Current through all regulations passed and filed through September 16, 2024
(A) Helping Ohioans
move, expanding choice (HOME choice) assists individuals to transition from an
institutional setting into a community setting.
(B) Definitions
(1)
"Assessment"
means an in-person meeting with the HOME choice applicant to determine
eligibility for the program, conducted by the Ohio department of medicaid (ODM)
or its designee.
(2) "Community setting"
means a location that meets the home and communitybased setting requirements
set forth in rule
5160-44-01 of the Administrative
Code or for those moving from an intermediate care facility for individuals
with intellectual disabilities the requirements set forth in rule
5123:2-9-02 of the
Administrative Code.
(3) "HOME choice
participant" or "participant" means a person who is enrolled in HOME
choice.
(4) "Institutional
setting" means a hospital as described in Chapter 5160-2 of the Administrative
Code, a nursing facility as described in Chapter 5160-3 of the Administrative
Code, or an intermediate care facility for individuals with intellectual
disabilities as described in Chapter 5123:2-7 of the Administrative Code.
(C) To be eligible for HOME choice, an
individual must:
(1) Be enrolled in medicaid
in accordance with division 5160:1 of the Administrative Code at the time of
HOME choice application and during the entire HOME choice enrollment
period;
(2) Currently reside in an
institutional setting in Ohio and have resided in an institutional setting in
Ohio for a period of not less than sixty
consecutive days;
(3) Be eighteen
years of age or older;
(4) Complete
the ODM 10239, "HOME Choice Application" (5/2021)
which includes:
(a) Agreeing to adhere to the
participant responsibilities outlined in the HOME choice application;
(b) Agreeing to move to a community setting
in Ohio within one hundred eighty days of enrolling in the program.
(5) Participate in
an
assessment and be determined by ODM to have:
(a) A need for the program. Examples include:
(i) Requiring physical or emotional supports
to successfully transition from an institutional setting to a community
setting;
(ii) Lacking family or
informal supports willing and capable of assisting with any of the following;
(a) Locating, securing or moving into a
community setting;
(b) Acquiring
household furnishings and supplies;
(c) Restoring credit or obtaining financial
resources necessary to obtain or set up a household;
(d) Accessing community resources and
supports; or
(e) Arranging
necessary home adaptations required for community living.
(b) Health care needs that may be
adequately met in a community setting; and
(c) Enough income or means to sustain
community living at the time of HOME choice application and during the entire
HOME choice enrollment period.
(6) Have not previously transitioned through
the HOME choice program after July 1, 2019;
(7) Not be moving to another institutional
setting.
(8) Work with a transition
coordinator to develop a safe transition plan, and discharge in accordance with
that plan.
(9) Not be a foster
child, as defined in Chapter 5101:2-1 of the Administrative Code; and
(10) Not be eligible for both:
(a) Targeted case management, as defined in
rule 5160-48-01 of the Administrative
Code, and
(b) Community transition
services, as defined in rule
5123-9-48 of the Administrative
Code.
(D) An
individual may be enrolled in HOME choice when all the criteria in paragraph
(C) of this rule are met. ODM will notify the individual of enrollment in
writing. The HOME choice enrollment period begins on the date of the enrollment
letter and continues for up to one hundred eighty days pre-transition and up to
thirty days post transition.
(E)
Services available through HOME choice include activities approved by ODM or
it's designee to assist the participant in their transition including:
(1) "Transition coordination" which includes:
(a) Working with facility discharge planners
to determine what services and supports the participant will need in the
community;
(b) Helping the
participant obtain housing;
(c)
Linking the participant with community resources;
(d) Coordinating the use of community
transition services;
(e)
Collaborating with the participant's comprehensive care team and nursing
facility or hospital to coordinate services at the time of discharge from the
institutional setting, and after the transition into the community setting when
applicable.
(2)
"Community transition service" as set forth in rule
5160-44-26 of the Administrative
Code.
(3) HOME choice services can
not duplicate services available to a participant enrolled on a home and
community-based services (HCBS) waiver.
(F) A participant may receive HOME choice
services for up to thirty days post transition beginning on the date the
participant moves from the institutional setting into the community
setting.
(G) If an individual fails
to meet any of the requirements set forth in paragraph (C) of this rule before
the HOME choice enrollment period, the individual will be denied participation
in the program and afforded notice and hearing rights in accordance with
division 5101:6 of the Administrative Code.
(H) If an individual fails to meet any of the
requirements set forth in paragraph (C) of this rule after the HOME choice
enrollment period begins, the individual will be terminated from the program
and afforded notice and hearing rights in accordance with division 5101:6 of
the Administrative Code.
