(A) Only an individual meeting all of the
following qualifications is eligible for the state-funded component of the
assisted living program:
(1) Consultation: The individual
participated in a long-term care consultation under section 173.42 of the
Revised Code and Chapter 173-43 of the Administrative Code.
(2) Financial requirements:
(a) The individual contacted either ODA's designee or
ODM's administrative agency to apply for the medicaid-funded component of
the assisted living program, but the application is still pending because
ODM's administrative agency has not yet made a final determination on the
individual's financial eligibility. If ODM's administrative agency
already determined the individual was eligible to participate in the
medicaid-funded component of the assisted living program, the individual would
enroll into the medicaid-funded component of the assisted living program. If
ODM's administrative agency already determined the individual was not
financially eligible to participate in the medicaid-funded component of the
assisted living program, the individual would also not be eligible to
participate in the state-funded component of the assisted living
program.
(b) The individual agreed that, if the individual enrolls into
the state-funded component of the assisted living program, and ODM's
administrative agency determines the individual is financially eligible for the
medicaid-funded component of the assisted-living program, then the individual
would transfer immediately to the medicaid-funded component of the assisted
living program.
(c) The individual is cooperative and actively assisting
ODM's administrative agency in determining if the individual is
financially eligible to participate in the medicaid-funded component of the
assisted living program by timely providing ODM's administrative agency
with information and copies of any records ODM's administrative agency
needs to make its financial eligibility determination.
(d) ODA or its designee determined that ODM's administrative
agency would most likely determine that the individual meets all financial
eligibility requirements for the medicaid-funded component of the assisted
living program listed in rules 5160:1-2-03 and 5160:1-2-10 of the
Administrative Code.
(3) Non-financial
requirements:
(a) ODA or its designee and the individual entered into an
enrollment agreement, and the form indicated the individual chose to enroll in
the state-funded component of the assisted living program, named the
individual's representative (if any), and authorized ODA or its designee
to release information.
(b) ODA or its designee determined the individual meets all
non-financial eligibility requirements for the medicaid-funded component of the
assisted living program in rule 5160-33-03 of the Administrative
Code.
(c) The individual agreed to reside in a resident unit of a
certified RCF while receiving assisted living services under the state-funded
component of the assisted living program that meets the requirements for
resident units in rule 173-39-02.16 of the Administrative Code.
(4) Post-eligibility treatment of income
(PETI) (i.e., patient liability or share of cost): After ODA or its designee
assessed the individual's income and resources using the methodology
described in rule 5160:1-6-07.1 of the Administrative Code to determine if the
individual should pay any share of cost and the individual agreed to pay, and
does pay, any share of cost as it becomes due.
(B) If, at any time, an individual
enrolled in the state-funded component of the assisted living program no longer
meets all the requirements under paragraph (A) of this rule, unless the only
requirement the individual no longer meets is the PETI requirement in paragraph
(A)(5) of this rule, the individual is no longer eligible for the state-funded
component of the assisted living program.
(C) An individual who is eligible for the
state-funded component of the assisted living program is not eligible to
participate in the state-funded component of the assisted living program for
more than ninety days, unless ODA's director approved an extended number
of days.
(D) ODA's designee may allow an
individual to provide verbal agreement for intent to enroll in the state-funded
component of the assisted living program at the time of assessment if unable to
provide a unique identifier of the individual. ODA's designee may collect
the unique identifier of the individual for the agreements required in
paragraphs (A)(2)(b), (A)(3)(a), (A)(3)(c), and (A)(4) of this rule no later
than thirty days after the individual's original enrollment
date.
