(A) The purpose of this rule is to outline
the requirements that must be met for an individual to be eligible to enroll in
the medicaid funded component of the assisted living program.
To be eligible for the medicaid funded
component of the assisted living program, an individual must meet all of the
(1) Be eligible for medicaid in
accordance with Chapters 5160:1-3 to 5160:1-6 of the Administrative
Have an intermediate or
skilled level of care in accordance with rule
of the Administrative Code. If the individual requires skilled nursing care
beyond supervision of special diets, application of dressings, or
administration of medication, it must be provided in accordance with rule
3701-16-09.1 of the Administrative Code.
(3) Be age twenty-one years old or older at
the time of enrollment.
Participate in the development of a person-centered services plan in accordance
with the process and requirements set forth in rule
of the Administrative Code.
Have the ability to make room and board payments calculated at the current
supplemental security income (SSI) federal benefit level minus fifty dollars.
Providers shall not charge or collect room and board payments from individuals
in excess of the room and board payment calculated in accordance with this
paragraph. In the event an individual does not have sufficient personal income:
An individual may arrange for informal
supports to provide a supplemental payment to the provider in order to meet
room and board requirements;
supplemental payment shall represent no more than the difference between the
individual's personal income and the maximum room and board payment established
in paragraph (B)(5) of this rule.
(ii) The amount of the supplemental payment
shall not be considered when calculating the individual's patient liability as
described in rule 5160:1-6-07.1 of the Administrative Code.
(b) A provider may elect to accept a reduced
room and board rate.
Have health and safety related needs met, as determined by the Ohio department
of aging's (ODA) designee.
The individual must reside in a
residential care facility (RCF) licensed by the Ohio department of health. At
the time of initial and continued enrollment, the individual must reside in a
certified living unit, in an RCF certified by ODA that possesses the home and
community-based setting characteristics set forth in rule
of the Administrative Code.
the individual fails to meet any of the eligibility requirements identified in
this rule, the individual shall be denied enrollment in the assisted living
HCBS waiver. In such instances, the individual shall be notified of his or her
hearing rights in accordance with division 5101:6 of the Administrative
Once enrolled in the assisted living HCBS waiver, an
individual will not be disenrolled unless the individual requests
disenrollment, moves out of state, transitions between the assisted living HCBS
waiver and the mycare Ohio waiver, or expires.
An individual will not be disenrolled from the assisted
living HCBS waiver if disenrollment will result in losing eligibility for Ohio
medicaid, unless the individual requests disenrollment, moves out of state, or
Ohio Admin. Code
Five Year Review (FYR) Dates:
Prior Effective Dates: 07/01/2006, 03/22/2008, 09/19/2009,
09/29/2011, 10/04/2015, 11/25/2016, 10/01/2019, 06/12/2020 (Emer.),