5160-1-06 Home and community-based service waivers: general description.

(A) Section Section Section 2176 of Public Law 97-35, the Omnibus Budget Reconciliation Act of 1981, established a waiver program under which states can be reimbursed for providing home and community-based services (HCBS). Under the HCBS waivers, states can designate specific target populations who can receive a wider range of HCBS than normally covered under the state plan. Waiver requests submitted by the states to the secretary of the department of health and human services may be approved for a three-year period; each waiver may be renewed for five-year periods.

(B) Eligibility for HCBS waiver programs is limited to medicaid recipients who, in the absence of home and community services, would require long-term care in a nursing facility (NF), intermediate care facility for the mentally retarded (ICF-MR) or hospital as designated by the specific waiver.

(C) HCBS waivers must be limited to one of the following target groups or any subgroup thereof that the state may define:

(1) Aged or disabled, or both; or

(2) Mentally retarded or developmentally disabled, or both; or

(3) Mentally ill.

(D) At no time during the term of a HCBS waiver may the number of individuals approved to receive waiver services exceed the specific number annually allocated in the waiver.

(E) Descriptions, approval information and reimbursement rates for each of the HCBS waivers can be found as follows:

(1) PASSPORT HCBS waiver information can be found in rule 5101:3-1-06.1 of the Administrative Code.

(2) The payment standards governing reimbursement for HCBS waiver programs administered by the Ohio department of mental retardation and developmental disabilities (ODMR/DD) can be found in rule 5101:3-41-11 of the Administrative Code.

(3) Ohio home care waiver reimbursement rates and billing procedures are set forth in rule 5101:3-46-06 of the Administrative Code.

(4) Transitions MR/DD waiver reimbursement rates and billing procedures are set forth in rule 5101:3-47-06 of the Administrative Code.

(5) Transitions carve-out waiver reimbursement rates and billing procedures are set forth in rule 5101:3-50-06 of the Administrative Code.

(6) Choices HCBS waiver information can be found in rule 5101:3-1-06.4 of the Administrative Code.

(7) Assisted living HCBS waiver information can be found in rule 5101:3-1-06.5 of the Administrative Code.

Effective: 07/01/2006
R.C. 119.032 review dates: 03/24/2006 and 07/01/2011
Promulgated Under: 119.03
Statutory Authority: 5111.85
Rule Amplifies: 5111.01 , 5111.02 , 5111.85
Prior Effective Dates: 10/1/87, 7/1/98, 1/1/04