(A) Process:
(1) When an individual
contacts the program administrator to seek information about options available
to meet long-term care needs, the program administrator shall offer a long-term
care consultation to the individual, which may also be done by telephone or
video conference.
(2) When an individual applies for
admission to a nursing facility or is seeking medicaid payment for a continued
stay in a nursing facility, the program administrator shall provide a long-term
care consultation to the individual, which may also be done by telephone or
video conference.
(3) The nursing facility
shall notify the program administrator of any individual who is a nursing
facility resident that was admitted under a time-limited convalescent exemption
or who was admitted under a categorical determination in accordance with rule
5160-3-15.1, 5122-21-03, or 5123-14-01 of the Administrative Code, but has
since been found to require a stay in a nursing facility that will exceed the
time limits specified in those rules. The nursing facility shall notify the
program administrator no later than seventy-two hours after the expiration of
the time limit, unless rule 173-43-03 of the Administrative Code exempts the
individual. Upon being notified, the program administrator shall determine if a
long-term care consultation is required.
(4) If the nursing facility determines
that an individual is exempt from a long-term care consultation under rule
173-43-03 of the Administrative Code, the nursing facility shall document the
reason for the exemption in the individual's record.
(5) If the program administrator
determines that it is not required to provide a long-term care consultation to
an individual under rule 173-43-03 of the Administrative Code, the program
administrator shall provide documentation to the individual (or the
individual's representative, if any) and to the nursing facility (if
known) that identifies the exemption being met.
(6) For an individual for whom the
program administrator is required to provide a long-term care consultation, the
program administrator, in consultation with the individual, shall determine
whether to provide a long-term care consultation before or after admission to a
nursing facility.
(7) Information about an individual who
is applying to a nursing facility or seeking medicaid payment for a continued
stay in a nursing facility may come from the individual, the nursing facility
to which admission is being sought, or through the pre-admission screening and
resident review process. The program administrator may access the nursing
facility resident assessment data the nursing facility collects through the
resident assessment instrument to identify individuals who are likely to
benefit from a long-term care consultation. As used in this paragraph,
"resident assessment instrument" has the same meaning as in rule
5160-3-43.1 of the Administrative Code.
(8) Concurrent assessments: The program
administrator may provide a long-term care consultation to an individual that
also assesses the individual's functional capabilities, so long as ODA has
authorized the program administrator to assess the individual's functional
capabilities, as follows:
(a) Level of care: The program administrator may incorporate the
level-of-care assessment that section 5165.04 of the Revised Code requires in
the long-term care consultation it provides to an individual. The individual
who is subject to the level-of-care review shall comply with the requirements
for the level-of-care review. The program administrator providing the
level-of-care review shall comply with rules 173-43-05 and 5160-3-14 of the
Administrative Code.
(b) Pre-admission screening and resident review: The program
administrator may incorporate portions of the determinations that section
5165.03 of the Revised Code requires in the long-term care consultation that it
provides to an individual. The individual who is subject to the pre-admission
screening and resident review shall comply with the requirements for the
pre-admission screening and resident review. The program administrator
providing the pre-admission screening and resident review shall comply with
rules 173-43-05, 5160-3-15.1, and 5160-3-15.2 of the Administrative
Code.
(9) At the conclusion of
the long-term care consultation, the program administrator shall provide the
individual (or the individual's representative) with a written or
electronic summary of options and resources discussed.
(B) General standards:
(1) When providing a
long-term care consultation, the program administrator shall focus on the
individual's needs, circumstances, and values and provide the individual
with information about options available to meet the individual's needs.
At a minimum, the program administrator shall include the following information
in each long-term care consultation:
(a) The availability of any long-term care options open to the
individual.
(b) Sources and methods of both private and public payment for
long-term care services.
(c) Factors to consider when choosing among the available
program, services, and benefits.
(d) Opportunities and methods for maximizing independence and
self-reliance, including support services provided by the individual's
family, friends, and community.
(e) Support for the individual as the individual explores the
range of options available, makes decisions about the appropriate services to
meet the individual's needs, and creates a plan of care.
(2) The nursing facility
shall not deny or limit access to the facility or a resident of the facility to
any person who is attempting to provide a long-term care
consultation.
(3) A nursing facility
that has a provider agreement with the department of medicaid may only admit an
individual as a resident upon receipt of evidence that the nursing facility has
complied with this rule and rule 173-43-03 of the Administrative Code and that
the program administrator has provided a long-term care consultation to the
individual, unless rule 173-43-03 of the Administrative Code exempts the
individual.
(4) The information the program
administrator provides to an individual during a long-term care consultation is
not binding. The individual may choose the long-term services and supports that
best meets the individual's needs.
