Ohio Admin. Code 5101:1-17-01 - The residential state supplement (RSS) program
(A)
The purpose of RSS is to provide cash assistance to
medicaid-eligible aged, blind, or disabled adults who have increased needs due
to a medical condition which is not severe enough to require
institutionalization. The RSS cash payment is used together with the
individual's personal income to help prevent premature or unnecessary
institutionalization, and to deinstitutionalize those aged, blind, or disabled
adults who have been inappropriately placed in long term care facilities and
who can return to the community through alternative living arrangements.
(B)
Definitions.
(1)
"Individual," for the purpose of this rule, means a
person who is applying for or receiving RSS benefits.
(2)
"RSS
administrative agency" means the Ohio department of mental health or its
designee.
(C)
RSS registration and enrollment process.
(1)
The RSS
application process is initiated upon receipt of:
(a)
A completed JFS
07120 "Residential State Supplement Referral" (rev.3/2003) from the residential
state supplement administrative agency verifying that the individual has been
selected for placement in the RSS program; and
(b)
A medicaid
application, if the individual is not currently in receipt of medicaid.
(2)
If the individual completes the JFS 07120 at the
CDJFS, a copy of the JFS 07120 will be forwarded to the residential state
supplement administrative agency to register the individual for the RSS
program.
(3)
If the individual submits the JFS 07120 to the CDJFS
by mail, a copy of the JFS 07120 will be forwarded to the residential state
supplement administrative agency to register the individual for the RSS
program.
(4)
The signature date on the JFS 07120 shall be the RSS
application date. In some instances, medicaid retroactive eligibility must be
determined in accordance with Chapter 5101:1-38 of the Administrative Code to
cover the RSS protected date.
(D)
County
department of job and family services responsibilities.
(1)
The
determination of eligibility for RSS shall be coordinated between the CDJFS and
the residential state supplement administrative agency.
(a)
The CDJFS is
responsible for determining eligibility for medicaid and financial eligibility
for RSS.
(b)
The residential state supplement administrative agency
is responsible for determining eligibility for RSS placement, appropriate level
of care and the subsequent monitoring of the placement to insure that the
individual's needs continue to be met.
(c)
The CDJFS shall
inform the residential state supplement administrative agency of the
individual's eligibility for medicaid and an RSS payment, the type of RSS
living arrangement that can be supplemented, and the amount of the RSS payment
that can be authorized. Since the RSS financial need standards vary according
to the RSS living arrangement, an individual or couple may be eligible for an
RSS payment for one type of RSS living arrangement but not another.
(d)
The
CDJFS shall also inform the residential state supplement administrative agency
of any change in the individual's or couple's medicaid and/or RSS financial
eligibility.
(2)
Once the individual has been selected for enrollment,
the CDJFS in the county in which the individual resides shall accept and
process the JFS 07120 that has been submitted by the residential state
supplement administrative agency in accordance with the application procedures
outlined in Chapter 5101:1-38 of the Administrative Code. A copy of the JFS
07120 shall be maintained in the assistance group's case record that is located
in the CDJFS.
(3)
For an individual who is not already receiving
medicaid, the CDJFS shall preview medicaid eligibility and RSS financial
eligibility within five working days of receipt of the JFS 07120 and medicaid
application from the residential state supplement administrative agency.
(4)
For
an individual who is receiving medicaid, the CDJFS shall, within five working
days of receipt of the JFS 07120, determine if the individual meets the RSS
financial eligibility criteria. The CDJFS must notify the residential state
supplement administrative agency of the results of the preview of RSS and
medicaid eligibility.
(5)
The CDJFS shall not delay the determination of
eligibility for other assistance programs when RSS eligibility is still
pending.
(6)
The CDJFS shall not treat the level of care
determination for RSS eligibility as evidence that the limiting physical factor
requirement for medicaid eligibility as defined in rule
5101:1-39-03 of the
Administrative Code has been met.
(7)
If RSS income or
resource eligibility are not met, the CDJFS shall deny the RSS application. The
denial notice shall be sent to the applicant and authorized representative, if
any. A copy of the denial notice shall also be issued to the residential state
supplement administrative agency.
(8)
The CDJFS shall
document in the case record that the individual has received an appropriate
level of care determination, and shall identify the RSS placement.
(E)
Individual responsibilities.
(1)
The individual
shall cooperate with the CDJFS in order to determine eligibility for RSS.
(2)
The
individual is responsible for reporting changes within ten days to the
CDJFS.
Replaces: 5101:1-17-01, 5101:1-17-03, 5101:1-17-04
Notes
Promulgated Under: 111.15
Statutory Authority: 5111.011
Rule Amplifies: 5111.01, 5111.011, 5119.69
Prior Effective Dates: 12/1/82, 7/1/83 (temp.), 9/24/83, 9/1/84, 1/1/89 (Emer.), 3/6/89, 10/1/90, 9/12/91 (Emer.), 12/2/91, 11/1/93 (Emer.), 1/30/94, 5/1/94 (Emer.), 7/24/94, 7/1/95 (Emer.), 9/24/95, 4/1/96, 10/1/02, 7/1/11 (Emer.)
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