(A) "Community transition services" means non-recurring set-up expenses for a consumer who is transitioning from an institutional setting or another provider-operated living arrangement to a living arrangement in a private residence where the consumer is directly responsible for his or her own living expenses. Expenses are furnished only if the service plan clearly identifies the expenses as reasonable and necessary for the consumer to establish a basic household, if the expenses don't constitute room and board, and if the consumer is unable to meet meet the expenses or to obtain them from other sources. Non-recurring set-up expenses that meet this criteria may include any of the following:
(1) Security deposits required to lease an apartment or home. (For the purposes of this rule, mortgages and rents are room and board, but security deposits are non-recurring set-up expenses.)
(2) Household furnishings required to occupy and use a private residence, including furniture, window coverings, food preparation items, and bed and bath linens.
(3) Set-up fees or deposits required for utility or service access, including telephone, electricity, heating, and water. (For the purposes of this rule, regular utility charges are room and board, but set-up fees and deposits are non-recurring set-up expenses.)
(4) Services required for the consumer's health and safety, such as pest eradication and one-time cleaning prior to occupancy.
(5) Moving expenses.
(6) Home accessibility adaptations required for the consumer that are not the landlord's responsibility.
(7) Activities to arrange for and to procure other non-recurring set-up expenses.
(B) Eligibility criteria for the community transition service:
(1) A case manager may authorize one or more expenses for:
(a) A consumer who is enrolled in the assisted living program and is in transition from a nursing facility to a residential care facility; or,
(b) A consumer who is enrolled into the PASSPORT program and is in transition from a nursing facility to a house or apartment.
(2) In a consumer's service plan, a case manager may only authorize an expense if no other person, including a landlord, has a legal or contractual responsibility to cover the expense and if family, neighbors, friends, or community agencies are unwilling to provide the expense for free.
(C) Requirements for a community transition service in addition to the conditions of participation under rule 173-39-02 of the Administrative Code:
(1) Deadline: The provider shall furnish the service no later than ninety days after the date the consumer enrolls in the assisted living program or the PASSPORT program.
(2) Consumer choice: The provider shall involve the consumer in the selection of items to be purchased on the consumer's behalf.
(3) Limitations: The provider shall not seek reimbursement for any expenses in excess of those authorized in the consumer's service plan.
(4) Provider qualifications: Only an agency that ODA certifies as an agency provider, a person that ODA certifies as a non-agency provider, or a residential care facility that ODA certifies as an assisted living provider shall provide this service.
(5) Service verification:
(a) For each service provided, the provider shall retain a record of the:
(i) Consumer's name;
(ii) Date of service;
(iii) Accurate description of each expense;
(iv) A receipt for each expense;
(v) The consumer's signature to verify that the consumer was involved in the selection of any item purchased on the consumer's behalf; and,
(vi) The consumer's signature to verify that the service was provided.
(b) The case manager shall record the consumer's signature of choice in the consumer's service plan. The signature of choice may include a handwritten signature; initials; stamp or mark; or electronic signature.
(c) The provider may use a technology-based system to collect or retain the records required under this rule.
(d) The agency provider shall retain records required under this rule and provide access to those records for monitoring according to paragraph (B)(5) of rule 173-39-02 of the Administrative Code. The non-agency provider shall retain records required under this rule and provide access to those records for monitoring according to paragraph (C)(5) of rule 173-39-02 of the Administrative Code. The assisted living provider shall retain records required under this rule and provide access to those records for monitoring according to paragraph (E)(5) of rule 173-39-02 of the Administrative Code.
(1) The sum of the community transition service expenses authorized in a consumer's service plan constitutes one job of community transition service.
(2) The per-job rate for a service is negotiable, but is finalized by ODA's designee.
(3) The maximum rate allowable for the service is established in the appendix to rule 5101:3-1-06.5 for the assisted living program and in the appendix to rule 5101:3-1-06.1 of the Administrative Code for the PASSPORT program.
Replaces: 173-39- 02.17
R.C. 119.032 review dates: 06/10/2018
Promulgated Under: 119.03
Statutory Authority: 173.01 , 173.02 , 173.391 , 173.40 , 5111.89
Rule Amplifies: 173.39 , 173.391
Prior Effective Dates: 03/31/2006, 03/22/2008, 07/03/2008