Chapter 5160-49 Ohio Access Success Project

5160-49-01 Ohio access success project.

(A) This rule sets forth the eligibility requirements and benefit limitations for the non-medicaid-funded Ohio access success project in accordance with section 5166.35 of the Revised Code.

(B) Definitions:

(1) "Fiscal year" is defined as the fiscal year of this state, as specified in section 9.34 of the Revised Code.

(2) "Helping Ohioans move, expanding choice (HOME choice)" is Ohio's money follows the person demonstration project funded by the centers for medicare and medicaid services as defined in Chapter 5160-51 of the Administrative Code.

(3) "Nursing Facility" is defined as a facility or a distinct part of a facility as defined in division (DD) of section 5165.01 of the Revised Code.

(4) "Relocation" is defined as transition from a nursing facility into the community.

(C) The application process for the Ohio access success project requires:

(1) Completion of the ODM 02372 "Ohio Access Success Project Application" (rev 07/2014); and

(2) An assessment of the individual's care needs in the community.

(D) In order to be eligible for Ohio access success project benefits, an individual must meet all of the following criteria :

(1) Be receiving medicaid-funded nursing facility services at the time of application;

(2) Be able to safely remain in the community as a result of receiving project benefits, as determined by ODM;

(3) Not qualify for similar services that are reimbursable by medicaid;

(4) Have been determined ineligible for HOME choice as set forth in Chapter 5160-51 of the Administrative Code; and

(5) Have estimated costs of medicaid health care services in the community that shall not exceed eighty per cent of the average monthly nursing facility reimbursement rate.

(E) The Ohio access success project benefit shall be used to purchase goods and services to assist in the relocation of an individual from a nursing facility to a community setting.

(1) Goods and services include:

(a) First month's rent in a community setting;

(b) Rental deposits;

(c) Utility deposits;

(d) Moving expenses; and

(e) Other expenses not covered by the medicaid program that facilitate an individual's move from a nursing facility to a community setting.

(2) A participant shall be allocated no more than two thousand dollars for goods and services under the Ohio access success project, and part of the participant's allocation shall be paid to the ODM-designated financial management service provider for costs associated with the administration of the benefit.

(F) Adverse determinations for the Ohio access success project may be appealed in accordance with division 5101:6 of the Administrative Code.

(G) ODM has the authority to limit the number of participants in the Ohio access success project to the extent funds are available. ODM may direct the available funds toward the relocation of individuals at the greatest risk of remaining in the nursing facility, as determined by ODM.

Replaces: 5160-49-01

Effective: 11/1/2016
Five Year Review (FYR) Dates: 11/01/2021
Promulgated Under: 119.03
Statutory Authority: 5164.02, 5166.35
Rule Amplifies: 5164.02, 5166.35
Prior Effective Dates: 7/1/04, 10/1/05, 12/10/09, 10/01/2011