Ohio Admin. Code 5160-33-04 - Enrollment process for medicaid-funded component of the assisted living waiver program
(A) The purpose of this rule is to outline
the requirement that must be met for an individual to enroll in the
medicaid-funded component of the assisted living waiver program.
(B) To be eligible for enrollment, an
individual must:
(1) Have been determined to
meet the eligibility requirements set forth in rule
5160-33-03
of the Administrative Code; and
(2)
Upon initial and continued enrollment, reside in an approved living unit
in accordance with paragraph (C) of rule
173-38-03
of the Administrative Code, located in a licensed residential care
facility (RCF) certified by the Ohio department of aging (ODA) that possesses
the home and community-based setting characteristics set forth in rule
5160-44-01
of the Administrative Code.
(C) If the individual has been determined
eligible and the medicaid component of the assisted living waiver program has
not reached the centers for medicare and medicaid services (CMS) authorized
limit of participants for the current year, the individual shall be enrolled in
accordance with the assisted living waiver program's home first component, if
applicable, and rule
173-38-03
of the Administrative Code.
(D)
Pursuant to Chapters 5160:1-3 to 5160:1-6 of the Administrative Code, if an
individual is determined eligible for medicaid by the county department of job
and family services, the individual shall not enroll in the assisted living
waiver program until ODA's designee establishes a waiver program enrollment
date and authorizes the provision of waiver services by an ODA certified
assisted living provider. The waiver program enrollment date shall in no way
restrict retroactive eligibility for non-assisted living waiver services
available to individuals through the medicaid state plan.
(E) Any applicant for the assisted living
waiver program is entitled to notice and hearing rights as set forth in section
5101.35 of the Revised Code and
division 5101:6 of the Administrative Code.
Notes
Promulgated Under: 119.03
Statutory Authority: 5166.02
Rule Amplifies: 173.54
Prior Effective Dates: 07/01/2006, 03/22/2008, 09/19/2009, 09/29/2011, 04/01/2017, 10/01/2019, 06/11/2020 (Emer.)
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