(A) Initial contact: An individual may
initially contact either ODM's administrative agency or ODA's
designee to apply for the medicaid-funded component of the assisted living
program. The two agencies coordinate processing applications for enrollment as
follows:
(1) If the individual
makes initial contact with ODM's administrative agency, then ODM's
administrative agency shall help the individual to apply and process the
applications for medicaid (unless already enrolled in medicaid) and the
medicaid-funded component of the assisted living program. If ODM's
administrative agency notifies ODA's designee that the individual meets
all financial eligibility requirements, then ODA's designee shall initiate
contact with the individual to conduct an assessment by telephone, video
conference, or in person to determine if the individual meets all non-financial
eligibility requirements in rule 5160-33-03 of the Administrative
Code.
(2) If the individual makes initial
contact with ODA's designee, then ODA's designee shall help the
individual apply for medicaid (unless already enrolled in medicaid) and the
medicaid-funded component of the assisted living program and conduct an
assessment by telephone, video conference, or in person to determine if the
individual meets all non-financial eligibility requirements in rule 5160-33-03
of the Administrative Code.
(3) After the individual
applies for the medicaid-funded component of the assisted living program, ODA
or its designee shall notify the individual of the existence of the
state-funded component of the assisted living program in Chapter 173-51 of the
Administrative Code and offer the individual an opportunity to apply for
enrollment in the state-funded component of the program.
(B) Denial: If ODM's administrative
agency or ODA's designee determines the individual does not meet all
eligibility requirements for the program under rule 5160-33-03 of the
Administrative Code, the following responsibilities apply:
(1) If ODM's
administrative agency determines the individual does not meet all financial
eligibility requirements, it shall notify ODA's designee and notify
individual of the denied application and appeal rights under section 5101.35 of
the Revised Code and division 5101:6 of the Administrative Code.
(2) If ODA's
designee determines the individual does not meet all non-financial eligibility
requirements, it shall notify ODM's administrative agency and, in turn,
ODM's administrative agency shall notify the individual of the denied
application and appeal rights under section 5101.35 of the Revised Code and
division 5101:6 of the Administrative Code.
(C) Enrollment: If ODM's
administrative agency or ODA's designee determines the individual meets
all eligibility requirements for the medicaid-funded component of the assisted
living program under rule 5160-33-03 of the Administrative Code, then
ODA's designee shall calculate the individual's medicaid waiver
program enrollment date according to paragraph (C)(1) of this rule and enroll
the individual according to paragraph (C)(2) or (C)(3) of this
rule.
(1) Medicaid waiver
program enrollment date:
(a) The individual's medicaid waiver program
enrollment date is the latest of the following dates:
(i) The individual's
basic medicaid effective date.
(ii) The date the
individual meets all level of care requirements to participate in the medicaid
waiver program.
(iii) The date the
individual met all medicaid waiver program requirements listed in rule
5160-33-03 of the Administrative Code.
(iv) The date ODA's
designee approved the individual's person-centered services plan with
authorization for at least one medicaid waiver service.
(v) The date the
individual began residing in an ODA-certified provider's RCF in a resident
unit that complies with rule 173-39-02.16 of the Administrative
Code.
(b) The medicaid-funded component of the assisted living
program does not pay for any service provided to an individual before
ODA's designee establishes the medicaid waiver program enrollment date
according to paragraph (C)(1)(a) of this rule.
(c) The individual's medicaid waiver program
enrollment date for the medicaid-funded component of the assisted living
program may differ from the basic medicaid effective date.
(2) Available slot:
ODA's designee shall enroll the individual in the program without placing
the individual on the unified waiting list if all the following conditions
exist:
(a) A waiver slot in the medicaid-funded component of the
assisted living program is available.
(b) ODA's designee established the individual's
medicaid waiver program enrollment date.
(c) The individual continues to meet the eligibility
requirements for the program.
(d) The individual continues to want to enroll in the
program.
(3) No available slot: If
a waiver slot is not available in the medicaid-funded component of the assisted
living program, ODA's designee may enroll the eligible individual when a
waiver slot becomes available by one of the following two means:
(a) Unified waiting list: ODA's designee shall place
the individual on the unified waiting list according to rule 173-44-04 of the
Administrative Code, unless the individual qualifies for the home first
component of the medicaid-funded component of the assisted living program, as
addressed in paragraph (C)(3)(b) of this rule.
(b) Home first: If an individual meets all requirements for
the home first component of the assisted living program in section 173.542 of
the Revised Code, ODA's designee shall enroll the individual before
enrolling any individual from the unified waiting list.
(D) Reassessment: ODA's designee
shall reassess each individual enrolled in the medicaid-funded component of the
assisted living program no less often than one time before each anniversary
date of enrollment. After ODA's designee conducts each reassessment, if
the individual continues to qualify for the medicaid-funded component of the
program, the individual may decide if the individual wishes to remain in the
program by signing an ODA-approved enrollment agreement as a condition of
continued enrollment. During an emergency declared by the governor or a federal
public health emergency, ODA's designee may collect the individual's
handwritten or electronic signature on the enrollment agreement on a date later
than the date the individual agrees to continue in the program, but no later
than the next reassessment of the individual.
(E) An authorized representative may
represent an individual in the enrollment and reassessment
processes.
(F) As used in this rule, "basic
medicaid effective date" means the date an individual becomes eligible to
receive services under the medicaid state plan. Rule 5160:1-2-03 of the
Administrative Code establishes the basic medicaid effective date.
