Ohio Admin. Code 173-43-03 - Long-term care consultation program: required consultations and exemptions
(A)
The program administrator shall provide a consultation
to an individual satisfying one or more of the following categories, unless
paragraph (B) of this rule exempts the individual:
(1)
An individual who
applies, or indicates an intention to apply, for admission to a nursing
facility.
(2)
A nursing facility resident who was admitted under a
categorical determination under rule 5160-3-15.1, 5122-21-03, or
5123-14-01 of the Administrative
Code, but has since been found to need a stay in a nursing facility that will
exceed the time limits in those rules.
(3)
An individual who
contacts the program administrator to seek information about options available
to meet long-term care needs.
(4)
Any individual
that ODA or the program administrator identifies as being likely to benefit
from a consultation.
(B)
The program
administrator is not required to provide a consultation to an individual if any
of the following is the case:
(1)
The program administrator has attempted to provide the
consultation, but the individual or the individual's representative refuses to
cooperate.
(2)
The individual is to receive care in a nursing facility
under a contract for continuing care, as defined in section
173.13 of the Revised
Code.
(3)
The individual has a contractual right to admission to
a nursing facility operated as part of a system of continuing care in
conjunction with one or more facilities providing a less-intensive level of
services, including a residential care facility licensed under Chapter 3721. of
the Revised Code; a residential facility licensed under section
5119.34 of the Revised Code
providing accommodations, supervision, and personal care services for three to
sixteen unrelated adults; or an independent living arrangement.
(4)
The individual is
to receive continual care in a home for the aged that is exempt from taxation
under section 5701.13 of the Revised
Code.
(5)
The individual is seeking admission to a facility that
is not a nursing facility with a provider agreement under section
5165.07,
5165.511, or
5165.512 of the Revised
Code.
(6)
The individual is exempt from the requirement for a
face-to-face level-of-care determination under rule
5160-3-14 of the Administrative
Code.
(7)
The individual is being admitted to a nursing facility
directly from a hospital and the program administrator expects the individual
to have a stay of thirty days or less based upon factors such as medical
condition, probable need for longterm care services, history of
hospitalizations, availability of informal supports, and awareness of options
available to determine the appropriateness of the consultation.
(8)
The program
administrator determines that the individual has care needs clearly exceeding
the services available to the individual in an alternative setting to the
nursing facility based upon the availability of existing formal and informal
support systems, the availability of potential formal and informal support
systems, the functional abilities and limitations of the individual, the
individual's diagnosis, the individual's prognosis, and the individual's plan
of treatment, placing special emphasis on end-of-life treatment, because such a
treatment is most likely an indicator that the individual will not benefit from
a consultation.
(9)
The individual has been admitted to a nursing facility
under a categorical determination or hospital discharge exemption under rule
5160-3-15 of the Administrative
Code.
(10)
The individual received a consultation from the program
administrator within the previous one hundred twenty days.
(C)
The
source of payment for an individual's care in a nursing facility is not a
factor in determining whether the program administrator may provide a
consultation to an individual who resides in a nursing facility.
Replaces: 173-43-03
Notes
Promulgated Under: 119.03
Statutory Authority: 121.07, 173.01, 173.02, 173.42
Rule Amplifies: 173.42; 42 U.S.C. 3002, 3012, 3025, 3032
Prior Effective Dates: 06/30/2007, 07/22/2012, 12/19/2013, 08/01/2018, 06/11/2020 (Emer.), 12/31/2020, 01/24/2022
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