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Ohio Laws and Rules
(A) The 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. The RSS payment is used together with the individual’s countable income to pay for the RSS living arrangement and the individual’s personal needs each month.
(B) The processing and distribution of RSS payments are completed in accordance with the applicable provisions found in Chapter 5101:1-37 of the Administrative Code and in the CRIS-E procedures except that RSS payments of ten dollars or less will be issued to RSS assistance groups. The procedures for changes in payments, delayed payments, and retroactive payments described in Chapter 5101:1-37 of the Administrative Code and the CRIS-E procedures are applicable to the RSS program.
(C) There are two types of aid payments in RSS:
(1) Unrestricted money payments – these are RSS payments that are delivered to the RSS individual.
(2) Protective payments – the RSS payment is made to a substitute payee serving as a representative of the RSS individual. The representative can be the RSS individual’s legal guardian, authorized representative, a relative, friend or the caregiver at the RSS living arrangement. When the need exists for a protective payment for RSS, the PAA is responsible for assisting the RSS individual in securing a representative payee.
(D) The RSS program has no provision for vendor payments. A vendor payment is made directly to a provider of services on behalf of an individual.
(E) The approval date for the RSS payment can not precede the signature date on the JFS 07120, the date of placement in an appropriate RSS living arrangement, or the date when all financial and resource eligibility requirements are met, whichever is later.
(F) When an individual leaves an RSS placement after the 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 RSS payment has been made to the previous residence, a second RSS payment will not be made for the new residence.
(G) 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.
(H) When an individual moves from a nursing facility or his personal residence into an RSS living arrangement the first day of the month and he is otherwise eligible for RSS, he is eligible for a full month’s RSS payment.
(I) When an individual moves from a personal residence into an RSS living arrangement on a date other than the first of the month and is otherwise eligible for RSS, he may have had non-RSS needs during the initial month of RSS placement. To give consideration to these expenses, it will be necessary to determine how much of an individual’s countable income is actually available to be applied to the RSS cost of care for a partial month.
(1) If an individual enters an RSS living arrangement after the first in the month, it will be necessary for the CDJFS to determine how much of his countable income is available to be used in the financial eligibility determination and payment computation.
(2) The use of the “prudent person concept” is of great importance here. In many cases the individual will have expended his available income to meet his non-RSS needs. The CDJFS will need to explore this area carefully with the individual.
(J) When an individual moves into an RSS living arrangement on a date other than the first of the month and he is otherwise eligible for RSS, the first month’s payment is calculated according to the following formula:
(1) Determine the monthly RSS payment in accordance with rule 5101:1-17-04 of the Administrative Code.
(2) Take the monthly RSS payment amount and divide it by the number of days in the month to arrive at the daily supplement amount (round cents up to the nearest penny).
(3) Take the daily supplement amount and multiply it 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. For example, an individual who moves into an RSS living arrangement on the ninth of February (not leap year) is in placement for twenty days during the month of February. The ninth through the twenty-eighth day of February totals twenty days in placement.
(4) The amount arrived at in paragraph (E)(3) of this rule equals the prorated RSS payment or the amount of the first month’s RSS payment to an individual who moves into an RSS living arrangement on a date other than the first of the month. This prorated amount is rounded up to the nearest whole dollar amount.
(K) RSS 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 institutionalization. These RSS benefits are intended to allow the individual to maintain and provide for the expense of the RSS living arrangement in which the individual intends to live when discharged.
(L) RSS individuals not in receipt of SSI are eligible for continued RSS benefits provided the following criteria are met:
(1) Institutionalization – 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).
(2) Recipient status – the individual must be eligible for an RSS payment both the month prior to and the month he is placed in an institution.
(3) Physician’s certification – a statement from the physician that the individual’s period of medical confinement is not likely to exceed ninety consecutive days, beginning the day after the day of admission.
(4) Need to maintain the RSS facility placement – the individual must demonstrate that he needs to continue to maintain his placement in the RSS facility and that the RSS facility will keep the individual’s place available for him. A written statement from the RSS facility to this effect is necessary.
(5) Evidence required to establish temporary institutionalization for RSS individuals not in receipt of SSI must be provided no later than ninety days after the date of admission to the institution or day of release, whichever is earlier.
(M) RSS individuals in receipt of SSI must provide the verifications required in paragraph (L)(1) to (L)(5) of this rule. In addition, the individual must also provide verification that the social security administration (SSA) has approved continued SSI benefits. Verification required to establish eligibility for RSS individuals in receipt of SSI, must be provided no later than ninety days after the date of admission to the institution or the day of release, whichever is earlier.
(N) The CDJFS shall continue RSS payments to all individuals meeting the above criteria. Additionally, RSS payments and personal income are exempt from consideration as income in the long term care patient liability calculation for individuals entering a LTCF. The income exemption continues through the last day of the month in which the temporary period of medical confinement ends. The CDJFS must stop the RSS payment and count the individual’s income in the patient liability calculation, to be effective the following month.
(O) If an RSS recipient who is receiving extended benefits exceeds his/her expected stay in the medical facility, RSS benefits shall be terminated and the recipient’s income shall be counted in the patient liability calculation the following month, if appropriate. 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.
(P) Prior notice is not required to stop RSS payments and start vendor payments to a long term care facility.
(Q) When the license/certification of the RSS living arrangement expires, is revoked, or is suspended, the RSS payment is stopped.
(R) If the license/certification of the RSS living arrangement is not renewed and a new alternative living arrangement is not secured for the RSS individual, the RSS case is terminated. If the living arrangement’s license/certification is pending recertification, the RSS payment is stopped.
(S) When the living arrangement’s license/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.
(T) The PAA will maintain a copy of the RSS living arrangements’ license or certification in the RSS case record that is maintained by the PAA. The PAA is required to notify the CDJFS whenever an RSS living arrangement’s certification or license has been revoked or suspended or has expired. 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 RSS individual’s RSS eligibility will be terminated because the individual no longer resides in an RSS living arrangement.
Eff 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
Rule promulgated under: RC 111.15
Rule authorized by: RC 5111.011
Rule amplifies: RC 5111.01, 5111.011, 173.35
Replaces: 5101:1-17-11, 5101:1-17-12, 5101:1-17-14, 5101:1-17-15
R.C. 119.032 review dates: 10/01/2007