(A) An individual is to meet all criteria
specified in paragraph (C) of rule 5160:1-5-01 of the Administrative Code to be
eligible for RSS payments. OhioMHAS first determines whether the individual
meets the non-financial eligibility criteria and then the appropriate CDJFS
completes the financial eligibility determination. The RSS non-financial
eligibility criteria are all of the following:
(1) The individual is at least eighteen
years of age.
(2) The individual meets at least the
criteria for a protective level of care as specified in rule 5160-3-06 of the
Administrative Code. An individual who is receiving (or authorized for)
medicaid vendor payment of the nursing facility stay and is being discharged
from a nursing facility as defined in section 5165.01 of the Revised Code meets
this requirement without the need for an additional level of care assessment by
the local area agency on aging.
(3) The individual does 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 does 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 has been accepted for
placement or is residing in one of the following living
arrangements:
(a) A class two residential facility of the type described
in division (B)(1)(b) of section 5119.34 of the Revised Code that is licensed
by and in good standing with the Ohio department of mental health and addiction
services; or
(b) Either a residential care facility, as defined in
section 3721.01 of the Revised Code, that is licensed and in good standing with
the Ohio department of health under section 3721.02 of the Revised Code, or an
assisted living program, as defined in section 173.51 of the Revised Code, as
long as either of the following applies:
(i) The facility or program is in a county where there are
no class two residential facilities licensed by the Ohio department of mental
health and addiction services; or
(ii) There are no open beds in licensed class two
residential facilities within the county that provide housing to individuals
with mental illness.
Individuals who were enrolled in the RSS
program on November 20, 2014, may continue to reside in the living arrangement
they were in on that date without regard to the living arrangements
eligibility pursuant to this paragraph.
(6) The individual is not related to the
owner or caregiver of the living arrangement.
(7) The individual is not a participant
in any federal waiver program.
(8) The individual is not a participant
in the Ohio department of job and family services' program of
all-inclusive care for the elderly (PACE).
(9) The individual is not enrolled in a
medicare or medicaid-certified hospice program.
(10) The individual is not a consumer of
any home and community-based waiver program.
(11) The individual or legal
representative has executed a release of information form permitting exchange
of information between OhioMHAS, the Ohio department of medicaid, the Ohio
department of job and family services, the CDJFS, the local area agency on
aging, the living arrangement operator, and other care providers and key
contacts as needed for continuity of care and eligibility
determination.
(B)
(1) Except as provided
in paragraph (B)(2) of this rule, if the individual no longer meets all the
criteria in paragraph (A) of this rule, the individual is ineligible for the
RSS program.
(2) An individual who
meets all of the criteria in paragraph (A), except for the criteria in
paragraph (A)(5) of this rule, maintains non-financial eligibility for the RSS
program as long as the individual has continuously remained in the same living
arrangement since November 15, 1990, and that living arrangement received state
supplementation on that date under former section 5101.531 of the Revised Code
(repealed July 1, 1993).
(C) OhioMHAS may determine that an
individual is responsible for repaying an RSS payment the individual received
on or after the date the individual became ineligible for RSS or moved from an
eligible living arrangement described in rule 5122-36-04 of the Administrative
Code. In such cases where the payment has already been deposited or redeemed by
the individual or the individual's legal representative, but not yet
submitted to the eligible living arrangement, the individual or legal
representative is to return the funds by sending a check or money order, made
payable to the "Ohio Treasurer of State," to: "RSS Return
Payments, c/o OhioMHAS, 30 East Broad Street, 36th Floor, Columbus, Ohio
43215." The full name of the individual to whom the payment relates, as
well as the time period for which the returned payment covers, is to be applied
on the memo line of the check or money order. If, however, the RSS payment has
not been deposited or redeemed, the individual or legal representative is to
return the original check to the address specified in this paragraph. If the
individual or legal representative has already submitted the payment to the
eligible living arrangement, the living arrangement is to return the payment to
OhioMHAS in accordance with paragraph (B) of rule 5122-36-04 of the
Administration Code.
All returns of funds described in this paragraph
are to be made not later than thirty days after the individual became
ineligible for RSS or the individual moved from an eligible living arrangement
described in rule 5122-36-04 of the Administrative Code.
