5160-33-07 Assisted living home and community based services (HCBS) waiver rate setting.

(A) The purpose of this rule is to describe the methods used to determine provider rates for the assisted living HCBS waiver as set forth in appendix A to rule 5101:3-1-06.5 of the Administrative Code.

(B) Provider rates will be determined for the following categories:

(1) Per job bid rate or deposit made.

(2) Unit rate.

(C) A per job bid rate or deposit made shall be determined on a per job basis for the community transition service as set forth in rule 173-39-02.17 of the Administrative Code.The cost per job shall be reimbursed at a per job bid rate that is negotiated and approved by Ohio department of aging's (ODA) designee and accepted by the consumer. The per job bid rate includes the cost of the purchase, delivery, and set-up of items. Deposits made include set-up fees or deposits for utility service access.

(D) A unit rate shall be based on a three-tiered model, and shall not exceed the amounts in appendix A to rule 5101:3-1-06.5 of the Administrative Code. These rates will be used for assisted living services as set forth in rule 173-39-02.16 of the Administrative Code.

(1) The rate for assisted living services for each consumer shall be determined by the preadmission screening system providing options and resources today (PASSPORT) administrative agency through an assessment of the consumer's service needs in four areas:

(a) Cognitive impairments,

(b) Medication administration,

(c) Nursing services, and

(d) Functional impairments.

(2) The assisted living HCBS waiver provider must agree to provide the services in the consumer's plan of care at the rate determined by the assessment.

(E) ODA certified assisted living providers shall only be reimbursed for assisted living services authorized by the PASSPORT administrative agency (PAA) and reflected on the consumer's service plan.

(F) Assisted living service payment constitutes payment in full and may not be construed as a partial payment when the payment amount is less than the provider's charge. The provider may not bill the consumer of assisted living HCBS waiver program services for any difference between the medicaid payment and the provider's charge or request that the consumer share in the cost through a co-payment or other similar charge.

(G) The assisted living service payment is for assisted living services as defined in rule 173-39-02.16 of the Administrative Code and does not include payment for room and board as calculated pursuant to rule 5101:3-33-03 of the Administrative Code, which is the responsibility of the consumer.

Effective: 09/29/2011
R.C. 119.032 review dates: 07/14/2011 and 09/01/2016
Promulgated Under: 119.03
Statutory Authority: 5111.85, 5111.89
Rule Amplifies: 5111.85, 5111.89
Prior Effective Dates: 7/1/06, 3/22/08, 9/19/09, 7/1/07