Chapter 5101:3-43 HCBS Residential Facility Waiver

(A) Purpose

The purpose of this rule is to terminate the residential facility waiver as a component of the medicaid home and community-based services program pursuant to sections 5111.85 and 5111.871 of the Revised Code and to set forth reimbursement standards for eligible claims pursuant to section 5111.02 of the Revised Code.

(B) The department of job and family services (ODJFS) shall terminate the residential facilities waiver program as a component of the medicaid home and community-based services program effective June 30, 2005. All rules, standards, guidelines or orders adopted or issued by the director of ODJFS or the director of the Ohio department of mental retardation and developmental disabilities (ODMRDD) to govern the residential facilities waiver program before its termination shall remain in effect on and after July 1, 2005 for the following purposes:

(1) To establish the legal obligations for claims arising from the program;

(2) To determine an individual’s previous eligibility for the program;

(3) To determine the validity of a claim for services under the program;

(4) To recover erroneous payments pursuant to section 5111.02 of the Revised Code, and collect interest pursuant to rule 5101:3-1-25 of the Administrative Code.

(C) The ODJFS shall reimburse a claim for services rendered by a facility certified by ODMRDD in accordance with section 5123.19 of the Revised Code as a residential facility waiver provider, and that provider holds a valid medicaid provider agreement. Such claims shall be reimbursed only if the claim is received by the ODMRDD not later than May 27, 2006.

(D) Provider payment standards

Payment for claims reimbursed pursuant to this rule shall be in accordance with Appendix A of this rule, paragraphs (A) to (C) of 5101:3-1-60 and rule 5123:1-2-11 of the Administrative Code.

Appendix A

Rule 5101:3-43-01

Residential Facility Waiver Rates

Service Code Service Billing Maximum Billing Unit

MR401 Homemaker/Personal Care $179 Day

MR402 Supported Employment $24.00 Hour

MR422 Supported Employment $6.00 15 min

MR403 Adaptive Assistance Equipment $10,000 Item

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.

Effective: 07/01/2005

R.C. 119.032 review dates: 07/01/2010

Promulgated Under: 119.03

Statutory Authority: 5111.85

Rule Amplifies: 5111.85, 5111.87, 5111.871, 5111.91