Current through all regulations passed and filed through September 16, 2024
(A)
The purpose of this rule is to describe the eligibility
requirements for individuals residing in a continuing care retirement community
(CCRC), life care community, or a philanthropic long-term care facility
(PLTCF).
(B)
Definitions.
(1)
"CCRCs" and "life care communities" mean housing
communities that provide different categories of care based on each resident's
need over time. CCRCs and life care communities may range from independent
living in an apartment, to assisted living, to full-time care in a nursing
facility. Residents may move from one setting to another, based on their needs,
but continue to live as part of the community. Generally, CCRCs require a
written contract and an entrance fee, in addition to monthly fees. CCRCs and
life care communities may also be PLTCFs.
(2)
"Entrance fee"
means a payment generally required for admission to a CCRC, life care
community, or PLTCF and may vary in amount based on the type of housing
accommodations and/or category of care.
(3)
"PLTCF" means a
not-for-profit long-term care facility.
(C)
For purposes of
determining or redetermining eligibility for medical assistance, an
individual's entrance fee for admission to a CCRC or life care community shall
be considered an available resource to the individual, in accordance with
42 U.S.C.
1396p (as in effect October 1, 2023), when
all of the following conditions are met:
(1)
The entrance fee
can be used to pay for care, under the terms of the entrance contract, when
other resources or income of the individual are insufficient;
and
(2)
The individual is eligible for a refund of any
remaining entrance fee when the individual dies or terminates the contract and
leaves the CCRC or life care community; and
(3)
The entrance fee
does not confer an ownership interest in the CCRC or life care
community.
(D)
Eligibility for medical assistance for individuals
residing in a PLTCF.
(1)
An individual residing in a PLTCF who has not entered
into a life care contract must have eligibility for medical assistance
determined in accordance with Chapter 5160:1-6 of the Administrative Code and
the entrance fee paid to the PLTCF shall be considered an available
resource.
(2)
An individual residing in a PLTCF, who has entered into
a life care contract with the PLTCF, is eligible for medical assistance, and
the entrance fee shall not be considered an available resource, when all other
eligibility requirements for medical assistance are fulfilled, and the
following conditions are met:
(a)
The PLTCF must provide evidence that it is financially
unable to operate. The PLTCF must show that the total financial situation of
the facility indicates an inability to fulfill its responsibilities under the
life care contract; and
(b)
The entrance fee would be depleted had the individual
paid the facility at the medicaid long-term care rate for a comparable
facility.
Replaces: 5160:1-6-02.3
