Current through all regulations passed and filed through September 16, 2024
(A) The purpose of this rule is to outline
the requirements that must be met for an individual to be eligible to enroll in
the medicaid funded component of the assisted living program.
(B) To be eligible for the medicaid funded
component of the assisted living program, an individual must meet all of the
following:
(1) Be eligible for medicaid in
accordance with Chapters 5160:1-3 to 5160:1-6 of the Administrative
Code.
(2) Have an intermediate or
skilled level of care in accordance with rule
5160-3-08 of the Administrative
Code. If the individual requires skilled nursing care beyond supervision of
special diets, application of dressings, or administration of medication, it
must be provided in accordance with rule
3701-16-09.1 of the
Administrative Code.
(3) Be age
twenty-one years old or older at the time of enrollment.
(4) Participate in the development of a
person-centered services plan in accordance with the process and requirements
set forth in rule
5160-44-02 of the Administrative
Code.
(5) Have the ability to make
room and board payments calculated at the current supplemental security income
(SSI) federal benefit level minus fifty dollars. Providers shall not charge or
collect room and board payments from individuals in excess of the room and
board payment calculated in accordance with this paragraph. In the event an
individual does not have sufficient personal income:
(a) An individual may arrange for informal
supports to provide a supplemental payment to the provider in order to meet
room and board requirements;
(i) The
supplemental payment shall represent no more than the difference between the
individual's personal income and the maximum room and board payment established
in paragraph (B)(5) of this rule.
(ii) The amount of the supplemental payment
shall not be considered when calculating the individual's patient liability as
described in rule
5160:1-6-07.1 of the
Administrative Code.
(b)
A provider may elect to accept a reduced room and board rate.
(6) Have health and safety related
needs met, as determined by the Ohio department of aging's (ODA)
designee.
(C) The
individual must reside in a residential care facility (RCF) licensed by the
Ohio department of health. At the time of initial and continued enrollment, the
individual must reside in a
resident unit
that meets the qualifications in rule
173-39-02.16 of the
Administrative Code
and
possesses the home and community-based setting
characteristics set forth in rule
5160-44-01 of the Administrative
Code.
(D) If, at any time, the individual
does
not meet any of the eligibility requirements identified in this rule, the
individual shall be denied or disenrolled from
the assisted living HCBS
waiver. In such instances, the individual shall be notified of his or her
hearing rights in accordance with division 5101:6 of the Administrative Code.
