5101:3-41-05 Waiting lists and long-term service planning registries for medicaid services administered by the Ohio department of mental retardation and developmental disabilities.

(A) Purpose

This rule sets forth the requirements a county board of MR/DD must meet to establish and maintain waiting lists and long-term service planning registries for home and community-based services. This rule prohibits the establishment of waiting lists or service substitution lists for certain categories of medicaid services.

(B) Definitions

(1) “County board” means a county board of mental retardation and developmental disabilities established under Chapter 5126. of the Revised Code.

(2) “Home and community-based services” means medicaid-funded home and community based services provided pursuant to section 5111.871 of the Revised Code.

(3) “ICF/MR level of care” means a determination made in accordance with rule 5101:3-3-07 of the Administrative Code.

(4) “ODJFS” means the Ohio department of job and family services as established under section 121.02 of the Revised Code.

(5) “ODMR/DD” means the Ohio department of mental retardation and developmental disabilities established under section 121.02 of the Revised Code”ODJFS” means the Ohio department of job and family services as established under section 121.02 of the Revised Code.

(1) County boards that have local medicaid administrative authority shall establish and maintain waiting lists and long-term service planning registries for home and community-based services in accordance with rule 5123:2-1-08 of the Administrative Code.

(2) The following individuals shall not be subject to waiting lists or service substitution lists:

(a) Medicaid eligible individuals who are assessed and determined to need medicaid state plan services, including habilitation center services and medicaid case management services, in accordance with their individual service plan. These services shall be provided to the individual within ninety days of the date the need was documented on the individual service plan.

(b) Individuals enrolled in a home and community-based services waiver for persons with an ICF/MR level of care and who are assessed and determined to have a need for the services covered by the waiver, in accordance with their individual service plan. These services shall be provided to the individual within ninety days of the date the need was documented on the individual service plan.

(c) Individuals enrolled in residential facility, home care transition or individual options waivers who are being transferred to a different home and community-based services waiver for persons with an ICF/MR level of care.

(d) Children who are subject to a determination under section 121.38 of the Revised Code and who require home and community-based services through a medicaid waiver administered by the ODMR/DD. For all other services, such children shall be treated by the county board as having emergency status.

(D) ODJFS shall monitor compliance with this rule by the county boards and their contract agencies.

Appendix A

Rule 5101:3-40-01

Individual Options Rates

Service Code Service Billing Maximum Billing Unit

MR770 Adaptive/Assistive Equipment $10,000 Item

MR771 Environmental Modifications $7,500 Item

MR503 Home Delivered Meals $7.00 Meal

MR405 Home maker/Personal Care $337 Day

MR540 Homemaker/Personal Care $4.97 15 min

MR541 Homemaker/Personal Care $19.88 Hour

MR542 Homemaker/Personal Care night supervision $14.00 Hour

MR551 Homemaker/Personal Care_Reserve $19.88 Hour

MR552 Homemaker/Personal Care_Reserve $4.97 15 min

MR514 Interpreter Services $12.00 15 min

MR524 Interpreter Services $48.00 Hour

MR508 Nutritional Services $12.00 15 min

MR528 Nutritional Services $48.00 Hour

MR800 Program Specialist $7.00 15 min

MR801 Program Specialist $28.00 Hour

MR510 Social Work $15.00 15 min

MR520 Social Work $60.00 Hour

MR516 Supported Employment $6.00 15 min

MR526 Supported Employment $24.00 Hour

MR576 Respite Care $200 Day

MR660 Transportation $0.38 mile

The service codes listed are used by ODMRDD. All Individual Options and Residential Facility Waiver providers must bill ODMRDD directly using the service codes authorized by ODMRDD pursuant to rules filed in accordance with agency designation 5123 of the Administrative Code.

HISTORY: Eff 2-15-02 (Emer.); 5-9-02

Rule promulgated under: RC 119.03

Rule authorized by: RC 5111.85, 5111.02

Rule amplifies: RC 5111.01, 5111.02, 5111.85, 5111.871, 5123.046, 5126.042

R.C. 119.032 review dates: 05/09/2007