(A) Only an individual meeting all of the
following requirements 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
be enrolled in 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 if the individual is enrolled into the
state-funded component of the assisted living program, then ODM's
administrative agency determines the individual is financially eligible for the
medicaid-funded component of the assisted-living program, the individual would
immediately be transferred to the medicaid-funded component of the assisted
living program.
(c) The individual is 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 completed form ODA1115 and determined
that ODM's administrative agency would most likely determine 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, and ODA or its designee has no reason
to doubt that determination.
(3) Non-financial
requirements:
(a) ODA or its designee and the individual completed form
ODA1116, 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 indicated the individual
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 certified living unit of
an Ohio licensed RCF that is authorized by a valid provider agreement to
participate in the medicaid-funded component of the assisted living program
while receiving assisted living services under the state-funded component of
the assisted living program.
(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 shall not participate in
the state-funded component of the assisted living program for more than ninety
days, unless ODA's director approves an extended number of
days.
(D) ODA's designee may collect the
individual's handwritten or electronic signature for the agreements
required in paragraphs (A)(2)(b), (A)(3)(a), (A)(3)(c), and (A)(4) of this rule
on a date later than the date the individual makes each agreement, but no later
than the next reassessment of the individual.
