(A) The purpose of this rule is to define the
terms used in Chapter 5160-33 of the Administrative Code governing the medicaid
assisted living HCBS waiver program.
As used in this chapter:
(B) "ADL" means activities of daily
living including bathing; grooming; toileting; dressing; eating; and mobility,
which refers to bed mobility, transfer, and locomotion as these are defined in
5160-3-05 of the Administrative Code.
(C)(B)
"Assessment" means a face-to-face evaluation used to obtain information about
an individual including his or her condition, personal goals and preferences,
functional limitations, health status and other factors that are relevant to
the authorization and provision of services. Assessment information supports
the determination
that an individual
requires
needs waiver services as well as the development of a
service
person-centered services plan.
(D)(C) "
Assisted living
HCBS waiver
program"
(ALW) means the
medicaid-funded component of the assisted living program
created under section
173.54 of the Revised Code
and
home and community based services
waiver, approved by the centers for medicare and medicaid services
.
, that is administered by
the Ohio department of aging.
(E) "Authorized representative" has
the same meaning as in rule 5160-1-33 of the Administrative
Code.
(F)(D) "CDJFS" means a
county department of job and family services.
(G) "C.F.R." means the code of
federal regulations.
(H)(E) "CMS" means the
centers for medicare and medicaid services, a federal agency that is part of
the United States department of health and human services, and
that administers the medicaid program and
approves HCBS waivers.
(I) "Case management" means a set of
person centered activities provided by ODA's designee that are undertaken to
ensure that the individual receives appropriate and necessary services. Under a
HCBS waiver, these activities may include, but are not necessarily limited to,
assessment, service plan development, service plan implementation and service
monitoring as well as assistance in accessing waiver, state plan, and other
non-medicaid services and resources.
(J)(F)
"Certified" or "certification" means
providers
a provider's
state of being certified by the Ohio department of aging (ODA)
to provide services for
as an assisted living
provider
HCBS waiver
individuals pursuant to Chapter 173-39 of the Administrative Code
or the certification ODA gives to a certified assisted
living provider.
(K)(G) "HCBS" or "home and
community-based services" means services furnished under the provisions set
forth in
42 C.F.R. Part 441 Subpart G (October 1,
2016
2021)
that permit individuals to live in a home setting rather than a nursing
facility (NF) or hospital. HCBS waiver services are approved by CMS for
specific populations and are not otherwise available under the medicaid state
plan.
(L)(H) "Home first" means
the component of the assisted living HCBS waiver program that offers priority
enrollment in the waiver
for
to certain individuals in accordance with section
173.542 of the Revised
Code.
(M)(I) "Individual" is a
person enrolled on the assisted living HCBS waiver.
(N)(J) "Level of care"
(LOC) means the designation describing an individual's functional levels and
nursing needs pursuant to the criteria set forth in rules 5160-3-05, 5160-3-06,
5160-3-07, and 5160-3-08 of the
Administrative Code.
(O) "NF" means a nursing facility as
defined in section 5165.01 of the Revised Code.
(P)(K)
"ODA" means the Ohio department of
aging.
The Ohio department of aging (ODA) is
responsible for the daily operation of the assisted living home and community
based services (HCBS) waiver. ODA will operate this waiver pursuant to an
interagency agreement with the Ohio department of medicaid (ODM) in accordance
with sections 5162.35 and
5166.21 of the Revised Code. ODA
will establish processes and procedures to enroll individuals on this
waiver.
(Q) "ODJFS" means the Ohio
department of job and family services.
(R) "PASSPORT" means preadmission
screening system providing options and resources today.
(S)(L) "ODA's designee"
has the same meaning as in rule
173-39-01 of the Administrative
Code
".
(T)(M) "Residential care
facility" means a residential care facility as defined in section
3721.01 of the Revised Code that
is issued a license pursuant to section
3721.02 of the Revised
Code.
(U)(N) "Room and board"
means a payment made by an individual enrolled in the assisted living waiver
directly to the ODA certified assisted living waiver provider. When paying
"room" the individual
shall
will not be charged for the same furnishings and
other shelter expenses the residential care facility provides at no cost to
private pay non-waiver residents pursuant to the facility's resident agreement.
The term "board" means three meals a day or any other full nutritional regimen.
Room and board does not include charges for ancillary items,
services, and/or social activities purchased or paid for by the individual
including hygiene and supplies not provided through medicaid and reflected on
the individual's care
person-centered services plan, recreation and
activities, and/or other items or services purchased by the individual; however
ODA certified assisted living providers may, at their own discretion, provide
ancillary items, services and/or social activities as part of the room and
board payment.
(V)(O) "
Service Plan
Person-centered services plan" has the same meaning as
the personcentered service plan in paragraph
(B) in rule
5160-44-02 of the Administrative
Code.