. Subject to the individual's choice, he or she will be enrolled in the
HCBS authority best meeting the totality of his or her needs regardless of the
order in which the individual applied for or became eligible for
HCBS.
(E) Eligibility for this
program shall be determined for applications for medical assistance filed on or
after the effective date of this rule.
