Ohio Administrative Code Search

... determined in accordance with Chapter 5160:1-3 or 5160:1-4 of the Administrative Code and the rules in Chapter 5160:1-6 of the Administrative Code do not apply. (C) If both spouses are likely to receive LTC services for more than thirty consecutive days, the following rules apply: (1) If the spouses are no longer living together (for example, one spouse is residing in an medical institution...

... determined in accordance with Chapter 5160:1-3 or 5160:1-4 of the Administrative Code and the rules in Chapter 5160:1-6 of the Administrative Code do not apply. (C) When both spouses are likely to receive LTC services for more than thirty consecutive days, the following rules apply: (1) When the spouses are no longer living together (for example, one spouse is residing in a medical institut...

...(A) This rule implements section 1917 of the Social Security Act (as in effect on October 1, 2016) and describes the treatment of transfers of assets when an institutionalized individual, as defined in rule 5160:1-6-01.1 of the Administrative Code, is seeking medicaid payment for long-term care (LTC) services. This rule, and rules 5160:1-6-06.1 to 5160:1-6-06.8 of the Administrative Code, only apply to institutionali...

...e to cooperate as required by rule 5160:1-2-10 of the Administrative Code. (D) Treatment of annuity purchases or transactions on or after February 8, 2006. (1) Any purchase or annuity transaction, including annuities purchased by a spouse, shall be treated as an improper transfer subject to a restricted medicaid coverage period (RMCP) in accordance with rule 5160:1-6-06.5 of the Administrati...

...ilure to cooperate as required by rule 5160:1-2-10 of the Administrative Code. (D) Treatment of annuity purchases or transactions on or after February 8, 2006. (1) Any purchase or annuity transaction, including annuities purchased by a spouse, shall be treated as an improper transfer subject to a restricted medicaid coverage period (RMCP) in accordance with rule 5160:1-6-06.5 of the Administrati...

... period (RMCP) in accordance with rule 5160:1-6-06.5 of the Administrative Code. (B) This rule does not affect whether the contents of the trust or payments or distributions from a trust are considered resources or income to the institutionalized individual for purposes of determining base eligibility under Chapters 5160:1-3, 5160:1-4, and 5160:1-5 of the Administrative Code. (C) This rule applies to any revocable ...

...ving a life estate, as defined in rule 5160:1-3-05.17 of the Administrative Code, was an improper transfer in accordance with rule 5160:1-6-06 of the Administrative Code: (1) Review the life estate instrument to determine the nature of the life estate and the rights, responsibilities, and/or restrictions placed on the life estate owner and/or the remainderman, as defined in rule 5160:1-3-05.17 of the Administrative ...

...ving a life estate, as defined in rule 5160:1-3-05.17 of the Administrative Code, was an improper transfer in accordance with rule 5160:1-6-06 of the Administrative Code: (1) Review the life estate instrument to determine the nature of the life estate and the rights, responsibilities, and restrictions placed on the life estate owner and the remainderman, as defined in rule 5160:1-3-05.17 of the Administrative Code. ...

...ry note, property agreement, or loan: (1) Have a repayment term that is actuarially sound as determined in accordance with actuarial publications of the office of the chief actuary in 26 C.F.R. 20.2031-7 (as in effect on October 1, 2016); (2) Provide for payments to be made in equal amounts during the term of the promissory note, property agreement, or loan, with no deferral and no balloon payments made; and (3) P...

...ry note, property agreement, or loan: (1) Have a repayment term that is actuarially sound as determined in accordance with actuarial publications of the office of the chief actuary in 26 C.F.R. 20.2031-7 (as in effect on October 1, 2024); (2) Provide for payments to be made in equal amounts during the term of the promissory note, property agreement, or loan, with no deferral and no balloon payments made; (3) Prohi...

... an asset. (B) RMCP calculation. (1) Total the value of all improperly transferred assets. (2) When the first month of requested payment of LTC services is less than a full calendar month, an initial pro-rated period of restricted coverage (IPPRC) shall be calculated as follows and is considered the first month of the RMCP: (a) Determine the daily average private pay rate (APPR) for nursin...

... an asset. (B) RMCP calculation. (1) Total the value of all improperly transferred assets. (2) When the first month of requested payment of LTC services is less than a full calendar month, an initial pro-rated period of restricted coverage (IPPRC) shall be calculated as follows and is considered the first month of the RMCP: (a) Determine the daily average private pay rate (APPR) for nursin...

...verage period (RMCP) described in rule 5160:1-6-06.5 of the Administrative Code. (B) The institutionalized individual will not be subject to a RMCP if the imposition of the RMCP would cause an undue hardship. (C) An undue hardship exists if the imposition of the RMCP would deprive the institutionalized individual of: (1) Medical care such that the institutionalized individual's health or life would be endangered; ...

...verage period (RMCP) described in rule 5160:1-6-06.5 of the Administrative Code. (B) The institutionalized individual will not be subject to an RMCP when the imposition of the RMCP would cause an undue hardship. (C) An undue hardship exists when the imposition of the RMCP would deprive the institutionalized individual of: (1) Medical care such that the institutionalized individual's health ...

... were improper in accordance with rule 5160:1-6-06 of the Administrative Code.

...e improper in accordance with rule 5160:1-6-06 of the Administrative Code.

...ices from the DODD and/or the ODMHAS. (1) DODD and ODMHAS provide for any and all personal needs, e.g., recreational activities and services necessary to assure a better quality of life for individuals under their care. Many of these services are not covered by medicaid and exceed the individual's available personal income. (2) DODD and ODMHAS maintain records and documentation of expenses incurred on an individual...

...rvices from DODD and/or OhioMHAS. (1) DODD and OhioMHAS provide for any and all personal needs, e.g., recreational activities and services necessary to assure a better quality of life for individuals under their care. Many of these services are not covered by medicaid and exceed the individual's available personal income. (2) DODD and OhioMHAS maintain records and documentation of expenses i...

...methodology in accordance with Chapter 5160:1-4 of the Administrative Code. (B) The administrative agency will reduce its payment to a medical institution, for services provided to an institutionalized individual, by the amount of the individual's patient liability calculated in accordance with this rule. (C) The individual must pay the patient liability amount to the medical institution. (D) Patient liability mus...

...methodology in accordance with Chapter 5160:1-4 of the Administrative Code. (B) The administrative agency will reduce its payment to a medical institution, for services provided to an institutionalized individual, by the amount of the individual's patient liability calculated in accordance with this rule. (C) The individual must pay the patient liability amount to the medical institution. (D) P...

...methodology in accordance with Chapter 5160:1-4 of the Administrative Code. (B) The administrative agency will reduce its payment to a medical institution, for services provided to an institutionalized individual, by the amount of the individual's patient liability calculated in accordance with this rule. (C) The individual must pay the patient liability amount to the medical institution. (D) P...

...ncome level (SIL) as described in rule 5160:1-6-03.1 of the Administrative Code and receiving HCBS waiver or PACE services. (B) The administrative agency will reduce its payment to the HCBS waiver or PACE providers identified in paragraph (C) of this rule for services provided to the individual by the amount of the individual's patient liability calculated in accordance with this rule. (C) The individual must pay t...

...e level (SIL) as described in rule 5160:1-6-03.1 of the Administrative Code and who is receiving HCBS waiver or PACE services. (B) The administrative agency will reduce its payment to the HCBS waiver or PACE providers for services provided to the individual by the amount of the individual's patient liability calculated in accordance with this rule. (C) The individual must pay the patient lia...

...e level (SIL) as described in rule 5160:1-6-03.1 of the Administrative Code and who is receiving HCBS waiver or PACE services. (B) The administrative agency will reduce its payment to the HCBS waiver or PACE providers for services provided to the individual by the amount of the individual's patient liability calculated in accordance with this rule. (C) The individual must pay the patient lia...

...romulgated in accordance with section 1347.15 of the Revised Code, the following definitions apply: (A) "Access" as a noun means an instance of copying, viewing, or otherwise perceiving whereas "access" as a verb means to copy, view, or otherwise perceive. (B) "Acquisition of a new computer system" means the purchase of a "computer system", as defined in this rule, that is not a computer sys...