Current through all regulations passed and filed through December 16, 2024
(A)
This rule sets
forth the eligibility requirements and benefit limitations for the
non-medicaid-funded Ohio access success project in accordance with section
5166.35 of the Revised
Code.
(B)
Definitions:
(1)
"Fiscal year" is
defined as the fiscal year of this state, as specified in section
9.34 of the Revised
Code.
(2)
"Helping Ohioans move, expanding choice (HOME choice)"
is Ohio's money follows the person demonstration project funded by the centers
for medicare and medicaid services as defined in Chapter 5160-51 of the
Administrative Code.
(3)
"Nursing Facility" is defined as a facility or a
distinct part of a facility as defined in division (DD) of section
5165.01 of the Revised
Code.
(4)
"Relocation" is defined as transition from a nursing
facility into the community.
(C)
The application
process for the Ohio access success project requires:
(1)
Completion of
the ODM 02372 "Ohio Access Success Project Application" (rev 07/2014);
and
(2)
An assessment of the individual's care needs in the
community.
(D)
In order to be eligible for Ohio access success
project benefits, an individual must meet all of the following criteria :
(1)
Be receiving
medicaid-funded nursing facility services at the time of
application;
(2)
Be able to safely remain in the community as a result
of receiving project benefits, as determined by ODM;
(3)
Not qualify for
similar services that are reimbursable by medicaid;
(4)
Have been
determined ineligible for HOME choice as set forth in Chapter 5160-51 of the
Administrative Code; and
(5)
Have estimated costs of medicaid health care services
in the community that shall not exceed eighty per cent of the average monthly
nursing facility reimbursement rate.
(E)
The Ohio access
success project benefit shall be used to purchase goods and services to assist
in the relocation of an individual from a nursing facility to a community
setting.
(1)
Goods and services include:
(a)
First month's rent in a community
setting;
(b)
Rental deposits;
(c)
Utility
deposits;
(d)
Moving expenses; and
(e)
Other expenses
not covered by the medicaid program that facilitate an individual's move from a
nursing facility to a community setting.
(2)
A participant
shall be allocated no more than two thousand dollars for goods and services
under the Ohio access success project, and part of the participant's allocation
shall be paid to the ODM-designated financial management service provider for
costs associated with the administration of the benefit.
(F)
Adverse determinations for the Ohio access success project may be appealed in
accordance with division 5101:6 of the Administrative Code.
(G)
ODM has the
authority to limit the number of participants in the Ohio access success
project to the extent funds are available. ODM may direct the available funds
toward the relocation of individuals at the greatest risk of remaining in the
nursing facility, as determined by ODM.
Replaces: 5160-49-01
