(A) The program administrator may provide
a consultation in person or by telephone or video conference.
(B) The program administrator shall offer
a consultation to any individual who contacts the program administrator to seek
information about options available to meet long-term care needs.
(C) On application for admission to a nursing facility or
on seeking medicaid payment for a continued stay in a nursing facility, the
following apply:
(1) The nursing facility
shall notify the program administrator of any individual that was admitted to
the nursing facility under a a categorical determination in accordance with
rule 5160-3-15.1, 5122-21-03, or 5123-14-01 of the Administrative Code, but has
since been found to need a stay in a nursing facility that will exceed the time
limits identified in those rules. The nursing facility shall notify the program
administrator no later than seventy-two hours after the expiration of the time
limit, unless rule 173-43-03 of the Administrative Code indicates that the
program administrator is not required to provide a consultation to the
individual. On being notified, the program administrator shall determine if a
consultation is required.
(2) If the program administrator is not
required to provide a consultation to an individual under rule 173-43-03 of the
Administrative Code, then the nursing facility shall specify the reason why the
program administrator is not required to provide a consultation in the
individual's record.
(3) The program administrator shall
provide a consultation at a time agreed to by the program administrator and the
individual, whether before or after admission to a nursing
facility.
(4) The nursing facility
shall not deny or limit access to the facility or a resident of the facility to
any person who is attempting to provide a consultation.
(5) The program administrator may obtain
information about an individual who is applying to a nursing facility or
seeking medicaid payment for a continued stay in a nursing facility from the
individual, the nursing facility to which admission is being sought, the
pre-admission screening and resident review under rules 5160-3-15.1 and
5160-3-15.2 of the Administrative Code, or through the resident assessment
instrument as defined in rule 5160-3-43.1 of the Administrative
Code.
(6) A nursing facility
that has a provider agreement with the department of medicaid may admit an
individual as a resident only if the nursing facility has evidence of all of
the following:
(a) The nursing facility complied with this
rule.
(b) The nursing facility complied with rule 173-43-03 of
the Administrative Code.
(c) The program administrator provided a consultation to
the individual, unless rule 173-43-03 of the Administrative Code exempted the
individual.
(D) Concurrent assessments: The program administrator may
incorporate either of the following assessments into a
consultation:
(1) The level-of-care assessment under
rule 5160-3-14 of the Administrative Code.
(2) The pre-admission screening and
resident review under rules 5160-3-15.1 and 5160-3-15.2 of the Administrative
Code.
(E) Components of each consultation: When
providing a consultation, the program administrator shall focus on the
individual's needs, circumstances, and values and provide the individual
with information about options available to meet the individual's needs,
including all of the following information:
(1) The availability of
any long-term care options open to the individual.
(2) Sources and methods
of both private and public payment for long-term care services.
(3) Factors to consider
when choosing among the available program, services, and benefits.
(4) Opportunities and
methods for maximizing independence and self-reliance, including support
services provided by the individual's family, friends, and
community.
(5) If the individual is
a veteran, as defined in section 5901.01 of the Revised Code, or the spouse,
surviving spouse, or representative of the veteran, the following additional
information:
(a) The availability of health care or financial benefits
through the United States department of veterans affairs.
(b) Information about congressionally-chartered veterans
service organizations or the county veterans service office that can assist
with investigating and applying for benefits through the United States
department of veterans affairs.
(6) Support for the
individual as the individual explores the range of options available, makes
decisions about the appropriate services to meet the individual's needs,
and creates a plan of care.
(F) At the conclusion of the consultation, the program
administrator shall provide the individual (or the individual's
representative) with a written or electronic summary of the options and
resources discussed. The information the program administrator provides to an
individual during a consultation is not binding. The individual may choose the
long-term services and supports that best meet the individual's
needs.
