Chapter 173-43 Long Term Care Consultation Program

173-43-01 Introduction and definitions.

(A) Introduction: This chapter regulates the long-term care consultation program that sections 173.42 to 173.425 of the Revised Code established. The program provides information to individuals and their representatives about options available to meet their long-term care needs and factors to consider when making long-term care decisions.

(B) Definitions for this chapter:

(1) "Individual" means a person who may qualify to receive a long-term care consultation.

(2) "Level of care" means the review and determination process under rule

5160-3-14 of the Administrative Code.

(3) "Long-term care consultation" has the same meaning as in section 173.42 of the Revised Code.

(4) "Nursing facility" has the same meaning as in section 5165.01 of the Revised Code.

(5) "ODA" means "the Ohio department of aging."

(6) "Pre-admission screening and resident review" has the same meaning as in rules 5160-3- 15.1 and 5160-3- 15.2 of the Administrative Code.

(7) "Program administrator" has the same meaning as in section 173.42 of the Revised Code.

(8) "Representative" has the same meaning as in section 173.42 of the Revised Code.

Effective: 12/19/2013
R.C. 119.032 review dates: 07/05/2017
Promulgated Under: 119.03
Statutory Authority: 173.01 , 173.02 , 173.42
Rule Amplifies: 173.42
Prior Effective Dates: 06/30/2007, 05/07/2009, 07/05/2012

173-43-02 Process and general standards.

This rule sets forth the process and general standards for providing long-term care consultations.

(A) Process:

(1) When an individual contacts the program administrator to seek information about options available to meet long-term care needs, the program administrator shall offer a long-term care consultation to the individual.

(2) When an individual applies for admission to a nursing facility or is seeking medicaid payment for a continued stay in a nursing facility, the program administrator shall provide a long-term care consultation to the individual.

(3) The nursing facility shall notify the program administrator of any individual who is a nursing facility resident that was admitted under a time-limited convalescent exemption or who was admitted under a categorical determination in accordance with rule 5160-3- 15.1, 5122-21-03, or 5123:2-14-01 of the Administrative Code, but has since been found to require a stay in a nursing facility that will exceed the time limits specified 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 exempts the individual. Upon being notified, the program administrator shall determine if a long-term care consultation is required.

(4) If the nursing facility determines that an individual is exempt from a long-term care consultation under rule 173-43-03 of the Administrative Code, the nursing facility shall document the reason for the exemption in the individual's record.

(5) If the program administrator determines that it is not required to provide a long-term care consultation to an individual under rule 173-43-03 of the Administrative Code, the program administrator shall provide documentation to the individual (or the individual's representative, if any) and to the nursing facility (if known) that identifies the exemption being met.

(6) For an individual for whom the program administrator is required to provide a long-term care consultation, the program administrator, in consultation with the individual, shall determine whether to provide a long-term care consultation before or after admission to a nursing facility.

(7) Information about an individual who is applying to a nursing facility or seeking medicaid payment for a continued stay in a nursing facility may come from the individual, the nursing facility to which admission is being sought, or through the pre-admission screening and resident review process. The program administrator may access the nursing facility resident assessment data the nursing facility collects through the resident assessment instrument to identify individuals who are likely to benefit from a long-term care consultation. As used in this paragraph, "resident assessment instrument" has the same meaning as in rule 5160-3- 43.1 of the Administrative Code.

(8) Concurrent assessments: The program administrator may provide a long-term care consultation to an individual that also assesses the individual's functional capabilities, so long as ODA has authorized the program administrator to assess the individual's functional capabilities, as follows:

(a) Level of care: The program administrator may incorporate the level-of-care assessment that section 5165.04 of the Revised Code requires in the long-term care consultation that it provides to an individual. The individual who is subject to the level-of-care review shall comply with the requirements for the level-of-care review. The program administrator that provides the level-of-care review shall comply with rules 173-43-05 and 5160-3-14 of the Administrative Code.

(b) Pre-admission screening and resident review: The program administrator may incorporate portions of the determinations that section 5165.03 of the Revised Code requires in the long-term care consultation that it provides to an individual. The individual who is subject to the pre-admission screening and resident review shall comply with the requirements for the pre-admission screening and resident review. The program administrator that provides the pre-admission screening and resident review shall comply with rules 173-43-05 , 5160-3- 15.1, and 5160-3- 15.2 of the Administrative Code.

(9) At the conclusion of the long-term care consultation, the program administrator shall provide the individual (or the individual's representative) with a written summary of options and resources discussed.

(B) General standards:

(1) When providing a long-term care 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 his or her needs. At a minimum, the program administrator shall include the following information in each long-term care consultation:

(a) The availability of any long-term care options open to the individual;

(b) Sources and methods of both private and public payment for long-term care services;

(c) Factors to consider when choosing among the available program, services, and benefits;

(d) Opportunities and methods for maximizing independence and self-reliance, including support services provided by the individual's family, friends, and community; and,

(e) Support for the individual as he or she explores the range of options available, makes decisions about the appropriate services to meet his or her needs, and creates a plan of care.

(2) 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 long-term care consultation.

(3) A nursing facility that has a provider agreement with the department of job and family services may only admit an individual as a resident upon receipt of evidence that the nursing facility has complied with rules 173-43-02 and 173-43-03 of the Administrative Code and that the program administrator has provided a long-term care consultation to the individual, unless rule 173-43-03 of the Administrative Code exempts the individual.

(4) The information the program administrator provides to an individual during a long-term care consultation is not binding. The individual may choose the long-term services and supports that best meets his or her needs.

Effective: 12/19/2013
R.C. 119.032 review dates: 08/05/2017
Promulgated Under: 119.03
Statutory Authority: 173.01 , 173.02 , 173.42
Rule Amplifies: 173.42
Prior Effective Dates: 1/1/95, 06/30/2007, 08/05/2012

173-43-03 Required consultations and exemptions.

This rule sets forth to whom long-term care consultations are provided and the conditions under which exemptions may be made.

(A) The program administrator shall provide a long-term care consultation to each individual in the following categories, unless paragraph (B) or (C) of the rule exempt the individual:

(1) An individual who applies, or indicates an intention to apply, for admission to a nursing facility, regardless of the source of payment to be used for the individual's care in the nursing facility;

(2) A nursing facility resident who was admitted under a time-limited convalescent exemption or who was admitted under a categorical determination in accordance with rule 5160-3- 15.1, 5122-21-03, or 5123:2-14-01 of the Administrative Code, but has since been found to require a stay in a nursing facility that will exceed the time limits specified in those rules, unless paragraph (B) or (C) of this rule exempt the individual;

(3) An individual who contacts the program administrator for the purpose of seeking information about options available to meet long-term care needs; or,

(4) Any individual that ODA or the program administrator identifies as being likely to benefit from a long-term care consultation.

(B) The nursing facility or the program administrator shall determine that the program administrator is not required to provide a long-term care consultation to an individual if any of the following apply:

(1) The program administrator has attempted to provide the long-term care consultation, but the individual (or the individual's representative) refuses to cooperate;

(2) The individual is to receive care in a nursing facility under a contract for continuing care, as defined in section 173.13 of the Revised Code;

(3) The individual has a contractual right to admission to a nursing facility operated as part of a system of continuing care in conjunction with one or more facilities that provide a less-intensive level of services, including a residential care facility licensed under Chapter 3721. of the Revised Code; a residential facility licensed under section 5119.34 of the Revised Code that provides accommodations, supervision, and personal care services for three to sixteen unrelated adults; or an independent living arrangement;

(4) The individual is to receive continual care in a home for the aged that is exempt from taxation under section 5701.13 of the Revised Code;

(5) The individual is seeking admission to a facility that is not a nursing facility with a provider agreement under section 5165.07 , 5165.511 , or 5165.512 of the Revised Code; or,

(6) The individual is exempt from the requirement for a face-to-face visit, as described in rule 5160-3-14 of the Administrative Code.

(C) The program administrator may determine that it is not required to provide a long-term care consultation to each individual in the following categories unless the individual (or the individual's representative) requests a long-term care consultation:

(1) The individual is being admitted to a nursing facility directly from a hospital and is expected to have a short length of stay (ninety days or less). In making this determination, the program administrator shall consider factors such as medical condition, probably need for long-term care services, history of hospitalizations, availability of informal supports, and awareness of options available to determine the appropriateness of the long-term care consultation;

(2) The individual has care needs that clearly exceed the services that are available to the individual in an alternative setting to the nursing facility. To make this determination, the program administrator shall consider the availability of existing formal and informal support systems, the availability of potential formal and informal support systems, the functional abilities and limitations of the individual, the individual's diagnosis, the individual's prognosis, and the individual's plan of treatment, placing special emphasis on end-of-life treatment, because such a treatment is most likely an indicator that the individual will not benefit form a long-term care consultation;

(3) The individual has been admitted to a nursing facility under a convalescent exemption from the pre-admission screening and resident review, under a time-limited categorical PAS-SMI defined in rule 5122-21-03 of the Administrative Code, or under a time-limited categorical PAS-MR/DD determination defined in rule 5123:2-14-01 of the Administrative Code; or,

(4) The individual received an in-person long-term care consultation from the program administrator within the previous one hundred and twenty days.

(D) The program administrator may provide a long-term care consultation to any individual residing in a nursing facility regardless of the source of payment used to pay for the individual's care in the nursing facility.

Effective: 12/19/2013
R.C. 119.032 review dates: 07/22/2017
Promulgated Under: 119.03
Statutory Authority: 173.01 , 173.02 , 173.42
Rule Amplifies: 173.42
Prior Effective Dates: 06/30/2007, 07/22/2012

173-43-04 Time frames.

This rule sets forth the time frames in which the program administrator shall provide a long-term care consultation.

(A) The program administrator shall complete every long-term care consultation no later than five calendar days after it receives a request for the long-term care consultation, unless the program administrator has an exemption from the five-day time frame under paragraph (B) of this rule.

(B) Exemptions:

(1) If an individual has applied for medicaid coverage, the program administrator shall complete the long-term care consultation in accordance with the applicable time frame for providing a face-to-face level-of-care determination .

(2) An individual (or the individual's representative) may request that the program administrator provide a long-term care consultation before or after the date required under paragraph (A) of this rule. In such cases, the program administrator shall provide the long-term care consultation at a time that is mutually agreed-upon between the individual (or the individual's representative) and the program administrator.

(3) If the program administrator cannot complete the long-term care consultation before the date required under paragraph (A) of this rule, the program administrator shall provide the long-term care consultation as soon as practicable.

Effective: 12/19/2013
R.C. 119.032 review dates: 07/05/2017
Promulgated Under: 119.03
Statutory Authority: 173.01 , 173.02 , 173.42
Rule Amplifies: 173.42
Prior Effective Dates: 06/30/2007, 07/05/2012

173-43-05 Staff certification.

This rule sets forth the certification criteria to perform a long-term care consultation and general standards regarding certification.

(A) Certification criteria:

(1) Only a person that ODA certifies to provide a long-term care consultation may provide a long-term care consultation.

(2) ODA shall only certify a person to provide a long-term care consultation who is an employee of the program administrator and who meets at least one of the following four criteria:

(a) The person possesses a current, valid license to practice as a registered nurse under Chapter 4723. of the Revised Code or a valid license to practice as a licensed social worker under Chapter 4757. of the Revised Code .

(b) The person possesses a current, valid license to practice as a licensed professional counselor under Chapter 4757. of the Revised Code or a current, valid license to practice in a related profession upon approval by ODA .

(c) The person possesses a bachelor of arts degree or a bachelor of science degree and also possesses at least one year of experience in the following:

(i) Providing individuals with information about options available to meet long-term care needs or providing individuals with related information such as that which is provided through information and referral, information and assistance; or,

(ii) Managed care experience or other such healthcare experience related to individuals' long-term care needs.

(d) The person possesses at least three years of experience in the following:

(i) Providing individuals with information about options available to meet long-term care needs or providing individuals with related information such as that which is provided through information and referral, information and assistance; or,

(ii) Managed care experience or other such healthcare experience related to individuals' long-term care needs.

(3) Any person who performs an in-person long-term care consultation that includes an assessment of the individual's functional capabilities, fulfills any portion of a required pre-admission screening and resident review determination , or fulfills any portion of a level-of-care review shall meet the requirements of paragraph (A)(2)(a) of this rule.

(4) No employee of a provider of long-term services and supports shall provide a long-term care consultation.

(5) ODA shall only certify a person to provide a long-term care consultation if, according to Chapter 173-9 of the Administrative Code, the person's criminal record does not disqualify the person from being employed in a direct-care position.

(B) General standards regarding certification:

(1) ODA shall notify the program administrator the date that it certifies a person to provide long-term care consultations.

(2) If, at any time, a certified person no longer complies with this rule, the person shall not provide another long-term care consultation until he or she complies with the rule.

(3) Training:

(a) The program administrator shall train and orient each certified person. Training and orientation shall include, but is not limited to, the following topics:

(i) Local availability of publicly-financed and privately-financed long-term care options, programs, services, and benefits;

(ii) Factors to consider when choosing among available options; and,

(iii) Opportunities and methods for individuals to maximize independence and self-reliance.

(b) Each certified person shall successfully complete fifteen clock hours of professional development every two years beginning with the date ODA certified the person to provide long-term care consultations. The professional development curriculum shall transmit knowledge relevant to the duties involved in providing a long-term care consultation.

(4) For each certified person, the program administrator shall track and keep records demonstrating that the requirements of this rule are met.

Effective: 12/19/2013
R.C. 119.032 review dates: 07/05/2017
Promulgated Under: 119.03
Statutory Authority: 173.01 , 173.02 , 173.42 , 173.422
Rule Amplifies: 173.42 , 173.422
Prior Effective Dates: 06/30/2007, 07/05/2012