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Ohio Laws and Rules
(A) Only an individual who meets all of the following criteria is eligible for the state-funded component of the assisted living program:
(1) The individual has participated in a long-term care consultation under section 173.42 of the Revised Code and Chapter 173-43 of the Administrative Code;
(2) The individual completes and submits forms JFS07200 and JFS02399 to the CDJFS;
(3) ODA’s designee and the individual complete form ODA1116, which indicates that the individual chooses to enroll in the state-funded component of the assisted living program, names the individual’s representative (if any), and indicates the individual’s authorization to release information;
(4) ODA’s designee has determined that the individual meets the non-financial eligibility criteria for the medicaid-funded component of the assisted living program under rule 5101:3-33-03 of the Administrative Code;
(5) ODA’s designee completes form ODA1115 and the form indicates that the individual meets the financial eligibility criteria for the medicaid-funded component of the assisted living program under rules 5101:1-38-01.6 and 5101:1-38-01.8 of the Administrative Code;
(6) After ODA’s designee assesses the individual according to rule 5101:1-39-24.1 of the Administrative Code, the individual pays any patient liability amount that ODA’s designee determines the individual shall pay to the entity to which ODA’s designee instructs the individual to pay; and,
(7) While receiving assisted living services under the state-funded component of the assisted living program, the individual resides in an Ohio licensed residential care facility that is authorized by a valid provider agreement to participate in the medicaid-funded component of the assisted living program.
(B) If, at any time, a consumer enrolled in the state-funded component of the assisted living program no longer meets all the criteria under paragraph (A) of this rule, the consumer is no longer eligible for the state-funded component of the assisted living program.
(C) An individual who is eligible for the state-funded component of the assisted living program may not participate in the state-funded component of the assisted living program for more than three months.
Effective: 12/29/2011
R.C. 119.032 review dates: 12/29/2016
Promulgated Under: 111.15
(A) Disenrollment: ODA’s designee shall disenroll a consumer who is enrolled in the state-funded component of the assisted living program if:
(1) The consumer no longer meets all the criteria under paragraph (A) of rule 173-51-02 of the Administrative Code;
(2) The CDJFS has determined that the consumer meets the medicaid financial eligibility criteria under rules 5101:1-38-01.6 and 5101:1-38-01.8 of the Administrative Code;
(3) The CDJFS has determined that the consumer does not meet the financial eligibility criteria under rules 5101:1-38-01.6 and 5101:1-38-01.8 of the Administrative Code; or,
(4) The consumer has been enrolled in the state-funded component of the assisted living program for three months.
(B) Appeals: ODA shall provide notice and an opportunity for a hearing in accordance with Chapter 119. of the Revised Code to any individual whose application for the state-funded component of the assisted living program is denied, or whose participation in the state-funded component of the assisted living program is terminated before three months of enrollment has elapsed.
(C) Post-disenrollment prohibitions:
(1) After ODA’s designee disenrolls a consumer from the state-funded component of the assisted living program, ODA’s designee shall not subsequently re-enroll the consumer back into the state-funded component of the assisted living program.
(2) After ODA’s designee disenrolls a consumer from the state-funded component of the assisted living program, ODA’s designee shall not subsequently enroll the consumer into the medicaid-funded component of the assisted living program until the CDJFS determines that the consumer meets the medicaid financial eligibility criteria and the non-financial eligibility criteria in rule 5101:3-33-03 of the Administrative Code.
(3) After ODA’s designee disenrolls a consumer from the state-funded component of the assisted living program, ODA’s designee shall not subsequently enroll the consumer into the state-funded component of the PASSPORT program.
Effective: 09/29/2011
R.C. 119.032 review dates: 09/29/2011
Promulgated Under: 111.15
Statutory Authority: 173.01, 173.02, 5111.89
Rule Amplifies: 5111.89
(A) A person or entity that seeks to become an ODA-certified assisted living provider may apply to become so under rule 173-39-03 of the Administrative Code.
(B) “Assisted living provider” means a residential care facility that is licensed by the department of health and that ODA certifies to provide services according to rules 173-39-02.16 and 173-39-02.17 of the Administrative Code.
Effective: 09/29/2011
R.C. 119.032 review dates: 09/29/2011
Promulgated Under: 111.15
Statutory Authority: 173.01, 173.02, 5111.89
Rule Amplifies: 5111.89
(A) A consumer’s service plan may authorize no more than these two services:
(1) The assisted living service under rule 173-39-02.16 of the Administrative Code; and,
(2) The community transition service under rule 173-39-02.17 of the Administrative Code.
(B) While a provider may provide a consumer who is enrolled in the state-funded component of the assisted-living program with a service that is not authorized in the consumer’s services plan, ODA (or ODA’s designee) shall not reimburse a provider for any service that is not explicitly authorized in the consumer’s service plan.
Effective: 09/29/2011
R.C. 119.032 review dates: 09/29/2011
Promulgated Under: 111.15
Statutory Authority: 173.01, 173.02, 5111.89
Rule Amplifies: 5111.89