Chapter 5101:1-17 Residential State Supplement Program

5101:1-17-01 The residential state supplement (RSS) program.

(A) The purpose of RSS is to provide cash assistance to medicaid-eligible aged, blind, or disabled adults who have increased needs due to a medical condition which is not severe enough to require institutionalization. The RSS cash payment is used together with the individual's personal income to help prevent premature or unnecessary institutionalization, and to deinstitutionalize those aged, blind, or disabled adults who have been inappropriately placed in long term care facilities and who can return to the community through alternative living arrangements.

(B) Definitions.

(1) "Individual," for the purpose of this rule, means a person who is applying for or receiving RSS benefits.

(2) "RSS administrative agency" means the Ohio department of mental health or its designee.

(C) RSS registration and enrollment process.

(1) The RSS application process is initiated upon receipt of:

(a) A completed JFS 07120 "Residential State Supplement Referral" (rev.3/2003) from the residential state supplement administrative agency verifying that the individual has been selected for placement in the RSS program; and

(b) A medicaid application, if the individual is not currently in receipt of medicaid.

(2) If the individual completes the JFS 07120 at the CDJFS, a copy of the JFS 07120 will be forwarded to the residential state supplement administrative agency to register the individual for the RSS program.

(3) If the individual submits the JFS 07120 to the CDJFS by mail, a copy of the JFS 07120 will be forwarded to the residential state supplement administrative agency to register the individual for the RSS program.

(4) The signature date on the JFS 07120 shall be the RSS application date. In some instances, medicaid retroactive eligibility must be determined in accordance with Chapter 5101:1-38 of the Administrative Code to cover the RSS protected date.

(D) County department of job and family services responsibilities.

(1) The determination of eligibility for RSS shall be coordinated between the CDJFS and the residential state supplement administrative agency.

(a) The CDJFS is responsible for determining eligibility for medicaid and financial eligibility for RSS.

(b) The residential state supplement administrative agency is responsible for determining eligibility for RSS placement, appropriate level of care and the subsequent monitoring of the placement to insure that the individual's needs continue to be met.

(c) The CDJFS shall inform the residential state supplement administrative agency of the individual's eligibility for medicaid and an RSS payment, the type of RSS living arrangement that can be supplemented, and the amount of the RSS payment that can be authorized. Since the RSS financial need standards vary according to the RSS living arrangement, an individual or couple may be eligible for an RSS payment for one type of RSS living arrangement but not another.

(d) The CDJFS shall also inform the residential state supplement administrative agency of any change in the individual's or couple's medicaid and/or RSS financial eligibility.

(2) Once the individual has been selected for enrollment, the CDJFS in the county in which the individual resides shall accept and process the JFS 07120 that has been submitted by the residential state supplement administrative agency in accordance with the application procedures outlined in Chapter 5101:1-38 of the Administrative Code. A copy of the JFS 07120 shall be maintained in the assistance group's case record that is located in the CDJFS.

(3) For an individual who is not already receiving medicaid, the CDJFS shall preview medicaid eligibility and RSS financial eligibility within five working days of receipt of the JFS 07120 and medicaid application from the residential state supplement administrative agency.

(4) For an individual who is receiving medicaid, the CDJFS shall, within five working days of receipt of the JFS 07120, determine if the individual meets the RSS financial eligibility criteria. The CDJFS must notify the residential state supplement administrative agency of the results of the preview of RSS and medicaid eligibility.

(5) The CDJFS shall not delay the determination of eligibility for other assistance programs when RSS eligibility is still pending.

(6) The CDJFS shall not treat the level of care determination for RSS eligibility as evidence that the limiting physical factor requirement for medicaid eligibility as defined in rule 5101:1-39-03 of the Administrative Code has been met.

(7) If RSS income or resource eligibility are not met, the CDJFS shall deny the RSS application. The denial notice shall be sent to the applicant and authorized representative, if any. A copy of the denial notice shall also be issued to the residential state supplement administrative agency.

(8) The CDJFS shall document in the case record that the individual has received an appropriate level of care determination, and shall identify the RSS placement.

(E) Individual responsibilities.

(1) The individual shall cooperate with the CDJFS in order to determine eligibility for RSS.

(2) The individual is responsible for reporting changes within ten days to the CDJFS.

Replaces: 5101:1-17-01, 5101:1-17-03, 5101:1-17-04

Effective: 09/29/2011
R.C. 119.032 review dates: 09/01/2016
Promulgated Under: 111.15
Statutory Authority: 5111.011
Rule Amplifies: 5111.01 , 5111.011 , 5119.69
Prior Effective Dates: 12/1/82, 7/1/83 (temp.), 9/24/83, 9/1/84, 1/1/89 (Emer.), 3/6/89, 10/1/90, 9/12/91 (Emer.), 12/2/91, 11/1/93 (Emer.), 1/30/94, 5/1/94 (Emer.), 7/24/94, 7/1/95 (Emer.), 9/24/95, 4/1/96, 10/1/02, 7/1/11 (Emer.)

5101:1-17-02 RSS eligibility requirements.

(A) Non-financial eligibility requirements. The individual must complete a JFS 07120 "Residential State Supplement Referral" (rev. 3/2003) and meet all of the following criteria to be enrolled into the RSS program:

(1) A county department of job and family services (CDJFS) must have determined the individual to be eligible for medicaid.

(2) The individual must currently reside in a skilled nursing facility or need at least a protective level of care as defined in rule 5101:3-3-08 of the Administrative Code.

(3) The individual must not require more than one hundred twenty days of skilled nursing care, as defined in section 3721.01 of the Revised Code, during any twelve month period unless the individual resides in a licensed residential care facility authorized to provide skilled nursing care in accordance with section 3721.011 of the Revised Code.

(4) The individual must not have a cognitive impairment which requires the presence of another person on a twenty-four hour a day basis for the purpose of supervision to prevent harm.

(5) The individual must be accepted for placement or residing in an approved community living arrangement, and a residential state supplement administrative agency must have determined that the facility is appropriate for the individual's needs in accordance with section 5119.69 of the Revised Code. The appropriate living arrangements are:

(a) An "adult foster home" certified under section 5119.692 of the Revised Code;

(b) An "adult family home" as defined in section 5119.70 of the Revised Code, that is licensed as an adult care facility under section 5119.73 of the Revised Code;

(c) An "adult group home" as defined in section 5119.70 of the Revised Code, that is licensed as an adult care facility under section 5119.73 of the Revised Code;

(d) A "residential care facility" as defined in section 3721.01 of the Revised Code, that is licensed under section 3721.02 of the Revised Code;

(e) A residential facility of the type defined in section 5119.22 of the Revised Code, that is licensed by the Ohio department of mental health; or

(f) An apartment or room that is used to provide community mental health services, is certified by the Ohio department of mental health under section 5119.611 of the Revised Code, and is approved by a board of alcohol, drug addiction, and mental health services in accordance with section 340.03 of the Revised Code.

(6) The individual must not be related to the owner or caregiver of the RSS living arrangement.

(7) The individual must not be a participant in any federal 1915C waiver program.

(8) The individual must not be a participant in ODJFS' program of all-inclusive care for the elderly (PACE).

(9) The individual must not be enrolled in a medicare or medicaid-certified hospice program.

(10) The residential state supplement administrative agency must have funds available to make another RSS placement.

(11) The individual must agree to participate in the development of a plan of care that includes residential needs and supports, and must sign the RSS resident agreement.

(12) The individual must execute a release of information form permitting exchange of information between the RSS provider and other care providers and key contacts as needed for continuity of care and eligibility determination.

(13) An individual who has been selected by the residential state supplement administrative agency for an RSS enrollment eligibility determination, or the individual's authorized representative, must apply for medicaid if he or she is not currently a medicaid recipient. The application for medicaid must be filed with the CDJFS within thirty days of the day the individual is notified of the selection.

(B) Financial eligibility requirements.

(1) The definitions of earned and unearned income in Chapter 5101:1-37 of the Administrative Code are applicable to the RSS program.

(2) When a husband and wife reside in the same RSS facility and both have appropriate levels of care, the CDJFS shall determine their RSS financial and resource eligibility collectively utilizing the appropriate couple need standards.

(3) When a husband and wife reside in the same RSS facility and only one of them has an appropriate level of care, the CDJFS shall determine RSS financial and resource eligibility utilizing the appropriate individual need standard. The spouse who does not have the necessary level of care shall have medicaid eligibility determined in accordance with Chapter 5101:1-39 of the Administrative Code as an individual with one exception: income cannot be deemed to or from the RSS-eligible spouse.

(4) The financial eligibility methodologies for medicaid and RSS are the same, with three exceptions:

(a) SSI income is countable income in the RSS program, except that all SSI cost-of-living adjustments after October 1, 1982, are disregarded for all RSS assistance groups with SSI income.

(b) The medicaid spenddown provision does not apply in the RSS program. If an individual has countable income equal to or in excess of the financial need standard for the appropriate RSS living arrangement, the individual is ineligible for RSS.

(c) The RSS program has no deeming provision. For an RSS spouse and a non-RSS spouse residing in the same living arrangement, there is no deeming to or from the RSS spouse. They are both treated as individuals for purposes of determining RSS eligibility. If applicable, the non-RSS spouse shall have medicaid eligibility determined as an individual in accordance with Chapter 5101:1-39 of the Administrative Code with no deemed income allocation from the RSS spouse.

(5) Twenty dollars of any income, earned or unearned other than income from SSI, is disregarded. Only one twenty dollar disregard is applied per couple if both husband and wife are eligible for RSS.

(6) The disregard allowed from an eligible individual's earned income is sixty-five dollars plus one-half of the remaining income.

(7) Earnings which are used to pay for blind work expenses and/or impairment-related work expenses may be deducted from the earned income in accordance with Chapter 5101:1-39 of the Administrative Code.

(8) If the RSS individual's countable income is less than the financial need standard for the appropriate RSS living arrangement, but the individual's RSS enrollment is not yet completed, the CDJFS shall pend the RSS application until the RSS enrollment determination is completed.

(9) If the RSS individual's countable income is less than the financial need standard for the appropriate RSS living arrangement, the individual is eligible for an RSS payment.

(10) The CDJFS shall determine retroactive medicaid eligibility in accordance with Chapter 5101:1-38 of the Administrative Code for coverage of non-RSS medicaid services.

(11) Qualified medicare beneficiary (QMB) and specified low-income medicare beneficiary (SLMB) eligibility determinations.

(a) QMB and SLMB eligibility determinations shall be made upon application for all programs, including RSS. If eligible, the CDJFS shall approve QMB or SLMB unless the individual, after having been fully informed of the benefits of each covered group, chooses not to have QMB or SLMB approved.

(b) If QMB or SLMB eligibility does not exist, the CDJFS shall deny QMB or SLMB. If RSS eligibility is subsequently approved, the CDJFS shall enroll the individual in the state buy-in only.

(c) QMB and SLMB financial eligibility is determined for the husband and wife as a couple even if only one has an appropriate level of care.

Replaces: 5101:1-17-02, 5101:1-17-04

Effective: 09/29/2011
R.C. 119.032 review dates: 09/01/2016
Promulgated Under: 111.15
Statutory Authority: 5111.011
Rule Amplifies: 5111.01 , 5111.011 , 5119.69
Prior Effective Dates: 12/1/82, 7/1/83 (temp.), 9/24/83, 9/1/84, 1/1/89 (Emer.), 3/6/89, 9/12/91 (Emer.), 12/2/91, 11/1/93 (Emer.), 1/30/94, 5/1/94 (Emer.), 7/24/94, 7/1/95 (Emer.), 9/24/95, 4/1/96, 10/1/02, 7/1/11 (Emer.)

5101:1-17-03 Determination of RSS payment.

(A) The residential state supplement (RSS) payment to the assistance group shall be equal to the difference between the countable income and the financial need standard for the appropriate RSS living arrangement.

(B) The approval date for the RSS payment cannot precede the signature date on the JFS 07120 "Residential State Supplement Referral" (rev. 3/2003), the date of placement in an appropriate RSS living arrangement, or the date when all financial and resource eligibility requirements are met, whichever occurs last.

(C) When an individual leaves an RSS placement after the monthly RSS payment has been made, a refund of the payment will not be made to the individual. If an individual leaves an RSS placement and moves to another RSS living arrangement and the monthly RSS payment has been made to the previous residence, a second monthly RSS payment will not be made for the new residence.

(D) When an individual leaves an RSS placement the CDJFS must determine the individual's continued medicaid eligibility. If an adverse action is required (e.g., a change to delayed spenddown medicaid) the individual must be afforded hearing rights in accordance with Chapter 5101:6-2 of the Administrative Code.

(E) When an individual moves from a nursing facility or a personal residence into an RSS living arrangement the first day of the month and is otherwise eligible for RSS, the individual is eligible for a full month's RSS payment.

(F) When an individual moves into an RSS living arrangement on a date other than the first of the month and is otherwise eligible for RSS, the first month's payment is calculated according to the following formula:

(1) Determine the regular monthly RSS payment in accordance with paragraph (A) of this rule.

(2) Divide the monthly RSS payment amount by the number of days in the month to arrive at the daily supplement amount. Round amounts up to the nearest dollar.

(3) Multiply the daily supplement amount by the actual number of days of RSS placement in the month. The actual number of days of RSS placement in the month includes the day that the individual moves into the RSS living arrangement through the last day of the month.

(4) The resulting product is the prorated RSS payment.

(G) Impact of temporary institutional placement.

(1) Individuals who temporarily enter a public or medicaid certified facility are potentially eligible to receive full uninterrupted RSS benefits during the first three full months of institutional placement. These RSS benefits are intended to allow the individual to maintain and pay for the expense of the RSS living arrangement in which the individual intends to live when discharged.

(2) Individuals are eligible for continued RSS benefits provided the following criteria are met:

(a) Institutional placement. The individual must continuously reside in one or more of the following: a public medical institution, a public psychiatric institution, a medicaid approved hospital, or a Title XIX certified long term care facility (LTCF).

(b) Recipient status. The individual must be eligible for an RSS payment both the month prior to and the month of institutional placement.

(c) Physician's certification. The individual's physician must provide a statement that the individual's period of institutional placement is not likely to exceed ninety consecutive days, beginning the day after the day of admission.

(d) Need to maintain the RSS facility placement. The individual must demonstrate the need to continue to maintain the placement in the RSS facility during the institutional placement, and that the RSS facility will reserve the individual's space. A written statement from the RSS facility to this effect is necessary.

(e) Evidence documenting that the criteria listed in paragraphs (G)(2)(a) to (G)(2)(d) of this rule have been met must be provided by the earlier of:

(i) Ninety days after the date of admission to the institution; or

(ii) The day of release from the institution.

(f) Individuals in receipt of supplemental security income (SSI) must provide verification that the social security administration (SSA) has approved continued SSI benefits.

(3) The CDJFS shall continue RSS payments to all individuals meeting the criteria in paragraph (G)(2) of this rule.

(4) RSS payments and personal income are exempt from consideration as income in the long term care patient liability calculation for individuals entering a LTCF.

(a) This income exemption continues through the last day of the month in which the temporary period of institutional placement ends.

(b) Effective the following month, if the RSS individual remains in an institutional placement, the CDJFS must stop the RSS payment and count the individual's income in the patient liability calculation.

(5) Any RSS payments made under the continued benefit provision are not overpayments if the recipient's actual stay exceeds the expected stay of ninety days or less.

(6) Prior notice is not required to stop RSS payments and start vendor payments to a long term care facility.

(H) If the license or certification of the RSS living arrangement expires or is suspended or revoked, and a new alternative living arrangement is not secured for the individual, the RSS case is terminated.

(1) Upon notification that the RSS living arrangement's license or certification has expired or has been suspended or revoked, the CDJFS must provide prior notice that the individual's RSS eligibility will be terminated because the individual no longer resides in an RSS living arrangement.

(2) When the living arrangement's license or certification has been renewed, the RSS payment may be made retroactive to the effective date of the living arrangement's recertification, as long as all other RSS eligibility factors are met.

Replaces: 5101:1-17-05

Effective: 09/29/2011
R.C. 119.032 review dates: 09/01/2016
Promulgated Under: 111.15
Statutory Authority: 5111.011
Rule Amplifies: 5111.01 , 5111.011 , 5119.69
Prior Effective Dates: 7/15/82 (Emer.), 12/1/82, 1/1/89 (Emer.), 3/6/89, 4/1/89, 9/12/91, 1/30/94, 10/1/02, 7/1/11 (Emer.)

5101:1-17-04 [Rescinded] Medicaid and RSS financial eligibility determinations.

Effective: 09/29/2011
R.C. 119.032 review dates: 07/14/2011
Promulgated Under: 111.15
Statutory Authority: 5111.01
Rule Amplifies: 5111.01 , 5111.011 , 173.35
Prior Effective Dates: 12/1/82, 7/1/83 (Emer.), 9/24/83, 9/1/84, 1/1/89 (Emer.), 3/6/89, 9/12/91 (Emer.), 12/2/91, 1/30/94, 10/1/02

5101:1-17-05 [Rescinded] Determination of RSS payment.

Effective: 09/29/2011
R.C. 119.032 review dates: 07/14/2011
Promulgated Under: 111.15
Statutory Authority: 5111.01
Rule Amplifies: 5111.01 , 5111.011 , 173.35
Prior Effective Dates: 7/15/82 (Emer.), 12/1/82, 1/1/89 (Emer.), 3/6/89, 4/1/89, 9/12/91, 1/30/94, 10/1/02, 7/1/11 (Emer.)

5101:1-17-06 [Rescinded] RSS financial need standards and allowable fees.

Effective: 09/29/2011
R.C. 119.032 review dates: 07/14/2011
Promulgated Under: 111.15
Statutory Authority: 5111.01
Rule Amplifies: 5111.01 , 5111.011 , 173.35
Prior Effective Dates: 5/1/98, 10/1/02

5101:1-17-07 [Rescinded] Pass-along of SSI income cost-of-living adjustments (COLA) for RSS.

Effective: 09/29/2011
R.C. 119.032 review dates: 07/14/2011
Promulgated Under: 111.15
Statutory Authority: 5111.01
Rule Amplifies: 5111.01 , 5111.011 , 173.35
Prior Effective Dates: 12/1/82, 7/1/83 (Emer.), 9/24/83, 1/1/85 (Emer.), 4/1/85, 1/1/86 (Emer.), 4/1/86, 1/1/87 (Emer.), 3/20/87, 7/1/88 (Emer.), 9/1/88, 10/1/88 (Emer.), 12/20/88, 1/1/89 (Emer.), 4/1/89, 10/1/90, 9/12/91 (Emer.), 12/1/91, 1/1/92 (Emer.), 3/20/92, 11/1/93 (Emer.), 1/30/94, 4/18/94, 2/1/95, 4/1/96, 1/1/97 (Emer.), 2/9/97, 12/31/97 (Emer.), 1/1/00, 1/1/01, 8/22/02